“The quality of mercy is not strained. It droppeth as the gentle rain from heaven upon the place beneath. It is twice blessed. It blesseth him that gives and him that takes.”
The Merchant of Venice, William Shakespeare
The computer lights up as I start rounds. My co-worker and I are case managers for HMO primary inpatients in a gritty urban hospital. Like many nursing jobs, this one has long stretches of routine that have little to do with actual nursing. Sometimes I wonder why I or any nurse would do this job. But now it’s time to hit the floors running.
Mr. Hadaway, age 72, myeloma, new transfer from acute care rehab, hit hard with chemotherapy, now with aspiration pneumonia, as a tumor fills his chest and knocks out his airway protection. NPO, neutropenia precautions, blood pressure in the 80s. I pull on the blue paper mask and knock on the door.
“Hi, Mr. Hadaway. How are you doing?” Eyes burn out of sunken sockets; he can’t talk. A week, I think. Maybe. Other blue-masked faces with anxious eyes around the bed. They follow me out to the hall, pulling masks away from flushed cheeks and strained expressions. “Let’s go find a place to sit down,” I suggest.
He looks pretty bad, they say. I say the words to explain about “palliative.” They said it’s impossible, he has cancer but he was only diagnosed five weeks ago, and can it grow this fast? He put up the holiday decorations on the roof just six weeks ago, just like always, had a little backache and of course he was tired, at his age that’s no surprise.
I explain that he likely had the tumor for some time. It’s very aggressive and now fills his lungs. He hasn’t seen us without masks for a month, they say, and I think of children’s kisses. I give them the “Hospice Light” talk.
The hospitalist wants three days of antibiotics. I tell him about the masks and he discontinues the neutropenia precautions. I go back to ask Mr. Hadaway if he wants to go home. Eyes burn their dark fire as he grips my hand and whispers, so painfully, “Thank you,” and says no more. His children kiss him without blue paper. The burning eyes silently fill. The oldest smiles through tears. “Why can’t we take him home tomorrow?” and I say, “Why not?” It is arranged [em] hospice at home, tomorrow morning.
The youngest, quiet and bookish, says shyly, “He’s been asking for orange popsicles for days, but they won’t let him have anything by mouth.” I have to explain aspiration. And then I say, “I think there are orange popsicles in the floor refrigerator, over there.” She says with a start, “Can you stay for a minute? He’s afraid to be alone.” Eyes burn into mine as I hold that hot dry hand.
“Mercy,” says the daughter as we pass at the foot of the bed. “The quality of mercy is not strained,” I say. She says, “Portia, The Merchant of Venice,” and our eyes meet. As I leave she is bending over the bed, tenderly holding an orange popsicle. Twice blessed.
