I arrived for my shift in the surgical ICU at a large New England city hospital and was informed in report that the patient was a cantankerous, alcoholic, homeless man, resistant to sedatives, rather nasty to most staff, and a challenge for anyone caring for him. Additionally, the patient stated that he was going to die that day, and he had been increasingly interfering with medical treatment to the point that he was restrained.
The first thing I did as I began to care for this gentleman was to take off his restraints but let him know that I would put them back on if he tried to harm himself or anyone else. As I was doing my assessment, I asked him about his tattoos. One was of dog tags that had someone else’s name on it. His explanation was, “It’s from a brother who died.” He wasn’t making eye contact, so I didn’t ask any more questions about that. He had a tattoo of an American flag, but it was colorless, so I inquired about this. His initial response was snarky, saying I was too curious. I apologized and stated that, in my experience, people get tattoos to tell a story, and I was interested in his. I acknowledged that it could be a difficult conversation to have, and he did not need to tell me anything, but I was attentive if he wanted to talk. I then thanked him for his sacrifices he made for our country.
I was stunned when he started sobbing. I was very taken aback and explained that this was something I always did for veterans, and I was sorry if I made him upset. He started shaking his head, then explained that he spent several years in Vietnam, and when he came home, people at the airport spit on him. His own family and community rejected him, and he ended up moving to the East Coast to restart his life where no one knew him. I was the first person to ever acknowledge his service and the only one to ever thank him.
Then he asked if he could talk. I was thinking. . . . Who was I to refuse a man who was crying? So I told the charge nurse that I was going to be busy for a while. I closed the door to my patient’s room, pulled up a chair, and let him talk. He spoke about what it was like to be drafted, leaving his family and friends behind, and getting acclimated to “that God awful humidity” in Vietnam. He spoke of friendships he made, brothers he lost, and the horrors of war. He struggled with his personal disagreement with the United States going to war with Vietnam, but he did not want to abandon his country. He told me about things he had done that haunt him. Things that he had seen that he can’t “unsee,” and how he is not the same person he was when he left. He was so angry when he got home, he turned to alcohol to help dull the mental pain, and had been in and out of homeless shelters for years. Tears were rolling down my face the entire time he was talking.
There were parts of his story that repulsed me and parts that made my heart ache. When he finished talking, he grabbed my hand and apologized for making me cry. I chuckled and said that we were even. He said that it felt good to get all that off his chest and he acknowledged that he never spoke about any of this before; he felt like the weight of the world had been lifted off his shoulders. He then asked to rest as the conversation had exhausted him, so I obliged. I walked out of his room and realized that 2 hours had passed! As I went into the med room to get his late medications, the telemetry alarms went off in his room. He went into cardiac arrest, and we were never able to get a rhythm back despite all our efforts. Remember how he said he was going to die that day? He did.
I do recognize that I was able to let him clear his conscience. I just wish he was able to have a little more time to enjoy being unburdened. I will never forget how at peace he looked after he passed. We opened his chest to try to revive him, and, despite all that, he looked at peace. To me, he’s both one that got away and one I was able to save . . . just in a different manner.
I continue to educate staff on minimizing use of restraints on veterans, as this can be a trigger for their post-traumatic stress disorder. I see this frequently in veterans who have been prisoners of war. Reorientation strategies are far more effective than restraints. I will continue to thank veterans for their sacrifices and let them know that I am a judgment-free person with whom they can talk. I know that I can’t pretend to understand what my patient and other veterans have gone through, but I can be someone who will listen and treat them with dignity. I can’t imagine how difficult it must be to be proud to defend your country, but to hate what that can entail, so . . . I listen.