The pale, haggard face and the expression of fear in the elderly gentleman's eyes are still fresh in my mind as I try once again to focus on getting myself safely home through the crush of Friday night freeway traffic. Gone is my customary resentment of "why-does-EVERYTHING-happen-at-five o'clock-on-Fridays?"; all I can think of is how trapped the poor man looked as he wheezed and coughed up frothy, pinkish-tinged bubbles with his middle-aged daughter seated on the bed beside him. I'd been notified of his three-pound weight gain that morning; accordingly, I'd called AND faxed his doctor with this information, which did not bode well for a ninety-four-year-old man with congestive heart failure; still, he'd been up and around per usual at noon, and staff and family alike were hoping he'd be able to hold on until his scheduled appointment on Monday.
One pass with the stethoscope told me that a quiet weekend, spent with his little wife in their assisted-living apartment, was not to be. His lungs were filling quickly with fluid, and I knew I needed to send him to the ER without causing the family to panic. Momma has Alzheimer's and does not do well when he is in the hospital, and daughter and I have only recently had The Talk---a tearful, emotional ordeal for both of us---about end-of-life care for Dad, who has been bouncing in and out of the hospital for the past several months and coming home weaker every time. We've tried the 2-gm Na+ diet that caused him to lose all interest in food, the fluid restriction that made him miserable, the diuretics that rendered him incontinent and humiliated, the daily weights, the physical therapy---all of it. None of it has helped him, and his quality of life is so poor at this point that I'd suggested a hospice consult.
That was where we had left it; she clearly needed time to process, and I was only too happy to give it to her because this quiet, dignified fellow is one of my favorite residents. (Yes, I know nurses aren't supposed to have favorites but I am, after all, only human......and in my opinion anyone who fails to bond with at least one patient in her/his career probably shouldn't even be a nurse.) This, however, was not the time to debate whether or not to send him back to the hospital---not when his heart sounded like it was beating underwater, not when Momma was crying, "Dad, no, don't cough, you're not sick, you can't be sick!" I wanted to breathe for him. I wanted to be able to stick a straw in his chest and draw out the fluid that was drowning him. I wanted to put my stethoscope back over his heart and hear a normal, strong, regular beat.....
Instead, I calmly asked the med aide, who had summoned me to the room, to go downstairs and call 9-1-1, make copies of his MARs and the face sheet (like most of our residents, he doesn't have an advanced directive in his chart) and instruct other staff to give Momma extra help tonight while hubby was at the hospital. To her credit, the daughter remained calm as well---she's almost as case-hardened as I am after repeated crises with both parents---and called her brother to have him meet her at the hospital. Within minutes, we had Dad all bundled up and ready for the EMTs, who swiftly noted his respiratory distress and put on their best scoop-and-run road show, with daughter following closely behind in her car.
Shortly thereafter as I was charting my findings and details of the transport, I found myself fighting back tears because I knew he might not make it this time. As a clinician, I'm not even sure it's in his best interests to continue with the repeated hospitalizations and interventions that only make him more uncomfortable, considering the way he has been suffering these past months. But that decision is not mine to make, and his daughter's fervent "Thank you" as she raced out the door alongside her father's stretcher convinced me that my whispered prayers should be aimed in the direction of recovery.
Now, reflecting on these events in my own car on the way home, it occurs to me that such dramas are not the norm for most people in the course of an average workday. They're no longer the norm even for me, as I work in community-based care where they are the exception rather than the rule. But I have to admit that I love knowing what to do---and how to behave---when confronted with a life-or-death situation. I'm proud of the fact that I can keep my wits about me even when everyone around me is losing theirs. I used to be very anxious and prone to panicking in any strange or frightening circumstances, and to have triumphed over that is one of the crowning accomplishments of my life.
More than that, however, I find myself thinking of how privileged I am as a nurse to hold not only the lives of those in my care, but the trust of their loved ones. Sometimes, I am literally the only thing standing between a resident/family and utter catastrophe; more often, I am there when their frustrations are boiling over and they need to vent, or when they're afraid and they feel too intimidated by other professionals to ask what's really going on.
I am a fount of medical knowledge to a layperson who hasn't learned to decipher initials like CHF and COPD. I am a counselor for the bereaved and about-to-be-bereaved. I am a source of information about everything from health insurance to how to avoid foods that cause gas. I am also a cheerleader.......a life coach.......a confessor........a teacher.......a minister.
How many jobs can boast those mad skills?
I know I've been complaining a lot about my chosen field lately. Yes, I admit that after less than two decades in health care, I'm tired. In fact---to be totally honest---I'm close to burning out. At almost fifty-three, I've developed a batch of health problems that make me old for my age......some of which were a result of my career choice, and others exacerbated by it. And given my family's lousy genetics in the longevity department, I am keenly aware of the passage of time; that's why I want to spend less of it working and more of it following my bliss. (Whatever that is.)
But tonight, as I flip on the cruise control and glide through the now-thinning traffic, I finally realize that nursing has given me the greatest gift I could have ever asked for, which is the ability to make a difference. I'm far too jaded now to believe I've made any difference at all to many of the people I've taken care of over the years, but there have been enough times that I have helped someone to convince me that my life has counted for something........which is all I've ever really wanted anyway.
Tonight was one of those times. And for now, that is enough.
