Why I have the best job in the world!

I want to tell you about someone very dear to me. Everything in me wants to just tell you her name, but HIPPA won't allow me to do that. I want you to know her name because I want you to know the person that I've come to know and love for the past five years and somehow her name just fits her. I can't use her name but I will do my best to paint you a picture of the saucy yet sweet, demanding yet giving, abrasive yet compelling, exasperating yet delightful woman that I will simply refer to as R.

 

 I think I first took care of R at the hospital the very first week that I worked there. R is one of those people that has to "grow on you". And I will be the first to admit that it took me a little while to appreciate her. She can be so demanding at times, making you want to remind her that you do have other patients to take care of as well. She has mastered the art of manipulation.  The call button is never far from her hand and it is par for the course to be in her room ten times in an given hour to fluff her pillow, hand her a box of tissues, tuck the blanket around her feet "just so", and a multitude of other small things that simply "must be done". She is not interested in how many other patients are in your care or whether or not you've had a chance to eat that day. R is 78 years old. She is a petite woman with short dark hair and a gravely voice. I simply adore her. I can't explain it, I've tried. She just wormed her way into my heart five years ago and I'm helpless to resist her. Her (second) husband of 47 years "C" has made her the center of his universe. I suppose one gets used to that kind of treatment. C set the bar, the rest of us can only hope to keep up the standard.

 

R has a considerable cardiac history. She has had cardiac bypass surgery and suffers from congestive heart failure. She made the comment a few weeks ago that she has never gotten to spend an entire month at home in the past five years. She is a fixture on our unit. She'll come in with an exacerbation of her CHF and we set about getting the fluid off her and send her back home for a week or two. Every time we discharge her we know she'll be back again soon. On average, she's there about 2 weeks out of 5.  Some of the nurses on our unit don't appreciate R's unique personality. There are a few of us that love her in spite of and because of it. Those of us that have acquired the taste, love her with a fierce protectiveness that would rival a mother lion. We are not special, we are not more compassionate than our counterparts, we are not better nurses than the ones that don't  particularly care for her, what we are, I believe, are the lucky ones. We "get her". And because we get her, we have been the ones to receive the special brand of love that only R can give. The charge nurse knows who to assign R to on any given shift. It works. One night about a week and a half ago I was finishing up with R, giving her night time meds, tucking her in for the night (which always includes a goodnight hug and kiss on the cheek). I was leaving her room and had just turned off the light when she said, "I wish you could stay all night." When she said it, there was a sadness in her voice that alarmed me. So, I asked her why. With her little flair for the dramatic she said, "Oh, sometimes I get scared. I'm not going to name any names (I stifled a giggle when she said this because it's so typical of her brand of manipulation) but some of those night shift nurses just scare me". What that really meant was that not everyone has fallen under her spell and they don't cater to her like the handful of us that are helpless to resist her considerable charm! 

 

R has been in the hospital this time for about 2 weeks. She came in with the usual CHF and it's accompanying lower extremity edema and shortness of breath. She had a touch of pneumonia. We soon had the CHF under control and she has been getting IV antibiotics for her pneumonia. For about a week, however, her white count has been alarmingly high. I took care of her last Wednesday and the word leukemia was being uttered among her doctors. I felt my own blood run cold. On Friday when I got to work I learned that they'd done a bone marrow biopsy that day. R had a distant and far off look that entire night. The doctor had told her what they were looking for but I don't think it was registering with her just how serious it could be. I played it by ear and let her set the tone of our conversations that night. We've talked about dying before. With her heart history she has always known that her heart could give out on her at any time. She has always used her special brand of humor  to cope with that possibility. Always, though, when she's discussed it with me her anguish concerning dying is not for herself. She is worried about "C". Many times over the years she's made the comment that she hoped she would outlive C because her pension is better than his and she doesn't know how he would be able to live on his pension without hers. I think her way to handle the news that was so fresh was to not dwell on it that night. I was happy to follow her lead. I wanted to enjoy our time together that night like we always had, with playful banter and her scorching sarcasm. I will be forever grateful for that night with her.

 

I went to work yesterday at 3 pm. When I got there they were begging someone to stay and work a double shift because one of the night shift nurses had a death in the family and had called off. I swore I'd never do another double shift, especially one including an overnight shift. Before I even knew what I was saying, I had agreed to do it. I work on a cardiac telemetry unit and all of our patients are on a heart monitor. We have a monitor watcher who sits in front of a bank of computer monitors and watches heart rhythms for the entire shift. Our monitor watcher had called in sick. They said that since I was doing a 16 hour shift that I should be the monitor watcher for the first 8 hours and save my feet for the last 8 hours. Sounded like a plan to me! I went in to tell R that I was not going to be taking care of her for the first 8 hours but that I would be watching her heartbeat all evening and that I would be answering her call light in the station  and that if she needed anything to let me know. She pretended to pout and  act like I had deserted her. Typical R!!!!

