Second Place Winner, 2023 Temple Health Essay Contest

September 8, 2023

John Mulligan, RN, MSN, CCTC Abdominal Organ Transplant Program

In May of 1986, I graduated from a three-year program at a school of nursing.  I went straight from nursing school to a critical care unit.  This was unusual back then as the thought process was that going directly into a critical care position was probably too much for a new nurse.  In hindsight, this was probably true for me. 

I was about three months into my position and heading toward the end of my orientation program but still working with a mentor every shift.  One evening I came in for 3-11 shift and was told I was being pulled to a step-down unit.  I was going to a unit I had never worked on before as a RN.  My mentor was not coming with me, I would be flying solo.  By today’s standards this all seems a little crazy but back then there was much more of a ‘throw the new RNs into the pool and let them swim’ mentality.  Thank goodness things have changed. 

I had four patients on the step-down unit.  One patient, who we will call James, was very sick.   James was in his 40’s, probably never went to a doctor in his adult life but recently was experiencing severe shortness of breath and a nasty productive cough.  By the time he came to the hospital he was diagnosed with lung cancer which had metastasized.  On the evening I received James he had two chest tubes; he had just been told of his diagnosis and he was physically and emotionally reeling.  The RN giving me report let me know that in her opinion he was nasty and unapproachable.  Her advice to me was to stay clear of him as much as I could – yikes!

By the time I walked out of report I was a wreck.  I was feeling as if I was in way over my head.   I went to see my patients and saved James for last.  I knew with my limited experience that he was going to be clinically challenging.  I figured what I could not provide him with in clinical expertise I would try to make up in effort and in doing whatever I could in providing him with emotional support.  I would also be as kind to him as I possibly could despite how he treated me. 

My first few visits with James during my shift were tense but eventually we seemed to begin to trust each other.  By the end of the shift, we were engaging in conversation easily but most importantly I felt as though I had given him sound clinical care.  I went home completely drained and seriously questioning my career choice, I could not do this on a regular basis. 

The next evening, I came to my critical care unit for 3-11, my mentor Patty told me that James was now on our unit.  James was vented and unresponsive, his wife was at his bedside.  I had not met James’ wife the evening before therefore I did not know her.  I was still emotionally drained from the night before; I told Patty I could not take care of James this evening.  Normally, Patty would not allow me to dictate how we were going split the assignment or who we were going to take care of. On this evening, Patty could see that I was at the point of a breakdown, she permitted my request.  Patty and I agreed that she would take care of James and I would take care of a stable post MI patient.   

Throughout the evening I steered clear of James’ bed and kept myself busy with my patient.  Patty was very busy with James all evening and we had very little contact.  It was about midnight when Patty and I were finally leaving the unit together.  As we came out of the unit and were walking toward the elevators Patty saw James’ wife, she told me she needed to briefly discuss something with her.  As I was walking away, Patty said to me, “John, meet me at the elevators.”  Keep in mind there were not many male nurses at this time.  James’ wife heard Patty and said to me, “excuse me, did you take care of my husband on the step-down unit last night?”  Oh boy, I was thinking, do I admit that it was me?  I hesitantly admitted that I had cared for James last evening.  She burst into tears and said, “James told me you were the best nurse he ever had.”  She walked toward me and gave me a hug, at which point I broke down with her. 

The evening of caring for James, along with the stress of trying to assimilate into the profession of nursing almost drove me out of nursing before my career ever took flight.  The interaction with James’ wife may have saved my nursing career.  I was clearly not the best nurse who ever took care of James, I was at best competent.  I learned a valuable lesson in this experience, patients often need kindness as much as they need clinical expertise.