Monday, April 05, 2010

"Ronnie," I say, a little louder than is natural, "Ronnie, I'm going to brush your teeth now."

Ventilator-associated pneumonia is a big (in the words of Joe Biden) fucking deal. It can be prevented with careful deep suctioning and good mouth care. And good mouth care is what I'm doing now.

Once during the shift, I use a toothbrush connected to suction. Twice during the shift, I deep-suction and swab.

This patient is younger than I am, with no risk factors for laryngeal cancer. The surgeons had gone in, expecting to take a biopsy, but had ended up having to take her whole larynx. She was a singer, before. I was a singer, before.

I shake off the associations and continue. I've already turned up her paralytic drip so she won't bite down on the brush. "Ronnie, here comes the brush. I'm just brushing your teeth, okay?"

I hate it when nurses end their sentences with the word "Okay?" I prefer statements: We're doing this, NOW. You're going to get out of bed. I am going to brush your teeth. But this time, I say, Okay?

She grimaces, but she doesn't have the coordination necessary to bite down on the toothbrush. For a long two minutes, I scrub: it's important to get the mouth bacteria off the teeth before I suction, to make sure they can't migrate past the endotracheal tube cuff and into her lungs.

"Ronnie, I'm going to suction you now. If you cough, that's okay; I can take care of that. Go ahead and cough. That's right; good cough. Give me another."

I suction under and behind her tongue, then grab the suction connected to the ET tube to suction down further, where her cough might've brought up some garp.

There is a boom-box in the corner playing her favorite music. She was a contralto, unlike me: I sang early music, with the occasional foray into Britten and the moderns. She sang the Magdalen in cantatas and led her church choir's alto-section woodsheds. I sang songs that nobody really knew the rhythm to, they were so old. She sang songs that had been written down long after the ones I sang had passed on.

They took her larynx, and left her her life. Whether or not it's a life she would want, not being able to sing, is not my problem. It is not my problem. I shake off the associations and move on.

There's a lot of crap in her lungs. I get a whole load of it out, then give her a break. I turn up the Versed, so that she won't remember any of this, and get the hell out of the room. I don't sing to my patients any more; they're generally not sick enough.

Back in the day, when I was in school, I sang to premature babies. It was my last semester, and I was constantly exhausted. The nurses would find me a pair of twins, or a baby who was so premature he looked like a monkey, with hair all over, and I would button them or him into my uniform top and lie back in a rocking chair. I'd sing them to sleep, and myself to sleep, with songs from "Jesus Christ Superstar" or "Fame" or the things the troubadours sang in the 1300's.

Since then, I have sung once, to one other person, outside the hospital. "Oh, wow, man/I ain't complainin'/Only thinking out loud/My life would've been different/If I knew then what I know now..."

I hope she can turn her singing voice into something else.


Becca said...

I was a musician before my progressing condition took it from me, too. Then I thought maybe I could at least sing in an amateur choir. Then it took most of my voice, for good measure.

Five years ago... no, even just three years ago I would have sworn up and down that without the ability to play I'd rather be dead. The 2nd of February 2006 was my last concert as an embryonic ‘professional’ musician. I knew. I almost choked holding back sobs - equal parts physical and mental pain - as we performed.

Afterwards, I went back to my room while my classmates partied, and tried to work out how to die. Fortunately I didn't get as far as trying to do anything.

It still breaks my heart each and every time I hear on the radio something I played - there was almost nothing I didn't love playing - but the ability of good friends and good support to carry people through has won out, again. These days I'm PEG fed, can't sit without support, struggle to make myself understood and need round-the-clock care to stay as safe and well as I can be.

And y'know what? I'm okay. More than okay. I live in a house, not a Home, with a lovely flatmate, not fellow patients. I play Rock Band on our PS3 endlessly. I'm going back to university in a couple of weeks, and hopefully I'll be getting one of these soon, which will definitively solve the communication problem.

Your patient has some deeply crappy weeks and months ahead of her but she will be Just Fine, with time and love and the right support.

ThirdDegreeNurse said...

Great post, Jo. Just worked the weekend at the Big Internationally Famous Hospital, where, if you're hospitalized over Easter, you are really damn sick.

Albinoblackbear said...

Beautiful post.

I treasure the patients that give me an existential wake up call. It is easy to feel numb and disconnected from the suffering of others when you see it day in and day out. These reminders, I think, are what keep us humane and tender.

Heidi said...

Aww, the image of you singing to the babies is making me cry... beautiful post.

Albinoblackbear said...

Becca--you are clearly an amazing and brave woman!

I think it is really good for health care workers to know stories like yours. Very inspiring, thank you.

Halie said...

Beautiful song. Beautiful post!