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The Power of Nursing
The
Power of
Nursing Claudia R. Ravin, MSN, CNM, RN-BC
i I remain profoundly grateful to that ER nurse. She held such power in her hands that morning.
344
© 2007, AWHONN
It was a sunny, crisp Saturday morning in October 2003. I was making mushroom soup when the call came from the nursing home saying my mom was having trouble breathing. An ambulance was called to take her to the nearest hospital. This had happened before; she had been largely bedridden for the previous six weeks and on two occasions had thrown a pulmonary embolism. After a day or two of anticoagulation, she’d be discharged back to the nursing home, a little depressed at her frailties but always hopeful she was “over the worst of it.” She was 81 and sharp as could be, with every neuron still firing. Only five months earlier she had been gallivanting around Europe with a
friend from college. But everything went downhill in late August after an untreated urinary tract infection led to septic shock and kidney failure. On dialysis now, she didn’t feel much like eating, and the bland, soft nursing home food didn’t help matters. I could get her to eat my cooking, though. She loved mushroom soup with real cream and portabello mushrooms. The pot I was cooking now was almost done; it just needed another half-hour to simmer. I mulled leaving it unfinished and heading out to the hospital immediately. But instead I decided to wait, reasoning that I often wasn’t allowed
(continued on p. 342)
http://nwh.awhonn.org
She intuitively knew what I needed to hear, see and feel so that I could go on.
Claudia R. Ravin, MSN, CNM, RN-BC, is associate director for educational services at AWHONN in Washington, DC. DOI: 10.1111/j.1751-486X.2007.00172.x
342
to see her for several minutes after she was brought in. I added a little parsley and sherry to the soup, cleaned a thermos, and packed a spoon and a colorful ceramic bowl. I puttered some more until the soup looked done. I put on an Irish cable knit sweater she had knit me a few years prior. After a health crisis she often said she felt “so useless”; I thought seeing evidence of her handiwork would remind her how skilled she was. And it was a beautiful sweater. The drive to the hospital took about 50 minutes in heavy, slow traffic—apparently there was a local college football game and tailgating starts early here. But I didn’t fret; part of me dreaded yet another long day spent in the hospital running interference for mom—deterring phlebotomists with poor aim, searching for blankets and bedpans, eyeballing her meds, and investigating interminable delays in getting her to radiology. I listened to country music, sang along with Brad Paisley and comforted myself with visions of my mom’s pleasure in the soup. Once she got settled in a room, I’d serve the soup and we’d call my brothers in New Mexico. Together they could rant about the pitiful Oakland Raiders. That always cheered her up. No matter how horribly the team played, she was a devoted fan and she and my brothers could go on happily for hours about the latest quarterback controversy or disappointing draft picks. After parking, I wended my way through the cluster of smokers outside the emergency room (ER) door, precious soup in hand. The ER was very busy but controlled, not frantic. All the beds were occupied, with drapes pulled shut and nurses in blue-flowered scrubs scurrying purposefully from one patient to the other. I asked at the nurse’s station if I could see my mother, carefully spelling her name. The clerk froze and said “wait here.” In that instant I knew something awful had happened, but rather than consider the possibilities I focused on the Halloween decorations taped to the desk. I watched numbly as the clerk conferred with a nearby nurse who looked somberly in my direction and then went to get yet another nurse. Barely breathing now, I obediently waited. The newly beckoned second nurse sat down next to a youngish doctor—a man. In synchrony their heads swiveled in my direction. They rose and must have introduced themselves, but I don’t remember their names. The nurse said
Nursing for Women’s Health
they wanted to talk to me about my mother and steered me to a barren little room and shut the door. There were no windows, just a few metal chairs and a dusty coffee table stained with old coffee rings. They motioned me to sit and took chairs opposite me. The doctor wasn’t unkind, just very formal and stiff, with his eyes mostly on the chart he carried. He told me they had done everything they could. He rose and asked if I needed to talk to a social worker or a chaplain. I thanked him and said no. He quickly exited. The nurse waited for me to speak, shifting to the chair adjacent to mine. I started babbling inanely about the soup, the sweater, the traffic, not being there when she died. Not being there to save her. Not being there to hold her hand. Not being there to tell her I loved her. Not being there. The nurse’s eyes welled with tears and she reached out to hold me. Rocking me a little as she crooned, “It’s OK. It’s OK.” She told me that my mother was barely conscious when she arrived, that she wasn’t in pain, she wasn’t afraid. She said she never left my mother’s side. She asked me to tell her about my mom. I told her how my mom single-handedly raised the four of us, working as a third-grade teacher in a backwater town south of Jacksonville, FL. My mom was brilliant, brave, independent and fiercely competitive at any kind of game. No one would play ping-pong with her anymore; she was equally good at bridge and gin rummy. Her victory dances rivaled end zone antics in the NFL. In her early thirties, she had played golf in a semipro league and had always lamented my complete lack of talent and coordination with a 3-iron. She loved us more than anything and in moments of despair about her health she said she didn’t want to die because she couldn’t bear never seeing us again. She had a wonderful voice, throaty and musical with a rollicking laugh. She’d been raised in Kansas City, MO, and still felt it was the best place in the world. She graduated from Cal Berkeley and told us stories about the day Pearl Harbor was bombed. She had been on the way to a final exam in chemistry and her teacher made them take the test anyway. Surely I’d been talking for 30 minutes, crying and laughing a little, while the nurse cried and laughed with me. She asked if I wanted to see my mother and if she could call anyone for me. My husband was playing baseball and was
Volume 11
Issue 3
unreachable, but my youngest son, a college freshman, was home for fall break. I gave her his number and she led me to my mother’s room. All the code blue detritus had been removed. Even her IV was out; she was lying on the gurney, looking pale but somehow lovely and far younger than just days before. The nurse told me to talk to my mother, that she would hear me. She got me a chair and a cup of tea and left me alone with my mom. I sat for a long time; I could hear the nurse shooing a morgue orderly away and telling another nurse that the room wasn’t available yet for another admission.
