BY TONI CAUSHI
A scabrous hand waved in the darkness while I checked on the room where no lights ever came on. On the bed closest to the door, Bobby’s long body weighed on his left side. His face peeked through the bed rails, and his free arm waved — begging for someone’s — anyone’s — attention.
“What’s going on, man?” I asked.
From the door of the room, I could define Bobby’s mouth, tortured in a dilemma between trying to speak and letting air in. Indiscernible, silent-but-worried words formed on his lips as the ventilator rhythmically, steadily wheezed.
His vitals pulsated on monitors, but without sounds. ‘Good,’ I thought.
I slid my hands into rubber gloves, and flicked a lightswitch on. The plastic mattress on the bed nearest the curtained window shone under the spotlight, empty.
I walked up closer to see if I could catch any of Bobby’s words. From a few feet from the bed, I dodged a swing of his arm which sent his whole body towards the other side of the bed.
His eyes swelled up as his jaw jolted in an effort to speak.
“Ahh….cahn’t….bhhreathe,” his diaphragm grunted as the blue vent tube stemming from his throat trembled with three hisses.
There was nobody else in the room except the two of us, but a voice from within my head shouted, ‘CALL THE RESPIRATORY THERAPIST! DON’T JUST STAND THERE, CALL THE FUCKING RESPIRATORY THERAPIST!’
Up to this moment, I had religiously observed the work of a nursing assistant trying to memorize as much as possible of a routine that ranged from feeding a patient, down to cleaning them.
However, I had yet to react to a patient who was asphyxiating.
In a hospital that admits mostly patients with breathing difficulties, the majority are on ventilators to compensate for inability to breathe independently. Their conditions bind them to a bed for periods that range from the short-term, to for-life.
I work as a nursing assistant on a floor of fewer than 100 beds and even fewer patients, with nurses running around to pass out medications with due times that almost always converge. The constantly moving world inside of a small, but busy hospital, slows down
in the eyes of a newly hired nursing assistant. Every patient has a story that makes an impression because of how usual their pasts are, and how unusual their futures will be.
Because of COVID-19 restrictions, two visitors at a time are allowed in the whole facility, with one visitor per day per patient for a 30-minute visit — all arranged by appointment.
In a juggle between these guidelines and the engagements of life, Susan, who has been at the facility for much longer than any other patient, sees her daughter only once a week for those allotted 30 minutes.
As I feed her breakfast on my first day there, she doesn’t talk much. When she does, she says how her oldest daughter, out of the many children she has, brings favorite foods or merchandise of her favorite sports team.
But the isolation doesn’t seem to bother Susan. She has accepted life for what it is. Her bed rails are the boundaries of her life and she accepts her fate.
A well-known ‘grump’ amongst staff, she has strict guidelines for how her food should be prepared.
“Warm up the turkey, then put the cheese on the turkey and warm them up together,” she says laboriously over the ventilator hiss. “Then, put them together on two pieces of toast with spinach. I’ve always liked it like that.”
Her demands are one of her attempts to roll life back to normality.
Later that day and a few rooms from Susan’s, Noah, much younger than the average patient, rolls over on the side opposite to me to let me change his sheets. A tattoo of a green, tribal, predatory bird is revealed pointing viciously with an unforgiving beak towards the back of Noah’s head.
Metonymic for uncaged freedom, the image strikes with depressing irony as he was dependent on my help to start and end his days.
Ben sits in his wheelchair daily by the main station. With every cough his battered lungs cannon out phlegm from the uncovered trach opening. With the pandemic in the back of my mind, my eyes always scan to check for the cover that should be on the opening.
The nurses, however, don’t. They duck the projectile secretions, wipe it off the floor with gauze from their pocket, throw the ball in the trash, and continue about their day after fixing Ben’s hair saying, “Hi, handsome!”
A few hours from the end of a shift one day, I sat in the only breakroom of the hospital staring into the cavity of the microwave, where Susan’s turkey and cheese slowly rotated. Feeding Susan her dinner would mean that I would at last get to sit after hours of hurrying from room to room to help nurses with their patients.
In a space that comfortably fits five to six four-chair tables, it was difficult to miss the quiet sniffles of Sarah — a young, yet seasoned nurse — while she cried over a lunch which she should’ve eaten hours ago.
Before I could ask “Are you ok?” another nurse approached her, and whispered while rubbing her shoulder. Sarah listened and with a fork mindlessly moved her food around in the plastic container.
