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What One Thing Will Make Today Better for You?

Goff, Susan L. MS, RN

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AJN, American Journal of Nursing: September 2011 - Volume 111 - Issue 9 - p 72
doi: 10.1097/01.NAJ.0000405069.28269.63
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Illustration by Lisa Dietrich.

It's been at least 10 years, but I still remember that it was a difficult morning getting to work. The snow was piled high and the roads weren't yet plowed. Nevertheless, all staff showed up—the usual when you worked on a busy oncology unit.

As nurse in charge of the unit, I received the night report from the off-going night nurse in charge. Mrs. Smith vomited for a good portion of the night; Mr. Jones's wife had to leave to go home and get the kids off to school—she was hoping to make it back "in time"; Mr. Ricker's wife stayed with him last night. She told me who was "critical," and what needs were primary in caring for each.

I made a round of the unit. As I walked into the patients' rooms, I greeted each with a touch on the hand or forehead and asked them, or their family if present, "What one thing would make today better for you?" I'd used this approach since the 1970s, when I'd realized that my assumptions about what mattered to patients were often incorrect.

The answers were always worth paying attention to. "Please turn off the light"; "please put another blanket on me"; "can I have some grapefruit juice?"; "when is my next pain medicine due and can I have it now?" All of these could be solved with a quick flick of the switch or pull of the blanket. A call to dietary directly from the room got the grapefruit juice within minutes, and a check of the med record directly outside the patient's room showed he was due for his medication and the nurse in charge of his care was on her way with it.

As I entered Mr. Ricker's room, I remembered that the night nurse had mentioned that his wife had been with him overnight. I knocked very lightly and opened the door a crack. The two of them were cuddled up closely in the bed. I asked quietly, "What one thing would make today better?" The answer came in a raspy whisper from Mr. Ricker: "rice pudding." Pondering the fact that he hadn't eaten in days, I said, "Let me work on that."

Mr. Ricker had been a patient on our unit for three weeks and was "actively dying." As I worked my way through the hallway, greeting family members and patients recovering enough to be up and about, I was preoccupied with his request.

Sure enough, when I checked the chart, his orders were NPO ("nothing by mouth"). I paged Dr. Miller; when I got his return call, I was ready for it. After hearing my request, he said, "Sue, are you crazy? I don't even know what pipes are connected to what since he's had so much surgery." I said I understood his concern, but that Mr. Ricker had requested the pudding and I'd really thought he looked much worse today. Couldn't we just try it, "even if we just let him put it in his mouth and taste it?" Dr. Miller's answer was a tentative "Well, all right." I thanked him and promised him I would have the suction ready and be available to assist his wife.

The next hurdle was to call dietary and find out if they even had rice pudding. They did. I told them the name and room number, but asked them to bring it to me at the nurses' station. I wanted to be sure I was present when the rice pudding arrived.

Then it was back to the work of the unit. After many phone calls and questions from physicians making rounds, the rice pudding was on the desk at the nurses' station in front of me. I'd consulted with Mr. Ricker's nurse and told her what was going on.

I brought the rice pudding to Mr. Ricker's room, knocked quietly, and entered. Again it was very quiet, with the two of them cuddled up in the bed. After a moment, his wife got up and took the rice pudding from me. Jim, in his raspy whisper, said, "Thanks Sue, you are the best." After she'd reassured me that she knew how to use the suction and would pull the emergency cord if she needed me, I left.

I remained outside the door with my ear to the door for several minutes, but I didn't hear a sound.

About an hour later, I checked back with Jim and his wife. Both were sleeping soundly. The empty rice pudding dish was on the bedside table.

That afternoon at about one o'clock, Jim died peacefully in his sleep with his wife cuddled up to him in the bed.

I never did find out who actually ate the rice pudding—Jim or his wife.

© 2011 Lippincott Williams & Wilkins, Inc.