Being A Nurse At Christmas Time
The familiar monotony of "The Twelve Days of Christmas" floated from the hospital intercom as I took a shortcut through the emergency room to the intensive coronary care unit. The repetitious carol matched my mood. Another shift, another round of patients, another holiday that I had to work. Normally, I enjoyed my job as a staff nurse in the ICCU, but lately coronary care had been chaotic, with each evening turning into a hectic progression from crisis to crisis.
As well as working part time through the holiday season, I had filled 130 Christmas stocking for the inmates of the Indiana Women's Prison, carried food baskets to the needy, and directed our church Christmas drama. I was very tired. It was Christmas Eve, my family's most cherished holiday, and I had to work. I shook myself mentally and hurried down the hall. Another eight hours and I would be home with my husband and children, who would delay our traditional buffet dinner until I could join them at midnight.
A quiet night In the ICCU
The hours would pass quickly if I could keep busy, but with typical hospital irony, the ICCU was unusually quiet. The patient census had been down for 36 hours. We had only five patients instead of the usual 12, with three nurses to take care of them--and all of the patients were enjoying uneventful recoveries. The hospital had extended visiting hours during the holiday season, allowing a steady stream of family and friends bringing gifts and flowers. The satisfied patients didn't even want their water pitchers refilled. The day nurses had already restocked the unit's supplies and checked the equipment, leaving us nothing to do except observe the monitors and watch the clock.
The nurses' station, stocked with food gifts from grateful doctors and patients, resembled a supermarket's gourmet food aisle. Although I longed to nibble, I didn't eay anything, preferring to wait for the midnight feast my family had planned. Moving aside a box of pears and cheese to make room for yet another gift of cookies, I noticed a New English Version of the Bible on the chart desk. I wondered how it came to be there. We were well supplied with Gideon Bibles, but a New English Version was unusual.
I idly flipped through its pages, pausing at a familiar passage in the New Testament look of Mark. As I read the story of the rich young ruler, one verse seemed to stand out from the rest. The rich young man had reminded Jesus of all the good he had done. Verse 21 said, "Jesus looked straight at him; his heart warmed to him." Odd, I had read that passage before but never noticed that particular sentence until this moment. Thoughtfully, I returned the Bible to its place before going to check on my patients again.
The evening drapped on until 11 p.m., when everyth ing happened at once. One night nurse called in sick; another with car trouble said she'd be an hour late; and there were two admissions in the emergency room. The first patient was a 51-year-old man with an acute myocardial infarction and complete heart block. The second admission was a 67-year-old man with undiagnosed chest pain. While the other nurses set up for a temporary pacemaker insertion for the first patient, I'd admit the second. As I hurried to open a room, I vowed that this would be the fastest admission on record.
But that was before I met Charlie Tall. He was a wiry little man with rounded shoulders and piercing blue eyes. His chest pain in no way hindered him from directing a running monologue at anyone who would listen. Any comment triggered lengthy stories about events of 30 years ago or an opinion based on Charlie's own brand of home-spun philosophy.
Hypochondria--or something else?
It was hard to keep Charlie quiet while I took his vital signs, which were all within normal limits. His Lead II ECG strip revealed a normal sinus rhythm. His heart sounds were normal without a rub or mumur. His lungs were clear and he wasn't short of breath. The closest he came to a complaint was to describe "a funny feelin' right here" while waving his hand in the general direction of his chest. I knew instinctively that Charle wasn't an MI, and that his chest pain wasn't cardiac related. I'd bet my ECG calipers on it.
A quick check of his admission orders revealed that his doctor, one of our most respected cardiologists, had ordered a regular diet and bathroom privileges. That doctor never ordered regular diets for anyone, and BRP were begun only after Stage II cardiac rehabilitation. What was Charlie doing in the ICCU on a regular medical unit? I groaned as I glanced at my watch. There was not enough time now to puzzle over his doctor's choice of beds. The physical assessment alone had taken me a precious 25 minutes, so I hurriedly began to take the history.
"Charlie, have you ever had any heart trouble before this?" I asked.
"Nope. Was laid up with chest pain a while back when I fell off a ladder while painting a house. You shoulda seen that house. She wanted it painted pink. Now ain't that crazy? Well, I..."
"Charlie," I said, interrupting his monologue, "have you had any other serious illnesses?"
"Had quinsy oncet. It was when I was a boy. Ol' Doc Carson had to lance my throat. Even got my tongue."
Not his tongue. I was convinced nothing had ever affected his tongue.
"Is there a history of heart trouble in your immediate family? When I say immediate, I mean your mother, father, sisters, or brothers?"
Silence greeted my question.
"Charlie?"
"I heard you. Happens I don't know about that."
"What do you mean, 'I don't know?'"
"Was raised in an orphanage--never knew my family."
