Harry

Harry is an 83 year old man who worked hard his entire life. He is a God fearing man who through that hard work developed pulmonary fibrosis eventually rendering him nearly confined to a wheelchair. Harry was doing well these past months up until two weeks ago when he suddenly tried to climb out a window and escape. At the time he simply said, I just want to go home.

We moved him to a locked down unit to prevent him from getting injured should he wander outside and into traffic. Several days before I had evaluated him and just felt that something was wrong with him. Any health care provider worth his salt will tell you that if one is tuned into the patients wellbeing they will know when something is wrong. This is the feeling I had as I evaluated Harry. Something was wrong. His lungs were clear, his heart regular, his skin was warm, pink, and dry without peripheral edema. His speech was clear and steady and his mentation had not changed. But something was wrong, something had changed, something had happened as yet to reveal itself to us. I called Harry’s son and told him what I felt. He rushed down from his mountain cabin and visited his father the next day. We talked at length on the phone over the next several days. I could tell he was a little frustrated that I had called him and alarmed him over apparently nothing. The next day Harry was found trying to crawl out the window. I had not told the son that Harry had told me days before that he, just wanted to go home.

The lab work I had ordered all came back normal. The chest x-ray was also normal, I filed a thought in the back of my mind that chest x-rays lag about three days behind the disease process. I called the son again and told him about the tests I had run and that everything looked good, except Harry.

Two days later I went to see Harry in the lock down unit. He had no complaints when I talked to him, he told me again he, just wanted to go home. The problem was he wasn’t ok. His respiratory rate was in the forties and his left lung sounded like a bagpipe. His skin was cool and clammy and his peripheral pulses were now diminished. I ordered a chest x-ray and even before it was completed Harry began receiving intravenous (IV) antibiotics. I was not sure Harry would live through the night and I told the son my thoughts. He thanked me and called the rest of the family.

We again moved Harry to a unit that was better able to take care of him. Twenty-four hours after receiving the first dose of IV antibiotics he was sitting up in the dining room shoveling food in as fast as he could. I passed by the dinning room and he smiled and waved to me at a distance. I was pleased but cautious about being too excited. We would have to wait and see.

Several days passed and I continued to check on Harry daily, sometimes several times a day. The weekend rolled around and I gave report to the on-call Nurse Practitioner and he agreed to check on Harry over the weekend, and he did.

Monday came and I made my first stop at Harry’s place. His daughter was at the bedside and looked fried when I walked in to the room. She had long circles under her eyes accentuated by her blond hair.

He’s not doing so well she said.

When did this start, I asked?

Late yesterday he just started to go bad. He still recognizes me and responds to questions but he’s not getting better. Have you spoken to my brother she asked?

No, not yet, but I will right now.

I left the room and called her brother and we agreed to stop the IV antibiotics and call hospice to come and assist in his care. Harry was complaining of chest pain and I was beginning to become frustrated. The only morphine I had available was not concentrated enough to keep him from choking when given orally. I did something I don’t like to do, I ordered IV morphine. At the end stages of life oral morphine just seems to work better than IV morphine. I would never have thought this had I not experienced this with my own family member. I talked again with his daughter and told her we would do everything we could to make him comfortable. She thanked me and I left.

I made rounds at two other buildings and was bogged down with other patients I really didn’t have time to deal with today. One clerk handed me a CBC with an H&H of 7.4 and 22. Damn, this is going to kill my day, I thought. I finally finished my rounds and headed back to see Harry.

When I arrived I spoke to the nurses and tried to get a feel for what Harry’s condition was. I then went to check on him. He was now unresponsive and in an almost agonal respiratory rate.

His daughter was still at his side and was holding his hand sobbing softly. I placed a hand on her shoulder and we talked briefly about death and pain. I assured her there was no limit to the amount of pain medicine he could have and  my goal was to make him comfortable with what ever it takes. I made sure she was satisfied and spoke on the phone with another daughter and then left to see other patients.

Several hours later I went back to check on Harry. His daughter was still silently sobbing while seated in a chair next to the bed and holding his hand. I walked around the bed and sat in a chair opposite Harry’s daughter. I reached out and held his hand in mine. I quietly felt for a pulse and was able to deduce that his BP was still above 80 systolic based on his radial pulse. I checked his feet and felt a strong pedal pulse and warm feet without mottling.

How long, she asked?

I shook my head, I don’t know, only God knows that, I replied. She accepted this graciously. Earlier in the day I had been told by another family member of a patient that the doctor had “given” her 6 months. This type of prognosticating really pisses me off. Only God, if you believe in him, knows that hour when one will stand before him. I again had this conversation with the family member of the other patient and assured her that I would do all I could to make sure the patient was comfortable until that final breath. She accepted the limitations to time I proposed.

Back at Harry’s bedside I asked Harry’s daughter if Harry went to church. His daughter replied that he had accepted Christ and was ready to meet his maker. I asked his daughter if she went to church. She replied that she did. I asked her which church she attended and she told me.

This was not easy for me. My faith has been greatly fractured by the death of a family member just a short time ago. The illness was not painless or pleasant leading up to the death. I remembered the LPN’s coming in late one night and placing their hands on our shoulders and praying. It made a huge difference.

I had paced the hall several times trying to decide what to do. Should I go in and offer to pray with Harry and his daughter?

As I paced the hall I stopped in front of a picture of Yosemite National Park. I had been there dozens of times with my father before he was killed at a young age. The picture was of a trail I remembered from my youth. A trail my father and I had hiked many times in my youth. It was as if my father was saying to me, go in and do what it takes to help this woman. I stood and stared at the picture for a long time before I took a deep breath and entered Harry’s room.

Back in the room I asked his daughter if she would like me to pray. She nodded in the affirmative. I grabbed Harry’s hand and prayed a short but heartfelt prayer. I prayed for Harry and his painless death. I prayed his acceptance of Christ. I prayed for his daughter and her family that God would give them strength. Then I ended the prayer with tearful eyes I apologized to his daughter. She had tears rolling down her cheeks as she said it was alright. I stayed a short time and left.

 As I drove away from the Care Center I reflected that I had never had a better day at work in my life.

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