Beyond Mere Science

God has a way of bringing patients into my life who serve to remind me of what this nursing stuff is all about. Through these encounters, He restores my sense of the holy purpose of nursing. Without this sense of altruism, nursing becomes nothing more than an application of mere science and aesthetics; The patient is reduced to nothing more than a problem to be fixed- the "kidney stone in room 3"- rather than a human being in need of care.

Dealing with malingerers and drug-seekers on a daily basis tends to make me more cynical and suspicious than I can comfortably admit. After dealing with at least one malingerer per shift for nearly a week, I have to admit that I can get pretty jaded.

Sometimes a patient will come in for emotional distress. There may be no underlying pathology. But an emotional or spiritual emergency is still an emergency. The person's life is a shambles and he or she has run out of ideas and hope. If ignored, it can be devastating. (The reader need only refer to my recent post about a coworker's suicide to see my point).

Some may suggest that a counselor or a church would be a more appropriate place to take one's personal demons. My answer to such a statement is simply that while counselors and churches are not open 24/7, Emergency Departments are. And when there is nowhere left for a distraught, frightened or hopeless person to go, the ER is the perfect place to come for help. Why shouldn't they come here?

I had a patient a couple of weeks ago who came through triage complaining of "loneliness" (her stated chief complaint). She was three months pregnant, and her boyfriend had left her. She had come with him from the East Coast, and she had no way to get back home. She had been living day-to-day and roof-to-roof for nearly a month and had run out of friends, money, shelter, and strength. She was tearfully apologetic about taking up my time as I assessed her in the treatment room. She never asked for any medication. She never asked for so much as a blanket, although it was chilly and her arms were covered in goosebumps. I gave the woman three blankets fresh out of the warmer.

It is amazing how therapeutic a fresh warm blanket can be, and how strongly it can communicate compassion. It says, "You're safe here." The woman visibly relaxed and smiled with a sigh as I wrapped one around her shoulders and covered her body and upper legs with the second, and wrapped the third around her lower legs and feet.

We ran some basic tests on the woman just to make sure she and the baby were okay, and everything checked out fine. I assessed fetal heart tones and pointed out the fast, loud wow-wow-wow-wow of the baby's heartbeat under the doppler head. The woman brightened when she heard the sound of her baby's heart rocking steady in her belly.

A nurse's responsibility is not for a heart, a lung, a brain, or a lacerated toe, but for the whole patient. Certainly, the woman and her baby were physically fine, and there was nothing medically to be done for her. But emotionally, the woman was a train wreck. She was a harmless, stranded, frightened and lonely human being whose toolbox was completely devoid of coping skills. She was isolated from her family, cut off from a way home, and cold. And she was pregnant. She didn't want drugs; she just wanted to feel safe and that she was cared for- or more to the point, cared about.

Some might criticise the woman for abusing an already-overstretched Emergency Department. I must confess that I fought hard to suppress an involuntary rolling of my eyes as I read the patient's chief complaint. But as her story unfolded, God softened my heart. He reminds me about how important to Him human beings are. And by the time I finished listening to the woman's story, I had a good idea of what God expected me to do for her.

I approached the MD, who was sitting at his computer and sat down. He paused from his dictation and turned to me.

"You have that look," he said suspiciously. "Who is it?"

"The pregnant woman in 12," I said. "I know you haven't examined her yet, but she isn't physically ill."

"Why is she here?"

"Her heart is broken," I answered. The MD raised an eyebrow and I held up a hand. "She isn't asking for meds, she isn't in pain, and the baby is fine. But she's in a heckuva jam, she's scared, and she needs some help. I'd like to get Social Work involved."

"If you think she needs it, go for it. I'll go in and examine her so we can get things going."

I entered an order in the computer for a Social Work consult. I then called the SW to see how soon she could come.

"What's going on?" the SW asked. I laid out the problem and she said, "I'll be right there."

ER Social workers amaze me. These people can conjure up support resources seemingly from thin air. IN my ER, we nurses love our SWs and view them with something close to awe. This particular SW was a real veteran and one of my favorites. She came to the desk and chatted with the MD and me about what we felt should be done. The MD and I agreed that getting the woman back home would be a great goal if possible, and that finding shelter for her in the meantime would be icing on the cake.

The SW sighed. "You don't ask for much, do you?" She stood up, grabbed her papers, and went into the woman's room. She was in there for nearly an hour, and at one point I clearly heard the woman sobbing. At last, the SW stepped out. I noticed her left shoulder was wet. She sat down next heavily next to me at the nurse's station and said, "She is a wreck."

"Yep. What did you find out?"

"Well she doesn't fit the mold, for starters. She's smart and very articulate. She has a degree in economics. She came out here because her boyfriend got a job at the Geek Palace. They were going to buy a house together and she was going to try to get on at the University. Then she got pregnant. He didn't want the baby, and she wouldn't get an abortion, so he threw her out. She couldn't find a job and ran out of money and friends. She hasn't called her family for help because she was afraid they would be angry with her. But she gave me her parents' phone number and gave me her consent to give her folks the whole story. I'm going to go call them before it's too late over there. I'll be in my office if you need me."

Twenty minutes later, the SW came back and sat down. I looked at her expectantly. She sat down and folded her hands in her lap.

"Well, we can get her home and put her up in the meantime," she said at last.

"I never doubted you for a moment. What did her folks say?"

"They had no idea. They said she sent letters and called almost every day until about a month ago. Then she just vanished. They were worried about her and I had to convince them that their daughter was not dead. They want to talk to her, but I told them that I had to let the patient know first. I'll go in and give her the news. When I give you the high sign, call this number-" she handed me the paper- "and then transfer them to the phone in her room."

The SW went into the room with another warm blanket and closed the door. A minute later the SW opened the door, stuck her head out, nodded, and closed the door again. I called the parents, introduced myself, and then transferred the call. Within seconds the woman was sobbing again. Shortly thereafter, the SW stepped out.

"How's it going?"

"Just fine," the SW answered with a smile. Her parents have old friends here, and they gave me the number. They live about thirty miles north. I called them from the room, and they're on their way to pick up our patient as I speak. Her parents are going to arrange for a flight home in the next day or so."

"Wonderful! How is our patient?"

"Remorseful, but relieved. She'll have some things to work out for herself, but she'll be home in a few days and her parents are just happy that she's alive and healthy."

I informed the MD that things were squared away for our patient and gave him the plan. He smiled and printed out discharge instructions for pregnancy-related nutrition. The patient was already dressed when I entered the room; I gave the patient her instructions and informed her that she could wait in the lobby until her parents' friends showed up.

As we stepped into the hall, I offered my hand and said, "All sorts of good luck to you, ma'am."

She shook my hand and said, "Thank you. I'm glad I came here."

"Me too."