Nursing is both Roses and Thorns

Pam and I sat in the nursing unit's drab brown kitchen across from the station. I drank strong coffee and made herbal tea for her. It had been a quiet night and Pam couldn't sleep. She had crept painfully down the hall, refusing a wheelchair, not ever wanting to give in. We had become close. Perhaps in another universe, we'd have lunch before circling our quaint town square to poke through antique stores.

Pam, always polite, asked about my two children. Being a teacher, she was genuinely interested but tonight the question felt like good manners.

I gave her a brief update. "Fine, depends on the moment. Chris has trouble with desk disorganization and Paul for talking back, same lovable kids."

"I'm sorry. What did you say?"

"It wasn't important. What is going on, hon? Can't fool a veteran."

Then she confided her IV medication site was painful. We both knew this was serious. Her immune system had been depleted by chemotherapy and infections could go straight to the heart. I gloved up and gently pulled the bandage back to look.

"I'll page Tommy". Our IV team was great and could often prevent another painful procedure.

I watched a tired tear travel over her cheek, land on her lips and she ran her tongue over it. A new IV port was a crummy stumbling block. She was holding her tea and her hands began to shake. I put my hands around hers and guided the cup to the table.

She sighed and looked deep into my eyes. She had to decide what was important to say these days. Talking came with a cost of pain and breathing difficulty.
"It never stops, ya know. The punches keep coming. I'm so tired."

I had to strain to hear what she was saying. "Gwen, Teddy Jr. wants to know if the cancer will kill me."
A kindergarten teacher, Pam was only thirty-six, with two children. Teddy was seven and Amelia, five.
Her husband, Ted, seemed supportive.

"What do you tell him?"

"We don't know."

"What do you think?"

"I am going to die."
Then in an angry tone, "But Ted won't tolerate depressing talk. Keep smiling!"

I tried to reassure her.
"That is his problem, not yours. Kids seem to sense when things aren't getting better. You need to tell them. One on one, don't you think? They will be sad and probably angry. Love and honesty are always best."

She nodded her head. I put my hand over hers. She closed her eyes, dark circles against pale skin. Her head was framed by tufts of blonde hair. Like a newborn, her hair was soft and you could see thin skin covering her scalp's tiny blue veins. Her last course of chemotherapy had been the worst.

I paged Tommy and walked Pam back to her room. She settled under the quilt made for her by cancer survivors from all over our Atlanta area. It was beautiful, each square true to its owner, covering her with their love and warm wishes.
I went into the conference room. I put my head on the table. Pam was my age and I had no idea how I would handle what she was going through. I admired her and realized how close I had become to her. Our unit didn't usually get patients that came back.

It was a year ago when I first met her. They were flying home to Chicago from Disney World when Pam suffered a severe headache, followed by vomiting, while changing planes. They rushed to the closest ER. Pam's parents lived here in Atlanta and came to get the children.

She said when the pain first came, it was like a stabbing knife. She seldom complained. Since she had trouble sleeping, she would walk in the halls. If it was quiet, one of us would ask her if she would like to sit in the nursing station. We laughed while comparing the fun and fumbles of child-rearing. She could forget her situation for awhile, I would like to believe.

Pam had such a sweet smile, large inquisitive eyes, dimples and a heart shaped face. She reminded me of Bob Dylan's song lyric, "she breaks just like a little girl".

She just didn't understand saying, "I have always been healthy; no surgeries, two easy deliveries."

Then along came the Kudzu Monster, Pam's name for her cancer. The Oncology radiologist thought it had started about two years ago. It had sneaked around, invading and eating good stuff, taking prisoners. No one knew until the headaches. By then it was in the bones, liver, and brain.

Our floor is a Women's Unit. Pam would ask for us whenever she had to be admitted. I knew her Oncologists wanted her on their unit but she had gotten close to us. It was easier for her to stay in Atlanta since her Mom could help with the kids.

So, for a year she was in and out of the hospital. First surgery, then CAT scans with radiation, the internal radiation beads, and chemotherapy in several types and doses with nasty side effects.

We watched her slipping away. The staff and physicians loved the whole family. Sometimes, her husband stayed with the kids. If she was really sick, we would bring their two munchkins in pajamas to the nursing station.
Then Pam had private time with her sweetheart.

He would crawl into bed with her and I knew the pressure had to hurt but she would smile and kiss him. It was the same with the kids. They would climb up with her and she created her own stories as she pushed the button on her Morphine pump.

We helped her make memory books for the children. Ted brought pictures and she wrote poems and memories.

Pam got to go home for three weeks and Hospice took care of everything. The reason she came back to us was putting in another central IV line into the heart. Between antibiotics, narcotics plus the cancer attacking her poor body, she needed round the clock care.

Christmas time came around. Pam's room was decorated by her children and her Mom. It was beautiful with artificial snow on the windows, a tree their grandparents had helped with. It had popcorn and cranberry strings, all homemade ornaments with lots of glitter and special touches for Mom. The carolers had come through and family had joined in.

Dr. Watson thought Pam had a couple of weeks at the most. Now she required continuous Morphine for pain.

The kids went to their Grandparents so Santa could come. Ted stayed on the cot that was next to Pam's bed. Ted asked that they be left alone. He said he would call us.

We only had five patients.

Suddenly, I saw a glow from under Pam's door. I quietly opened it and the room was flooded with light. The pain pump was silent. Ted lovingly held her hand.

Pam looked ethereal, peaceful, pure and innocent.

Outside, Atlanta sparkled with a rare snowfall.
Lace snowflakes collected on the window pane. The wind was gently blowing, promising a stinging cold on my cheeks when I left for home.

I felt and listened for a heartbeat which wasn't there but Pam's hand was still warm. It wouldn't be for long. How fast death claims it's own.

Our Pam was one of a kind, a perfect chantilly snowflake.



By Kathie Stehr
Edited in 2018



This was in the 1980's before Hospice covered all nursing services to keep terminal patients comfortable. Most of our Oncologists wrote a DNR (Do not resuitate) so the code team wasn't called. We would just notify one of the ER physicians to pronounce a death.