Not all of my stories about patients are sad.
Ms. R, only 54, came to us with thyroid cancer. She had a mass that was obstructing her airway so she had to have a trach put in. She then went through many rounds of chemo and got radiation to her neck, which is a tough place to have that treatment because it left her skin burned and the tissue inside her mouth fragile and sore. Since she came into the hospital in May she hasn’t eaten or spoken. She gets fed through a tube in her stomach, and if she wants to say something she uses a whiteboard to write it down.
The thing is, Ms. R has been very depressed. She sleeps almost all the time and doesn’t really attempt to communicate. When she was first on our unit I wasn’t assigned to her very often. But one thing led to another and a month in I became her primary nurse. For a couple of weeks I really didn’t know what she thought of me. We had established a routine of care, she was compliant, but I had no idea if she liked me or not.
Then one day, after one of my days off, Ms. R slept in until 2 p.m. When she finally woke up she wrote down on her board, “You leave at 3?” When I said yes, she made kind of a frowny face. I smiled and said, “You’ve been sleeping all day! It’s almost time for me to go home!” Then she wrote, “I missed you yesterday.” That was the first time I got any clue as to how she felt about me.
I had never seen any of Ms. R’s family, so I wasn’t sure if she had any support at home. But then one day her sister came up to surprise her. Apparently her family usually comes in the evening after I’m gone. From Ms. R’s sister I learned that she used to be a great cook. When I heard that, I paused, thought, then made a decision. I took a deep breath and just started rambling. I decided that since she couldn’t open up to me, or was unwilling to, I would talk to her about my life and see what happened. I told her about how I’m a newlywed and I’m just now learning how to cook because I never did much of it before. I told her about how I always eat Lean Cuisines for lunch because I think they’re good and they’re easy. I told her about how my parents were coming over for dinner the next night and I was going to be making them enchilada casserole and I was nervous.
Her eyes lit up. She asked me (or rather, wrote) all about the ingredients and how I was going to prepare it. I blabbed for awhile, and then at the end of our conversation she finally wrote, “I miss cooking. And eating.” And she looked up at me with her big, round, sad eyes.
Not many days later, Ms. R’s trach got plugged up deep inside and she couldn’t breathe. I’m so, so grateful that I was there when it happened because she was practically dying in front of me from suffocation. I couldn’t get anyone to come help, and I couldn’t suction it out myself. I had to call a code on her, which flooded the room with doctors and respiratory therapists and nurses. They brought her back, but we had to transfer her to the ICU. I sat down on her bed and told her that we were going to have to move her, but that it would only be temporary. Huge tears started rolling down her cheeks. She had been to the ICU before and she didn’t want to go again. I held her hand while she was stuck with needles and given breathing treatments and her bed was prepared for transport. I escorted her down to ICU and I promised her that she would come back to me soon.
She did. She came back the next afternoon, and ever since then she’s been improving. The amazing thing is that her cancer is gone. Gone. She’s still recovering from her chemo and radiation, but the cancer is gone. I was with her when her doctor came in and said, “This is the lady who USED to have nasopharyngeal cancer.” After three months, he had a 10-day plan to get her home.
Ever since then, almost every day when she sees me she’ll write, “Did you cook?” Most of the time I have to say no. I try to explain to her that I’m taking it slow, that right now once a week is about all I can handle. One day last week I got tired of disappointing her and I promised her I would cook the next day. The next day came around and David and I got busy and I didn’t get to start the meal until late. David asked me, “Are you sure you want to do this tonight?” I snapped, “You don’t understand. I can’t go back to work tomorrow and see the look on my patient’s face when I tell her I didn’t cook!”
I was off yesterday, and all this morning I was stuck in a computer class. I returned to my unit in the afternoon to help out. When I went into Ms. R’s room to give her some medicine, she SMILED. I mean a real, big smile like I’ve never seen on her face. We talked about where I had been, her plan for going home, and of course, cooking. She planned out my whole meal for me, and that’s why on Saturday we’re going to be having spaghetti and meatballs, salad, and garlic bread.