What We All Need

My first patient in nursing school was a man in his early sixties who lived in a small town in mid-Missouri.  He had come to Boone County Hospital because he was in the early stages of liver failure.  His legs had swollen up a great deal and it became too much for him to walk so he called an ambulance to pick him up from his home.  He wasn’t my first patient, my very first patient had the honor of my first bed bath, preceded by 30 minutes of me talking to her like nothing out of the ordinary was going to happen, that is, until my professor came in and asked why was I not finished like everyone else.

No, this was my first real patient.  I was 20 years old and this was the very first patient that was all mine, that I would be attending to for 6 hours, three days in a row.  The day before my first clinical with him I came onto the floor to read his chart so I could study that night and be prepared in the morning.  His albumin was very low, so what was albumin again?  And why does it matter?  His legs had +4 edema?  Can’t go higher than +4 so that’s not good.  Oh my god, he is on so many medications…  I’m not so sure what I really signed up for here…

I woke up the next morning at 4:45 and went to my first clinical, everyone nervous and excited, some more nervous than others.  We received a prep talk from our clinical instructor, Sherri, and were sent off to get report from the night shift nurses.  I listened to a woman who was clearly ready to go to sleep after working 11p-7a and walked to the room.

“It feels like I gotta piss!”

Oh jesus, I got my first patient and he’s an asshole.

I walked over and saw that his foley bag wasn’t in a position to drain very well, so I rearranged it and urine started flowing, and seeing the result he laid back and shut his eyes.

“Good morning, John.  My name is Dan, I’m going to be your nurse this morning.”

“Wonderful,” his eyes still shut, his head now turned away from me.  He had a greyish stubble that had been neglected for days, his hair a short crew cut.  I checked his IV to make sure everything was all right and fumbled around, not sure if I need to wake him up or if that will just upset him more.  Finally, I speak up and tell him that I need to do my nursing assessment.

“Fine.”

I roll back his covers and he complains that it’s too cold, put it back.  I begin to take his vital signs and he does so begrudgingly.  I decide the assessment can wait till after breakfast.  I go to the med room and collect his morning medication and go back to the room, his breakfast sitting in front of him.

“This stuff tastes like shit!  How do you expect people to eat shit like this?”

It didn’t smell too bad to me, I was really not understanding why this guy was so hostile to me.  It wasn’t my age that seemed to throw him, it wasn’t because I was a guy.  I explained his diet plan and it’s relation to his breakfast and pushed him to drink his protein shake because that looked the best to me.  I did eventually get that assessment in, but that’s about as far as it went.  He didn’t get out of the bed for me, he didn’t want to talk, and by the time our shift ended I asked my professor what it was about that guy and his attitude.  Apparently, I had the most unruly patient of the class for the day.

“I don’t get it.  I mean, I read his history, the reason he is here is because of his own choices.  He cares enough to get treated here, why treat everyone so poorly?”

“Listen, Dan.  Some patients are easier than others.  Just know that he’s not upset at you, but he is very sick.”  I went back to campus and eventually to sleep, just thinking about what the hell I am going to do the next day.

When I walked into his room the next day, there was still no love coming from this man, though less cursing and yelling.  He ate breakfast, decided not to refuse any of the pills I gave him this time, and watched TV.  At one point I asked him if he wanted a shave, and amazingly, he accepted.  I told him that I would be happy to do it but he needs to sit in the chair while I do, and amazingly, he accepted.  I shaved his face fairly quickly and efficiently, he being grateful not just for the attention but because shaving with multiple needle wounds and an IV can make shaving pretty difficult.  Afterwards we sat together and watched FOX News, him grumbling about liberals and whatnot, me sitting and trying not to look annoyed.  The day ended, I went home, feeling better.  I had been more firm with him, and he did stuff for me.  I decided that was it, some people will walk all over you if they think they can, and I showed him that he couldn’t.

When I came in for my third and final day I was told in report that he would be taken to a rehab center that morning.  I went to his room and greeted him, and he acknowledged me, his voice soft now.  I spent my time preparing to send him to rehab in the ambulance and gathering his things.  He watched me taking his personal things out of his closet – a Vietnam hat, an old leather coat that reeked of cigarettes, crummy army boots and pants.  We got him into a wheelchair and I took him down the elevator, saying little, just ready to have this man out of my sight.  Outside on the sidewalk, getting ready to go into the ambulance, we waited for a minute.

“John, you got to eat better.  You got to take care of yourself.  I don’t want to see you again,” I said with a smile, trying to convey the same firmness but care that I felt he needed.  John looked up at me and said only one thing in a very sincere, softly spoken voice.

“Not under these circumstances.”

Not once did John have family come and visit.  I remembered that he didn’t even have a wife’s name written on his medical record.  I took him as some curmudgeonly old man that didn’t care about anyone or anything.  But after three days of having him as my patient I realized how wrong I was.  I gave him the most undivided attention he had probably had in years.  He warmed to me more than he warmed to anyone else in the hospital.  I wanted him to like me, and I wanted to really understand what was going on with him, and on accident I opened up a man that expected rejection and hurt and to be ignored.  All he wanted was to be loved, to be cared for, by somebody, anybody.  I guess that’s when I realized that I really made the right decision to be a nurse.  I am proud of what I do, and I realize that my job is so much more than just the knowledge and schooling I went through, it was that other thing, that human connection that everyone needs, that I need, and that he needed.