patient stories

Purposeful Hourly Round

Liam was a young, 20-something male who was out drinking with some friends. He was too drunk and high to drive home, so his friend came to pick him up. His friend Neil was stone-cold sober. The driver that was driving in the wrong lane at highway speeds who hit his car was not. The cars were totaled, both drivers dead, and Liam was left with a bad break in his arm and a couple of rib fractures because, thankfully, he had been sleeping in the backseat.

By all means, Liam was lucky. For a young twenty-something male, he was coping fairly well in that he was semi-motivated to participate in therapies and cares that would speed his recovery. He had pain issues, some issues taking deep breaths and coughing, some issues moving around, but he was recovering. His chest tube was out. His pain was tolerable. He was eating, pooping, peeing, and otherwise, a fairly functional human being. He would likely go home tomorrow or the next day.

As the offgoing nurse gave me report in his room that evening on our trauma surgery unit, Liam shifted uncomfortably in his bed. He squirmed especially during the retelling of his accident after hearing he had alcohol on board at admission and how the driver died. As I conducted Liam’s initial assessment an hour later, his family, girlfriend, and a couple friends surrounded him, showering him with food, comfort, and encouragement. Amid the chaos, I gathered he was bothered by the accident more than he was letting on. I assessed and settled my other patients before conducting my next check on him an hour later.

I knocked on the door and entered slowly. Everyone had left. Liam was half-heartedly watching ESPN while he did something on his phone. “Hey, Liam,” I said as I entered. “I’m just checking in on you. How’s it going?”

“Fine,” he said without looking at me.

“Do you need anything?”

“No. Thanks.”

I could sense in his flat tone, his dead eyes, his defeated body language that he demanded something of me. I looked at him and could not help but empathize. I had been the same way. I recognized that determination to be emotionally and mentally fine. I had had it too, even though I was anything but.

My freshman year of high school, a girl I had known since kindergarten died unexpectedly. She, her sister, and her mother were driving back to town on a Sunday night in mid-spring when her mother lost control of the vehicle. My friend and her sister were sleeping in the back seat, and they were both thrown from the vehicle. Her sister died on scene. My friend was alive enough to make it to the helicopter meant to carry her to the hospital.

She never made it.

Her mom did, thankfully. Her dad was safe in town since he drove back early for work, thankfully.

Slowly, my whole high school learned of the accident that very night. I was watching Grey’s Anatomy with my mother when my sister found out. A high school senior, my sister was only a year older than my friend’s sister. I saw her crying in the bathroom when the episode ended, and I said nothing. I thought she and her boyfriend of the time were in a fight or something. I went back to my bedroom and was aimlessly reading or working on something when my mom called me into her room.

My sister was already on the bed crying. I sat down, a healthy distance away from all of her emotion and tears. I was and am not one for a lot of emotion. As my mother so delicately puts it, “Your emotions are in your feet.” They wouldn’t be for long that night.

My mother began with saying my friend and her sister were dead. As she went over the small, known details of the accident, I nodded tearlessly.

It took twenty minutes for the knowledge of the accident to take. The tears started, and they would not stop. I just saw her, I reasoned. She was just dancing like a fool to a bad 80’s song as we worked on building the set for the school’s spring play. She can’t be dead. But she was. I cried myself to sleep, angrily asking God how this could happen and running through minor, unimportant details for the next day of school, like how I would need waterproof mascara.

I did need the waterproof mascara the next day, even though I fought back tears obstinately for the majority of the day. Most teachers let students leave, talk to the school counselors as needed, and spend time in the school’s chapel to make cards or write letter or do whatever they needed to do to cope. A Catholic high school has its advantages like that I guess.

I refused to take advantage. I wanted to pretend life was normal even though it was anything but. I went to my classes, which were mostly like a study hall anyway, but I made myself go. I needed to pretend like I would know life would go on. I needed to pretend I was fine.

