Gillian Graham ‘15

Posted: February 17, 2015 | Author: | Filed under: Writing Pieces | Tags: , , , , , , , , , , , | Leave a comment

Mr. W

“Patient assignments are on the charge board,” my preceptor chirped, “and you got a tough one!”

Dread. There were only two days of clinical left and I couldn’t wait to tick each one off the calendar. One obligation over. Final exams were looming, and I just needed to get through the next six hours so I could study. The dread deepened as I scrolled through pages and pages of notes. He was here for another amputation on his leg after a long history with uncontrolled diabetes. A visiting nurse had reported that his apartment revealed “possible hoarding.” I imagined a dark place full of old newspapers and cigarette smoke. He had come in to the hospital at 324 pounds. He had lost 78. I wondered how much legs weigh.

His nurse blew into the charting room. “Hey, kid. You got Mr. W? He needs his vitals and we’re in a fight. He won’t let me in the room anymore. Let’s send in the fresh meat, shall we?” I knew which room it was already. There were loud, beefy groans emanating from room 116. I tried to muster my best cheery nursing student facade, but it was a weak try.

A messy shock of white hair greeted me as I entered. He was a big man, but it wasn’t just flesh. His features were large, his head was large, his hands were large. His skin was pale and freckled with age spots. All of the fluorescent lights were on and the room was hot and stuffy and smelled of unwash. Two full urinals stood alert on his bedside table and one more, a little more than half-filled, lay on its side on his bed, with the lid on. The urine sloshed back and forth as he heaved himself closer to the edge to get a look at me. His sheets had brown stains and there were bits of yellow flaky skin in the pockets and folds of the blankets.

“Are you gonna tell me I have to bathe too? It’s not happening.” He was perched on his right side to avoid any weight on his left side, his bed raised higher than usual so his body was at the level of my elbows. Both of his hands grasped the right side rail and the bandaged stubs of his legs rested, one on top of the other.

“They washed me up yesterday. People don’t need to shower every day. Your skin dries out and then you itch and bleed and then that becomes another medical problem.”

He had a point. I tried to remember the last time I had showered. It was the post-clinical shower that was sacred. Peeling out of your scrubs and throwing them directly into the washing machine. Pulling the hair tie out and releasing a headache you didn’t know you had. Cranking the faucet with a screech and waiting for the room to fill with steam, then stepping in and letting the heat and pressure wash off the sweat, the who-knows-what, the sadness. A far cry from a tub of tepid water and washcloth.

“Well I’ll talk to your nurse about that. What about breakfast?”

“You have to check my sugar first, with the machine thing.” He looked down at me from his perch like a bird of prey.

I pricked his finger with the lancet and watched the small strip on the meter suck in the blood, digesting it and spitting out a number. 186. We’ll need some insulin. I wiped off his finger with a small square of gauze and held it in place for a second.

“I’ll be right back with the insulin. Can I get you anything else while I’m out there?”

“No.” He was looking at the ceiling, his neck arched and his eyes pointed upward as if praying.

After finding my preceptor, we headed to the machine where the medications were kept to check his orders and draw up the insulin. For a sugar of 186….2 units. My preceptor tapped the computer screen with her long, pink fingernail. Click, click. I found the two-unit measure on the syringe and drew an exact amount of air into the barrel before injecting it into the small bottle of insulin. I flipped the contraption over and pulled out the liquid, flicking the needle to get rid of air bubbles. For a second I felt like a real nurse.

Later, after he had polished the last dry crumb of French toast off his plate with his finger, I presented the idea of a bath again. His sheets clearly needed changing. The room needed fresh air and natural light. He refused my offer, loudly, forcefully. The PCA appeared in the doorway and reminded him that if he doesn’t move onto that left side his might get a sore, and sores can lead to infections, and infections can lead to surgeries. That there are consequences to these actions.

That seems to be the lesson up here on cardiovascular floor. I wondered how much of it is true. Do we blame these patients for their heart conditions and their diabetes because they are overweight and they don’t go running three times a week and eat more vegetables? But what of poverty, forcing people to make choices between vegetables and electricity? What of anxiety, depression, tragedy? What about waking up and realizing that you are a widower who no longer has a job because the economy tanked, and to numb that realization there are Oreos. And suddenly you have to give up your toe, and then your foot, and then both your legs. You are seventy-six years old and two small women in their twenties are telling you to roll over. You can feel their impatience. You can imagine their judgment. So you cling to the side rail, you assert you last small shred of authority and you refuse your bed bath.

