We all have patients that have an impact on us. Usually, we've been involved with them for several shifts or over longer periods of time in other settings. This one made his lasting impact in a few hours.
NursesAnnouncementsArchiveArticle
He had just turned 18 when he came into the ER with chest and shoulder pain. I walked into his room and introduced myself. He was polite and soft-spoken. I asked him about his pain and the cough that accompanied it. He stated it was an 8/10 and braced himself as he coughed. When I asked him if anyone had been sick at home, he said no. Then, as I asked him more about medical history, he says, very matter of factly "Well, I have osteosarcoma in my lungs."
"Oh.....and when was your last treatment?" Nothing on the triage note mentioned any of this, and he was listed as not being on any medications. I imagine it wasn't brought up. I didn't want to charge into this situation like a rhino on rollerskates so my mind scrambled on how to continue the conversation.
"They stopped treatment about a year ago. There's nothing they can do, ma'am."
"Oh....", I said, brilliantly, as this sweet teenager just told me he was dying as casually as if he was telling me the time.
I asked him a little bit more. He had been on Dilaudid prn at home but tried not to take it too often and it had been a few weeks since his prescription ran out. He had been hoping he wouldn't need it anymore as it made him sleepy. I finished my assessment and went out to chart and get his info in so I could get meds for him. An order for Ibuprofen popped up. I found the intern and asked if we could start with something a little higher up the chain. She said, "We'll try this first." I felt like an idiot offering this kid 400mg of Motrin for his cancer-riddled body. I started an IV and drew some labs too. "That wasn't bad," he exclaimed, "It's been a while since I've had to have one of those", referring to the IV.
I went in half an hour later to check on him. He was curled up in a ball on the stretcher, his eyes closed and his long limbs tucked close to his body. His mom had fallen asleep in the visitor chair with her head on the counter.
"Nurse, how long does it usually take to work?"
I went out to speak to the intern again. She ordered 2mg of Morphine. Ok a step up. I went back to him and gave him the morphine. I checked on him shortly after and he smiled and said he did feel better. He wasn't coughing as much so I'm sure that helped alleviate some pain at least temporarily. He thanked me politely and closed his eyes again.
The CT showed mets to his spine including his shoulder where he had been having pain. I saw the doc go in and come out. He was discharged with a prescription for Dilaudid. I went in to remove his IV. It was almost 0500. I told him to go home and get some sleep.
"Oh no, I can't sleep. I have a test today. And I have a dentist appointment later."
"A test? What is your test for?"
"I'm taking some college classes," he beamed.
"Well, good luck on your test. I bet you can reschedule that dentist appointment though. It was really nice meeting you."
"It was nice to meet you too. Thank you for all your help." I didn't notice his limp until he walked out of the ER, waving at us all.
The lump in my throat has remained. This kid, this young man, was told he was going to die but his instinct was to still take care of himself, to still improve himself. College. Even the dentist. You can bet I'm not going to worry about seeing my dentist if I've got months to live. I am honestly not sure that my first thought would be to start going to college if I was told I was dying. I might be tempted to sit around and feel sorry for myself. To think of all the things I would be missing. But I also had immense respect for him. It might have been his dream to go to college and he was living his life even as he was dying, his body betraying his youth at a time when he should have been able to embark on a new part of his life.
I'm sure he suspected his symptoms were related to his diagnosis. I'm sure it was on his mind even as he went to his class after a night in the ER. But it was never even an option to skip his test or even miss a dentist appointment. I never got the impression he used his diagnosis to make excuses. I was impressed with him as I interacted with him. Impressed by his maturity and coping. He impacted me more than a lot of adults ever have. But then he stunned me into a humble silence with those last sentences to me.
What would you imagine doing with the knowledge that you were living your last few months? We pose this question a lot. But how do any of us know how we would react? We can speculate. Would you stop everything and be with family? Would you get that urge of motivation to do something you've always wanted to do? Would you cherish the mundane like going to the grocery store? I honestly don't know what I would do but this young man made me totally rethink what is possible.
