A Nurse's Touch
When one thinks of nursing they may envision a nurse sitting bedside with the ill, holding their hand, or hugging them. Commercials and medical tv shows strengthen this misconception by showing barehanded nurses caressing the hair or cupping the face of a patient they are bonding with. In reality, the majority of touching a nurse does is with some form of barrier between nurse and patient.
As we enter a patient's room we layer our hands with an antibacterial foam or gel and immediately put on gloves. Some times we double glove. Subconsciously, or consciously, we add yet another degree of separation from our patient.
It is rare to use bare hands on a patient, even if it is just to reposition an arm or a leg of a patient admitted for pain management of a bulging disc. There are departments employed specifically to watch whether we are possibly spreading germs. And they, along with management, and the media, have convinced nurses that we are the culprits to every hospital acquired infection. Therefore, we burn our hands raw with foam, put on gloves before touching a bed rail, and most definitely before touching another human being. We remove those gloves, apply foam again as we leave a potentially contaminated room, and go wash our hands in the nurse's station. Repeat for the next patient.
If touch is part of the healing process, no wonder so many remain stagnant in both mental and medical illnesses. And when barriers are broken down, when no degree of separation exist, and touch is one of the last senses you remember... well, it can be quite profound.
I was on the last night of my five night stretch. "Glen" had been my patient those five days. It was nearly 2 am on Sunday morning. Glen called me in and said that he was having trouble using the urinal in bed and asked me to assist him to the bathroom. He was in end-stage liver disease. He was not a transplant candidate due to years of excessive drinking. On the previous shift, he had been told that his prognosis was poor. Despite having the classic symptoms of liver failure, jaundice and acites, he was a good looking man. He was fifty-seven years old, six foot three, had a full head of hair and a full grown beard. He reminded me of Hugh Jackman and the Brawny paper-towel man. His gentle and polite spirit quickly made him a favorite among the nurses.
Another nurse helped me stand him at bedside and test his leg strength. He took the walker and shuffled from his bed, past the empty bed next to his, and into the bathroom. "You're mobility is much better today," I commented.
He asked to sit down on the toilet. I moved the walker and helped him to the seat. I stood between his legs for support and we continued making small talk. Suddenly, he was not responding. "Look at me," I said. His gaze drifted right as if he had not heard me. "Glen, look at me!" I yelled. He looked up and his pupils were fully dilated - not enough oxygen to the brain.
I fumbled for the phone in my pocket and dialed the hospital operator. "This is Julie on Four West. I need a Rapid Response in room 4402." The operator repeated my name, location, and request, as confirmation. The other nurse ran out of the room to alert the others. Within the second it took me to put the phone back in my pocket, I felt Glen getting heavier in my arms. And then his head fell onto my chest. A dull, heavy, thud on my sternum. My standing body was completely supporting his seated body. His face was flat against me. I grabbed at his thick hair to move his head back so I could see his face. He was gray. He was dead.
"Code Blue," I yelled out.
I blinked, or so it seemed, and I found myself straddled over his left leg performing chest compressions. The lower half of his body was on the small bathroom floor, while the upper half of him was across the bathroom doorway into the room. I blinked again, a respiratory therapist was on her knees with portable suction and an oxygen mask. I felt my leg get wet, as urine released itself from Glen, soaking my pant leg. I blinked a third time, a male nurse from the third floor took over chest compressions. I stood up, cornered by my patient's legs, another man on top of him doing chest compressions, the toilet and the shower. Blood oozed from my patient's nose and mouth and created deep wine colored streams through his beard to the back of his head. I blinked a fourth time, the room was full of nurses, respiratory therapists, and doctors there to help.
It was as if I was watching through an old-fashioned slide projector and with each blink the next scene appeared. Even though I was part of the action, a few seconds, or a slide, was missing each time the projector clicked forward. How had my patient gotten to the floor? Who lifted him and stretched him out? How had the room become crowded so quickly? How much time had really passed? I couldn't recall.
The men surrounded my patient and lifted him to the empty bed near him. His limbs and head hung lifelessly. He was ashen, his face and hair viscous with his own blood. My patient, Hugh Jackman, Brawny paper-towel man, now looked like depictions of Jesus Christ being taken down from the cross. I can not get that visual out of my mind.
