Monday, October 27, 2008

Grumpy? or Misunderstood?

She had loud, insistent voice; despite her low oxygen levels and labored breathing. "You will not stick me again, I won't have it!!" Her voice grew shriller as she restated the phrase.
I drew a long, deep breath and sent a quick prayer for patience. I replied sweetly "OK, I have personal policy of only sticking people twice and if I don't get the IV after that, I find someone else to do it." I refrained from adding onto the end of it "But, I'm the person they come find for their hard IV sticks"; although I really wanted to say it.
As I was cleaning up the large amount of trash I had generated, I took a moment to ask her kindly; "Is there anything else I can do or get for you while I'm in here?". I find this phrase often helps prevent repeated trips to the same room for trivial things. She glanced up at me and for the first time I noticed how baby blue her eyes were and how well they went with her wavy light brown hair. I inwardly kicked myself for not even noticing the PATIENT before. Oh, I knew what brought her in; I knew her vital signs, I even knew her lung sounds better than I knew her face.
Now, when I looked at her; I could see the frustration and the exhaustion etched across her face. She had many, many chronic lung problems out of no fault of her own. She hadn't smoked, had taken reasonable care of herself and yet, here she was again with her 5th ER visit in 4 months. She didn't come in until she was really, really sick. In fact, last time she ended up intubated for awhile. This time, she finally called 911 when she no longer had enough breath to tell the dispatcher where she lived. Her neighbor did that for her. She had improved and stabilized quickly with some albuterol, oxygen, and steroids.
She started crying, small tears rolling down her cheeks etched with wrinkles from years of living. "I have been using my home nebulizer 5 or 6 times a day, plus all my medications on time, plus my inhaler; and I still don't get any better!!" "I have a little granddaughter, she's 2, and a brand new grandson; and all I want is to grow old normally and be able to play with them! I can't even walk into their house right now, much less get down on the floor and play with them."
She had been demanding from the moment she could talk, "Get me another blanket", "Don't keep on sticking me", "I'm not a pincushion", "I hate that heart monitor", "Please fix the swelling in my feet", "Adjust the bed for me", "I hate that person, why does she keep calling my phone?" and on and on. Frankly, I was extremely busy, and my co-worker was too (a new RN just off orientation), her patient kept having runs of v-tach and I was needed elsewhere. But, I hadn't taken the time to truly see the PERSON lying in front of me.
I slowly took off my gloves and straightened the bed for her. I squatted beside the bed to retrieve things from the floor (don't ever kneel on ER floors, that's too gross to think about). As I did so, I looked into her eyes and truly listened to her.
She didn't talk for long, but just long enough to let me hear the cry of her heart; a heart saddled and held down by years of chronic illness. "I know I won't be perfect, but I want to stay at my good, and not keep getting bad and coming in here", tears kept rolling down her cheeks. It didn't take long and the tears stopped, and she looked up. "Thanks for staying and listening, nobody ever does, they are all too busy" she said, dabbing her eyes with a Kleenex.
She asked for another blanket, the bed to be adjusted, the lights dimmed, and some ice chips. I found all those things quickly for her, and got another nurse to come try the IV. He is a massive fellow with long, curly brown hair. He walked in and before I could have opened my supplies, he already had an IV in. It was small, but it worked. He smiled at her, said a few kind words, and walked out.
As I adjusted the bed for her, she spoke up again; "thanks for seeing ME, most people only try to fix me without seeing ME under here."
I was smitten, I had done the exact same thing. I had seen her illness, tried to fix it; but had not noticed her under there. Had not noticed that her demands were really a way to try to get attention onto her and off the illness. Had not noticed the very real human soul struggling with being sick again. Had not seen her eyes pleading for some love and attention for HER, not her illness.
Funny thing was, after I took the time to listen to her; she was a new patient. She didn't once call out, didn't ring her light; did just what we asked. Her soul's request for someone to see her had been fulfilled, and she was satisfied. She kept thanking us for seeing her underneath the layers of illness.

3 comments:

Indian Medic said...

Its true how we often we only think of the case or the patient rather the person or the human. the eventually turn into bed numbers, blood pressure or blood sugar values and what not...

welcome to med blogging...

Indian Medic said...

Its true how we often we only think of the case or the patient rather the person or the human. the eventually turn into bed numbers, blood pressure or blood sugar values and what not...

welcome to med blogging...

AlisonH said...

Thank you.