With news of the family’s arrival, the team went into action, assisting Mr. Nolan into a geri-chair. Linens covered the ventilator tubing and dialysis equipment, and the bed curtains were strategically placed to block the family’s view of the numerous IV pumps, tubings, monitors and equipment. I put his glasses on him, then welcomed his family into his room.
For the first time in weeks, Mr. Nolan greeted his wife and family sitting up in a chair with a smile and a twinkle in his eye. The family’s laughter and tears flowed while I carefully monitored the machines behind the curtains. The preparations for this brief visit had taken every extra minute I could eke out from his complex nursing care time. Yet the memory of the smiles that family shared will stay with me a lifetime.
Mr. Nolan passed away during my next days off. A few shifts later, I was surprised to see one of his daughters waiting at the front door of the ICU as I arrived. She said the family had directed her to come and tell me how seeing Mr. Nolan sitting up, looking like “Dad,” rather than a “hospital patient,” was a positive memory that made the ordeal of his hospitalization and death more bearable.
Now as a nursing instructor, I teach my students that every nurse must have complex technical skills, high-level knowledge and thinking abilities. Yet I urge them to aim beyond knowledge and skill and recall that while only God controls the outcome for each of their patients, they can, through the nursing care they provide, powerfully impact the process. I urge them to provide the sort of nursing care that considers the memories the patients and their families have forever.
Catherine Hoe Harwood
Just What I Needed to Hear
I have worked closely with nurses all my professional life and have been enormously enriched by their competence and expertise, as well as by the friendships and affiliations we have shared. The first nurse who made a significant difference in my life worked in the newborn nursery at Tripler Army Hospital in Hawaii, where I delivered my first baby in 1968, as a twenty-year-old, premedical student and Navy wife. My sailor-husband, Larry, had returned home a few days earlier from a six-month tour of duty in the West Pacific during the Vietnam War. Our nearest relatives resided thousands of miles away. We were overwhelmed with parenthood and totally inexperienced in infant care.
Although everything appeared to be routine after Peter’s birth, he soon developed jaundice, due to an incompatibility between his blood type and mine. The morning after his birth, the babies born to the other three women in our rooming-in unit were brought in their bassinets to remain with their mothers. When I inquired about my baby, I was informed that Peter would be kept in the nursery for observation and regular monitoring of his bilirubin level (the chemical that causes the yellowish skin discoloration of jaundice). As a military dependent, I had seen a different doctor at each prenatal visit and did not have a designated personal physician who could answer my questions and calm my fears.
Being a premedical student, I owned a Merck Manual that provided a brief synopsis of common medical diagnoses. Larry brought the book to the hospital so I could read the paragraphs about newborn jaundice. I learned that elevated levels of bilirubin could be toxic to an infant’s brain, and that a level exceeding 20 mg% potentially could cause brain damage (a medical belief at that time). Unfortunately, a little knowledge proved dangerous, as I exaggerated the gravity of Peter’s condition and was consumed with anxiety. I became obsessed with the results of each bilirubin measurement and fixated on the number 20, which was now linked in my mind with certain brain damage. To make matters worse, the visitation practices of that era did not permit me to enter the nursery or hold my baby.
For a brief hour each day, I could look through a glass window and observe Peter being cared for by capable nurses, while there was seemingly nothing I could do for my son. By the second day of life, Peter’s bilirubin level had risen to the high teens, and by day three, the level peaked at 22 mg%. I was asked to sign permission for an exchange transfusion to be performed to quickly reduce Peter’s bilirubin level to a safer range. I was frantic with worry and dread. Even if Peter survived what I surmised was a life-threatening procedure, surely he would be brain-damaged, since his bilirubin level had already exceeded the ominous number of 20.
Throughout the whole ordeal, a compassionate, matronly nurse, who took a special interest in our situation, stood out as our emotional anchor and our source of hope. As preparations for the procedure began, this nurse angel gently reassured Larry and me that Peter would be all right. She hurried to my room afterwards to be the first to report that all had gone well. I found out later that she had even baptized our son before the exchange transfusion, in an unabashed act of love.
