Down to Sleep

SoldierNurse22, BSN, RN

I remember one day when you were receiving blood. I went into the room with your primary nurse to double-verify. You were sitting on the couch, that same smile greeting us as we entered.

"Let's get the good stuff running, sir." I said.

"Is it good stuff?" You asked, the corner of your mouth pulling into a smile. "The last time I got blood, it was Air Force blood on my way over from Germany. I felt weaker immediately."

I laughed. "The inhumanity to man." I empathized wryly.

You smiled wider. "I think my H&H actually dropped, LT." You are clearly picking up on our medical lingo and using it well. I verify the blood, exchange a few more quips back and forth with you, and say farewell for now.

The next few months pass quickly. I am rarely assigned as your nurse. It's the way the winds of fate blow, but I know you because I know your smile. I know you because of the way my techs, particularly my corpsmen, talk about you with fondness. You're the one who keeps a loaded squirtgun under your pillow and attacks without mercy when they enter your room for 0400 vitals. You're the one who tells one of my corpsmen, who continues to fail his physical fitness tests, that you're going to help him pass when you can run again. I know the sight of the top of your head passing the nurse's station, a tirade of sarcasm trailing behind you as transport wheels you to radiology, MRI or CT, your least favorite places in the world. You return to us with stories, aptly told in that fluently cynical manner, mere words weaving together a play-by-play of the chaos downstairs. Oh, it'll be a good day if you don't have to go back tomorrow.

Chemotherapy begins. You're feeling good. It's the start of induction and you're invincible, like many I've seen before you. We push you through a few rounds of chemo, and overall, you're holding up well. Pain, aches, a few fevers. Everything we usually see. Antibiotics start. Your fevers subside. Looks like everything's even-keel here. Your optimism is waning with every ache and pain you develop, but we reassure those symptoms are normal.

It's the first day you're assigned to me and my orientee, who is familiar with you as all of us are. We come in to see you, do your assessment, give your meds, tend to your needs. You're in one of those moods--you're not up for guests. We place the sign on your door and warn off all would-be visitors: not today.

In the afternoon, you spike a fever. Shortly thereafter, we go into your room to hang an antibiotic. Your words are slurred. Your mentation is altered. Your mind is between our world and another we cannot see. Your wife looks at me and my orientee with worry in her young eyes.

I page the Oncology team immediately. I update them on your status. As I'm on the phone, my orientee returns to the desk. You just...urinated in the bed? The worry in your wife's eyes has invaded my orientee's. Something is wrong.

The team orders a fluid bolus. I argue with them. They need to assess you. Something isn't right. The "nursie hairs" on the back of my neck are standing on end. Something just isn't right.

The physicians come down the hallway, all four of them in a little herd moving in your direction. I follow on their tails. They do an assessment, talk to you and your wife. Your mentation has improved, but your temper is short. You don't want anyone in your room. The doctors take some offense once we get outside. I know you're just a modest man and embarrassed at what has happened. But that lurking sense nags at me. Why are you suddenly so aggressive? That isn't like you,either.

We continue your care and you apologize to my orientee and then, more broadly, everyone on the ward--nurses and corpsmen, that is. My orientee graciously assures you there's nothing to worry about. We all do. Life goes back to business as usual and the shift ends anticlimactically.

Two days! Who knew paradise could be so simple? There's nothing like a little break from the hospital drag. I spend my time cooking, bike riding, buying groceries, packing for home. I have a four-day pass coming up for the holiday and the plane can't take off soon enough. All I have left are these two days off and three more days of work before I'm home again.

When I return to work, I'm told almost instantly of your transfer to the ICU. Your condition is grim from what my coworkers tell me. I hear their words, their descriptions of what has happened registering logically in my mind, taking an observant seat in the part of my brain that computes the nursing and medical and physiological sides of my work. Your wife, crying comes to us, asking us to pray for you, encouraging us to come see you. You're not in good shape, but come, she asks. And we do because we know she needs us--she needs someone else--to see.

So in waves, we come. We give a quick report to our fellow nurses with a grim tell-all at the end: "...and that's about it. I'll be back soon. I'm going to see the Major."

For several days, I work on going to see you, but, just as when you were my patient, I am steadfast in my commitment to my assignment; the pain assessments, medications, and concerns of my patients come before my own desires. Days one and two of my three-day streak pass and I am unable to escape my ward long enough to make the trip. Your wife continues to migrate to our ward, to your old room, to sleep. She updates us, we reassure her that we're behind her, she goes back to you.

Finally, today, day 3, I join Ms. Lewis and 1LT Torres, who are bound for the ICU to visit. Your wife is in the hallway, talking with some of your family members. We pause a moment, talk to your wife, and then myself and Torres take a few bold steps into your room.

And then everything I heard from your wife, I see with my eyes. And now, I know. You're intubated, that smile interrupted by a life-saving tube that forces your chest to rise and fall unnaturally. You have an IJ, a femoral line,and a Hickman. The standard BP cuff, SpO2 sensor and cardiac monitor tell us about your heart, which, fatigued from some unknown antagonist, tried to stop working a few days back. The waves on the screen tell me a story about rising Troponin and the cath lab--the same story in your wife's eyes. You're unshaven, which would never have happened were you awake. You're laid out in bed, your heels buoyed by heel guards, pillows below your knees and elbows, turned off your back slightly to one side. Your skin is discolored and purple, bruised from IV failures. You're edematous throughout your body; your hands are a dusky purple.

Torres talks, her words like a radio playing indistinctly in the background. She takes your hand on the other side of the bed. I reach for your hand. You're cold; most unlike you. I watch as the ventilator forces you to breathe, and instead of seeing a grotesque tube that most families see, I see the tube that's saving your life. I gaze over the mess of wires and IV lines and thank God for their presence, because as terrifying as they are, they're the reason you're still with us.

Torres falls silent. I take the opportunity to tell you that I'm the other one here with you, that we're praying for you, that you're strong enough to come back to us. Torres adds quietly, "Everyone is praying for you." I take a breath as your ventilator pushes air into your lungs and exhale as you exhale. We linger a few moments, promise to return, and slip out of the room.

We hug your wife again, repeat our promise, and retreat to our ward.

I went home that night, finished packing for my 4-day pass and went to bed. As I fell asleep, I prayed that God would wake you up again. I prayed for your wife, for your family, for your tired, worn-down body. I prayed and thought about you and fell asleep just after midnight, your memory heavy on my mind.

Home passed in a beautiful blur of family and friends. When I returned, I was told that just the night before, you had been declared brain dead and taken off of life support.

This is the best eulogy I can write you. I could drone on about how you will be remembered, about how you will be missed, about how you were an example even in sickness to all of us who had the pleasure of knowing you. But none of this would do you justice. So I will remember you, I will miss you, and I will follow your example. When the time comes, I will be there with your wife, your family, and my fellow nurses at Arlington to lay you down to sleep for the final time. And one day, I trust that I will see you again when we all wake with the morning light.

Down to Sleep

About SoldierNurse22, BSN, RN

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