Nursing in the Cave (no pictures)

A 12-hour hospital shift can be an infinitely fertile experience for a student of humanity.

Take the alcoholic patient who ends up in the hospital after 2 hours in rehab because her liver is failing. Her shame and fear fill the room like a cold wind, her jaundiced eyes plead for understanding as her shrunken arms and swollen belly announce the years of self-destruction that she has yet fully to acknowledge. Alone with her nurse, she swings between heartbreaking bravado and unnerving stillness. When family members come to visit she lapses into tears, or shouting, or melodramatic embraces. This is a soul in chaos, body and mind at war, paralyzed between exhausted denial and intolerable hope. No one can fix this; it’s an existential struggle in which the outcome depends not on strength or intelligence but on whether the suffering creature in the trap will find the door in time, providing that it ever becomes clear where creature ends and trap begins

Medically the patient is stable; she’ll go back to rehab today. The nurse is only waiting for confirmation that her bed is still available. The phone rings, and the plan changes; the rehab facility can’t accept the patient back into their program until she is re-assessed by their nurse as a viable candidate, and their nurse won’t be available until tomorrow to perform the assessment. The doctor postpones the discharge, and the patient is informed that she’ll have to spend another night in the hospital before beginning her program.

This change of plan is too much for her. She’s already dressed, has called her family to pick her up, can’t bear the thought of another minute where she is. She springs to her feet, weeps, curses the hospital, the rehab staff and the moment of weakness in which she reached out for help. She threatens to leave and go to a bar. Her diatribe ricochets from how the rehab facility has betrayed her to how the hospital is trying to dissuade her from recovery. Her emotional pain is so real and so immediate that her body responds as if it were physical: grimacing, rocking back and forth, punching at the air.

This is where it really helps if the nurse has read Plato and can conjure up the mental picture of men cowering from shadows on the wall of a cave. Or the Bible, where Jesus himself believed that his own Father, the Almighty, had forsaken him. Or Shakespeare, where Lear is driven mad by his own despair and self-loathing. Because this patient, on this day, in this hour, is all of these, the paradigm of a person trapped by who she is, a tragic hero.

It is to that tragic hero that the nurse reaches out her hands. It is to the infinite sorrow that accompanies our capacity for joy, the darkness which swallows some of us up despite every advantage, every natural gift, every opportunity for happiness. And when the nurse reaches out in that spirit, when she is present to and humbled and awed by the magnitude of what stands before her, the patient reaches back and the connection is made.

Then the emotional spiral decelerates and the way to peace re-opens. The nurse can hold a hand, offer a tissue, speak the words of courage and empowerment that we are trained to speak. It doesn’t always work. There are abysses of misery that are too deep for any mind to encompass. But it worked today.

2 thoughts on “Nursing in the Cave (no pictures)”

  1. I’m in tears. Truth is, if not for the grace of God, the patient might have been you or me. I am so happy that the nurse was present for that patient today, just when she needed someone with the proper humility and wisdom.


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