The American Gazette

Commonsense political and social commentary from "Flyover Country"

Location: Rural Michigan, United States

Sunday, October 10, 2004

My Friend Claude

I need to take a bit of a time out this morning and tell you about my friend Claude. Claude didn't start out as my friend, he was simply a patient.

10 months ago I got a call from a local agency wondering if I would be interested in providing wound care to a home care patient. One of the nurses who worked with the patient was married to someone I worked with. At the time I was working strictly as a wound care nurse. The patient had developed some nasty wounds and the gal I worked with suggested to the agency that I was the right person to handle the situation. I went in and spoke at length with the agency director, gave them my references etc... and the next day the clinical director took me out to the home. She was a little concerned because the patient she said could be a bit grumpy and was very picky about his nurses.

I went into his home, took off my shoes and introduced myself and what I was there for. I called him Mr.---- and answered his questions with yes sir and no sir. He started to laugh and told me that Mr.---- was his father's name, not his and that I didn't need to call him sir. I explained that I always called my patients by their last name unless they gave me permisson to do otherwise and calling people sir or ma'am was the way I was brought up but if he was ok with me calling him Claude I would be happy to do so. He said we might as well get familiar since I was going to be looking at his butt.

Without giving too much detail, Claude had been in an auto accident 8 years prior, he was paralyzed from the waist down and had only gross motor movement in his upper extremities. He was trached but able to be off the vent during the day, with the vent on at night while he slept. That way he could talk by having a talking cap on his trach. He ate, though poorly. He didn't like to turn to his left because his left shoulder would hurt from the injury he had received to it from the accident. His poor nutrition coupled with no wanting to turn had led to a couple nasty bed sores.

In the beginning I went out only a couple times a week. My job was to measure the wounds, assess what they were doing and to recommend treatment to the physician and then to reassess if treatment was working appropriately. The first little while we were not getting anywhere with the wounds, so I began to go out every day in an effort to be more aggresive with them. As I became a more familiar face at his home I got to know his wife very well, his children and his grandchildren.

I always liked Claude and in time he got to like me. We joked and we laughed. He loved to tell a dirty joke and it delighted him that I didn't get flustered or act like a prude. He wanted to know all about my life and my family, asking to see pictures of my children. He wanted to know what my husband did for a living, you name it he asked it. Once when I was running late to the time I was to be there and had my youngest in the Jeep with me I called ahead to his home and asked if it was ok if I just kept my son with me instead of taking him home so I could be there on time. I told his wife that my son would sit in the Jeep and wait for me. She said that would be no problem. After I got there and went into the home Claudes wife went out to my Jeep, had Ryan get out of the Jeep and come up on the porch with her grandchildren for some lemonade and to play with the dogs. Ryan asked to go with me to Claude's frequently after that but feeling it was not professional I discouraged it. I told Claude that Ryan had really enjoyed being out there and wanted to come again, his response was "by all means!" I did bring Ryan a couple times after that and he would stay outside and play with the dogs while I did the dressing change. Claude enjoyed watching Ryan play.

On Mother's day I went to his home in the late afternoon. I usually went a little earlier but since it was Mother's day and they were having a big dinner with all the kids out there I had waited so I didn't interfere with family time. After dinner at my own house I had worked most of the day in my flower beds. When I got to Claudes the first thing I noticed was that he was working too hard to breathe. His color was bad and he was not very alert. I immediately called an ambulance and the physician. At that time he was on the vent but still not venilating well. The physician, an old time doc, got there before the ambulance did. Understand we live in a rural area and where Claude lived was no different. He lived between two small towns out in the country, one town has an all volunteer fire/rescue squad and the other had paid ambulance attendents, but only two ambulances. It took some 30 minutes to get an ambulance to the house.

By the time the ambulance got there I was bagging Claude as the ventilator was not oxygenating him enough. The ambulance attendent asked me to ride with them so someone could continue to bag leaving another person with free hands in case it was necessary. So I went to the hospital in the ambulance. Claude was scared, but I assured him all would be well. In the ambulance I joked with him, talked to him about anything and everything I could think of. That admission he was in the hospital for 4 weeks.

