AACN News—July 1998—Hope Gives Patient the Will to Live

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Vol. 15, No. 7, JULY 1998

Holly L Cirlin, RN, BSN, CCRN, CRRN, CNA, is a staff nurse and nurse manager at Healthsouth Rehabilitation Institute of San Antonio (Tex). She received the 1998 Excellence in Caring Practices award, which is part of AACN’s Circle of Excellence recognition programs. The deadline to nominate yourself or a colleague for a 1999 Circle of Excellence award is September 1, 1998. For more information, call (800) 899-AACN (2226) or visit the AACN home page at www.aacn.org.

By Holly L Cirlin

There seemed to be nothing unusual that night in April 1996. The 11-7 shift started the same as every other one, beginning with report on 10 patients. I listened carefully as the individual patients and their needs were described.

In 301W is a new admission, Mrs Talley, a 56-year-old female with a brain stem infarct. She is completely paralyzed, but can blink her eyes. She stares blankly and is slow to respond. Even though she can blink appropriately to simple questions of orientation, it doesn’t seem like there is anyone at home upstairs. I guess that’s a blessing. She has a new trach and is on 40% 02. There is no swallow reflex, so she is fed through a PEG (percutaneous endoscopic gastrostomy) tube. Her family was here earlier. They are very supportive, but emotional. There’s not really much we can do at this point, except to continue anticoagulant therapy and monitor her cardiac and respiratory status. The prognosis given to her husband is poor.

As a critical care nurse for 15 years, I knew that there was more that could be be done for her.

I distinctly remember the first time I saw Mrs Talley. Her room was dimly lit and quiet, except for the occasional alarms of the cardiac monitor and pulse oximeter and the steady gurgling of the oxygen humidifier. She was on her back, her chest rising and falling rhythmically. I said, “Good evening, Mrs Talley. My name is Holly and I will be your nurse tonight. We are all terribly sorry for your circumstances, but we’re delighted that you are here. Our job is to work like crazy to get you out of this mess and get you back home with your family, where you belong.” Mrs Talley looked up at me, and I began to feel her spirit.

During my assessment, she started coughing violently. The respiratory therapist, another nurse, and I were trying to help her through it. She looked terrified. As we bagged her and helped to remove the secretions, I was close to her ear, telling her everything that we were doing and trying to calm her fears. Just as the worst was over, she looked at me and mouthed a few words. I thought I understood. “What?,” I asked. “Can you say that again for me, only a little slower?” Her lips moved, enunciating each syllable. “What is my ox-y-gen sat-u-ra-tion?” Tears filled my eyes. “Yes, yes!” I said, with both relief and delight. “It’s 98%, and you’re doing fine.”

I wondered why no one reported that she could mouth words. Did we miss something? Maybe this was new. As I continued my assessment, I explained everything to her. I told her about rehabilitation. The team would work with her and her family on goals. I’m not sure she believed me. She knew she was still very ill and that there was a high risk she would have another stroke and die.

Mrs Talley had been in the hospital for 2 weeks. I asked her if she had had a bath and shampoo since her stroke. Somewhat embarrassed, she said she had not. I thought that a shower might help her to feel better. I explained that, if she was willing, I’d put her on a stretcher and take her to the shower room for some “girl time.” Her eyes opened wide. “But how can you move me with all the tubes and equipment?” she asked. I assured her that I have experience in both critical care and rehabilitation nursing, and promised that I would monitor her every step of the way.

The shower was a wonderful experience for both of us. I remember the smell of the raspberry soap her daughter brought in. We talked a little as I bathed her, but mostly there was a reflective silence. Mrs Talley seemed to have something on her mind. I watched as her tension faded and a new woman emerged. She started dozing while I shampooed her hair. After we returned her back to her bed, she immediately fell asleep and slept quietly the rest of the night.

The next evening, I found a completely different woman. She was surrounded by her family, her husband, son, daughter, son-in-law, and daughter-in-law. They were the most attentive family I’d ever seen, and they were delighted at how much better she seemed. They rejoiced in telling me about her and what a remarkable person she is. Their stories were filled with love and laughter.

Mrs Talley had been “in charge” of the family. It wasn’t always easy, but she made it work. She took care of everything and everyone. She was active with her children, in her church, and with her husband in a car collector’s club. She found tranquility in painting and could complete several pieces in an evening. And, she wrote with all the style and humor of Erma Bombeck. It was no doubt difficult for them to see her this way—and even more difficult for Mrs Talley to be dependent on them for the first time in her life.

Our staff fell in love with Mrs Talley and her family. Her stay at RIOSA (Rehabilitation Institute of San Antonio) lasted about 4 months. Rehabilitation was slow, but it was her inner strength and the never-ending support of her family and our staff that kept her going. We learned so much about life from her. She was truly an inspiration to everyone who met her.

During the third month of her stay, she told me a story that explained many of my unanswered questions on that first night. She told me that, in the acute care hospital, shortly after her stroke, she overheard staff members say that it was a “tragedy” she had survived, because she would more than likely be a “vegetable” for life. They went on to comment about what a burden she would be to her family.

Mrs Talley had understood completely. Not wanting to be a negative force in her family members’ lives, she thought it best to help “get this over” as quickly as possible. But how? She had virtually no control over anything. She was completely paralyzed and could do nothing for herself except breathe. Mrs Talley knew she was having cardiac arrhythmias, which seemed to be related to her breathing. She thought that, if she could hold her breath long enough, the arrhythmias would become aggravated and solve the problem for her.

“I held my breath so long and kept thinking any minute now I should begin to die,” she told me. “I must have held my breath for a good 5 minutes. I didn’t even feel the need to start breathing again. What was going on? That’s when I remembered I had a trach and I couldn’t even kill myself. I just knew that rehabilitation for me was impossible.”

That’s why she seemed so despondent when she was first admitted. She had given up. Mrs Talley explained that the reason she told me this story was because her life was changed that first night at RIOSA. “You all treated me like I had worth. And even though I thought you were nuts, you kept talking about the future saying that anything is possible. You weren’t afraid to touch me or talk to me. You took the time to try to understand me. The shower washed away many of my fears and I began to feel human again. Now I wanted more than anything to live.”

I think about Mrs Talley and her family almost every day. I am proud and honored to have made a difference in their lives. She remains a very important part of her family and a symbol of strength and courage to many others. It’s obvious that the “tragedy” was not in her survival, but most assuredly would have been in her death.
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