How much that time? he asked.
Forty milligrams, I replied. Is it enough? I added.
He had stopped clutching his chest but his face was still creased with pain.
Could you try a little more, just another ten? That should do the trick.
The instructions given to us by the consultant were to give Mr Holdsworth whatever it took to keep him comfortable, so I administered a further ten. With the additional dosage the last vestiges of pain left his face.
Youve been good to an old fool like me, Mr Holdsworth said.
We all make mistakes, I replied.
It wont be long now and Ill pay the ultimate price.
My mind was blank. There was no suitable response. I chose that moment to leave the room, my Christmas spirit well and truly dampened.
The next morning something strange happened; as I headed towards the nurses station I found myself taking a detour until I was standing outside Mr Holdsworths room. The first thing I noticed was that his name had been removed from the door; the second was the deathly silence in the room.
I felt strangely depleted. I think that deep down, I had been believing that a Christmas miracle might happen. I quietly opened the door and there, staring me in the face, was an empty room. I headed to the office, where the nurses seemed to have gone mad.
Jenny greeted me with a big smile. Have you heard the news?
I didnt know what news she was thinking. I know we all had mixed feelings about Mr Holdsworth, but it didnt seem quite right to be so damn happy first thing in the morning when a patient has just passed away.
Its Mr Holdsworth, she was almost exuberant. They came for him last night. They found a donor. Hes getting a new heart.
Everyone in the office was so genuinely happy that he was going to have a chance at life regardless of whatever past mistakes he had made. Without a doubt that had to be the best Christmas present ever.
Mr Holdsworths transplant operation had taken place far away in a big city hospital, so Jenny had to phone the hospital every few days to get an update on how our patient was doing.
He could be discharged soon, Jenny informed us, three weeks after he had been taken away. The doctors say he is doing really well. No sign of rejection.
Three months later and Mr Holdsworth was back at home and living a normal life although, we assumed, a much more careful, healthy life. It makes sense that a near death experience makes a person wiser.
During the two and a half years I had spent with patients in the medical/surgical ward, I thought Id seen it all. I had seen how high the human spirit can soar, and then how low and selfish humanity can be. But then, along would come someone new, who would set up new boundaries, whether high or low.
One April morning I was greeted by Jenny, who had news to share: Mr Holdsworth is in the emergency room.
Organ rejection, I blurted out.
Oh no, its much worse than that What could be worse than your body rejecting your new heart? Hes back to his old habits. Hes overdosed on morphine.
Jenny didnt attempt to hide the scorn in her voice.
But thats not even the worst part. When he gets out of here, hes got an interview with the police. It seems hes been selling it as well.
I guess not everyone learns from their mistakes. As I look back at some of the ambivalent feelings I had had while looking after Mr Holdsworth, I wonder if deep down I doubted that he really had changed. That heart could have gone to someone else less likely to waste it. I try not to judge, but the fact is were all human and we do have opinions. I just hope that as a nurse, I can always accept people for who they are and give them the best care that I can.
Making a difference
Mr Henderson has taken a turn for the worse, Colleen read to the assembled nurses. He wouldnt get out of bed today and his chest is sounding bad.
Colleen looked pretty upset about this; moisture was pooling in the corners of her eyes. Colleen was straight out of training and hadnt lost a patient yet; everyone was wondering if Mr Henderson was going to be her first.
All of the nurses liked Mr Henderson; he was a truly genuine, down-to-earth sort of man, with a heart of gold. At the age of 69 he should still have had some good years in front of him, but he had a bad case of pneumonia that the antibiotics couldnt seem to get rid of.
The doc requested another chest X-ray. The infection hasnt improved at all, she continued. He even thought it was a bit worse. Every breath Mr Henderson takes is an effort. Its horrible to listen to.
The sound of a rattling, bubbling, straining set of lungs is never nice.
Everyone kept quiet we had all had our first lost patient, and though Colleen might shed a few tears if Mr Henderson passed away, she would eventually recover.
With the report over, we filed quietly out of the office, talking with muted voices about the patient, as if he had already passed.
With the report over, we filed quietly out of the office, talking with muted voices about the patient, as if he had already passed.
I was helping Colleen with Mr Henderson that day. As I entered his room, I took in his sickly grey skin. Good afternoon, Mr Henderson, I hear youve been giving the girls a bit of trouble.
This brought a smile to his face. Could be better, son, he rasped.
