Sarah Kleinman CWA 2008

Sarah M. Kleinman, 08 is a graduate of the University of Massachusetts, Amherst, with a bachelors of art in Family Studies, Magna Cum Laude with Interdisciplinary Honors and Commonwealth Honors. An Outward Bound instructor, classroom teacher, research assistant and self-proclaimed novice film maker, Sarah has found her home in nurse midwifery.

Listen to Sarah Kleinman’s In Sickness and in Health as a netcast on Yale’s iTunesU

Transcript of the Reading:

In Sickness and in Health

“Who’s the nurse for In Sickness and in Health?” The man who is asking has short white hair that sits close to his head and bright, well-polished teeth, the enamel gleaming in the florescent lights of the gynecology-oncology floor of the hospital. He’s wearing a crisp powder blue dress shirt and a crimson colored knit tie under his lab coat. There’s a smooth and easy confidence around him as he leans over the counter of the nurses’ station to inquire about his patient’s RN. “I have 68.” I say.

“You’re her nurse?” He says smiling at me. He is tan and relaxed, like he just got back from a golf game or a trip to Naples. “I’m the swallow doctor.” He holds out his hand for me to shake. “And you are?”

“I’m Sarah.” I say, grabbing his hand firmly.

“Well, Sarah, very nice to meet you, my dear. You ready?”

“I-” I stammer, not sure what I should have prepared for.

“They haven’t told you about me?” He smiles, looking sideways at the other nurses sitting behind the counter and filling out their patients’ flow sheets. “Don’t worry, you’ll be fine. Nothin’ to worry about. I don’t bite. Right, girls?” They giggle and roll their eyes.

“What do I do!?” I mouth to one of the nurses over my shoulder as I follow the doctor into my patient’s room.

“Just do what he tells you. You’ll be fine!” She whispers back and paws the air with her hand.

My patient is recovering from thyroid surgery which she had three days ago. She’s overflow from a general medical floor and I am completely unfamiliar with her diagnosis and daily needs. She now has a temporary tracheotomy, is receiving TPN around the clock and the multicolored tubes and wires covering her body are difficult to ignore. Her husband is sitting at the foot of the bed, wearing khakis and a button down shirt that is open at the collar and wrinkled throughout. He’s been sleeping here since his wife was admitted: two nights on the vinyl chair that lays out semi-flat to become an uncomfortable bed for overnight guests. He is halfway through a Tom Clancy novel and he dog ears the page he is on when he sees the swallow doctor and me walk into the room. “Hello folks!” The doctor calls out. “Howyadoin?” He doesn’t wait for an answer but happily and busily begins setting up shop on my patient’s left side, plugging in the mini computer he brought with him under the bag of white nutrition that is being pumped into her veins.

“This is the doctor who’s gonna make sure you’re okay to go back to eating some normal food.” I say trying to explain his presence. “You’d like that, right?”

My patient’s mouth turns down at the sides and her eyes get wide as if she’s saying, “Sure, I’ll try it. Why not?” with her face. Her trach has prevented her from talking since the surgery so she’s written out some of her needs and questions on a small pad of paper that she keeps on her chest. For the most part, she sits back, passive and exhausted by this extra step needed for, at the very best, inefficient and only partially effective communication. She and her husband are often just sitting quietly in the room. He reads. She stares. The machines whirr.

“Great, so I’m gonna ask Sarah to stand on the other side of you and we’re gonna place this teeny tiny camera through your nose and down into your throat. It’s not the most comfortable feeling in the world but it won’t last long. The more you can keep still, the quicker it’ll be. Got it?” He is talking hurriedly and I look to my patient’s face for any sign of understanding. “Okay?” I say. She nods and shrugs. “I don’t know. I guess.” She says with her eyes.

“Hold her head down against the pillow, Sarah.” The doctor says. I put my left hand on the patient’s forehead like the doctor shows me and he begins to feed the camera into her nostril. She jerks and pushes against my hand. She squeezes her eyes shut as tears start to well up and roll down her face. She suddenly reaches out and grabs my right hand tightly.

“Firmly please, Sarah.” The doctor instructs. I continue to apply pressure to keep my patient’s head as still as possible.

“Okay, we’re in. Just swallow for me now,” the doctor says. He’s only looking at the computer screen which is now, as my patient follows the doctor’s order, showing the light and dark pink mucosa of the inside of her throat.

“That wasn’t so bad was it?” He asks. I dab at the corners of my patient’s eyes and she shakes off what I imagine to be the sensation of being temporarily gagged. “Right here is your epiglottis and it’s moving just beautifully.” He points to the screen and turns the cart so my patient has a better view. I can feel her pulse racing through the hand that I am still holding.

“Slow deep breaths.” I say to her. “The worst is over.” Though I don’t know that for sure, I am praying that the rest of this routine test is not as traumatic as the camera insertion and that I won’t have to go home feeling like an accomplice.

The doctor places a brown paper towel on my patient’s chest. On it he places a spoon, a snack size cup of vanilla pudding, a crumbing graham cracker and an unopened carton of milk.

“You ready?” He says. “This is the fun part.”

“Oh this is the fun part?” Her face says. “Oh! Okay! I thought the last part where I felt like I was choking was the fun part. My mistake. I get it. We’re just getting to the fun part now.” She rolls her eyes.

“It’s gonna be okay” I say. Because nothing else would come out of my mouth. “Sarah, please give the patient one small spoonful of pudding.” The doctor instructs. I scoop up the pudding, feed it to my patient and she swallows. We all watch in silence as the pudding appears and then disappears on the screen. “Graham crackers next please. A small piece.” I do as I am told and again we all look at the computer screen and watch while tiny pieces of wet graham float into view and then vanish into blackness.

“And one swallow of milk.” I place a straw into the carton and put it to my patient’s lips. She takes a small sip and suddenly white liquid fills the screen, covers her insides and then, slowly, trickles away.

My patient finally gets the okay to eat soft foods. Pudding, jello, broth, Italian ices. She seems unenthused with this news and only relieved to hear that the test itself is over but she nods to communicate that she understands. “And you can start to try to use your voice again if you want.” The swallow doctor adds. “That is, as long as your husband doesn’t mind you talking again. Am I right my friend?” The doctor smiles at her husband, elbowing the air in his direction and amused by his own sarcasm. Her husband half-laughs uncomfortably. “Take a deep breath in” The swallow doctor instructs. “Now put your fingers over your trach firmly and try to talk while you exhale.” The doctor shows her once with his own hand over the hole in her throat.

“…Hhhheeeeelllllooo…” she says in a barely audible whisper, working hard, forcing the air out of her body in a way that looks alien and difficult. “Great!” The doctor says. “Now you try it.” He begins to clean up his materials and hum contentedly to himself. I watch as my patient takes a deep breath, covers her wound with her first two fingers and tries to speak. “Ah-ahh…” she tries to get words out but stops, frustrated. She shakes her head slumps over for a moment but then tries again. This time, when she presses her fingers against her trach she looks at her husband. He looks back at her, waiting for his wife’s voice. “Ahh.” She starts. “Ahhaaii…aaii-I love you.” She speaks. And then lets her arms drop to her lap.

“I love you too, honey.” Her husband says squeezing her foot under the white hospital sheet. “I love you too.”