ANN J. BRADY
HE WAS 16
He was 16. Immobilized in a
hospital bed, he had to wait for us. The sheets were rumpled, Hershey bar and
M&M wrappers littered the tray table, bags of clear IV fluids swayed above
him. His veins bulged in his forearms, the kind that made starting an IV easy.
He had no tattoos, none that I saw, but he had the muscular body of a boxing
champ and the vacant eyes of a coyote, averted each time I entered his room.
He'd been shot, twice. And he sucked his thumb.
One bullet had ripped through his
groin causing massive damage and swelling that required bilateral lower leg
fasciotomies. The trauma surgeon ordered the protective dressings be changed
once per shift. It took three of us to do it: one to hold his leg, another to
cautiously unwind the gauze making sure the loose threads that adhered to the
wound were carefully removed. A third poured saline over it and loosened any
sloughed skin or debris. He stared
out the window as we worked, intent on the mechanical equipment housed there.
The hum of the outside machinery was constant, not the comfort of white noise
but the low rumble like an oncoming train. It was a lousy room. He was in a
lousy place. With his head turned away he sucked his thumb. I only saw the
movement of the curled fist moving up and down, faster when the soiled dressing
was removed, slower when the clean band of nubby gauze was applied. It was
physically taxing for all of us. But it was emotionally difficult too because I
was afraid of him. It wasn't the anxiety of adhering to strict isolation to
protect the patient from my germs or me from his. I wasn't afraid of catching a
disease from him. I was afraid of the parts of his life that might rub off on
me, of what social contagion I might take home on my uniform. He sensed my discomfort,
I was certain of that, so I labored to hide it from him, though in truth I was
hiding it from myself. He worked his thumb the way my baby did when he was too
tired to fight having his diaper changed and it was easier to turn his head and
let me change him. I tried to remember my son when we changed the leg
dressings, reminding myself that this 16 year old wasn't really much older than
my boy was. I was old enough to be his mother. I wanted to know the story of
the shooting, thinking it might ease my fear. He was admitted with a pseudonym,
not John Doe but John August, maybe because it was August and the ER couldn't
come up with something clever. I didn't know if he was a victim or the
perpetrator so I worried that another gang member might come by and finish the
job. But I also was afraid that another gang member might come by and I'd have
to figure out how to interact with him as well.
I'd never seen fasciotomies
before, the layers of glistening pink muscle, the pale tendons and the ragged
edges that pushed away from the swollen tissue. The sweet yeasty smell combined
with a waft of cloying odor from the rim of scab. In my mind healing meant
closed wounds and crusted suture lines, not the constant oozing of flayed
calves. I spoke as I worked and directed the others, the echo of my voice a
testament to my belief that if I sounded confident I would be confident. But it
was impossible to pretend that his thumb sucking was not significant, to act
like we didn't see what he was doing. I tried to bring him around with the few
tricks I had in my nursing arsenal: humor, soothing tones, open ended
questions, but it was as if I wasn't there. He had blocked me out. I worried
that I sounded patronizing and that was what made him turn away. I wasn't sure
if he acted like he did because he was in the hospital and afraid, or if his
behavior and lack of social skills were what caused him to be shot. He never
spoke to me. He never answered my questions. He never made eye contact. I
touched him but I couldn't reach him.
I am always learning from my
patients. From some I learn a new nursing skill or technique; some teach me new
life skills. He was one of those patients who did both. As I wrapped Kling over
the wet 4x4's I wrapped him with parts of myself, the part that had to overcome
my fear of him, the part that had to remind myself to be compassionate. Our
lives touched each other. While I concentrated on being careful to re wrap the
legs correctly; cautious about where to start the continuous line of gauze - not too tight, not too loose, too dry or too wet, I also focused on
acknowledging my feelings. What could I do to help him, what could I do to ease
his fear of me? What part of me needed to change to care for him? The
physicality of the dressing changes was as taxing as the mental challenge. I
wanted my care of him to say something about me - that I had heroically
conquered my apprehension, or at least quelled it, that I was open enough not
to judge him. I thought my positive attitude would help me to reach him and he
would see the effort I made. I thought if I did a good enough job that he would
be grateful and one day when I walked in his room he would look up and thank
me. I thought if I healed his wounds I could heal him inside too. None of that
happened. He never shifted his attention from outside the window. My
breakthrough came when I realized that even if I couldn't connect with him,
couldn't make him see or be part of my brighter world that I had to care for
him as if that would happen. His attitude didn't have to determine mine. Even
though I was repelled by guns and violence and gangbangers set on killing each
other I could forget all of that and instead concentrate on providing the kind
of care I wanted for my own child. I ignored the fact that a 16 year old was
sucking his thumb. I normalized it and blocked any negative comments or
snickering about his thumb-sucking made by my co workers and redirected them. "He's just a scared kid," I said. Even so, it was impossible to make
believe it wasn't sadly pathetic.
He had gotten to age 16 without what he needed. As tough as he seemed to
be he sought solace from the most primitive of stimuli.
Turns out part of him did rub off
on me. He is with me each time I have a challenging patient, reminding me to
examine my own prejudices, to take on my part of the relationship without
blaming the difficult parts on the difficult patient. My experience with him
made me search for the 16 year old thumb sucker, not just in my patients but in
those I encounter outside of the hospital too. I learned that nursing isn't
really about nurses at all, it is about patients. The cliche of meeting people
where they are, in their place, is true.
It doesn't matter if he doesn't
remember me, if I made no impression on him, if I didn't heal him inside. He
made one on me by showing me that the turned away glance and the thumb were
another way of coping. We all have our own thumbs, our own way of shielding
ourselves from pain. He never spoke to me. I never heard his voice. Yet he
reached me. He shook me up and I believe helped make me a better me.
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