As nurses, we consider it a good day's work when nobody has yelled at us or thrown bedpans at us. When we hear, "Thank you for being my nurse; you are so kind," it borders on the near miraculous. Then again, there are those rare and truly treasured patients that come along and say, "You made a difference to me. You're a great nurse." It is those heartfelt words that make all the sleepless nights in nursing school, the patient overload, the overtime, calming the confused or belligerent patients, the condescending, berating from doctors, the tired feet and aching back worth every torturous moment.
The following describes such a situation that occurred during the summer of 2005. I share this story with you not so much to boast but to remind us, as nurses, that we do leave lasting impacts on our patients and that there are rewards in nursing that go beyond quitting time and paychecks.
Since I am a tall and rather large person, I can present a rather intimidating appearance. To ease tension, I frequently use humor as a means of warming up to patients. At the time, I was a relatively new nurse and still searching for my own personal nursing doctrine. As such, I see each patient as a fresh opportunity to try new things or confirm tried-and-true practices. I have tried to live my life by the Golden Rule and make every attempt to be the kind of nurse I would like to have if I were hospitalized. If I made my patient smile, then I feel I have accomplished my goal for the day. My experience with the following patient forever cemented my conviction that my holistic approach, though not necessarily true to any one nursing theory, is the right one for me.
I first came to know Diana* as a patient when she was admitted to our local rural hospital as a rehab patient. She was 17 year old, but, because she was mentally challenged, had the functioning capacity of a much younger person. A few weeks prior to her admission, she and her family had been involved in a MVA with a semi-truck. The pictures of their car (an older model car--the kind made when they still had metal in it!) I later had an opportunity to see, showed a barely recognizable accordion of crumpled metal. How they survived the accident only affirmed my belief in a Higher Power and guardian angels. While her parents survived with only minor lacerations and bruising, Diana suffered the brunt of injuries. She had an open book pelvic fracture with additional dislocation injuries of the pelvic girdle and bilateral femurs. In addition to these, all her lower abdominal organs had been pushed out over her pubis bone, her liver was bruised, and her pancreas was lacerated; all of which caused sever internal hemorrhaging. In addition, she had a fractured right ankle and multiple abrasions and bruising over her entire body. The paramedics who pulled her from the car had little hope of her surviving but said nothing at the time. She spent nearly 2 months of touch-and-go in the ICU of a larger hospital and had multiple surgeries. Needless to say, by the time she arrived at our facility, although grateful for having survived, she was deeply depressed at the prospect of the long months of therapy that lay ahead and the prospect of never walking again.
The first day I entered her room, I saw a battered, bruised, sweet young, lady who was obviously in a tremendous amount of pain despite her PCA pump. Moreover, Diana was also slightly mentally challenged. To add insult to injury (pardon the pun), she had an external fixator attached to her pelvis and her lower extremities in traction. I determined to make her stay with us as pleasant as possible despite the long journey ahead.
That journey began on a rocky road. The second day of Diana's hospitalization, she received news that her beloved grandmother had passed away. This news hit me rather personally as I had recently loss my own dear grandmother. I let Diana express her grief as often as she needed. Since our personal experiences often come into play as a nurse, I shared with Diana and her family ways I had learned to cope with loss. In doing so, I frequently found myself sharing the little humorous anecdotes handed down from Granny. I often had Diana laughing. Her parents were more than overjoyed at the sound of their daughter's laughter.
Diana was a time intensive patient but I never regretted the extra time I had to spend with her. The insertion areas for the fixator had been sutured closed but, due to the frequent turning and repositioning and the little extra weight she carried in the abdomen, the sutures had pulled through the skin, leaving two gaping holes in which you could see all the way to the bone. These areas had to be cleaned and packed each shift. In addition, the fixator had rubbed raw places on her abdomen making padding part of the frame necessary. The dressing changes were the times Diana most feared. They reminded her of her injuries and just how far she had to go, not to mention painful. I always made every attempt to keep the pain to a minimum. While on the PCA, I gave her Lortabs prior to the dressing change; after the PCA, Toradol was made available. However, no analgesia can take away the dread. It was during this time that I most shined and forever earned the respect and admiration of not only Diana, but her parents as well. I told jokes and funny stories to keep her distracted. When help was available, I and another nurse sang all the funny little songs we could think of, including "Rubber Duckie" from Sesame Street. We became know as "the singing nurses." (If you've seen the movie Patch Adams, you will understand this scenario.) On a few rare occasions, the entire nursing staff joined in the songs. We eventually had other patients commenting how they were impressed with all our dedication to nursing. Because of the extra touches we put on her dressing changes, Diana actually began to look forward to these times. Each night before I left for home, she would always call me back into her room to tell me how much she appreciated all the extra effort I put in to helping her.
