I Love You

Our class waited patiently to find out our next clinical assignment. We successfully completed our clinical in long-term care and the consensus was that most of us would be just as happy never setting foot into a long-term care facility again. As eager as I was to forget my experience, I don’t think I would ever forget the rancid smell of urine that would greet my nose when I walked into the building in the morning. I made a vow to myself that I would never let anyone in my family ever set foot in one of those places.

When the instructor walked into the lecture hall, all 48 students’ eyes lifted to look at her. We already lost two students that dropped out feeling the work of careplans prior to each clinical day was “ridiculous, extreme, and bullshit!” In her arms she held our next assignment. My stomach rumbled, the nervous feeling encountered with every morning of clinical reemerged at the simple thought of a new instructor and a new clinical site. As she passed the list around, Lisa, Tracy, and I crossed our fingers in hope that we would be at the same site. I met Tracy in microbiology class. She joined Lisa and me in our study sessions and the three of us had been inseparable since. We held our breaths as we peered at the list. My heart sank when I saw Lisa’s and Tracy’s names together, but not with mine. In the row below me, Sherry and Page were smiling, as they were also together and there was my name right below theirs.

Before I started the nursing program, I would see Sherry and Page on campus. They were always together, off studying in a private corner in the library or having lunch on the lawn. I wondered who they were and what they could possibly be studying because they always seemed to be there. When it turned out they were in the program with me, my curiosity of them infected Lisa and Tracy.

The three of us would go from studying to gossiping. We would make bets on the nature of their relationship. Were they in a relationship, lesbians that pined for each other in the night, or just friends with an equal ambition to succeed? Regardless of their relationship we found it quite odd as looking at them they were about as different from each other as night and day.

Sherry had brownish hair that was highlighted with blonde streaks. It was styled in a wild fashion making any order to it indecipherable. Her face yielded a different pair of glasses every day depending on the outfit she was wearing. Her bright red lipstick was never amiss. Some days she would come to class sporting a classy jogging outfit with matching shoes and other times she would come in a tight fitted low cut blouse. Every bit of eccentricity that Sherry flaunted Page would conceal.

Page was very conservative. Her dark brown hair cut above her shoulders was styled the same every day. Like a porcelain doll her make up was flawless, very natural and clean with just a hint of color high on her cheekbones. She dressed in a preppy fashion, getting her clothes from Ann Taylor or Banana Republic. She was fashionable in a business casual sense with her Dockers and slacks matched with sweaters and shirts that were not too tight fitting nor revealing in any way. Where Sherry wore bright, flashy colors, Page wore neutral and black. Where Sherry wore high heels and boots, Page wore casual loafers. Not one aspect of each other’s fashion sense matched the other.

My clinical rotation, shared with these two mystery women, was at a small community hospital on the orthopedic floor. As our rotation got underway, I got to know these two women on a more personal level and slowly the mysterious walls between them and my study group came down. It was hard not to get close to those around you as the stress and difficulty of program was so intense that you relied on each other for help, guidance, and support. As I got to know them I found that their differences did not end with their appearance. Sherry from the south side of Chicago had a typical south-side accent. She was loud and boisterous in her words and actions. Often stories told by Sherry were exaggerated to the point that there was a fine line between the truth and fiction and distinguishing between the two was difficult. Page on the other hand was more reserved, slow and calculated in her decisions and actions. If they were in modern political arena their opposition could be compared to Jim Carville and Bill Frist yet their friendship was strong.

It was our second week of clinical when I encountered my first death. As always I was sleep deprived. I envied Lisa who could complete her careplan half-assed or not complete it at all and still sleep soundly. My warm bed was calling me. It was midnight yet my work was not complete. As loud as the calling was, I knew that going to bed before I was done would leave me in sleepless sleep. Since I was a child, I was always one that would have to have my homework complete before I went to bed for if not my sleep would be fitful and restless in worry. So at 2am and a half pot of coffee down, I finally finished and could sleep for two and a half hours. It seemed like so little time yet I was still grateful for it and even with the caffeine was able to fall asleep quickly.

