Episode Transcript
[00:00:01] Hi, everyone. This is Dawn Clem, and you are on my podcast, Milkweed and monarchs.
[00:00:08] I'll be talking today about my last year while I was stationed at Balboa Naval Hospital in San Diego. Prior to being stationed overseas, there were three patients in that last year that I worked at the hospital that definitely impacted me as a clinician and carried forward with me throughout my practice for the rest of my time, even after I became a nurse and a clinical nurse specialist. So I'm going to share those three patient stories with you.
[00:00:46] The first patient's name was chance. He was a large black man. He was probably 6364, and he weighed close to 300 pounds of when he was first admitted to the unit. I took to him immediately. He was so kind. He was soft spoken, he was kind, and you could tell that he would never hurt anyone. He just had that demeanor about him.
[00:01:19] Well, he was in the open bay warden, and a lot of the men that were in the open bay ward were healthy, for the most part, enlisted men. So he was a chief petty officer, still on active duty. And most of the time, what that meant was they could get up and roam around the unit as freely as they wanted to, which included going to the snack refrigerator and getting whatever they wanted to eat or drink whenever they wanted to. So they were pretty independent. They might even go into the linen closet and get their own washcloth and towel if they needed a second one. They would take their showers independently.
[00:02:11] So for the most part, they were not extremely ill by any stretch of the imagination.
[00:02:19] So when he came in, he came in for a workup. Um, he had a medical, um, medical related problem with his blood, and they were doing a workup on him.
[00:02:34] Once again, I'm going to remind you that I had ten weeks of training for hospital core training, and I would say, um, the amount of education that we got on pathophysiology, Washington, extremely limited. So I really didn't understand that much about what his workup was entailing. I knew that I was drawing labs regularly on him and just taking his vital signs, but he was pleasant, and so it was no problem for me.
[00:03:10] Well, we got into a routine together where he was asking me to bring him snacks, and I didn't really mind. In the beginning, I was fine with it, but then towards the end, he had been there about two weeks. I'm like, why can't he get up and get his own snack, you know? And I was starting to pass judgment on him.
[00:03:34] Remember, I'm only 20 years old, completely inexperienced. I'm trying to give myself an out here, but.
[00:03:43] So anyhow, because most of the other men would get up. So I was starting to feel like I was his personal waitress. And it was bothering me. I did not like it at all. Nonetheless, he didn't know that. And I still managed to meet his needs. When he requested something, it wasn't too much longer that he was there. I think he was there about two and a half weeks, and he got discharged. And I remember thinking in my mind, thank God he's going home. I'm not his personal waitress. He needs to go and take care of himself. I shouldn't be making his snacks for him every day. So that's really was my thought. When he got discharged, it was about six weeks later when chance got readmitted.
[00:04:38] And when he got readmitted, he came in comatose.
[00:04:43] And I was like, what?
[00:04:46] I had no real understanding of what was going on. Well, apparently he had been being worked up for liver failure, and I really didn't even understand that at the time. And he came back in, in a hepatic coma or a liver coma, and he came in with tubes all over the place. So he had a nasogastric tube, which is a tube that goes down your nose into your stomach. And he also had a rectal tube, which is a tube that was placed in his rectum. And then he had a catheter that went into his bladder to collect urine. One collected feces, and then one collected stomach contents. And we were drawing labs on him, and we were having to turn him side by side. And he was a large man, so it really was a lot of work to be able to take care of him. And he was still on the open bay ward, so we would pull the curtains around him, and it would take at least three of us to get him turned and repositioned, and his tubes emptied and get his lab drawn. He had oxygen on. Basically, he turned out to be an end of life care patient because he was dying.
[00:06:16] And I remember thinking, Don, this is so terrible. You were passing judgment on him three weeks ago for getting up, for getting his snacks for him and him not getting up himself.
[00:06:37] He probably was so sick, and I didn't even know it. I had no awareness of it. That's how naive I was about healthcare and what was going on.
