Every now and then I leave work feeling like a good nurse. Like perhaps I actually made a difference in someone's life that day. I had the blessing of that experience earlier this week.
My patient was an old man, brought to us for a general decline in function and some signs of maybe an infectious pneumonia. He had a history of a stroke and his right arm was curled into his body where it had been useless for years. He could move his left arm slightly, but his hand was so gnarled from arthritis that its usefulness was limited. He watched me as the paramedics moved him from their stretcher to ours, recounting their understanding of his past and present medical issues. His eyes seemed lucid, like he was aware of what was happening, but any question I asked him was met with silence, or at best a slight grunt.
“Do you have any idea of his baseline mental status?” I asked the paramedics.
“Mmm… not sure. He’s had a few strokes… doesn’t sound like his wife will be coming in either, she has the flu.”
A few minutes later while sitting at the nurses’ station with his chart the doctor approached me. “I can’t stand how that medic or whoever she was talked to that patient.”
“What do you mean?” I asked.
“She’s talking to him like he’s stupid or 5 months old. A grown man doesn’t appreciate that kind of condescending attitude. He knows what’s going on – he just has expressive aphasia.”
I paused for a moment to take in the irony of that statement coming from the most condescending doctor I know, but what he said influenced the way I treated my patient the rest of the day. Expressive aphasia is the fancy medical term for when a stroke leaves you with the ability to understand everything said to you and everything going on around you, but robs you of the ability to be able to form and express words. It’s like being muzzled… you try to speak, but can’t seem to ever get the words out. I’ve seen it in patients with a brand new stroke, and the frustration and fear in their eyes is a truly horrible thing. In an older person with this condition, it is far too easy for caretakers and others to make the assumption that they no longer have their mental faculties and to fail to explain things to them or treat them like they would someone who can grasp what’s happening.
Taking all this in mind, I made a point the rest of the day to address my patient by name, to look him in the eyes and explain everything that was happening, what we were waiting on, and what he could expect. He could nod yes and no, and I did my best to help him communicate his needs in this way. I listened when he tried to make words and reinforced that I knew he was trying to communicate, but wasn’t able to find the words.
At the end of my shift I went in to say goodbye and to let him know he would be admitted to a hospital bed shortly and dinner would be waiting for him with someone to help him eat it. As I was about to go he was reaching over to me with his one usable arm. Very slowly he took my hand and reached it over to his mouth to kiss it. Then he held my hand to his chest for a while and looked up at me with glistening eyes and a small grateful smile. All the thank you cards in the world could never amount to that moment and that gesture of gratitude by a little old man.
As I left that day, I was so thankful for the reminder I had from the doctor about the man’s need for respect. It’s too easy when you are busy and under pressure and when someone can’t communicate with you, to fail to give it to them. To buzz in and out, taking blood and starting IVs and pushing medications without ever letting them know what’s going on. It was good to be reminded that what I do can affect people for good or for bad, even if I never know it. This time it was for good.
