Power of Nurse Patient Storytelling: Mitch's Story

“Can you ask my wife if she’ll be my roommate if I’m positive?” Mr. Jones yelled to me through the door of room 32 on Ellison 12. It was the spring of 2020, during the first COVID 19 surge, and I had been redeployed from my usual job as an MGH PACU nurse to work on a COVID unit. So many questions were yelled to me during those three months, as I rotated throughout the hospital, going where I was needed. From behind the glass on White 3, Ellison 3 and Wang 3. “Can you get me more syringes, pain medication, the blood sugar machine? Can you call the Prone Team? Do you know how to speak Spanish?” Mr. Jones’ question was an easy yet hard one to answer.

I started nursing school in the fall of 1988 in the middle of the AIDS epidemic, during a time when everything was changing. I remember my nursing instructors reviewing a new policy of wearing gloves for patient care that involved contact with body fluids. By the time I graduated I recall my first months of practice being inundated with traffic signal colored universal precaution bags outside the patient’s rooms. Red for bio hazard linen, yellow for standard soiled linen, and whatever you were unsure of was to be placed in the green containers. I was often afraid that I would dispose of things incorrectly during those uncertain times.  How was I to remember all of this as a new nurse? How would I pass my boards? I felt overwhelmed. I am pretty sure the patients did, too. How could they not? 

At these times, I would remember my father’s words: “Talk to the patients, have them tell you their life stories. Don’t let the technical part of your profession make you lose sight of your vocation.” When I was 15, my father, a brilliant nuclear physicist, told me to become a nurse because, as he put it, I cared about who people are and what made them special. “You ask people questions and you listen,” he said. 

So, I followed his advice and did what I was good at, asking and listening to stories from people in times of need. “What’s your favorite vacation spot?” I would ask. “What’s the most entertaining concert you have been to? What’s your favorite food (outside of the hospital, of course)?” 

In 1995, after meeting my husband on a beach while watching a sunset, I moved to Boston to be near him and started working at MGH, where I spent 15 years caring for cardiac patients. Cardiac medical situations can be extremely stressful. I tailored my questions. “Who makes your heart feel good and how did you meet them?” I would listen to the answers -- “my mom”, “my grandson” and sometimes even “my dog,” followed by the story of why and how they met. These moments of listening to someone share with me a moment of their life that was not filled with fear, pain and anxiety was a connection. A connection that I was honored to be a part of.

For the last 10 years I have worked in the post anesthesia recovery unit—the PACU--for patients going home the same day after elective surgery. For me, this nursing environment has been less stressful than I experienced as a cardiac care nurse, yet for my patients it is still quite stressful. I ask the same question just worded differently. “Who is bringing you home and how did you meet them?“ These stories bring smiles, to me and to the patients who are sharing, and these smiles seem to lessen the post-surgical pain.

Now 30 plus years into my nursing career I have come full circle. There is a pandemic. Everything is changing. There are new policies and procedures seemingly changing every day. I am overwhelmed. Patients are alone and fearful, but they have stories and I am good at asking and listening.

The day I met Mr. and Mrs. Jones I was the float/helper nurse on a step-down 36 bed Covid unit. I had not provided patient care as a clinical bedside nurse in eleven years. As I walked onto the unit that overwhelming feeling of disorientation I had 30 years ago returned. So many new protocols to remember. Donning and doffing my PPE. Would I remember the proper sequence to keep myself and others safe from this virus? I actually had written a cheat sheet of the step-by-step order on a 2x2 pink post-it note and taped it to the back of my name badge. My MGH ID in a clear plastic sandwich bag I had brought from home. The plastic making it easier to clean at the end of my shift.  

During my 12-hour shift I was informed at morning huddle that the unit census was full, with one patient—Mr. Jones --alone in semi-private room because his Covid test results were still pending. His wife, who was known COVID positive, was in room 16, bed A, with a COVID positive roommate in bed B. Mr. Jones was in room 32, bed A. Bed 32B was empty. The charge nurse of the day continued on with the rest of the unit updates but I remained focused on her description of “the non Covid/pending covid“ patient in bed 32A. How isolating that sounded. I had been self-isolating from my family during my deployment. I had already been tested for covid the first two weeks of the surge because I had rash and a sore throat. I knew that lonely, impending doom feeling of waiting for results.  I worried about Mr. Jones, a person, not just a case in bed 32A. 

I met Mrs. Jones in the morning as I administered her medications. She exhibited many of the classic Covid virus symptoms – including body aches and loss of her sense of taste and smell. She also had a noticeable cough and an oxygen saturation of only 90 percent. She required supplemental oxygen and was receiving multiple medications and breathing treatments. As I administered her medication, she mentioned that she was waiting to hear how her husband was feeling. “I really hope he has a better view than I do,” she said, as she sat upright in bed. She was slight in size and her enormous black purse, next to her on the mattress, seemed to fill all the space.  She kept on taking articles out of her purse and laying them on the bed next to her. She took out her cell phone, looked at it, turned it in her hands. She rummaged and dug deep, pulled out a lip stick, crackers, keys, a small package of tissues. She then systematically put them back into the bag in the same order she had removed them. Watching her fidget, I thought to myself that she must be worried about her husband. 