[00:06:50] Ultimately, he ended up passing away. But I never forgot him because I was so angry at myself for passing judgment on something so small.
[00:07:05] And I do think we do that in our lives, don't we? We meet someone, we might have an impression right away. But we don't know the full story behind what's really going on here.
[00:07:17] So that changed me. From that moment on, I knew I had to dig deeper and understand more in order to be a better clinician. And I had no right, really, to pass judgment on patients that came in. So there's the first story.
[00:07:38] The second story is about a patient named Mister Tislow.
[00:07:48] Now, Mister Tislow came into the unit an angry man. He also was a chief petty officer. And he had been on our unit for about five days and talked to absolutely no one. It was like a big discussion when we were talking about him at the nurses station, because none of us could get him to talk. We were just delivering food trays to him, taking his vital signs, but he did not talk to any one of us at all, ever.
[00:08:25] And so the day came, the physicians would come in in the morning to round on the patients. And the physicians were all officers. They would always come in and their dress whites to make rounds. So they weren't in scrubs, they were in dress whites. And they would stop at the foot of everybody's bed, introduce themselves, and then start talking to the patient about their case and what's going on. We would pull the curtains around each patient so that they had some limited privacy. But you can imagine in an open bay ward, it's just so hard to believe that that's how we delivered care back then. When I look back on it, I go, that's just crazy. That's just crazy. But anyhow, so he, Mister Tislow was in on a patient on the port side of the unit. So we always started on starboard side. And if you figured there were, you know, twelve patients on each side. Yeah. So we would go down, start at the top and go down, do the first twelve, come back up, do the second twelve, and then go over to the port side and go down the port side. And he was halfway up on the left hand side of the port side. So by now we had been rounding for probably 2 hours. So it's the physicians, the nurse, and the corpsman was always there to make sure that they didn't need anything right away. We acted like a runner for them, or we could fill in what their vital signs had been and how they'd been responding to care.
[00:10:21] And the nurses came along to make sure that they would get new orders taken right away.
[00:10:27] So we're now rounding the end of the bed, and we get to Mister Tislow's bed, and we pull the curtains around him, and the lead physician is going to introduce him to the staff, the other physicians, so that we can talk about him.
[00:10:52] So one thing you should know that the hierarchy in the military is enlisted. And enlisted people are those who have not gone to college. So you don't have a college education like me.
[00:11:10] Many of them went in right after high school, though I had gone to college for a year. So you have to have graduated from a bachelor's program. Even if you had an associate degree, you would not be an officer. You actually have to have your bachelor's degree to go in as an officer.
[00:11:32] So the. There is a hierarchy there. And even when you're in the military, you're not allowed to fraternize between the two groups. The thinking always was war related. Because if we were ever in a time of war, they didn't want you to be friends with an officer. Because if an officer had to give you orders, they didn't want you to feel like you were being bossed around by your friend.
[00:12:05] I hope that makes sense to you. So they always said no fraternization. And that is the reason why right there. Not that we didn't talk, not that we didn't get along, but there was definitely this hierarchy that we always maintained. And the same thing goes for the patients, because now all these patients on this unit in particular are all enlisted. And the physicians rounding are all officers. So here we are in front of Mister Tislow's bed, a man who has not spoken, spoken one word to any of us in five days.
[00:12:43] And the lead physician is getting ready to introduce him to the group. And he said, good morning, Mister Tismore.
[00:12:53] Mister Tismore, we're here to do rounds on you immediately. The patient was completely offended because the physician just said his name wrong. So he was like, he was not happy. And he sat straight up in bed and, pardon my English, he looks straight at all of them and he says, it's Tizlow, you fuckers. And, oh, my God. Okay, first of all, I was trying so hard to keep a straight face because I could just imagine, you know, here he is, sick. He doesn't feel well. He hasn't been talking to anybody. He's got a bunch of in starch white uniform standing at the foot of his bed. And they don't even have the decency to know what his real name is, even though they had the chart right in front of him. Right. So I started laughing. I know that's terrible, but I just couldn't help it because I thought they kind of deserve that. That kind, you know, I mean, from an enlisted point of view, I felt like, yeah, somebody's finally going to tell them how we really feel, because they always feel like they know so much more that we're beneath them and we're not beneath them.
