On Being Human

 

And Now I Lay Me Down

Posted on January 3, 2014 by Daniel H McCarty

She was 38 years old.  I’ll call her Sandra.  She went to her Primary care Doctor complaining  of Stomach Discomfort and frank blood in stool.  He sent her straight to the hospital for a CT of the Abdomen and a KUB.  Standard tests to rule out tumors, growths….any monsters present in the abdominal cavity.  They did not.

Her daughter was 18 months old.  I’ll call her Emma.  Sandra lived for 16 days after her diagnosis.  Inoperable cancer with extensive Mets, no Chemo, no Radiation….too late.  For two weeks I was her night nurse, an assignment that I would lobby for.

She never stopped smiling.

She did her hair  daily and her makeup was always fresh.

She wore tasteful nightgowns instead of hospital fare.

She memorized every employees name and thanked each for the most mundane of tasks.

She kept a movie camera on a tripod at the foot of her bed  and had stacks of notebooks that she jotted down the events of her life, stories of a family that came before her and silly little jokes.

They were for Emma.

I would go to her room and adjust the zoom of her camera and she would hold out her little remote and it was showtime.  Her face would fill the viewfinder and I swear a John Williams movie score would come out of nowhere.  I would stand at the doorway observing as her  hands fluttered first to her lips and then her finger to her chin as she pretended to ponder a point.  I started backing away but with the 6 others behind me it was a little crowded, and 2 of those were other patients.

About the 10th day she was there I started to notice gray circles under her eyes.

“Dan, what is it?  Hand me a mirror please.”

It was the first time I saw her frown.

“Oh dear.”  softly, but I was sure that was what I heard.

I walked to the nurses station and told Wendy and Tammy.  Tracy was listening in and before I finished my statement she had her I-Phone out and talking to her friend at a local salon.

Two hours later Tony Tone flounces in with two-tone hair and a cosmetic case.

“Wheres the Princess?”

He was marvelous.

It was the second best show we had been treated to that week.  And Sandra was transformed from a Princess to a Queen and until that final Thursday Tony and his Hairdresser friend showed up nightly as soon as their shift ended shuffling family members from side to side with little hip bumps and“Shoo-Shoos”.

And then Wednesday Night.  I had been stuck with the Charge position.  I slipped into Sandra’s room as Tony and Colette were leaving.  There would be no filming tonight.  Tony and Colette had done miracles but the sparkle was gone and her breathing was down to 12 rpm.  I took her hand and her eyes fluttered open.

“I think Phillip is jealous of you.”

“Oh that’s silly.  Phillip is young and handsome and everything a girl could want.  And Emma adores him.”

“But you’re funny and he can’t manage that anymore.  You make me laugh.”

I stood silent for a moment.

“It’s getting harder to do.   You got dealt the worst hand possible, how do you manage this?”

“I don’t fold.   I am a terrific poker player, I can outbluff anyone.”

The room was silent.

“Dan, my daughter probably would not remember me by the time she was 12.  Just shadows of stories that her Father and Grandparents told her.  I didn’t want her to see a sad dying shell.   No.  I want her to remember a pretty, happy Mama.”

She closed her eyes and folded her hands across her chest.  I walked out of the room, rounded the corner and stood with my hand against the wall attempting to compose myself.

  It didn’t work.

I glanced to my right at Marianne and motioned to her to close the door.

And I wept.

To my left stood Tony facing the wall with tears streaming.

“Hey sweetheart.  Your makeup is running.”

He threw his arms around my neck and buried his face in my shoulder.

“So is yours Danny Boy.  Why can’t I find a girl like that?”

“Keep looking Sweetheart.  She’s out there.”

 The  two of us busted  out laughing so hard that we were holding each other up.  Colette gave us a sullen look and then her dam burst open.  Marianne had to bring her a chair.   I turned around to see every Walky-Talky patient on the floor in the hall, half with tears in their eyes.  They knew.  They all knew.

And the next morning she passed three hours after I had left for the day.  She was surrounded by her family except for Emma.

Sandra wouldn’t allow it.

Yes this tale is about Sandra.  And it is about the noble souls that hold their emotion in check.  Until they can’t.   Who take care of every need.  It is about the nobility of service.  About those who brush wispy white strands aside and stroke foreheads.  Those that sit beside a bed at 3:00 am and hold cold hands and search hopefully for a pulse.

  It’s about ninety pound  Tran who advocates for more pain medication and won’t back down from a reluctant MD even though it runs counter to everything she learned in her culture.

  It’s about 6’5″ 280pound  Mike who walks through doors sideways and bends over beds and gently lifts ancient bodies as if they were a child because he doesn’t want to risk sliding them and shearing their skin.

 And it’s about Gail, Evelyn, Jennifer, Robert and Aubry that have punched the clock 5,000 times and probably will a 1,000 times more because there isn’t anything else out there that satisfies them as much.

  And it’s about Kelly who tells raucous colorful jokes and probably could win an arm wrestling contest at any saloon but she’s the first one through the door and pumping CPR if a code is called and she doesn’t quit until she looks up to see everyone silently looking at her.

It’s about Jeff in the ER that pulls his coat from the rack and hands it to a homeless man shivering in the doorway.

And Nancy and Wendy in the Sierra Nevadas that work Oncology because it makes them humane.

And Muhammad in Oakland who runs a code better than any ER Doctor because he has to.

And Doris in North Atlanta that runs the rapid Response team and rehashes every decision  she made, looking for a miscall, because she couldn’t reverse the course.  You didn’t miss a thing Doris.  It was just time.

