Storms

There are storm clouds on the horizon as I drive back into work for the second time today.  They are dark and ominous.  They match the way I feel right now.

This is the worst part of my job.  I love visits where we get to hear the heartbeat of a healthy baby for the first time as a young woman realizes that she will become a mom.  I love well child exams that come with the excitement of a new school year or an opportunity to play sports.  I even like it when there is something I can do to fix pneumonia or a sore throat.  I don't like this.  This feels........ichy.

I had asked the nurses to notify me when her family arrived.  I didn't want to give her news like this without people she loves at her side.  I got the report late the day before, but waiting until today would not make a difference.  Not in this case.

I didn't expect to still have her in the hospital.  I was sure I would have had to send her emergently to a bigger hospital during the night due to blood loss, but she became stable and was able to stay here.  People continue to surprise me.

She is 90+ years old and maybe all of 100#.  She is as mentally sharp as a tack.  I stop at the nurses station and collect the paper chart.  I don't bother getting my white lab coat --- she knows who I am.  Carrying the chart next to my chest like a life preserver or maybe a shield --- I enter her room.  Her husband and daughter watch my every step.  They know they are here for test results and that there is a reason I have asked for them to be here.  I have their full attention.

I start with what I know for a fact:  There is an infection.  Then I move into what I deduct from my years as a nurse and y training as an advanced care practitioner.

It seems an odd place to be --- as a nurse practitioner, I mean.  You still maintain a nursing license, but then go back for more classes in advanced pathophysiology, research and coding and you come out as something that resembles a doctor, only different. and not the same as a nurse.  We replace no one, but compliment both fields.  Tonight, no one wants this job of giving this news; not even me.

As I discuss the test results, I frequently look back at the paper.  I don't want to mis-speak.  The other reason is that the bravest person in this room is the person who is dying.  I try and give each person here direct eye contact unpreferrentially and when I am done with all that there is on the paper there is a pause where no one speaks.  Then it's the patient who breaks the silence.

"Well, I have lived a good life.  I have children and I have grandchildren.  I have seen things.  I have loved and I have been loved.  If what you say is true, then I am ready."

There is no sadness in her voice.  There is no regret.

I look from the patient, to her husband.  They have been married many, many years.  There are tears in his eyes, but he will not let her see them.  This is not how he thought it would go and he is not sure how it can be possible that he will have to exist without her.  Yet, he doesn't try to get her to agree to a surgery or intervention that I know she would not survive.  He can see how brave she is and I think to myself; she is the strength that her family was built on.

As I leave the room, I wonder if I will be able to be as strong as this amazing woman.  I think about how it is not the good and easy times in our lives that defines us, but the hard ones.  The storms that come our way will serve to test us and reinforce our roots so that we can survive the next ones; or not.

I return the chart to the nurses' station and leave the hospital through the emergency room entrance.  All the ER rooms are full down here which means I will probably get called in again before the night is over. 

I walk outside and into the parking lot as the rain begins to fall.

~ June 2016