 

At 11:00 pm I took on a patient load and started with R. I had learned by this time that she did, indeed, have leukemia. From what I could read in the chart and learn from others, R had not been given the news...yet. Part of me wanted to bundle her up and take her home with me, forever protecting her from the news that she would soon need to hear. Instead, I kept up my side of our fun bedtime ritual.  I took her vitals, did my assessment,I fluffed her pillows, I rubbed her back with lotion. I got her a snack. I listened to her grumble about all the things she likes to grumble about. I gave her her sleeping pill and kissed her goodnight. We didn't discuss tests, or sickness, or dying. As I turned out the light and said goodnight she said something to me that she's never said before. She said, "Melissa, honey, I love you." in that gravely voice that I so love. I've told her many times that I love her,but she's never said it back to me. It wasn't something that I needed to hear, I knew that she loved me. But I never expected to hear it and when I did, because of the circumstances surrounding it, my heart broke in a million pieces. I managed to say "I know, R, I know" as I closed the door. It was a long night.

 

Around 6:00 this morning R was awake. I walked into her room to hear her proclaim that she needed me to help her get a bath and get ready before her favorite doctor made rounds. He "gets her" too. They have such a fun cat and mouse game with one another. She makes fun of him and gives him a hard time and he gives it right back to her. It's fun to watch them together. I helped her get a bath and changed the linens on her bed. I handed her her lipstick and watched her put it on while she entertained me with her quick wit and sarcasm. I left her sitting on the side of her bed with a big smile on her face anticipating the arrival of her favorite doctor. At 6:30 I noticed that her hematologist/oncologist (this is not her favorite doctor)  was in the nurses' station. I was keeping my eye on him because I wanted to be on hand if he went to see R. I was called to the room of another patient and when I came out of that room and was walking by R's room I saw her lying on her bed crying. When I went into her room she  said, "That doctor was just in here and he told me I've only got 3 to 6 months to live. He told me I've got the worst kind of leukemia that you can have and that my heart isn't strong enough to have chemotherapy." I was speechless. How in the world could anyone be so callous as to go into the room of a person that they've seen 2 times in their life and dump that kind of news on someone at that hour of the morning and then just leave them there alone!! There were nurses all over the place! He could have asked for her nurse to go with him. How could he not know that when someone hears news that dire that they need someone there to hold their hand and care about them. I was furious with him. He walked in, dumped his bad news and left her there crying her eyes out. I just sat on her bed holding her and listened to her cry. There were no words that would comfort. I was so frustrated by my lack of words. Of course, her immediate concern was C. "How will C ever make it without me? C won't eat when I'm gone, C won't take care of himself when I'm gone, what in the world will happen to C when I die?" She cried and she cried. All I could do was hold her. Then she grabbed her chest. I asked her if she was having chest pain and she shook her head yes. I ran for the nitroglycerin. One nitro took the pain away and then the man that she'd put on her lipstick for entered her room. I assume that Dr. S had seen her hematologist/oncologist in the nurses' station and had learned that he'd broken the news to her. She loves Dr. S. I've always liked him, but he became a hero to me this morning. He held her hand and told her that he knew she was scared and that he was so sorry that she had gotten such bad news. He turned to me and gave me a verbal order to give her some Valium. I wanted to kiss him. When I returned with the Valium, he was sitting on her bed, holding her hand and reassuring her. Her sobbing had stopped, her chest pain was gone and I was witness to  the personification of compassion.

 

After he left, I sat on her bed with her and just let her talk. It's amazing the way the mind protects one from too much grief at once. She squeezed my hand as she talked once more about Charles and how he would take this news.  The hema./onc. was calling him as we spoke with the news (I shudder to think of him hearing that news over the phone with no one there to comfort him). R stopped right in the middle of what she was saying and reached up and touched my small silver hoop earring. "I really like these little earrings you wear. I have some earrings similar to those. I have a little green pin, and a little pearl necklace, and a diamond ring." She continued with small talk about nothing in particular. It was like a little oasis of normalcy in a sea of pain and grief. Evidently C had called their son to come pick him up after he'd talked to the doctor because her son called and said they'd be there in an hour. She hung up the phone and told me that the doctor had said she'd probably go home tomorrow. She said she'd be gone before I came back to work. Then she told me, "You look like you've been ridden hard and put up wet, go home and get some sleep!" I was being dismissed. Her breakdown was over. She was back in charge and I was back to doing her bidding. She kissed my goodbye and sent me on my way, saying only, "I've got your phone number, I'll be calling you."

