When silence heals

THE waiter set the breakfast tray on the table beside his bed at 3 in the morning. He instantly woke up, told me he really hadn’t slept at all. I was about to remind him he’ll be eating breakfast early today because he needs to fast for several hours before his open heart surgery when I saw him bury his face on his hands, thin shoulders racked by tears he tried to muffle at first. I have seen bloody chests gaping in front of me and have thought no scene could possibly shock me more, but I wasn’t prepared when Farid, a grey-haired accountant, cried in front of me, utterly scared.

In the years I’ve studied and worked as a nurse, I have learned how to give medications through every route possible, assist a doctor in inserting a line down a patient’s jugular if there are no veins to be found, insert a breathing tube if the patient couldn’t breathe on his own. I thought I got everything covered, until Farid, inconsolable, shattered my illusion that medicines and artificial tubes could solve almost all of a patient’s problems.

In nursing theory, the solution to this problem would be to offer emotional support by using therapeutic communication. Farid’s heart rate is climbing up to the 140s again and his rhythm getting erratic and we want his heart rate to be stabilized as much as possible. But how do I go about making “emotional support” silence the damned monitor’s beeping and keep the red warning lights down?

When inserting a needle into a vein, there are steps: locate a vein, swab with antiseptic, insert. Even hand washing has seven specified steps. But “offer emotional support” doesn’t come with standard operating procedures, just generic lines like offering self, silence, using general leads to help patient cope with his feelings.

At the surgical intensive care unit, most patients are already aware of their critical situations and have accepted it, thereby making them less anxious. But sometimes, patients like Farid, though all questions about their condition and operation had been answered thoroughly, still have extraordinary levels of anxiety.

I tried an open-ended question, “Mr Farid, tell me what’s bothering you.” He answered, “I’m very nervous about my operation, I just know I will die” then cried like a baby, not a word could get through him nor could I get a word out of him.

Should I just forget about therapeutic communication? “Mr. Farid, everything’s going to be fine, and we shall see you again Inshaallah” (while thinking about the surgeon’s assessment that surgery could kill him, what with his kidneys not functioning and his immune system compromised.)

After deciding nothing I could say could help at all, I tried the last thing I thought would work: silence. I stayed silent by his side like my whole world revolves only around him. I opened his bowl of fuul, squeezed the lemon on it, and wedged two slices of white cheese between ayeesh. He acknowledged the gesture, and through sobs, told me this would be his last breakfast. I felt like a warden serving an inmate’s last meal before he’s brought to the electric chair. A lump in my throat suppressed a sob; crying would be the most non-therapeutic thing to do.

His wrinkled hand gently took the spoon from me as I was about to help him to another spoonful of fuul. He held my hand for a few seconds, mouthed a thank you, closed his eyes and continued to cry, at least soft broken sobs this time.

The doctor passed by, saw the heart rate still a bit high, and decided we will have to sedate him. The beeping of the monitor finally stopped. In that quiet room, I realized that I’ve somehow forgotten that a patient doesn’t need me running for all sorts of medicines to treat his heart or the monitor. Sometimes, all that an anxious heart could understand is a silent, unhurried presence, not a thousand words of reassurance.

(Mr. Farid died ten hours after the surgery. He was advised beforehand that his mortality risk is high due to pre-existing kidney failure, requiring him to undergo dialysis twice weekly. But his sons insisted, and Mr. Farid consented, for the surgery to go through, clinging to a very thin slice of hope for a few more good years.)