Lost A Patient

Last week, I lost a patient for the very first time. I have been a home care nurse for one year.

I work in home care in the Bronx, New York. I had been seeing this patient for about 7 months, 2-3x/week. He had a medical history of HTN, CHF, and venous stasis ulcers. He had a personal history of a hard life, drug addiction, imprisonment, alcoholism. He had no family nearby, just some neighbors on his block and in his building who would come by and help him by doing groceries and laundry when he couldn't get out. I was seeing him to care for a progressing venous stasis ulcer.

He was pretty non-compliant with his meds at first, never went to the doctors appointments he had, and I pretty much had to beg him to follow up with the community clinic. For the first few months, he was flat-out nasty with me: mumbling things under his breath while I did my visits about me not caring about what happens to him and one time he even greeted me from his stoop, beer bottle in hand, with beligerent yelling and cursing. I always kept my cool with him, did everything I had to do, and would always reply back with: I do care for you, even if you don't think so! Truthfully, some days I dreaded to visit him because I was not sure whether he would be in a good mood or not. Four months into our working relationship, I stopped hearing negative comments and he was proudly telling me he was taking his meds, which he was.

He tried his best following up with community doctors from then on. He remained stable. But to make a long story short, I think he got lost in the system. He never had the same doctor at the community clinic so his needs were not met, despite his attempts and mine. Orders remained the same for meds and wound care. I then found a wound clinic that accepted his insurance and would provide transportation. We set him up to go. I visited him on Monday, March 1st and told him I'd be back Wednesday to follow up and jokingly said, "If you're not here, I'll know you're at the wound clinic!" He replied, "Yes, dear!" as he always did.

Wednesday came and I had to call out sick. Later that day, I reviewed my patients' cases online, and read a short note on the nurse's visit to my patient. "Pt expired". What?

Could not be true. I called the nurse who attempted to visit him and asked if he was sure. He replied, "I believe it is true. His apartment door was sealed by NYPD tape. And there were candles in front of the building. His neighbors all informed me he died on Monday. I am sorry. Get some rest and get well yourself."

For a few days, I could not stop thinking about my patient: where was he now? What did they do with his body? I kept thinking back to our visits and how we were making progress. Weren't we trying our best? Did I? Did he? When I went back to work, I drove by his building, and the candles were still lit, and the side of a cardboard box was taped above the candles with messages scribbled onto it. I could not yet get myself to stop and walk up to read the messages.

A lot of things ran through my mind the following days. It stressed me out. But by thinking it through a couple of times, I remembered I would never know everything. All the questions I had would not be answered. I realized all I am ever left with was myself. I realized that my patient had left a profound mark on me although I only knew him on the surface. I then became somewhat comforted that I knew he (eventually) valued me. I knew that this experience re-affirmed my duties as a nurse, as a person; that each patient, PERSON, deserves 100%, and that we need to at least try to give them that while they or we are around. RIP RB.