"Mrs. R? Which room?" I asked in return.
"Room four." Ms. O, a plump, pleasant woman of African origins, replied. Her thick accent and tendency to say things with a smile seemed to smooth a much-needed salve over my less-than-lovely evening.
The oncology grind was getting to me, wearing on nerves that could snap at anytime, like an anvil held up by cheap dental floss. The loss of a 23-year-old newlywed to lung cancer the week before had hit hard. It was far from my first patient loss, but it had affected me more than any other. To make things harder, Little Brother was back with us, struggling after his last round of chemo. He was keeping his chin up, but watching him pace the wards at night made me anxious. Those factors combined with the cocky, "do-it-for-me" attitudes of a few of my coworkers and the against-odds hope for a permanent change of station (PCS) found me wishing myself anywhere but work.
"Sure. I'll be right there." I replied. I pulled up the MAR, checked the orders and headed to the Pyxis. I drew up dilaudid, my old ally, almost robotically. Dose check, label, flush, heparin lock and alcohol swab. Ready to roll.
I headed down the hall toward room 4. I was admittedly much more content on nights than I was on days, staffing issues aside. There's something I enjoy about tending midnight. Her concerns are about comfort, about sleep, about a patient's fears and hopes for the next day. I love it when the lights go down in the hallways, when patients finally get to lose themselves in much-deserved slumber, when my friends and I sit around the call bell answering machine and play Uno until the wee hours of the morning.
And tonight, I'm the narcotics queen, I told myself wryly as I entered room 4. The pungent smell upon entering reminded me that Mrs. R had throat cancer and a trach. As I neared the bed, I took note of a small, frail woman who lay entrenched in bed as though she were a cork in a bottle. Blankets protected her from the cold of the hospital air, enveloping her in a sea of white.
"Hi, Mrs. R." I said. The little lady smiled thinly. "Ms. O tells me you're having pain." Her little head, sporificely populated by white hairs, bobbed. "I've got some dilaudid for you." Relief flooded her dark brown eyes. "Can you rate your pain?" I asked. She held up six fingers, then seven. "Six to seven?" She nodded again. "All right. Let's see if we can knock that down." I replied.
I deliver her dilaudid, flush, and was in the process of heparin-locking her port when Ms. O entered the room behind me. Mrs. R began to gesture, but Ms. O was at a loss as to how to interpret her needs. Looking a little frustrated, Mrs. R wrote down what she needed on her clipboard and Ms. O thanked me for giving the pain med. I asked if she needed help and she declined.
"All right. Call if you need me." I offered on the way out.
A few hours later, another push request comes in for Mrs. R. "Man, that poor lady." I told Ms. O. In the time between pushes, I had been fulfilling my charge nurse duties by reviewing every patient's history and plans of care, preparing for report in the morning. Mrs. R had metastaticc ancer that had spread to her larynx. The trach had been her only option to prolong her life as the tumor threatened to completely close off her airway. She was set to meet with hospice come morning to finalize her discharge plans and then head home.
"I know." Ms. O sympathized. "She's a nice lady." She observed.
"I think so, too."
I drew up more dilaudid. By now, the lights were down, the halls were dim, and the rooms were dark. I tiptoed into Room 4, plunging into the dark.
"Hi, Mrs. R. I've got some dilaudid for you again." I said as I reached reflexively for the string to turn on the over-bed light. It was at that point that I realized Room 4 was the only room that didn't have an over-bed light. The only light in the whole room was the harsh fluorescent controlled at the wall switch. "I'm going to have to turn on the overhead light, OK?" I asked, unable to see my patient but preferring to inform her before the lights blinded us both. "Here they come." I said as I switched them on.
When the lights came on, I was relieved to see that Mrs. R had her eyes closed. She opened them slowly. I had already drawn off her heparin lock and was in the process of flushing her port. "Is that pain back up to where it was before?" I asked. She nodded, exhaustion in her eyes. "Still in your neck?" I asked. She nodded again, then motioned toward her face."Face, too?" I asked. She nodded, a smile back on her face telling me she was relieved that someone understood what she was trying to communicate. "Did the dilaudid work well the last time?" I asked. She nodded emphatically. "Good. We'll get this dose in and check on you in about 30 minutes, all right?" She smiled gently.
I finished pushing the dilaudid. Before I left, she mouthed "thank you" from the bed. "You're welcome, ma'am. We'll be back in a little bit to check on you." She mouthed "OK" and I turned off the light.
Midnight came and went. The witching hour slipped by. Before I knew it, it was nearly time for shift change. As I prepared the report sheets and the assignments, Ms. O joined me at the desk.
"Mrs. R would like some dilaudid." Ms. O said, pulling her glasses down her nose and giving me a smile.
