Got So Much But Nothing to Give...

I've got a story to tell....

First, allow me re-introduce myself. My name is Towanna Enoch. I am a MUSC/Duke educated nurse practitioner. I have been a nurse for 8 years. A nurse practitioner for 9 months of those 8 years. I never quite had a chance to get my feet wet after graduation last Spring. I showed up at work on a Wednesday. 3 days of orientation and computer training. 2 weeks shadowing another nurse practitioner. Less than a month in, I was seeing a full schedule of patients and I was completely in love. Still am. Always will be.

Now, if you've been paying attention (and even if you won't admit it, I know you have) you know that I was tasked with/volunteered to be part of the start-up of a handful of homeless clinic sites in Columbia --- from the ground up. Now in a perfect world things would be, well,  perfect, and I would have endless resources in order to accomplish what I have been tasked to do.

Unfortunately, that is not the case.

I'd be lying if I told you it was easy. Most days, our small staff and I find ourselves playing doctors, nurses, pharmacists, social workers, secretaries, accountants, and telephone operators. All at the same damn time. But even on our worst days, I still think my job is the best in the world. And I think I'm the best one for my job.

But this blog is not about me. This blog is about my patients. This blog is about what I have seen. What I see. And what I hope to see. I don't know that my perspective will do their struggle justice. I don't even know that what I am doing here is appropriate. All that aside, I feel that what will be shared here is necessary. Important. Maybe even a matter of life and death.

 I should correct my previous statement. I don't have a story to tell. I have a million stories to tell, but I'd like to start with just one that I hope will convey the spirit of what I'd like to accomplish here.

And so it goes....

Wednesday, August 1, 2012

We were sitting at our makeshift nurse's station going over the days tasks. All of a sudden we hear a funny sound ---- like someone dragging a metal chair across the floor. But the sound wasn't steady. It was staggered. I looked at one of my nurse's and said, "It sounds like someone is scratching up our dang floor." I leaned forward in my chair to peep around the large partition that separated where we sat from the open door way leading to the exit. At first glance, my eyes fell on what I thought was the cutest little old man. holding on to a four-legged walker. The first thing that crossed my mind was that he was belonged to one of the respite beds at the shelter. But as I let my eyes linger on him, I realized that something wasn't right. He was holding tight to the walker with his right hand trying to move forward, but his left arm and leg just did not seem to want to cooperate. He opened his mouth to speak and I realized that the left side of his mouth also seemed to be stubbornly refusing to move in sync with the right side. My nurse and I assisted him to one of the recliners in the room and I asked him if we could help him. What he said was barely intelligible, but we were able to make out that he'd had a stroke 3 weeks ago. He was homeless and someone had found him in the street and had the ambulance transport him to a downtown hospital. He could not remember how long he'd been in the hospital, but he did know that he was discharged with only 2 days worth of medicine and no place to go. He had managed to get a bed a the local mission for a night or 2 here and there, but had been sleeping on the street for the past few days. He explained to me that he did feel well and just needed some medical attention.

I listened to his heart. Regular, rate & rhythm. No rubs, clicks or murmurs. His lungs. Clear to auscultation. Pulses were normal. No jugular distention. No bruits. No headache. No jaw or arm pain. No SOB. No nausea. No acute mental status change. But his blood pressure was 240/110. His pupils were dilated and only mildly reactive to the light that I shined into them. He explained that he was also almost totally blind and it seemed to him that his vision had worsened after the stroke.

His blood pressure needed to be brought under control to avoid another stroke. And it needed to be done in a hurry. I asked my nurse to call 911. I crushed an aspirin for him to take and watched the water I gave him to wash it down trickle out of the left corner of his mouth and down his chin. My heart nearly broke in two as I watched my medical assistant dab at his mouth with a tissue.

In the few minutes that we waited on the ambulance, among other things, I learned that his name is James. He is not a resident at the shelter where our clinic is housed. He said that he was standing outside the gates that morning, not knowing how he would make it through the day, when another resident of the shelter, who was also our patient, assisted him onto the grounds, fed him, shaved him, bathed him, gave him a change of clothes and fixed up the old walker enough that he could use it to get around a little.

Pause.

What I can promise you is that while James stood outside those gates that morning, at least 5 shelter employees walked or drove past him on their way into the building. My money would be on the fact that none gave a backwards glance.

Most of the people that live at this shelter have nothing in the vein of material possessions. What little they do have, they must ration in order to sustain even a meager existence. Many rely on outside donations of even simple things such as soap and toothpaste. Decent clothes, shoes and socks sometimes come at a premium. That one of the residents thought to give all he did when he really has nothing to give makes a sound so loud that we should all be deafened by the blast.

The funny thing is that some of us accumulate so much material foolishness trying to keep up with one another, we can't even wrap our brain around "giving" anything up for the greater good. Got so much, you got nothing to give. The irony is astounding.

And yes. I am talking about you. And her. And him. And my selfish ass, too.

Ok. Now where was I?

So the EMT guys show up. Looking annoyed of course. I give them a quick report, they strap James in and he's off to the hospital.

I wish I could tell you that this story has a happy ending. That he went back to the hospital, was nursed back to health, found a place to stay and lived happily ever after.

But I can't.

I went to the shelter on Thursday morning for a meeting and there was James. Sitting at a table in the day room with one of the residents, Martha, helping him to feed himself breakfast. Martha explained that she was there when he was brought in and cleaned up the day before. She saw him on her way in this morning and brought him in for breakfast. James had not been kept even overnight at the hospital. Blind. Nearly crippled. Not even overnight.

I didn't ask any questions. Because I didn't want to know anymore.

Besides, he wasn't really my patient. He was nobody's patient. Right? RIGHT??!!!!

I went to my meeting.

And when I was done, I got into my fancy BMW and I went and bought a fancy bag for one of my fancy friend's birthday.

Business as usual. I'm just like the rest of them.

Except.

I'm different.

I have serious work to do.

I might be in for the fight of my life.

Naw. There I go being selfish again..

I might be in for the fight for their lives.

The revolution many not be televised.

But I am going to do my best to blog the hell out of it.....

Towanna