He was insistant about coming home so he was reluctantly released from the hospital, despite the lung doc not feeling he was ready. He came home late in the evening and had his wife call me and ask that I not come right out that night, but to wait until the morning, he was tired. So I did. The following day we had no electicity, there had been a terrific storm in the night and electicity was out all over several counties. With no electicity we had no water, so I couldn't wash my hair. I put a fair amount of stuff in my hair to style it and so it looked really bad. My solution was to put a dew rag on. I use these when I garden and had several. On my way to the house I called the shift nurse to let him know I was on my way, I got a paniced nurse on the other end. Claudes oxygen sats had dropped into the 40's, the ambulance had been called but hadn't gotten there. I began racing to Claudes home, doing literally 90 on the back country roads, paved or I wouldn't have been able to do that. I was screaming at the other nurse bag him, bag him! I got to the home just as the ambulance did. I used to be an ICU nurse and that training simply takes over in an emergency, I was giving orders to this person and that person while doing an assessment of Claude who was starting to come around as his oxygen level was coming up. The ambulance people were looking at me like I was from outer space when it occured to me that they did not know who I was and here I was dressed in a pair of jeans, a tank top and a damn dew rag on my head. I then explained who I was, and in the midst of all this Claude winked at me. At that point I knew he was going to be ok.

He ended up in the hospital for 6 weeks that time. Going to the facility I used to work at when I first started working with him. It is a long term acute care facility or to make that understandable, it does what hospitals used to do before patients got kicked out of the hospital 2 days after being admitted. He was sent there to wean back off the vent. After 6 weeks he had not weaned but he was insistant he was going home. He may not have been able to talk but he could use an alaphabet board and he made it clear he was going home. Through the two admissions he had gotten a colostomy because of a bowel obstruction, and it would also help allow the wounds on his backside to heal without worrying about stool getting into them, and he also got a G-tube to feed him through since he had not weaned off the vent and could not eat.

The day he came home and I went to see him he looked awful. He had lost at least 30 lbs. His color was poor and he just seemed exhausted. The treatments to his wounds needed to be done twice a day so I would be seeing him every day twice a day. I was glad because I wanted to be out there more frequently as I felt strongly that for him to succeed at home he would need a great deal. The first couple weeks home were hard, he could not tolerate being off the vent at all and not being able to talk frustrated him. As time went on though we were able to deal with everything thanks to outstanding nurses who were in the home, a wife who was willing to do everything in her power to make life good for him and a patient who had a strong will. The first question that first day that Claude asked me using his alphabet board was "how is Ryan?" I chatted to him about Ryan, about my oldest who had come back home from Texas and how he was doing, and about my daughter and the newest boyfriend. Over the next couple months even though we had to communicate through the board we had wonderful conversations and he still told jokes.

3 weeks ago we started weaning Claude off the vent at home. He wanted that so very badly. It is unusual to do this at home but he was unwilling to go back to the hospital and after much consultation between the physician, the nurses, the agency and the family we decided to go for it. I had started not only doing wound care out there I was now working the 11-7 shift on Sat. and Sun out there. I had done it to cover someone's vacation first but Claude liked me out there for a shift so much that I kept doing it and gave up my overtime at the hospital. The first day of weaning went great, he was off the vent for two hours the first day and maintained his O2 without any problems. It was absolutely delightful to hear his voice again after so many months. The first thing he said was a joke. "Why do women like animals so much? Because they like a mink in the closet, a tiger in bed, a jag in the driveway and an ass to pay for it all!"

Each day he was off the vent more and his O2 sat never dropped below 97%. He was jubilent, us nurses were jubilent and his wife and family were jubilent. We had passed a major milestone. On Sept. 29 a couple days before my birthday, I got there and Claude told me he had something for me. Told me to go look in the box by the wall. I gingerly opened the box, since he was such a jokster I had no idea what might be in it. Inside was a beautiful little calico kitten. One of their cats had had kittens. It was just old enough to be weaned. He then said "Happy Birthday!" Of course I couldn't say no so I took the little thing home with me. A couple days later on my birthday I went out to the house after our school's homecoming football game. I had my oldest son with me as we came straight from the game to his house. I left Ray out in the Jeep but Claude asked for him to come in, he wanted to meet him. This child who he had heard all about, his college time, his girlfriend, his time in Texas. So I got Ray and he went in and Claude and he talked for a bit. Then Claude's wife and Ray went into the kitchen where Linda got him a cup of coffee while I did the dressing change. Claude told me what a great kid he was and that he could tell he was a bright boy. Ray and I took another kitten that night, the last one. Claude knew that Ray had one of his kittens die of distemper two months before and I had told Claude that the last kitten left looked like the one that Ray had lost. Ray picked up that little kitten and got teary eyed and said he couldn't have it in his apartment, so I said I would take it to my house and Ray could visit it at home. Ray thanked Claude profusely, and Claude just winked at him.

