My cell phone pinged. Mrs. K's name flashed on the caller ID. For months, her 80-year-old husband had been struggling with chronic obstructive pulmonary disease and small cell lung cancer. She was his caregiver as no children or other family members were available to help. I was his nurse care manager. Both Mr. and Mrs. K were alert and engaged in his treatment plan. They accepted many of my practical suggestions regarding adaptive equipment and emergency alert devices but rejected hospice and other referrals to help with personal care. "Can you visit later today?" she asked.
"Yes," I said, remembering the several long conversations we'd had about long-term planning. Other than a lumpectomy for breast cancer 10 years ago, Mrs. K had no pressing health concerns and felt confident handling her husband's problems.
That afternoon, I visited the Ks, who lived in a middle-class suburban neighborhood. Before I could ring the bell, Mrs. K opened the door of their small ranch home and stepped outside. "Let's talk here on the porch for a minute," she said.
We sat across from each other on well-worn Adirondack chairs. "The visiting physician came this morning. She ordered another round of antibiotics and steroids. Ben's not sure he wants to restart them. He's tired. He'll die without ..." Her sobs broke up her words. "Says he's lived a good life."
"It's such a difficult time for both of you."
Her voice cracked. She'd never sounded so vulnerable.
"Tell me more," I said.
She shared details of the physician's visit and her resolve to keep her husband alive. Her voice sounded stronger the longer she spoke. "With steroids and 10 days on antibiotics, he should be his old self. He wants to have a serious talk with you today."
I nodded. "All right."
She stood up and led me into their bedroom. Mr. K lay in the middle of their queen-sized bed. He smiled and reached for my hand. "I'm glad you're here. After you've finished your nursing stuff, I have some things to say."
Mr. K lay quietly in bed while I auscultated and percussed his lungs. After coughing up thick yellow mucus, his pulse oximeter reading rose from 91% to 93% on supplemental oxygen.
I helped him into his wheelchair. His fingers shook as he adjusted his nasal cannula. "We never told you about Jon, our son, our only child."
"Your son?" Although I'd sensed something was missing from the family history, this new information surprised me. I looked at Mrs. K who sat at the foot of the patient's bed. "We have a son yet we don't. We haven't seen or heard from Jon in over 15 years."
I squeezed her hand. "Such a heavy burden."
Mr. K looked at his wife. "Last night Helene told me she wants to try to find Jon to let him know I'm so sick."
Tears filled Mrs. K's eyes. "When our son was in college, we found he had anxiety and depression and was on street drugs. Too late to get him the treatment he needed. He moved 2,000 miles away after he graduated from college. He could never keep a decent job or girlfriend for more than a few months. For 20 some years, he'd pop in and out, usually for money. We mostly gave in to his pleas even though we were depleting our savings."
A tear rolled down Mr. K's cheek. "The last time Jon visited, he threw a chair close to where Helene was standing. I was strong back then and forced him to leave the house."
Mrs. K bit her lip, then continued talking. "We've lost him. For a long time, we were afraid he'd come back and hurt us. That didn't turn out to be a problem. Two years ago, he sent us a certified letter he never wanted to hear from us again and that he'd hired an attorney to make sure we would never locate him."
"We don't know if he's dead or alive," Ben said.
"Can you help us find him?" Mrs. K picked at a loose thread on her blouse. "The police are no help since we don't even know what state he lives in. Our computer is old, and I don't understand how to search for him online."
I sighed. This request was unexpected yet as a community health nurse, complicated family issues often surfaced at unexpected times. "I'm not the person for this, but I'll find someone to advise you. The agency social worker may have some ideas."
Mr. K cleared his throat. "Good. Before you came, I decided to take another round of the medications a couple of hours ago. I say it's for Helene but it's for me, too. I'd like to see Jon at least one time before I die."
"That makes a lot of sense," I said.
Mrs. K hugged me as I left the home. "I'm glad I got this off my chest. It's bothered me for a long time, but I never talked about it. I should have told you sooner."
"I understand. It's not easy to talk about the serious problems of our children."
My case manager role had taken a 180-degree turn. My first step was to contact the agency social worker. He met with the Ks several times for counseling regarding their feelings and expectations. Two months later, through http://www.namus.gov and other people-search websites, he located Jon in a supervised group home setting in Nevada, where he had lived for the last 18 months.
On a follow-up visit, the Ks and I sat at their dining room table. Mrs. K pulled an envelope from her apron pocket. "The social worker sent us this photo of Jon in a hometown newspaper. He's part of the painting crew at Habitat for Humanity. We look at it over and over and study every line in his face."
Mr. K fingered the armrest of his wheelchair. "It warms my heart to see him smiling. He still doesn't want any family contact." His voice cracked. "We'll never see him again, but it's good enough to know he's being taken care of."
Mrs. K leaned forward. "Our children don't belong to us. We love them, we guide them, but in the end, they go their own way."
Mr. K rubbed his forehead. "We'd like to talk about hospice now."
Mrs. K nodded. "It's time. We just needed to tie up some loose ends."