I was briefly exhilarated when the medical crisis was over, but a nagging thought soon stifled my joy. What about the chance of brain damage?
Even though I was young and the risks were low, I had contemplated during my pregnancy the very real possibility that my baby could have a birth defect or other medical problem. I resolved that I could love him no matter what. Now I wondered whether I was a bad mother for wanting to know his prognosis.
I mustered all my courage to ask the pediatrician on rounds, “Do you think my baby could have suffered any brain damage from his high bilirubin level?”
His answer devastated me. “We won’t be able to tell for about a year.”
I couldn’t handle such uncertainty. I needed a vision of hope after spending Peter’s first four days in an emotional wringer. The doctor left my room, unaware that his answer had stunned me.
Shortly thereafter, the wonderful nurse who had offered such optimism yesterday returned to my room. Her benevolent face reflected genuine concern, and I ventured to ask my question again.
“Do you think my baby could have suffered any brain damage?”
“Absolutely not,” she shot back.
“How do you know?” I countered.
“You see, when I bang his crib, he startles and throws his arms out, and that reflex proves he is normal.”
Her unwavering reassurance was precisely what I needed to hear. I was instantly ecstatic. Bolstered by her words of encouragement, I triumphantly took my baby home and treated him like a normal child.
A few years later, during my pediatric training, I would learn that the arm-flailing response the nurse had described was known as the Moro reflex, a primitive startle reaction of newborns that is present even with minimal brain function. Yet, my nurse had mercifully cited this reflex as definitive proof that my baby would be all right, and I had believed her. I thought about the doctor’s answer to my question and realized that his ambivalence reflected his preoccupation with being right, without weighing the impact of his answer on me. Although his response was technically correct, I wondered what might have happened if I had taken Peter home with lingering doubts about his development. Would I have interacted with him differently? Could I have created a self-fulfilling prophecy?
The nurse’s answer was based on right motives, at the risk of being proven factually wrong one day. I will always be grateful to her for allowing me to embark on motherhood with unrestrained hope and optimism.
Today Peter is a highly competent and compassionate psychiatrist, and often, when I am with him, I smile and say jokingly, “Just think what you could have been if it weren’t for the brain damage.”
“Dr. Mom” Marianne Neifert
All Pain Being Equal
Pain is the deepest thing we have in our nature, and union through pain and suffering has always seemed more real and holy than any other.
Arthur Hallam
It was getting close. We all knew it.
“What did the doctor say this morning?” I quietly asked my mom, seated by Dad’s bed as he slept fitfully. It was a daily question yet, before she opened her mouth to speak, I could see by the look in her eyes that the news wasn’t good. She turned her weary face toward me and whispered so as not to disturb him.
“He’s developed pneumonia. One lung showed up compl
etely white on the X rays.” She began to cry softly. My heart sank. I still clung to the childlike hope that if I wished hard enough, it would all go away. The cancer, the drugs, the withering body, the suffering and the waiting. The agonizing waiting. I did not want to watch my father die anymore. And I did not want to watch a part of my mother die right along with him. I didn’t know how much more I could take.
I drew in a deep breath and motioned for her to join me outside of the room. She nodded and rose to leave but paused a moment. Looking into his sunken face, she softly caressed his cheek with her trembling hand. He did not stir from his drug-induced dreams.
“Let’s get some air,” I suggested as I placed my arm around her shoulders. We walked past the nurses’ station, and for a moment I marveled at the men and women I saw there. Dad’s room was just across from the large partitioned area, and I had come to recognize most of the faces over the course of the last month. Warm smiles popped up from behind the desk. That alone amazed me. Smiles. Always smiles. On a floor solely dedicated to the dying and grieving.
