Wednesday, March 14, 2018

I Remember Martin

This was an essay I wrote many years ago, about a patient who stayed with me throughout my career.  

I remember Martin. I was 20 years old, barely a nurse. He was 53 and about to die.

While I was studying nursing in the late 1970s and early 80s, there wasn’t much emphasis placed on dying. We were focused on saving patients, teaching them how live with chronic diseases, or helping them heal from various medical procedures. Patients did die of course, but that was when we failed to keep them alive. Palliative and hospice care had been introduced, but were not yet mainstream. We were taught that nurses helped save people, and this is what I believed. Until the day I met Martin.
Martin was admitted to our medical unit to die – to 514, a private room across from the nurses’ station. He had been living with cancer for a few years now and had come to the point that his chemotherapy was no longer providing him with a good quality of life. He had stopped all treatment, including kidney dialysis. On his admission papers, we were told that he would likely die within three days – four days at the most.
I was next in line for admissions that day, so Martin became my patient. I watched as he came out from the elevator. He walked slowly, deliberately towards the unit. I noticed that he wasn’t much taller than I was. He had piercing blue eyes in a round, creased face, and fading blond hair. He was so polite, so nice, so alive. I was told to complete the admission like all others – take a nursing history, ask the questions, fill out the forms. In other words, I was to act as if he was like every other patient on our floor. But he wasn’t. At least he wasn’t to me.
Other than a few patients who had died while I was on duty, and grandparents who I barely knew and who had died in country on another continent, I had little experience with death. But I knew that Martin wasn’t just another patient.
For the first few hours, I didn’t know what to say to him. I went in and out of his room more than I normally would have. I was looking for a way to connect with him. But I didn’t know how. What to say? What to do? I had no guidance, no map.
His daughters came. They were my age, another thing to think about. Martin wasn’t just a patient. He wasn’t just a dying patient. He was a father of two young women who would soon be losing their father. His wife came. She quietly cried in the hall for a few minutes before composing herself. She would be a widow in a few days.
I had been warned that Martin would start to lose mental function as toxins built up in his blood – he would become confused, disoriented. I wanted to connect with him before this happened. But I had no idea how. What I didn’t know was that Martin did.
During one of my visits in his room, he said, “Can I talk to you? Do you have a moment?” I had more than a few. I had cleared away all my other work so I could have time for him. He asked me to sit. I did.
I don’t recall all that Martin talked about, but I do remember him saying how he was afraid that he might start not making sense. How he might say one thing but mean another. He told me that certain things just didn’t matter any more. He explained it by comparing shapes and colors – triangles and circles, red and green. He said, does it really matter that the shapes or colors aren’t the same? Does it really matter that we aren’t all the same?
For the rest of that afternoon, I took care of Martin’s physical needs as he talked about his life, what he had done, and his love for his wife and his daughters. He talked about his regrets and the things he wouldn’t get to do. And he talked about dying. How he was afraid, but he knew it was time.
I went off shift at 4 pm. I didn’t want to go to work the next day. I didn’t want to witness Martin’s decline. I didn’t want to see him die. But I did, because that is what nurses do.
The next morning, I listened to our change-of-shift report and the nurse described Martin’s night. It hadn’t been an easy one. The team leader had thoughtfully given me a lighter patient load so I could spend time caring for Martin. As I entered his room that morning, it was obvious that the man I knew the day before was already gone. He barely opened his eyes, barely responded to my questions.
I tended to him, talking to him every step of the way. I talked about some of the things he had mentioned just the day before. And sometimes there was just silence.
The rest of the day, there was always a family member in Martin’s room and I didn’t want to intrude. I popped in to do what needed to be done, and then left the family to themselves. I left at 4 pm again, after saying my good-byes to the family. I wasn’t scheduled to work the next day. I would likely never see them again. I had no idea what to say.
I thought a lot about Martin that night and all the next day. When I returned to work for my next shift, there was a new patient in 514 – someone with hopes of recovering and going home. Martin was gone.
Twenty-five years later, I began working in hospice The time, the place, and the situations were all very different from that first experience with an expected death. I knew what to do. But I never forgot Martin. When I think about him from time to time, I don’t see him as he lay dying, but as the 53-year-old man who walked onto our floor. And those piercing blue eyes.