‘Maybe the other nurse will make her feel better,’ I thought while leaving the room. ‘Maybe she even goes home early.’
An hour later, minutes from the end of the shift, Sarah hastily moved past me, with a smile, offering a fist bump and her usual “Great work today, bud!”
To my shock she had reverted from helpless dejection into her everyday demeanor within the hour.
Sequences like that erupt from work overload, which coupled with the sadness witnessed among patients, weigh on anyone’s conscience. The following optimistic reaction is a mask that they wear as part of the job — a resolution that finds root in believing that the day is not over until the shift is over.
The second day of being there was the first day that I was assigned Bobby.
The nurses were annoyed by his constant calling, which is why his call light seemed to always remain on. With eyes glued to their cellphones, they’d share a silent understanding that it would fall on me, the nursing assistant, to answer his call light, which most of the time seemed to be over nothing.
The sentiment about Bobby was best characterized by a nurse saying, “He’s just…ughhh.”
With time I started understanding that the “ugh” wasn’t because they thought he was repulsive or annoying; they didn’t know why he behaved like he did. And most of the time, neither did he.
Everytime I’d enter his room, Bobby spun in his bed, sometimes pretzelling his vent tube around his torso. He would slide his ankles on the bed, removing the sheets and pillow cases, and sometimes even his untied johnny, to then finish up his struggle for comfort by resting his head on his hand, laying down only in a brief, on a naked mattress.
The restlessness had attracted the curiosity of doctors, but they almost always left the room with some medical advice for the nurses, even them not understanding why he acted how he did.
My eventual calling of the respiratory therapist at three p.m. dominoed into them calling the nurse, and then the nursing supervisor, and the latter ringing the doctor’s suite for the pulmonologist.
Shortly after, the room was fully lit, while three or four people examined Bobby. I stood behind them in case I’d be needed.
The decision was to send him to a different, better-equipped hospital, one that would be able to provide him better medication and care, according to the pulmonologist. As the patient’s aide, I was assigned to sit in for a one-on-one with him until the transporting ambulance came in.
Once everyone left, and the lights were flicked off, silence set in, troubled only by the swishing of Bobby’s slithering legs. The low mumbling left with the group, all giving me a smile and look of reassurance, while I sat on a chair next to his bed.
The sheets had no chance of staying neatly tucked in under him, so I let him lay on the empty mattress. Weighing mostly on his left side, his head dipped between the pillow and the side rail.
I wasn’t sure what to expect as I waited. From my experience as a EKG technician, I had observed the heart rate of patients waver into dangerous patterns which was almost always followed by a nurse screaming “RRT!” from somewhere down the hallway. In a Rapid Response Team call, doctors usually come running from their suite, still trying to find the other sleeve of their white coat, while notebooks and pens bang and rattle on the floor as everyone rushes to answer the emergency.
I have had to call it several times as an EKG technician, never — yet — as a nurse’s aide.
The reality that it could be me calling that was sounding truer, as Bobby’s thick fingers were for some reason reaching for his neck. Despite his constant agitation, he moved considerably slowly, which made it easier for me to reach for his hand before he could touch the tracheostomy tube. A strong yank of the tube would mean a few seconds of time for the appropriate respiratory staff to sprint into the room.
But the image of one of the respiratory therapists lined up outside the hospital in the smoking area, and the age of the other, did not give me peace of mind regarding their 40-yard dash.
I accompanied his attempts to reach for the tube with “nope, we’re not doing that” in the usual stern-but-caring tone of a medical worker towards the patient, while sweeping his hand clear of the neck.
The first time I did it, I got his full attention.
His eyes, barely showing because of his exhausted eyelids, looked up from between the pillow and the bed rail. He twisted the hand into a questioning position. He was asking for an explanation.
“What’s up?” I asked, giving him my left ear.
“Youh…dohn…seeh…a-lot-of…guyhs….’rhound…heer,” he exhaled with a raspy jolt after every word.
“I guess they had to break the streak,” I said smiling, also realizing that I was the only male in that shift.
He asked for my name, introduced himself, and asked about his condition. Seeing me answer the last one with a shrug, he lifted enough fingers to indicate how many months he had been hospitalized for.
The conversation seemed to keep him busy from thinking about the trach tube. “Got any hobbies?” I asked, still trying to distract him from any sudden movements.
He lifted his two pawlike fists, held them next to each other, and twice jolted back the right one.
“What do you ride?”