Mom and I went for a cup of coffee, and before long, she wanted to return to Dad’s room. She was never away long. In fact, the nurses had set up a cot for her so she could spend her nights as close to her husband as possible. I walked her back and decided to stroll the hallway yet again.
I wasn’t doing well that morning. I hurt. Yet, my own grief seemed so insignificant and unimportant compared to Dad’s and even Mom’s. I fought my tears and assured myself that I would be strong for her.
Later that evening after I had run home for some rest, I returned to the care unit. I noticed one nurse who had been there in the morning and was surprised to see her almost twelve hours later. As I approached I could overhear her discreetly talking with a coworker. I didn’t catch who they were talking about, but I understood that a patient wasn’t expected to make it through the night. I knew it wasn’t my father, yet I felt weakened by this even though death was almost a daily occurrence there.
Another life was ending.
When I walked into Dad’s room, I was happy to see him awake and talkative. Mom was dressed up, her hair was shiny and styled, and she had put on some makeup. Though her deep sorrow and exhaustion could not be masked, she looked so beautiful. Tenderly she peeled back the covers and cradled his swollen foot in one hand and gently spread lotion with the other.
Deeply moved by this display of strength, love and dedication, I listened to the chatter between them. For a brief moment they seemed to forget all they were facing. I excused myself and stepped out of the room. Once the door was closed, I leaned against the hallway wall for support. Pain racked through me in great waves, and I could not deny my own grief any longer.
I didn’t notice the nurse leave the desk and approach me. She was the same woman whom I had seen in the morning. She stood before me, and I looked into her weary face. Without a word, she wrapped her arms around me. I sobbed as she held me and all of my fear, pain and fatigue flooded forth. I grabbed onto the strength and comfort she surrounded me with.
“I . . . I’m so sorry,” I began to say.
“Don’t be. That’s what we’re here for,” she replied tenderly.
I chuckled through my sniffles. “Like, you don’t have enough with the caring of those people who are dying.”
“All pain deserves as much comfort as we can give— including yours.”
So few words, yet so much meaning. She had held me for a few moments more and when we separated, I felt so tired I could have collapsed. But that wasn’t all I felt. Something had shifted within me. The gift she gave me in those moments in the hallway gave me the courage and the strength to face my father’s death two weeks later. It got me through the funeral and the weeks that followed as we all tried to determine what life was, now that he was gone.
Most of all, it gave me the ability to acknowledge that although all pain may not be equal, it all deserves as much comfort as we can give.
Corinne Pratz
The Nurse’s Best Medicine
Nursing has been called a “rewarding profession,” so much so that it’s become something of a cliché. But more than that, nursing tests you, asking more of you than you ever thought you could give. Nurses are generally people who know who they are. We come to that knowledge through our reflection in the eyes of our patients.
It is our patients, more than our colleagues, who have made us what we are, by forcing us to rise to the occasion.
You stand by the side of a young girl named Maria, lying on a stretcher. Maria is very depressed. She doesn’t speak, sleeps very little and has to be spoon-fed. Her doctor has prescribed electroconvulsive therapy. This is Maria’s first treatment and yours, too. You don’t want to be here; they say ECT is scary. The doctor pushes a button and Maria’s body rises from the table as you hold her arm. She begins to convulse and you want to turn your head away. Do they have to treat mental illness this way?
What made me think I wanted to be a nurse?
Six weeks later, Maria’s treatments end. She’s ready for discharge. She’s eating and sleeping normally. She talks. She smiles, too, and laughs a little-girl laugh, calculated to touch the heart. She is beautiful—and well. She approaches you and takes your hand. “Thank you for helping me.” Then you think, Maybe I am in the right place after all.
The six-year-old’s head is larger than his entire body. You’ve had a hard time coping with this monster of a disease known as hydrocephalus. You want to run, hide even. Instead, you put your hand under his mammoth head and put a spoon to his mouth. Is there any point in all this? What kind of life does he have? Then, on visiting day, his mother comes. You see the love between parent and child. Then you understand. You’re glad you didn’t run.
