One of the first patients I cared for during my first semester of nursing school was Mr B, a nursing home patient with multiple medical issues including ORSA in the secretions from his capped tracheostomy. Because of this, Mr. B was on special precautions, requiring any staff who entered to wear gown, gloves, and faceshield.

I was paired up with another nursing student to care for him, since the staff had noted he was very needy. My classmate and I sat down early in the morning to devise a plan of care. We decided we would ‘cluster’ our activities, not only so as not to tire Mr. B out but also to try to cut down on our visits in and out of the room, and thus decrease our exposure to the ORSA, and consequent risk of spreading it to other residents at the facility..

The first time we went into the room, we brought in towels and washcloths, ready to bathe Mr B and get his dressed. He had an appointment at physical therapy at 11, and given it was 0830, we thought we had plenty of time.

Yeah, right.

First we forgot the soap. Degown, deglove, damask, get the soap, regown, reglove, remask. Next we had to get some extra towels (we were still pretty green at bed baths.) Again, degown, deglove, demask, get the towels, regown, reglove, remask.

We were working on our physical assessment paper, so poor Mr. B patiently sat through a double assessment, as my classmate and I both painstakingly looked him over head to toe, wondering to each other if his capillary return was really <3 and if his skin should be considered pale or pink. Finally, we had him dressed and in a wheelchair, a mask on his face and over his trach, and ready to go to his appointment.

While he was gone, we tidied his room, changed his linens, and worked on our assignment together.

When Mr. B. came back, he didn’t want to eat his lunch. He seemed restless and irritable. And he was on the call light often. I tried answering from the door, but there was often something he needed that I just couldn’t get from the doorway. There were increasing rounds of gowning, gloving and masking for all sorts of things. He dropped his remote, he needed a tissue, needed the urinal, needed the pillow adjusted. Finally, I got my instructor and explained to her what was going on, and how I was beginning to think maybe there was something wrong with Mr. B.
My instructor and I went into Mr. B’s room together, and the image of her sitting on the side of the bed with him, her face near his so he could see, and holding his hand is an image that I want to carry forever, as her body language and words conveyed the compassion that all of us as nurses strive for. My instructor held his hand and asked him what was wrong.

“I’m scared.” Mr B said shakily. “I feel like its almost time to die.”
:”You are scared that you are dying, Mr. B?” My instructor reflected back.
He nodded. “Is there anything I can do to help you?” She asked.
“Just don’t leave me alone,” he said.

My instructor pulled me aside and said that for the rest of the day, I was excused from any duties but staying to care for Mr. B one on one. Together we checked his vital signs, which had been and continued to be stable, and we got him up out of bed and into his chair. I sat next to him and we watched television.I don’t think I’ll ever forget the show; it was a documentary on the History channel of the history of salt mines.
Mt. B seemed a little calmer. He began to tell me about his ‘lady friend’ who was expected later in the afternoon. He told me that they used to dance together “before I got too weak.” I remember how he lit up and smiled when he talked of her and how the two of them could cut a rug in the old days. Unfortunately, after only a half hour, Mr. B began to become agitated again. “I want to go back to bed now,” he finally told me. I went to the door and tried to get someone’s attention, but it seemed that all the nurses and aides managed to look away just as I tried to catch their eyes. I began to see how frustrating it must have been for Mr. B, alone in the room, having to rely on other people to come in all the time, and all the layers of protective clothing between him and simple human touch.

Finally, my classmate came by and helped me get Mr B back into bed. He seemed calmer, and after telling my classmate about the upcoming visit from his ‘lady friend’, he drifted off to sleep.

Soon my clinical day was over, and my classmate and I stayed a little late to work on our assessment paper together. Our instructor stayed with us, and we discussed Mr. B’s care, and the fears he verbalized. He had stayed clinically stable the entire day, with no obvious physical distress. His mental distress, we theorized, was from being alone so much of the time, and that our therapeutic presence had seemed to calm him. We stayed almost an hour late, leaving finally around 2pm.

Two days later, before school, I saw Mr. B’s obituary in the morning paper. His date of death was the same day that we had cared for him at the nursing home. 
Upset, I went to my instructor, who told me that Mr. B had died peacefully in his sleep within 15 minutes of us leaving that day. I remember feeling sad that he had passed, and then glad that perhaps I had made some bit of small difference during his last day on earth. I can only hope that that he and his lady friend are still up in the stars somewhere, dancing on moonbeams and cutting a fine rug.

Tags: nurses, nursing home, nursing instructor, nursing srudent, ORSA, patient

This entry was posted on Tuesday, June 10th, 2008 at 3:58 pm and is filed under Deanna, RN, For Student Nurses.You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.