Said Another Way

Please, Don't Leave Me Alone

by Nelda Samarel, RN, EdD

Nelda Samarel, RN, EdD, is Associate Professor, School of Health Professions and Nursing, William Paterson College, Wayne, NJ.

Nursing is multidimensional, interactive, interdisciplinary, and complex. Almost any- thing that can be said about nursing can be said another way. Some things worth being said and heard will not follow the norms of journal presentation. A forum accommo- dates the emerging voice, the new format, the innovative approach. Nursing Forum, in an effort to honor the "independent voice" in nursing, presents here the voice who elects to enter the dialogue, but who does so "in another way."

My eyes open to intense pain pervading my entire being. There is no awareness of the point of origin of the pain, just the feeling of the pain. 1 see harsh lights, movements, a blur of white with bright green or blue interspersed here and there. The noise is incredible, creating a din mufling sounds of rolling wheels, doors opening and clos- ing, voices. The only thing that outweighs the pain is fear. Actually, terror. What is going on here? Where am l?

1 believe 1 know who I am, but everything else is unclear. What is persistently real is the pain. The din and the movement are all in the background. Only the pain is here. And the fear.

I am dreaming and i f1 can wake myself up it will be over. But it is so difficult to wake up. 1 feel drowsy. Not drowsy enough to mask the pain, but too drowsy to will myself to move. lfl focus all my energy, 1 know 1 can wake up and end this nightmare.

So 1 try to sit up. I cannot. Something is prevent- ing mefrom moving. 1 ty to turn my head. I cannot. The pain, already intense, becomes unbearable. 1 try to speak. No sound comesfrom my mouth. But my arms move. So, using the only resource available, my arms, I try to change what is happening. lf1 can move my arms hard enough, perhaps the rest of my body will wake up. lflail my arms.

As ifcoming through a long tunnel, 1 hear a voice in the distance. The voice repeats, "The operation is over. You're in the recovery room." The voice is speaking to someone who has had an operation. I t comesfrom an unseen person. Speaking to whom? Certainly not to me. Where am I?

1 am totally out of control of my situation. This new experience of being out of control evokes a terror that begins to overtake the pain. Again and again 1 hear, "The operation is over. You're in the recovery room. " But 1 see no one. Am 1 in a "recovery room" somewhere? Perhaps a nurse is trying to reassure someone else about her operation. Straining to look on either side without moving my head and increasing the

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Please, Don‘t Leave Me Alone

pain, 1 see what appears to be endless rows of stretchers with people on them. Now the dream begins to make some sense.

1 vaguely remember having a problem with a tumor on my thyroid. Wasn’t 1 supposed to have surge y? Yes, that’s it! I am scheduled to enter the hospital for thyroid surgery tomorrow and 1 am now having a dream (nightmare?) about the impending surgery. I must wake myself up. I can- not stand the pain. 1 ty to thrust myselffiom side to side, pulling at whatever my hands touch.

And then, for thefirst time, someone else enters the reality of my dream. I recognize the scrub clothes. A nurse’s face appears before me and again says, “The operation is over. You’re in the recovery room.” But 1 don’t care about that now. I only care about the pain. 1 try to mouth the word “pain. “ She understands. Thank God!

”You’re having pain. ” A blessed validation. ”I’ll get you something,” ln what seems like ajlash, she returns with an injection. Soon 1 drift off into merciful unconsciousness.

When 1 next open my eyes the pain is gone, but the fear remains. 1 feel movement at my feet. The nurse is there placing a clipboard at the foot of my stretcher. ln doing so, she brushes against my feet. 1 feel her and so 1 know she is there. I mouth the words, ”Please, don’t leave me alone.” 1 am so afiaid that the pain will return and 1 won’t be able to tell her about it.

”1’11 be right here. You won’t be alone,” she reas- sures. In relief, 1 close my eyes for a moment. When I open them, she is gone. Again, I am alone, afraid.

M y face feels wet. When 1 try to touch it my hands feel the cool plastic of an oxygen mask. I f1 can remove the mask I will be able to communi- cate. 1 try to pull on the mask. From nowhere, the nurse instantly reappears.

”We’re just going to take this tube out of your nose. ” The mask is quickly removed and some- thing (the nasotracheal tube?) is pulledfvom my nose. At least, I think it’s my nose. I had no idea there was anything in my nose and now a tube has been pulled fYom it. How strange and fright- ening not to know what is happening to my own body. The mask is being reapplied to my face as 1 mouth the word ”wet.”

”Your face is wetfiom the mask.” Another wel- comed validation. ”1’11 dry it.” The dry mask is replaced on a dry face.

1 hear myself saying, ”Please, don’t leave me alone again.” Now that I am extubated, 1 can make sounds. I can be heard!

“Don’t worry. 1’11 be right here.”

