AJN, American Journal of Nursing:
Kathryn Mason, formerly a clinical educator at St. Luke's Cornwall Hospital, Newburgh, NY, is now a QM/PI project manager at the same hospital. Contact author: firstname.lastname@example.org. Reflections is coordinated by Madeleine Mysko, MA, RN: email@example.com. Illustration by Anne Horst / www.i2iart.com.
What we don't know about our patients.
Willy had a long last name that we believed to be of Hungarian or Czechoslovakian descent; however, this was purely conjecture. We really didn't know his country of origin, and Willy wasn't talking.
Figure. Illustration...Image Tools
Willy had suffered a debilitating stroke some years earlier and his most striking deficit was profound expressive aphasia. He was unable to articulate more than a few errant words at a time and most of the time his speech consisted of garbled, unintelligible sounds. Willy's affliction belied an otherwise sturdy appearance for a man in his late 70s. He had carved features, with a strong, square chin and gnarled hands that hinted of an earlier life filled with manual labor. I privately imagined that, before his stroke, he had spoken with an accent and a cadence similar to those of Arnold Schwarzenegger.
Our home care agency had maintained Willy on service for several months, treating a nonhealing diabetic wound on his foot. The home health nurses were his only resource: we filled his medication box and made certain that there was food in the house through the Meals on Wheels program (or by bringing food on our visits). The agency provided a home health aide and generally looked after his safety and well-being. It was an unspoken understanding that Willy wouldn't be discharged from services in the near future. We were all willing accomplices.
For a time, I was assigned to be the primary RN on the case. The nursing care plan called for dressing changes to the foot four to five times per week. I made at least three of those visits each week and my routine with Willy became fairly rote. He sat in the same chair each time, with his foot propped on an ottoman; I was positioned in front of the foot, my back to his decrepit television. I would chatter away to compensate for his lack of dialogue, regaling him with stories of my children, the weather, or whatever other bits of news came to mind. Sometimes he would give me his rapt attention and at other times he would be more intent on the news or a game show.
On Labor Day weekend 1997, I found myself unexpectedly having to cover patient visits. It was to have been a holiday off for me and I was annoyed at this sudden change in plans. My family was enjoying a barbecue and company at home while I was traversing rural roads, visiting homebound patients. Like Willy.
Willy was my last visit of the day. When I arrived, he was already ensconced in his chair, awaiting my arrival. He didn't seem to notice my stormy countenance or my marked silence. While I worked on his foot, he continued to watch the news in silence (which somehow irritated me even more). As I neared the end of my task, Willy's foot inexplicably became a squirmy moving target that I was struggling to dress in gauze wrap. Head bent over the foot, determined to swiftly complete the task and head home, I found my attention suddenly arrested by a rich male voice: “The Lady died.”
I whipped around to see who had entered the home undetected, but no one was there. Suddenly, I knew—Willy. He had spoken those three words to me, without impediment or hesitation. As I looked incredulously into his face, I realized that he was pointing at the television behind me, where the tragic news of the death of the Princess of Wales had broken into the regularly scheduled program.
On shaking legs, I sank to the ottoman. To this day, I don't know if I was more stunned by the news of Princess Diana or by Willy's unexpected utterance. He was clearly shaken and moved by the death, and I found myself deeply ashamed of my earlier display of petulance. I moved a chair next to his and took his hand. We watched the news of the accident in Paris for about an hour in silence. Willy spoke no more that day, nor did I ever again hear him clearly speak understandable language.
Driving home later that afternoon, it occurred to me that Willy had spoken without a trace of accent, Hungarian or otherwise.
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