Slowly but surely, Diana improved. The traction was the first to go. Then physical therapy began passive range of motion exercises. The bruises and abrasions slowly disappeared. The foot drop Diana developed was a minor setback, but with daily therapy soon disappeared. In an effort to help keep her positively motivated, I frequently pointed out just how far she had come. I reminded her often that "the journey of a thousand miles begins with the first step" and "one day at a time." When these cliches failed to help, I let her vent her frustrations and we explored outlets. Most of all, Diana missed the connections with home, primarily her pet cat, Whitley. Another nurse brought in a stuffed, animated cat. While it helped a little, it was no Whitley. As it turned out, the rehab program had a pet policy and Whitley soon joined our staff. We brought in tuna fish and kitty treats for him to help him feel at home during his visits. It was during these times, Diana really shined.
In time, Diana left us for a day to have her fixator removed and to have a check up by her orthopedic specialist. He was well pleased with her success and how happy she seemed to be. We received a brief note to keep up the good work. He also added that he had never seen a patient before that was so animated about the wonderful nurses who provided care, especially singing ones. When Diana returned with her fixator in hand rather than in hip, we had a little celebration for her. Now the healing and therapy could begin in earnest.
The gapping holes soon closed completely on one side and had a pencil thickness opening on the left. Diana could now sit up in bed. With the help of therapy, she was soon in a special wheel chair. The little trips around the hallways made her spirits soar. It was then that we all really could see the proverbial light at the end of the tunnel.
The day comes when all long term patients must go home. This day cay came sooner than we had all expected or planned when her insurance company informed the billing department that it would no longer pay for services. So we had to quickly put everything together and do impromptu lessons for dressings each time the opportunity presented itself. When she left, her parents were a little apprehensive about the care involved. We assured them that with the help of home health and PT, they would get by just fine. It's times like these you truly appreciate the other team players in the hospital.
We said our good-byes and sent Diana home with the help our local ambulance service. At best, we truly believed that she would be lucky to be in a regular upright wheelchair, for while she was with us, we discovered she had some type of deficiency which caused her bones to be brittle. I did my best to not let professional opinion dash her hopes of walking again. I suppose I succeeded somewhere along the way, for now I had a friend.
A few days before Thanksgiving, Diana came by to visit and show us her surprise. Her parents parked the wheelchair at one end of the hall and brought out the walker. I had to resist the urge to assist her to standing. She not only stood up alone but walked the entire length of our hallway with just the aide of a walker. I could only stare in humbled surprise and admiration at her determination. She walked up to me and reached out to me. She and I embraced for a hug and we both had alligator tears streaming down our faces. The surprises weren't over. While the two of us stood there hugging each other, the nurses at the station began to applaud. And they were crying, too. When we finally pulled apart, she said something that will stay with me forever--"I owe it all to you. You gave me the strength to go on each day. Each time the pain from physical therapy became unbearable, I thought of you singing 'Rubber Duckie' and it made me smile and put up with it. Thank you for having been my nurse; you made a difference to me." She and her family soon left and I attempted to go back to work; I wound up taking a small break to compose myself. That warm and fuzzy feeling melted all the heartache I have ever had. What she had said had left me speechless.
I thought of Diana for days after her visit and felt blessed at having had some small part in her recovery. She had gone farther than any of us had hoped. However, she had one more surprise for us.
Just a few days before Christmas, Diana and her parents came back for another visit. I was greeted with my supervisor telling me that I had a visitor who had been waiting to see me as I came to work. I had no idea of what was about to take place. I saw a small group of people standing at one end of the hall and did not recognize them at first until she turned around. There stood Diana and her parents. She had no walker, no wheelchair. The girl who wasn't supposed to ever walk again was walking to me. I was again standing there with my mouth open and the tears falling. Diana walked right up to me and gave me another big hug. We stood there for a few moments crying and thanking God for the miracle we had just witnessed. I hugged her parents and tried to dry my eyes. Diana took an envelope from her tote bag, telling me, "I just wanted to come by and show you I was walking now and to give you this special Christmas card. I wanted to let you know just how special you are to me. I couldn't have done it without you. You gave me hope to go on when I had none. On my darkest days, your smile brought me sunshine and your jokes made me laugh in spite of everything. It is you who helped me walk again." I tried desperately to reassure her that I merely brought out her own inner strength and couldn't take the credit for her healing. It was she who suffered the agony of all those long painful days, not me. And I had to give credit to God who helped her survive. While she admitted that God was influential, she made it clear that the strength came from me. "You're a special nurse with a special gift." I tried convincing her that I was merely doing my job. To which she replied, "It's more than a job to you. You put your heart into it. Besides, how many nurses do you know sing 'Rubber Duckie'?" Good point! I could only thank her for her kind words and told her she had left a lasting impression on me, too. Then I smiled and marveled at her as she walked away. It was then I realized that I was doing exactly what God had intended me to do and all doubts about my sanity for having chosen nursing vanished. I finally understood that nurses not only heal broken bodies, but also help heal broken hearts. Yes, I am a nurse and proud of it! Thanks to you, Diana, I now have the courage to look ahead and walk with pride as I go about my duties. Seems the "healing" goes both ways.
* Name of patient changed to protect identity.