MY FIRST NURSING job was at a community health center in a small, rural town in southeast Arkansas. We had many elderly patients who often had to decide between buying food or medicine on their meager monthly incomes.
All of us at the center loved our work and the sense of purpose to be able to help these patients, even just a little bit, with a drug assistance program. In processing intake assessments for this program, we had to ask our patients detailed questions that helped me form a personal relationship with most of them.
Enter Ms. Smith
One Thursday morning, that personal knowledge of a patient would be the thing that saved her life. Ms. Smith was a sweet woman in her seventies, and she and I often exchanged recipes and stories about our children and her grandchildren. I also tried to educate her about her chronic conditions: hypertension, congestive heart failure, past history of pneumonia, and weight loss. She lived in an assisted-living complex about 25 miles from the clinic and had to rely on friends and the senior citizen transit van for rides to her appointments.
One Thursday morning we were busy as usual. The phone rang, and it was Ms. Smith requesting a refill. As was our policy, the receptionist passed this call to a nurse-me-and I proceeded to find out what medication she needed.
Ms. Smith wasn't her usual jovial self. She coughed as she tried to explain that she needed the cough syrup she'd taken a couple of months earlier refilled. I usually asked patients to hold while I pulled their charts to see if the patient had an order for the medication they requested, but something in Ms. Smith's voice told me not to hang up. I continued to talk to her as I pulled her chart. I asked when her cough had started and if she was experiencing any shortness of breath or fever.
Ms. Smith denied a fever but said she'd been short of breath for a couple of days. She seemed agitated by my questions and told me so, saying she just needed to know if the cough syrup prescription could be refilled. I don't know if it was the nature of my questions, the look on my face, or the tone of my voice that made my supervisor come over to my desk with a distinct look of concern, mouthing "Is something wrong?" I nodded.
I asked Ms. Smith if she was breathing okay, where she was, her address and phone number, and if anyone was with her. She stated she was feeling more short of breath and no one was with her. She gave me her address as my supervisor dialed 911. I kept Ms. Smith talking and explained that I was sending an ambulance because we were concerned about her shortness of breath. I secretly was afraid that it was her chronic heart failure.
Help arrives
The emergency rescue service arrived at Ms. Smith's apartment while I was on the phone with her, and I could hear them asking her questions. She said good-bye and hung up the phone. I sat at my desk wondering what would become of this sweet lady who only wanted something for her cough but instead was getting a ride to the ED. I called the hospital before I went home for the day, and the nurse on duty told me that Ms. Smith was in the ICU and in very serious condition. Apparently, she stopped breathing and had no pulse on her way to the hospital and was experiencing congestive heart failure.
When I got off the phone, I was heartbroken and questioned myself for the rest of the day. Had I kept her on the phone too long before calling 911? Had I agitated her with my questions and caused her to exert energy and oxygen that she couldn't spare?
The next day, her status hadn't changed. As often happens, work and responsibilities at home took up my time and I didn't get to check on her again for almost a week and a half. On the day I realized just how long it had been since I'd checked on Ms. Smith, I was paged to the front desk-and there she sat in a wheelchair.
The greatest gift
Ms. Smith's daughter told me her mother insisted on being brought to the clinic as soon as she could travel. Ms. Smith smiled at me, took my hands, and held them to her heart. With tears in her frail blue eyes, she looked up at me and said, "Do you feel that? It's the heart you helped save. If you hadn't been the kind of nurse who listens to her patients with more than just her ears, I wouldn't be here today. Thank you so much for caring enough to question me and not just refill a medicine because it was what I thought I needed."
I had a lump in my throat the size of a golf ball and didn't know how to tell this lovely lady that she'd just given me the greatest gift. She made me feel again that sense of purpose I'd felt when I first became a nurse. She made me realize that what we're taught in school is only one part of nursing. I knew it was just as important to connect with and care about our patients. And I knew that from that day forward I would never see even something as simple as a refill as "simple." I hope I'll always learn as much from my patients as they do from me.