June | July 2007
My son arrived and we left after I smoothed my mom’s hair and told her I loved her one more time. The nurse walked us to the ER door and told me that my mother had been so lucky to have us and us to have her, that it was clear she had a very rich life. It has been more than three years now. I still miss my mom, but mostly the memories are happy ones. For example, it’s fun to see how talented my youngest child is at golf. She would have loved that. I remain profoundly grateful to that ER nurse. She held such power in her hands that morning. I could have left
the hospital shattered, grief stricken and overcome with guilt. Who really knows if my mother felt pain or if the nurse was truly at her side, comforting her till the end? That wasn’t the issue anymore. The nurse knew that her responsibility had shifted from my mother to me; she had to send me home whole and coping. She intuitively knew what I needed to hear, see and feel so that I could go on. That ER nurse was not unique; as nurses, we all hold the same extraordinary power and most use it as wisely. It is an awesome thing we do. NWH
Nursing for Women’s Health
343
Power of
Nursing Claudia R. Ravin, MSN, CNM, RN-BC
i I remain profoundly grateful to that ER nurse. She held such power in her hands that morning.
344
© 2007, AWHONN
It was a sunny, crisp Saturday morning in October 2003. I was making mushroom soup when the call came from the nursing home saying my mom was having trouble breathing. An ambulance was called to take her to the nearest hospital. This had happened before; she had been largely bedridden for the previous six weeks and on two occasions had thrown a pulmonary embolism. After a day or two of anticoagulation, she’d be discharged back to the nursing home, a little depressed at her frailties but always hopeful she was “over the worst of it.” She was 81 and sharp as could be, with every neuron still firing. Only five months earlier she had been gallivanting around Europe with a
friend from college. But everything went downhill in late August after an untreated urinary tract infection led to septic shock and kidney failure. On dialysis now, she didn’t feel much like eating, and the bland, soft nursing home food didn’t help matters. I could get her to eat my cooking, though. She loved mushroom soup with real cream and portabello mushrooms. The pot I was cooking now was almost done; it just needed another half-hour to simmer. I mulled leaving it unfinished and heading out to the hospital immediately. But instead I decided to wait, reasoning that I often wasn’t allowed
(continued on p. 342)
http://nwh.awhonn.org
She intuitively knew what I needed to hear, see and feel so that I could go on.
