Visiting Nurse

When I lived in Massachusetts I was a visiting nurse. I essentially worked for a doctor group who referred their patients to my company when they (the patients)became homebound, or if they had a sudden crisis/setback, i.e. surgery, acute process like pneumonia. Over the years I saw a wide variety of situations. Wealthy, powerful people who lived on estates so big that I wasn't sure which mansion on the grounds was the actual "house", elder abuse and neglect in all socioeconomic brackets, a young doctor recovering from a car accident, a mayor, a mother of 8, Gloucester fishermen, people dying, people living. By in large, my case load was elderly folks who weren't able to make it out to the doctor, but could easily fall through the proverbial cracks and become very sick with little notice. In each admission I had to list at least three diagnoses that justified financial reimbursement from the insurance companies. The one illness that, were it a real diagnosis, would have been listed on 90% of my intake paperwork: loneliness.

Many of the men and women lacked significant interaction. Their children were long-distance, busy or uninvolved (some I could understand why). Most were widowed. Their friends were dead or sickly. They hadn't been to church or synagogue in years; they were too weak or fragile to venture out to the hair salon, the store, even the lobby of the highrise. They were alone. I was roughly the age of their grandchildren (early 20's). I would hear the phrase, "You remind me of my granddaughter", probably one out of three times. If there was a spouse present the patient would call for consensus, "Doesn't she? The way she smiles (laughs, talks), it looks just like Jill." This generally made for an endearing relationship. I could care for their bodies while I nourished their spirits with a little tender interaction. A visiting nurse is a special visitor, and it wouldn't be unusual to enter the home and find that the patient had somehow managed to put on a spot of tea and locate some stale cookies for our little visits. It was a time to connect.

One particular patient I went to see embodied the diagnosis of loneliness. She lived in a beautiful half-million dollar house in an outstanding Boston suburb. Walking up to the home one would expect the finest of visits. She didn't answer the door when I knocked. I regularly let myself in because they knew I was coming and had agreed to the visit. I cracked the door in order to be stunned by the overwhelming smell of cigarettes. "Hello?" In the distance I heard a TV, seemed far away. "Hello? Visiting nurse." "Up here," came the answer. I let myself in to see a fully furnished home literally yellowed by nicotine. The walls, the carpet, the wood, the windows. I went up the stairs to find a tiny little woman sitting in an upstairs kitchen watching noon soaps and drinking a Manhattan. She was testy and suspicious, all the while dragging on a cigarette. The reason doctor had sent me out was "weight loss." You ain't kidding. She was a walking skeleton. He hair was brittle from malnourishment, she admitted she was too weak to wash, you cannot imagine the shape her skin was in. Her eyes were dull, her spirit more so, all in a swirl of yellow smoke. When I managed to find a scale, she was barely strong enough to stand on it with my help... 83 pounds. I completed my assessment, she barely ate a thing, drank three Manhattans a day and smoke at least two packs of cigs in the 12 hours she was awake. What ever she could dump out of a can or take out a wrapper was her meal. She was too weak to stand and cook. Her family had helplessly watched her slip into this state, they had begged the doctor to send a nurse. She fought them at every turn. She wanted to be left alone, and this was her perogative. She may have been nasty, but she was still sane. Fortunately, she took a shine to me. At the end of my visits she would ask, "When will you come see me again?" Soon, I would assure her, very soon. After several weeks she allowed me to send in nurse's aides to help her with her hygiene, a physical therapist to evaluate her strength and equip her with a walker, an emergency responder to fit her with a fall button. But somewhere along the way we stumbled onto a nutrition drink that she agreed to try, I believe it was called Resource. I bargained with her to please try one, because we both knew she was dying from malnutrition. She agreed, and as she started to enjoy Resource I began to see her gain weight. Five pounds, six pounds, she was mildly stronger, more cheerful. Ten pounds, fifteen pounds, we beat the clot she developed in her leg without hospitalization. Twenty pounds, she had a glint in her eye, though her hair never really did recover, her skin was much softer. Upon my discharge she was drinking EIGHT cans of Resource a day and had gained 50 pounds. My bouncing baby girl, we would joke. The last visit she would barely look me in the eye. "You can't leave me," she cried. I cried too, but we knew we would see each other in the future if she ever took another turn downward. I praised her progress and her effort. "You know," she reflected, "I think I was depressed. Really, I think I was dying from being so lonely. Thank you for your visits."

The ability to listen and laugh, learn and share, touches a tiny spot in our hearts that, though cardiologists have never mapped it, drives the body and soul of a person to choose to live.