Remembering Mary..

I held a dandelion in my hand the other day and an image of  Mary W. filled my memory.  It happened a long time ago.  That is as I, a mere human, reckon time.  I was a young person and an inexperienced nurse.  As I calculate the decades that would have made me about 20 years old.  I was working the night shift in a small private hospital that was rumored to have  beeen operated by "the mob" (more about that aspect of the tale another time).  I worked with one nursing assistant and cared for 30 patients.  The nights were slow most of the time. The seriously ill went to the likes of the Mass General or the Peter Bent Brigham. The absence of a critical care or E.R. rush  gave me an opportunity to spend time with my patients when needed.  I could be someone to talk to or someone to hold their hands as they waited for pain to subside.  On one particular winter night, the hand I held was a small frail part of a dying woman named Mary.  She had been in the hospital for many weeks.  Those were the days when patients could linger and are now long gone.  Mary was yet another patient for whom the doctors ordered placebos ~ she received saline 3 out of 4 injections.  Two hours prior to sitting with her I had dutifully delivered the saline injection. So many were treated with placebos in those years  

It was perhaps 1 A.M. when we sat in the dark together.   Mary and I could  hear a trolley clatter by on the track outside.   A few late night, rowdy college students piled out of the  transport and  slogged through the snow on their way back to the near by dorms.  They chatter away filling the night with youthful laughter.  I listened to their voices and wondered at a life that was so free.  I felt Mary's hand flutter.  She was impossibly thin.  The translucent skin with its blue veins covered delicate nearly weightless finger bones.   She tapped her finger impatiently...little rain drops on my palm.  "The medicine isn't working.  I hurt awful".  My heart sank.  I knew it wouldn't work, couldn't work.   She had a soft Irish accent (that sound, an intonation, a lilt, I came to love as a year turned into decades of living in Boston and other parts of New England).  "Will you let the Doctor know this medicine isn't helping me Dearie?"  I reassured her I would tell the morning nurse (again) and that I had documented the lack of relief.  The morning nurse and Mary's doctor  thought Mary was malingering.  She had endless diarrhea and was so thin that she could have blown away in a stiff wind.  Her condition had been written off to 'drug seeking' and living a hard life.  Mary was in her 40's, single and lived unmarried with a man.  He visited her often and  wept at her bed side from missing her.  Their relationship met with sharp disapproval from the staff.  When did the medical and nursing staff  stop seeing her?  Stop seeing her plight?  I was too young and inexperienced and not yet the 'bossy nurse' who learned over time to speak up and demand someone do their job for their patient.  Sadly, Mary was one of the women who helped me learn to do just that.  It was too little and  too late for her. My heart aches just a bit now as I remember her.  That night as we shared a moment, her room filled once again with the acrid odor of loose stool.  She winced and began to apologize for the 'mess'.  As I worked to clean her up I realized that the feces was pouring out of her vagina.  The sick odor was cancer.  It is, as I well know now, unmistakable.  Mary lasted several more weeks.  Our moments of chatting were brief.  She told me about her girlhood in Ireland and working in factories north of Boston.  She spoke through a haze of morphine.   The last week of her life, her man never left her side.  I'll never know why they never married.  I simply remember that thin delicate hand of hers laying in his huge hard working bear-paw of a hand.

Rest in peace Mary W.

When It Goes Wrong

A man lies in his bed dying. A relative sits stoically next to the bed bearing witness to the end of his time on this earth. The Nursing Assistant assigned to his care - nowhere to be found. The Nurse Supervisor is buried under the month end paper work and cannot see her absence. The medication nurse, brand new to her license, has thirty patients to attend. She frantically passes 350 doses of medication to her patients over the eight hours of her shift. She visits the man once during the day. His pain in control and she moves on to the next person. She assumes the Nurse Assistant will do her duty. The man dying harbors a bacterium that terrifies the Nursing Assistant. She tells no one that she is afraid. No one knows that she has decided to refuse to care for him. The relative of the dying man watches the minute hand on her watch and becomes angrier with every passing second that this dying man receives no care. The relative is angry but tells no one of the over sight. She is afraid to leave his bed side. She does not think to ring the call bell. Eight hours pass and no one enters the room. It is not until the next group of workers arrive that the care begins. The evening Nursing Assistant listened to her trainer and knows how to protect herself and her patient from the germs lurking in the dying man’s body. She comforts and sooths this dying man. A nurse with many years of experience assesses his needs and renders care to him. Some balance is restored in a system out of tilt – dignity and compassion again find their places at the bedside. The other Nursing Assistant calls in sick for her next shift. There is a reckoning awaiting and she knows it.