 

I'm sure she'll be back in the hospital with us again very soon. We will play it out by her rules. She will be the queen on her throne and we will be her ladies in waiting. I will cherish every moment of it.

I've spent a lot of time in a bubble bath lately. I've been accused of hiding from the world in the bathtub. OK, I stand accused. I'll even admit that it's true. I could find worse places to hide from the world. I was born in July. I am a Cancer; a water sign. Maybe that has something to do with it. Water soothes me. It's the place I've always gone when I needed to be alone. As soon as the bubbles and the warm water surround me, I feel able to cope with most anything. As I said, I've spent a lot of time in a bubble bath lately.

For a few weeks I've been terribly worried about my daughter, Sarah Kate. A few weeks ago she began having joint pain. It started in her shoulders and every morning when she awoke the pain and stiffness had moved to another place in her body. Sarah is a very young woman. Only 22 years old and a new wife. She is one of the brightest lights in my world. She is kind and loving and compassionate. She has always felt like a special gift that I was given, undeserved. I remember the moment they placed her in my arms and the feeling I had. She was my third child in three years and four days, not planned, but very wanted. They placed that pink little bundle in my arms and I remember having this overwhelming feeling of a sense of her. A knowing of what she was going to be. I wasn't able to adequately articulate it on that day and I still can't, really, not the way I want to. But what I said out loud at that moment, and have felt in my heart ever since that morning was, "This child was born to be my friend." There is an easyness we have with one another, an unspoken understanding that I cherish. I am blessed beyond measure to have her call me Mom. So, when she began feeling bad several weeks ago I became very scared. I am a nurse. Sarah Kate is a nurse. We see all of the things that can go wrong with the human body. In fact, when you work in a hospital, taking care of the sick, you begin to marvel that anyone is well. It certainly teaches one to count their blessings. She would mention to me how she was feeling. Sarah is not one to complain of aches and pains. When she did, I was alarmed. We played this little game with each other. We were both scared. We both had a million diseases running through our minds, knew what the possibilities could be. But we kept our thoughts to ourselves. She not wanting to worry me, (ha!) and I not wanting to alarm her. We pretended that it was nothing. We played it down. Finally, after two weeks of worsening symptoms she called me when she woke up on a Monday morning. She was miserable, near tears. We immediately made an appointment with her doctor and I took her there that day. The doctor is one that we see on a regular basis at the hospital. She knows us. She began her exam and was asking all the questions that I knew that Sarah and I had not wanted to acknowledge needed answering. The blood work she was ordering made my heart freeze with fear. She had all the signs of Rheumatoid Arthritis and systemic Lupus. I know a lot of people live with this condition every day. But this was MY daughter. Young and vibrant. A new wife looking forward to being a mother in a couple of years. I went with her to the lab and watched as they drew vial after vial of blood from her. We were told it would be at least two days before there would be any results back. It was Monday. The week loomed long in front of us. Wednesday came, no results. Thursday, no results. Friday, no results. There should be a law against putting people through that kind of agony. On Monday, she called the office and demanded some results. They would fax her a release form and she was to sign it and send it back. Then they would fax her lab results. She came to my house to wait by the fax machine. We made small talk. I silently started making deals with God. She is so young and has so much ahead of her. Please God, don't let her be sick. Give it to me. I'll take it, but please, please, please, let her be healthy to have babies and be able to take care of those babies. The fax machine rang, the release was signed and sent back and we sat watching the fax machine in anticipation of lab results. Finally, after an agonizingly long time, it rang and her verdict began its slow extrusion from the machine. Sed Rate was normal....I released the breath that I had been holding. RA factor within normal limits...another breath. RBC's within normal limits....another breath. Lab after lab within normal limits. Then we got to the EBV. Positive. Ok, this could mean a lot of things. The doctor had made a note on the results that she still wanted her to see the Rheumatologist. Appointment made for this coming Thursday. We celebrated. We cried, finally.

I hope we haven't celebrated too soon. Although I feel more optimistic after seeing her labs, I still cannot completely relax. Her symptoms have lessened a little, but are still there. If you're reading this and are one who prays, could you please say a little prayer for my beautiful daughter with the sweet spirit? I will be forever grateful.