Thursday, November 12, 2009

a cab to drive him home.

my clinical rotations have been progressively harder. we are actual nurses now, taking on 2-3 patients independently. though i still feel somewhat incompetent as The Nurse, i have fallen into a certain level of comfort on the unit. i have been giving report to physicians, helping make life changing decisions that i hardly feel qualified to be helping make. we interpret sheets of lab values, and pore over medications. one wrong move and patients can die. you have to be aware 24/7 while you are working, never knowing that an error has already occurred and you have to catch it. my patient crashed yesterday, with a heart rate soaring to over 190 from a normal 70. i had to run down the hall and grab the physician. i stood with him as he walked me through the prognosis, the ekg, the crucial heart drugs. but then he walked away and i was left alone. no amount of book-knowledge gives you the assurance in that moment. there is nothing i learned in class that prepared me for announcing imminent death to a patients family who is holding onto hope with everything they had.

i had three patients yesterday, the first a patient who had renal disease and was going to hospice in a few weeks, to spend the last moments of their life. the second a young stroke victim who had a 2% chance of recovery and only a few months to live as her family had chosen to not rescucitate. the physician, a kind and smart man, was very busy, and had to run to his other patients. that left me as the bearer of devastating news. i was the one who had to walk back into that room and sit with the children of the stroke victim and tell them they need to consider hospice care for her. i was the one who watched them dissolved into tears and still gather vital information to make the patient comfortable. i was the one who had to share in that moment of their world crashing down around them.

i had to go into the next patients room and deal with the spouse of another dying patient who refused to believe she was dying. he tried to comfort her with "therapy" of his own and odd chants that i am fairly certain he was making up as he went, and he told me God was going to smite me for using my "worldly knowledge" to be a nurse. underneath that tough exterior, though, was a man who held the hand of his wife and wasnt ready to face her death.

my last room was the hardest. i went in to discontinue an iv on a patient who was going home. normally, this is a happy visit, and i had only seen his chart, so i was entering the room thrilled to be discharging him. i walked in to find a tiny old man, just skin and bones physically, with a few wisps of hair, and a tremor that made simple movement hard. i reread the chart and realized he wasnt going home because he was getting better...but because there was nothing we could do anymore. i felt my heart sink and i realized i would be the last nurse who cared for him in this hospital, maybe ever. i went over the medications i was giving him, and gave him some pain meds. i cleaned up his room as he gathered his things, his weathered hands shaking.
i realized it was veterans day, and i asked if he had been a veteran. he said "i was in the service for six years, served overseas in world war II. i saw it all...killing, death, hope." i commented about it being a very ugly war, and he said softly, "miss...they all are." i went to take out his iv then, and there, along his tiny forearm, under the tape and cords and tubes, was a faded service insignia. now long since faded to a dull grey, i could still make it out and he proudly showed me it. underneath, in looping cursive, were the names of his buddies who had died in the war. four of them, unreadable, but still there. and i stopped wiping his tubes and cleaning his arm to look into his eyes and he told me about each of them, how they all had left their "pretty girls" to serve overseas. they were my age, just 21, when they enlisted. i finally got his iv out, a lengthy process because his skin almost tore from the clear tape. as i bandaged the site carefully, he touched my arm and said softly, " done good. youre the first nurse who has cared about me". i smiled and combed his hair, brushed his teeth...little things that make patients feel human again after lying in a bed for days. and as i went to get the discharge educator, he said "miss...can you call me a cab?" i thought i had heard him wrong, but i made sure. "you don't have anyone to come get you? would you like me to call your family or a friend?" his eyes filled with tears as he said "miss, my family is on the east coast. they dont care about this old guy. and my friends all died a long time ago." i fought back tears as i nodded, and told him i would find him a ride home. i had to run to another room just then, and another nurse called a cab, but i helped him out to it, walking him out with a tiny walker and his little bag of belongings. it seemed so wrong to send him home all alone. sure, home health would be by, and soon he would be in hospice, but i still felt so sad.

he got into the cab, and i put his sweater on his lap. before the door closed, he thanked me again, this tiny, frail man who had just a few weeks to live. and i knew it was me who needed to be thanking him. society should be thanking him. instead he was going home to die alone, in a cab that the hospital called.

i went back into the unit and before i completed my last assessments, i went to the staff room and sobbed for my patients. everyone tells you you cant get involved, that you cant be emotional. to a level, thats true. you have to compose yourself so you dont collapse into tears everytime you leave a room. but no matter what you do, you always become attached to your patients because they are yours. and for that moment, however brief or long, you get allowed a window into their lives. you are allowed just one chance to be Jesus in their lives. you are allowed the privilege to hold their hands while they cry, and to sit and listen to stories about the war, and sometimes... you have to call a cab to get them home.