Thursday, June 30, 2011

The Story of Mr. Choi

by Teddy Jr Untalasco

It was November last year when I was assigned to handle a certain patient. He was Mr. Choi (not his real name), a Filipino-Chinese male in his 40’s with chronic renal failure who was about to undergo another creation of an AV fistula. We knew him quite well already since he was “comebacker” (a term we used in our station to identify patients who were frequently readmitted
on our station). He is a married businessman with two children who are already in their early 20’s. By his looks and his choice of room (he always chose the most expensive suite room), we knew he was rich.

I have always liked this patient. He was jolly, full of stories, and easy to converse with. He puts much value to hygiene, and he was not the “demanding” type. However, we noticed that Mr. Choi was alone in his room for most of the time. He was just living nearby, yet he had no regular companion inside his very spacious room. Every now and then some relatives and employees would just come and visit. We came to know that he and his wife were already separated and that his children, and even a considerable number in his immediate family, did not like him that much.

In a span of 6 months last year, much of his life changed. He was diagnosed with diabetes mellitus in May, and the first two digits of his left foot got amputated because of gangrene in June. Due to poor compliance to medications and lifestyle modifications, he developed kidney failure in August. An AV fistula was made during that time, but the graft failed to heal and grow optimally, hence he was scheduled for the creation of another.

When he was readmitted, it was already late at night. Just a few minutes before I had to endorse to the evening shift nurse. I asked him how he was and how he was dealing with all the medications and lifestyle suggestions his doctor prescribed. He responded by bringing out the manila paper and telling me, “Itong papel ang kodigo ng buhay ko.” The manila paper he brought was the same kodigo we devised before. It was where all his medications including his insulin sliding scale were written in big letter. According to him, he had been doing fine with the medications and he began sharing the things he had been doing to manage his condition, including the yoga and massage sessions at out Wellness Institute that I suggested before. However, he said that he had been feeling weak and easily-fatigued during the past few weeks. According to him, for most of the time, he would have to call for their male house helper to help him ambulate.

He also asked how I have been. I was just an orientee nurse in our hospital when I first handled him. He even praised for having the patience in pursuing my dream of becoming a staff nurse. I knew from this instance that he considered me as a person who was there for him and not just another nurse. I knew that he is confident in me and that he could entrust his life to me. I am certain that this patient knew about my commitment to care for him and to help him get through this new challenge.

But by the manner of how he spoke, I could sense that he was some sort of being gloomy and sad. Probably this was due to the upcoming operation. However, I actually cannot assume since I would still have to hear it directly from him.

I helped him put his things in order and while doing so, I asked him about his feelings and plans. He explained that life had been “difficult, yet manageable,” and he just wanted to go home as soon as possible. According to him, he was invited by his son to the baptism of his first grand son in US. He still had to pack his things. He said he was excited for his trip, but he was kind of fearful for any medical complication that might happen. I assumed that he was looking at this event to reconnect with his family who had been “ran” away from him.

He asked me to help him go to the comfort room. As I was assisting him, he said to me, “Tignan mo, kung ngayon nahihirapan ako, pano na lang kaya kapag nasa eroplano na ako? Dati-rati, ako ang tumutulong, ngayon ako na ang tinutulungan.
I felt something was wrong. When he was done, I asked him to clarify his statement. He explained, “Kapag naglalakad ako sa bahay, parang ako na mismo ang sakit. Nilalayuan ako kahit ng pamangkin kong mga bata.” According to him, he was often ignored even by his siblings and during special family occasions when his relatives would go out and have dinner somewhere, he was often not invited. He said, probably because they knew, “Lahat din naman ng pagkain, bawal.” And he shared that his employees seem not to give him the usual high regard anymore. As a result, he was already not able to manage his businesses well.
He made me realize the importance of caring based on respect and based on the preservation of dignity. I realized how much the way people dealt with Mr. Choi affected him that much.
He even said, “Buti pa nung maliliit pa mga anak ko, nakakalaro ko pa sila. Takbuhan kami sa garden namin.” “Peste talaga ang sakit na ito,” he added. From this I was able to deduce the impact of family relations and health to his outlook in life.

I was so speechless! I did not know what to reply. I did not want to respond with a generalization nor a false reassurance. I wanted to instill hope, but I have to be more creative and determined. I wanted to bring harmony back to his life, but I am not sure how. I would just want to take care of him. I knew he needed my help.

I saw him close his eyes and raise his blanket. I sensed that he wanted to be left alone. I told him that I have to leave already so that I could already make my endorsement and informed him that I would be returning to his room before I leave the hospital. He thanked me and I left.
I felt some sort of relief when I reached the nurse’s station. After our endorsement, I tried to reflect further on my encounter with Mr. Choi, and I could not help but let guilt drown me.
When I checked him again, he was already asleep. I spent some time watching a game show with him over TV after my afternoon shift during his previous admission. Mr. Choi asked me to stay before and my supervisor granted me permission to do for she knew the patient was alone and he needed someone to talk to.

But he was already asleep. If he could have requested for me to stay, I again would.
That was my last encounter with Mr. Choi. I was on night shift the following day and he already went home before I entered.

A month ago, I responded to a “Code 33” from the Emergency Room (an institutional alarm triggered when staff needed an extra hand in performing cardiopulmonary resuscitation efforts). I thought it would just be a usual case and I was surprised when I saw the patient being revived. He was Mr. Choi and he was having respiratory failure secondary to severe acidosis. He was unresponsive and was already turning pale to blue. Nonetheless, after 20 minutes of CPR and his father singing a waiver, he was declared expired already.
My experiences with Mr. Choi taught me valuable lessons as a nurse. My encounters with him taught me to use every moment in time as an opportunity to care for my clients. I have realized that since my last encounter with him during his readmission, I have been trying my best to spend more time with my clients. I have been really trying to initiate conversations and elicit information from them, so that I knew how I could better take care of them. I have been initiating creative ways in improving our service and have personalizing every nursing activity to the specific needs of our clients. This is to make my clients feel that I care. Caring anyway is the truest essence of nursing.

I know, there is a “Mr. Choi” in every person we meet every day. He could be someone who just needs someone to talk to, or someone who needs to give him his pain medications. He could be someone who could feel relief after feeling the warm touch over his hand. He could be someone who would feel important after you made an effort of checking him out at certain intervals. And there would always be that one Mr. Choi whom you would always remember for teaching you an important lesson on caring. I already have mine.

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