"Not a problem." I replied. "I'll be right in."
One more trip for the narcotics queen tonight, I told myself.
In Room 4, Mrs. R sat up in her chair next to her bed. She leaned against a pillow, partially asleep. When she heard me approach, her eyes opened.
"Up to the chair for a bit, Mrs. R?" I asked. She nodded groggily."Does it help the pain?" I asked. She shook her head and motioned for her clipboard. She wrote as I pushed dilaudid. "I can talk a little bit. The bed was wet." She had written. I glanced at the bed, which appeared dry. Noting my confusion, Mrs. R pointed to Kleenex in a pink bucket that sat on the bed. It was then that I saw the mucous draining from her trach, a stream of gooey brown dripping down her chest. "Oh, I see. Do you want me to change your sheets and clean you up? We can get you back to bed if you'd like." I offered. She shook her head no, looking away despondently.
"I hear you may be going home today." I said, glancing up at her. She nodded distantly. "Are you ready to go home?" I asked.
Mrs. R shrugged. She met my gaze with mournful eyes. "No one to go home to." She said in a low whisper.
And at that minute, I forgot my PCS request. I forgot my lazy coworkers, the grouchy day shift that was just beginning to arrive, and the emotional trials of the past several weeks. The lonely little woman in front of me captured my full attention. She had no one to care for her at home. She was dying of a painful, ugly cancer. Her every whim was suddenly my only concern.
"I'm sorry to hear that, Mrs. R." I replied, at a loss. When I first became a nurse, moments like that were incredibly awkward. I searched high and low for what to say to comfort patients that were ensnared deep in the depths of that deadening depression. Eventually, I realized that sometimes in moments like those, all a nurse can do is be there in the silence with their patient and hope that the knowledge that another person has heard and validated their suffering is enough to alleviate it, at least for a while. At least long enough for them to realize they aren't really alone.
"It's cold." Mrs. R said, her voice a low whisper. Her quiet comment drew my attention to the cocoon of blankets around her.
"I know. Unfortunately, our blanket warmer is broken." I empathized, my mind suddenly snapping into gear. "I can get you some hot packs, though. Would you like that?" I asked.
Mrs. R's eyes lit up and met mine. "Yes." She replied.
"Not a problem. I'll be right back." I said, hep-locking her port and heading across the hall to the storage room. I grabbed three hot packs and three pillowcases and hurried back to Room 4.
At her bedside, I activated the hot packs, slipped them into their pillowcases and handed them to my patient. She closed her eyes as she took the first one, placing it in her lap. The second one went under an arm, the third under the other.
"Better?" I asked.
"Better." She nodded.
I wasn't quite satisfied. Her blankets, which had previously been over her head, had slipped down behind her back and the chair.
"You know, we have some knitted caps if you'd like them to keep your head warm." I offered.
Her eyes lit up again and she nodded.
"Sure. Any particular color?" I asked with a smile.
She shook her head and smiled dimly.
"All right." I cajoled. "I'll find one that I think you'll like and I'll be right back."
Down the hallway, I slipped into the assistant manager's office and pulled out the bags of colorfully knit caps, donated from some saints who surely have no idea how much their contributions meant to our cold, bald oncology patients. One of the caps was baby blue and fuzzy, promising to warm the head that wore it. I took it immediately. I rifled through the bags a few times, trying to decide what colors she would like. Was she a fan of pink? That can be hit or miss. What about blue? Nope, already had a blue one. Green? Brown? Red? Yellow? When did picking the best cap become more complicated than taking the NCLEX?
Finally, I came across a white, purple and light-purple striped cap. I smiled. It was bright and looked like spring blooming on yarn. Perfect.
I returned to her room and held up her options. "Which one would you like, Mrs. R?" I asked. Instantly, her eyes jumped to the purple one. Her fingerpointed to her decision. "Purple it is." I said, sliding the cap over her head.
"Anything else I can get you, ma'am?" I asked.
She shook her head and gave me a smile as bright as her hat. "Thank you so much," she said.
It was my honor to smile back into her eyes. "You're very welcome. We'll check on you soon and make sure your pain goes down. Get some sleep?" I half-suggested, half-asked.
She nodded, resting her head on her pillow, that smile still on her lips.
I gave report, finished my charting, checked my patients and headed down the hall. I had walked a few paces past Room 4 before I turned on my heel and took a few steps back.
Mrs. R sat up in her chair, sleeping soundly, her purple cap jumping out against the clean white of her blankets. Nothing could change her diagnosis, her situation or her permanently ease her pain. But that purple cap, vibrant like Easter in the dimly lit room, reassured me that while I couldn't reach all the lost and lonely, one of them slept just a little bit warmer deep in the dark of my ward.