Manny is catatonic, a huge man who looks straight ahead, ever motionless. Every day you pull and tug, trying to get him to move. During his shower, you get as wet as he does. His flat expression never changes. He seems completely oblivious. Does he even know you’re here? You can get so frustrated trying to care for a man who offers no help. Would it make any difference if you just turned and walked away?
But then comes that special day with Manny, a day you will remember the rest of your life. You are face-to-face with another man holding a table leg; a man bent on destroying you.
Out of the corner of your eye you see movement. A huge fist stops the man holding the table leg. A massive shoulder crashes into the chest of the one who might have killed you. Weeks later, when Manny is on his way out of your ward, you ask him, “Manny, on that day—why?”
A beefy hand touches your shoulder. Manny smiles. “You helped me—it was time for me to help you.” You spend the rest of the day digesting Manny’s words. Then you say to no one in particular—“I like being a nurse.”
Allan is schizophrenic and self-destructive. You spend hour after hour trying to see into his world. You can’t. It seems so hopeless. Sometimes, it gets so discouraging, you think Allan would be better off dead. But then, wonder of wonders—you connect.
His conversation becomes lucid—he’s talking sense! One of his favorite topics: “You know, Donnie, when I get out of here, I’m going to get me a little puppy.” He nearly drives you crazy with that puppy talk, he just won’t get off it—but at least he’s out of his shadow world.
Two years later, you’re walking on the hospital grounds. A car horn blows. You look up to see a shiny convertible pulling alongside, a huge dog in the back seat. “How do you like my little puppy, Donnie?” Allan laughs, “At least he was a couple of years ago!” You follow Allan’s car with your eyes as it pulls away, and you think, I almost gave up on him.
Harry is manic-depressive, a physically powerful, violent man, who spends most of his time in a seclusion room. You’re working nights, sitting at a kitchen table, eating a bowl of Rice Krispies. Harry approaches. A lump forms in your throat. He stares at your bowl of Rice Krispies. “Can I have some?” You get him a bowl, a spoon and push the cereal and milk
toward him. He scarfs down the Rice Krispies. It becomes a nightly ritual. No more seclusion, no violence. Harry will have other admissions. Your Rice Krispies are not a cure. But everyone asks, “How come Harry never gives you any trouble?” You smile. How do you explain the power of a bowl of Rice Krispies?
So now you sit, looking back at forty-five years. You’re content, fulfilled; you’ve been “rewarded.” Did you come to this by your own effort entirely? No. So, you say a thank-you: to Maria, to a hydrocephalic child, to Manny who saved your life, to Allan and his puppy, to Harry and his bowl of Rice Krispies.
They were your patients, you the nurse.
Who helped who the most?
Hard to say.
Don Haines
Always a Nurse
Some people credit their decision to become a nurse to a life-changing event. Not me. I just always knew I wanted to become a nurse. From my early years, I used my (sometimes willing, sometimes unwilling) sisters as patients. My dolls were constantly bandaged and dotted with marks from ballpoint pen “shots.”
I loved nursing school and was filled with pride the first time I put on my uniform. I even liked the cap! Graduating from nursing school ranks as one of the happiest days of my life, as does the day I opened the letter announcing I had passed State Boards. At long last, my dream had come true. I was a nurse!
After graduation I worked in a psychiatric hospital, a nursing home, a telemetry unit and doing private duty with sick children. My satisfaction and confidence in doing assessments, starting IVs, learning medications, and relating to patients and their families confirmed my career choice.
When our first child was born, I quit working outside the home. I loved being with my new baby. Then several months ago, I realized it had been almost three years since I had worked as a “real” nurse. Sure, I continued to read nursing journals and attend a nursing workshop occasionally, but the advances and changes in technology, medications and procedures were overwhelming. Could I ever find my place in nursing again?