Don kept me on my tippy toes from day one. All of my patients are special, in their own way – – and every once in awhile a patient comes along who touches me deeper than any other. Don is one of those types.
I’ve said from day one that walking into his house was always like walking into a Walter Matthau movie – – – you know, Cranky Old Men parts I and II? Having Don as part of my caseload is Cranky Old Men part III – – I could write the script, honestly!
Don is an ex-nurse. For anyone who has ever taken care of a nurse as a patient – – you already know, going in, that it won’t be pleasant by any stretch of the imagination.
Diagnosis of Lung Cancer with probably mets to the brain.
Don needed to be in control of everything, right down to when he took a shit. His pain was so great – it hurt just looking at him. I’ve never met someone with such a high tolerance for pain. He had pain meds – – I made available every type of pain med available to treat his symptoms. He was on a Duragesic patch and used Vicodin, as needed, for breakthrough pain. I ordered morphine tablets for him because he also became very short of breath – and morphine helps with that quite effectively.
I had to fight tooth and nail to get him on the Duragesic patch to help take the edge off the pain. Don’s issue was that he didn’t want to take narcotics because they made him confused – – and he needed to be mentally alert in order to be there to take care of his wife. What I tried making him realize was that she was the one taking care of him, at this point.
He wanted the control of when he felt sedated, and when he didn’t. One time I walked in to his house and he was shaking uncontrollably in pain — he was very pale, sweating and groaning out loud. I sat with him for two hours trying to convince him to let me give him some medication – – but he would have nothing of it. He said to me, “Don’t let my pain bother you so much – it’s not as if you’re the one feeling it.”
I visited him three times every week in his home. Got to know his family and became very close with this old codger. He picked on me a lot. Always had a biting sarcastic remark every time I walked in. He complained about not seeing me enough – – even though he saw me every Mon., Wed and Friday – – I would walk in and he’d say “Well, well – – and here I thought you dropped off the face of the earth….do they actually pay you for what little you do?”
I rolled with it, though. I gave it back to him as good as he gave it.
This went on for about two months. Then his health really started to fail. He became weaker and it got to the point that it was unsafe for him to get up and go to the bathroom on his own, without substantial assistance. His wife is a mere 98lbs and simply cannot handle his weight (he weighs in at 240lbs). I suggested many types of equipment that would help him with the safety issue. Of course, he declined them all.
Until one Friday night. I was on call and I received a page at about midnight. It was Don’s wife telling me that he had fallen, hit his head and was bleeding everywhere. It took me about 10 minutes to get to his house, where I found him lying on the floor with quite a large gash on his forehead.
My immediate reaction was to say “I told you not to try and do anything on your own, Don!” – – but instead, I tended to his wound, helped him get back up into his chair and proceeded to tell him that he needed to go to the ER to have stitches placed, because no amount of pressure applied was stopping the bleeding and the gash was way too deep for a simply dressing of tape and gauze.
Wiping the blood out of his eye, he argued and fought and finally gave in – saying “Fine – you get your way this time, but it’s the last!”
He went to the ER and was home within an hour. I received another page and had to go tend to another patient, but left after advising Don not to try to get up and walk without someone strong enough to assist him. His son was planning on being there in the morning at 8am – he should wait until then.
At 6am that morning – I received another call from Don’s wife. He had fallen again – trying to get a drink of water at the kitchen sink. No injuries this time, thankfully. When I visited – he was a bit more compliant with options for treatment. He allowed me to administer pain medications, insert a Foley catheter (to decrease the amount of trips to the bathroom, thereby decreasing potential for further falls). I scheduled nurses to sit with him round the clock through the next 48 hours – – during which his condition declined, considerably.
I ended up admitting him to the hospital at the end of that weekend for acute pain management and terminal agitation and restlessness. Between myself, his wife and his doctor – we determined that Don was too weak, unsteady and unsafe to stay at home any longer – – so the decision was made to admit him to a nursing home.
He was so angry at me. I came into his hospital room that day and he looked at me and simply said, “I am not speaking to you – you were supposed to prevent this.” And then promptly asked me to leave.
I followed his case in the nursing home. I saw him this past Friday. His moments of lucidity alternated with moments of paranoia and confusion. He looked at me when I walked in and he half-smiled and said “Well, well – and here I thought you dropped off the face of the earth.” I sat with him a bit, did my exam and when it was time for me to leave – he grabbed my hand and said, “Stay here with me while I eat lunch”. So I did.
He ate – and was silent. I sat and made small talk about this and that. When he finished, he looked at me and said, “Lisa – I love you. You have been my absolute angel on earth…thank you.”
I visited Don again today. He was non-responsive and, to my knowledge, wasn’t aware of my presence in his room. His respirations were congested and labored and I administered the necessary meds needed to make him comfortable. I held his hand and consoled his wife, who was also at his bedside. I explained to her that Don has entered that phase where he is what we call “actively dying” – and that his life expectancy, at this point, was probably no more than a week.
She cried – and I held her for a long while until it was time for me to go.
I leaned over and kissed Don’s cheek and whispered into his ear “Don, my friend – it was my priviledge.”
I don’t think I’ll see Don again. I plan on visiting him and his wife again tomorrow morning – – but I have this sinking feeling that visit will be cancelled.
I’ll miss the ol’ fart.