Saturday, October 4, 2008

Dying

My patient, Miss Smith (not her real name), is sleeping once again, as she has been most of the day. For the third time, she forgot where she was and what day or year it is. For breakfast I had to feed her slowly, bite by bite, and she was very proud of how much she ate - the most expressive she was all day. "Will you tell my daughter how good I did?" she croaked hoarsely. After she ate, I gave her a bath, careful of her paper-like skin, and noticed just how frail she was under all her blankets. Her thighs were only a little larger than my upper arms, and she was so dehydrated that her skin was dry and flaking over most of her body. Prior to today, I was nervous about bathing patients and giving them "complete care," but this woman was child-like in her confusion and for some reason it wasn't awkward - it just seemed like something that needed to be done - the care she deserved.

All day long I wished for a smile from her, something to let me know that she understands I'm here to help her. Occasionally when she opens her eyes I see a recognition in her face, but her cloudy eyes blink and its gone. I checked on her nearly every twenty minutes on my 12 hour shift - one, because she was my primary patient for the day, and two, because no one else on the floor seemed to care.

An hour after she ate, I found her sleeping once again, covered in yellow vomit full of all the food I had so carefully fed her and she had so painstakingly eaten. I made sure she was not any more confused or unconscious, and then internally freaked out. I found the charge nurse and she kindly helped me clean her up and change the linens. Miss Smith was still confused and disoriented, but luckily no worse than before, and there were no signs she aspirated the vomit into her lungs. I was sorely disappointed that she got sick - especially because she had just taken her pills for the day and was malnourished enough already. I gave her another bath, but she was bewildered and only asked "Can I go back to sleep now?" in just about the saddest way possible, like it was the only thing she wanted.

Later in the day her IV became infiltrated, and I berated myself for not noticing it sooner. Her painfully thin arm had a swelled lump the size of a grapefruit near hear inner elbow, and in a way to make it up to her I continued heating a wet washcloth to help it go down, checking on her every few minutes. At lunchtime, they brought her greasy ground beef and noodles and green beans, and I tried to pick them out for her. She refused them and turned her head after two bites, and I was kind of glad - the sound of her grinding dentures made me nauseous. It sounded like dying, like a desperate attempt to make old jaws process forced food when the body just wants to give up.

She left me thinking about death all day, and now still. Not so much death itself, but this act of dying so slowly and with such little dignity. This wonderful 97 year old woman left me wondering what she was like when she was younger. I wished I could talk to her, and kept willing her medicine to start working so she'd really wake up. Regardless of the effectiveness of the medicine, her Alzheimer's would've undoubtedly prevented us from having a meaningful conversation. I wondered what growing up as a young black woman in the early part of the last century was like for her, and what effect living through the wars and Great Depression had, and whether some mistreated part of her from long ago made her frightened of me. Mostly, I wondered what I would do if I went into her room and she wasn't breathing. I asked my instructor at the end of the day, and she was chipper and made a joke. The other students in my clinical made a joke about a student giving CPR chest compressions to a patient in the ER last week, how maybe it was him that killed her. I was the only one who didn't laugh. I wonder if it's because I'm an atheist, that maybe I have a different outlook on death and dying, because it's so final - there is nothing else after. Or maybe I'm the only one that hasn't turned myself off and become numb to caring for a dying human being. All I know is that I don't want to become numb.

3 comments:

Makarios said...

Hmm, I've been in the hospital a lot over my life and I've never met even one nurse or doctor who seemed numb to my illness or pain.

I don't doubt that I may have been the object of "black humour" in the staff room from time to time. However, because I've also worked in an intensely emotional job my guess is that most of what you're hearing from the other students is just one of the ways we deal with uncomfortable feelings.

Regardless of all that, I wish you all the best in your career choice and that you may remain a caring person. God bless.

jb6573 said...

this is an amazing blog. im also an atheist nursing student. i found this blog while googling decerebrate/decorticate to see what they looked like because my idiot clinical instructor had no idea. i really enjoy reading your blogs, they are very relatable and emotional, keep up the good work and good luck. its times for me to retur to the wonderful amazing biliary system.

parenting noobs said...

I've often wondered about the bathing thing... but, I guess if you look at the patient as a helpless child-like being then it's no longer about being naked or touching another adult.

Glad you are enjoying your chosen profession and that you still have heart. I'm sure working around the dying would get difficult.

Also, thanks for proving that a god isn't the reason people do good or care for another... :)