The room 16A in the Ellison tower is the room near the stairwell, with no view. If you stand at the foot of the bed and look out the window, all you see is the corner wall of the Lunder building – solid and gray. I encouraged Mrs. Jones to sit in the chair and have her breakfast. With much hesitation and cajolement, she was sitting in the recliner chair within the hour. As I was leaving her room, I asked Mrs. Jones if she would like me to check on her husband for her and if it was OK if I gave him an update on her condition. She replied that she was so exhausted and worried that she would appreciate it if I did.

I stepped into the hallway to doff my PPE – removing the disposable gown, the hair bonnet and gloves, everything but my N95 mask which would remain on until my short lunch break, for seven hours straight. The indentations and sore on my nose would last for many days. 

As I donned a new set of PPE outside the door of Mr. Jones’ room 32, I could see blue sky and the Charles River. The beautiful view made me breathe easier. I spent the next two hours administering care to Mr. Jones, just the two of us in his room. Me with gown, gloves, face shield and an N95 mask. Him with just a hospital gown and slippers. I asked my questions. “Tell me Mr. Jones, how did you meet your wife” I have no idea how much time passed in that room. Mr. Jones told me how he met his wife at a Red Cross dance. He recalled she was there with her sister. He laughed when he told me she wouldn’t dance with him when he asked her. They sat and drank coffee instead. He asked her to marry him two days after they met! He told me how he had gone to be a soldier in World War II.  With his return he and his wife raised a family in the city of Boston and now his children lived in the same neighborhood with their children.  With all the conversation he became short of breath and required oxygen. “My wife and I do everything together,” he told me, “so I know that we both caught Covid. I really miss her now. Can you ask her if she’ll be my roommate if I’m positive?”

Mr. Jones’ results came back as positive for the Covid virus at 6pm. My shift ended at 7pm. Before I left, I mentioned Mr. Jones’ request to the nurse in charge. “Only if they both agree,” she replied. I called into Mr. Jones’ room, utilizing the mounted iPad to ask his permission to disclose his results to his wife, as well as to confirm his request. He agreed. After donning PPE once again, I walked back into room 16A to meet the concrete wall view, paling in comparison to the Charles River of 32A. I informed Mrs. Jones that Mr. Jones had tested positive for the virus. “Your husband would like to propose an idea. If you would like, you can become his roommate in bed 32B. You can recover together, and he has a fantastic view from his window.” With the smirk of a wife who had been married for 40 years, she agreed. With help of other staff members, we wheeled a masked Mrs. Jones into room 32. Rolling into the room, her husband’s face lit up. Looking out to the Charles, she turned to her husband with a smile in her eyes and said, “I’m here for the view”. Mr. Jones then asked me a question that during this Covid pandemic I was happy to answer. “Can you see why I missed her?” 

I never went back to Ellison 12 after that day. My rotation on the unit had ended. The next four weeks, I cared for Covid patients in the ICU overflow units, the post anesthesia recovery care units that I had worked in for the last 10 years converted to serve this purpose. The patients were ventilated, sedated and really sick.  I was fearful, anxious and scared. In my thirty years as a nurse I had these feelings during emergency medical situations, but the moments had always passed. Now, day after day in the Covid ICU, these moments lasted longer. It was me, the nurse, who now needed a sense of connection to get me through. But sometimes I was paralyzed.

I remember one evening when I was caring for a patient named Juan, working with my nurse colleague, Bonnie. Every night, Juan’s wife would call the unit at a scheduled time for an update on her husband's condition. A medical interpreter would also be on the phone to translate our report into Spanish. Juan was still on the ventilator, too sick to speak for himself. That night, before the interpreter was dismissed, Bonnie asked Juan’s wife important questions that I was too overwhelmed to ask in that moment: “What does Juan do for fun? Does he fish, watch sports? What are his grandchildren's names?” Juan’s wife answered with tears in her voice that we did not need an interpreter to understand.   I could breathe again. I asked her “How did you meet Juan?” Her reply “En la playa.” At the beach.

Unknown to me, Bonnie had been asking patient families questions about their loved ones and then creating story board posters for the patient rooms. These beautiful posters were the connection, lining the walls with brightly colored pictures of the patient on vacation, with loved ones, with the names of loved ones written in colorful letters next to the photos. The following evening Juan’s room was decorated with a poster featuring a photo of him and his wife. That day, the anxious feeling that had been weighing me down lifted a little. The connection that I had been working to create for my patients for so many years had now been created for me.  I finished my shift that day recalling the photo of Juan and his wife at the beach and their smiling faces.

Now, the PACU is no longer a Covid ICU. Elective surgeries are again scheduled. I guess we are “back to normal,” but not really. Being a nurse during this Covid pandemic has changed me and opened my eyes. I now become more concerned when patients are alone. Where are their support systems?  When I ask a patient the question “Who is taking you home and how did you meet them, “ it’s different. Sometimes, the answer is “I have no one.” I now take more time than before to help them find someone, so they won’t be alone. I am grateful for my peers who do the same, and who ask patients questions that help us see their humanity. I think often of the Jones' and how Mr. Jones’ question -- “Can you ask my wife if she’ll be my roommate if I’m positive?” --brought a smile to my face and a connection to my heart amidst the surge of unanswerable questions.