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The reciprocity of touch

Woodley, Lisa K., MSN, RN, CNE, CHPN

doi: 10.1097/01.NURSE.0000534091.41368.08
Feature: SHARING

To honor a dying patient's wishes isn't always easy, but it can remind us of what it means to truly be human.

Lisa Woodley is an assistant professor at the University of North Carolina's School of Nursing in Chapel Hill, N.C., and a Certified Hospice and Palliative Care Nurse.

The author has disclosed no financial relationships related to this article.

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NURSES HAVE the opportunity to touch others in a way that no one else can, and if we let them, patients will do the same for us. One of my hospice patients was a testament to this. Adofo (the Ghanaian word for warrior)* was a 32-year-old man full of dreams and hope. He had a gentle yet indomitable spirit. He'd fought fiercely for his independence, but his battle with AIDS was nearing its end.

As Adofo's health rapidly declined, he faced some difficult decisions. His hospice benefit didn't cover his antiretroviral therapy (ART), an expensive treatment that was no longer effective. Adofo, however, wanted to keep taking the ART for as long as he could swallow. He also wished to remain at full-code status. I struggled with this decision and wondered if it was the best course for him to take.

In his final days, Adofo began to experience severe lower extremity pain and muscle spasms. On one rainy summer afternoon, after answering his call bell because of persistent leg spasms, I opened Adofo's doors to the outside patio. I then asked permission to gently massage his painful legs and feet. “Oh, you don't want to touch my nasty feet,” he said. I took a deep breath and asked again. This time, he silently nodded. As I gently rubbed lotion on his feet, Adofo jumped and flinched, but as he got used to my touch, he directed me where I could apply pressure and how much to use. I asked him to close his eyes and focus on the sound of the rain and his breathing as I gently stretched his stiff joints and massaged his wasted muscles.

He whispered, “This is the best I've felt in a long time.” I didn't respond in words but continued on. He, in turn, fell asleep. When I quietly left the room, Adofo had the breeze on his face from his open window and the sound of a summer rain in his room as he slept. As it turned out, those were the last words he spoke to me. When I returned to work a few days later and glanced at our patient census board, I saw that Adofo's name was gone. No one had to tell me. I knew what had happened. I was glad I hadn't been working when Adofo went into cardiac arrest. The nurse who found him started CPR as he'd asked us to do, but resuscitation attempts were unsuccessful.

Later, I sought out the hospice chaplain as I continued to struggle with the events that surrounded his death. The seeming cruelty of performing CPR on this man haunted me. My dialogue with the hospice chaplain led to an epiphany: Adofo had spent much of his adult life fighting a stigmatized disease. He had to quit his job and live on disability. He experienced physical changes that transformed him from young and strong to weak and cachexic, and he struggled with constant pain. Maintaining his full-code status was the last thing he could hang on to—a cry to those around him that his life was worth living, too.

I came to believe that CPR was the final gift we could give to Adofo. It wasn't about a successful resuscitation. It was about the message from our souls to his, that he was important and worth fighting for.

I've cared for many other patients at the end of life in the years since Adofo. But I haven't forgotten about him or the lessons he taught me. The power of touch and presence. The reciprocity in nurse-patient contact. An appreciation of the little things. A reminder of why I entered nursing in the first place—to make a genuine difference to others.

Adofo taught me in the most poignant way possible that every life is unique, and that all people have intrinsic value. To honor a dying patient's wishes isn't always easy, but it can remind us of what it means to truly be human. For that, I'm eternally grateful to be a nurse.

* The patient's name has been changed to maintain confidentiality.

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