Shannon Thompson’s heart beat faster as the door of the patient’s room opened before them. Nine. It had been nine days since the woman had last been bathed, and the aroma of body odor coming from inside the room was an evident contrast to the smells of alcohol rub and soap Thompson was accustomed to smelling in the hospital’s sanitized hallways.
“You two will be in here,” the nurse said as she directed the clinical students into the patient’s room.
Thompson and a fellow nursing student from Texas Christian University, Joey Micci, carried their buckets of washcloths, water and soap to the bedside and began to work.
They scrubbed the woman’s pale, wrinkled skin, and Thompson tried not to scrunch her nose as she twisted the used rag above the bucket, causing a stream of brownish liquid to fall into the water. She looked across bare skin at Micci and then back down at the patient: 80-years-old, heart failure, most likely terminal.
Not many college students in their early twenties have hands-on learning experiences outside of the classroom, and Thompson had to remind herself that she was not a normal 20-year-old; she was a nursing student. According to data from the National Center on Education Statistics, students in health profession majors accounted for only 8 percent of college undergraduates in 2012. That number was so small mainly because few can handle the academic rigor and intense hospital environment day in and day out. Thompson, however, was part of that minority, and the coursework preparing her for such a life was just this, working in the hospital and caring for patients, even if that meant bathing an older woman as part of course requirements.
“This is my normal now,” Thompson thought. “She needs a bath. You do whatever.”
Micci and Thompson continued their duty.
Thompson had never had a boyfriend or even kissed a guy before, and now here she was, bathing a completely naked 80-year-old woman with her 20-year-old, perfectly eligible, male classmate. What a first date.
She could have talked. She could have flirted, but the two students just worked repetitively until their third companion broke the silence.
“Thank you. Thank you,” the woman repeated. “Thank you.”
Thompson smiled as she picked up the bucket of water, dirt and washcloths.
“Even doing the smallest things you feel so accomplished,” Thompson said. “I guarantee we made that person’s day.”
“We all have different stories in nursing. I’m preparing that person like they’re going to have to take care of my family. We need more nurses. There’s a lot of opportunities for women beyond what there was years ago, so I want the best nurses taking care of me. And it’s not just the science part of nursing but the art of nursing.” – Professor Barbara Patten
Thompson had been in hospitals regularly since she was 16-years-old, and the goose-bumps lining her arms as she walked through the cold, whitewashed hallways were all too familiar to her.
She grew up in Dallas, Texas, with her parents and two siblings. Thompson’s Highland Park world, however, was flipped upside down when her younger brother, Justin, was diagnosed with leukemia in 2009. He was only 10-years-old. For the next four years, Thompson and her family were regulars at Dallas Children’s Medical Center where her brother underwent treatment.
“I vividly remember it all,” Thomson said. “On some nights when my mom needed to spend the night at home or take care of the dogs or something, I would spend the night with my brother in the hospital.”
It wasn’t abnormal for siblings like Thompson to stay the night with sick younger brothers and sisters. It happened a lot on that floor at Children’s Medical Center, because most of the patient’s were just like Justin: 10-years-old, leukemia, chemotherapy and radiation therapy.
It was the best part of Thompson’s day, though, seeing Justin laugh even at 3:00 a.m. as a nurse came in to check on him. Thompson knew her brother’s mood depended on how good or bad the nurse’s interaction was with him that day, and the most helpful thing they could do was treat him like a friend, not a patient.
“Some would come into the room and just do their job,” Thompson said, “but others would come in and make him laugh and just love him.”
It was in Children’s Medical Center that Thompson decided she wanted to work in a hospital for the rest of her life.
“I want to help people,” Thompson thought. “I want to be that good nurse.”
“What I like about it is, in this first semester, you get to see a lot of lightbulb moments. Students get to do something that I might take for granted that is very exciting but as simple as getting to give your medication for the first time or getting to listen to somebody’s heart or getting to see a wound dressing change or give an injection. We are preparing them to be professionals, so part of that is being on time, being prepared and ready to go.” – Professor Barbara Patten
“What are his medications?” the clinical instructor asked the group of eight students who were waiting in the hospital lobby to meet the nurse they were scheduled to follow that day. These pre-conferences were mandatory before each day of clinical work, and the instructor would test each student on the details of the patient he or she would be tending to throughout the day, including the person’s age, health condition, and the necessary medicines and dosages for treatment.
The night before, Thompson had spent three hours searching through the hospital’s database of patients’ charts, all to pick this one: 20-years-old, sickle cell anemia, sickle cell crisis, excruciating pain.
