1. Miller, Dorothy RN

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Valentine's Day at the senior center didn't seem promising. It had snowed the day before, causing the county to halt all bus service. Many of us had made it in only through the help of family and friends. As I sat with my cronies, I said to myself, "This is going to be one dull day."

Figure. Tending Mr. ... - Click to enlarge in new windowFigure. Tending Mr. Brown

Then the nursing students arrived. They checked blood pressure, discussed our medications, asked about our lives, and after much amiable conversation and banter, gave us a test to determine our mental acuity. They were young or almost young, and I was caught up in their enthusiasm. But I also knew they would have to master an ever-increasing array of skills and technology to meet the demands of today's nursing care. How many of them, I wondered, would go beyond those skills to become truly dedicated nurses? What would it take?


I remembered a time when I believed enthusiasm and skill were all I'd need in my career. In the 1970s, I was a staff nurse at the Lubin Rehabilitation Center at the Hospital of the Albert Einstein College of Medicine in the Bronx. Our unit was well known and respected throughout New York City. We cared for patients with all types of injuries and neurologic impairments, and I considered myself among the best of the nurses, minding neither the number of patients I was given nor how much care they required.


But there was one big flaw in my commitment. One type of neurologic impairment-Parkinson disease-so appalled me that I did my best to avoid patients who had it. It was a gut response. Maybe I just couldn't stand to be reminded of how helpless and vulnerable we all can become. (I'm still afraid of it: I'm visually impaired, and when I eat at a restaurant, I hate the idea that I could spill food on myself and not even know it.) This was more than 30 years ago, before patients with Parkinson disease were diagnosed early and treated with drugs to lessen and slow their symptoms. These patients were so rigid that it was a struggle to transfer them from bed to chair. They drooled, spoke in ghostlike whispers, had terrible tremors, and always wore their food at mealtime. I had made my feelings about this known to our team leaders, so I was never given these patients. None of my colleagues ever complained; they knew I could be depended upon to take difficult patients others might not be comfortable handling.


One day during the flu season we were short staffed. At the morning briefing, the team leader said, "Sorry, Dot, you'll have to take Mr. Brown today." I felt annoyed, alarmed, and challenged all at once, but I thought to myself, "I'll show them how to do it."


It was the practice on the unit to dress the patients in their own clothing, something we had long ago stopped doing with Mr. Brown. There were often food spills all over him, or a therapist would wheel him onto the unit soaked in his own urine. He would be put into his room to wait for his nurse, who was involved with the other patients' care.


In making out the care plan for my patients, I considered how I could find time to attend to Mr. Brown regularly throughout the day. I began by making the decision to dress him in his own clothes. After caring for each of my other patients, I retrieved Mr. Brown from wherever he was to get him to the toilet. At mealtime, I covered him with a sheet that caught all of his spills. After lunch, the patients sat around the nurses' station waiting to be picked up for their next therapy session. I was pleased when people passed by and said, "Mr. Brown, you look great today." He responded with a smile forced through the mask of his face.


I felt gratified by my success with Mr. Brown. I was settling him onto his bed for a rest before going off duty when I felt a tug at my uniform. I thought he had accidentally clutched it in the vise grip common to those with Parkinson disease. Turning to release myself, I saw that he was staring at me, trying to get my attention. I bent closer, and he said, in a whisper, "You [horizontal ellipsis] don't [horizontal ellipsis] know [horizontal ellipsis] what [horizontal ellipsis] you [horizontal ellipsis] have [horizontal ellipsis] done [horizontal ellipsis] for [horizontal ellipsis] me [horizontal ellipsis] today."


Jolted by shame, I realized what really mattered-his dignity, his well-being. I hugged his rigid body and thanked him.


I am certain that there is a coming resurgence in nursing, part of the cycle of dying and rebirth that is in the nature of things. My wish for new nurses is that they might grasp what my teachers emphasized in nursing school a lifetime ago, but which I learned only from intimacy with patients: the importance of the three Hs-head, hands, heart-in treating the whole, sentient patient.