Nursing

A special individual taught this nurse that each patient is a person in need, and not just a bed with a diagnosis.

Another day, another assignment. That's what I thought to myself as I walked down the halls of our med/surg unit one day, 14 years ago. There was care to provide, teaching to do, and of course, paperwork to complete. I readied myself for the blur of patients and tasks that lay ahead.

Report from the night shift was unremarkable. I learned that one of my patients, who I'll call Mrs. Haller, had pneumonia. When I went in to make up her bed, I chatted with her friendly husband. He filled me in on a few details I hadn't heard in report, most notably that his wife had had pneumonia three times in the past few months. No one knew why.

Ours was a good fit from the start. Mrs. Haller was personable, full of laughter, and in her early 30s, like me. Between tests, she, her husband, and I discussed books and philosophy, and even ventured into politics. They asked me to call them Carol and Jerry and told me that they'd been planning a family for several years. Now they were ecstatic that she'd at last conceived.

Before leaving that day, I asked to be assigned as Carol's primary nurse. My nurse manager agreed and wrote my name on the board next to Carol's. Little did I know that this small request would ultimately have a big impact on the way I practice nursing.

An unexpected diagnosis changes three lives

Everyone hoped for a quick and easy explanation for Carol's recurrent pneumonia. Yet on the train home that night, I had an uneasy feeling. I dismissed it, thinking it was probably brought on by the dark clouds and impending rain.

The next day was dismal and rainy, and the gloominess seemed to extend inside the hospital's walls. After report, I checked Carol's chart and reviewed the results of some routine testing from the day before. One physician thought Carol had an immune dysfunction, another thought she had a cardiopulmonary problem, and still another considered TB. Carol was certainly getting a thorough diagnostic workup.

I saw that her chest X-ray was unremarkable and her CT scan was inconclusive. But I became concerned when the MRI done with contrast media showed several shadows on her lungs. A transesophageal echocardiogram (TEE) was scheduled for mid-morning.

Carol and Jerry wanted the strange-sounding diagnostic procedure behind them and were anxious to sit down with the attending physician to discuss the results. At about noon, Carol went for her TEE, and later that afternoon, her usually calm and collected doctor walked somewhat nervously into her room. He sat at her bedside and explained to Carol and Jerry that she had an inoperable tumor twisted dangerously around her heart and lungs.

"Did we hear you right?" they asked. "What can we do?" "Will this affect our baby?" And then Carol said, "Why me?"

Carol and Jerry depended on their doctor and me for support since their out-of-town parents couldn't get there until the next day. It took every bit of my energy to maintain a good balance between subjective feelings and objective facts. I tried to provide them with information about the tumor, but then realized that their high anxiety prevented them from focusing. So, I just listened.

The doctor said he'd return the next morning to discuss treatment options and suggested that they try to relax. He left a prn order for Ativan if Carol needed it.

Then he gently excused himself and asked me to continue on rounds with him. At the end of the hall, he told me what I'd already suspected: He needed to consult with the oncologist but didn't think that Carol could maintain a pregnancy while she underwent the chemotherapy and radiation that was required.

My head was spinning. Carol hadn't shown any signs of limited cardiac output, like cool skin or a pale complexion. She was young, exercised, watched her diet, and never smoked. In other words, she did everything right.

An impossible choice, a need for support

The next day, the doctor asked me to be with Carol and Jerry when he and the gynecologic oncologist talked to them about treatment. The physicians strongly advised that she terminate her pregnancy because the baby could not survive the toxic side effects of aggressive chemotherapy and radiation. Other treatment plans were considered; but this one offered the most hope for a patient like Carol, who was young and otherwise very healthy.

In her mind, Carol knew that this had to be, but she and Jerry were brokenhearted. It had taken several years for her to conceive and now, five weeks later, she was being told that terminating the pregnancy was medically necessary. Both could barely speak. They reluctantly agreed, knowing that it was Carol's best chance of survival.

Jerry's eyes welled with tears and Carol's attempts at being stoic failed. Later that day, Jerry couldn't hold back his tears as I prepared and pre-medicated Carol for her trip to the procedure room. I watched as the orderly, with Jerry alongside holding Carol's hand, wheeled the stretcher down the hall. Then I, too, sobbed in the nurses lounge. I wondered if the orderly knew that he was carrying two lives into the room but would be returning with only one.

An ending followed by a new beginning

After the termination of the pregnancy, Carol and Jerry began to regroup. They started to talk about what needed to be done next. While I was giving her discharge instructions, we discovered we were neighbors, living only four blocks apart.

I accepted a dinner invitation, and we all had a great time. Some weeks later, Carol and Jerry took a needed vacation to relax before her therapy began.

When they returned, Carol received high doses of chemotherapy followed by very aggressive radiation as planned. She could barely eat because of nausea and vomiting, mouth sores, and a poor appetite. She became very weak.

Even though she lost her hair, her features were still remarkable and hats flattered her pretty face. A nutritionist visited and taught Carol ways that she could minimize the side effects of treatment and help her eat.

On Carol's good days between treatments, she, Jerry, and I would go out to grab a bite to eat or to hear motivational speakers. Together, we learned about stress management and other self-help philosophies.

Little by little, Carol's health improved. In fact, it seemed like nothing short of a miracle when, just over a year after receiving her last treatment, Carol conceived again. Nine months later, she gave birth to a healthy baby boy.

Some more good news followed. They conceived again and gave birth to twins. Thankfully, her cancer did not recur.

Though we've since fallen out of touch (Carol and Jerry relocated), they remain close to my heart.

And I've gone on to study the mind/body connection and have begun class work to earn a certificate in stress management—skills that will make me a much more effective and compassionate nurse.

Since meeting Carol and Jerry, I have stopped taking things for granted and seeing patients as just a room number and a diagnosis. My experience taught me to see patients for the people they are and the lives they are living. It also taught me not to rush through my encounters with patients. By spending a few extra moments with those in my care, I've learned that we can be present for patients during the very worst—and best—that life has to offer.