Phipps, Marcy C. RN, CCRN
Marcy C. Phipps is an ICU nurse. Reflections is coordinated by Madeleine Mysko, MA, RN: firstname.lastname@example.org. Illustration by Denny Bond.
“We have lingered in the chambers of the sea
By sea-girls wreathed with seaweed red and brown
Till human voices wake us, and we drown.” - —from “The Love Song of J. Alfred Prufrock,” by T. S. Eliot
It was early. The sun had yet to rise, but already the ICU was filled with stark fluorescence and beeping alarms. My patient sat alone and aphasic, helpless amidst the bustle of the unit. The day stretched long ahead of us.
Figure. Illustration...Image Tools
The circumstances of Frank's admission were unusual. The nursing report (conveyed with a snicker) was that, while vacationing in our coastal city with his mistress, he'd slipped away and visited yet another lady friend. While engaged in an “intimate” act, he'd hit his head on the coffee table and been knocked unconscious.
The paramedic's report backed up that version of events, but Frank's admission CT scans of the brain weren't consistent with head trauma. Instead, a vascular abnormality was found. He'd suffered two seizures since admission to the hospital.
Frank's aphasia was primarily expressive; his affect was appropriate. He communicated mainly with gestures and facial expressions. He could formulate brief verbal responses, but only with great effort.
He struggled to tell me his first name. When asked what events had brought him to the hospital, he stuttered and replied, “table.” When asked whom we could contact on his behalf, Frank frowned and shook his head. Twice he said, “call Mona,” but he couldn't tell me her last name or phone number. No one called to check on him.
It was early afternoon before anyone came to see him, and it was Mona. She was lovely and fit, well dressed and made up. She strode purposefully into Frank's room, and when he saw her his strained countenance lifted in relief. She pulled a chair up to his bedside and murmured reassurances in a slow Southern drawl, patiently waiting while he searched for words. She held his hand and encouraged him. They laughed together.
They seemed close, and I was surprised when Mona abruptly stepped out of his room and pulled me aside to talk.
“Listen,” she said, “I'm not going to tell you the whole story, but I will tell you this: we were, you know, getting kind of intimate in my living room, when he just fell over and started thrashing around. I didn't realize right away that something was really wrong. I guess he was having a seizure.”
This gave me pause. “So he didn't hit his head?” I asked.
“Not unless it was during the seizure,” Mona said. “But he sure didn't hit his head first!”
She went on to tell me that she'd only been seeing Frank for a few months and didn't really know him at all.
She knew more about him than we did, though, and certainly more than he could tell us. She knew he liked to take long walks on the beach. He took vitamins and hated going to the doctor. He was estranged from his family. She didn't know any of his friends, and wasn't sure he even had any.
When I asked Mona if we could list her as a contact person, a pained expression clouded her face.
“Look,” she said. “I guess you can write my name and number down. But I'm really not close to him. We have a good time, and that's all it is. He makes me laugh. I'm not gonna be his mom, and I'm not gonna be his wife. I don't need this.”
Irritated, I wrote down her name and number on a piece of paper that I immediately considered throwing away. Could she not see that Frank needed her? That he had no one else? But I knew my frustrations were misguided—Frank's alienation was not Mona's fault, nor was it hers to fix.
When I last entered Frank's room there were seagulls flying past his window, their breasts illuminated by the final slanting rays of golden sunlight. The ICU was briefly suspended in calm. Frank lay curled on his side amidst a tangle of monitor wires and IV tubing, snoring softly. His thick gray hair was matted and askew, and the frown lines that had creased his forehead throughout the day had fallen slack. It was the first time I'd seen him rest, and the peaceful glow of evening light that filled the room contrasted starkly with the frenzied day of diagnostic tests and cold fluorescent light.
I stood at the threshold, struck still. For a moment I contemplated loneliness, and the fragile ties that bind. I thought of those I hold close, and wondered which loves would withstand the trials of time.
But only for a moment, for my shift was over. I was going home, where my family was waiting for me.
I hope that, at least in sleep, Frank finds the words he's looking for. I hope that his dreams are full of mermaids, and that they'll sing to him.
© 2012 Lippincott Williams & Wilkins, Inc.