His daughter came after breakfast, a middle-aged woman in a baggy sweatshirt and short curly hair. She put on the gown and the gloves with a practiced ease and stepped into her father’s room. Before pulling back the curtain, she turned back and smiled at me, apology in her eyes.

“You’re the nursing student? I hope he hasn’t given you too much trouble. He…changed a lot in the last few years.” She hesitated for a minute and then nodded, quickly, and to herself before she entered the room.

After an hour or so had passed she came out of the room. As she removed her gown and washed her hands, she started speaking, without looking at me.

“He took me prom dress shopping for five hours once in high school. We went to five different stores and I couldn’t find anything. He hated shopping and he sat there, looking miserable, but he never said anything about leaving. He just sat there, telling me I looked great.” She pulled a dry, coarse paper towel from the dispenser and the wet from her hands made a dark stain on the grey-brown paper. “He was a great dad.”

“I’m sure he was, is…” I smiled at her, but she was still wiping her hands, carefully examining her rings, and in between her fingers.

What had he looked like on that day in the department stores, surrounded by great swathes of pink and yellow tulle, bows and strappy heels? What had he looked like when he walked his daughter down the aisle? What kind of clothes did he wear? What had he loved?

He was whistling when I went back in, the practiced whistle of someone who knows music. The whistle of someone playing an instrument in his head.

“Are you a musician?” I asked as I straightened up his bedside table.

“I used to play. The saxophone. I was in the Navy band. We traveled all over, the Pacific, mostly, and the west coast. We were trouble.” He smiled. “The ladies knew to watch out when we were on leave. I was handsome then.”

“Do you still play?”

“Sometimes.”

I pictured him in his apartment. It wasn’t such a lonely place in my mind this time. Maybe it had a few plants. A cat. Stacks of sheet music. Some neighbors who stopped by to chat. I pictured him at home, his wounds healed and smooth, the stumps of his legs bobbing to the rhythm as he played his saxophone, his wild white hair swaying to the beat.

BIO: Gillian Graham graduated with an English degree from the University of New Hampshire in 2009. Fascinated by the intersection of medicine and the humanities, she went on to earn a degree at Columbia University in Narrative Medicine. Here at Yale, she is a co-founder of the YSN Narrative Nursing group with Rebecca Theise. She will graduate in 2015 as a Psychiatric Nurse Practitioner.

Gillian Graham ’15

Posted: June 19, 2013 | Author: | Filed under: Writing Pieces | Tags: , , , , , , , , , , , , , | Leave a comment

“Multiple myeloma is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow and often results in extensive skeletal destruction with osteolytic lesions, osteopenia, and/or pathologic fractures.” -uptodate.com

The sky outside my apartment window is alive with pink and orange clouds. I am at my desk, a textbook splayed open in front of me, notes with similar pink and orange streaks highlighting words like “infection,” “immunocompromised,” and “mortality” scattered in a semi-circle around me. It is the night before an exam and I am trying to learn everything about cancer by bedtime. Frustrated by how little I am retaining, I get up to make some mint tea and slip on the smooth wood floor on my way to the kitchen. Steadying myself, I think of those bright red, non-slip, scratchy socks I made you wear that morning in the hospital. As I wait for the water to boil, I think of you in your darkened hospital room and wonder if your feet are warm.

* * *

When I received my patient assignment the night before, the charge nurse happened to be sitting nearby charting. She snorted when I read it out loud. Great, I think, the day before an exam and I get the difficult patient. As I went through your chart my mood sank lower. You had been in and out of the hospital for the past 6 months, spending as long as 3 months in one stay. I will be up all night putting this picture of your illness together. I learned from your chart that you have multiple myeloma, cancer in your bones. Cancer feels like an illness that beds down in the soft, vulnerable parts of the body. Bones seem impenetrable, too sturdy and solid, fixed and reliable.

When I arrived the next morning you were still sleeping. The night nurse told me you were a 41 year-old male, two days post-op for the removal of nodules on your left lung, and you have a chest tube to drain the fluid. She said you were ambulating around with assistance, but that you refused to wear the socks, the red ones with the little grippy white dots on the bottom. You are a “fall risk,” she told me; your bones are fragile and if you fall on the hard, cold linoleum floor of the hospital they will most likely break. The cancer has weakened you from the inside out.

