By Marti Trudeau, RN, CPHQ, MPA, director, University City State Programs Office, BAYADA Home Health Care, Philadelphia
I was anxious as I arrived at Mr. Johnson’s house. He was my first centenarian patient. He lived alone, taught Sunday school, and had no ailments. He didn’t need help, but his family thought he should occasionally have a nurse visit. After assessing this healthy man, I asked him, “What has helped you live so long?”
Surely he’d been asked this question many times, yet he thoughtfully answered, “Every morning I wake up, drink a large glass of water, then look in the mirror and smile.”
“You drink a glass of water?” I responded.
“Listen to what I said, sweetie,” he answered.
I recall this because when patients called me “sweetie,” I would say, “Please do not call me sweetie, and feel free to call me Marti.” But I didn’t say anything to Mr. Johnson. I figured that at 101 years of age he could call me anything.
Weaving through my mind as I left were the words, “Every morning . . . water . . . ” Thus began my habit of drinking a large glass of water each morning—not exactly what he recommended, but what I heard at the time.
Through the years, patients told me many things.
Sometimes my effort to comprehend was rewarded with special messages. For example, following her stroke, Mrs. Larson could not utter a word, yet over the times we chatted I learned that her husband had died years ago, she had a son about whom she was very proud, and she was at peace. Each day she looked so happy. Her round face looked angelic as she sat in her wheelchair, properly dressed and primly listing to one side.
Her limitations could have frustrated her, but her face told me otherwise. She smiled and held my hand, nodding in response to questions that she couldn’t verbally answer. Her eyes told many stories which, with a little patience, I was able to hear. Most importantly, she told me to live in peace.
Sometimes what I heard was startling.
Entering an extended care unit for the first time as supervisor, I was met with an animal-like sound. When I asked about it, staff members responded by saying, “That’s Mrs. Gobbler. Don’t you think she sounds like a turkey?” Indeed, that was exactly the sound. Before I went in to see her, I asked that everyone please refer to her by her proper name, Mrs. Harris.
To each of my questions, Mrs. Harris gobbled an unintelligible response. Day after day she gobbled. After several weeks, I began to pick up a cadence to her sounds, but I always left not knowing if she’d really said anything. Finally, one day I sat very close to her and said, “Maybe if you speak very, very slowly, I will understand you.”
With determination, she stunned me by gurgling, “I—am—scared—to—death!”
When I reported back to the staff that Mrs. Harris could speak, they looked dubious. She’d lived on that unit for months and had never spoken, or so they’d thought. “Well, she is scared to death,” I answered. “Maybe that is why it’s so difficult to understand her.”
“How do you know she’s scared to death?” they asked. I replied, “She told me so. It took a little time, but she told me.”
Listening to the past.
So many patients and so many thoughts shared. These are just a few of those stories from my collage of memories. Sitting one day savoring those memories, my thoughts went back to Mr. Johnson. He had come into my mind many times through the years, and each time I smiled at the thought of a glass of water being the secret of living over a century. This time, though, a spark ignited while I was repeating the conversation to myself:
“Wake up, drink a big glass of water, look in the mirror and smile.”
I don’t know why, but this time I listened and heard the “smile” rather than the “water.” It was a revelation. The part that had seemed inconsequential when I first heard it now made so much sense that I was embarrassed that decades had passed before I really heard it.
Perhaps reading about research on the therapeutic benefits of smiling brought his words to the forefront of my thoughts, but in any case, if I had concentrated on the smile when Mr. Johnson first presented to me his recipe for long life, I don’t believe he would have referenced any research except his own N of 1 experiment: his well-lived life. If I had given him the chance to elaborate on his advice at the time, he might have explained that if you can’t smile at yourself in the morning, you have the rest of the day to improve, or maybe that it was just wonderful to wake up each day and he couldn’t do anything but smile.
Analysis may suggest that he was self-accepting, a good problem solver, perhaps with a foundation in faith, but what was most basic to him was a simple smile. How do I know this? He told me when he said, “Listen to what I said, sweetie.” It took me awhile to hear his gift of a message.
For other thought-provoking blog posts exploring important aspects of patient experience, click here.