My patient was Edna Harris, a 78 year-old African American woman admitted with a fractured hip. She had a hip replacement a week earlier that was complicated by a blood clot in her leg that traveled to her lungs causing a pulmonary embolism or PE. Once a blood clot lodges in the lung all oxygen exchange past the clot ceases resulting in reduced oxygen saturation and a reduction of oxygen supply to all organs. Depending on the size and location of the lodged blood clot a PE can be fatal. For Edna, it would be, for her PE was also complicated by a chronic lung disease.

The PE coupled with her chronic lung disease left her gasping for air. Over the night her oxygen saturations dropped requiring an increase in her oxygen mask. Her two daughters, Ellen and Sierra, were at her bedside throughout the night.

The next step for Edna would be a breathing machine, however, I knew from my research that once on the breathing machine, getting Edna off of it would prove nearly impossible. The lung doctor that spoke to her daughters about her treatment urged them to take this route. Both Ellen and Sierra knew their mother’s wishes and opted to make her comfortable and refrain from any heroic measures. Working closely with Edna’s nurse I did my best to make her comfortable. Her nurse hung the Morphine drip and when her breathing eased up a bit Ellen and Sierra went to get some coffee. I prepared to give Edna a bath as her skin was flaking but her gown was damp with perspiration.

I started with her face, wiping the beads of sweat off of her forehead then moved down her neck and around her ears. Edna must have taken comfort in that. I could feel the tension in her neck release as her head tilted back and her eyes closed. I carefully wiped down her body not only cleansing her skin but also refreshing her body. It was cleansing the skin that left me bewildered. The used washcloths piled higher and higher and higher at the end of the bed as I continued to stroke her skin.

Page poked her head in to see if I needed any help and when I asked her for more washcloths her face gave me a look of puzzlement. I poked my head around the curtain and whispered, “I’m trying to get her skin clean. Every time I wipe her the white cloth comes back dirty.”

Page, so sweet in her response, was careful not to make me feel stupid, “Hope. The patient is black.”
The rationale not sinking in I responded, “I know and she is dying. I want her to be clean and comfortable.”

Page gave me a smile. “Hope. She is black. The discoloring you keep seeing on her wash cloth are her dead skin cells not dirt. You cannot see dead cells of white people because they are white.”

I quickly closed the curtain on Page. I could hear her chuckling as she walked away.

Feeling really, really stupid I thanked the lord in heaven that it was Page who came in and not my instructor. I hastily dumped the dirty wash clothes into the dirty linen bin, getting rid of any evidence of my stupidity before either my instructor or Edna’s daughters returned.

I finished up Edna’s bath and gave her a new gown. I was about to leave to find her daughters when she grabbed my hand. Her fingers were cold as they enveloped my warm hand. If she could have spoke or whispered she would have said, “Thank you.” Instead she mouthed the words to me as any effort to speak stole oxygen from her body.

Ellen and Sierra returned from lunch and with them brought some friends from Edna’s church. I left the room to give them privacy. At the nurses’ station I reviewed Edna’s chart and lab values from the morning. From my chair at the station I began to hear singing. Originally sounding like a chant, soft and sweet but then building in intensity, the sound was comforting and beautiful.

Following the sound, I walked into Edna’s room to find all six women holding hands around Edna’s bed. They were singing Amazing Grace in a gospel-like melody; each woman was in tune with the others. The song never sounded so beautiful in all the years of my life. Sierra saw me gazing in and motioned for me to come join them. As I joined the circle, each of my pale white hands were enclosed by a black hand and accepted as if there were no difference at all. They continued their singing and picked up the beat. One side of the room started tapping their feet as the other side clapped to the tune, and all of their heads bopped to and fro to the beat of the music. I never heard such a melodious sound without instruments and being in the room I couldn’t help but get sucked into the sound. Forgetting my surroundings my hands clapped with them and my body moved back and forth with the sound of the music. Five of them sang the chorus while the eldest in the group yelled, “Sing it sister!!” When the song ended, I was brought back to my surroundings, smiling and invigorated I looked at Edna and her face looked angelic. Her eyes were closed but a faint smile was on her face. Her respirations were less labored and instead of the pallor color that was present earlier a pinkish tone resonated from her face.

