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This is a Article on Pickels and Elbows... in General Nursing Discussion, part of General Nursing ... Pickels and elbows…. “Get the hell out of my room!” That, more often than not, was the greeting...Feb 27, '08 by mother/babyRNPickels and elbows….
“Get the hell out of my room!” That, more often than not, was the greeting I received from my ornery elderly patient David. He was so angry that I could literally feel the hatred seething from him. Unfortunately for me, David was my patient and I was the newest nurse on the unit. That meant I was usually assigned to him, and it didn’t matter that I preferred not to be. I had to figure out some way to reach him. Thus far, I was failing miserably in the attempt. Had I been a military member it wouldn’t have been unreasonable to simply admit that I’d failed my mission.
David was a crusty individual. His wife Jane was a lovely lady. The two were certainly opposites, at least in appearances. But, I really didn’t know them or their history. I had no idea who David had been before being somehow directed to us at the hospital. His baseline and my first impression was that of irascible, grouchy, pain in the posterior., I was not happy to be continually assigned to him simply because everyone else had had their fill of him.
Once, as I was packing his abdominal wound, which had dehisced, or separated after some surgical procedure which escapes me now, his demeanor switched mid sentence.
I remember that he grabbed my hand and fiercely yelled, “You stupid idiot; don’t you know what the hell you’re doing?” Disgusted, he bellowed, “you probably don’t know the difference between a pickle and an elbow.” Somehow I maintained my composure long enough to reply that of course I did, Inwardly though, I was feeling violated and attacked. Even in the relatively embryo stages of nursing, I was innately aware that despite my hurt feelings, it would not be wise to show it. Surprisingly, David released my hand and although he didn’t talk to me for the rest of that session, he did allow me to finish his dressing change.
Through out the coming weeks, David and I crossed paths often, I dodged more than one dinner tray he tossed my way. His verbal onslaughts were frequent and cutting; his demeanor rapidly deteriorating into cruel viciousness, I came to dread the inevitable call light every fifteen minutes, but soon came to realize that it didn’t matter who answered the light. Even for the most trivial of requests, David always wanted to know where I was. In his words specifically, “where the hell is that little blond nurse?” Gradually I figured out that however testy or fragile the bond, David and I had a connection of some sort. I was at a loss to define it. All I was certain of was that it existed, however shakey or uncertain. David did not have an easy time of it. Just as his wound was showing promise of healing and his abdominal packing became a thing of the past, he started slurring his speech . It was determined that he had suffered a stroke. His anger, already stoked by circumstance, erupted. Usually his anguish and pain was verbally unleashed at me and his devoted wife Jane, who sat religiously at his bedside, vainly attempting both to calm him and protect the staff, He hated everybody and truth be told, I couldn’t blame him for that. Limit setting was getting nowhere, He drove the physical therapist to tears. It didn’t matter that his speech was slurred. The message David was trying to convey was crystal clear. He wanted nothing from anyone but was fearful of being alone.
Weeks into the the most recent dilemma, David was physically improving but mentally declining. I was still routinely assigned to him and just as routinely dreading my days because of it, To get through it I elected to simply talk about my life whenever I was involved with his care, If he threw his tray, I picked it up and set it in front of him. Some days the tray flew past me more than once, If he lashed out verbally and called me a name, I would counter that there was no reason to do that , and remind him my name was Martha, Upon the numerous occasions he accused me of being a stupid nurse, I replied that although I disagreed, I was “his” stupid nurse and however wrong he was, he was entitled to his opinion,
After awhile I noticed that he was a bit less crusty, If I hadn’t discussed the antics of my young son in awhile, he would ask me how he was, albeit in language I had to interpret as friendly. “How is that little brat of yours,” he would testily ask as I attempted to shave him. To his wife’s rolled eyes, I would try to smile and share with him the events of my young son’s daily life, from baseball games to homework. Those sessions would invariably be followed by silence or a shrug, Then one day, a breakthrough,
“He (my son) sounds like a good boy.” You must have screwed up and done something right, I paused in mid range of motion exercise long enough to realize that for David, this was a compliment, I said nothing as he continued, “ That boy needs a dad,” “Who plays catch with him and teaches him about baseball.?” “That would be me and my mom“, I answered, watching from the corner of my eye, I swear he sneered back at me, but it was enough. I had seen he had a heart.
We developed somewhat of a rapport after that incident, although we never officially discussed our bond. There were days I even looked forward to being his nurse, and noticed that the faint outlines of a smile formed whenever I breezed into the room.
Then David had another stroke. It was not severe clinically, but it was just another awful thing to happen on an ever expanding list of bad events. It didn’t matter what Jane and I said or did to try and cheer him. It was just too much. Days and nights of the old David reappeared, as did my dread.
One sunny Tuesday morning on a day when I wanted to be anywhere but the hospital, I was again assigned to
David. I ignored the yelling and picked up the breakfast tray he flung at me. “So I guess breakfast is not to your liking”, I said halfheartedly. He paused to look at me with a quizzical smirk. “ You think you can take me today little girl?” I sighed and ignored the remark. I was resigned to him; resigned to my fate; sick of being the empathetic all understanding nurse person. It was only a matter of time before the damn would break and I prayed that day would not be the day. But, it was not to be.