"Well, what about your present family? Who should we call in case on an emergency?"
"Ain't nobody to call."
"You don't have any relatives?"
"Got a daughter in Philadelphia. Ain't heard from her in two years. Then there's my landlady, Mrs. Oakes, but she went to Michigan to be with her son for Christmas."
There was a long pause. I looked up from my nursing history. Charlie's head was tucked into his chest; big, silent tears were streaming down his face. I dropped the clipboard and reached for the box of facial tissues.
"What's wrong, Charlie? Want to talk about it?"
"It's Christmas," he choked. "It's Christmas, and I don't have nobody. Me and Fred Arnold used to sit through it together, but he passed away last August, and now it's just me." The tears continued to fall.
An unlooked-for Christmas present - in the form of a christmas onesie! http://www.onesiezoo.com/uncategorized/christmas-onesie-and-costume-ideas/
Now I understood why Charlie's doctor had admitted him to our unit, which was known for its personalized care. A lonely old man who had no one would at least get the persisent attention of the intensive care nurses. Even the detached care of strangers was better than spending Christmas alone.
Suddenly the scripture verse I had read earlier flashed before me: "Jesus looked straight at him; his heart warmed to him." Jesus, whose birthday we were celebrating, had looked at each person individually and more--Jesus had seen each person's total need and responded to it. It was time for me to look straight at Charlie. He was more than just a set of symptoms to be diagnosed and treated. How could I have missed seeing his real need?
How long, I asked myself, had I been reducing patients to sets of symptoms? When had the transition from caring nurse to mechanical medical assistant occurred? Was my idealism of earlier years buried under a tight dressing of cynicism and taped down with a ruthless technology? I had once vowed that would never happen to me, but now I knew it had. I thanked God for that Bible and this tenacious little man. They had forced me to take a close, painful look at myself. But enough analysis--it was time to address the problem.
"Charlie, have you had dinner?"
"Nope," he sniffled. "Wasn't too hungry. Did have a banana around six, though."
"Well, I haven't eaten either. The hospital kitchen is closed, but we have a lot of food at the nurses' station. Why don't I fix us both a plate, and I'll join you here in your room?"
After a short pause, he slowly raised his head. "Would you really do that?"
"Sure would. Here's the call light. Push the blue button if you need anything before I return."
There was a new purpose in my step as I hurried to the nurses' station to assemble our dinner. There were fresh pears with cheese, smoked salmon, and Texas fruitcake. No one would mind if I borrowed the small red candle arrangement, and where was that little green stocking cardiac rehab had sent to us?
Oh, yes, I'd have to call my family to tell them I'd be late.
As well as working part time through the holiday season, I had filled 130 Christmas stocking for the inmates of the Indiana Women's Prison, carried food baskets to the needy, and directed our church Christmas drama. I was very tired. It was Christmas Eve, my family's most cherished holiday, and I had to work. I shook myself mentally and hurried down the hall. Another eight hours and I would be home with my husband and children, who would delay our traditional buffet dinner until I could join them at midnight.
A quiet night In the ICCU
The hours would pass quickly if I could keep busy, but with typical hospital irony, the ICCU was unusually quiet. The patient census had been down for 36 hours. We had only five patients instead of the usual 12, with three nurses to take care of them--and all of the patients were enjoying uneventful recoveries. The hospital had extended visiting hours during the holiday season, allowing a steady stream of family and friends bringing gifts and flowers. The satisfied patients didn't even want their water pitchers refilled. The day nurses had already restocked the unit's supplies and checked the equipment, leaving us nothing to do except observe the monitors and watch the clock.
The nurses' station, stocked with food gifts from grateful doctors and patients, resembled a supermarket's gourmet food aisle. Although I longed to nibble, I didn't eay anything, preferring to wait for the midnight feast my family had planned. Moving aside a box of pears and cheese to make room for yet another gift of cookies, I noticed a New English Version of the Bible on the chart desk. I wondered how it came to be there. We were well supplied with Gideon Bibles, but a New English Version was unusual.
I idly flipped through its pages, pausing at a familiar passage in the New Testament look of Mark. As I read the story of the rich young ruler, one verse seemed to stand out from the rest. The rich young man had reminded Jesus of all the good he had done. Verse 21 said, "Jesus looked straight at him; his heart warmed to him." Odd, I had read that passage before but never noticed that particular sentence until this moment. Thoughtfully, I returned the Bible to its place before going to check on my patients again.
The evening drapped on until 11 p.m., when everyth ing happened at once. One night nurse called in sick; another with car trouble said she'd be an hour late; and there were two admissions in the emergency room. The first patient was a 51-year-old man with an acute myocardial infarction and complete heart block. The second admission was a 67-year-old man with undiagnosed chest pain. While the other nurses set up for a temporary pacemaker insertion for the first patient, I'd admit the second. As I hurried to open a room, I vowed that this would be the fastest admission on record.