I left clinical that day feeling good and I hoped that when I returned tomorrow that Edna would still be with us. The Harris family inspired me to be more spiritual and although this spirituality would not last, I prayed that night. I prayed that Edna would make it another night and that her final moments whenever they should come would be peaceful for her. I prayed also for her daughters who had the courage to make such a difficult decision to honor their mother’s final wishes knowing that those final wishes would end in death.

The next morning I arrived on the orthopedic floor a little early. I was eager to see if Edna made it through the night. Rushing into the hall I nearly collided with Ellen. She was just coming up from the cafeteria with a hot cup of coffee in her hand. She looked tired but still smiled when she saw me.

“Will you be taking care of my Mom again today, Hope?”

“Yes after I meet with my group. I’ll be back around seven. How did she do through the night?” I asked.

“She did pretty well. Her oxygen saturation is still low but she seems to be comfortable.”

“Oh, good. I was hoping she would get some rest. I have to meet with my group but I’ll see you in a bit.”

When I came back up from pre-conference, Ellen and Sierra were sitting at the bedside. Edna was not up for eating this morning and her oxygen level was critically low. Not sure how much longer she would last, I asked her nurse, Barb, how long she could live like that.

“It’s hard to say Hope. Some hold on for days, sometimes leaving us to wonder what they are holding on for or what they are holding on to. Others only last a few hours or minutes.”

Concerned for her daughters I asked about them, “Are her daughters aware that she could go so quickly?”

“I’m not sure, Hope, but I was just going to go in and assess her and talk to them about it if you would like to join me.”

“Of course.” I said as I followed her into the room.

Barb was the type of nurse that you admired and wanted to be like. She was patient and kind to her patients and put the patient’s needs first. As she approached the bed I could see the tension in Ellen and Sierra lift. They had already developed a trusting relationship with Barb during their stay. Barb kneeled down so that she was eye level with them both. She broached the subject delicately. Resting her hand on Ellen’s knee she started the discussion by describing Edna’s current condition with them.

“The night nurse informed me that Edna’s oxygen saturation has been critically low for some time now.” As both sisters nodded their heads in agreement, Barb continued. “I know that Edna wishes only to be comfortable if she were to stop breathing and that both of you have agreed to that.” Both sisters, looking intently at Barb, shook their heads yes.

“Does your mother, Edna, have any last spiritual wishes that we could help her with?” Barb paused for a moment. “I only ask this as with her oxygen level so low I don’t know how much longer she will keep going. It is quite possible that today could be her last.”

Ellen and Sierra held on to each other. It was Sierra who spoke, “Yes, she would like to be baptized. We will call Pastor William from our church.”

What I learned about Baptists that day was that they don’t always get baptized as a child. The belief was that a person only sinned after he or she was baptized. Therefore, some Baptists would delay baptisms until a person was thirty. Other Baptist religions, realizing that adults were just as sinful as children, waited until a person was elderly or on their death bead before they would get baptized. Edna’s family was Southern Baptist and as some Southern Baptists practiced they rejected infant baptism. The Baptist Pastor would perform a baptismal ritual on Edna. The ritual was intended to be a spiritual cleansing of the soul and symbolized repentance. It is a ritual that is similar to the reading of the last rights.

Ellen and Sierra waited in silent prayer for Pastor William to arrive. As they waited, Edna’s oxygen level drifted even lower to the 70’s. Both were aware that above 90 was normal. With the decrease in oxygen, Edna’s blood pressure also became low. Her level of consciousness waxed and waned as she drifted in and out of lucidity. Barb and I waited anxiously. Every time the double doors opened we would get up to greet the Pastor only to find a lab personnel or a visitor walking through. We prayed silently that the Pastor would arrive before Edna passed.