“Hydromorphone,” Thompson sounded out to her instructor. She allowed a sigh of relief as the instructor continued down the line.
It was 6:00 a.m. The bustle of the nurses changing shifts added life to the usually quiet hallways as they talked and debriefed on patient reports and updates. Thompson followed her nurse up to their floor to perform a morning full body assessment of the patient.
Entering the room, Thompson saw a young man who she thought could be in her biology class, laying between the sheets, barely moving.
He groaned as she approached the bedside. Listening through her stethoscope, Thompson made sure to check all of the key points, but heart beats, lung sounds and pulses were difficult to hear over the grunts and moans of the young man.
On a normal day, the patient would have been studying mechanical engineering and going to class like an ordinary college student, but today, crisis was normal. Living since birth with sickle cell anemia, he knew to come to the hospital on days like this, he knew his blood cells were getting stuck in veins all over his body, and he knew it would be excruciatingly painful. All Thompson knew was to give him pain medicine.
Thompson distributed the hydromorphone and watched as the young man relaxed in anticipation of relief, calming down enough to talk a few moments with the inexperienced nurse curious to know about his life.
“My life isn’t normal,” he said. “I’m in the hospital on so much pain medication that I’m like a vegetable. I can’t function because I’m so out of it.”
When she left to follow her nurse throughout the rest of her day, all Thompson could think was, ‘“I’ll never take a healthy body for granted.”
“Think about the pilot you have out there that’s flying your plane. He didn’t learn how to fly the plane in the plane. He had to go be in a simulation environment with a lot of the technology that is the same as what he would use if he were flying the plane. It’s a safe environment. You’re not going to kill anyone, literally.” – Professor Barbara Patten
She was going to die, probably within the next three hours.
No one was in the room when Thompson and her nurse came in to check on the patient: stage four lung cancer, terminal.
Thompson slid the pulse oximeter onto the woman’s finger and noticed immediately that the oxygen saturation was abnormally low.
“It’s usually supposed to be between 98 and 100 percent,” Thompson said, “but hers was in the 70’s.”
A reading wasn’t necessary to know the end was in sight. Doctors and family deliberated whether or not to take the woman off of the ventilator that had been sustaining her life, but the grey-blue tint of her skin was evidence of the cancer forging its final attack. In the end, the decision was made, and the cancer won with each IV, cord and machine Thompson unplugged from the woman’s body.
She was unconscious as Thompson and her nurse rolled the woman to hospice, a nicer, more homelike hospital room where most patients are taken when they are about to die. As strange as it was seeing a person on the verge of death lying in the bed Thompson pushed through the hallways like a cart in a grocery store, something else disturbed the 20-year-old even more.
“No family was there,” Thompson said. “She had no one with her.”
“One of the things we say to them is that they then have the license to continue to learn. We can’t teach all the different areas, but it’s learning the nursing care for that population that you are working with, and it can be very specific. If you learn these basic skills, you should be able to apply them.” – Professor Barbara Patten
“Beep. Beep. Beep. Beep. Beep.”
The alarm of the cardiac monitor grew faster and faster as the man’s blood pressure fell and fever spiked. Nurses rushed in to assess the situation and aid in any ways they could, as the doctor yelled commands across the room.
He was one of those patients you see only in textbooks: 45-years-old, paraplegic, stage four pressure ulcer on sacrum, bone exposed, sepsis infection, possibly terminal.
A motorcycle accident 20 years earlier paralyzed this man from the chest down, and now, here he was in the hospital again, but for a different reason.
He came into the Emergency Room with no pain. The ulcer pulling and gaping on his back had caused an infection of the blood that sent the man into septic shock, and yet he couldn’t even feel it.
Thompson could see the bone as it lay exposed through the ulcer. What normally would be a stage one pressure ulcer had progressed to a stage four, all because the man couldn’t know his flesh was being torn away the longer he sat still.
“He’s just a perfectly normal guy,” Thompson thought as the Texas Ranger’s hat lay by his bedside. “Sporty,” she noticed, “but he couldn’t get out of bed to go brush his teeth.”
Despite the wound, what stood out most to Thompson was the anxiety and depression she could see in his face even 20 years after the accident.
“He’s probably the saddest case I’ve seen, but like all the other patients, I just have to rely on the fact that there are people in his life who love him and care for him,” Thompson said, “just like when it was my brother.”
“It’s hard to see the things I see and to go home at night and not take the baggage with me. I have to remember that the place I can help is in the hospital. I’m passionate about nursing, because I see how it makes a difference in people’s lives.” – Shannon Thompson