Jane had been asked to bring in some sneakers that David could wear in order to participate in physical therapy post CVA. Even I gasped when I saw the bright yellow boat shoes she brought in, That was nothing compared to David’s reaction, which was fierce and fiery. “You stupid jerk,” he spat at his wife, “What the hell kind of shoes are these?” There was nothing wrong with his upper body strength and he flung them at Jane, As she fled the room in tears, I started to go after her, “Where the hell do you think YOU”RE going?” he shouted. I turned and stared at him for a millisecond before answering. “Do you think you are the only person on earth who is angry?” What gives you the right to be such a gigantic pain in the butt?” “The way I see it we aren’t the ones with the problem.” I was out of the room to see after Jane.
David and I didn’t speak of that episode after that, and Jane continued to visit daily and listen, mostly in silence, as I continued his care and spoke of my life outside the hospital.
A week or so later when I thought we had reached a silent understanding, I was putting on David’s shoes for yet another grueling session with PT, when he erupted in anger. I stood there, fluorescent yellow boat shoes in hand, shell shocked as he continued with his tirade. When he was through, it was business as usual for him. “Come on Blondie, get a move on”, said David as though nothing had occurred. But, I stood still and watched him, as tears I just couldn’t stop streaked down my cheeks. The more I tried to quell it, the more the tears flowed. I remembered my dad had always said that silent tears are the ones that usually hurt the most. I was embarrassed but I wasn’t sure if it was because he had reduced me to tears (he often did) or that he had finally seen me cry. I excused myself and left the room. Somehow I was able to arrange that another nurse assume his care for the rest of the afternoon. At the end of that day, when I went home, I remember wondering what I was going to say when I returned the next day, and it bothered me for much of that sleepless night. Like it or not, on some level, David and I were a team bonded by unfortunate circumstance. Or perhaps it was simply destiny designed to teach some sort if lesson. What KIND of lesson, I couldn’t possibly imagine.
The next day after report, I took a deep breath and walked into the room, intent on not saying anything about the incident of the previous day. That was my comfort level. If I ignored it it would just go away. David and I were together on that. It was much like my relationship with my own dad. Communication was on the one hand a strong point for me, and on the other, it was my weakness.
Fully expecting a food tray to whiz by me, or some verbal epithet to spew from David’s mouth, I was totally unprepared for what was about to happen. Jane came out and asked to speak to me before I entered the room. I started to apologize for leaving the room the day before and she stopped me. Softly she added, “David has been telling me that he made you cry.” Nodding my head in embarrassment, I apologized for breaking down. “Dear,” “I’m glad you did.” “I think it knocked some sense into his thick skull.” She smiled. “Now you go right on in there and give him hell.” “He needs that spunk from you.” “ He might not say it but you are his favorite nurse; the one who wouldn’t give up on him.” “Please don’t give up on him now.” So in I went. For Jane, for David, but mostly and possibly even selfishly, for me.
Things improved between us after that, David apologized to me for his behavior. He remained his crusty self but we had some sort of genuine banter back and forth. I eventually even looked forward to my days with David and Jane. It almost seemed as though we were family. So much so that my heart momentarily stopped one morning when I waltzed into his room before report only to discover another patient in his bed. “Don’t worry”, said the night nurse, aware of the bond David and I shared, “David was discharged because he was doing well enough to go home.” “That’s a good thing,” she offered kindly as she patted my shoulder. It was that moment that I realized just how much I missed him; just how much I had invested in his care. Mentally, I wished him well and sent him prayers for a complete and happy recovery.
Six months or so later, I had resigned my position at that hospital and was moving on. Thoughts of David and Jane floated in and out of my mind from time to time but began to lessen after awhile. On my last morning there, I was late for an evening shift and rushing in from the parking lot when a car somewhere behind began honking and slowed to a crawl matching my pace. More curious than upset, I turned and waited as it pulled to a stop.
My face lit up and the frigid winter wind ceased its abrasive sting as I realized Jane and David were in the car. Jane got out and came around to open the passenger door. Slowly a walker emerged, and then a white haired elderly gentleman, who stood up and started the walker on a path directly toward me. I brightened as I realized it was David. He hesitantly maneuvered the walker until he stood directly in front of me, As I looked into his face I noted there were tears forming, and that his expression was soft rather than angry. His eyes were smiling, which reminded me of my grandfather, From the inside of his jacket he took out a single white rose, and handed it to me . “Please take it MarthaJean”, he asked. “It isn’t much for what I’ve put you through but I have something to show you.”
Silent, I smiled back at him, With Jane at his side as always, David moved the walker aside and took two steps toward me. Standing directly in front of me, he extended his arms and invited me into a great big hug.
“Thank you for not giving up on me”, he said as he hugged me tightly to him. “I won’t ever forget you and I really AM sorry I made you cry.” While I looked on David and Jane returned to their car and drove away out of my life but, twenty years later, not out of my mind or heart, On some level I am both glad and fortunate that he brought me to tears. It taught me so much about patient care and about myself as a nurse. It was only one of so many experiences that shaped me as a nurse and opened my eyes to the many faces of patients and the way they cope. David is and always will be, one of my heroes, and I can only hope that I was, at least for a moment in time, one of his.
Written by… Martha RNLast edit by mother/babyRN on Feb 27, '08
mother/babyRN has been a member since Feb '02 - from 'East Coast'. Age: 56 mother/babyRN has '27' year(s) of nursing experience and specializes in 'cardiac, diabetes, OB/GYN'. Posts: 1,959 Likes: 397 You can find mother/babyRN on