Finally, the doors opened and Pastor William walked in. I escorted him to the room, eager to learn about the ritual but hesitant to impinge on the family’s personal privacy. Stepping forward to ask if I could stay my reservations got the better of me and instead slowly started to slip out of the room. “Hope!” Sierra called my name, waved me back, and held her hand out to me. Taking her hand in one of mine and Ellen’s in the other, the three of us stood as one at the end of Edna’s bed. With our backs straight and our heads bowed we prayed repeating after the priest as he offered the immersion of Edna as a symbolic gesture of faith, death, and the resurrection of Jesus.

The priest concluded his prayer and as we said amen Edna’s body first tensed then as if by cue she took one last deep breath before she exhaled and with it her entire body lay calm and peaceful. An awkward silence followed as we all held our breaths waiting for her to breath in another. When she didn’t I watched her body expecting to see her sole float out of her body to heaven above. Her eyes open and wide were fixed to the ceiling as if a calling from above had eluded her to a much better place. I imagined her sole had already gone and Edna was watching us from above.

The realization of death didn’t quite hit me until I heard the sobbing of her daughters.

Ellen and Sierra had each took one of Edna’s hand in theirs. A low hum of grief initially came from Ellen but as the comprehension of her mother’s death set in the low hum evolved into a loud uncontrollable sob. Sierra’s sobbing followed and as she went into a fit of hysterics, she threw herself onto her mother. Still standing at the end of the bed I didn’t know what to do. My mind, in a roller coaster of emotions that had never been experienced before, told me to run but my feet wouldn’t move. Ellen came over to me and hugged me. She clung to me as if I was the last thing she would ever hold on to. My body remained frozen but my mind continued to run. I didn’t know what to say and in my altered state of mind I said, “I am so sorry!” Then holding back a sob of my own in search of comforting words I said, “I love you.” Ellen replied, “I love you too.”

That is when my words struck me. Like a slap in the face, I came back to Earth and was humbled into silence. I could feel my face redden but I don’t think that Ellen even noticed. Slowly she released me and as Ellen went back to her mother’s side I excused myself from the room. Humiliated and embarrassed, I cursed myself as I went into the conference room to get a grip of myself and my emotions. I love you! Did I really just say that? As I sat in the conference room, feeling like a complete idiot, Page walked in.

Page paced the floor of the room walking up and down the length of it without taking any notice of me. I could tell by the grimace on her face and the furrowing of her brow that she was distraught about something.

“Page, what’s the matter?” Before Page could even answer I saw the blood on her clean white pants. “Oh Page, you have blood on your pants!” Startled for a moment, she turned to face me. I could see every nerve in her face was tense. She looked a bit panic stricken and I thought she was going to cry. Her left hand appeared to be shaking while she wrung her right hand over and over on the side of her pants.

“Oh, Hope! I am going to get in so much trouble. I stuck myself with a needle.”

“What? A dirty needle?”

“No, no. I had to give my patient a pain shot. I drew up the medication. I was so nervous with the instructor breathing down my neck. My hands were shaking and when I went to recap the syringe the needle poked my finger. The instructor is going to fail me.”

“Did she say that? What did she do when it happened?”

“Nothing she didn’t actually notice and after it happened I hid my finger.”

“That’s good Page. She doesn’t have to know about it. Just put a bandaid on it and don’t tell her.”

“But Hope, you don’t understand. After I did that, I gave the shot to the patient. Oh my God, I’m going to be kicked out of the program.” Page’s face was remorseful as she held back tears in an attempt to control herself.

I refrained from making a gasp myself but knew that Page would have to take this to her grave. I walked closer to her and taking her hands in mine I looked her in the eyes and spoke firmly. “Page, we are going to put a Band-Aid on your finger and pretend that this never happened. You are not going to tell the instructor about it. Do you understand?”

“But Hope. What if I infected that patient with something?”

