TO LESSEN THE BOREDOM of waiting my turn in the Social Security office, I studied the woman seated opposite me. Uncombed gray hair jutted from under a backward baseball cap. Her glasses were black plastic surrounding hot pink lenses. A hooded sweatshirt was stretched tightly across a distended abdomen. Plaid cuffs of a long-sleeved shirt extended past the sweatshirt and hung loosely, half obscuring her unwashed hands.
The loose fit of a long flowing skirt contrasted sharply with the baseball cap and sweatshirt. She shifted in her seat and crossed her legs, exposing striped socks and worn-out shoes. Her lips were covered in bright, almost iridescent pink lipstick.
Brief encounter
My back hurt from sitting and I stood up and stretched. Suddenly I was conscious of someone moving just to my side and close behind me. The woman with the bright pink lipstick stepped around and faced me briefly. She stared into my face and said, "Hi." I was startled but responded "Hi," with the expectation that she wanted to talk. Instead, she turned quickly and went back to her seat.
The minutes dragged on. The woman then stood up and immediately sat down. After repeating this a few times, she leaned back in her seat and patted her thighs in a drum-like fashion. For the first time I noticed that while her hands might not be clean, they were rather delicate and pretty. I also noticed that those hands hadn't held the small white paper that indicated in what order she'd be seen. I wondered if she'd even taken a number at all. I didn't need my training as an RN to recognize that she was intellectually disabled, most likely one of the army of castoffs from the closed state hospitals destined to live in the shadow world of the streets.
A closer look
Now I questioned my superficial analysis of her appearance. The baseball cap was a faded red, and her ill-fitting sweatshirt looked as if it had, at one time, been the same color. The plaid cuffs showed traces of pink, and her striped socks also reflected tones of faded rose and pink. And there was that splash of bright pink lipstick.
Could it be that she dressed with care, that her outfit was well thought out and deliberately coordinated? This was no haphazard mix of castoff clothes from Goodwill bins. She dressed as carefully as the limitations of her circumstances permitted.
At first glance, how could I have missed it? And I realized that was it: "At first glance." My initial observation had been superficial and I'd failed to see the total picture. Certainly some of my assessments were accurate. Her clothes were ill fitting and unclean. She demonstrated behavior that suggested mental illness. She probably wasn't at the Social Security office for an appointment.
But she was more than how she looked and more than the limitations of her illness. She was a woman who wanted her appearance to reflect something of her real self, a lady who dressed with care and attention to detail. Perhaps her wardrobe reflected her struggle to create order in the chaos of mental illness.
I was ashamed of my hasty judgment. She may have greeted me to test the reality of my existence. What effort did it take for her to enter even briefly into a world that must be less real to her than the one inside her head? And why of all the people in the room had she chosen me? Had she seen me rubbing my back and grimacing? Did she say "Hi" to let me know someone noticed and cared? Of course I couldn't know what motivated her, but she'd acknowledged my existence by leaving her nebulous world for a moment.
Hoping to make amends, I moved to the seat next to hers. She stared straight ahead. Before I could speak, she bolted from her chair, ran to the door, and collided with a man entering the office. Head thrust forward, she pushed past him and raced around the corner, disappearing from my sight. But not from my memory.
Assessments, not judgments
I stared after her, sorry that despite all my education I'd missed the opportunity to reach out to someone who may have needed help. One of the most important lessons I learned in nursing school was to make assessments, not judgments.
It's not always been easy, but I thought I made every effort to remember that no matter how difficult, serious, or strange the complaints, every patient is first and above all else unique. Even when busy with procedures, assessments, and care plans, I thought I was conscious of my patients' humanity.
Then I met the Pink Lady in the Social Security office and my reaction to her made me less sure. She made me question my actual practice-and that's a good thing. If I review my practice and analyze it honestly, I can keep what's good and valuable and change what isn't. That's the only way I can give every patient the kind of care he or she deserves.
Thanks to the Pink Lady, I'll try even harder to honor those core nursing values in both my private and professional lives.