[00:14:16] So when I started laughing, everybody else started laughing. He laid back down. He laid back down. They continued talking about him. He still never said a word. But after that rounding, he started talking to everyone. I think he felt like he finally got to say his piece, you know, he finally got to tell somebody off, and maybe that just made him feel better.
[00:14:44] But for me, what it made me realize is that we all have dignity, right? We all have dignity and deserve to be treated with dignity. So it's not appropriate to ever feel like you're above someone when you're providing care for them. And that kind of went back to my experience with chance, too. Like, what do you care if you're getting him a snack? Don? He really was so sick, I realized later on, so now I've gotten hit with that twice. And I started to realize, yes, I need a change in the way I'm thinking. I need to have a better attitude when I'm caring for sick patients.
[00:15:36] So that was good for me.
[00:15:39] The third patient is a patient. I'll call Charlie.
[00:15:44] Charlie was in one of our private rooms. We had three private rooms outside of the open bay ward that were in the hallway, and those rooms were reserved for patients that had a communicable disease at that point. We had a lot of patients that had tuberculosis, so we could not have patients with tuberculosis out on an open bay ward. They needed to be isolated. Then we would put patients in there that were undergoing chemotherapy that had a cancer diagnosis. So if they had gone through chemotherapy and their blood counts were off, so, in other words, their white blood cell count had gone low, then they would need to be in isolation to protect them from contacting any infection from anyone in the open b unit. Cause we had a lot of people that came in with pneumonia, so you're not gonna want somebody to get pneumonia that has cancer and is undergoing treatment. And then one of the other rooms was used for patients where we didn't really have an actual diagnosis for them, but we thought it would be better for them to be in there in a private room because we were going to be doing a lot of testing, and we wanted to make sure that they were protected in case it turned out to be something that. That maybe they had communicable or maybe they could get a disease from someone else. So it was really more of a protection for that patient while they were going through a complete workup.
[00:17:43] So Charlie was in there because he was going through a complete workup. He was also a chief petty officer, and he came in because he had these lumps on his upper extremity and chest and back. And all I remember, I didn't really understand what was going on with him, I'm going to be honest with you. But what I remember is doing rounds with the physicians when they went in there, and they. They would take the tape measure out every day, and they would measure his lumps to see if they had gotten any bigger. I remember at the time feeling so bad, I mean, how horrible that must have been for them to say, yep, it looks like this one's growing, that kind of language. And they didn't know what they were. They had biopsied them, and we were waiting to find out what the treatment was going to be.
[00:18:44] So I think the first biopsy came back, and there really wasn't a firm diagnosis on it, but Charlie. So they decided to assign me to take care of him. I usually got along with most of the patients. I tried really hard to get along with them, and he was one that not many people could get along with. He was quite cantankerous. Who wouldn't be? I think I would be, too.
[00:19:15] And he was in a lot of pain. He just didn't feel well, you could tell. And he didn't want to talk to anybody, and he didn't want to be bothered by anybody. So they put me in there because they thought maybe I could get along better with him than most of the others could. And I remember I was in there for, like, you know, the first three days. I mean, he didn't really even talk to me. He would just grunt, you know, if I'd asked him a question, how are you feeling today?
[00:19:46] You know, that kind of thing. And so I was like, oh, boy, this is going to be a challenge.
[00:19:53] But every day I would go in, I'd say, hi, Charlie, I'm here to take care of you again today. Let's get you cleaned up. I'll change your bed. I'll put you in a clean Johnny. Johnny is what we called the night shirts in the hospital back then.
[00:20:09] So I'll get you in a clean Johnny, and I'll make sure you're getting all your medications. And is there anything I can get for you now before we get started? So that was kind of my routine when I would go into that room, and he would be like, no. You know, I don't want anything. Basically, I don't even want to talk to you.
