The Fifteen

SoldierNurse22, BSN, RN

I didn't ask to be an oncology nurse. I had no real interest in oncology at all, but a friend of mine who is a leukemia survivor was assigned to go initially, and when he requested a reassignment, I was sent in his stead. My experiences on my ward would soon prove unparalleled.

The first day I worked on Ward 71 was sunny and bright. We were on the top floor and looking out the windows at the ground below was like looking out of a castle. I remember listening to report, receiving my assignment and my preceptor, and thinking to myself, this doesn't seem so bad. I was well aware that the mortality rate on the ward would likely be higher than usual, but my reasoning was that everyone was going to die at some point. I had seen patients die on other wards. Why should oncology be so different?

My first patient was actively receiving chemotherapy. Being that I wasn't chemo-certified, I remember looking for my preceptor when the alarm on the IV pump started beeping. She dealt with the issue and I stood behind her, watched her gown and glove before pulling the air out of the tubing, and with it, a syringe full of chemotherapy.

A few weeks later, I was given a patient who had lost her hair, her strength and near everything but the will to live. She was the first patient I ever cared for who looked like a cancer patient. Perhaps it's because she was female and her alopecia was more striking. It's interesting what we clinicians will tell our patients who are dealing with hair loss. She told me once that a few well-intentioned female nurses had told her, "Don't worry about it.It's just hair." Her reply was cutting and honest: "Really? Then why don't you shave your head?"

As the weeks passed by, I began to notice a strange phenomenon when we were in report. Occasionally, we'd get a new admission and as soon as the reporting nurse stated the patient's name, the room would resound in moans and groans from my coworkers. They'd repeat the patient's name, passing it around the room to each other like a lost item rediscovered. But it wasn't a vocalization of exhaustion that one hears when it's announced that a frequent flier has returned. I slowly began to realize that when the room groaned like that, it was because every nurse in the room knew that patient, knew their families and was calculating how long it would be until that patient saw their last stay on our ward. And I didn't know it at the time, but it wouldn't be long until I joined that chorus.

Just as the sun set on our time at Georgia Avenue, I found myself caring for a high-ranking officer who was dying of several types of cancer. GVHD had ravaged his formerly military-toned body. He was unable to move or speak, but he was one of my favorite patients. I spent my days hanging his IVPB medications, making sure he was clean, and helping to reposition him with my coworkers. He never complained, always smiled and tried to thank us as best he could with a mouth he could no longer control. I remember one dark night as I changed his IV meds, he sang along with "Roll Out the Barrel" while black and white figures sang on the classic movies channel. There's nothing like the moment you realize that the body in the bed is a person who used to live and move and enjoy life, much as you do.

The merger with Bethesda happened in late August. Everyone, including my patient, transferred to the old Naval hospital. On my new ward, I found new coworkers, new patients and new challenges. But the greatest challenge was yet to come as my patient, exhausted from GVHD, slipped away one autumn night.

About a month later, a longtime patient of Bethesda, well-loved by the Navy nurses, died while under my care. She was on comfort care, her pain and desperate respirations soothed away by a morphine drip. We all knew she was actively dying, but no one predicted that a few short hours after transferring to our ward that she'd slip away. I had very little to do with her assessment after she died as the Navy nurses stepped in immediately to bid farewell to an old friend in the only way that we nurses can. Together, we bathed her, showed her to her family one last time, and escorted her to the morgue. I remember being struck at how lifelike she felt an hour after her death. Were it not for the lack of movement,the complete absence of respiratory effort and the stillness in her wrist whenI felt for a pulse, I would've never thought her dead.

Winter roared into our ward like a nightmare. Longtime patients of both the Army and Navy facilities were admitted in increasingly worse condition. In early December, the deaths of two beloved patients rocked the ward just in time for Christmas. In January, two more passed at the end of the month, including the woman I had cared for on Georgia Avenue who had taught me so much about how oncology patients are different from other med-surg patients.

In February, I found myself frequently assigned to a young woman battling GVHD.Together, we braved my 12 hour shifts between IV pushes of morphine, zofran and conversation about anything and everything. We discussed food, politics, cats,her husband, my lack of husband, and whatever else came to mind. She was witty and observant and wise beyond her 30-some years. One day, the news on her TV reported that a handful of customers who had placed orders for their significant others for Valentine's Day were upset because their loved ones hadn't received the orders on time. A young man being interviewed said somewhat smugly, "Yeah, it's pretty devastating to order flowers for someone and have them come a day late. I mean, she was just standing there, waiting, and nothing came." My patient shook her head and smiled slightly. "You know what love is? It's your husband helping you back and forth to the toilet every couple of hours for two months.That's love."

By March, she was discharged and we were on to other patients. No one was ready when our clinical nurse specialist told us the news: my patient from February had died 5 days after being discharged from our ward.

April continued in similar fashion, only the mortality rate had increased significantly. I admitted a patient in late March who passed recently. When I first met him, he told me I looked like someone. Our CNS would encourage me to step to the front of the crowd in mid-April when we celebrated his birthday."He likes you. You remind him of his wife."

Another patient whom I cared for over the weekend passed away when I returned to work a few days later. I listened to his apical pulse for a minute, all the while staring at his sleeping wife. There is nothing in the world, much less in nursing school, that can prepare you for the day you must wake up a spouse and tell them they are a widow.

We had a total of six patients die in April. Six patients that we all knew well. Some died inpatient. Some died at home. Some died on our ward and some died in the ICU, but no matter where they died, their passing resounded on our ward. All in all, fifteen people I knew as both patients and human beings, who were unique and beautiful and entirely too young, passed away from cancer in my first year.

I know now what I didn't know a year ago. The reason oncology patients are different from other patients is because they die from a disease that their own cells created. Sure, many people die from genetic disorders or pass away from abnormalities at the cellular level, but cancer is devastating because it isn'ta virus, bacteria or some sort of external pathology that's out to get you.It's your own body invading itself. It's the beautiful gift of cell division,the very process that gives us life, gone horribly wrong.

For a year, I have worked on a ward where medicine frequently fails and death comes far too young and far too often. I have learned a vast many things over the past year about nursing, about what it is to be human, and about myself. But by and large, the most important thing I've learned is that it acceptable and right for me as a nurse to grieve the loss of my patients.

I remembering learning in nursing school that it is important to keep myself emotionally distanced from my patients lest I burn out. I was told emphatically that allowing myself to become emotionally attached to my patients was not only bad for me emotionally, but it was unprofessional and set a bad example. But I have discovered that it is just that distanced, uninvolved approach that will send me running from nursing the fastest.

There is, to be sure, a certain amount of professionalism to be maintained when dealing with patients, but that doesn't mean that professionals do not mourn the loss of their patients. Because patients aren't simply nameless, family-less,transient beings that we nurses give our time, our energy and our lives to caring for. They're people, too, and to do anything less than mourn them when their time comes is to dishonor the memory of a fellow human being. It is my sincere hope that others in the nursing profession will honor this sentiment and allow those of us who deal with death on a daily basis the right to grieve,for it is impossible to work sun up to sun down with other human beings and not find yourself becoming attached to them.

So,with the end of my first year as a newly employed RN only a week away, I push on to a new year, to new patients, to new struggles. May God grant me the strength to care, the fortitude to act with knowledge, dignity and grace, and the beautiful memory of the fifteen who will forever guide my practice, my compassion and my hope.

The Fifteen

About SoldierNurse22, BSN, RN

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