Tomorrow is kind of a big day. Tomorrow will be my last with a particular patient. The stress surrounding their care has ebbed and flowed for ten long months, and it will finally come to an end as all things do.
It shouldn't have been that big of a deal, but after Grandma's stoke and my hiatus from work to help with her care, it all changed. It was no longer just a patient and family who received preferential care because of their connections to our CEO and upper management. It was no longer just trying to make important improvements in the most pinnacle of the patient's mobility needs (transfers with assistance) with the family repeatedly asking when he will walk on his own again (likely never). It was no longer just a patient who had been under my care for six months (at that time) and whose insurance gave them twice as many visits as anyone else for no reason except nepotism.
This patient became a continual reminder of just how much change is possible with rehab. No one expected this much recovery due the great severity of their original stroke. And I should note that the stress and aggravation a came solely from the family. The patient was nothing but sweet, motivated, caring, and in many ways an ideal patient. It was why I simultaneously loved working with them while also, because of the family and the context, dreaded it each week.
So last November while I was in Iowa and later Illinois, this patient was continually on my mind with every single decision I made to allow my grandmother a respectful and graceful death. The fact that I did not push for rehab because I knew that was against my grandmother's wishes. Once the plan was settled with palliative care I sat next to Grandma holding her hand, wondering how much she would recover if we were to try - how much we were giving up on her, even though that wasn't the case because it was per her written directive and previously verbalized wishes. It was still on my mind the night I slept at her side in the nursing home, waking at every little breathing change, hoping she'd last long enough for Sam to get back from a work trip to Australia to say goodbye in person.
Once back in Alamosa, I had to work to keep my composure when this patient came around. This patient became a reminder of my role in Grandma's death, the appropriateness of that role notwithstanding. Patients were told I had a family emergency the week of my unexpected absence, but no more than that. So the spouse - ever needy, ever overwhelmed and unable to remember, ever naively hopeful for the patient's full recovery - didn't know that they were nitpicking on little nothings at a time when they should just be grateful that their spouse survived, was able to speak (albeit with moderate aphasia), and was able to enjoy interactions with family.
Everyone's situation is different; their beliefs, their expectations, their former roles that have changed in ways small or large. But at some point you HAVE to take a breath and realize what you still have in front of you. I had bought Grandma a get-well-soon card for her cardiac episode the previous August, but for one reason or another it never got mailed. I spoke with Grandma on the phone, emailed through my uncle for updates. But something as small as that card turns into guilt for all those those things you took advantage of - and that you can no longer redo.
At this point, tomorrow will be my last appointment with this patient, signaling the end of a very long ten months - the latest four with a little black nagging spot on my heart. Every week I would physically wash my hands before their arrival so that I wouldn't place any of my own "things" onto them. Every week the patient tried their best and the spouse repeated the same questions based off their state of denial.
I didn't expect the end to hit me so hard. And it didn't, or at least not until last week.
Luna, our sweet yet single-minded dog, got skunked and we had to leave her out overnight when temps dropped to zero at the most with negative wind chill. Our neighbor's garage door got stuck half way down, so instead of staying inside she followed me home. I felt guilty going inside, hoping she'd migrate back to the garage soon. At 11:30pm I got up to use the bathroom, and she was still sitting on our stoop. SO GUILTY. The next morning I went on my pre-dawn run but never saw her. Turns out our neighbor got her settled with the door down, but I didn't know it. I worried that if she died overnight that it would be my fault. Nathan checked the garage on his way to work, and she came bounding out as wiggly as ever. It still gave me a bit of a meltdown nonetheless.
Then this weekend our rancher neighbors were branding most of their calves. They were mostly done by the time I got home from my long run, but as I walked to get the mail I heard a bleating cry of higher pitch than most mama cows. Immediately I was back in the hospital with Grandma, holding her arm in place while the nurse tried to get one last needle stick for an IV while still at UI hospital. The sticks were her most hated part of medical care, and even with facial paralysis and aphasia from the stroke it was clear that she still hated them. Had I helped with the branding I would not have lasted longer than two minutes.
Grief is a very unique and highly personal process, and no two people can grieve the same. I, for one, will be grateful when Grandma's memory rests simply as her own instead of series of "what ifs" in the face of another. I can only hope that the patient's spouse may find their own peace with their situation and that they may enjoy the time they still have together.
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