Notes on nursing as witness.

Room 652 and 653 couldn’t be more different, except they’re both bald.

Room 652 is a woman with a glioblastoma. It’s the kind of brain tumor that often kills fast, usually within six months of diagnosis. She’s 57. Her name is Teea. The doctor says I’m history, says Teea softly, without apparent fear. Her humor is deceptive. I bet she’d bribe, threaten, or supplicate all creatures, medical or otherwise, two-legged or four, who promised they she could buy her even one extra week. She wants to live so bad she could scream it to the heavenly rafters, but she doesn’t, at least not in the hospital. She behaves calmly here.

Each of her three daughters is as beautiful as their mama, even though radiation therapy fried the hair right off their mama’s head. She only has curly clumps above her ears now, like a clown. I’m thinking of having them bronzed, she says, so she can put the last follicular evidence from the upper end of her body on her mantle above the fireplace, next to her baby boots. Nobody remarks that the boots are from the beginning of her life and the hair is likely to be from the end of it.

The oldest daughter is studying primates somewhere in Africa, and came home two days after her grandmother telephoned. The middle daughter’s in the air force, is training to be a pilot. The youngest lives nearby, her dancer’s body temporarily compromised by an unexpected pregnancy offered as a goodbye gift from a yoga instructor. All are with their mother in the hospital as regular as rain.

Teea figures the lion’s share of her own parenting duties are behind her, and she wants to sit back on some padded chaise lounge, drink a nice Australian wine, and watch her daughters do what they do best. She wants to be the audience. Applaud, witness, detach if she can, but not die.

Room 653 is bald too, clean-shaven after smashing into a windshield of a stolen car he careened into oncoming traffic. Both the men he hit died right there on the highway — a father driving his visiting son to the airport, a young and popular volleyball player, finishing his college career with 731 digs. His grinning picture was all over the news.

Even though the wreck was mid-afternoon, 653’s blood toxicology screen was positive for methamphetamines, benzodiazepines, alcohol, and cocaine.

He’s skinny. Street drugs suppressed his appetite’s voice, tricking him into thinking he was not just high, but full. At first glance his body looks like it belongs to an emaciated, dying old man. Closer up it’s easy to see his sculpted muscles are like hardwood. He’s seventeen years old. He wears a plastic diaper, and his limbs are splayed like a book, his feet and hands tied to each corner of the bed so he doesn’t hurt himself or us nurses. He yells nearly constantly. Most of the noises are unintelligible, but he does seem to know three words: sit, no, how. We’re suspicious that sit is a mispronunciation. More often than not, how is a long sound with several syllables, like a chant. The emphasis is usually on the ow, leading us to wonder if he’s in pain. We nurses give him analgesics even though the meds don’t seem to do much. We give the meds because it makes us feel like we’re doing something useful. We give them because his yelling drives us crazy.

He’s a hard one to like, is 653. Most the time all we can do is retie him, put mitts on his hands so he doesn’t chew into his own fingers or scratch himself bloody, clean him up from time to time. I’ve never seen anyone visit him, but there’s a note on his board that says Grandma and Noni love you. Get well soon.

For someone tethered in four places, 653 is all over the bed. In just two weeks he’s already rubbed his heels down to the bone. His diaper hangs low on his angled hips, and most of the time he’s able to squirm out of it. If he gets his hands loose he tears up the diaper and eats it. Or throws punches. Last week he gave a night shift nurse a nasty bruise on her upper arm while she was pushing a syringe of liquid food into a gastric tube going into his abdomen. While her focus was on his G-tube, he bit through the wrist restraint and swung at an enemy none of the rest of us can see.

Teea is my age, and we’ve had a few good talks about God and destiny and health. Today, however, I spend my precious few extra moments here with 653. I don’t really want to, but my job (as a pain and palliative care clinical nurse specialist) is to assess his discomfort. I also want to relieve the pain of the staff nurses, which will happen briefly if I can quiet him down.

His name is Brandon. I discovered yesterday that if I call him by name, he stops yelling. But when I start to leave he just starts up again, no matter how many tranquilizers or opiates the nurses give him.

“Brandon!” I shout over his shout. He makes full-on eye contact and stares like a baby does, not quite in focus but very intent on something he sees. Does he recognize his own name long enough to stop the spinning of some kaleidoscope of fears that dominate his visual field?

“Brandon, do you have pain?”

“No,” he says, as clearly as if we’d just resumed a lucid conversation over a cup of coffee.

I take a couple of charts into his room. After I say his name and he goes silent, I do some paperwork. He stares at me, he stares at the walls, he stares into thin air. Every once in a while he tracks something across the ceiling, as if a shooting star has flared above him. His temporary quiet is a relief.

I tell him about things. Tonight I tell him I want to make a movie of him, to show high school kids what really happens on drugs. I figure the diaper might get them. I ask him how could it be that some people want to live with every fiber of their spirit, and others seem to dare death to come get them. Brandon doesn’t argue or interrupt. He lies there in total silence. He doesn’t do it because he hears just any words, but because he hears a voice speak his name. His name is his talisman, his clue, his Geiger counter, his compass, his home base, his organizer, his horizon, his divining rod.

“Brandon, I have to go.” He stares at my lips as if he hears something remotely familiar and unnerving, like the pulsing of a troubled mother’s heart.

Heading toward Teea’s room, I see her husband Robbie leaning against the wall outside her door. His eyes greet me with a grief as dense as the door itself, and a question that has no answer. Still, his grief is soft somehow, a metal tempered with gratitude. Grief tempered by guilt is barbed wire.

I lean up against the wall next to him. He tells me that the hardest thing about Teea’s diagnosis is the helplessness. A high school biology teacher, he likes tangibles. He tells me the ground beneath his feet moves like sand, he cannot find purchase.

Nooooooooooooo, shouts Brandon from 653.

I follow Robbie into Teea’s room.

Honey, says Teea, seeing her husband’s helplessness. Go sit with that young man next door, and Robbie leaves willingly, taking his question with him.

Hob Osterlund (hob@hawaii.rr.com) is a writer, nurse, and scholar of humor as nursing tool at Queen’s Medical Center in Hawaii; for the last eleven years she has traveled widely performing skits starring the legendary fictive nurse Ivy Push, RN.