I readily admit I have either bent or broken some rules that nurses are supposed to stringently uphold. However, I hope I'm not alone when I say that some of these rules seem so cold, bureaucratic and alien. If breaking a rule will make a patient's day a little brighter, if only for one moment, I will toss bureaucracy aside and do something that is normally forbidden.
I believe rules can be bent at times. Heck, I feel that some rules can even be outright broken as long as doing so has brightened someone's day.
Billie is a pseudonym for the septuagenarian nursing home resident whom I first met seven years ago when I was a brand new nurse in long term care. She was a strikingly pretty model during her youth, and even as an elderly woman with a terminal prognosis, she still maintained a whimsical cuteness and a stylish flair through tasteful choices in makeup, haircuts, clothing and jewelry.
Billie received hospice services because her physician did not expect for her to live another six months due to advanced congestive heart failure. Although she barely stood five feet tall and weighed no more than 100 pounds, her lower extremities were chronically wet, weepy, heavy, discolored, swollen, and resembled crude elephant legs. Diuretic medications did not help to pull the extra fluid off. Neither did pressure wraps, sodium restrictions, or keeping the legs elevated. Keeping her comfortable was an uphill battle.
She suffered from mild cognitive impairment, but was very well-versed regarding her dietary restrictions. One day she asked me, with the impression of defeatism stamped on her face and a sense of sorrow prominent in her tone, "Will I ever be able to eat a hamburger again?"
My dark brown eyes made contact with her pale blue eyes. I realized some of the things that I, a young and reasonably healthy adult, take for granted are small pleasures that many elderly nursing home residents will never enjoy again. Most, if not all, of these people will never take another vacation to a faraway city, state or country. Some will forever lose the ability to walk. Others will be robbed of their ability to talk after having a stroke. Still, others will never be able to enjoy a tasty meal due to dysphagia, feeding tubes, pureed textures, restrictive diets, or the notoriously bland foodstuffs commonly served to institutionalized elders.
I did something I should not have done. I broke a rule. During my lunch break I visited a local fast food joint and ordered a hamburger with extra tomatoes. Since Billie spent the vast majority of her time in her room due to depression, smuggling the burger to her was an easier feat than I had expected. Her eyes lit up with joy and anticipation.
"Thank you, thank you, thank you!" she exclaimed. She kept her door closed and picked at the burger for several hours, eating the fixings individually before finally polishing the sandwich off. This was the first hamburger she had eaten in several years.
Billie died a couple of months later. She passed quietly, serenely, on her bed in the nursing home surrounded by the hospice nurse, a nursing student, and myself. She had two attentive adult children who visited frequently, but they did not want to be present during her final hour.
I broke a rule by supplying an elderly resident under my care with an unhealthy food item. But if it alleviated some of the bleakness of her existence during her final days on earth, I feel no shame for doing what I did. To every rule there's an exception.
