“She’s fighting hard, but the doctors are struggling to stay ahead of her injuries.”
“Sandy has an incredible will to live, but there is only so much the doctors can do.”
“They are holding out hope, but the odds are against her.”
Finally, as 11:00 PM neared, Janet approached the weary group and said with tender compassion, “Sandy has lost her fight.”
Drained, the group quietly began embracing each other and turned to Sandy’s husband to offer support.
Feeling a bit like an intruder and out of place, I walked back to the OR with Janet and commented on how long Sandy had held on.
“Actually,” Janet said quietly as we walked, “she died over an hour ago.” Responding to the obviously confused look on my face, she continued.
“An hour ago, her friends and family still had great hope and weren’t ready to hear the news. Sandy had fought hard with an incredible spirit, but had I told them so quickly that she had passed, they would have been in shock and would never have heard those words about her wonderful spirit. The last hour was preparing them, emotionally and psychologically, for the news that they would have to hear. But now they know and understand everything that we did and everything that Sandy did to fight. The ending is the same, but they deserved to hear more than the simple, cruel fact that she died.”
Despite their profound grief, so many took time to thank me for my help, though I was reluctant to accept their gratitude. I had the easiest job that night—the surgeons had the hardest.
But it was a remarkable nurse named Janet who had the greatest impact on Sandy’s “family,” and on me. She was Sandy’s voice, to help all who loved her understand.
David Avrin
A Lesson in Saying Good-bye
Love one human being purely and warmly and you will love all.
Jean Paul Richter
As I sat with my father during his final days, my mind sometimes wandered to years gone by. One afternoon my thoughts drifted back to my sixteenth year, when the mother of my future husband was dying from breast cancer. When she told me, “I’m dying,” all I could manage to reply was, “I know.” I was young and inexperienced and felt terribly inadequate.
But now, after more than twenty years of nursing, I’ve learned that there are many ways of dealing with death. One death in particular affected me tremendously.
On that memorable day, Terri, the night nurse, told me in report that Paddy Doyle had been admitted the previous evening. A spirited elderly man, Paddy had been a patient many times in the past. He was as jolly as Santa Claus, and we’d all grown fond of him.
But this time he was dying.
Terri said, “His wife went home ‘to refresh’ late last evening. She left strict instructions to be called if his status changed. Did you know they just celebrated their sixtieth wedding anniversary? It’s so sad.
“Paddy’s feet are dusky and he’s been slipping in and out of consciousness for the last hour. I called his wife and she’s on her way.”
The words were barely out of her mouth when Mrs. Doyle glided down the hallway, looking so elegant that I could hardly believe she’d been a bride sixty years ago. She looked as though she’d had her hair coiffed at the beauty parlor and her makeup was flawless. I doubted that she’d slept a wink getting ready for her final date with her husband.
She took the news of his impending death in a dignified way. Squaring her narrow shoulders, she made her way to his room, her feet barely making a sound on the polished floor.
Being young, I didn’t want to consider that someday I might have to go through the same thing with my own husband. I wanted to cry for her loss. They hadn’t had children, and most of their relatives were old and sick. How was she going to adjust to being alone?
On my rounds to assess patients, I paused outside of Paddy’s closed door. I didn’t know what to say to this couple, who were like grandparents to me.
I knocked lightly on the door but got no answer. As I started to walk away, the door slowly opened.
“Come in, child,” said Mrs. Doyle graciously, stepping back from the door.
He looks awful, I thought as I approached my patient. Why is this so hard? I wish I’d called in sick.
I immediately regretted my sentiments. Better get your act together. She’s going to need you.
Then I noticed that she didn’t need me. In fact, she was holding up quite well.
Mrs. Doyle resumed her business and seemed unaware of my presence. She spoke to her husband softly, saying, “I’m going to get you cleaned up, Paddy.”
“Do you need help?” I asked.
“No dear. We can manage.” With that, she moved to the sink to fill a basin with water.
I listened while she told him, “I’m going to wash your face now.” He muttered something unintelligible. I don’t know how she understood what he said, but she did. Locks of his white hair had fallen across his brow. As she swept the strands back, she murmured, “There they go again.” I realized I’d witnessed an intimate moment that had been repeated for sixty years.
With her fingertips, she lightly caressed the back of his hand, then scooped his hand into hers. “There now,” she said. He gave her hand a barely perceptible squeeze.
I suddenly noticed that the air was filled with cologne. After all the time I’d spent caring for Paddy, I’d never noticed his scent before.
Paddy stirred.
“Hush, I’m right here.” Mrs. Doyle sat on the edge of the bed. She gazed into his clouded blue eyes. “It’s okay. I won’t leave.”
That was it. I started looking for the exit. It was breaking my heart to watch them on this day, their last together. Of course she wasn’t going to leave him, but I could.
Hesitating by the door, I wondered, How is she doing it? I’d be crying and screaming mad at the whole world.
Mrs. Doyle reached into her pocket and withdrew her rosary. She began to pray.
Clutching my necklace cross for strength, I prayed too. God, let this be over for Paddy. Please don’t make him suffer any longer.
