It was during my first month on Hospitalist service when I was called to 6400- Senior Behavioral unit- the penthouse I like to call it. "You need to talk to M's son about her status. She is declining and rapidly," Kristen said in a calm but all about business voice. "We have done all we can for her." When I entered the unit, there was someone screaming out in agony. It was M. Kristen told me that she had been this way for more than 4 days. She has not been eating or drinking much. M's screams affected everyone, the staff, the patients and now Me! She is letting us know she is tired of this life. I must have looked like, "What is really going on here?" "If you have never seen end-stage Alzheimer's disease, this is what it looks like," Kristen said.
I placed the call. Her son was patient with me. He understood how his mother ended up in the senior behavioral health unit. He understood that eventually, her disease will progress. At some point, he stopped and asked me if I could move to another location to have this phone call. He could barely hear me on the phone over "that person" screaming in the background. I replied, "Unfortunately, I cannot; we have to keep an eye on your mother." She is at the nursing station where she has been daily under close vigilant eyes of the nursing staff. He took a long pause on the phone and decided that she should be placed on hospice. "Do you think she will hold on until I am able to come and see her?" he had been helping Hurricane victims in Florida. I told him I will let her know he was coming for a visit and to hold on. I hung up the phone and started crying like a baby. It was my first hospice order in my 18 years as a physician's assistant. Kristen came up to me and said, "You are not a cry baby, you are just human. Alzheimer's disease can be like cancer, it can even be worse. It steals so much from the patient and their family."
Once her code status was changed, the patient was moved to her room. Some very soft music was being played when I walked in. M was not screaming as loudly. Kristen was talking to her at a very low voice, "You are not alone," "We are here to take care of you," and "Your son loves you," are just some of the things that she was whispering to her that afternoon. Kristen continued to hold her hand and her screaming eventually stopped. Her colleagues helped care for her other patients while she acted as a comforter to M. She was eventually transferred to the medical floor and passed away.
We have bookends to our lives; our parents are the first bookend at birth, welcoming us into this world. With end-stage Alzheimer's disease, the patient is not even aware of who is acting as the other bookend, sometimes it is family, but other times its nurses like Kristen.
Kristen, like all the nurses on 6400, have helped me realize the power of a soft touch, playing music to calm one's soul and kind words in the healing and end of life process. End of life care happens often on this unit. Kristen, I'm sure would not say she did anything exceptional that day, but for me, she showed me that if I were in M's place, I would want her at my side, holding my hand, whispering kind words and playing soft music; being the other "bookend" of my life. Just letting me know that I am not alone and that I am loved. Thanks, Kristen!