My knowledge about motorcycles was limited by what I had read in Hunter S. Thompson’s writing, but it was enough to know something about his Harley Davidson, which at the moment meant ‘something to get us closer to the ambulance arrival.’
“When did you get that?” he asked with the usual shotgunning diaphragm while pointing at my inner arm.
“It’s nice looking isn’t it?” I said smiling, showing him the two red and pink flowers tattooed on my inner right arm.
He nodded, with his dilapidated expression not changing. His frown seemed to be frozen on his face by now.
But any progress that I had made distracting him from pulling at the tube, seemingly almost crumbled, when he suddenly moved the right hand towards his chest. I tried to grab it, but his much bigger, stronger hand managed to slide past mine.
In the ever so small window of time from the hand slipping to what I expected to be him pulling the tube, my readiness to react to that moment made me exclaim “NO!”
But his hand reached for the left shoulder. He pointed with his meaty index finger, poking his upper arm.
I lifted the johnny sleeve and revealed two roses, both in shades of blues. “Got it for my…” his grunting stopped and the frown deepened.
“Why?” he asked. “Why me?”
Anger, sadness, and rage rushed along with tears. The repeated “I miss my family” rolled like violent waves in a room that I was now drowning in. I sat in my chair, with numbed knees, and a pathetic “I’m sorry, [Bobby]” truly not knowing what to do.
For a moment, my caution seemed unnecessary, while this man cried at missing his family and friends. One cousin had visited, but the older age of everyone else in his family had made it impossible for them to visit out of caution.
As he cried, I imagined him riding East along the Atlantic with friends, stopping somewhere along the coastline to fish. I imagined his hands were cut by the slicing fishing lines, or I could even see them jolting back when touching a heated piece of metal on his Harley Davidson.
His stories painted a past full of life, and even though his current state didn’t absolutely confine him to a robotic vent machine, he would have to acknowledge hard truths about his future, ones which he could not find the power to face in a reality in which he felt alone.
As the October night set, Bobby’s crying slowly stopped. His devastated and capitulated face rested on the pillow, while the TV lights danced around the darkness of the room.
I pressed the volume button so we could hear a game show, but only enough so it wouldn’t disturb the silence in the room.
The elegantly-dressed show host grinned as he read questions. Light bulbs on the set rapidly disappeared and reappeared to a typical, urgent game show theme.
“Heeh…hah…ho,” Bobby said.
I turned my head to him. His eyes were now staring at me, waiting for an answer. Seeing my confused expression, he repeated.
“I can’t tell what you’re saying, man.”
“Ohh, the Chicago Bears,” I said, totally caught off guard by his suddenly soothed mood.
Realizing he was referring to one of the answers of the show, I changed my expression quickly, trying to salvage the new direction of the situation.
After three or four correctly-answered questions, Bobby surrendered to his exhaustion, nosediving into a deep sleep, with his scarred hands curled inward under his chin. I spread a blanket over his bearish body and waited in the darkness, answering the rest of the game show’s questions in my head.
While Bobby’s nose calmly wheezed in his sleep, I stared at the cheap wallpaper next to the TV, thinking.
Bobby was a manifestation of how life in a hospital, especially during a pandemic, weighs on the mind and emotions of a patient. It is a phenomenon that the nurses know about, but also forcibly ignore because of workload and limitations of staff and equipment.
In instances like nurse Sarah’s, other members of staff approach each other in difficult moments like those, and offer a soft shoulder rub and a whispered, soothing word of comfort, and most importantly, push for encouragement.
And in the end, I myself had to think about how I had to isolate myself from friends, and try to keep my circle from expanding beyond those closest to me.
The COVID-19 pandemic was unprecedented for society, but in a hospital setting, it is devastating even when not present.
At four p.m., red lights flashed by the window, as the ambulance tires rocked into potholes.
I helped the paramedics slide Bobby into the wheeled stretcher, and then into the back of the ambulance. Before leaving, I tapped one of his feet, which had by now stopped kicking.
“The Fat Boy’s waiting for you, man,” I said. “You’ve got this.”
Although the everlasting frown was still frozen on his face, he slightly nodded, before one of the paramedics slammed the doors closed.
The ambulance lazily whirred away, wailing the siren as it turned away from the hospital grounds.
A strong, sudden wind filled the sky with a hive of fiercely spinning, brown, dead leaves. The globe-shaped bevy slowly disintegrated and each leaf landed on different parts of the hospital.
I saluted the nurses, who were lined up against the wall to smoke, as I walked back inside the hospital.
I had to get back to work. END