So I lean over him, and I remind him that he should let me know if he's uncomfortable--because, what the hell, he's gonna die anyhow; the graft's fighting his body--and I'll bring him more meds. Even if it's not time. He doesn't need to know that; he just needs to know that once his pain hits a four on a one to ten scale, I'll be there with the happy drugs.
And he says to me, "How many counselling classes did you need to take before you learned how a person feels?"
I said, "None. It's all experience." I didn't tell him that grimacing and guarding and short, gasping breaths are indicators of pain, universally, that don't need a lot of training to recognize.
"Trial and error," he said, "that's bullshit."
"I've been doing this longer than I'm willing to admit" I said, "and you wouldn't believe the number of patients I killed before I got to you."
That brought a smile.
I'm sure there was some point, maybe working at Planned Parenthood or the abortion clinic, when I realized that what was coming out of the person's mouth didn't match what was on their face, or in their body language. I can't remember that particular moment, but looking back, I'm sure it happened like a lightning strike.
Ever since then, I've been much more conscious of what the person isn't telling me. I had one nursing instructor who bothered to touch her patients with an un-gloved hand, and I've followed her example ever since. Sometimes a simple skin-to-skin touch makes all the difference in letting somebody know that you're not just some sort of health-care-providing automaton; you're a person like them who actually gives a damn what they're feeling.
If I have to hurt somebody by starting an IV or a catheter, I try to touch them just afterwards without gloves on, just to make sure that their last memory of the whatever-it-was isn't plastic and pain. Sometimes I even hug my patients without a gown on, zut alors! despite the rules.
By the same token, sometimes it's best to just shut the hell up. The dude I was working with was worried that his insurance wouldn't cover his return to the ICU. I let him vent for about ten minutes about how stupid his insurance company was, and it helped. His heart rate went down, his blood pressure dropped. Shutting up and being a body in the room who's attentive is a therapeutic intervention just as much as a Cardene drip is.
And as much as I hate to admit it, a lot of nursing has to do with intuition and gut feelings. We don't get trained in intuition, but we all use it. You have to develop the skill, and so you do.