Layers

“He pulled his Dobhoff again.”

The pager’s words echo on my retina as I indulge in a prolonged, beleaguered sigh. These are the five-minutes-til-sign-out pages that are going to push me to start Amlodipine (a blood pressure medicine) before I’m thirty.

He’s ninety-six years old. He doesn’t remember his name, where he is or what year it is. He has no proxy or next of kin. He’s not talking.

Like everyone else on this unit, he has Omicron. Even though he’s asymptomatic, I still need to wear all my PPE, creating additional layers between us. When I’m in his room in the morning, I can’t tell if he’s really seeing me.

I walk toward the supply closet, dreading the task in front of me. We’ve been waiting for weeks for his court-appointed guardian to get the expanded authority that will allow for a change of code status. For now, if this ninety-six-year-old emaciated man’s heart were to stop beating, my legal obligation would be to break ribs to keep death at bay for just a little longer. Until his status changes, we have to keep feeding him, too.

The Dobhoff is a feeding tube that runs through his nose to his stomach. He fights the Dobhoff from the confines of his restraints, writhing underneath my arm. I’m sweating underneath all my PPE, and my glasses fog up, but I still see the tube curl in the back of his oropharynx. Time to try again. And again. I see tears stream down his face, and the Dobhoff tip is streaked with blood. My attending physician gives me permission to give up for the night, and I feel the patient and I have both been granted a vestige of mercy. I try to rationalize torturing a patient on my drive home. When I get there, I watch Laguna Beach reruns and fork through a bag of shredded cheese, trying to dissociate.

Every morning this patient has a different nurse who unfailingly catches me during prerounds to ask, in tactful terms, what the medical team is thinking. I don’t know if I have the wherewithal to claim helplessness for many more days. When I walk into the patient’s room, I see his arm rustle under the blanket. It’s drenched in blood—he’s ripped out his IV. I look from his arm to his face and our gazes meet. With the bloodied arm, maintaining full eye contact, he throws the blanket over his face. The last crutch of doubt supporting my conscience splinters beneath me.

Despite all the layers, he still sees me.

Laura Burns
Boston, Massachusetts

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1 thought on “Layers”

  1. How incredibly sad that we treat our patients with less “humanity” than our pets, at the end of their life. I will never forget my demented grandmother being tube fed because her brother and P.O.A. thought it was the right thing to do. And how sad that your poor patient had no one to speak for him. Bless you for your work.

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