Sunday, May 9, 2010

My most memorable patient

When I was in nursing school and in my pediatric rotation, I took care of a teenage boy who had been sent to us from another hospital. He was a cute kid, moody as hell, screamed at the nurses and refused care constantly. Slept most of the day and was basically every nursing student's living nightmare.

Here I was, barely a year into nursing school and in one of the hardest quarters of the program (my peds teacher was the only one to ever make me cry). I get my assignment for the day and as I'm researching my patient's chart I discover this kid had an osteosarcoma of the femur. He had been through a battery of surgeries including removal of a large portion of his femur with a titanium implant to replace it. Multiple rounds of chemo with countless hospitalizations from the side effects and neutropenia and after all of that landed in the hospital because he had gotten an infection in his mediport.

The poor kid had survived well over a year in his battle with cancer and at this point was waiting to hear if he was tumor free. Just as he thinks he is done and ready to go back to school he gets knocked down with a massive infection in his mediport; a staph infection that had spread to his blood.

At this point, it's barely 7am in the morning and I have to go in to do my assessment.
I quietly crept up to him, nervously shaking him awake. Within seconds I had a swinging, screaming teenager demanding that I, "leave him the f*** alone." Yeah, it was not fun. By 7:30am I was ready to pack up my stuff and forget nursing school completely. I spent the rest of the day hiding from my teacher, in hopes that she wouldn't discover I was hours behind on my assessments and charting.

That day was hard because it never really got easier with him. I watched as people would go in and tip toe around him, trying to find a way to actually provide care without pissing him off and causing a huge fit. As I sat back and watched people interact with him and how they talked with him and his family, I started to notice a trend. Everyone was treating this kid as if he was already dead. They were afraid to be stern with him because they pitied him. When they saw him, they didn't see a teenage boy, they saw a kid with cancer who was dying and you know what? I think he saw it too. He knew that he could get away with being awful to people because, well hell he had cancer!

I made it through that day and the next morning guess who my patient was? Yup, that's right. Despite the charge nurse's request to not have students take him on anymore, my teacher pulls me aside and says, "I think you handled him very well yesterday and I think it'll be good for you to take care of him again."

Are you kidding me? What PLANET were you on? But I wasn't about to argue with the person who had my grade in her hands, so off I went. This time was different though. I walked into the room, turned on the lights and said, "Good morning!" nice and loud.
Just before he sat up and was about to begin telling me off up one side and down the other...I cut him off. "Ok, here's the deal. I know you're tired and you're sick and miserable and you just had a crap year full of chemo and cancer, but you're in the hospital because you need our care. I know the last thing you want is to deal with a pain in the ass nurse all day so here's what I'm gonna do. I have to give you medications around 9am. It's 7am now so I will come back at 9am to give your meds, do your assessment and take care of anything else I need to. After that, if you want to eat lunch...great. If not I will see you at 1pm for my afternoon meds and check in. Other than that you can sleep all day. Deal?"

He was stunned. I knew no one had talked to him like that in a very long time and I think, despite his shock he actually appreciated being treated like a normal teenager for once. "Sure, whatever." he says and he buries his head back under the covers.
I take a deep breath and head for the door.

The rest of the day was completely different. He was up waiting for me at 9am and stayed up for the rest of the day. His mom came to visit that day since his dad was busy and the three of us sat and talked about what the past year had been like. He told me all about his rounds of chemo and the horrible side effects he got. He told me about the day he shaved his head and how people reacted to him at school. He joked about how he used his medical ID card as a way to get what he wanted. "Every time my mom says I can't do something I just throw this at her and say, 'CANCER CARD' and I eventually get what I want." he smirks.

We discovered we used to live in the same area and we talked about our favorite spots in the downtown area and how much we loved that town. He told me about his girlfriend and how he was so happy to finally be done with chemo because they had their Sadie Hawkins dance coming up in a few weeks. He hadn't been able to go to any of the dances this year and this would be one of his last chances since he was a senior now. I could hear the sadness in his voice as he shared about the sports he used to do and how he was the captain of the track team and had been on varsity soccer since he was a freshman.
I saw him laugh and joke and smile through the endless shots and IV's I gave him. He even tried to use the cancer card on me once.

"Haha nice try buddy!" I smiled.

At the end of the day I was able to discharge him home. He was lucky enough to have insurance that covered at home nursing care and IV antibiotics at an outpatient center. We gathered up his things, changed the needles on his mediport and gave him and his mom all the instructions he needed for at home care of his IV's. And then I'll never forget what happened next.

He stood up and hugged me.

"Maybe we'll see you around downtown sometime?" he said.

"You bet, kiddo." was all I could mutter. The lump in my throat was already welling up.

Then I watched as he grabbed his things and began limping down the hall. At the time, I had no idea we were supposed to walk patients out in a wheelchair and I had actually never seen him walk. I had no idea he had a limp, but it made sense. He had part of his LEG removed. Then it hit me like a ton of bricks. Here is this seventeen year old boy. Popular, cute, athletic...and in an instant had his whole life...his whole identity ripped out from underneath him. The normal angst and drama of being a teenager was replaced with cancer and hospitals and fighting for his life.

He looked back, smiled and waved. As I watched him turn the corner, my chest tightened and uncontrollable tears began streaming down my face. The gravity of what I had just witnessed absolutely floored me. The vulnerability he had shown and the absolute blessing I had of sharing a mere 2 days with such strength and hope was moving. The resilience of the human spirit was shown to me that day in the form of a young boy who had overcome so much. I doubt he will ever know the impact he had on my life, but at that moment I knew, without a doubt, I loved being a nurse.

I still think about him often. I pray for him and I hope, wherever he is that he is healthy and happy and living life to its fullest. And I only hope that someday I can touch someone else's life the way that young boy touched mine.

1 comment :

  1. I've just discovered your blog, and as a new student (starting in a month) I only hope I can have the good sense to stand back and assess patients like you did. I bet you made an impact on this kid too, more than you realise. All the best :)