That was Mr Henderson, having a joke in the face of death. I grabbed a passing nurse and together we heaved him upright in his bed to help his breathing.
I dont think I have much time, Mr Henderson said to me when his coughing passed. Ive had a good life. Im not ashamed of the life Ive led.
I felt a lump in my throat.
Its not over yet, Mr Henderson I had to at least try to be optimistic The doc has just started you on a new antibiotic; you might feel like a new man tomorrow. Besides, you cant go letting young Colleen down after all her hard work.
Mr Henderson managed a wry chuckle before bursting into another round of coughing.
Youre a bad liar, but you and the wee lass have done a lot for me it would be a shame to disappoint you.
Still, I wished there was something more I could do. Often its just a case of being there for a patient, and willing to listen. Every so often, though, theres the option of doing something extra. Later that evening I had a chat with the other nurses about how we could make Mr Henderson more comfortable.
Room 5 is free. What do you say to that? I asked Rose.
The poor fella is in a four-bedded room. Its not nice for him, or for the others in the room. Lets move him, Colleen added.
This was the same Rose whod been with me during my first patient death. She was the acting charge nurse for the late shift. She had as much experience as most of us on the ward put together, but she would never be a full-time ward manager. For her, nursing was a hands-on profession. Hands on patients, not hands on pen and paper. Once you started to move up the nursing ranks to managing you lost a lot of that daily contact with your patients.
Thankfully, Rose approved the move.
Whats so great about room number 5? Just ask Mr Henderson.
I never get bored with the view, he told Colleen and I as we gave him his bed sponge.
It was early summer and the view from his window was pretty spectacular. It was on the top floor, and looked out over the local gardens and playground. From room 5 you could see mums and dads playing with their children; you could watch as young couples strolled through the rose garden; and, best of all, room 5 was at the end of the ward and had windows on both sides, so it was possible to watch both the sun rise and the sun set.
It sure is lovely, Colleen said. I dont think I would get bored either.
Still, Mr Henderson had been in room 5 for over a week now, but had only slightly improved.
I guess it must be frustrating to be so close, yet so far, I added.
I dont often make such shrewd observations, but I just knew that Mr Henderson would give anything to be outside in the fresh air. He didnt reply, though; he had dozed off to sleep, but little did I know how much my comment had affected Colleen.
It was a gorgeous, early summer Sunday afternoon and now Mr Hendersons fourth week in hospital. Unfortunately, he had taken another slight turn for the worse. Its not uncommon for a patients health to have its ups and downs. The infection in his lungs had spread throughout his body. The doctors were using terms like sepsis and triple antibiotic therapy, but nothing we administered seemed to make any difference.
Colleen, however, had an idea that she felt sure would.
Come on guys, what harm can it do? Were not exactly busy we have the time.
All the nurses in the office shook their heads. Colleens idea was to take Mr Henderson, bed and all, out into the garden. It was a hell of a risk to take. If anything happened while he was out there, out of the controlled environment of the ward, we could lose our jobs. If his breathing got worse suddenly, or he had a heart attack, he could die.
Look guys, you all think hes going to die anyway, so why not do this? Whos going to complain if something happens? He doesnt have any family, at least none that have bothered to visit him. Imagine if it was your father or grandfather lying there.
That clinched it five minutes later we all gave the plan the go-ahead. We even managed to coerce the junior doctor on duty into keeping his mouth shut.
There were four of us in total: two porters to push the bed, one nurse to push the emergency equipment and one for good luck. Dont stop breathing on us, Mr Henderson, at least not until we get back, I said as we wheeled him along the corridor.
Ill try my best, Mr Henderson replied.
It was the most upbeat I had seen him in over a week.
We wheeled Mr Henderson out of a side door, along a footpath and into the gardens. Unsurprisingly, people stopped and stared.
Others came over to say hello.
One boy came and asked, Whats wrong, mister? and Mr Henderson responded with the happiest look a look that Ive not forgotten.
I dont know if it was the feeling of wind on his face, the sensation of breathing in fresh summer air, the smell of the freshly cut grass and roses, or even the sound of children playing, but Mr Henderson came alive.
Mr Hendersons white cell count has gone down and this mornings chest X-ray shows less infection, said the junior doctor to his consultant. White cells in our blood fight infection as a general rule, the higher their count, the worse the infection. The consultant just nodded his head as if he expected this, and why shouldnt he? After all, Mr Henderson was receiving the best care that modern medicine had to offer.