My Mother, My Nurse, Part 2

my mother, my nurse, part 2      10.31.11

It only made sense that Donna would be the one to stay in Cleveland after Laurie’s back surgery. She had the clinical skills, could speak “Hospital,” and keep a watchful eye on her daughter’s recovery. But when her husband went home, Donna was alone. I ask her if being a nurse made the time in the hospital easier or more difficult, and she says both. Easier, because she knew the course of treatment and what to expect. Difficult, because she didn’t get along with all of Laurie’s clinicians.

The next hurdle after surgery: dealing with all the tubes.

In total, Donna and Laurie spent three weeks at the Cleveland Clinic. Both describe the first few days as agony. The surgery left Laurie in pain and hooked up to a superhighway of tubes. Donna ticks them off like a grocery list: a chest tube, a catheter, an NG tube up her nose, and an IV tube in her jugular vein. Every time she saw Donna, Laurie would tell her, “I want this stuff off.”

Donna did not hit it off with the clinician in charge of Laurie’s overnight care, especially after Laurie called Donna crying at 6:45 one morning. When Laurie had asked for the phone at 5am, she was scolded with, “You know your mother needs sleep.” Donna, who would sleep on the floor next to Laurie’s bed when they got home, talked to a few people and someone new was assigned.

That same morning, the clinical team took Laurie’s catheter out and made her walk. Donna could see that it was excruciating. But beyond the pain on Laurie’s face, Donna could see something else: Laurie was standing up straight.

You’re not the boss of me

When the tubes were out and Laurie was strong enough, she and her mom moved to an apartment across the street from the hospital. Here, Donna was just a mother again. Any authority she’d had while Laurie was in surgery, recovery, or the ICU did not make it in the move. This became especially clear when Laurie refused to use the breathing machine that was supposed to help restore her lung function. Donna could explain why she needed it but Laurie didn’t have to listen. She was 19, had a spine full of hardware and up until recently, tubes in her nose, neck, chest, and bladder. Enough was enough.

On the third morning, Laurie woke up at 3am, unable to breathe. Donna listened to her chest and couldn’t hear any sound on one side of her chest. Back at the hospital, a CT scan showed that one of Laurie’s lungs had filled up with fluid. The overnight team in radiology drained 1500 ccs (about a liter and a half) from Laurie’s lung through a needle. “It hurt her like hell and she had a huge bruise, but after that she could breathe again.” I’m pretty sure I hear a hint of satisfaction in Donna’s voice when she adds, “She used the breathing machine after that.”

When they finally got back home after three weeks in Cleveland, Donna slept on the floor next to Laurie’s bed, watched over the mild withdrawal Laurie went through when she came off the pain meds, and took the sutures out of her back when they were ready. Then she went back to school.

From spine nurse to pain nurse

Originally I thought seeing Laurie in pain made Donna go into pain management but I was wrong. Pain was on her mind well before Laurie’s surgery. It wasn’t necessarily luck, but it was one of those things that the spine clinic where Donna worked closed not long after Laurie’s surgery. Donna went back to school.

These days, Donna says that she gravitates to the most difficult patients. Pain management is anything but straightforward. People react differently to the medications. Some people’s bodies break them down quickly, others don’t. Some people get relief right away while others continue feeling awful. She can account for weight, she can account for the patient’s reported level of pain, but there’s no way to know for sure how a patient will react until the drug is in his system.

The constant uncertainty plus the memory of seeing her daughter in pain keeps Donna on her toes. “Laurie is always on my mind every time I treat a patient,” she says. So she takes time to get it right. For her, a patient who doesn’t respond the way she expects is a chance for her to learn.

“Making someone comfortable, it floats my boat. To me there’s nothing better than to work with someone who’s in pain, figure out a way to make them feel better and have them say, ‘I don’t know what you did, but I’m glad you’re here.’”