After report, I gathered a thin towel and a tiny bottle of shampoo for your bath and approached your room. It was still dark but there was a light on over your bed. You were sitting up in bed, reading the breakfast menu.

“Hi, my name is Gillian. I’ll be your student nurse today.”

“That’s nice. Will you help me to the bathroom?” I helped you sit up and supported your weight as you inched to the edge of the bed. I noticed that your feet were bare, that the red socks were balled up in an angry pile at the foot of your bed. I tell you that you need to put them on. “Oh, you too? Come on, it’s just five feet to the bathroom.” You were sullen and looked away as I worked the socks over your large, bony feet. Later, after you had eaten two pieces of dry French toast and a syrupy fruit cup, I set up for your bath. You asked to do it yourself, and your voice was gruff. I fumbled with the basin full of toiletries.

“Okay. Just call me if you need to get out of bed for any reason. I don’t want you to slip.”

“Enough with the falling already!”

For a while there were sounds of splashing and the occasional grunt as I hovered just outside the drawn curtain around your bed. Then suddenly a clatter followed by sharp curses.

“I dropped my cell phone. Can you come get it?”

Your gown was around your waist and your sheets were soaked through. There were soapsuds on your glasses and a washcloth threatening to fall from the edge of the bed. You refused to look at me. Grateful for something to do, I bent down to peer under the bed. But as I reached over to retrieve the cell phone, my foot slipped and I bumped the wheeled bedside tray table, sending it spinning towards the wall. Desperately hoping to stop it so the urinal perched on top wouldn’t fall to the floor, I lunged for the table, knocking over the chest tube canister in the process. I managed to grab the urinal, but everything else — your glasses, the plastic container of ice, the menu, and your books, rained down on top of me. You looked down at me, desperately trying to right the fallen, tangled chest tube with one hand, steadying the table with another, and you laughed.

“First day on the job?” You snorted and cleaned the soap off your glasses, clearly satisfied with my demise. Then you looked at me slyly. “Or were you sent over here to prove to me just how slippery the floor really is?”

“Oh, you’re a funny one.” I gather the fallen items and pull myself back up to standing.

Once the room was straightened out, you showed me how to hang the canister from the side of the bed so it doesn’t fall. You let me wash you, change your sheets, and massage lotion into your skin, loosened from all the weight you’ve lost. You showed me your sketchbook, full of distorted monsters and intricate battle scenes, light and dark fighting for control over the smooth pages. We talked about a show we both saw in New York and you seemed pleased that I’d heard of some of your favorite painters. I learned that your brother had cancer too, but he refused treatment because of something that happened in Vietnam that he never talked about, something to do with hospitals. He died last April, and you think he was more courageous than you, that these constant hospitalizations are killing you faster than the cancer. You told me to study hard in school, that if I can figure out how to give a bed bath without trashing the place, I might make a halfway decent nurse. When I came in to say goodbye, you were napping. You had your socks on.

* * *

The rising shriek of the teakettle brings me back to my chilly apartment. I pour the steaming water over the tea and return to my desk and my notes full of unlearned material. “Oncological emergencies: hypercalcemia, spinal cord compression, superior vena cava syndrome.” As I stare at the book I think of your skin, mottled with freckles and the occasional stray hair, you back whipped with a scar from your recent surgery. Even now, so soon after caring for you, your face is blurred in my mind. But I think of my hands, how they know what it feels like to rub lotion into your back and shoulders. How they now know how to hang a chest tube from a bed so it doesn’t fall and get tangled, how they know how to support you under the armpits and hold your gown closed in the back while you walk around the floor. Those memories are tucked into my bones, into the soft, spongy places I now know exist at our very core.

Gillian Graham graduated summa cum laude from the University of New Hampshire with a degree in English before attending Columbia University for her master’s degree in Narrative Medicine. Before coming to Yale she worked in the field of Narrative Medicine, researching the ways in which the arts and humanities can enhance nursing education, and helping to develop an interprofessional education initiative at the Columbia University Medical Center. She came to Yale as a GEPN in the fall of 2012 to pursue a career as a psychiatric nurse practitioner.