[00:20:31] Well, as time went on, I was assigned to him quite often during the weeks, and I think he had been there, like, three weeks, and he started to talk to me a little bit more because he started to get comfortable with me, and obviously I wasn't going anywhere, right. I was still getting assigned to take care of him, so he started to open up a little bit. I even got him laughing a couple times, and I was growing quite fond of him because I was like, he's not so bad. Who wouldn't act out if something like this was going on, you know? So then, of course, the humanness enters into it, and I'm like, how come you never have any visitors, Charlie? Don't you have any. Any friends here? You know, because a lot of times they would be stationed here, but it didn't necessarily mean their family was here. Sometimes they were on ships, and then the ships came into port, and then they would end up in hospitals. They had hospital wards on the big ships, but sometimes the wards couldn't handle the things that they had, and so they would have to come into the hospital. And he was one of those that ended up having to come into the hospital. So I was like, don't you have any family? Don't you have any friends? How come nobody's coming to visit you?
[00:22:00] The more I talked to him, the more I understood that he had been married and he was divorced. Neither one of them had gotten remarried, but his ex wife did live in the vicinity. So I was getting there. I was actually getting some personal information out of him, and I finally decided to go and talk to the social worker. I thought, well, maybe that social worker could call his ex wife and maybe she could come in and visit with him. You know, I was trying to think of anything I could to make him feel better, and I just felt so bad that he was alone during this time when he was so ill. We never really did figure out what he had for an illness.
[00:22:51] Well, the social worker did call his ex wife, and she thought maybe she could come in and see him. And one day I was working on the main unit in the open bay ward, and one of the corpsmen came out running out to find me, and he's like, don, you're not going to believe it, but Charlie's ex wife came in to see him. I'm like, really? He says, yeah, she's in there right now if you want to go in and meet her. So I'm like, yeah, I really do. I'm going to go in there and meet her and just talk to her a little bit, see if I can find out more about Charlie. Is there something I can do, maybe to make him more comfortable? Is there something you think that he might need? So I go into the room, and I meet her, and they were. They were talking, but not really talking that much at all.
[00:23:45] And so I was kind of trying to mediate between them.
[00:23:50] Then all of a sudden, out of the clear blue, Charlie got the strange look on his face. A very strange look on his face. And the next thing you know, he collapsed. And. And basically what happened is he died. He died right in front of us.
[00:24:10] We called in the code team, but they didn't really want to code him. It was before you had DNRs or anything like that. They didn't want to do CPR on him because he was so ill. And so he just died. But he died right in front of her. And I felt so bad. I'm telling you, I started crying right then and there. I started crying. I was sobbing, literally sobbing. And they had to go get lieutenant or Commander Hicks. She was Commander Hicks. Now they had to go get Commander Hicks. And Commander Hicks came down to see me, and she's like, don, it's okay. People die. I'm like, I've never seen anybody die, you know? So I was crying, and it was true. I had never been around anybody that had ever died in my life. I was just barely 20 years old. And the only person that had ever died was my grandpa on my dad's side, my dad's dad. And he died in the hospital.
[00:25:14] I never even saw him. I never really even went to his funeral because they had his funeral during the time that I was graduating from high school, and I was on my senior class trip. So my mom thought it was more important for me to go on my senior class trip than to go to my grandpa's fight funeral, which is so strange. When I look back on it, I don't know why that happened, but anyhow, I did not even see him in a casket or anything. So I have never been around anybody that died of period.
[00:25:52] And she came in and took me into the office, and she. You know, I'm still sobbing. Sobbing, literally. You know, I'd grown to really like Charlie, and I was hoping for the best. And I was so excited that his wife came in. And then all of a sudden, he just died right in front of us. It was more than I could bear.
[00:26:13] And finally she got me calmed down. I think it took about 20 minutes. And she said, you're going home today. Matter of fact, you're not coming back this week, and I'm going to get you signed up for death and dying classes. You're going to be going to classes so that you're going to be able to handle this from now on.
