Andy

Andy

Working as a nurse at an inner city teaching hospital can be stimulating as well as challenging. During the course of my career, patients have taught me more about living and how to practice the art of nursing than could ever have been found in a textbook or classroom. Strangely, they are unaware of those lessons that I internalized and carried forward in my life. Both my most and least favorite patient taught one such lesson.
One particular morning began just like so many before them. The Charge nurse called to me as I walked hurriedly passed her desk and said, “You’re getting an admission in room 17A. It’s a stroke patient. The Emergency Room called and said that they are swamped so he’s on the way up. Is the bed ready?” I nodded yes to her and dashed down the hall with my nine o’clock medication pass. It was nearly ten in the morning, and I was already late from receiving another admission that morning. Some of my patients were calling because they thought that I had forgotten them. “What is wrong with that Admissions Office”, I grumbled to myself. “Don’t they know how to spread the wealth around? Too bad that bed is empty and clean”, I thought to myself. “That would give me a few minutes to catch up with some of my morning duties.” Seconds later I heard my new patient yelling as he was being rolled toward his room. I knew why the E.R. was in a hurry to get him upstairs. The voice was recognizable, and I cringed with that familiar sound. It was Andy! My heart sank, as did my mood. He was every nurse’s worst nightmare.
Andy was a frequent flier at our hospital. He checked in six or seven times a year. When our hospital wouldn’t admit him, Andy made the rounds at the other local Emergency Rooms. He had had a stroke 4 years prior to that date, and the residual weakness left him with a somewhat spastic left arm and weakness in his left leg. There was a considerable limp; however, he was able to walk without assistance. Andy was average in height, had a slim build, poor hygiene habits, and a gruff manner. He arrived that day with a foul odor, several days’ growth of beard, and badly in need of a haircut.
His living situation was either a small rented room in a dilapidated hotel or a bed at the local mission. In warmer weather, he stayed down near the river with the rest of the homeless crowd. It was early November, and winter’s chill came early that year. I guessed that he was either broke or had worn out his welcome at the mission and had nowhere else to go in this frosty weather.
The E.R. nurse wheeled him into the room, and he hopped off the stretcher with ease. After a short exchange with her, she plunked the paperwork into my hands and quickly left the room. Andy recognized me and stared with a glare. He knew that I was firm and would not tolerate his usual verbal abuse, swearing, or unusual demands. I guessed that he had hoped for a younger nurse who would be less likely to stand firm with rules and policies. His language was crude and uneducated as usual. The first words out of his mouth were, ”I’m hungry,” he demanded, “Get me a sandwich and some milk!” He then went into the bathroom and inspected it as though he was checking out a hotel room’s accommodations. “Get me some soap!” he ordered. I told him that all of his needs would be met, but first we needed to complete the admission paperwork. I then told him that he was not going to get into that clean bed unless he took a shower and got some of the grime off of him. He knew the ropes so he resigned himself to complete those interminable forms with me. After an initial bout of grumbling, he realized that that battle for a shower was bound to be lost. He also understood that even though I was firm with his persistent behaviors, I had his best interests at heart and would try to meet them. After completing the forms and taking his shower, he settled in to watch television the rest of my shift.
This hospital stay was not any different from his previous visit. No one wanted to care for him because of his obnoxious behaviors. He rang the patient call light several times an hour with multiple demands for extra blankets, food, ginger ale, and fresh water. Sometimes, he even forgot why he called but would make up something just for the attention. He was often assigned to me because most everyone knew that I was more capable at keeping him under control than the younger nurses.
Even when this man was disruptive, if diagnostic studies were ordered, he always cooperated with having them done. I believed this was because he knew that those studies would buy him some extra days in the hospital. Additionally, he enjoyed the extra attention of technicians in those other departments. By knowing how to work the system, he could maximize his time spent with us.
He also understood that after those tests, if nothing new was found, the physicians would order that we increase his exercise level. Physicians on his case wrote for physical therapy. Staff was also instructed to walk him in the hallway. We could usually count on the Physical therapy department to give him his morning walk and exercise, but that left the afternoon and evening walk to the nurses or nurse’s aides. Admittedly, this was not a high priority for any of us. He was resistant to our walks and just wanted to be left alone to watch television and languish in his clean hospital bed with three meals a day plus snacks.
On one particular afternoon, as his hospital stay was nearing the end; I made time in my afternoon schedule to take him for one of those walks. “After all,” I thought, “we’ll never get him out of here if he can’t walk!” I waited until after lunch and just at a time when I knew he was not in the middle of a favorite television show. Then with a casual approach asked, “Andy, I have time to take you for your walk now. Let’s do it before I get too busy. Are you ready?” He surprised me by getting out of bed without an argument.
