I’m sure you’ll be surprised when you read this. There’s a chance you may not even remember me, and I get that. I’m a nurse, too.
For you, it was another weekend shift in the ICU at Kaiser West in Los Angeles. For me, it was the weekend I lost my mother. This is how the two came together.
I got a call from my brother, Rob, on Saturday “Beth, Mom’s in the hospital. On a ventilator. She doesn’t look good.” By the time I got to the hospital, my eighty-nine year old mother with advanced Alzheimer’s disease had a nasogastric tube (NGT), a foley, soft wrist restraints, propofol drip, central line, was intubated, on a ventilator, and was unresponsive due to sedation. They had turned her into That Patient. You know.
None of this was supposed to happen … mother had long ago made her wishes known. Papers had been signed, witnessed, notarized…but there was a mis-communication between the facility where she lived, and the ambulance…and now, well, here we were. It’s faster and easier to intubate than to extubate, we soon discovered.
As soon as I took it all in, at a glance, the ventilator setting of assist control with a rate of 14 (but noted her respiratory rate was 18-20), the white liquid propofol being pumped into the right internal jugular vein (IJ), the foley with scant cloudy amber urine, the urometer looking like an oversized, silly, container holding all of 30 cc (her output for 6 hours), and angrily noted the (necessary, I know) wrist restraints…
Anita, it was you I looked for. Her nurse. Who were you, this person suddenly assigned high importance in my mother’s life? Were you competent? Kind? Could we trust you?
Why can’t I be the nurse? I want to be the nurse! I want to be in control, not a mere visitor, dependent upon a complete stranger to be kind, and to treat my mother well. [Tweet “Wait, no…I can’t be the nurse, I’m the daughter.”]
I’m big on first impressions. My first impression of you was a good one, I was relieved. I took in your appearance- short brown hair, young, reserved manner, beautiful fresh skin, no make-up, a gray spandex athletic sleeve (that I admired for its functionality) which perfectly matched your gray scrubs, that you wore on your right tattooed arm.
Calm and soothing. Talking whilst skillfully gliding around the bed, hanging some fluid here, changing some tubing there. Like a choreographed dancer, performing a dance you’ve danced many times before. And all with exquisite composure. With a quiet presence that belied your years.
How long could you possibly have been a nurse? I wondered. Not so long. But it was clear that you were comfortable and confident. Something you did especially well was first listen, and then talk. Thank you. You parceled out information to us in bits, precisely when we needed it.
I looked up at the white board to see a description of Mom’s skin- a stage one on her backside (blanchable, you explained. Probably reversible, you’d keep an eye on it, you said). A two-person, full body skin assessment had been done at point of admission. My confidence was rising.
Good. They have high standards here. I looked at the padded heel protectors already in place (to float her heels, you explained. A red spot was noted, you said). You were very attuned to what I was looking at when, and what I needed to know.
You knew the story from report, that the family wanted her extubated. You told us that you had called the intensivist, and that she’d be here soon. I didn’t believe that (the “soon” part), but, amazingly, she was, within fifteen minutes.
Dr. Kim gathered information from us…told us what it means to extubate…that Mom may die, but promised us she’d be kept comfortable. Said she’d leave us alone for a few minutes to think about our decision. She was very professional, and she did a thorough job of explaining the risks, alternatives, and what to expect.
The Respiratory Therapist, Kathleen, was in the room with us almost continuously. Kathleen was bubbly, friendly, and knowledgeable. She was chatty with me, which helped to normalize the surrealness I was experiencing.
I tend to prattle when I’m nervous, or feeling needy, and Kathleen kept pace with me. I went from joking one moment, to crying, to nurse- analyzing the next.
Every person we met at your hospital was professional, including the registration clerk who came in briefly.
But Anita, it was you, the nurse, who coordinated everything and everybody. The others came and went, making their professional contributions, but you stayed. You had one dedicated job-your patient, my mother, and her family.
The extubation went smoothly. You were there, ready with the morphine. Except that I cluelessly stood between you and her IV site, but you got me to move, tactfully, without making me feel in the way. Or stupid. Kathleen expertly suctioned copious amounts of secretions.
We all watched the screen as her 02 sat briefly dropped down to 65%. Kathleen asked if it’d be OK to put her on a non-rebreather. Of course, yes, please, thank you! Mom soon settled down and her resting respirations were an even 18, with a reassuring O2 sat of 96%.
“Let’s take the NGT out now too, OK?” you asked, staying one step ahead of me, before I had to ask. Relieved, I said yes, and you deftly removed it and untied the offensive wrist restraints, all in one smooth motion.
You waited until afterwards to ask all the tiresome questions required for every new admission. “I’m sorry,” you apologized, “but I have to ask.” Yes, I know. Regulations. How can we best meet your Mother’s learning needs? Did her second cousin or hair stylist ever have malignant hyperthermia? (just kidding, Anita. A little nurse humor)
Any dietary needs? (Yes, a nice chilled glass of Chardonnay with dinner would be great. Napa Valley). But you made the process fairly painless.
Later, when it was clear that Mom was stable and resting, and was safe in your capable hands, I felt comfortable enough to leave. Walking out, I stopped near the nurse’s station and hugged you. Out of gratitude. You were surprised (I could tell you’re not touchy-feely, I’m not either, except when I’m emotional) but then you said those simple words “I’m back tomorrow.”
Words of reassurance. I slept well that night, until around three am, when I called and talked to Jason, the night nurse. He was informative, nice to me, and equally on top of things, I could tell.
Despite the successful extubation, my mother died when her heart again went into a lethal arrhythmia. This time, she was not resuscitated. It was her time to go, and it was a blessing. A loss, and a blessing. Now she can no longer continue to sink deeper into the abyss of Alzheimer’s, confusing her daughter with her sister, her son with her husband, and being held hostage by imaginary people who come in the night and steal her things.
Rest in peace, Mom.
Anita, you bore witness to some intensely personal moments in my life. We will probably never meet again. As a nurse, I’ve learned that I’m not always aware of the enormous impact I have on patients and families…Anita, maybe you aren’t, either. Keep your sensitivity.
Thanks to you, I got to see from the other side the best of what we nurses do. You reminded me again how important nurses are, that we’re the glue that holds the care together. The orchestra conductor. The quarterback.
Thank you, Anita. Thank you, Kaiser West
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Until next time friend,