It’s cooler this weekend that it was last week, and I’m glad for that. I can’t really complain: we have insulated windows and air conditioning. It’s just the pits to go outside when the sun is out….that’s all.
As I tried to go to sleep last Saturday night, it was too warm to be comfortable. Sleep did not come easily.
I found myself remembering a long-ago encounter with a patient and reliving it in my head. Not just remembering it: analyzing it to figure out how I could have done it better…
Have I mentioned that I think too much? I do….
So, it was about ten years ago, on a very hot, muggy evening. I was the nurse on call for my home health agency and there was a little boy who needed to be seen and given antibiotics at six in the evening.
He was so little. About four years’ old, if I remember correctly. His skin was very light colored, and his huge, brown eyes were dull, not shiny. He had been home from the hospital for about an hour when I arrived.
I must have looked like the circus came to town, hauling in a box of IV supplies and dragging an IV pole behind me. Usually, the infusion company would deliver the IV supplies but I didn’t want to have to wait for them, so I picked them up myself.
His mother spoke only Spanish, so my interpreter was his six-year-old sister. As I assessed the little boy and asked the required questions, I began to realize just how hot it was in their apartment. I began preparing the IV infusion, and prayed that I would be able to start his IV on the first stick. (Some well-meaning RN in the Peds Unit at the hospital was “afraid” to send him home with an IV needle, so she took it out….)
I excused myself to go to the kitchen to wash my hands before doing the IV, and there, on the counter, was a slab of brown-gray meat covered with flies. Apparently, mom was defrosting it for supper. Knowing that the little boy was hospitalized with sepsis, I wondered if the family food preparation practices had anything to do with his condition.
Should I say something to Mom? Could a child-interpreter really do justice to what I had to say? Was it really something I needed to address, or was I out of line? As the visit unfolded, I realized just how much this young mother was overwhelmed with her son's illness. And life, in general...
I returned to the patient’s bedside and started his IV. I needed to stay until the infusion was complete and discontinue it. Another RN would come to the home the next day and do the infusion again. Since it was only for three days, and since there was a significant language barrier, it was decided that we would not teach the mother to do the infusion.
I could feel my uniform sticking to me, wet with perspiration in the stifling heat of that little apartment. My patient was sleeping now and it was quiet in the room. Mother sat staring at nothing and stroking her son’s hair, soothing both of them.
Suddenly, there was a loud BANG as the front door slammed shut. Mom stood up with a look of panic on her face: her husband was home and she had forgotten to turn on the air conditioning so he would be comfortable. She ran and turned it on as he walked towards the bedroom.
I turned around and looked up to see him glaring at me. He turned to his wife and asked her, in Spanish, “Who is this woman and what is she doing to my son?” I was genuinely concerned by his demeanor. Mom explained to him that I was a nurse and that I was giving him his IV medications. He said, in English, “no more! Finish what you are doing and NO MORE!”
What to do? I decided to be as blunt as he was. I explained that the ONLY reason his son was able to come home from the hospital was because a home health RN would come administer the remaining antibiotic doses. If he would not let us do it, his son would need to go back to the hospital. Or risk becoming very ill again...
After a heated discussion with his wife, in the hallway, he came back in and said: "OK.”
I walked out into the warm evening relieved. The visit was over and, although I had a couple of hours of documentation to do on the computer, the worst of my evening had just passed. I chastised myself for not being…..whatever it was that I thought I should be. I didn’t feel comfortable about that home situation but I didn’t know what to do…
All these years later, I can still see that little boy and his mother and sister. I can’t remember dad’s face that well, but I will never forget his voice. Was I too intimidated to do the right thing? That was the question that went through my head over and over last week…
And I still don’t have an answer…