dear to the heart

It’s nearly the end of Nursing Week in Canada, established to recognize the work nurses do and the hardships of the job. Some franchises give out free coffee or tea, and hospitals tend to have special events for their staff.

I’ve heard many times that nursing isn’t just a job, but a passion – and while I don’t know if I entirely agree with that, being passionate about it does help. Because every once in a while, you get that patient – someone you wish in your heart that you could help, with everything you’ve got.

There’s been a few patients I’ve been really attached to. I remember them vividly. But there is one particular patient that I find myself thinking back to a lot, moreso than the others.

It was my first of three twelve-hour shifts. Day 1 always sucks, because you’re getting to know the patients and you’re learning how to organize your day based on your assignment. To my dismay, I had an admission. She was in her early 50s, but unless you looked at her chart you wouldn’t have known; she looked like she was much younger. She was frail and tiny, and her dark hair fanned out in tendrils around her pallid, slightly sweaty face. But she had big eyes and a gentle, shy smile. It was the only thing that distracted me from the sinister black and purple decay that rose from her breast towards her neck. It looked like a wet bruise. Breast cancer. She was dying…and soon. The goal was to move her to a palliative unit when a bed was available, but as soon as I saw her I doubted that she’d make it that long.

We put her in a semi-private room and kept the other bed empty so that she would have some peace and quiet and privacy. She didn’t ask for much, and she hated being repositioned. She was in a great deal of pain. Her appetite had long vanished, and the only thing she wanted was a large glass of cold water. It was difficult for her to maintain her grip, so I moved the table as close as comfortably possible so that she just had to lean forward slightly to reach the straw. She had a small fan that her family had brought her, and a few brightly-coloured get well cards. I arranged them on her table so that she could always see them. Despite her condition, she was kind and sweet. English wasn’t her native language but she spoke it pretty well, and even when she didn’t I could quickly figure out what she meant. She’d always say “thank you, thank you,” so gratefully, which really touched me. She had a son, who would come in every day with his girlfriend. In the evenings, her brother and his wife would come visit. They clearly loved her very much. Their presence seemed to be the only thing that brought her true comfort and a distraction from the constant pain she was in. She was on scheduled pain medication – Dilaudid, 2mg – but every time I came in to administer it she was reluctant.

On Day 2, her dressing change was due. She had gauze along her right breast, covering the oozing purple sores caused by the cancer. I gave her the pain medication and started unwrapping the gauze, which was soaking wet from the weeping wounds. I was horrified. I had never seen anything like it before, and to this day I still haven’t.

It was all over her breast, into her neck, down the side of her chest, spreading out to her back. She winced and whimpered uncomfortably. I called in a colleague to help me, completely overwhelmed with the task at hand. Together, we gently dressed the wound again and put a loose tank top over her. She couldn’t lift her arm, so she told us to cut one of the straps and not to worry about it. My colleague left the room to attend to one of her patients, but I stayed there and held my patient’s hand. I apologized that she was in so much pain. She smiled at me, and my eyes filled with tears.

“Don’t cry,” she said, still smiling. “Thank you for helping me.”

“You’re in a lot of pain,” I replied, brushing the tears from my eyes, trying to regain my composure. “Do you want more pain medication?”

“No, no,” she muttered, a frown settling on her face. “I don’t want that.”

“Can I ask why?”

“I don’t want to…” she trailed off, struggling to find the right words. “I don’t want to…” she closed her eyes and mimicked slumping over, and I understood. My hand tightened around hers.

“Listen. I won’t give you too much pain medication, not an amount that can harm you. I promise. But you’re in a lot of pain, and the medication can ease that. I’ll keep a really close eye on you. I’ll only give you enough to make the pain better. Okay?”

She stared at me for a second and then nodded. “Please, one more thing…”

“Name it.”

“When it happens…don’t do the…” she raised one hand and clenched her fist. “Beep beep beep.”

“Ah,” I said, understanding that she was talking about a defibrillator. “No, we won’t do that.”

“I have instructions for when it happens. Please…leave me sitting up for an hour. Read this letter, it explains what I want…”

She gestured to a slightly worn piece of paper, covered with fold marks and words written in blue ink. I read it over. It said what her chart already stated – no resuscitation, keep her sitting up for an hour after she had passed.
“Okay,” I said as I read it over. “We’ll do exactly as you ask.”

“Promise?”

“Promise.”

From then on she let me give her pain medication without complaints. I ended up calling the palliative doctor and asking for a higher dose, as the prescribed amount wasn’t touching her pain. She spent the rest of the evening relatively comfortable. Her son and brother came in, and I brought extra chairs so that they’d have enough space to sit. I popped my head in the room every once in a while but tried not to disturb them. But I’d smile every time I walked past the door, hearing the chatter and laughter that was inside. They adored her.

Day 3 came. When I arrived to the unit and went to check on her, I could see that she had rapidly deteriorated overnight. She was difficult to rouse and breathing heavily. A sheen of sweat covered her face, and the fan pitifully blew wisps of her black hair over her eyes and mouth. I gently smoothed the hair from her face and softly offered her a sip of water. She gave the slightest of nods, and I raised the straw to her lips. She struggled to suck the water from the cup, but slowly, slowly, she drank. A drip of water ran down her chin and I took a piece of tissue paper to gently dab it away. Part of the tissue touched the sore on her neck. When I lifted it, it was black.

