A Picture is Worth a Thousand Reminders

It's sometimes hard for a lot of nurses to admit when their compassion begins to fail them and slips into dread of a certain difficult patient. Most of us like to think we are equally compassionate towards everyone, until "that one patient" comes along.

That One Patient takes the shape of many different things, and for me it was Mr. Smith, a patient admitted with Altered Mental Status due to an infection in his spine that had allegedly gone to his brain and made him a completely different person than the one he used to be. He now had transient confusion, literally from one minute to the next; he lost the ability to use his "inside voice" and now yells instead of talking quietly, or at a normal volume and has a sitter 24 hours a day to quiet him down and reorient him; he is usually less than cooperative.

He has been in the hospital now for well over a month in a half; I'm just coming up on my one month mark as a [still new] RN in my very first nursing job. On my first day on the floor, he was one of the patients assigned to me and my preceptor. Every nurse on the floor had something to say about Mr. Smith, and admittedly I have yet to hear anything positive, only frustrations and exasperations to the tune of, "He's STILL here?" and "Seriously, they need to find somewhere else for him to go."

I was always warned by my nursing school instructors to not let a noxious atmosphere like that warp me into having that same attitude about a patient. Unfortunately, it's easier said than done when the nursing instructors are gone and you are with your new coworkers; their opinion will begin to change yours if you're not vigilant against it. And that's exactly what began happening - their exasperation became mine, when it really had no reason to because my preceptor was always the one who would "deal" with him, I hardly ever even went in his room, only heard his yelling from outside his room and down the hall.

All of this changed yesterday.

My preceptor had received an order from the doctor to put a Coude catheter in him; he had not voided all day and was bladder scanned for almost 800 cc's of urine. I went into the room with my preceptor and another new nurse to watch the procedure. As my preceptor was getting ready, I looked around his room. His wife had printed out pictures and posted them on the wall; below each picture was written Mr. Smith's name and the date the picture was taken: "Earl Smith, March '09". One picture was of Mr. Smith and his wife, holding their young grandson. Another picture was Mr. Smith and his wife, and another picture was Mr. Smith, his wife, and their children. The Mr. Smith in the pictures beared little resemblance to the Mr. Smith now in the hospital bed, but there was still resemblance.

And it was then that I realized something that I think many people, many nurses, forget: This person is not their illness. They had a life, a family, friends, hobbies, a job, outside of this place before their illness took that all away. Mr. Smith had a wife, children, and young grandchildren. He was a normal, lucid, functional individual, and how quickly that all changed. Suddenly I realized how heartbreaking it must be for his family to look at those pictures and remember their husband, father, grandfather, friend, and then look at him now and see that he is only a glimmer of the person he used to be.

But he is still a person, and I have no doubt that his wife put those pictures up to remind us, the medical and nursing staff, of that fact. And I am very grateful for that reminder, because I did not want to be the kind of nurse that I was becoming for Mr. Smith. Even if her intent is lost on the rest of the nursing staff, it is not lost on me, and I hope that I always remember the lesson I learned yesterday in Mr. Smith's room.