As I held tight to my cross and closed my eyes, something strange happened—I felt the presence of someone else in the room. Opening my eyes, I saw only the elderly couple. I closed my eyes and felt it again. Someone or something else was there.
I opened my eyes and saw a young couple, lovers, gazing into each other’s eyes. Two people meeting and falling in love and laughing. I could feel the joy inside the sorrow. A feeling of peace came over me.
I’d found what I’d desperately needed. I walked over to the bed and gave Mrs. Doyle a hug. I held Paddy’s hand and told him, “I’m going to miss your smile.”
Then I left the room. This was their time to say good-bye.
My father stirred as I held his hand. I said, “Hush Dad, I’m right here. I won’t leave you.”
Barbara Scales
as previously published in Nursing ©2005
One Patient
Hear my prayer, O God; give ear to the words of my mouth.
Psalms 54:2
I often review this episode in my mind. Little did I realize at the time that one patient would have such an impact on me.
She was an eighty-seven-year-old woman, who I’ll refer to as Mrs. G. She was transported from the local nursing home with an acute inferior wall myocardial infarction. Until a year ago, she lived with her family, who said that, although she was physically weak, she remained “sharp as a tack.” Presently, she was in acute pulmonary edema and hypotensive with an unstable cardiac rhythm. I remember how frightened she looked as she lay there surrounded by two nurses, three physicians, and a respiratory therapist. Within minutes she had a tube placed in her mouth, another in her nose, and a catheter inserted into her right neck, and both hands firmly restrained at her side.
Her “periods of agitation” were noted by everyone in the room. Even though both hands were snuggly restrained, she continued to pull and thrash in bed. It became obvious to me that sh
e became more agitated each time I entered the room, and I said a silent prayer that no one else noted my effect on her. I wondered if she thought I was the one who had intubated her, or if the restraint I applied was too tight. I spoke to her often and she seemed alert, nodding appropriately to the questions I asked her.
Before long, Mrs G.’s condition started to deteriorate; medications were started and titrated as we closely monitored her progress. In spite of this, she followed me with her eyes, pointed to me with her restrained hands, and continued trying to speak. The pulmonologist insisted she was becoming more restless and confused secondary to hypoxia and should be sedated to avoid self-extubation.
At this time I was alone with her and stood by her side. “What is it you are trying to tell me?”
I untied her right hand and, still holding it firmly, placed a pen in it. I held a paper and watched this aged woman trembling, determined to write something she obviously felt was important.
After she wrote three words, her head fell back on the pillow and her hands relaxed. I restrained her again, although for the first time I felt no resistance.
I looked at the paper and saw the words she was so desperate to write, so large they covered the entire page: “God bless you.”
Peggy Krepp
There Is Nun Better
For health and the constant enjoyment of life, give me a keen and ever-present sense of humor; it is the next best thing to an abiding faith in providence.
George B. Cheever
Sister Catherine Higley, a Benedictine nun, was my colleague, friend, and teammate at the hospice. As a nurse, she was a blessing to many and she and I had wonderful times caring for people at the end of their lives. She had such a balanced view of life and death, and her wisdom was a great support to me.
Sister Catherine had the ability to give it to you straight while showing an extraordinary amount of compassion at the same time. One of her patients referred to her as Attila the Nun! Yet he lovingly followed her every command because he knew that she cared for him and he deeply respected her.
Once she was working with Mr. Johnson who was terminally ill. I was the social worker assigned to the case. I called his wife to schedule my first visit. We set up a time and just before she hung up the phone, she said, “Can you save my husband?”
I didn’t know if she meant save him physically or spiritually, so, in my zealous intent to do the right thing, I said, “How do you mean?” (You must realize that “how do you mean?” comes from two years of intensive graduate study in the art and science of social work culminating with the perfect question to elicit just the right response from the client!)
She said, “Can you save his faith?”
I immediately knew that this was a job for the chaplain, so I explained to Mrs. Johnson that I would have the chaplain follow up with her as soon as possible.
The next day, I was approached by “Attila” in the hallway at the hospice office. She was furious. “I can’t believe you’re sending the chaplain to Mr. Johnson’s house. They said from the very beginning that they wanted nothing to do with chaplains and you know we respect that!”
“That’s odd,” I said, “I just spoke to Mrs. Johnson yesterday and she said she wanted someone to save her husband’s faith.”
“No she didn’t,” Sister Catherine retorted, “She wanted someone to ‘shave his face.’ And she’s very confused as to why the chaplain has to do that!”
Thanks to Attila the Nun, I headed off the chaplain and avoided a very close shave!
Ronald P. Culberson
Reprinted by permission of Mark Parisi and Off the Mark. © 2006 Mark Parisi.
Fish Therapy
The most wasted of all days is one without laughter.
e. e. cummings
Several years ago I had the pleasure of lounging around as a hospital patient for several days as the result of a staph infection. My profession was in health care and in fact I worked at this facility, so I knew many of the hospital staff well. Although it was a serious infection, I did not feel sick per se, and found myself on the receiving end of a few minor practical jokes, which of course were totally undeserved. (I swear I have no idea how the door to the supply cabinet in my room got stuck shut with a dozen strips of heavy-duty, two-sided tape hidden on the inside cabinet doorjamb.)