In an effort to maximize the duration of that walk, I began to strike up a informal conversation about him and his life. It was not his usual characteristic to reveal anything personal about himself. This day, however, he chose to share some of that with me. We reached the end of the hallway. There was a large window that looked towards the East side of the city. We paused to look out over the city.
It was a crisp, clear day, and half the town could be seen. Because of the season, the fall landscape looked like a picturesque watercolor. From that fourth floor window, we could spot a white tower on the right in the distance that belonged to the old State Mental hospital. Various colored gray rooftops of center city row homes lined the streets below. All of those homes had the same architecture with front porches and large bay windows on the second floor. The small yards were a mixture of neatly cared for and neglected rectangles at the rear of the properties. Some residents had carved their yards in half to allow for off street parking. The top that belonged to a monument in the town’s center square jutted above some buildings in the distance. City hall and the old turn of the century county prison were part of that distant landscape as well. The tree-lined streets were littered in places, and I reflected how this differed from those times when I was a young girl. In those days, no one relied on the city to sweep the streets. Each person maintained their own property and the street in front of their home was swept as a sense of pride in their property.
We stood for about five minutes. The trees that lined the streets had lost only about half the leaves on their branches. The remaining foliage was brightly colored. Leaves with those vivid autumn colors were holding on for their final performance before they gave up to winter’s frost. “Andy”, I asked, “Aren’t those leaves beautiful?” “They remind me of home,” he said quietly.
It wasn’t until that moment that I had ever considered this man standing next to me as anything but a nuisance. In that split second, my opinion of him began to change. I asked where he was raised. He related that he grew up in a small town in the Pocono Mountains. The family was poor and lived outside the town in a small home. His father only worked sporadically and usually lost his job when he drank too much. His mother pinched pennies to raise him and his three brothers. She always maintained a large vegetable garden and preserved them for the winter. They had a few chickens and his father hunted small game for meat. The property surrounding his home was lightly wooded. He knew that they were poor; but in those days, many other families lived under similar conditions. He related that the autumn was his favorite time of the year. He and his brothers played outside in the woods. Hide and seek, war, cowboys and Indians, and tree climbing were what most all boys enjoyed at that time. They were no different. It was just cool enough for a long sleeve flannel shirt or light jacket. The heat of summer was a distant memory. He continued to share reminiscences of those days.
It seemed as though he felt safe enough to reveal those private thoughts with me. I was honored. Moment by moment I began to feel the sense of suffering from his many unfortunate experiences. He had followed his father’s pattern of drinking and lost many jobs. His bad temper while inebriated alienated all of his friends. His wife left with the children after a few years. Drifting from place to place became his way of life. He learned to depend on himself and rarely became emotionally connected with people. I was privileged that he chose me to reveal those personal thoughts. He talked on and on and kept my interest. As he related those few stories, I listened knowing that something inside me was changing. Afterwards, we walked back to his room, and he thanked me for the walk. Thank you’s were not usually in his vocabulary, but I pretended not to notice this change in his behavior. “You’re welcome.” I replied and left him there to return to his television shows.
I returned to the desk and had to sit down. Coworkers told me there was a strange look on my face. I had tears in my eyes. After a few minutes, I headed for the nurse’s lounge to collect my thoughts. Thankfully, the lounge was empty. I sat alone reflecting over the previous few minutes. My shift ended and I left for home a different person than when I arrived that morning.
All evening I considered the events of that day. I mulled it over and over in my head. There were lessons for me on so many levels. I felt a sense of spiritual growth as I realized that I would now be forced to view all of my patients as more than just a body with a disease. They were more than men and women who came to me for care. They were also sons, daughters, husbands, and wives who brought the sum total of who they were to that hospital. Their lives prior to the disease had history and meaning to them. Their hospital visits and diseases were merely a hiccough in their lives. They were only in my care until they could return to those lives. I was on my life journey just as they were on theirs.
Ironically, the day of his discharge, he exhibited a change in his condition. The symptoms presented with his usual disruptive behavior that escalated and could not be diffused. Even though I made several attempts to resolve the conduct, it spiraled out of control until we finally had to restrain him for his own safety. I paged the physicians and apprised them of this change. Because of his indigent status, the medical residents were caring for him. They had some shared history with him also and told me that he was “acting out” because he was aware of the impending discharge. “No,” I told them firmly, “This is different.” They replied that they would come down soon. I returned to his room to check his vital signs and found him less conscious. After assessing his status, I called the medical resident immediately and told him of the problem. Andy was transferred to an intensive care unit that day and died the next day. No opportunity ever presented for me to thank him for changing my nursing practice, but I never failed silently thank him for the gift.