On that Monday morning, I walked onto Public Medicine, proud of myself as always in my white bib and apron over a blue under-dress, with starched collar and cuffs, distinctive hospital cap, white nylons, and white Cuban-heeled shoes. After a brief orientation to the unit, we were assigned our patients. Mrs. Z was 71, with carcinoma of the lungs; she had had a lobectomy but the cancer had returned along with a nasty bronchial infection.
When I went in to do her a.m. care, she was smoking. With no oxygen present in her 4-bedroom, this was commonly allowed in those days, but I was horrified to see her doing it given her diagnosis. I did health teaching about smoking and cancer (read: lecture) but Mrs. Z. continued to puff defiantly, ignoring me.
Our next encounter was her a.m. med pass, and these she refused. Another lecture about the need for taking prescribed medications and the war was on. I was not able to sign off my meds as "given"!
This continued all day, with Mrs. Z. refusing every med and treatment, smoking all the while. I was used to pediatric patients doing as they were told, and this Adult Patient was not listening to reason.
The next day, I finally went to the head nurse with my indignation. To my surprise, she said quietly, "Don't push her too much."
I backed off with my lectures, but for the rest of the week continued to offer Mrs. Z. her medications, and could at least look disapprovingly at her ashtray full of butts. When I brought her meal trays in, she would yell at me, " You go way! You make nervous me-you go!"
On the Friday she was discharged, and as was the custom, I wheeled her to the lobby to await her son's arrival. It was a raw February day and the lobby was full of puddles of melting snow and folks awaiting pick-up. Suddenly Mrs. Z.' s usually grim face lit up and she waved at a car under the portico. I prepared to wheel her forward to the exit door.
Suddenly she opened her purse, took out a handful of change and flung it on the floor, yelling at me, " This is you TIP! You get it!" She got up out of her wheelchair, made for the door and let herself out into the waiting arms of her son.
I had to get down on my knees and crawl in the slush among the legs of the public, picking up so that no one would slip on them in the wet, a total of 17 pennies. As people stared down at me, watching my humiliation, my seething anger slowly transformed into a new awareness. My immaculate apron dirty and soaked, my cap askew, my knees black, and my pride crushed, I awkwardly got to my feet with those wet pennies in my hand and a tip more precious and lasting than money.
I failed you, Mrs. Z., but you gave me a gift that lasted over my forty years of nursing.
Anne, BN RN CPMHN©
Psychiatry
