Tuesday morning, eight o'clock, and I have seven things to do. Check vitals, change a dressing, get a patient out of bed, send another to the operating room. Review lab results, give medications, start a blood transfusion.
I have six patients, and they have an average of five morning medications each. I make three trips to the med room for supplies, two trips to the pantry for fresh water.
Mrs. Napoli has eight pills. She has trouble swallowing them, so I circle the unit to find the pill crusher, stopping again at the pantry for applesauce to mix them up in.
Mrs. Napoli is a wisp of an old woman, light enough for a strong wind to blow over. Her wide blue eyes, which usually radiate a steady calm, look strained. The lines and grooves of her face are tense with pain.
The pain is a seven. Earlier this morning it was a five. It was a ten when she fell in her backyard, fracturing her hip; right after her surgery, it was an eight. I go to the med room and draw morphine into a syringe and give it to her over two minutes, watching the second hand sweep around the wall clock.
"Thank you, dear," she says with a weary smile.
I spoon in her pills and pick up her breakfast tray. She ate three bites. Yesterday she ate two. Her appetite is improving.
I count my paces up the hall. Forty steps to the pantry to dump the tray. Thirty-two steps to the clean utility room for dressing supplies, nineteen steps back to Mrs. Napoli's room to change her hip dressing, twenty-eight steps to the dirty utility room to dispose of the old dressing. Fifteen steps to the med room for a blood-transfusion set and a bag of saline.
Counting helps. It calms me.
We all have something. Morgan, the charge nurse, chants, "I love my job, I love my job." Jeannie chews coffee beans. Becky, the aide, hums under her breath as she comes up the hall, bringing me Mrs. Napoli's unit of blood from the blood bank. I check it with Jeannie at the med cart, holding Mrs. Napoli's chart and tuning out the hubbub of the unit, Jeannie's coffee aroma floating around me. "Josephine Napoli. Date of birth, four ten nineteen-nineteen. O positive. Unit number..."
She nods, wincing as the patient across the hall begins to scream: "No, don't touch me! Don't do that! No! Don't touch!"
Then I hear humming, and Becky's voice, soft and calm: "It's okay, I'm not going to hurt you. It's only a washcloth.
I go into Mrs. Napoli's room to hang her blood transfusion. As I pass the nurses' station, three people call my name. The physical therapist wants to know when she can work with Mrs. Napoli, Morgan tells me my post-op patient is coming up, and Mrs. Napoli's doctor wants to know if she's had her blood transfusion yet.
Now it's twelve-fifteen, and I have twenty-six things to do. Admit a new patient, set up a bladder irrigation, give a tube feeding, collect stool samples, start an IV. Charting and more charting: nurses' notes, intake and output, patient education, plan of care. At the rate I'm falling behind, I'll be done with this day by two o'clock Thursday.
I go into Mrs. Napoli's room to see if her blood transfusion is finished. She keeps her eyes closed while I take another set of vitals. I try to be quiet, but she wakes up anyway.
"Are you okay?" I say. "Having pain again?"
She shakes her head, lifts one pale hand from under the blankets and opens three fingers, their dark pink polish nearly worn off. The pain is a three.
I hear the patient down the hall screaming, "No! Mama, mama! No!"
Mrs. Napoli waves her hand at the empty bag of blood hanging on the pole next to the bed.
"I'm not going to get better, am I? This is it, I think." Her voice is shaky, and she sniffs in a tired way. I give her three pats on the back and one abbreviated hug. She reaches for a tissue, but her table is empty except for her cup and pitcher and a copy of Reader's Digest.
Nineteen steps to the clean utility room for a new box of tissues. Nineteen steps back to Mrs. Napoli.
She's crying silently, tears leaking from her eyes and down her face. One, two, three, then another and another, until finally I lose count.
All the tasks, all the numbers fly from my head. Yes, this probably is it for her. Her broken hip has left her so frail, compromising her mobility, her strength, even her appetite, that one more setback will spell the end. The enormity of it is beyond the range of my calculations. Counting won't help. Five minutes of empathy won't help.
I hand her a tissue, and she dabs it at her eyes. I put my hand on her shoulder. It's all I can think to do.
"I'm going to stay with you for a few minutes." I pick up the magazine. "Would you like me to read something?"
Then I'm reading, and my mouth moves, but I'm not thinking about the story I'm reading.
I'm thinking that suddenly I know why I'm here.
Not for the tasks, the chores, the pills and blood transfusions and moving patients onto a stretcher and off again, but for this moment.
To read to Mrs. Napoli.
About the author:
Priscilla Mainardi is a registered nurse who attended the University of Pennsylvania. She has spent twelve years caring for patients at an acute-care community hospital in northern New Jersey. "My brief poignant glimpses into the lives of my patients, and their bravery in the face of grave illness, inspired me to begin writing, which eventually led to an MFA degree from Rutgers University, Newark." Her work appears in Toad, The Writing Disorder and Nurse.com.