Friday, September 17, 2010

Unforgetable Patients

I know the following story does not relate to telephone triage, but I do think there is something in it that anyone can learn from. Sometimes, in our hurried lives, we have to take time for the little things in life...

Time for Martha
I gathered my bag from the trunk of my car, took a deep breath, and headed for the door. I was new to Home Health, and Martha was one of the many patients assigned to my caseload. I was there to assess her, and draw labs, and was admittedly, a little nervous about meeting her for the first time. When you are a case manager, it is very important that you develop a bond with your patients, and I was not sure of how well our first meeting would go.
The one thing I was not aware of was, Martha had a HealthCare Power of Attorney, who was her friend and neighbor, and the Power of Attorney’s mother was her housekeeper. They too were waiting inside for me.
Martha appeared to be the picture of anybody’s grandmother, a typical petite, white haired, 80 something year old who was very cordial, but her POA was anything but nice. Jan almost immediately began laying out the rules of how things went in Martha’s house, and demanded to be included in her care. The mistake I made that day was focusing on Martha, and paying little attention to Jan. Martha, after all, was fully alert and oriented, and was capable of making her own decisions, and I wanted to be the good home health nurse and provide my patient the best care I could. I would learn later that Jan was very protective of her friend, and she felt it was her “duty” to take charge.
Martha took my hand, looked me in the eye, introduced herself to me, and welcomed me into her home. She was widowed, had no children, and had moved to our town approximately 20 years before to retire. She had been diagnosed with lymphoma less than 18 months earlier. Her prognosis was not good, and yet, what drew me to her was her liveliness. Instead of focusing on her condition, she immediately began asking me questions about my life. She was genuinely interested, and not just being respectful. I had a difficult time redirecting her back to the reason for my visit.
I finished my visit, and thought all had gone well, until I went back to the office and was called in to speak to my supervisor. Right after my visit, Jan had called my supervisor, angry that she was not allowed to “take charge”, and wanted me removed from the case. My supervisor had made the decision to call Martha and ask her thoughts on the matter before that decision was made. Martha being the honest, straight-forward person she was decided she wanted to give me a chance, and was not happy that Jan had called when she was unaware. Needless to say, the next few visits after that, I felt like I was walking on egg shells.
I scheduled Martha as one of my first visits of the day because she lived so close to the office, but I quickly learned that was not going to work. She was Jewish, and having tea or coffee with her visitors was very important to her. It was her way of welcoming you to her home and showing friendship. If you quickly completed your visit and left, she was insulted. So, I changed her visit time to the last one for the day, so there would be enough time for Martha. I would call her when I was on my way, and she would have the coffee and cookies ready by the time I arrived. Sometimes, Doris her housekeeper, would be there, but she never said a lot. She just listened. Over time, Jan began to appear less and less, and when she was there, she appeared more relaxed and friendly, much to my relief.
Martha and I developed a bond over the months that followed, and I for a while had a hard time believing her prognosis. She was so full of life. She loved to laugh, and tell stories about her days as one of the only female investment bankers in New York, how she met her husband, and how she learned her colorful vocabulary. Martha professed a strong faith in God, but would very quickly let the curse words fly if something made her mad. Only Martha could pull that off with class.
It was so hard to believe such a tiny person could have such a large heart. It did not take me very long to learn not to admire anything in her home, because if you did, Martha would give it to you. Value did not matter. What mattered to her was making her friends happy. During my time with Martha, I was pregnant with my third child, and she worried about me as if she was my grandmother. My friend and I went to lunch one day, and were involved in a minor car accident. I was not hurt, but asked the office secretary to call her and let her know that my visit with her that day was going to be delayed. By the time we arrived back at the office, the secretary approached me, and urgently advised me to call Martha and let her know that I was ok. Her words to me were, “Martha is ready to send flowers to your funeral”.
One day, I began to see a decline in Martha. She had less energy, and was having more pain. Suddenly, Martha was not as talkative as she used to be, but always smiled when I was there, and continued to ask me about my life and family. I think it created a diversion for her, even for a brief period, to help her forget about her pain. I approached Hospice with her, but she would hear nothing of it. “Hospice is about dying”, she would say, “And besides they cannot do anything for me that you cannot do”.
We continued to make adjustments in her pain medications, and try to make her as comfortable as possible, until one weekend, I received a frantic call from her housekeeper, Doris. She was very apologetic for calling me on my day off, but was distraught and said, “You are the only one she will listen to. Martha is very depressed, and saying she is going to take her entire bottle of pain medication”. I spent an hour on the phone with Martha and Doris that day, and hung up with Martha promising she would not do anything to hurt herself until I saw her again. She never threatened suicide anymore after that, but began to become more distant over time.
Not long after that, I learned Martha had been admitted to the hospital with acute leukemia. The next morning, I made plans to visit with her, but was stopped short by a telephone call from Doris. Martha had died that morning. As I sat there choking back the tears, Doris comforted me by telling me how much our visits had meant. She said, “You always made time for Martha, and that was so important to her”.
Thirteen years later, I still think about Martha from time to time, and laugh when I think about her spunk and charm, but most of all, I think about how she taught me that sometimes it is just the little things in life that matter most. ~