Each of us, regardless of our role on the healthcare team, develops a rhythm we become comfortable with that gradually allows us to acquire a level of ease. In my seventh week of medical surgical nursing clinical, I was starting to feel that assurance. I began the day by stuffing my pockets with the essentials - a couple black pens, a pair of bandage scissors, a pen light, and enough alcohol wipes to scrub every IV hub on the unit. After hanging my stethoscope around my neck, I tiptoed out from the break room to the nurses' station, not wanting to be the one to break the peace of night with the flurry of activity of days. I scanned the patient list to select my two patients for the day. One was an 82-year-old woman recovering from a pulmonary embolism.
Broken Heart Syndrome
After checking lab results and reviewing the patient's medications, I began to read the history and physical. It began like a familiar jingle. The patient was pleasant, but presented to the ER with chest pain. After a series of tests, labs, and assessments, it was determined she had a pulmonary embolism secondary to a deep vein thrombosis. Furthermore, there was dissonance; she also experienced broken heart syndrome, believed to be the conductor of all her problems. Broken heart syndrome had never been covered in a classroom lecture, much less a textbook. I pictured a fracture between the left and right atrium of the heart, the sapium no longer serving as the bond between the two. My professor remarked, "how sad," as she pointed to the broken heart syndrome diagnosis. As I continued to read the patient's history, it all began to fall into place.
For me, broken heart syndrome meant a good cry, a bowl of ice cream (read: pint of Ben & Jerry's), and a Nicholas Sparks movie. However, this woman had enjoyed over a half-century of marriage, five kids, and a lifetime of wonderful memories. The loss of love had left this widow bed stricken. Following weeks of confinement to her house, a clot dislodged and formed the pulmonary embolism. It is said, "true love leaves you breathless," but Hallmark never designs anniversary cards featuring someone gasping and wheezing.
What Can I Do to Help?
In all my initial interactions with the patient, she was sweet, but short. Her voice professed she was fine, but her eyes echoed back that she really was not. She insisted she did not want to be a burden, but also conceded she needed some help with her activities of daily living. As I entered her room for a late morning round, I noticed her staring down at her leg, which appeared a bit swollen. Despite my assessment that the inflammation was only minimal and my explanation that it was an expected finding due to the DVT, I recognized much more was bothering her than the fluid build up in her leg. I felt as helpless as she did - how could I possibly console a woman struggling to cope with the finality of the loss of a love like no other, when I had barely experienced true love myself? There was no medication or treatment I could provide, nor words to ease the pain she felt. All I could offer her was a cup of tea.
Somehow, the eight-ounce Styrofoam cup filled with the finest generic brand of decaffeinated tea was just the elixir this patient needed. The warmth of the cup radiated from her petite hands, relaxing her whole body. All the worries, the hesitations, and apprehension dissipated with the rising steam. With each sip, she revealed more about herself, and each story conveyed brought forth a new sense of assurance. While her husband's passing seemed like a tragic conclusion to the life she had known, she discovered that perhaps he was still a part of her life, as an angel watching over her new beginning.
I Made a Difference
The patient reached for my hand as I got up from the chair, and a smile spread from cheek to cheek on her timeworn face. I realized that I had not said much while she sipped her tea - however, I did not need to. After my brief, but sincere time with her, I understood that although the job may sometimes have more cacophony than harmony, it is in the vocation that I will always be able to find the melody. While the tempo may be fast-paced and the rhythm precise, as a nurse I must recognize that sometimes more is revealed in the muteness of time. That day, I learned that being a nurse goes far beyond writing care plans, hanging IV fluids, and measuring vital signs. While it may not be elaborated in a textbook, this patient helped me to understand the most meaningful and important nursing intervention I will ever be able to perform is taking the time to listen. Medications and machines cannot replace the comfort found in a conversation over a cup of tea.