RIP

R.I.P reminds me of a spooky cemetery scene in a child's Halloween cartoon. For me it really lacks a certain respect for the departed. Spelt out, it means so much more.

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One of the most difficult patients I've ever had on my orthopedic floor (6SE) was one I'd never guess I would find here. For the most part, our patient population on 6SE is littered with knee, hip, shoulder and spine patients; sarcoma and chemo patients fill most of the gaps. But when we have empty beds, we fill them with pretty much anything.

We happened to have an empty bed when She was admitted. And that is how She ended up on my floor.

For someone so young, She saw more pain and hardships than anyone should ever face. Unfortunately, She saw too much to recover from.

Once I got over Her emaciated appearance, which I guess I never really truly "got over," I noticed Her rough hands. On Her body, Her hands were huge, they looked like jumbo marshmallows on toothpick arms. Her hands were callused and looked so much like ones I've seen before on a few of the homeless patients that I've cared for. They gave away Her difficult past. She must have spend at least some time outside in the cold.

Drug abuse. Prostitution. Rape. HIV, which turned to AIDS. TB.

Only a few of the terrible things She endured during Her short life. The worst, I think, was the fact that Her very own mother, the person who should have cared for Her, was the person who introduced Her to this way of life. I'm disgusted to think about it.

TB patients are a lot of work, mostly because they have to be in a respiratory isolation. TB is very contagious, so when caring for a TB patient you must gown up and wear a PAPR or a special mask. This takes a lot of time, and so nursing tasks are done all at once in groups to limit the amount of times a person needs to leave and come back to the room.

For someone who is dying, this is unfortunate, because no one should have to die alone. With 3 or 4 other patients to care for, it is difficult to balance out the time spent with each patient. Tasks that normally take 5 minutes for a "normal" patient take 20 minutes for a TB isolation patient. And you better hope that you don't forget something, (or you'll have to call a coworker to bring supplies to you, which takes more time).

For this little lady, time was precious, more so than I thought.

I cared for Her one night, and we had a moment. She was clear mentally, and was talking with me, which didn't happen often. She had a terrible, productive cough, and I mentioned that it sounded like it hurt to cough. She asked me for an inhaler, "maybe that will help me." But I knew that was not the case. She was someone who valued truth and honesty, because She had experienced very little during Her short life. So, I told Her straight up: "I don't think that would help you hun." Then She said: "I'm dying." And went on to talk about "grandma" and would we call her tomorrow. She asked about "nana" and if "they" would be there and I'm not sure if She was meaning when She passed or literally there in the hospital.

Tears came to my eyes, but I was able to hold them in. She started to fall asleep again, and I told Her that I would stay with Her until She fell asleep, and She did very quickly.

* * *
I reported off that morning thinking that we had a good night. She and I had a good conversation, and connected.

When I got my assignment the next night, I didn't get Her back. I was actually a little upset that I wasn't assigned to Her. I was looking forward to talking with Her again. I wanted to make Her last few days comfortable and full of love. With some hand holding and brushing back Her hair. It was a lot of work, but I had a bond with Her that I wanted to continue. When I went to look to see who She was assigned to (to try to trade) She wasn't on the board. I was shocked. I thought for sure She had a few more days left in her.

Turns out She passed on a little after I left. And while that makes my heart lighten and smile, for She had so much pain, and needed so badly to rest, I was not ready for that to happen. I wanted to share a few more good times with her.

She will always leave a mark on me. The sometimes vulgar, frail girl, who aged way too quickly. A nurse I work with put it very well: her life was very short, but in so many ways She lived a very long, hard life. She partied too hard, too fast. And her mother was right there next to her through all of that. Funny that once Her mother found out that this hospitalization would be Her final resting place, she skipped out of town. She was there to cause her daughter's downward spiral, but not there to catch Her at the bottom. ("skipping out" and getting high are the only ways her mother would know how to cope...)

Before I cared for her, She was able to talk with the adoptive mom of Her only child. The adoptive mom said that Her little girl was healthy, smart, and HIV negative. A beauty. A wonder. A miracle. Her daughter has a chance in life that She never had. Love, support, and guidance. But most of all, a mother who will be there to catch her if she falls.

So, rest in peace my dear, you left your mark on the world.

Please note that facts have been changed to provide confidentiality.