Claudia R. Ravin, MSN, CNM, RN-BC, is associate director for educational services at AWHONN in Washington, DC. DOI: 10.1111/j.1751-486X.2007.00172.x
342
to see her for several minutes after she was brought in. I added a little parsley and sherry to the soup, cleaned a thermos, and packed a spoon and a colorful ceramic bowl. I puttered some more until the soup looked done. I put on an Irish cable knit sweater she had knit me a few years prior. After a health crisis she often said she felt “so useless”; I thought seeing evidence of her handiwork would remind her how skilled she was. And it was a beautiful sweater. The drive to the hospital took about 50 minutes in heavy, slow traffic—apparently there was a local college football game and tailgating starts early here. But I didn’t fret; part of me dreaded yet another long day spent in the hospital running interference for mom—deterring phlebotomists with poor aim, searching for blankets and bedpans, eyeballing her meds, and investigating interminable delays in getting her to radiology. I listened to country music, sang along with Brad Paisley and comforted myself with visions of my mom’s pleasure in the soup. Once she got settled in a room, I’d serve the soup and we’d call my brothers in New Mexico. Together they could rant about the pitiful Oakland Raiders. That always cheered her up. No matter how horribly the team played, she was a devoted fan and she and my brothers could go on happily for hours about the latest quarterback controversy or disappointing draft picks. After parking, I wended my way through the cluster of smokers outside the emergency room (ER) door, precious soup in hand. The ER was very busy but controlled, not frantic. All the beds were occupied, with drapes pulled shut and nurses in blue-flowered scrubs scurrying purposefully from one patient to the other. I asked at the nurse’s station if I could see my mother, carefully spelling her name. The clerk froze and said “wait here.” In that instant I knew something awful had happened, but rather than consider the possibilities I focused on the Halloween decorations taped to the desk. I watched numbly as the clerk conferred with a nearby nurse who looked somberly in my direction and then went to get yet another nurse. Barely breathing now, I obediently waited. The newly beckoned second nurse sat down next to a youngish doctor—a man. In synchrony their heads swiveled in my direction. They rose and must have introduced themselves, but I don’t remember their names. The nurse said
Nursing for Women’s Health
they wanted to talk to me about my mother and steered me to a barren little room and shut the door. There were no windows, just a few metal chairs and a dusty coffee table stained with old coffee rings. They motioned me to sit and took chairs opposite me. The doctor wasn’t unkind, just very formal and stiff, with his eyes mostly on the chart he carried. He told me they had done everything they could. He rose and asked if I needed to talk to a social worker or a chaplain. I thanked him and said no. He quickly exited. The nurse waited for me to speak, shifting to the chair adjacent to mine. I started babbling inanely about the soup, the sweater, the traffic, not being there when she died. Not being there to save her. Not being there to hold her hand. Not being there to tell her I loved her. Not being there. The nurse’s eyes welled with tears and she reached out to hold me. Rocking me a little as she crooned, “It’s OK. It’s OK.” She told me that my mother was barely conscious when she arrived, that she wasn’t in pain, she wasn’t afraid. She said she never left my mother’s side. She asked me to tell her about my mom. I told her how my mom single-handedly raised the four of us, working as a third-grade teacher in a backwater town south of Jacksonville, FL. My mom was brilliant, brave, independent and fiercely competitive at any kind of game. No one would play ping-pong with her anymore; she was equally good at bridge and gin rummy. Her victory dances rivaled end zone antics in the NFL. In her early thirties, she had played golf in a semipro league and had always lamented my complete lack of talent and coordination with a 3-iron. She loved us more than anything and in moments of despair about her health she said she didn’t want to die because she couldn’t bear never seeing us again. She had a wonderful voice, throaty and musical with a rollicking laugh. She’d been raised in Kansas City, MO, and still felt it was the best place in the world. She graduated from Cal Berkeley and told us stories about the day Pearl Harbor was bombed. She had been on the way to a final exam in chemistry and her teacher made them take the test anyway. Surely I’d been talking for 30 minutes, crying and laughing a little, while the nurse cried and laughed with me. She asked if I wanted to see my mother and if she could call anyone for me. My husband was playing baseball and was
Volume 11
Issue 3
unreachable, but my youngest son, a college freshman, was home for fall break. I gave her his number and she led me to my mother’s room. All the code blue detritus had been removed. Even her IV was out; she was lying on the gurney, looking pale but somehow lovely and far younger than just days before. The nurse told me to talk to my mother, that she would hear me. She got me a chair and a cup of tea and left me alone with my mom. I sat for a long time; I could hear the nurse shooing a morgue orderly away and telling another nurse that the room wasn’t available yet for another admission.
June | July 2007
My son arrived and we left after I smoothed my mom’s hair and told her I loved her one more time. The nurse walked us to the ER door and told me that my mother had been so lucky to have us and us to have her, that it was clear she had a very rich life. It has been more than three years now. I still miss my mom, but mostly the memories are happy ones. For example, it’s fun to see how talented my youngest child is at golf. She would have loved that. I remain profoundly grateful to that ER nurse. She held such power in her hands that morning. I could have left
the hospital shattered, grief stricken and overcome with guilt. Who really knows if my mother felt pain or if the nurse was truly at her side, comforting her till the end? That wasn’t the issue anymore. The nurse knew that her responsibility had shifted from my mother to me; she had to send me home whole and coping. She intuitively knew what I needed to hear, see and feel so that I could go on. That ER nurse was not unique; as nurses, we all hold the same extraordinary power and most use it as wisely. It is an awesome thing we do. NWH
Nursing for Women’s Health
343