But I wasn’t fine. After the school gathered for a small prayer session in the auditorium that afternoon, I lost it. I cried as I stared at the picture of my friend and her family and then at the picture of her and her sister not a year earlier at our homecoming dance. She can’t be gone, I told myself. But she was. As much as I wanted to change that reality, she was gone.

The tears kept coming, even as the school and I solemnly left the auditorium. My sister somehow found me and hugged me. I cried into her shoulder wordlessly, not hugging her back. Part of me was grateful for her hug, but most of me didn’t want the comfort because receiving comfort meant acknowledging my friend’s death was real. Eventually I gave in, hugged her back, and I think I let her take me home early.

As much as I didn’t want it at the time, I needed that comfort from my sister. I carry that friend and her family with my every day at work, and she was very present in my mind that night.  As I looked more carefully at Liam in the hospital bed, the metaphorical hospital bed my friend never made it to, the metaphorical one her mother eventually left alive, I knew he needed that comfort too.  If my friend had made it to the hospital, I would have wanted a nurse to sit with her. When her mother was in the hospital, I hope a nurse sat with her. As painful and awkward as it was, I felt a responsibility to be that nurse and sit with him.

I wordlessly sat down on the reclining chair in the room and let the silence hang for a moment. “Liam,” I said softly, “you’ve been through a lot…” Understatement of the century, I said to myself. “Really, how are you doing with everything?”

He continued to stare at his phone, but his fingers stopped moving. The silence hung awkwardly, but I waited. He started talking, and I listened. He talked about his life, his poor decisions, how he dropped out of college but had dreams of building computers, how he was able to manipulate his parents into letting him get away with almost anything, how great his girlfriend was and how lucky he was to have her. “Why’d it have to be him?” he asked quietly. “Why Neil? I’m the fuck up. He had it all together. He was going to be in the Navy. He wanted to be a naval doctor and help poor kids around the world. All I do is mess up. Why’d it have to be him?”

The silence hung again. He looked at me, his brown eyes demanding an answer, an answer that I didn’t have and that no one has.

I sighed. I had asked myself similar questions years earlier when my friend died. I still ask them from time to time, especially when my sweet, kind patients die or don’t fare well.

“I don’t know, Liam. But I like to think that as long as my heart is beating, that my lungs are breathing, that my body’s working that I have some sort of purpose in the world…even when I don’t know what it is.”

I hesitated, but continued. “Neil sounds like he was a great guy, but you’re not so bad yourself. Yeah, you’ve made some mistakes, but who hasn’t? Look at you. You’re saving to go back to school. You have goals. You recognize your mistakes. You can change if you want to.”

He looked back at his phone and talked for a while about his group of friends, how they pressure him into drugs and excessive drinking, how his parents disliked them, how he often lied to get out of the house and see them. “Maybe being stuck at home won’t be such a bad thing…”

“Maybe not,” I agreed. “It’ll give you the chance to see who your real friends are. Look at your girlfriend, look at those friends who came tonight. They showed up. They care. The friends who matter will keep coming…even if you’re stuck at home.”

“I guess so,” he mumbled.

“Liam,” I said firmly. “You’re a good kid.” He’s only a few years younger than you, I thought. Still, kid felt appropriate. “You’ve got a good head on your shoulders. Your heart’s beating, and your lungs are breathing. You can get through this.” I lightly used the moment to bridge to his lung function, jokingly encourage coughing and deep breathing, and ask about his pain.

“I’m fine,” Liam said of his pain. His were more hopeful eyes, he spoke in a lighter tone, and his stronger body language told me emotionally and mentally, he was closer to being fine.

I smiled and got up to the door. “I’ll check on you in an hour, ok?”

“Ok. Thanks, Marissa.”

I almost paused as I closed the door. Patients rarely called me by name, and even when they do, they usually mispronounce it. I smiled as I walked back to the nurses’ station to chart. So that’s why I’m a nurse, I thought as I once again began the monotomy of charting, that’s why.

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