There is a certain freeway which I have traveled often. One of the signs I always pass strikes me deep in my heart. It reads, “HOPE - 1 mile”. I know in reality it is only a sign for a very small out-of-the-way town called Hope. However, I can never pass this sign without thinking of it in a much broader sense. It makes me think about how often hope may seem to be missing in our lives and how hard it may be to keep hope from slipping away, sometimes appearing and disappearing, swirling around us and lingering. At times, it may even seem as if it is gone forever.
How difficult it may be to keep hope in our hearts and minds when difficult times and events are thrust upon us by our life on this earth.
A person cannot go to the local market and buy a box of HOPE; cannot ask a doctor for a refillable prescription for HOPE and HOPE cannot be grown in a backyard garden. Hope is something which needs to be found within the self. Look around the world and it may be seen that a person can find seeds of hope but may find it a struggle to let them grow.
Should we tell our children, grandchildren, friends, neighbors, and co-workers there is no HOPE? Not at all, because the future depends on it. HOPE. Only a sign along the road? Never! Hope is lost and gained in life. What follows are three true patient stories about different kinds of hope.
Sometimes when people would ask me as a nurse why my favorite place to work in the hospital was the Intensive Care Unit (ICU), they may have already had a preconceived notion about my answer. Maybe they thought it was because I did not like people, since there were so many machines and drastically ill patients who could not always respond. Or they may have thought I loved the fast pace of all the daily emergencies and situations which required immediate reactions and treatment. To put everything straight, the real reason was because I felt the ICU was where nurse, patient and family came closer together than anywhere else in the hospital, even though the time may have been short. I have always felt the ICU gave nurses an experience which could not be replicated anywhere else and I will and always will tell them none of these reasons had anything to do with my love for working in the ICU. However, the patients had everything to do with it. I learned so much as an ICU Nurse, not only about disease and health, machines and technology, but more about the concept of hope and what it means to patients. The ICU was the place where hope rose and fell every day. I learned about hope through the eyes of those patients. What follows are three stories about hope and you may be surprised at what hope meant to each patient.
One of my patients in the ICU was a very elderly lady, whom I will call Marie. Marie had an extensive gallbladder operation with no complications, but the doctors wanted her to spend at least one night in the ICU. However, that night at midnight Marie told me she knew that she was going to pass away soon and asked if I would stand by her bed while she prayed.
Now I knew better than to say, “No, you are not going to pass away; you are doing fine.” (Although she really was doing fine.) I also knew there were times when a patient did pass away after previously expressing a feeling that they would soon. The only thing I could do, was exactly what Marie asked… stand at her bedside while she prayed. So I did and she prayed quietly and calmly but with great conviction and faith.
Two hours later Marie’s heart stopped. Our efforts to resuscitate her failed. It seemed there was no hope.
Frank was a city postal worker who came into the hospital clinic one morning only to have some tests done. An hour later, while he was waiting in the clinic waiting room he had a massive heart attack and ended up as a patient in the ICU, in a coma, on a heart monitor, with a tracheostomy and on a respirator. He was not at all responding.
For at least a month Frank lay there, day after day and week after week. His kidneys were failing so badly so he had to be placed on the artificial kidney machine at least twenty times. His heart stopped time and time again and we had to resuscitate him more than a dozen times. On his patient Kardex card, there was a list stating the number of times he had gone into cardiac arrest and all the dates he had to be placed on the artificial kidney. I still remember how that card looked. We nearly had run out of space.
Frank’s doctor was going on vacation and since it was the consensus that if Frank lived he would have absolutely no quality of life, his doctor advised us to not attempt to resuscitate him anymore. The doctor dutifully took Frank’s wife and family aside and explained all of this and they fully accepted it and agreed to not have him resuscitated. When his doctor left on vacation, he told us nurses he really did not expect Frank to still be there when he got back.
So each day we also waited and watched with Frank’s family…the family without hope while we continued to care for Frank’s near lifeless body. Each day we saw hope fade away and it felt obvious to everyone there was no hope.
David was a 22-year old young man from the northern part of the state. He had been living alone with his father in a north woods cabin and they were very poor. David had been born with deformed and twisted legs and had been in a wheelchair all his life. He had not gone to school and could not read. In fact, he seemed and acted quite dull. He barely talked and never smiled. It was quickly assumed he was most likely retarded. He had developed a huge infected bedsore on his sacrum from sitting most of the time in his wheelchair all those years. His bedsore would not heal and had actually now become cancerous and was so widespread and in such a difficult place for healing that it really wasn't possible to do much of anything about it. There seemed obvious to everyone there was no hope.