While the first physician called out orders to the staff working on Glen, I gave another doctor a rundown of the medical history, the diagnosis, the most recent labs, vitals, and what medications he'd been given in the past twenty-four hours. He listened intently. He looked at my patient. He turned to me and said, "I don't think he's gonna make it."
"I know," I whispered.
"We'll keep trying," he said.
Was this my fault? What had I missed? What could I have done differently?
The code continued and continued. The second physician started giving orders. The first physician asked, "How much longer do you want to go on? We've given everything. Look at him." I know it was the first physician's fear that after all this time, with no oxygen to the brain, if Glen did "come back," it would be disastrous. He'd be brain dead, on life support until ethical decisions were made to his benefit or the benefit of his decision makers. "Just this last try," said the second physician. Those rotating on chest compressions were starting to tire. The second physician grabbed a pair of gloves and pounded away into Glen's chest. I was grateful for his effort, but not hopeful. This late in the code, I too was fearful of him being revived. But, I needed to see that we made every effort.
There was Glen. And there was nothing left to try. "Go ahead," said the second physician as he stepped away from Glen, removing his gloves.
"Time of death 2:51," said the first physician.
The room looked like a tornado ripped through it, with blood trails left behind, medical devices and packaging strewn about, and one dead man in the center.
The physician called the family. His parents were on their way. My manager and I donned gloves and gowns and got to work, making the room and their son presentable. I scrubbed blood out of his hair, beard, and ears. We fully bathed him, put him in a new gown and slid him over to a fresh linen bed. We picked up every syringe, empty bag, every single item that was used in the futile attempt to save him. He looked good. We lowered the lights. I washed my hands and made the phone call to report his death, per protocol.
A Mother's Touch
An elderly couple walked down the hall, apprehensively, to my patients room. "Are you Glen's parents?" I asked.
"Yes," said the mother.
"I'm Julie, his nurse."
They both nodded. The father spoke, "We knew it was coming."
"I'm so sorry."
"How did it happen?" the mother asked.
I could not tell her that he died on the toilet and we laid him on the bathroom floor. I did not want her to have that image in her head. "I took him to the bathroom, he said he didn't feel very well, so I helped him back to bed. Then he died. I called a code and we worked on him for quite a while."
"He just let his drinking go too far," said the father.
"We spoke with the doctor yesterday and it wasn't good news," said the mother.
"Would you like to see him?" I asked.
We entered the room and the parents began to cry. I felt my heart break for them. I know that my worst night at work still does not compare to my patient or his parents' worst night. I'm well aware of that.
"He's a very handsome man," I said.
"Yes, he is, isn't he?" said the mother as she touched his face and beard.
I gave them time alone with Glen. When they came out, I handed his mother a sympathy card that we all signed.
"I'm glad you were with him when he died," she said.
There they stood. Two elderly parents weeping outside their son's room. And there was nothing left to say. I hugged his mother. Two strangers, in a hospital hallway our roads crossed. She, the first woman to hold Glen as he took his first breaths in life. And me, the last woman to hold him as he took his last. We held one another. She held me for what seemed like an eternity. Perhaps the slide show projector was stuck on this frame for a reason. We both were in need of a healing touch.
For weeks after Glen's death, I constantly thought about him, how he died, and his parents. I couldn't understand why I was struggling with his death. I see people dying of their illnesses every day at I work. I bag bodies and transport them to the morgue without ever giving it a second thought. Yet, Glen's death affected me like no other death.
I finally concluded that it was because Glen's death was such a physical, touching event. I felt his head and his body weight against me the moment he died. My co-workers filled in the missing "slides" for me. They said that I and two other nurses lifted Glen off the toilet and gently laid him on the floor and that I started chest compressions immediately. I felt his urine wet my leg. I felt his rough beard and thick hair as I cleaned him. And most importantly, I felt the grief of his parents and warmth of his mother's touch.
After so many hospital "contact precautions," the human touch can almost feel foreign. As a nurse, a wall is built in order not to be emotionally touched with every situation. His death and his mother's hug provided no degree of separation, physically or emotionally. I hope never to forget that feeling.