Monday, May 2, 2011
The man slowly rubs his eyes and looks over towards his mother....She is turning restlessly. The hospital bed rails impede her as she tries to throw her legs towards the floor. Her head moves back and forth and her eyes squint towards the hallway and the pale flourescent lights. Nurses are heard scurrying towards patient rooms and a custodian absentmidedly mops the floor outside our door.
I gently coax the elderly women back into bed. She is confused. She grabs at the telemetry moniter in her gown and then thrashes wildly. I motion for her son to stand closer to form a mechanical barrier beween his mother and the floor which sits perilously yet innocently beneath her bed.
He is terrified. His mother is now a stranger. She is belligerent. Nonsensical. Agitated. She came into the hospital slightly confused. Now she is unrecognizable.
The ER physician said, "she looks ok but we better keep her overnight just to be sure". The weekend physician on call said, "labs and CT normal...she hasn't had a stroke....but lets give it one more day.
And then early Monday morning...to his great relief...I walk in. His mother had a horrible night and she appears to be in great distress. I stand above her. I listen to her lungs, her heart, and examine her belly and legs.
I clear my throat and with determination say the last thing he ever expects "you have to get her out of here....you have to take her home." His face shows emotions he is too afraid to voice.
He has always trusted me in the past, but his mother has never been this sick. I calmy huddle with him outside the room as a CNA sits with his mother. I explain the concept of delirium. His mother, who is fairly cognizant and clear when things are going well, is not as agile when under stress. Her ninety five year old brain is not able to adapt the way it did thirty years ago. I explain that the hospital creates severe strain on the elderly. The lack of windows, the constant 24 hour lights, the frequent awakenings and being taken care of by strangers. It is highly confusing
I can see that intellectually he understands but his heart doubts. I end the conversation by saying that I am willing to wait but if she were my mother I would take her home as soon as possible.
He decides he wants her to stay one more day. I leave the floor feeling discouraged but resolved.
A few hours later I recieve a call by the nurse....the son has returned and he is ready to take his mother home. She will not stay in the hospital another night.
Three days later they come to my office for a visit. His mother is back to normal. We are joking and carrying on like regular. The crisis has passed. I pat him on the back as they leave. I can see the relief on his face. No words are necessary.
But if they had been this is what I would say:
You see...I know it takes courage. Courage to trust that when I walk in the door I have the best intentions when treating you or your family member. That I am having a good day and have thought through all the implications before I foist my opinions on you. You worry that I don't understand the profundity of the advice that I give.
But don't forget that I live day in and day out with my decisions. that I see over and over gain the consequences of the choices that I make. That I have spent innumerable nights tossing and turning. That I have mourned countless deaths and celebrated even more victories.
And I do it daily. But it never gets easier.
Strangely I understand how you feel
It takes courage for me too!
Posted by Jordan Grumet at 5:32 PM