On Tuesday last week I finally got some specialized equipment I needed to accelerate the wound healing. The wound vac. It is a wonderful wound healing instrument. It works just like a vaccum and brings blood and nutriuents into the wound to build tissue quickly. It uses a specialized sponge and an occulsive dressing over it, when the vac is turned on the sponge pulls down so it looks like a raisin. That is one of the ways you know it is sealed right. Earlier that day I had gone to the hot tub with my hubby, we took some time with no kids and just enjoyed ourselves. I told Claude how nice that had been. Once I got the wound vac on and going and he was turned to his back I ran my hand under his bottom to make sure the seal had remained and he asked me what I was doing. I told him I was feeling his butt what did he think I was doing? We laughed and he told me turn about was fair play, and we laughed some more. That night when I went out for my second visit he told me he had something for me. Told me to look on the table and what do I find? Flavored condoms! It was the first time he actually made my face turn red, not only my face but from my chest up. I blushed so hard that it brought tears to my eyes. He told me he thought that would liven up the next hot tub adventure. And he laughed and laughed some more.

Yesterday I did not work out at Claudes for the 11-7 shift like I would have normally. Originally I had taken the night off because the agency had a trip to Chicago. They had a bus trip where we were have an educational session for CEU's (continuing education credit's) and then once in Chicago a shopping trip. I had intended on going but my daughter was going to her boyfriends homecoming dance and she really wanted me to stay home and do her hair and such, so I opted to do that. I did my twice daily dressing changes though. I was at Claudes at 9p last night, we talked about Kristen and her boyfriend and that I really liked this boy. Claude said she was the only one of my kids he hadn't meant yet and he wanted to know when I was going to bring her in so he could say hello. He had seen her picture and had commented she was very pretty, and he told me he wanted to see her in person so he could tell her so. I told him I would bring her either Sunday morning or Monday evening. He said that would be great. He also told me that he wanted to eat, and asked that I get in touch with the lung doc and talk to him about it. I used to work closely with this doc and Claude believed that I would be able to convince him to allow us to start to try it since the weaning had gone so well. I promised him I would get with the physician on Monday. When I left I waved at him from the door and told him I would see him in the morning. "See ya Bud, I'll be here about 11."

At 9:50 this morning just before I would be heading out for his house, the day shift nurse called me to tell me that Claude had passed away. At first I was just stunned, I asked what happened, he was doing so well! The day nurse told me the doc said his heart had given out. I hung up and cried. A little while later when I had better control of myself I called back to talk to Linda his wife. She told me that at 4a he had woke up and asked the nurse who had filled in for me to let the dogs out and to wait by the door because they would be right back, the nurse is new to the case and this was his first night, he wouldn't have known the routine. Claude was on the vent so they communicated with the alaphabet board. The nurse let the dogs out and then let them back in, turned Claude and got him resettled and Claude went back to sleep. About 6 the nurse noticed that Claude's color didn't look good so he started an assessment. Despite the vent still working and ventilating him he had passed away. Poor George, I can imagine how he felt. Linda was woke up, the doc called and so on. As I spoke to Linda she told me not to cry, that Claude looked more peaceful then he had in years, she told me she loved me and that she wanted me to know that Claude loved me dearly, which of course only made me cry harder, as I do now.

It's been years since I allowed myself to get close to a patient. After working with very sick people and tragic events in Neuro ICU and the long term acute care facility I used to work in I learned that in order to do my job effectively I had to learn to protect my emotions. So many of my patients over the years have died. In Neuro it was often young people who had been out doing stupid things that led to horrid tragic events. In the other facility it was mostly older people, but occasionally young people who had nasty diseases. Claude gave me a wonderful gift, the gift of remembering a patient is not just the sum of all that they need to have done, that taking care of patients is not just the technical aspects. This spilled over in my ability to laugh and joke with my patients in the hospital and remember to see them as people and not just what was wrong with them. I currently work in Cardiovascular Lab Recovery. In other words I take care of people before and after a cardiac cath. Many of them are highly anxious not only about the procedure but what will be found. Many are there straight from the ER after suffering chest pain and some with a positive heart attack event. They need a nurse who can calm them and treat them as more than whatever issue brought them into the hospital. Claude helped me to remember that.

So Rest In Peace my dear friend Claude. You gave me more than I gave you.



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