But that was before I met Charlie Tall. He was a wiry little man with rounded shoulders and piercing blue eyes. His chest pain in no way hindered him from directing a running monologue at anyone who would listen. Any comment triggered lengthy stories about events of 30 years ago or an opinion based on Charlie's own brand of home-spun philosophy.
Hypochondria--or something else?
It was hard to keep Charlie quiet while I took his vital signs, which were all within normal limits. His Lead II ECG strip revealed a normal sinus rhythm. His heart sounds were normal without a rub or mumur. His lungs were clear and he wasn't short of breath. The closest he came to a complaint was to describe "a funny feelin' right here" while waving his hand in the general direction of his chest. I knew instinctively that Charle wasn't an MI, and that his chest pain wasn't cardiac related. I'd bet my ECG calipers on it.
A quick check of his admission orders revealed that his doctor, one of our most respected cardiologists, had ordered a regular diet and bathroom privileges. That doctor never ordered regular diets for anyone, and BRP were begun only after Stage II cardiac rehabilitation. What was Charlie doing in the ICCU on a regular medical unit? I groaned as I glanced at my watch. There was not enough time now to puzzle over his doctor's choice of beds. The physical assessment alone had taken me a precious 25 minutes, so I hurriedly began to take the history.
"Charlie, have you ever had any heart trouble before this?" I asked.
"Nope. Was laid up with chest pain a while back when I fell off a ladder while painting a house. You shoulda seen that house. She wanted it painted pink. Now ain't that crazy? Well, I..."
"Charlie," I said, interrupting his monologue, "have you had any other serious illnesses?"
"Had quinsy oncet. It was when I was a boy. Ol' Doc Carson had to lance my throat. Even got my tongue."
Not his tongue. I was convinced nothing had ever affected his tongue.
"Is there a history of heart trouble in your immediate family? When I say immediate, I mean your mother, father, sisters, or brothers?"
Silence greeted my question.
"Charlie?"
"I heard you. Happens I don't know about that."
"What do you mean, 'I don't know?'"
"Was raised in an orphanage--never knew my family."
"Well, what about your present family? Who should we call in case on an emergency?"
"Ain't nobody to call."
"You don't have any relatives?"
"Got a daughter in Philadelphia. Ain't heard from her in two years. Then there's my landlady, Mrs. Oakes, but she went to Michigan to be with her son for Christmas."
There was a long pause. I looked up from my nursing history. Charlie's head was tucked into his chest; big, silent tears were streaming down his face. I dropped the clipboard and reached for the box of facial tissues.
"What's wrong, Charlie? Want to talk about it?"
"It's Christmas," he choked. "It's Christmas, and I don't have nobody. Me and Fred Arnold used to sit through it together, but he passed away last August, and now it's just me." The tears continued to fall.
An unlooked-for Christmas present - in the form of a christmas onesie! http://www.onesiezoo.com/uncategorized/christmas-onesie-and-costume-ideas/
Now I understood why Charlie's doctor had admitted him to our unit, which was known for its personalized care. A lonely old man who had no one would at least get the persisent attention of the intensive care nurses. Even the detached care of strangers was better than spending Christmas alone.
Suddenly the scripture verse I had read earlier flashed before me: "Jesus looked straight at him; his heart warmed to him." Jesus, whose birthday we were celebrating, had looked at each person individually and more--Jesus had seen each person's total need and responded to it. It was time for me to look straight at Charlie. He was more than just a set of symptoms to be diagnosed and treated. How could I have missed seeing his real need?
How long, I asked myself, had I been reducing patients to sets of symptoms? When had the transition from caring nurse to mechanical medical assistant occurred? Was my idealism of earlier years buried under a tight dressing of cynicism and taped down with a ruthless technology? I had once vowed that would never happen to me, but now I knew it had. I thanked God for that Bible and this tenacious little man. They had forced me to take a close, painful look at myself. But enough analysis--it was time to address the problem.
"Charlie, have you had dinner?"
"Nope," he sniffled. "Wasn't too hungry. Did have a banana around six, though."
"Well, I haven't eaten either. The hospital kitchen is closed, but we have a lot of food at the nurses' station. Why don't I fix us both a plate, and I'll join you here in your room?"
After a short pause, he slowly raised his head. "Would you really do that?"
"Sure would. Here's the call light. Push the blue button if you need anything before I return."
There was a new purpose in my step as I hurried to the nurses' station to assemble our dinner. There were fresh pears with cheese, smoked salmon, and Texas fruitcake. No one would mind if I borrowed the small red candle arrangement, and where was that little green stocking cardiac rehab had sent to us?
Oh, yes, I'd have to call my family to tell them I'd be late.