I was a first year nursing student.
It was my initial week of clinicals – the first week of hands on, with patients, putting into practice what we had spent a semester learning time, in an actual hospital.
Like most things, the lessons to be learned that day could not be found in a book.
The hospital was old. The urinals, bedpans, and emesis basins were all metal, and had to be rinsed out before going down to soiled utility.
Our instructor gave us our assignments. We eagerly walked toward our patient rooms, ready to be the nurse, fresh white scrubs clean and pure against the dingy hospital walls.
As soon as I walked in my patients room, I immediately knew she was dying.
There is an intrinsic “knowing” that can’t be explained. We had not studied death and dying yet, and I had never been around anyone who was dying.
Yet I knew as I walked into that semi-darkened room, I knew that my assignment for the day had nothing to do with assessing vital signs, and everything to do with assisting a soul.
I greeted her warmly by name, telling her my name, and that I was going to take care of her today.
She looked at me with huge, pleading eyes. She could not speak – she already was past that point.
My mind scrambled, trying to process in my head the thoughts that were behind my kind smile and murmuring words.
In report, I had learned that her husband had just left to go get a haircut. I remember being told he had stood by her side since her recent admission, and was finally taking a break.
I knew she was going to take this time to spare him having to see her transfer her citizenship from earth.
I looked over at the closed curtains, and briskly strode to them, snatching them open, leaving the sheers to filter in the bright morning sun.
Turning back to my patient, I did my head to toe assessment efficiently, noting she was quickly becoming soaked with the intense sweating called diaphoresis that comes before the final breath is drawn.
I clasped her hand, and she looked at me with an intensity that shot to my core. “Ma’am” I said gently, “let me go get you some clean bedding. Let’s get you dry and comfortable! I’ll be right back!”
I swiftly dashed out the door, around to cleaned utility room, and grabbed fresh sheets, towels, and a gown.
I wasn’t going to let her die in a puddle of her own sweat.
I returned to the room, and set the bedding down. “Let me get you dry and comfy” I said, as I placed a draw sheet over her, and began to unbutton her gown.
Slowly, but with absolute purpose, she brought her right arm up, laying her bruised and pale hand over the place where her right breast used to be. I stared into her eyes and nodded. “Don’t worry” I reassured – “I’ll keep you covered.”
I methodically went about changing her soaked gown under the draw sheet, ministering to her dampened body with warm, dry linens. I had a fellow student help me change the bedding, gently rolling her to and fro as we went through the basic bed making lessons we had learned. My helper left the room, and I turned my attention back to those pleading eyes.
I held her hand in mine. “Look what a beautiful day it is!” I smiled gently into her now terror filled expression. “It’s going to be okay – look at that sun shining in here!” I leaned in closer, whispering now in her ear. “It’s okay – if you want to go, you can, you know!”
It was like a switch turned. Her hand fell limp, and I tucked it under the crisp sheet. Her head moved just enough for her eyes to look toward the window, and immediately I saw the beginning of the change in her, one that would lead to the final outcome.
My heart raced, and I had a moment of panic. I cracked the door and called for a couple fellow nursing students, intensely whispering to them that I needed to step out for a second and get a drink of water, and they silently came in, standing on either side of her, murmuring words of comfort as they clasped her hands.
I made a bee line for the water fountain, gulping in water, and taking a couple of deep breaths. Had I done enough for her? Was I prepared for this?
My instructor appeared suddenly. “Get back to your patient” she snapped militantly.
“I didn’t leave her alone. I just needed a moment”. As I looked into her face, I knew she had given me this assignment today, knowing full well the probably outcome.
Resolute, I stood tall and walked past her, back into my patient’s room.
Now my patient was transformed, her breathing haggard and irregular, in the Cheyne-Stokes pattern that comes shortly before the final breath. My eyes darted back to the door frequently, looking for the return of her husband, lest he come in without knowing what what happening. I held her hand in mine, silently praying.
Then she was still.
I put the stethoscope that was stiffly hanging around my neck into my ears, and confirmed what I knew. I stepped out and asked the charge nurse to get the doctor.
He came and listed to her chest as he felt her wrist, and pronounced her deceased.
My fellow students and I straightened her hair, placed her arms gently at her sides, smoothed the blanket, and exited the room.
I positioned myself outside the room, perched on the edge of a chair, and waited for her husband.
Within minutes he came striding up the hall, eyes on her door.
I stood up and walked to him before he could get to the door – “Sir, the doctor needs to speak to you!”
And we stood in silence while the charge nurse got the doctor.
I don’t remember what happened next, because my caregiving for this situation had come to an end, as we were leaving our clinical assignment for the day.
As we walked out of the hospital to go to our cars, arms laden with notebooks and flash cards, I reflected on the day.
Her last purposeful movement was to bring her right hand up and lay it over the place where her right breast used to be.
This one, slow movement taught me more about breast cancer and it’s effect on the psyche of a woman’s heart, mind, and soul than any textbook ever would.
Or could.
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