After many years of nursing I celebrate every day I go to work and learn something new that improves my practice: a new drug, a new procedure, or some new machine. Recently nothing has taught me more than just being the patient’s wife. My husband, Dalt, injured his wrist cutting low hanging branches from a hackberry tree. When the chain saw broke through the branch, it dropped, yanked his wrist to an awkward angle, and triggered an autoimmune response that knocked my husband off his feet. The joints in his wrists and fingers looked like they had been hit with a baseball bat. His knuckles had not one wrinkle in them. The skin on his fingers, pulled tight from the swelling, turned his fingers bone white from the poor circulation. His usually active days became waking hours of agony. And I transformed from a competent health care provider into a worried, decompensating wreck.

Dalt went to see a hand specialist, had some x-rays, and got a prescription for pain pills. A few days after the “incident,” Dalt woke up in so much pain he couldn’t walk. I maneuvered him to the car and rushed to the ER. I happened to slip his pain pills into my purse. Because of his marked weakness, the doctor ran tests to see if Dalt had stroked. I knew he hadn’t, but didn’t want to be a “bad” family member. You know what I mean. The kind of person who micromanages the doctors, the nurses, the lab techs, even housekeeping. So I sat and waited and watched my husband moan with pain. I confess. I gave him one of his pain pills. In an hour he was 100% better. When the doctor came in to tell him she had scheduled an MRI of his head, Dalt declined. “I’m not having a stroke, I was just in so much pain.” I took him home.

Prior to this I assessed the silent symptoms of pain the way I learned in school: rapid heart rate, shallow breathing, a furrowed brow, even nausea. When Dalt was in pain, he aged ten years. Wrinkles impressed his usually smooth cheeks. He exhaled long, deep, gasping sighs when he slept. He wasn’t nauseated; he had no interest in eating. When he walked around the house, he held both arms close to his body, guarding his hands from anything that might accidentally hit them. I didn’t know how to help.

It took over a month to get scheduled for surgery to fuse Dalt’s wrist bone. The doctor promised pain relief with the procedure. We would have opted for the next day, but pre-op testing, booking an operating room, and allowing for the doctor’s schedule took time. Waiting. Something I never learned to do with grace, especially when someone I loved suffered. Watching him struggle through a day of pain wore me down as much as it did him. A man with strong faith, I sometimes worried about going to work and leaving him alone. That’s how much the pain changed him.

Dalt is a young 73, but not without health issues. I viewed the surgery as a panacea, a game changer, a pain ender. But on the day of surgery, the nurse in me kicked in and the “what-ifs” took over. Count on an experienced nurse to anticipate the worst case scenario. This was a post-Joan Rivers day where an out-patient procedure turned into a tragedy. I followed Dalt’s gurney down the hall to the operating room, then detoured to the waiting room. I let him see the tears, my fear, and told him to hurry back.

I knew this procedure was considered relatively minor, no intrusion on the heart, the abdomen, or the lungs. But this was my husband. It required general anesthesia. What may have been the most minor surgery on the schedule that day was most major to me. I checked the information board where computer graphics symbolized when the surgery started, with a knife, when the surgeon was closing, with cross stitches, and when the patient went to recovery, with a Band-Aid. Every time the phone rang in the waiting room, I strained to hear. The volunteer called a name I didn’t recognize. It was my married name; for most things I still use my maiden name. It finally dawned on me that it was my turn to rush to the desk and pick up the phone. Another hour to go a young woman’s voice told me.

It’s been done in movies and on television, the every five minute look at the clock. That’s how it happens. Every five minutes I sighed with a sound reminiscent of his pain and asked myself “Are we there yet? When would it be over?” Overhead I heard one Code Blue called, heard the room number, and recognized which ICU it was. Not in the OR. Thank God. One Code Red. Fire in the lab. I didn’t care. One Adult Rapid Response. Well I knew that wasn’t Dalt, and I was upright. We were both safe.

