First Lieutenant Elizabeth Spangler didn't quite know where to begin. Morning nurse report brought news of a newly admitted elderly woman with generalized weakness, Chronic Obstructive Pulmonary disease, supplemental oxygen dependence, extensive cardiac issues, impaired skin integrity, inability to reposition independently, lack of appetite, diarrhea, need for long-term placement, but possibly comfort care...The list of nursing care plans were stacked up for this lady, each condition competing for prioritization. The multi-faceted plan of care began rolling through Lt Spangler's mind right away, before she even set foot in the patient's room.
Clinical terminology from morning report came to life in a tangible sense for her as she passed through the patient's doorframe. Eye contact with a smile was her first intervention, shortly followed by an introduction and request for the patient's name of preference. She returned a warm smile and welcomed the opportunity to share the origination of her nickname.
Her name, let's say "Bonnie," became more than just a means of identification to me as I learned more about who she was and where she came from. She eagerly asked about my own name and I felt we were instantly friends. I took her hand and felt the fragile, bruised, and prodded skin within my own. She acknowledged her susceptibility to bruising and skin tears without much regard. She quickly changed the conversation by inquiring about my hometown and favorite NFL team. Raspy voice and her gulping for air communicated a constant struggle and continual dependence on supplemental oxygen. As I asked about her need for oxygen at home, she explained her longstanding oxygen use and swiftly averted the conversation to her dependency on community and gratefulness daughters and friends. While she understood the necessity of oxygen, medications, and medical care to survive, she thrived to survive for the interpersonal aspects of life.
Although Lt Spangler continued to follow through with the physiological and safety care plans, she made it a priority to continually incorporate a personable and friendly approach throughout all interventions.
The fun really began when her eldest daughter (her primary caregiver) entered the room. The stress of her mother's condition was apparent on her face. She welcomed my personable approach to caring for her mother. The three of us working together came up with unique methods of transferring from bed to chair, repositioning in bed, completing daily hygiene, and eating. Inside jokes were inevitably developed along the way. When her second daughter arrived, we conquered and thoroughly enjoyed the challenge of Bonnie's daily hygiene. Never have I experienced such a monumental shower. This unforgettable task was conquered with wheelchair, towels, teamwork, and was certainly not without laughs and accidental water sprays. No one came out of the bathroom dry. We concluded with several wet towels on the floor and a call to housekeeping. Before the end of that first day I met two of her daughters and nearly felt like a third.
It was a difficult time for the eldest daughter, who felt solely responsible for making her mother as comfortable as possible and she often went to Lt Spangler with questions or to share concerns. LT Spangler became well accustomed with Bonnie's preferences, such as the way she liked milk in her oatmeal, water out of the little yellow cup, repositioning on her right side, her favorite TV shows, and snacks, which she called "flavors."
Bonnie remained on our unit for several weeks, which was the rest of her life. Caring for Bonnie in her final days reminded Lt Spangler that there is more to caring for a patient than fulfilling clinical needs. To Bonnie, treatment interventions faded in comparison to the fulfillment of friendship. While clinical interventions served to keep her alive, it was the relationships that made life worth living. By choosing to be a lively part of that aspect, LT Spangler embraced the opportunity to maximize the fulfillment of a Bonnie's final days. As hemoglobin needs oxygen, the heart needs love; till the final breath.