on Nursing presence
how being with your patient is one of your most essential qualities
Hey nurses. What’s the weirdest noise you’ve heard a patient make? This can be from any orifice, of course.
Years and years ago when I worked in Oncology I had a patient who was in the hospital for botulism poisoning.
I rounded on him first thing in the morning, completed my assessment and asked him if he needed anything else.
He replied, “no,” and I turned to head out the door and on to the next patient.
As I was leaving he made this very random “ehhhhach-ehhhhhhach!” sound. A screech with a little “ach” at the end of it.
I turned. “Hey buddy, what’s up?”
He said that making that noise was part of the exercises the speech therapist gave him as a way to strengthen his vocal cords and facial muscles.
I was surprised at his sounds as I’d never had a patient work on that before. I told him, “please tell me more, I’ve got to hear what this sound is all about.”
Turns out the botulism poisoning, which he got from skin-popping drugs, affected his head, neck and chest muscles, making them very weak. He was first admitted to the ICU and ventilated.
By the time he came to my unit he was working on keeping his head upright, as his neck muscles often just let go and his head plopped down to his chest.
I left him working on his “smiling” exercises, which totally made me smile, too.
When I rounded on him again later that morning I greeted him with a conspiratorial “ehhhhh! How are you?” That gave him the biggest laugh.
I ended up being assigned to this man many times over the next several months. We always greeted each other with a nice loud “ehhhhhhach!” screech.
He stayed on the nursing unit for so long because he was a difficult discharge plan, and needed a lot of physical and speech therapy rehab.
“The character of the Nurse is just as important as the knowledge she possesses”
One shift I asked him how he was doing with everything, and he confided in me that he was nervous about going back home. Back to his social circle.
When I asked him about his concerns he said he’s been clean and wants to stay clean, but knows just how hard that is to do when you are back in an environment that encourages substance use.
My young RN heart sank.
Here we were, patient and nurse from different parts of the world, sitting together through the reality of challenges I couldn’t comprehend.
This patient had given me a new view on social determinants of health and what it really means to try to be in control of our health.
What he said next really stuck with me.
He thanked me for taking the time to talk with him every time I was his nurse, and for not offering up “shit-advice like don’t do drugs again.” We laughed together at that.
He said he liked how he could just talk and I listened.
Wow.
Talk about the opposite approach from what we in health care normally do. We are the experts and we tell people what to do. This man of course appreciated our expert care, and also needed his experience to be heard and understood.
He will always stick with me as one of my favorite patients. For bonding over the funny noises we made together, sure. But mostly for trusting me enough to share his most vulnerable thoughts.
One of the hardest things about bedside nursing is that you mostly don’t know what happens to your patients. Some of them come back into the hospital, but most we just never see again.
I am wishing my friend well. I want to thank him for showing me that our nursing presence alone can be the most important impact we have on our patients.
Thank you, Ehhhhhach!
Thank you to the bedside nurses out there listening to their patients every day. You are inspiring.
We can’t underestimate the power of just being with our patients. Listening to them or squeezing their hand.
You are not alone in how hard the nursing job is.
Talk to your peers about the crappy assignments you’ve had to release that pain and frustration.
And also, don’t forget to talk about the ones that make you smile. In that, we nurses are never alone.