I didn’t want to go to the bathroom for fear of missing the precious few minutes I knew the doctor would grant me after surgery. The door where I watched different doctors emerge, doctors with whom I had worked for years, opened and Dalt’s surgeon, young enough to be my daughter, came out. I liked her no-nonsense provision of information, post-procedure x-rays included.

It required more waiting before I saw Dalt. A bed assignment had to be made, report called to the receiving nurse. I wandered up to a room that looked haunted by emptiness. Then his bed rolled in and he was there talking, thirsty, complaining of pain, but okay. I helped him with his first sip of water and watched him fumble with the PCA button to give himself some medication. I didn’t think hand surgery would be so painful. Dalt measured time in hours between pain pills and minutes between pushing the PCA. I measured it in the days it would be until I felt I could help him feel better.

The days of the call light are gone. Now patients call their nurses on hospital cell phones. “I’m in the middle of something. I’ll be there when I’m through.” The wife simmered; the nurse boiled. The first time it took twenty minutes for the nurse to come. One time she was an hour late with pain medication. I wanted insta-care for my husband. And all I could do was sit and feel totally useless.

Dalt is home now. For the next ten days he has to keep his hand above his elbow. When he’s up and about, he maintains this position wearing a sling. A new lesson begins. I never appreciated how many things I do that require two hands. Slicing a banana, peeling open a yogurt container, buttoning shorts, tying shoes, unscrewing a bottle, using the computer. I no longer take these things for granted. I get to do them for Dalt. Finally I am useful! He’s getting cabin fever from his confinement, not just because he’s stuck inside, but because when he’s healthy, he’s always busy.

Better days are coming. Because of Dalt I’ll go back to work a better nurse. I’ll remember that if you’re the patient’s wife, lover, son, daughter, father, whoever, there is only one patient. That from your point of view any surgery is the most major surgery. That pain is real and urgent and needs to be addressed quickly. That demanding families are a product of stress, love, disruption of everyday living, and fear of an unknown future. I promise I’ll remember what it feels like to be “just the patient’s wife.”
 

Why does ED happen

In forty years of nursing, I fought for respect and autonomy in my profession. I pursued a graduate degree and believed a higher level of education would not only enhance my clinical practice, but would also earn colleague status with doctors wherever I worked. For the most part, this has been true.

In the critical care setting, my specialty, adaptation to change, continuing education, and the ability to make sound clinical decisions has been instrumental in the practice of nursing. A four year degree has become the expected entry level education. Certification in this specialty and the pursuit of a higher degree is becoming more commonplace. Both are encouraged and economically supported by health care institutions. This sounds like nursing is advancing as a profession.

Enter the new ad campaign by a large health care conglomerate that praises the “servant” who cleans up messes and changes the sheets. The ads devalue the educational requirements, both basic and ongoing, the responsibilities assumed, and the commitment to best patient outcomes manifested by consummate professionals. The portrayal of health care providers as servants discomfited me.

As a nurse, I have been a witness to and caregiver in the most deadly epidemic in modern times. I have watched women infiltrate medicine and men infiltrate nursing. I have lived a history in which critical care grew from the MASH units on the front lines of war into the technology driven units in tertiary care facilities. I have watched drugs come and go, so-called best practices be replaced by better practices, and health care become a right. I recognize my profession is one of service. I know that without the patient I am nothing. Without the trust of someone who allows me into his or her life at a most vulnerable time, I cannot do what I am trained to do. But I am not a servant.

Conversely, when I come into the hospital, I want an educated professional familiar with the latest technology, the newest drugs, the best treatments, and the dedication of someone who is prepared for his job. I neither want, nor expect a servant.

I am a professional nurse. I empty trash, clean the floor, clean up excrement, and turnover a room. I have successfully resuscitated a patient before the doctor could arrive. I started an IV when a patient was bleeding to death as the doctor stood over me and told me I had to find a vein. I have made countless decisions in treatment plans, made critical notifications, participate in interdisciplinary collaboration to devise the best plan of care, wept with families, attended funerals, and shared the pain and joy of loss and recovery. I am and will always be in service to my patients. However I am not a servant.

Why does ED happen