Mr. P was a 67-year-old male patient who had suffered a left-sided ischemic cerebrovascular accident and presented to the ED with sudden onset right-sided weakness and inability to bear weight which had resulted in a fall at his home. Basically, he got a blood clot stuck in the left side of his brain, causing him to have a stroke and oxygen to be blocked from getting past that clot. The stroke caused his right side to become so weakened that he fell. He had been admitted to the hospital immediately and was a candidate for TPA (a drug used to bust up that clot), which he received to reduce the damage of the stroke.
My first encounter with him was his fourth day in the hospital. One of the nurses had seen me in the hallway and asked me to perform oral care on one of her patients, Mr. P. While I performed some desperately-needed mouth care on Mr. P, all I could think about was how comatose he was. Mr. P could not swallow, move any part of his body except for his eyes, and could not speak. I wondered what he must be thinking, trapped inside his own body. While I performed mouth care on him, his eyes watched me and I knew he was probably grateful someone was finally helping moisten and clean his dry, neglected mouth. I talked to Mr. P while I performed oral care, using a record-breaking seven swabs to clean out all the gunk that had accumulated in the various nooks of his mouth.
My second encounter with Mr. P was his twelfth day in the hospital, in which he was my patient for the day. Mr. P had improved dramatically, now capable of moving his left side, head, neck, and face. He had also passed his swallow test and had been upgraded to a thickened-liquid diet. However, Mr. P still could not move any part of his right side, and could not speak at all. Despite his neurological improvement, Mr. P had also developed a case of C-Diff in the hospital since I last saw him, forcing him to wear diapers and taking away more of his independence. His inability to communicate seemed to frustrate him greatly, as he often grew exasperated with me, the other students, and even my professor when we tried to guess the things he was trying to say or ask for. He would throw up his left hand and shake his head, putting his head in his left hand, and glaring at us.
Mr. P’s wife shared with us that he had been a businessman, now retired, and was also an Army veteran. He was physically disabled before the stroke, due to his time in duty. The two of them were from a nice area of Brooklyn, and they had never had children. Mr. P’s favorite thing to do was drive his Corvette.
The nurse asked me to perform morning care on Mr. P, so I asked one of my fellow students to help me. Due to his immobile right side and C-Diff, I felt I needed assistance to give him a good bed bath. Mr. P grew very frustrated with us during his bed bath because of the various turning and re positioning. However, my fellow student’s response to Mr. P’s frustration was to attempt to explain to him why we were doing the things we were doing, which only frustrated him more. My fellow student left me to return to her own patient, leaving me to complete the bed bath on my own after we had mostly finished.
As I finished cleaning Mr. P, I thought about the situation and realized what was going on. Mr. P was depressed. He had gone from being an independent, retired man with a successful career in business to a man sitting in diapers who needed two young women to help bathe him, all in just a couple of weeks. His favorite thing to do was drive his Corvette; he probably was wondering if he would ever be able to just drive again.
He couldn’t talk to anyone about how he was feeling, as he couldn’t speak. He was right-handed, and he couldn’t move that hand, so he was unable to write. His wife had been by his side the entire time, but she was the type of person who tried to joke around about the situation and show him some “tough love.” He probably felt like he had lost all of his independence and that nobody understood what he was feeling, or even cared. I knew that if I were in that situation, I would be extraordinarily frustrated and depressed, and I would feel like the entire situation was a bad dream. And what a terrible nightmare to be in.
As I thought about how he was probably feeling, I felt myself start to get emotional, feeling a lump in my throat and tears welling up in my eyes. I swallowed my feelings, staring at the re-run of Wheel of Fortune playing on the TV, the only noise in the room at that moment, and I knew I needed to say something to Mr. P.
I shared with Mr. P that I understood that he was frustrated, and that I could not imagine what it must be like to be in his situation. I told him that it was okay for him to feel frustrated and upset and angry, and that he had a right to feel that way. But I also shared with Mr. P that although he may not have remembered, I had seen him the week before, and he had improved so much since I had last seen him. Although his progress may have felt slow to him, to me it was a huge difference that absolutely amazed me.
I told him that I would sit with him after his bed bath and we could practice learning how to brush his teeth using his left hand. I shared with him that strokes can often be really hard for people, and that many people go through the same feelings he was feeling, however things like re-learning to brush his teeth that may seem small go a long way in recovering. And he had already come such a long way.
As I shared these sentiments with Mr. P, he started to cry and he squeezed my hand with his left hand the entire time I spoke. Finally, I had been able to connect with him and he felt understood. It made me feel very sad and distraught to think that Mr. P had been cared for by so many people since he had entered the hospital twelve days before, and maybe nobody had had this conversation with him. Nobody had taken the time to acknowledge his feelings, that he was a person, and just sit with him. I can’t even imagine what that must be like.
After I finished cleaning up Mr. P, and he fell asleep, I told the nurse what had happened and suggested he receive a psych consult. The nurse agreed, and later that day the psychiatrist came to see and evaluate Mr. P.
Mr. P had lost nearly all of his autonomy, and due to his inability to speak, was extremely frustrated and depressed. He felt he had nobody to speak for him and advocate for him, and that he had no choices in his treatment. The stroke caused a quick decline in activities of daily living for Mr. P, and caused him to begin spiraling into despair. Autonomy is key in patient care, but in a case like Mr. P’s where the patient cannot speak, the patient’s autonomy may often be ignored or perhaps even forgotten. Although Mr. P could not communicate with staff, he still had feelings and opinions about his situation and the course of his treatment, and those deserved to be acknowledged and respected. Sometimes, health care can be so focused on fixing the physical that it’s easy to forget about the mental and emotional, especially when that patient can’t tell you how they’re feeling.
As I continue on my journey to becoming an RN, I will never forget Mr. P. My experience with him truly touched me and reminded me how great of an impact I can have on my patients, sometimes by simply taking the time to sit with them and see how they’re feeling. Even if I have a patient who cannot communicate with me, I will continuously try to connect with that patient, and ensure that the patient knows I truly care about them and their recovery. As a nurse, it will be my job to see that my patient not only gets better, but feels better. As a nurse, I will never doubt the importance of communication with my patients, and acknowledging their emotional state as well as their physical state.
I sometimes wonder where Mr. P is now, and I hope he’s driving his Corvette.