By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN.

by patchy patch, via flickr

I first met Ella (name and some details have been changed) when she was my patient in the intensive care unit. She’d been riding in a car she wasn’t supposed to be riding in, heading to a party she wasn’t supposed to be going to, high on drugs and not wearing a seatbelt when she was involved in a high-speed crash that left her with broken bones and internal injuries. She was in the ICU for more than a month.

Her situation wasn’t that remarkable. Ella could easily represent a common category of ICU admissions—the young adult who is often described by her parents as a “good girl,” yet who lives wildly, fearless and flip, taking risks as if consequences will never apply. I feel particularly protective of these patients, mostly because I relate to them, on some level. I remember the sense of invincibility that came with youth, and when I’m caring for these girls I often marvel at consequences I avoided in my own life. I shake my head at my younger self, alternating between feeling extraordinarily blessed and very lucky. I’m not sure the risks I’ve taken in life compare—but still, I had no concept of the fragility of life. I certainly didn’t comprehend its worth.

I cared for Ella often and became fond of her. I felt like I knew her, even though she was usually sedated. I fussed over her, when I had the time. “Don’t do drugs,” I whispered in her ear as I washed her hair. “Wear your seat belt. Stay away from bad guys!” And also, “You survive this, you can do anything!”

She slowly got better and was moved to the step-down floor. A few weeks later I ran into her mom in the cafeteria. She told me Ella was doing great, that she was walking with physical therapy and talking. She encouraged me to come and visit her, and so I did.

Ella was on the phone when I stopped by, casually capping her tracheostomy tube with her thumb to keep up her end of an animated conversation. She glanced over at me distractedly as I chatted with her mom. When she finished her call, her mom introduced us. Although Ella was polite, she said she didn’t really remember me; I just seemed vaguely familiar. And it occurred to me, while standing there, that I didn’t really know her, either—just her physiology. Which made meeting her this time feel sort of awkward, at least to me.

I told her she looked great, wished her well, and made a quick exit. Her progress was impressive, yet I found myself feeling removed and a tiny bit deflated. I suppose I expected that I would see in her some sense of relief in escaping a tight brush with mortality, some zest born of second chances and redemption—and although I don’t know what I’d thought such reverence would look like, she appeared, and acted, unaffected. She just looked normal.

But I hope she knows, somewhere inside, how amazing she is. I hope she believes she can do great things in life. I hope she heard me, even if she doesn’t remember me.

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