I recognized the end was coming, and very soon. At 10 am I was getting anxious, as the family hadn’t yet come in. I didn’t want her to die alone. I asked my colleague to call them and see when they’d be coming, and I sat in the room with her, holding her hand the whole time. She was very much out of it by then, and I don’t know if she even felt my presence.

The family arrived maybe 20 minutes later. Their faces were pinched and anxious, and they asked me if she was going to die soon. Hesitantly, I explained I didn’t know for sure when she would die, but that it would probably be that day. They understood. Her son immediately moved to take her hand, and that seemed to give her some strength. She opened her eyes and smiled at them. It was a fate that they had all accepted, and they seemed to find strength in each other.

I checked on them frequently. I wanted to make sure that she was as comfortable as I could make her, and that the family was too. I offered them water. I asked if there was anything I could get or do. By the afternoon, she was barely conscious and her breathing was worse. I steeled myself before turning to them and asking them if anyone had spoken to them about the dying process. They said no.

I explained that her breathing would alternate between very fast, and then very slow. They might hear a strange gurgle or rattle. I put nasal prongs on her and applied 2L of oxygen. I told them this would help her feel more comfortable. They asked if she could hear them. I paused.

“I think she can. At the least, I think she feels your presence. She knows you’re here. You can continue to talk to her and hold her.”

The son’s eyes were welling with tears and his shoulders shook. His girlfriend was sobbing quietly, one of her arms reaching round to hold him. I gave the patient her pain medication, told them to call me if they needed me, and quietly left the room.

They only called me twice after that.

The first time, they asked me to put a mask on her, because her breathing was worse and they were scared she wasn’t getting enough oxygen. I did so, but it was more for them than for her. I think she was already well past the point of unconsciousness; I don’t think she felt pain or discomfort at all.

The second time they called me, I met her brother at the door. Tearfully, he said he thought she had died. I put my hand gently on his arm and nodded, and then led him back into the room.

She looked weightless against the pillows and under the light sheet covering her legs. Her eyes were half open. The oxygen sounded loud and intrusive as I pulled my stethoscope from around my neck. I listened for a heartbeat as I watched the clock. A minute passed. She was gone. As I confirmed their fears my voice broke, and they fell apart. I removed the mask and turned off the oxygen, gently closing her eyes. I expressed my condolences and said they could stay as long as they wished. Then I had to call the doctor and start the paperwork.

I was in the nursing station, my head in one of my hands as I went through her chart. I had to call organ donation and notify them, although I already knew she wouldn’t be an eligible donor. I couldn’t stop thinking about her son. He was only a few years younger than me, in his early twenties. I guessed his dad wasn’t in the picture…he’d never come to visit. I gritted my teeth as I thought about how her son had come every day and spent all day at her bedside, watching her die. I was interrupted by my thoughts by a soft knock at the door. His girlfriend was standing there, and she said my name, looking like she needed to talk.

Although we don’t usually allow it, I invited her into the room and she took a seat. She had a few questions about what would happen with the body, and if there was anything else they had to do. We talked about the family – the patient’s brother, and her son. The girlfriend was very sweet. Before she left, she paused and turned to me. I’ll always remember what she said.

“Thank you so much for your care. You’re the best nurse we’ve ever had. It really, truly, means a lot.”

I had a lump in my throat as I hugged her, tears streaming down both of our faces. I told her how much I admired her for the love and care and strength she gave, and again apologized for her loss. Together we went back to the room and I went over the next steps with the family. I gave them all hugs. It was all I could do. They collected her things, and an hour later they were gone.

Every so often I wonder how they’re doing. I hope that the son is doing well and that he found a good job…he’d just graduated from college when we met. I wonder if he’s still with the lovely young lady that stayed by his side, and I hope that she too is doing well, wherever she is. I think about the brother and his wife and I hope they know they did everything they could for her. They stayed with her. They loved her. And she knew it. When the end is coming, as it does for everyone, I think that’s what matters most – that’s having a “good” death.

Most of all, though, I hope that she died with the least amount of pain possible, that she was comfortable, that she felt safe, that she knew her family was there. I don’t know if there is a Heaven, but I’ll settle for believing she’s in a better place.

Being a nurse is challenging and demanding, both physically and mentally. We’re told to stay professional, not get too close to the patients and the families – but how can we not? We care. We love. We feel joy as we watch patients recover, and we feel grief and despair when they don’t. We mourn those that die. But we continue on because death doesn’t stop the flow of the hospital. We have work to do. People still need our care and attention. So we give and we give until we’re burned out, even when we have patients that spit and kick and bite, even when we have families that take out their pain and frustration on us.

But knowing that we can make a difference in peoples lives, knowing that we can help to heal them and bring them comfort, is what keeps us going every day. Sometimes we can’t do much but we do what we can. So…yeah, maybe nursing is more than a job. It’s who we are. At least…it’s who I am.

 

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