yale school of nursing
To Miss K,
This is a letter. This is an admission. This is a promise.
You were just two or three years my junior when you died and I need to admit to you that I didn’t cry. I couldn’t cry. I’ve never really cried when a patient passed away. I don’t know, but I felt like I should have cried when you passed.
The last time I saw you was just before the end; you were so pale, almost gray in complexion, emaciated, degraded to your barest of human form, unable to stand without help, but there was something about you that has made you stick in my mind. Maybe it was that your age was so close to mine, maybe it was your spirit, maybe it was your smile, or maybe it was your story. But I’m not writing this to tell you your story (you already know it) but to make a declaration as I embark on my life as a nurse.
I met you some way through your treatment. I’d cared for people in your position before. That is, people dying of cancer. I would check in often to take your vital signs and check your urine. Do you remember how having a nursing assistant collect your urine became a running joke? Every Q2 void I would knock on the door and enter. ‘The pee man is back’ I would say and you would roll your eyes and chuckle’. It always amazed me how you could smile at me, teeth a whiter shade of gray than your skin and your head covered with a pink and blue beanie. Every time I asked you how you were doing, you had nothing negative to say: “oh, it could be worse”, “at least its sunny outside”, “look at the Marin headlands, aren’t they beautiful?” How could you be so happy? You were in the hospital. You had cancer. Your father had had cancer. Your sister-in-law had died in a car crash and your mother was estranged from you. I would be miserable. I would be angry. But even in your sickest moments you smiled.
I took care of you many times over the next year or so and got to know your fiancée, your father and your future parents in law. I remember coming into your room one day and you were extra happy. The doctors had just told you that you were in remission! Your cancer had gone! The months of chemo, the nights of nausea and vomiting, the days of looking at yourself in the hospital mirror, watching your former reflection give way to a skinnier, balder, paler you, all worth it!
You left the floor with your dad at your side: two warriors, two soldiers walking away from the battlefield, weary from the war, but victorious. I smiled at you and you both smiled back and said ‘thank you’. Those two words were more than I needed. More than I wanted. For you had won and that was a victory for me also! I told you ‘this is the only time we can ever say ‘we hope we never see you again’ and it not be a nasty thing to say!’
Months went by until one day I saw your name on the admission list. What? I looked at the charge nurse and said ‘why is Miss K coming back?’ ‘Didn’t she win?’ ‘It’s back,’ he replied to me, “it looks like this time it has spread to her spinal cord.” ‘Fuck’. That’s all I could say. I imagined what it must be like to receive such news. I imagined falling to my knees, weeping- the way they do in movies.
I felt like crying as I prepared your room but I didn’t, I couldn’t. Instead I slipped into ritual. I prepared your bed with care as I do for every one of my patients: folded the blankets into to a triangle on the bed, wrote a little welcome note and a smiley face on your white board, as I do for every person that is admitted to the floor. And then I left, probably to check a blood pressure, take a temperature, or to make sure that no one was reacting to a platelet infusion (you knew what that was like, eh?). Then we waited for you to arrive.
It’s about 1400 when you walk in with your dad. You’re smiling?! How are you smiling? It’s as if you are happy to see us?
Of course we were happy to see you but I would have rather we met in another place, under different circumstances.
The nurse escorted you to your room and I followed, Dynamap in hand. I stopped at the door and joked with you ‘no, sorry, wrong room’ you and your dad looked at me and I continued ‘no, you guys are in the wrong room- you’re supposed to be at home!!’ You and your dad laughed. How the hell do they do this, I thought to myself?
After a few weeks of your stay, I asked you ‘how do you stay so happy? I couldn’t be like you’. You replied quickly with a chirpy ‘what’s the point in being sad? It’s not the hand you’re dealt, it’s how you play it.’ Had you rehearsed that? Maybe a thousand people had asked you that same question? I don’t know. To this day I don’t know.
What is the point in being sad? Really? What is the point? But I watched you walk around the floor, seeing the younger kids, bald, attached by the chest to an IV pole on which a parent would roll them around the floor. You were sad for them. I know you were.
This admission was not a long one for you. A couple of months this time. Short, relatively speaking, wouldn’t you say?
During your stay you shared with me photos of you and your fiancée out hunting after you had ‘beaten the beast’. I remember seeing one picture of you holding up a buck’s head after you had, as you said, ‘got it with a real good shot’. There was something about this picture that struck me. You looked so happy, like the buck was your cancer and with one shot you had slayed ‘the beast’. You had the same smile that you had when you walked off the hospital floor.
I remember the end. It was inevitable. Your family surrounded you, your fiancée at your bedside. People were coming in and out to say their final goodbyes. You didn’t see any of this but when the end came your family was crying, your doctors were crying, your nurses were crying. I didn’t cry. I couldn’t cry and I don’t know why.
You didn’t see me but I saw you, as I tied a tag around your toe, linked your hands and saw you disappear with each link of the zipper. You don’t know this but I snuck in a single flower I had taken from the 8th floor. I taped it to your chest. You didn’t deserve to become another body in the morgue. Why did it have to be you? You were a flower. Hopefully you are resting in peace. Your presence will live on in each flower for me.
And now for my promise to you: I promise to be the best nurse I can be, to give to each patient the smile you gave to me. I believe in the power of a smile. I believe it helped heal you once, and despite the beast returning, you had the grace to smile in its face and meet it head on. This made you stronger than your disease ever was.
Finally, I promise one day to cry and when I do, I will cry for you.
Rest In Peace, Miss K.