There are times when I tell myself I should write about the lives I see in the ED, different presentations, family dynamics, stresses, but I never feel my words will do any justice, that the full story will not be told, so I don’t bother, because after a 12 hour shift I don’t have energy to try. And there are so many days when I turn my emotions off, push things aside because I can’t attach, I can’t cry, i just have to keep moving forward. Every nurse does it, it’s our way of coping.
But this time, today, I want to remember this. And I am crying.
This morning I cared for a patient with end stage Multiple Myeloma (MM). I cared for him months ago, but of course, never bothered to write down the effects he had on me. A former strong athletic father, husband, and ICU nurse who now has been beaten down to skin, bones, and pain. All by cancer cells, like the ones in the photo above, stained beautifully for your eye to see. I found a photo of the cells because I can’t show you the accumulation of those cells, the many other cells that make up a young man with a beating heart, and a wife that cared for him 24/7 since his MM diagnosis five years. There is nothing beautiful about the effects MM has on the body, making bones brittle and likely to fracture, susceptible to any all all bacteria (and on this morning necrotizing faciitis). But there is something beautiful that I witnessed in the wee hours of this morning about the hearts of those that care for family and friends with cancer, and the very people that struggle with cancer itself.
This wife had an incredible sense of spirit, trying to find joy and laughter in all of this pain. And this man was giving every ounce he could to hang on. At one point I was trying to look at all of his wounds, his back covered with sores and ulcerations because he moves side to side so much, never comfortable and never pain free, and no fat or muscle to provide a barrier or cushion for his bones. His wife looked up and said, “I never thought I’d have someone who looked like a concentration camp victim living in our home. Even when we’re admitted to the oncology floor, no one looks like him. People are bald, or just starting chemo, or puffy from steroids, but no one looks like him.”
I felt the air go out of me. What do you say?, because nothing you say will be enough. This is a man I could lift up in bed by myself. That was delirious from pain. This was a man I had had full conversations with last time I cared for him.
I was surrounded by all the Western medicine devices and supplies I could possibly ask for, but I wasn’t equipped with a response that seemed worthy enough to quench any level of her pain.
And then luckily, she said “What’s that on the floor?” A thin turquoise strap lay on the floor at the base of the gurney. “Oh it’s my bra strap!, she said laughing. I said I thought it was one of our tourniquets and I almost threw it in the trash. And then we laughed together, in all the ridiculousness of the moment, and the culmination of their suffering. And we both said we needed a good laugh.
I found out he passed away around noon today in the ED, with family by his side. I hope that it was peaceful, as peaceful as it can be in the ED. They opted not to have emergency surgery for the necrotizing faciitis, a procedure he most likely would not have made it through.
And now I wonder if his wife is at home, in an empty house. While I sit in my kitchen and write this while John is at work. I think about how quickly the course of lives can change, for better or for worse. And how important it is to love, to care. Sometimes I wonder if I made the right choice to be a nurse. Sometimes I think it is not something that “comes natural” and I really have to work at it. But it’s times like this that I hope I made an ounce of difference. I feel blessed to be a part of such intimate moments in life, in death.