Now it is time to state that the title of this story is very false.
The rest of these patient’s stories will let you see that the true title should be: Hope Gained.
Marie did pass away. However, she passed away in the midst of hope and totally with hope connected to her strong faith. She knew she was going to pass away and accepted this and her prayer reflected this. For her, hope was constantly there in her heart. She still clung to faith, hope and love of God to the last hour and her last breath. What a lesson in faith she gave the rest of us! Marie always had hope. She knew what hope really was and she set an example for the rest of us.
When I returned to work after being off work for four days, Frank was still in the ICU. He lay motionless with no obvious response it seemed. Then one moment as I approached his bedside, I noticed something. His eyes were open and he was staring at the ceiling. As I spoke his name he turned his head towards me. I walked around the bed and his eyes followed me. I nearly lost my professional manner when I got so excited and yelled down the hall at my fellow nurses, "Frank is waking up!"
I sent for his family in the waiting room. As they entered the room and cautiously approached his side, they began to talk to him with tears in their eyes even though he could not respond back to them.
From that day on, Frank became more and more alert. Little by little each day he soon began to move his head, then his fingers, hands, arms, legs and toes. He eventually was taken off the respirator and began to try to talk. When the doctor returned from vacation, needless to say he was totally surprised, overwhelmed and had absolutely no explanation. Frank improved a little each day and later was transferred out of the ICU to another part of the hospital to fully recover. He eventually left the hospital and returned to work.
Later when he came back to visit us in the ICU he told us he did somewhat remember being there and it was a strange experience. He said the first thing he remembered seeing was the ceiling. (It was one of those acoustic ceilings with lots of holes in the tiles.) He stared at them a lot and wondered about them because he thought the holes were little bugs and he couldn't figure out why all those bugs never moved and kept in such straight lines all the time. For Frank, hope was indeed always present.
Young David was to have surgery and the doctors would have to perform an extreme type of surgical procedure which was called a "hemi-corporectomy".
When we nurses saw this on the surgery schedule we looked at each other questioningly. Was it really going to be what we thought it was? We knew Latin terminology. This meant cutting the body in half and that is exactly what they did. The doctors amputated both of his legs very high up and repaired what they could while reconstructing any organs which were necessary.
After surgery, he returned to the ICU and we cared for what was left of David's torso. He had no legs and his body was only from the waist up. Once again he rarely talked to us and never smiled and we really didn't expect him to. Who would smile after the surgical ordeal he had been through? We placed a trapeze over his bed, so he could begin to learn to use this to lift or turn himself. Surprisingly, he actually managed to learn this quite well and quickly. Quite remarkable for a person who had just lost half of his body and probably all of his self-esteem and was rumored to be retarded. Some weeks later he was transferred out of the ICU and to the rehab part of the hospital.
As nurses we still had questions; large looming questions. The doctors had saved what was the viable part of his physical body, but we questioned what kind of a life would he have to face? Was he going to have to return to his home and still live in a wheelchair the rest of his life? Was this quality of life? Would this surgery really improve his quality of life? Many of us asked these questions.
We made it a point to visit David in the rehab unit during his recuperation period. What we saw answered all of our questions. We saw David smile for the first time. He had become talkative to both staff and other patients. The hospital had brought in a tutor to teach David to read. David was not at all retarded and learned quickly. He just had not been exposed to education.
He also teased us and made us laugh. He could lift himself up with the use of the trapeze and hold himself up there, while the nurses changed his bed. He could swing himself into a wheelchair from his bed with not much help at all. Soon he had a motorized wheelchair and was chasing up and down the hall talking to everyone he saw, especially the younger patients there. David was an inspiration to everyone; staff, patients and families and everyone knew David. He had changed from a withdrawn dependent individual into a young, fairly independent person with a bright personality. The last thing we heard about David was he was living in a local nursing home and racing up and down those halls in his motorized wheelchair, talking to residents and chasing and teasing the staff.
David taught us a lot about hope, even in his silence as well as what hope can mean and how it can change people’s lives like his. For David, hope was the only thing left and he used it and welcomed it into his life without saying much at all.
After experiences like these and so many more in nursing, no one can ever tell me there is no hope. Hope is what is always there whether we easily recognize it or not. Hope is a necessity and it cannot and should not ever be taken away from anyone. It is a great gift and needs to be treasured and passed on to any and all who are in need of it. In our lives, is hope really ever lost, or is it just faded for a while and then gained once again? I learned the answer in my work in the ICU and from so many of my patients who were my teachers.