As the nurse leaves my line of vision, 1 again drift offinto unconsciousness, alone. As 1 keep drifting into and out of consciousness, 1 look for

32 Nursing Forum Volume 25, No. 2,1990

the nurse. Several times I feel her at my feet with the clipboard. Other times 1 feel her moving my arms or touching parts of me. Those times, when 1 feel her touching me, I know that she is there. 1 need help, she will help me. But what i f1 need help when she is not there? Please, don’t leave me alone.

Looking Back

The four hours I spent in the recovery room fol- lowing a thyroid lobectomy seemed like four life- times. Each minute seemed like an hour. This was especially true in the minutes (hours?) that elapsed before I realized where 1 was. Reality was distorted; sleeping and waking merged into a continuous blur.

1 am normally a person who lives in my head, always maintaining control of my situation. The pain was frightening, but the disorientation and lack of control were worse than the pain. 1 had no control over my body parts nor did 1 have any knowledge of what was happening to them. I was alone, or so 1 thought. 1 could see no one who could help me when 1 so desperately needed help.

As a nurse educator, my thoughts now focus on what I can learn from my own recovery room experience. How could this experience have been different for me? How could my needs have been met in a dzfferent way so that the disorientation and resultant fear may have been somewhat miti- gated? In no way am I implying that the care I

received was inadequate. In fact, 1 continue to be impressed with the quality of the perioperative nursing care 1 experienced. Nevertheless, my recovery room experience was most unpleasant. Believing that my personal experience may be typical of others’ experiences when awakening from general anesthesia, I thought it would be helpful to other postsurgical patients if1 could identify ways that my own psychosocial needs may have been more adequately met. Living a personal philosophy that allows (or demands) one to learn and to take positive experiencesfram each life event, 1 searched for ways that may have made my own recovery room experience different.

The nurse continually tried to reassure me by saying, ”The operation is over. You’re in the recovery room. ” Yet those words offered me no reassurance. 1 was not sure they were directed to me. Nor did 1 realize they were spoken in real- ity-outside my dream. I questioned the reality of the words as I questioned the reality of my entire experience. Perhaps the words would have seemed more real if1 heard my name. Certainly, had 1 heard my name, 1 would have known that the words, whether real or a dream, were intendedfor me and not for someone else.

What was reassuring was being touched. The only touch I received was the casual touch accompanying routine assessment. This touch, however, reinforced the reality of the experience as well as the reality of the helpful presence of the nurse. When 1 felt the nurse’s touch, 1 knew she

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Please, Don’t Leave Me Alone

was present and I knew she was taking care of me. Knowing that the nurse was present reas- sured me that, if the pain returned, I could imme- diately let her know. When I was not being touched I had no way of knowing the nurse was present because I could not see her!

As in most recovery rooms, the nurse remained a t the head of my stretcher, out of my line of vision. Although she was with me constantly, watching and monitoring, I had no way of know- ing she was there. When I was unable to see the nurse and when I was not being touched by her, I was alone. Auditory stimulation, or the reassur- ance that, ”the operation is over; you‘re in the recovery room, “ was insufficient reality orienta- tion for me. Looking back on my own recovery room experience, I needed a combination of audi- tory, visual, and kinesthetic stimulation for reas- surance and reality orientation.

On a deeper, more humanistic level, what I sought to meet my needs during this most stress- ful event was the nurse’s caring presence. Caring in nursing is more than a feeling or intention. I t is an interactive process (Mayeroff, 1971) that requires the nurse’s existential presence, that is, attention fully with the patient, listening and responding in an unsolicited manner (Riemen, 1983). Caring denotes concern, devotion, and commitment and is expressed nonverbally more than verbally (Leininger, 1981).

While her verbal reassurances may have been

intended to orient and reassure me, what com- forted me most during my recovery room experi- ence was the nurse’s nonverbal interaction. Her visual presence and her touch conveyed a caring that comforted me.

As a nurse educator, I wondered what I could learn from the pain and fear of my own recovery room experience following a thyroid lobectomy. Through personal experience, I have learned that nursing must be practiced as a caring art if nurses are truly to meet the psychosocial as well as the physiological needs of their patients.

References

Leininger, M. (1981). Caring: An essential human need. Thorofare, NJ: Slack.

Mayeroff, M. (1971). On caring. New York: Harper & Row.

Riemen, D. (1983). The essential structure of a caring interaction: A phenomenological study. (Doctoral dissertation, Texas Women’s University). Dissertation Abstracts Intevnat ional, 44( 10):3041 B.

Erratum

In “Professional Eth~cs and Patients’ Rights: Past Realities, Future Imperatives” by Megan- Jane Johnstone (Nutsaig Forum (1989), vol. 24, issue 3/4), an error appears on page 32. ?he

first sentence of the first paragraph should read: “It is NOT fair to blame or label the entire medical or nursing profession for the deeds of a cowardly and unscI7lpulous few.”

34 Nursing Forum Volume 25, No. 2,1990