Jonathan Peter Robb works as a district nurse for the National Health Service in London and has published two essays in AJN‘s Reflections column in recent years, “How I Built a Suit of Armor as a Nurse (and Stayed Human)” and “Verification.”
I was working an evening shift and it was five o’clock when my mobile rang for a call-out. The patient was a woman I’d seen before, who’d been on and off our books for the past few years. She was old, and unwell, and when she last returned home, we were told she was dying. She had been made palliative. Her name was Ruth.
Even with her fluctuating health, Ruth remained incredibly sharp. She was also persistently positive. Ruth was the type of patient you could talk to and forget they were a patient. She asked me questions about myself. Despite the number of people I care for and my enquiries into their health and lives, it is a rare person who asks questions about my life.
I headed out to see Ruth. She was still living at home, her daughter acting as her carer, but I’d been told Ruth’s health had taken another turn and her daughter wasn’t managing. They were calling an ambulance. I was asked to come by to help shower Ruth before the ambulance arrived.
I rang the bell and was greeted by the patient’s daughter, who looked so rung out she could have been mistaken for the patient. She led me to where Ruth was sitting in bed, and a part of me sunk in shock at her transformation. When I’d last seen her she’d been a chubby woman, face flushed and animated, but the weight had bled from her and it was a much skinnier woman I found. Her skin hung from her cheekbones, pallid and limp.
I made sure to keep the surprise from my features and greeted her with a grin. She smiled and used my name and I was relieved to see the same tenacious woman living behind those tired eyes. We talked about her decreasing strength and need for hospitalization, and she spoke as if it were just another day. She wasn’t distressed. She accepted this was part of life, and at this stage in hers, it was necessary to return to those white walls. As she put it,
“If it needs to done, then I need to do it.”
She said it with a sincere smile and I told her I admired her attitude, and I hoped silently that I could retain such perspective when my body started failing me.
As I readied things for the shower, Ruth’s daughter told me Ruth had had gastro for the past three days, the cause of her recent decline. Due to the aggressive nature of the bug, she had been fecally incontinent. I assured her this was fine. I’m a nurse and this is nothing new to me.
I assisted Ruth to the shower, wrapping a towel around her pelvis to contain her saturated underwear. I was concerned at the large amount of fluid. It explained why Ruth had deteriorated so dramatically—passing so much liquid had left her dehydrated and weak. A poor combination for someone who is already unwell.
It was easier to cut away Ruth’s spoiled garments than to drag them over her limbs. I went to work with a pair of scissors and a garbage bag, and within minutes had removed the larger part of Ruth’s embarrassment. She took it all pragmatically. She didn’t waste time with flustered apologies or awkward attempts to straighten herself without my assistance, but let me do what had to be done while we conversed as if sharing a cup of tea. She knew her limitations and her own brittle strength and was happy to allow me to perform my role and she hers.
She asked about my family, recalling details I had shared with her months past, and I praised her on her memory and felt flattered that she considered these small aspects of my life worthy of chronicling. We talked while the water ran and washed away the evidence of her illness, and she sighed with pleasure to feel clean again.
She did slip out one apology, a minute thing, acknowledging the unpleasant nature of the job. I was quick to assure her that the task was no burden. I didn’t say this to comfort her, although I hoped it did. I said it because it was true.
I conceded the action wasn’t enjoyable—to claim otherwise would’ve been condescending—but I was proud of the job. I explained that to be there when someone is vulnerable and in need, to provide the one thing that person requires to feel better, is a unique thing. To be welcomed into such an intimate environment and be trusted is a privilege.
She relaxed, accepting my explanation, and I felt relieved I had been able to make her understand. It’s a hard thing to describe, this sense of privilege. It is a person putting their entire well-being into your hands and trusting that you will take care of them. It is daunting, and flattering, and humbling.
By the time Ruth was dried and freshly clothed, she more closely resembled the woman I remembered. She had color in her face and looked more a person than a patient. She thanked me while her daughter readied a bag to take to hospital, and I thanked her for her appreciation. Another rare thing.
I left them to wait for the ambulance’s arrival, farewelling Ruth and hoping I’d get to see her again. I felt gratified with the contrast of what I was leaving—a clean, contented person compared to the miserable soiled one I had found—and felt privileged I had been the one to accomplish it.