She had a past medical history list longer than my care plans, everything that could go wrong for this woman had. End stage renal disease on hemodialysis. Hypertension, hyperlipidemia, hyper-everything as I recall. And of course depression. Always depression.
I remember reading an article on the amount of depression that goes undiagnosed. It's a staggering number of people. This poor woman, cut in pieces, only her brain still working as it should. Lying in a bed. No family. No friends. Medical people were only connection left to the real world. Who was I to interfere with this process?
As I came to learn over those two days with this woman. A student was exactly what she needed. My instructor, an Irish woman with a voice that carried like she was a Greek goddess of old. Would bellow across the unit to her students, "Have you gone in the room yet... I will chase you in there if you don't go now"!!!... This woman changed my life this week and the six that followed. Here's what happened...
I started the week reading the laundry list of problems with this woman, and immediately broke into a sweat. Half of these words I couldn't even pronounce, let alone define. In those days we wrote our care plans the night before clinical, and I had worked so hard on mine. Still, I was sure I wasn't ready. How would I get her out of bed. She's non-verbal, how will we communicate?? Incentive spirometer?? Riiiiigghhtttt... I was petrified.
So I did what any well abled nursing student would do. I didn't go in the room, instead ran circles around the unit. ducked in and out of the room. Vitals already done, oh well. Assessment not done, she was sleeping. Residents reading x-rays, that looks like more fun. Then I got caught.
"Go into the room yet", she asked.
"No. She was sleeping and I didn't want to wake her. These residents were nice enough to invite me down to radiology to read xrays with them. I thought I would go. It sounds educational".
"Is this true", she asked... All the residents turned on me then. I guess they were used to the amount of anger heading my way and knew to avoid all eye contact. Traitors...
"It was... Now I'm not so sure. Should I wake her then", I asked with a voice that Mickey Mouse would envy. what happens next is still a legend at the school, it gets talked about every year I come back to teach, and all students hear about it.
"Get out.. of that chair... and get in that room... now...".. I knew Irish folks often had red hair, but I never saw a red face... I swear to this day that a rainbow appeared behind her as she focused on every syllable of each word. I was petrified and like in the old cartoons, a figure of me appeared on the wall I ran through to get in my room.
I walked in to find a woman in a dark room at 3pm, shades down, lights off. She lay there alone, silent, eyes open but unfocused. Not knowing what to do I went to the side of the bed a defined a practice that I still use to this day. See I've always been a bit funny and use sarcasm to drive points home in a good way. So I said Hi ma'am... I'm Phil and I'm scared to death that I'll do something wrong to you, so If I do, can you please not tell my instructor because I'm sure that window opens and I can't fly.
Her eyes moved. Towards me. Hmm...
So I said next, "ok, maybe we get you out of bed today. That bed looks ok, but really, lying around all day, how will you earn your keep... Maybe we'll walk the halls together... That'll show my instructor wouldn't it"
Still staring at me... Did her mouth twitch? Was I getting through??
Then it happened. See in all my preparation, I missed the letters AKA... I was about to learn a valuable lesson. I pulled the sheets down and instantly knew what AKA stood for. No legs... I knew my career was over before it started.
"Oh", I said... Pulling myself together, "I guess you and I aren't dancing tonight huh"? It was all I had... I was beaten... Then something happened...
She laughed. Loud and long. It was like music to my ears. She then said, "Son, I won't tell your instructor I don't have legs if you don't. I have a feeling getting out of this bed would do us both a world of good."
First words since she was admitted. She had been nonverbal before that, they weren't sure why but it turns out she was so depressed that she had almost given up. Until that quirky nursing student showed up to walk her around the unit. I spent the next 4 hours in there, telling stories, listening to stories, laughing with a woman who would not survive the year but had changed my life.
I now work for that instructor. We talk of my transformation often. I still use humor and sarcasm with my patients. My favorite line to them is: "You know you're sick in the hospital, your family knows your sick in the hospital, there is no need for me to come in here all glum and sad reminding you your here". Magic. I wish you all have a similar story of the "patient" that changed your life. Cherish it and cherish the gift we are given every day. I sure do.