“With what Page? It’s not like you are a crack cocaine user out on the streets shooting up drugs! Even if there was some of your blood on that needle you don’t have any communicable diseases. Seriously, Page, the chances of any significant amount of blood even being on that needle is miniscule anyway. Here I have a Band-Aid in my pocket. Put it on. It’s going to be ok.” Page took the Band-Aid from me and as she put it on her finger the worried look on her face began to relax.

I tried to convince her further, “It’s not a big deal Page.”

“Really Hope. You don’t think so?”

“No, now let’s get back out there before someone notices us missing.”

“Thanks, Hope. Please don’t tell anyone about this.”

“I won’t.” I promised.

Page regained her composure but as we turned to leave, the conference door swung open with a force and in came Sherry. Her hair was tamer today but even still it was a bit wild by professional working standards. Her eyes sported a pair of green Gucci brand glasses that matched our nursing smock. Her makeup was done conservatively but as she came into that conference room you wouldn’t be able to tell as her face was beet red and by the way she was ranting you could tell she was pissed.

She saw Page and me standing there and threw up her arms in frustration.

“The nurse that I was paired with today is such a bitch!” Before we could respond, Sherry continued. “I think she thinks I am her servant. She sits on her fat ass all day and just barks at me to do things. I’ve been working all morning doing so much of her dirty work that I was almost an hour late passing my meds. I got points taken off for that as ‘that is not acceptable’ and ‘I should work more closely with the nurse so that things are done in a timely manner.’” Sherry imitated our instructor’s voice. “I had to get out of there. I don’t know if I can go back out there. I think if I do I will bitch slap that nurse and get kicked out of the program!” As Sherry let out her rage her arms moved animated with every sentence. “Then after I have been running my ass off all morning I ask her if I can take a break. And you know what she says?” Without giving us time to answer she cocked her head to the side and imitated the nurse, “‘Well, I was just going to go to lunch. You can take a break when I get back.’” As Sherry continued her story her voice became louder and louder in anger. “I haven’t stopped since I got here and she has not moved her ass out of that chair the entire time and she gets to go to lunch! Then she has the gall to tell the other lazy nurse sitting with her that she hates working with nursing students. RIGHT IN FRONT OF ME! As if I wasn’t standing there at all. I wanted to spit in her face! You don’t know how hard it was for me not to.” Page and I stood and listened. I knew exactly what nurse she was talking about. You could almost hear the silent wishes of the students coming in for their assignments one by one praying that they did not get paired with her. When Sherry finally finished her ranting, she stopped and looked at us.

“What are you guys doing in here?”

I answered her, “Page just came in here to put a Band-Aid on a cut she got from a broken bed. And I…” I paused wondering if I should really reveal to them how retarded I was.

Page interrupted, “Oh yeah! What were you doing in here Hope? I was so caught up in my silly cut that I didn’t even stop to ask you.”

“I came in here to regain my composure. My patient, Edna Harris, died today.”

A look of concern came over Sherry’s face. “Oh, Little Hope. Are you okay?” As soon as I had gotten to know Sherry, she started calling me Little Hope. Not that she felt there was little hope in anything but referring to my size as I was a mere 5 ft 2 in and 110 pounds and the youngest in our class.

“Yes I’m okay. Surprisingly it wasn’t her death that made me sad. It was actually peaceful. She is the first dead person I have ever seen. I think I thought it would be… I don’t know, more gruesome, like in the movies or something. It was the emotions of her daughters that affected me and then I felt so awkward. I didn’t know what to say and then when I did say something I said I love you. I told her daughter that I loved her. I was so embarrassed. I’m such an idiot.”

Sherry responded, “Oh Hope. That is classic.” She started to laugh and that laugh became infectious and before we knew it we were all laughing. We had each entered that room alone to find our own little sanctuary but what we found was each other. Throughout the rest of that clinical rotation that conference room became our place. When things got hectic we would pop in for a breather. If one of us needed to talk or vent we’d just motion to the other. The room became our saving grace.