1. Goodman, Diane M. MSN, RN-BC, APRN


At the infusion clinic, the subtle interplay of the ordinary and the urgent.


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This particular wintry morning was bright and sunny in the outpatient infusion clinic-unlike the patients, who were grayish, pale skinned, and listless from months of chronic illness. They arrived in small finicky clumps, settling in, complaining about cold blankets or a favorite recliner already "occupied" by an earlier arrival. A few were taken aback by the stark beauty of the sunlight glancing off a bright wing from the bird feeder located near the window, but most just wanted to get on with the day's task: the infusion, and the tediousness that came with it.

Figure. Illustration... - Click to enlarge in new windowFigure. Illustration by Neil Brennan.

There was little camaraderie or conversation among this group, although they noticed each others' comings and goings. A lot of glancing out of the corners of the eyes took place, for no one wanted to look illness full-on, or recognize it for what it was. No one wanted to ask many questions, although concern and caring were evident. If anyone needed another blanket, or seemed to struggle to rise from a chair, people-staff, yes, but also patients attuned to each others' needs-were there to help. Although a quiet bunch, they were very observant. They knew who was losing weight, or paradoxically, who seemed to walk with a little more bounce than in previous months.


As the group got established, nothing seemed out of the ordinary. Men and women slowly arrived, got their individual infusions running, and settled back for a nice, relaxing stay. TVs were adjusted to the appropriate channels, meals were ordered for lunch, books and magazines came out of the tote bags, and sighs and coughs were winding down. It even looked like the nurses might get a chance to catch up on documentation before the next batch of arrivals came, usually around noon.


Suddenly, Denise sat bolt upright in her chair, struggling for breath, clutching her husband's arm, trying to muster enough air to yell for help. Massive welts were breaking out around the infusion; her face was beginning to swell and redden.


Everyone in the room came to full alert, grabbing the nearest nurse, nearly pushing them in the direction of Denise's chair. They'd seen this type of crisis before, and they knew speed was essential.


The patient in the recliner next to Denise calmly reached over and shut the clamp to the IV. "There now," she breathed, "take slow deep breaths. The nurse is here." She soothingly reassured Denise as she patted her arm and rubbed the edge of her blanket. "It will be all right. They have medication, you'll be fine," she repeated over and over again as the RN began pushing Solu-Medrol and Benadryl IV. Denise's breathing began to slow, as did her husband's panic, as the hives and swelling subsided.


Magazines and books were slowly replaced into laps as a collective sigh of relief passed through the room. Within minutes, Denise was breathing normally, her infusion resumed (at a much slower rate). The bird feeder was regaining popularity, and TV headphones were back in use. The patients had been entertained, oh so briefly, by the complication, but not overly so. These patients were seasoned, they were knowledgeable, they were "aware." "Miracles," they knew, happened every day. They were basic; they were "101" in this setting. After all, weren't they proof?