I Wasn't Always This Strong - part 8

For many years  I worked Pre-Op for both routine procedures such as colonoscopies and more serious orthopedic surgeries.  Pre-Op is one of my favorite jobs.  The majority of people come in anxious.  We increase their anxiety by having them take their clothes off,  put on a hospital gown and then climb into a hospital bed.  Their vulnerability is unparalleled as they lie in strange clothes, a strange bed, soon to have someone they know only marginally violate their bodies.  My challenge is to lower their stress level and if at all possible get them laughing and relaxed before the physician comes in to check on them.  My other challenge is to pick up on the subtleties of a patient’s behavior that could lead to the identification of hidden problems whether physical or psychological.  

Mary had cancelled her colonoscopy appointment twice already.  I finally had her here in the interview room, going through her history when she turned to me and said “Ya know, I don’t think I’m going to have this done today.  Would you tell Dr. Martin that I have decided to cancel.”  

“Oh no Mary.  I won’t.  If you want to cancel, I’m going to have you tell Dr. Martin yourself.  Let me go get him for you.”   I called Dr. Martin to the room.  He spoke to her in his gentle and calm manner and talked her into staying and having her colonoscopy done.  We prepped her for her procedure distracting her with conversation about her children and grandchildren.  Her anxiety showed but she was at least letting us proceed.  During her procedure Dr. Martin found a large, cancerous tumor.  It was stage four and unfortunately probably too late for Mary. She was the first patient I saw who I truly felt knew something was seriously wrong and just couldn’t face it.  In my experience as a nurse I have realized how intimately we all know our bodies and we are very aware when something isn’t right.  In some cases patients will come in with only vague symptoms but something serious will be found.  In other cases, ones like Mary’s case, the patient subconsciously (or, I believe, sometimes consciously) knows something is seriously wrong but for whatever reason cannot face the truth and will avoid the tests and treatments until it is too late.  In my 15 years as a GI (Gastrointestinal) nurse I am always very suspicious of people who cancel their appointments time after time.  They are the ones I really want to get in and get checked.  

It has been my experience that men and women very often respond to stressful situations differently.  Anxious women tend to become needy, high maintenance women.  Anxious men become mean or aloof.  Obviously this is a generalization but while I used to get impatient and angry at men who read the paper or were on their cell phones the entire time I was pre-oping them, it finally occurred to me that it was their way of coping with their fears and anxieties.  I have learned that despite the insistent needs of the women and the seeming rudeness of the men I would keep trying to initiate conversation and  eventually would get them to talk and even laugh.  Sometimes when I was really inspired I could get them to admit that they were in fact fearful at which point we could discuss their fears and hopefully allay many of them.  To me this was my challenge and I rarely failed.  I could send them to the OR or procedure room in good spirits rather than unsure and fearful.   Any anesthesiologist worth his weight will tell you that there will be better outcome the more relaxed their patients are — less medication, less stress on the body, less complications.  

One of the reasons I love pre-op is I hear the best stories.  Kevin was 65 years old and he was 15 years late for his first colonoscopy.  I chided him about it and asked what made him finally come in.  He told me this story.   He and his good buddy, John, had gone to a Giants baseball game.  While there John had his pocket picked.  His wallet and cell phone were gone.  Bummer.  The next day John called the DMV to get his drivers license replaced.  They told him that because he was diabetic they could not renew his drivers license unless he had a note from his physician stating that he was healthy enough to drive.  So John called his physician and asked for that note.  His physician said “John I haven’t seen you in 5 years.  In order for me to write that note, you are going to have to come in for a full physical.”  John was not pleased.  But he made the appointment for as soon as possible.  After the physical he said “So, can I get that note now so I can get my drivers license.”  His physician said “Actually, no.  You need to do one more thing.  You are way overdue for your colonoscopy and need to go in and get that done first.”  John said “No way.  I’m not getting a colonoscopy”.  

His physician shrugged and said “No colonoscopy, no note.”  So John made his appointment for his colonoscopy and on the day of his exam they found a large cancerous mass.  They found it in time for him to have surgery and a full recovery.  From that day on John gave thanks for the pick pocket that took his wallet at the baseball game.  “And that,” said Kevin, “is why I am here today.”   

One of my favorite questions to ask my elderly patients is “What is the most memorable historical event you have lived through?”  I have talked to people who fought with General Patton, spent a good portion of their childhood in a TB sanitorium,  been intimately involved in the civil rights movement and were in Dallas when JFK was assassinated.  People who have met presidents, flown fighter planes in World War II and attended the million man march in Washington DC.  It has given me an appreciation for the elderly that I never had before. It has been a much needed reminder that everyone has a story and everyone had a life before they got old. Now in my sixties I am starting to feel that invisibility that I believe most of the elderly in this country feel. How easily we forget their accomplishments, their experiences growing up in times we can only imagine. I remember telling Aunt Mary K who was a geriatric nurse how uncomfortable I was with old people. How I never knew what to talk to them about. I will always remember her reply as she looked at me quizzically. She said “But why? They are just like you and me, just older.”