Bless your heart buttons...

Back to oncology this weekend. I had picked two patients on Friday- that one of the AM RNs said would be around for the weekend. One had INR issues and the other was supposed to have a chest tube inserted so she assured me they wouldn't be discharged. I prepped on both and discovered they both shared virtually the same diagnosis...malignant cancer of the lung. One had a stage IV pleural effusion that needed to be drained. The other was coming off chemo with a persistent fever of unknown etiology and needed to be stabilized before his next round of chemo.

After prepping on my patients, I knew I was going to learn a lot this weekend because one was a retired health care professional in a specialty that involved his own diagnosis, and the other was an independent retiree who reminded me of my dad. Nothing was keeping "my guys" down. They had loving, well educated spouses who had been married to them for over 40 years. One of the spouses was a retired ICU nurse and the other was a fireman's wife.

These men both enjoyed long fulfilling careers in their fields. They were fighters through and through. The medical guy knew exactly how things were going to go for him and he taught me a couple things I'll never forget about respiratory assessments particularly. For example, he suggested that the best way to ausculate the lung fields is from the back side and if you ask the patient to say the letter E with each field through all the points of ausculation..and it gets to a point where the E sounds like an A...that's the point of effusion in the lungs and you can mark it with a pen. Since he had a chest tube inserted, I got him out of bed and tried this technique. My care nurse and I were both amazed that the E does sound like A..and we didn't need an X-ray to know where the effusion was in his lungs.

It is difficult to explain what it means at the end of the weekend when you are either discharging your patient home to an uncertain future of months or days or whether you leave them not knowing if they will be back next week because of an infection or recurrence of their symptoms. I always try to say goodbye to my patients because the time spent changing their dressings, assisting with personal care, medicating them, injecting them or teaching them something important about their care, is a time when a bond of trust is established. I feel the same way about the families who stay with them. When I left Sunday night, I knew my 'teacher' wouldn't be there the next day. He made eye contact with me, wished me well with nursing school and we bade our farewells...he might be back soon because his diagnosis is terminal, but knowing him, he will prefer to be at home when that time comes. It's the kind of person he revealed himself to be and I was certainly humbled by the inherent dignity our patients possess when they are the most vulnerable to us as nurses. I was able to medicate him, obtain cultures, humidify his oxygen and change his chest tube dressings. The best thing I did for him however, was switch out the remote control on his television set. He went a whole week waiting for one. Mostly, nursing is about listening. I haven't always been a great listener...because I like to talk. I am learning to be a better listener.

One LOL (little old lady) was on my unit this weekend with an acute bout of pancreatitis. I could read the body language of her son, who was irritated to be summoned to the hospital and it made me mad because he wanted nothing to do with her. As I took out her IV, she rubbed my arm and said "Bless your heart buttons." She was a dear. As a total stranger pulled up in the Lexus SUV to pick her up to take her back to the board and care home; they wanted us to scratch off the prescriptions we transcribed and phoned to the pharmacy, because they didn't want to pay for them. I knew the sweet LOL wouldn't be getting half the medications the doctor ordered for her because they owner of the board and care wouldn't pick them up at the pharmacy. As she waved good bye to me...I wished in my heart that her son would care enough and that she would never realize that he didn't. Bless her heart...sweet little button.