Simple gestures: a nursing student’s journey through the ICU

Elizabeth Cambier, RN
Loyola University Medical Center, Chicago (Winter 2010)

For those of us who have chosen to pursue careers in the healthcare field, the lessons we learn in life are what make us true professionals. Like the finishing touches that transform a sketch into a work of art, our lives allow us to read between the lines of our patients’ lives and peer into the anxiety of their families. They allow us to offer those simple gestures that are healing in themselves—although never exactly prescribed, just implied. These life lessons sculpt our character and not simply our minds. They provide a depth and substance to our learning that no textbook can provide. And the intimate nature of the work that we do can prompt these memories in unexpected ways.

Clearly life does not wait for the diploma to provide opportunities to learn. Life continued even as I embarked from a job working in activism to a four-semester nursing licensure program, the kind of program where you belong to the university until they set you free. The unexpected is not supposed to happen; but halfway through my studies, my mom was diagnosed with metastasized lung cancer. So, despite academic exhaustion, I spent the few precious weeks I had free at the end of the summer at home with her while she had a golf ball-sized tumor removed from her brain. Less than a month later, they removed a third of her lung as well.

By the end of October, I was called home because Mom wasn’t expected to make it through the weekend. She had recovered remarkably from her initial surgeries and had made it through her first week of radiation before her condition started to deteriorate. The scar tissue from the brain surgery had blocked her ventricles; she developed hydrocephalus and had a ventricular-peritoneal shunt placed. She never quite recovered from that surgery. After a few weeks she was transferred to a nursing home for rehabilitation, but within five days she returned to the hospital with unexplained hemorrhaging in her brain. That’s when I received “The Call”—the final one.

When I arrived after a 12-hour drive, I found my mom swollen, bald, intubated, with a feeding tube and two external ventricular catheters for draining the blood and spinal fluid, as well as for pouring vancomycin directly into her brain (I still can’t help but picture the mad scientist, with a skull hinged open, pouring beakers full of mysterious potions into someone’s head). I then spent a week in the neuro ICU.

This experience – the surreal passage of time, the sleeping in a hospital waiting room, the unexplained comings and goings of too many white coats – is one that I would wish every healthcare professional could have; except that of course, I would never actually wish it upon anyone. Throughout the week, she was sedated just enough to keep her panic at bay, but not enough to keep her from constantly trying to pull at all those tubes. For the next five days I stood or sat at her bed, almost constantly – one hand holding a book, checking my e-mail, on the phone, changing the TV channel – the other hand repeating the same motion again and again, pulling her hand back down to the side of the bed, even as she reached up the moment I let go to pull at the tubes.

By this point all the nurses in the ICU knew my mom fairly well, as she had been there after both of her surgeries (tumor out, shunt in), which means they all knew about her daughter the nursing student as well. They were amazing. They seemed to understand implicitly that I knew just enough to ask about  everything (unlike my brother, the lawyer, who was happier with a simple answer to the simple question: “how is she today?”), and they were endlessly patient with me. Josh, the nurse she had most days, would come into the room as soon as he saw me each morning to give me report. Throughout the entire week, he never failed to explain exactly what he was doing at each moment – every medication, every blood test, and every assessment – or to follow up after the endless stream of white coats who didn’t always take the time to even look at me.

Mom passed away at the end of November. Shortly before then, all the tubes had been taken out; we were simply waiting for her to peacefully pass. The last time she opened her eyes occurred four days before her death. She was out of the ICU and in a private room on the neuro step-down unit. The nurses, again, were phenomenal. There were the little things, like making sure we knew where the coffee pot was. And there were bigger things—answering questions, explaining what to expect, advocating on our behalf when there was talk of transferring her; and running down to the cafeteria in search of us when mom finally let go.

Sometimes your body holds a memory in a manner entirely different from your mind. You’ve all experienced it – when you’re walking down the street, and suddenly you are hit with a scent that knocks you off your feet with nostalgia. Two months after my mom passed away, I began my final semester-long clinical rotation on an ICU. Before I started, my clinical instructor had a long talk with me about how it would be, my fears and concerns following so closely after my mother’s death; the talk helped give me permission to respond to the inevitable emotions that would come.

I stepped on the unit, and one of our first patients was an older woman, intubated, with a feeding tube. She was sedated just enough to keep her panic at bay, but not enough to keep her from constantly trying to pull at all those tubes. I stood or sat at her bed— it could have been five minutes or five hours, waiting for the physician to sign an order for restraints—repeating the same motion again and again, pulling her hand back down to the side of the bed, only to have her reach up the moment I let go to pull at those tubes.

Suddenly, I felt as though the wind had been knocked out of me. I walked away for a few minutes, allowing the flood of emotions to pass through me; and for the next several months I let those emotions guide me as I learned to care for my patients and their families.

I made every effort to meet family members as they walked in, to give them an update. I never left a room without asking if they had questions or needed anything. I always offered a cup of coffee. I spoke with patients who were still able to make decisions about living wills and powers of attorney about talking with family members about their wishes. After a whirlwind family conference with a patient’s children about ordering a DNR, I sat with the daughter to answer her questions, and to listen as she worked through her emotions. A few days after the DNR was signed, she said what a blessing it was that her mom had died peacefully and that she had been able to simply be with her in her final moments.

People often talk about what a luxury it is to be a student, to still have time to spend with patients – before the hectic pace of your first actual job is upon you. I am so grateful to have had that opportunity at such an important moment in my life, thankful to have developed my habits, as it were, at a time when my own experiences were so fresh. I know that I will never have that luxury again; but I also know – have seen, from the nurses who cared for my mom – that it is possible to reach out even in the midst of that hectic pace. And I know that her memory will always be with me, every time I offer a cup of coffee.

 


ELIZABETH CAMBIER grew up in Central New York and pursued an undergraduate degree in Sociology/Anthropology and Spanish at Ohio Wesleyan University. After a few years working in various social service positions, she completed an RN program at University of Illinois in Chicago. She is currently working as an RN in the Medical ICU at Loyola University Medical Center and plans to focus on end-of-life care as her career progresses.

 

 

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