As a new RN in a large midwestern hospital, I started on the 8 hour night shift of a busy medsurg telemetry floor. Inexperience led me to rely heavily on my psychosocial skills and interactions with patients. After report one night, as I was assessing my patients, I felt particularly drawn to the new elderly lady, Ruth, in the last room at the end of that wing of our unit.
She'd suffered a stroke, was unresponsive, and the offgoing nurse had given me a mental picture of her grieving husband, who was trying to come to grips with this major life change.
I had all the other 12 patients on that wing of the floor to see safely through the night and they were all asleep. Ruth was fairly easy to care for, requiring turning, suctioning to keep her airway clear, and checking her IV occasionally. Her flaccid right side offered me no resistance as I went about taking her vital signs.
More for myself, really, than for her, I began to talk to her as I worked. I reminded Ruth of where she was and what had happened to her, and what I'd heard was happening with her family, which consisted only of her husband.
I faithfully told her what I was doing, when I was finished, and when I would be back. I told her to rest and let nature begin its repair work in her brain so she could return to her husband, even though I knew that they'd both suffered a brutal blow and nothing would ever be the same for them.
As the week progressed, her condition remained unchanged, but began to deteriorate toward the end of the week. A decision was made by Ruth's husband not to resuscitate her should she die. Each night I would continue encouraging her, talking to her while I worked. She remained seemingly oblivious to my ministrations and care.
By the end of the week, Ruth was no better than when I first saw her.
I realized that I was the one who was upset, learning in the report how her increasingly dejected husband was realizing the fatal turn that their life had taken. Her doctor was taking a non-aggressive approach, and evidently spoke daily with her husband, and by the end of the week, it was reported to me that a decision was awaited from Ruth's distraught husband about whether to place a feeding tube and transfer to a nursing home or not.
I felt encouraged by her doctor's care and honesty with Ruth's husband about the gravity of Ruth's prognosis. It was also reported to me that her husband was extremely tortured by his decision, and didn't know which way to go: he didn't want to appear to abandon hope for Ruth, yet he also didn't want to prolong her suffering.
I continued to talk to Ruth nightly about what I knew had transpired during the day, not knowing if her husband talked to her, held her hand, or spoke to her when he was there. By this time, she'd become "Ruthie" to me. I told her that her CT scan showed increased swelling in her brain, and what that meant.
I also wondered who would be her night nurse, as I had the weekend off, and Ruth probably wouldn't be there when I returned. As I suctioned her around 6 a.m., I noted Ruthie had lost her gag reflex in response to the suction catheter, and that her face had a slackness not previously present. My other assessments showed no other difference in Ruthie, and her vital signs were unchanged.
As I stood there looking at her, an amazing thing happened that I'll never forget. Having dimmed the lights, about to leave, my eye caught a small white rectangle of light that slid down the opposite side of Ruthie's bed, across the room to the far corner, up the wall, and disappeared into the ceiling.
I remember thinking that maybe I was more exhausted than I thought, or perhaps I had gotten a little too personally involved with Ruthie. I stood there a few minutes, and nothing else happened.
Ruthie's respirations were regular and unchanged, and her face remained slack and lifeless. Her vital signs were also unchanged, and I left to complete the vital signs, meds, I and O's, and prepare for the onslaught that was called the day shift. I was ready for the weekend off, yet I was aware that something momentous had taken place, even if I had no name for it.
During the report, I mentioned nothing of the light that had seemingly come from Ruth. I only reported her slack jaw, her stable vital signs, and stable neurological signs. Our report was a kind of walking rounds, and after I told Ruthie's new nurse of her condition and situation, she went in to see her before we continued on.
She came out and told me that Ruthie was gone.
I went in to see her one last time, feeling that perhaps she'd made her own decision, and feeling that, in some way, I perhaps had helped her process her life and situation, and she had maybe tried to help her tortured husband with his weighty decision.
As the charge nurse called her husband, I finished the report and went home, knowing that, at the very least, I had been witness to an extraordinary event, open to interpretation in different ways by different people.
I've only talked about it a few times, and only to other nurses, afraid, I suppose, of being labeled a sleep deprived and hallucinatory night nurse.
I often think of Ruth, and what she shared with me, and I've been satisfied to think that maybe I was able to interpret and validate for her what had happened to her, and perhaps offer her a small part in the last scenario of her life.
It reminds me of the crucial imperative of a nurse's position: our opportunity and responsibility to validate and interpret our patients' illnesses., situations, and affect their opportunity for input and response. I'll be always amazed and grateful at what Ruth taught me and perhaps chose to share with me.
Kristine Godecker Hilquist