[00:26:37] So I was like, okay. She says, you'll get a call from somebody tomorrow.
[00:26:43] So I was like, okay, go out, wait for the bus, of course. Get on the bus. Still trying the whole way.
[00:26:52] And then the next day, they called me and they said, gave me the time when I was going to be getting training for death and dying. It was at a time when Elizabeth Kubler Ross first came out with the five stages of dying, which are.
[00:27:12] So the five stages of Kubler Ross's theory on death and dying are, first is anger, then denial, then depression, bargaining, and finally acceptance.
[00:27:33] And so I carried that with me for a long time after that, too, because then I started working quite a bit with oncology patients after all this. And that is what helped me be able to handle things. So, once again, Commander Hicks had come to my rescue, thank God. And she was always there the whole time I needed her. And right before we were getting ready to go overseas, she was transferred out. Her assistant Terry, had left, and she had a new assistant in there now named Rory, who became one of my great friends while I was still stationed at San Diego. And.
[00:28:23] And then a new commander took over, which her name even escapes me, because Commander Hicks was the one that I had leaned on so much from the very first time I had gotten there. And I am eternally grateful that I had a mentor like her that helped me move forward in my career. And she actually inspired me enough to want go to nursing school after I got out of the navy. And that changed my life. It actually changed my life.
[00:29:00] So those are the three stories about the patients that impacted me that last year I was at Balboa Naval Hospital, and it really was about dignity and about really understanding the patient's needs, that you're putting the patient's needs first as a priority and showing compassion and care. It's not just an experience where you're just going in and checking a machine. It's so much more than that. Healthcare is. And so that was the beginning of my journey.
[00:29:45] Those first two years formulated who I am today, and those last three patients made a giant impact on me. As a matter of fact, I was interviewing for a manager position, and one of the questions that they asked me was what's a situation that happened to you where you wish you would have handled it differently? And the situation that I used was chances situation, because I always felt so bad that I had judged him because I thought he thought I was his waitress and that he wasn't showing me respect, but really, in fact, I was not showing him respect and treating him with the dignity, dignity that he deserved. And so that that's. That really lived with me. And I think it actually changed me. All three of them did. Even Mister Tislow. That changed me. Because just because we have more education than people, that doesn't mean we have a right to make them feel that they are less worthy than we are. And the very least we can do is get the patient's name right.
[00:31:11] So that that was good. And then, of course, Charlie, that was just the saddest thing, to see him die right in front of me. I was able to handle death and dying after that. And the classes definitely made a big difference for me. But that was a painful lesson to learn, too, because I was trying so hard to try and make him feel better. Just like even bringing in his. Having him get his hold of his wife and bringing his wife in there. And then it turned out the way it did. I just felt so bad for her. But maybe it wasn't so bad in the end. Maybe she got to say her goodbye, and it was a final goodbye. At that time, she wasn't crying as hard as I was. I was the one that was bawling like a baby.
[00:32:03] I hope you enjoyed the story today. I know it was a little different than most of them. There's always some message in there.
[00:32:14] I am still moving forward with the studio, and so I am looking forward to starting to get some live interviews. And I have a couple of people lined up. I'm gonna finish out. Just talking about my last year in the Navy. When I was stationed overseas, I was actually stationed in Keflavik, Iceland. So that'll be my last episode of me being in the Navy, Navy. And then I should. I'll start working on live interviews. So I hope you stay with me and that you are enjoying my podcast.
[00:32:52] If you have any questions or you would like to be interviewed personally, please don't hesitate to go. On my website, it's milkmon.com. m I l k m o n. All one word.com.
[00:33:07] and at the bottom of the introductory section, there's a place where you can submit questions to me or comments. I'd love to hear any comments that you have to make. And then my personal contact information is also there. And if you don't even want to write anything, you'd rather just call me, please feel free to call me, because I would love to talk to you and hear from you about a story that inspired you or changed your life from ordinary to extraordinary. I love sharing these stories. I think we're at a point in history where we could all listen to something like that. So thank you very much until the next time.
