Thursday, April 03, 2008

Of Order and Chaos

I enter the apartment building and stop at the security desk.

“Who are you here to see?” asks the surprisingly pleasant security guard. She is a large African American woman, and she regards me with a friendly and curious expression.

“I’m here to see Mr. A,” I reply, fingering the ID badge that's clipped to my jacket. “Visiting nurses.”

“Oh, God bless you,” she says. “Good luck. Tenth floor, turn right out of the elevator."

I travel the ten floors in the briefest of upward journeys, and make my way down the hall, looking at the numbers on the apartment doors. His door at the end of the hall is wide open. I stand on the threshold and peer in. I knock and a voice responds, welcoming me in.

“Mr. A? I’m from the visiting nurses. May I come in?”

“Sure, sure, come in, come in,” says a disembodied voice from inside.

I step inside the studio apartment. To my left is the kitchen, or what once was a kitchen and is now more of a storage closet which only pretends to be a kitchen. Every surface is covered with papers, pens, and trash. Even the counters are covered, and the sink is full of dishes as well as a sheaf of papers and a telephone book.

Mr. A pokes his head around the wall that separates the kitchen from the living room.

“Come in here, please, please,” he says invitingly.

The fax that I received on this patient said that he could be combative, distant, or uncooperative. This gentleman seems so much the opposite, at least at first glance, anyway.

“How are you this morning?” I ask, as I attempt with some difficulty to clear a place on the table to put my bag.

“Oh, not so good, not so bad, but I’m going to visit my sister later today.”

His accent could be Indian, or maybe Pakistani, but I don’t want to ask. His diagnosis is paranoid schizophrenia, after all, and as a nurse who is visiting him for the first time, I don’t want to potentially alienate him from the start.

I take in the rest of his living space. The twin bed in the corner is covered with papers, envelopes, and a few plates of partially eaten food. A rowing machine takes up most of the center of the small apartment, and I marvel at the flotsam and jetsam that covers every surface.

“Did you take your meds last night, Mr. A?” I ask.

“Oh yes, here you are,” he says as he hands me the pill container which yesterday’s nurse prefilled for him yesterday morning. It’s empty.

“How did you sleep last night?”

“Very well, thanks,” he replies. His eye contact is good, although he seems to be uncomfortable sitting still at the table with me.

“Oh, before I forget, could you sign this for me?” I hand him my visit note, which has a place for patients to sign as proof that the nurse was actually there for the visit.

“That’s for them to know you were here, right?”

“Yes sir, you have that right, “ I reply.

He is so conversant, so positive and forthright. He is like the opposite of what I was told to expect.

I survey the remainder of his living space and see piles of papers everywhere. There is trash on the floor, chicken bones, milk cartons, a few cardboard boxes. I wonder what trauma or experience caused him to live like this. Although his eye contact is good, there is a wariness that I am now picking up on, a sense that he is uncomfortable in his own skin. Still, I feel completely comfortable with him, and we smile at one another.

I busy myself filling his med box with his morning and evening pills, reading the list carefully and putting my initials in each little box after I place that particular pill in its rightful place. He watches me closely. Once I‘m finished with the meds, I double-check the list and feel satisfied that I did it correctly. I hand him his morning meds.

“Thanks,” he says as he pops them all in his mouth and raises a large mug of water to his lips.
I check his blood pressure and pulse, listen to his lungs, and questions him briefly about his bowels, his urinary status, his appetite, his sleep quality, all the while looking in his eyes, assessing his skin and getting a general intuitive “read” on his overall health.

“Thanks for coming,” he says, as he walks me to the door.

The floor, covered with trash and papers, is like the elephant in the room that I dare not mention. Were he my patient, I would slowly address these issues over time. But in my position as just one more nurse passing through, I leave the elephant for someone else.

We shake hands and I leave his apartment. Even though I have been to so many homes like this in the past, I am stunned by how this man lives, and by the quiet desperation that I saw in his eyes.

“And how was our friend today?” asks the security guard who blessed me just thirty minutes prior.

“Just fine today, just fine,” I reply. “Thanks for your help.”

“God bless you” is her reply, delivered with a wave and a smile.

The outside air is fresh and cold, and I welcome my reentry into the clean orderliness of the wider world.

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