I am constantly obsessing over fingers and toes in the ICU. They can tell us so much about whether our high-tech machines and drugs are helping to keep our patients’ bodies perfused with oxygenated blood. Some patients’ fingers and toes are warm and pink. Some are cold and black, even falling off. A lot are dirty…really dirty. Like with actual dirt clogged under overgrown nails. I won’t lie and pretend that these nails don’t gross me out a little bit. Or deny that I typically wear gloves when I am touching these patients’ hands or feet.
Amy’s nails, however, were painted glossy black when I saw her for the last time. Not gothic black, but chic black. Amy had been like a second mom to me for over a decade; she was always helping me be more chic and fashionable. I stared at her freshly manicured fingernails as I stood in her ICU room, and I couldn’t stop thinking that her nails looked the same as they did on my wedding day. When I touched her hands, they were warm–the machines were working, but her brain was not. I didn’t need or want to wear gloves when I touched Amy. Now I can’t stop looking at my patients’ fingernails and thinking about the last time I saw those of my dear friend and confidante. But my patients’ fingernails no longer tell me just about clinical indicators of blood perfusion. When I look at them now, I am reminded that my patient is a real person apart from all these machines and alarms and white lights, that each of them has a life outside these walls, that all of them have people who care about them. The dirt under their nails is from hard work or a tough life. I’ve learned to not always separate myself from them by gloving my own hands. But the patients with fresh manicures are the hardest for me now, because they remind me of Amy. Maybe one day I won’t think of her automatically whenever I assess a patient’s hands and feet, but I doubt it. She didn’t teach me just to be more chic–she taught me to be a better nurse by opening my heart up to my patients in a way that I couldn’t when I always wore gloves.