TODAY I CARED for the woman who was my very first nursing instructor, Mrs. D. Fifteen years ago I walked into her classroom at the local community college as a freshman nursing student. I remember her soft voice and calm no-nonsense manner. She exhibited grace under pressure throughout all of my classes. I learned to be calm in the midst of chaos from her.

Our first clinical practice setting was on an oncology unit and all of those in the class had many questions. No question was too silly or too simple for her to answer. Mrs. D gave us, the naive nursing students, the confidence and support we needed for our first clinical experience in a hospital. She became a mentor and role model, as well as our instructor.

Now here she was in my care at the end of her battle with renal failure. Our roles were reversed; I was providing the support to her.

Student to teacher

It was just a matter of months ago that she was in my hospital with a new class of nursing students. She asked me if I'd give the class a quick orientation to the medical-surgical unit. I took the time to welcome them and provide a tour of the unit. At the end of my talk I told them that she'd been my first nursing instructor. I added that she couldn't retire yet because I planned to take her position in 2 years after I finished my degree. She got a big laugh out of that and so did the students. Little did I know that it would be her last semester teaching.

Mrs. D was in her bed by the window as I entered. She looked small against the white sheets. She had flowers on her bedside table from family, and on the whiteboard was a picture of a heart with "We love you" written inside with the signatures of RNs in it. Many of my coworkers sat in her classes as nursing students. She taught us to seek excellence in our practice and we learned the lesson well. She rejoiced with us when our hospital obtained Magnet^(R) status and congratulated the nurses on what they'd accomplished.

Nurse to patient

Although she'd been a patient on my unit for the past week, this was the first time that I was her primary nurse. Her first question for me during walking rounds was "What are you up to in your schooling?" I'd seen her frequently in the years since my graduation and the question was always the same. She followed my progress all the way from passing the NCLEX to my current enrollment in an MSN nursing education program. I told her I was halfway through my MSN program. That brought a sparkle to her eyes because she'd always encouraged me to advance my education.

"I knew this day would come; I'm glad you're my nurse," she told me at the beginning of the shift. Although I'm a seasoned nurse, those few words of validation from my former instructor brought a spring to my step and joy to my heart. Once again she taught me the value of providing encouragement.

Mrs. D decided against acute treatment and had chosen comfort care. She was declining rapidly and didn't want futile treatment. During my shift we discussed options for hospice and palliative care. She decided that once discharged, she'd have home hospice care.

Mentor to mentee

I spent the day keeping a sharp eye on her comfort and pain control. I assessed her pulmonary status, monitored her skin for any breakdown, and observed her I.V. site for complications. These were all the basic skills that she'd taught me many years ago. We discussed her reluctance to take any pain medications and reviewed her new pain management regimen. The instructor was learning from the student. She accepted pain medication and finally obtained some relief.

At the end of my shift I was rearranging Mrs. D's pillows to help relieve the edema in her legs and make her more comfortable. The light from her window hurt her eyes so I adjusted the shades. I moved her table closer and gave her ice water and tissues. "You didn't need me as a patient today," she said to me apologetically. But she was wrong; she was exactly the patient that I needed that day.

I felt honored to give back to her, my nursing mentor, a comforting and caring presence. To take the knowledge that she'd once shared with me, combine it with my nursing experience and education, and now give it all back to her in her time of illness was a privilege. I was, in essence, able to pay it forward. It was an experience that I'll never forget.