Patients we all carry

While I was in nursing school I worked as a tele-tech and a CNA in a small rural hospital. I was responsible for reading the tele monitor on all the patients who were on tele during the shift, as well as taking off orders.

If there were no patients on tele and no orders to take off, or the evening shift was in need of workers, I worked the floor as a CNA. I also worked extra when I could, especially during breaks from school. I made better than minimum wage but not much more. Therefore I picked up extra when I could.

One week in late December I was working as a CNA on the evening shift and we were unusually busy and all the rooms were full. In room 249 was a patient who no one wanted to take care of. He was mean and didn’t participate in the ADLs. When we were turning him in the bed he would reach out to pinch our rear ends. Twenty plus years later I realize that he had no control over anything, including his own bowels and that made him frustrated and mean and prone to strike outs.

Compounding his general demeanor he had had a radical neck dissection and a permanent trach, essentially making him nonverbal. He had a “pipe” that he used to communicate with. He would put the pipe up to his mouth and speak into it. It translated the air into sounds. The sounds weren’t very loud and he was difficult to understand.

He was terminally ill, though, and became sicker as he was under our care. This was due to the cancer disease process. He knew he was dying and he hated it. He hated it, hated us, hated the food, hated the nurses. He made sure we all knew it.

And then his pipe broke and he was without even that meager communication tool. And he was madder than ever. He was dropping weight rapidly and becoming diminished. Which also made him mad. Not much made him happy.

Remembering my classes I made him a communication board. So that he could communicate through pictures.

He went home to hospice not long after than. The last image I have of him is him gesticulating widely at the EMTs as they were transferring him to the gurney and shaking his communication board.

Why I remember him is that communication is key. Not only among the caregivers, but also from our patients to us. Patients may be in our hospital, but we have entered their lives at a time of no control. We have to use any means necessary to communicate with each other, even with unconventional means.