I awoke the second day of my stay when a nurse came in to change my IV fluids, which included several differing bags of solutions and antibiotics. I noticed immediately that she was carrying a large, old-fashioned glass bottle of fluid—at least a liter in size.
That’s odd, I thought.
Then I saw the three goldfish circling happily in the water. I spotted my friend Gary, the pharmacist, lurking nearby, and he, the nurse, and I laughed and carried on about my fish. For some reason, it just seemed right to name the three fish Larry, Moe, and Curly Gary, which was a slight misnomer since Gary was a few hairs shy of curly.
They started to take the fish away, but seeing opportunity rear its mischievous face, I asked them to wait a bit.
“Don’t tell the nurses on the next shift about the fish,” I suggested.
It’s amazing how easy it is to enlist silent coconspirators. I turned the bottle spout up and uncorked it so the fish could breathe until the afternoon.
As the 3:30 shift change approached, I recorked the goldfish bottle and hung it behind the largest of my IV bags so the fish were mostly out of sight. I then carefully taped extra tubing from the fish bottle to my IV line so that there appeared to be a connection.
Just after the shift change, I pressed the call button. “My IV has a problem.”
The lambs are always the first to be slaughtered, so a newly hired nurse who was recently out of school was dispatched to my room to check the IV.
As she entered the room, she asked, “Your IV has a problem?”
“I hate to harp, but I think maybe the IV line is blocked.”
She started checking the IV site at my wrist, as most nurses are trained to do. Seeing no problem, she traced the line upward, checking each connection. As she got halfway up multiple tubes, the movement of one of the fish caught her eye. She shrieked so loudly that I jumped even higher than she did, which must have been impressive considering both the height of her leap and that I was lying flat on my back. I am sure even the fish jumped.
When she landed, she covered her mouth with both hands and shouted, “Oh my God, oh my God!”
The laughter of her coworkers filled the doorway behind her. She turned toward them, fanning her face with her hand.
“Man,” I said, “you scared the bejeebers out of me! That’s no way to treat a patient!”
“Out of you!” she said breathlessly. “You should have been in my shoes!”
“Are they still on?” I smirked
I had high hopes for the next shift change, but that nurse simply came in, gave me a “You-are-so-busted, Mister” look, shook her head, and went about her business.
The next day, Larry, Moe, and Curly Gary were discharged and sent home to live happy goldfish lives as pets of one of the nurses’ children. The day after that, as I was saying a fond farewell to my hospital “gown” and preparing to go home, a patient from the adjacent room stopped at the doorway of my room and said, “You know, I’ve been in the hospital a lot recently, but this was absolutely my best hospitalization.”
“Why is that?” I asked.
“Because laughter is good medicine.”
“Laughter is good medicine,” I chuckled. “Nurses and patients need a dose more often.”
Daniel James
Bridge to a Silent World
The words that enlighten the soul are more precious than jewels.
Hazrat Inayat Khan
As a nurse health educator, I’ve had many rewarding opportunities, from being a professor of nursing at a community college, to teaching health classes for the hearing-impaired children in an elementary school. The latter led me to teach sign language to the parents of a si
x-year-old.
On the day I first met her, the afternoon still held on to the sunlight. Inside the wood-frame home, shadows clung in the small kitchen where I sat with Michele and her mother, Carolyn. Michele, a student in the School for the Deaf in Great Falls, Montana, was on a home visit. Huge brown eyes spoke her confusion. The beauty of her delicate features was marred with sadness.
Over a cup of coffee, I explained the home-signing program to Carolyn. Michele sat on the floor in a corner with a few scattered toys. When she got up, jerky movements hampered her walking. Her hand clutched a string to a toy she pulled on wheels; a clown with a kitten tucked under its arm. Halfway across the room, Michele stumbled and sprawled across the coffee table, knocking several items to the floor.
Her mother frowned, shook her head, and gave an abrupt hand motion to wave her away. Her sharp words were cloaked with irritation as she pointed to a small chair in the corner. “Go sit there!” she said, knowing her daughter couldn’t hear her.
Mirroring her mother’s frown, Michele signed. “Why I go?”
Confusion swept across her mother’s face. “Don’t sass me!” She pushed Michele toward the corner chair. Sniffles accompanied Michele’s unsteady gait.
My spirits tumbled. “She was signing to you. Asking, ‘Why I go?’” I explained.
“Well, I didn’t know that. It looked like she was making fun of me. She’s always misbehaving. It’s difficult for everyone when she’s home.”
I knew of the pain parents felt. I worked with other parents who shared the guilt and blame they experienced having a hearing-impaired child.
“I think you’ll find it easier to have Michele at home when you understand what she’s signing to you,” I offered. “You’ll be amazed at the difference in her behavior after you’ve learned even a few signs.”