That One Patient with a Bullet in His Lungs

You do not get to choose your patients, or how they treat you. Most of them are not in the hospital because they want to be, and pain and fear make people short-tempered and uncooperative. This is a story about one of those patients, and what listening did.

I was assigned to Mr. M., a 65-year-old man with liver cirrhosis. He was withdrawn, quick to shout at his caregivers, and as uncooperative as they come. He pulled out his nasogastric tube more times than he agreed to have it reinserted. He refused to have his vital signs taken and spent most of the day sleeping to avoid us. Giving him proper care was a struggle for me and for every colleague who took him.

I am the cheerful kind of nurse. When I go missing on break, my coworkers know to check my patients' rooms, where I am usually trading stories. That is how I build rapport with patients and their families. With Mr. M., none of it worked.

How do you give good care to someone who is hard on you and on himself? How do you even start a conversation? I decided to keep my cool and try a different approach. There were times I just waited for him to offer his arm for a blood pressure reading. He kept it pressed to his chest.

One day he needed to empty his bowel, and since he could not tolerate standing or walking to the toilet, I had to help him. He found it bothersome and shouted at me. I apologized for "troubling" him and went on with my work. Every time I entered his room I asked how he was and encouraged him to help his own recovery. Usually I got a blank face and no reply. My colleagues were ready to give up on him. Even if Mr. M. had given up on himself, I would not give up on him.

When the doctors ordered a clear liquid diet to prepare him for NGT removal, I spent a full hour feeding him. That hour finally cracked something open. I started asking about his life and his work when he was young. He raised an eyebrow and gave me an unkind look, and I knew I had pushed past a boundary. Then he took a deep breath, looked at me again, and his face softened.

"You're annoyingly persistent, aren't you?" he said.

I was getting ready to apologize when he added, "This is my second life, you know?"

I could not think of a better reply than, "Please, eat your sou, I mean, why?" He smirked and nudged his tube.

"This has been my second life. I was shot in the chest during the war," he said after a spoonful of soup.

"You were a soldier?"

"During the Second World War. Against the Japanese."

"A piece of the bullet is stuck in my left lung. The doctors chose not to remove it. They said it was safer to leave it than risk a massive bleed. It has been in me ever since."

I sat and listened. He told me how he had persuaded his wife to marry him, and day after day, telling his stories made him smile. So during my shifts I made time for his rants about the government, his pride in his grandchildren, his daily joys and aches. His health improved, and so did his cooperation. The listening worked. Watching a patient recover is like winning the lottery. You cannot explain the happiness it brings.

The day before discharge, he asked me to wheel him around the floor. My colleagues waved and were glad to see him smile. When I brought him back to his room, he held my hand, teary-eyed, and said, "Thank you. Thank you for taking care of me even though I was pigheaded. Thank you for listening to all my stories, even the rants." Then: "Of all the nurses who handled me, you are my favorite. You were always there even when I told you to go away."

After he left, I was organizing his chart and saw his chest X-ray. I smiled, because there it was, the bullet, exactly as he had said. That story opened up everything else.

We carry out orders, take vital signs, and give medications, but we are also a patient's support system during one of the hardest stretches of their life. A professor once told me to treat patients as if they were my own relatives, because that is how you give the best care. You cannot give up and hand mediocre care to a patient who is difficult. Take it as a challenge. Those are the moments they need you most. Even on a packed shift, sometimes you have to slow down, sit with them, and say, "I am here, and I will help you get well."

As a nurse, we have the opportunity to heal the heart, soul, and body of our patients, their families, and ourselves. They may forget your name, but they will never forget how you made them feel. -Maya Angelou