To each and every one of my brothers and sisters in scrubs.  I send my love and respect.  I salute you.

Names have been changed in some cases and yes I took liberties.  The picture is the coast in Newport, RI.  And yes I took liberties with that too, there just wasn’t an appropriate picture.  I call it ‘Blue Monday’.

This post was inspired by a story of an Iranian woman who died in a Northern Michigan Hospital. The nurses hooked up a computer video system so the family in Iran that could not arrive in time could witness their daughters passing.  Everything the long distance family would have done for their child was done by the staff with strict adherence to Muslim ethics……with love and tears.  It was posted on Huffington Post this past Week.

I am a Nurse.   I try my best to be human.

A Familiar Face And Name

by Daniel H McCarty

When you deal with a person who’s experiencing dementia, you can see where they’re struggling with knowledge. You can see what they forget completely, what they forget but they know what they once knew. You can tell how they’re trying to remember.      Walter Mosley

He wasn’t that old.  He just looked it.  He had a thick thatch of pure white hair and had probably had it since he was in medical school.  He was one of the few that would rather do the right thing than be right.  I remember assisting him with a pulmonary assessment.  He finished his assessment and left the room to enter his notes in the medical record.  As I was lowering the patient back into a supine position he hiccupped and started in with a hacking cough that produced a blood tinged sputum.

“How long have you been seeing blood in your sputum?”

“Maybe two to three weeks now.”

“Did you tell this to Dr. Canada?”

“No, I’m here for the shortness of breath.  That blood ain’t much.  It goes away after a while.”

“So you’ve seen it before?”

“Off and on for about nine months, but never more than a few days at a time.  I been a smoker for forty years  What’d you expect?”

“I’ll be right back.”

I walked to the Nurses station and rounded the corner to the doctors dictation room.  Dr. Canada was on the dictation phone logging in his notes.  I gave him the cut sign, a quick slicing motion across the neck.  He looked up at me, pressed the pause button on the phone and placed it back in its cradle.

 “What is it Dan?”

“He’s got blood in his sputum.  states he’s had it off and on for nine months.”

“He didn’t mention that to me.”

“I know.  He thinks it’s his lot because he smoked for forty years.”

“Well come on, help me get him to an upright and have the unit clerk order a stat chest x-ray.”

Now if you have never worked in a hospital you may have never experienced the ‘Physician as God syndrome.’  It isn’t omnipresent but it is more common than it should be.  But Dr. Canada was never a member of that club and he always had one goal in mind.

 “Do what is right for the patient.”

And his ego never got in the way.

“You only know yourself because of your memories.”
― Andrea Gillies

What happens to a piano player that develops severe rheumatoid arthritis that twists his fingers into a gnarled mess?  Or the opera singer that is afflicted with throat cancer?

Or the physician that is cursed with the onset of Senile Dementia?

 “He easily gathered her in his arms; Gramma was made up of skin and bones and hate and crazy – and hate and crazy don’t weigh anything.” 
― Barry Lyga

“What the Hell is this?”

I’d known Robert for 10 years.  He wasn’t given to exaggeration or casual profanity.  He was in my opinion the best respiratory therapist in the hospital.  If you needed him, he was there…in a lick.

“What’s going on Bobby?”

“This order makes no sense.  This guy is a CO2 retainer and he wants him put on a non-rebreather.”

“Who does?”

“Dr. Canada.”  Guess I wake up Dr. Covina.  At what…..3:00 in the morning.”

“But Dr. Canada is in-house.  I just passed him in the hall.  I think he’s on 2E.”

“I don’t want to embarrass him.  I’ve worked with him for twenty years.  I’ll just call Covina.  He’s been covering this for three months now.”

“Covering what?”

He just stared at me.   Sad and helpless.

He went to the chart rack and pulled out three charts of Dr. Canada’s patients and opened to the Physicians order section.

“Notice anything?”

All three patients had the same order set.  Not surprising to me.  There were standard orders for common diagnoses.

‘Yeah, what?”

“211 is an end stage COPD and 247 is in with Pneumonia.  Now 234 is post op with a wedge resection.  All identical orders.  Everybody loves this guy but this is a problem.   Dr. Covina has been covering for his partner for months.  Dan, I think he has Alzheimer’s.  He doesn’t remember what we talked about an hour ago and he has started carrying 3×5 cards in his pocket to jar his memory.”

“looking at my reflection, in the window opposite, hollow and translucent, I see a woman disappearing. It would help if I looked like that in real life – if the more the disease advanced, the more ‘see-through’ I became until, eventually, I would be just a wisp of a ghost. How much more convenient it would be, how much easier for everyone, including me, if my body just melted away along with my mind. Then we’d all know where we were, literally and metaphysically.” 
― Rowan Coleman, The Memory Book

There is a profound sadness that accompanies Alzheimer’s.  Much like Kafka’s  ‘Metamorphosis’, they dry up and wither away.  The personality traits that comprised the individual disappear one by one until we are left with a familiar face and name but jumbled expectations.

 “Well, now
If little by little you stop loving me
I shall stop loving you
Little by little
If suddenly you forget me
Do not look for me
For I shall already have forgotten you

If you think it long and mad the wind of banners that passes through my life
And you decide to leave me at the shore of the heart where I have roots
Remember
That on that day, at that hour, I shall lift my arms
And my roots will set off to seek another land” 
― Pablo Neruda, 

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