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The Art of Medicine

Planting season

Katers, Laura A. MCHS, MS, PA-C

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Journal of the American Academy of Physician Assistants: September 2020 - Volume 33 - Issue 9 - p 58
doi: 10.1097/01.JAA.0000694980.29319.b3
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My patient was going to be okay. I knew this even as I rounded the corner and saw her pinched and red face, heard her quiet gasping. Rosie was a 54-year-old woman with a chart review of a hard life: alcohol use disorder, a bout with homelessness, and then the “dumb cancer,” as she called it. I met her in the PACU as she recovered from a thoracotomy to remove a branched knot of it.

Aside from maximizing her epidural, ketamine infusion, and opioid regimen, I hustled for the extras: more pillows, ice packs, ice chips, and a plastic spoon. Rosie lay on her left side and clutched the bed railing as if she were holding onto the side of a ship trying not to drown. The nurse and I built a wall of pillows at her back and had her lean on them for support. We worked on slow, controlled breaths and gingerly placed ice packs around the incision sites. When I looked up to the monitors to check her vitals, the squeeze came so hard I gasped.

I looked down to see Rosie's hands wrapped around mine. My hands, that were bare, ungloved. Hands that should not be touching, but Rosie saw my hands and eased her own from the bed railing, grabbing mine as if I were the ship. The life preserver.

The contact was so sudden I barely registered the fear. Thoughts tumbled. I don't have gloves on. Are we passing something deadly between us? The apocalyptic movies reeled by—had I just made a fatal error? Then I saw the look in her eyes—the same look that is in my cat's eyes on the way to the vet—wide-eyed and cautious, but with a sheen of understanding that she somehow knew I wouldn't let anything bad happen.

“Please don't leave me,” Rosie whispered.

I couldn't recall the last time I intentionally touched or held a friend's bare hand, let alone a stranger's. Surely in February 2020, before COVID became part of our language and hospital norms were scrapped and sidewalks were taped with 6-ft markers. In the hospital, staff were asked to work remotely if possible to reserve personal protective equipment for the EDs and ICUs. Masks and gloves were required when working with a patient with potential for bodily fluid exposure. Always gloves.

On this night, I hadn't anticipated touching a patient, or being touched by one. My examination is minimal contact: pupil size, deep breaths, strength and mobility, epidural site intact, BP, pain scores, sedation, relief. Human touch isn't always necessary for pain management, although experience has shown me its potential for comfort.

Most hands want to help, and when physical restrictions were enacted, I found other ways to use mine while working with patients through barriers and windows and plastic. When I craved something more tangible, I began weeding the large yard where I rent a home. My hands were greedy to remedy the neglect of 10 years, where snarls of weeds like its own cancer burst through cracks. Neglect I hadn't noticed before. My neighbor's massive camellia was breaking under the weight of the dying winter blooms. I pruned it. My days became less about the worry and what ifs and more the steadfast learning of intricate names and shapes of trees. The rough bark of the rhododendron before the wild and glorious blossom (red, yellow, pink!), and the knotted grip of the ivy choking out the large fir at the end of the driveway. The white skin of the camellia cool even on the hottest day, and so smooth. The skin-to-skin contact felt a luxury, almost sinful.

Now here I was, skin-to-skin with a stranger, a moment so sweet and somehow so wrong it brought heat to my face. I missed hands, and the warmth of handshakes and the firm one I've worked on since my grandmother told me, when I was 5 years old, “It's important for a woman to have a strong handshake.” The art of medicine had become disorienting: the abnormality of treating patients from doorways, the lost smiles and facial expressions now hidden behind masks, discussing care with patient's loved ones over a phone. In only 8 short weeks, human contact and interaction had irrevocably been altered. I could only imagine how it felt to be a patient in a hospital.

And so I held Rosie's hands as my plan took hold, and her pain became an 8 out of 10, then a 5, then she was ready for the floor. As she was wheeled out of the PACU, both hands still entwined with mine, she whispered, “Thank you.” I knew I would find a new way, a new rhythm for human touch and connection in these extraordinary times, still rife with so many moments of intimate human experience. There was more planting to do, another season to prepare for.

“Thank you,” I replied. And let go.

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