Generational lessons in clarity
By Elizabeth Fleming
I went to work twenty minutes after my mom told me the hospice nurse diagnosed my
grandma with pneumonia. She was finally dying. I allowed myself to cry for exactly three
minutes, packed my lunch and soldiered to the hospital. I plodded to the pediatric
emergency department, wishing to be staring at a differently patterned tile floor. I
reminisced about craft projects with red baubles and little jingle bells, I paged through
her tediously collected home remedy book in my mind, and conjured images of wedding
photos of draped satin.
That night I took care of a little pigtailed blonde with asthma. Her lungs were filled with
sounds, a violin wheeze and a small percussive rumble. I listened to her tired organs and
thought of my grandma. This little one had so much reserve, a heart growing in its
muscled strength, elastic alveoli to recover from this new assault, and synapses that
sweetly twist and twirl to interpret new input from her ever-growing experience.
My grandma is dying. Her neurons are coiling and infarcting. Her pathways are halting.
She plods along tiled hallways in the nicest of wheelchairs, grabbing at aids hands to join
her on her stroll. She communicates in agitated sounds that only occasionally form
words. She is fed each spoonful of her pureed food, pureed peaches, pureed peas, pureed
cheeseburger. She drinks three cartons of grape juice daily. My aunt read that resveratrol
helps with Alzheimer’s disease. She gives her juice the way she attends Sunday church,
religiously and somewhat resentfully. She thinks it keeps her alive.
I did my best to be a diligent medical student. I learned the story, recited it dutifully to
my attending, and guided the family through their ED treatment. I was gentle with my
exam and applied the tricks I have developed in my medical training. I lit the tip of her
finger like a jack-o-lantern with the otoscope and looked in her ear canals for Dora. I
hope someone shows these small kindnesses to my grandma. The nebulizer treatment
opened her airways. As air rushed through, the violins slowed their assault. We sent her
home.
My plane departed two days later. I met my parents at the airport and hugged my mom,
finding it difficult to let go. While I wanted to say goodbye to my grandma, mostly I got
on the plane to support her. It has been so hard for both of us to experience the decline.
My mother is a brilliant physician. She always wins at scrabble and she magically knows
the answer to every jeopardy question. I tried to convince her to be a contestant for years,
but she prefers the exercise of trivia nestled on the couch.
My mom bought me my stethoscope. It is a navy blue Littman. When I opened the box, I
viewed its shiny bell and rubbery tubing with reverence. I untucked it from it’s packaging
and gingerly put the earbuds into my virgin canals, backwards. She smiled and turned
them around.
Now, my stethoscope is painted in MRSA. I clean it with those alcohol wipes that scatter
nurse’s station counters and the antibacterial goo that oozes from the dispensers that
adorn hospital hallways. But like me, it has been encrusted with the experiences of
patient care. My stethoscope has listened to thousands of thumps, rustles, and growls.
Together we detected the harsh murmur of aortic stenosis in an avid bass fisherman and
sighed at the soft tinkle of obstruction in a woman too young to be recovering from
surgery.
My mom asked me to pack my stethoscope for the trip.
My aunt was in a harried frenzy when we arrived, she welcomed us warmly and talked
excessively, thankful to have company and a momentary respite from being the primary
care giver. She described each detail of the past week at the nursing home in one long
sentence. She paused and looked to my mother. “What do you think? Do you think it will
be long?”
My mom insisted she couldn’t know until our visit. My parents and I went to the nursing
home as a family. I hadn’t seen her for two years, but I remembered what it felt like to be
with the shell of the woman I knew and loved. I squeezed my mom’s hand as my dad
opened the locked inside door.
We found her in the dining room, slumped in her wheelchair in a row of well-kept
sleeping white heads. She had a hand-made valentine resting on her lap that said, “I love
you” in scribbled crayon. I didn’t recognize her at first. Her face has slid down her bones,
but when she opened her eyes I recognized the exact shade of blue that my mother
inherited. The color that pierced my defiant teenage stare and welled with tears the day I
got engaged. She looked at us blankly and recoiled from the coldness of my hand when I
brushed hers. I smiled my bravest smile, and we rolled her back to her room for a chat.
Her space is small, but not overcrowded. A blue recliner rests in the corner. It had a twin
when my grandpa was alive; they used to sit and complete crossword puzzles together
and watch chickadees flit past their window. There is a painting on the wall of two young
women dressed in petticoats winding through a meadow. I can’t help but wonder if my
grandmother was musing about her children as she placed each stroke on the canvas.
It was in the quiet of her room that I first noticed the calmness of her breathing. My
training took over without my consent. I counted her comfortable respiratory rate, I
observed her pink cheeks, and noted the turgor of her skin. The hospice nurse was wrong.
My mom listened first. She was gentle, showed the stethoscope to my grandma and
carefully slid it beneath her sweater to listen to her breathing. She reported a systolic
murmur and clear lung fields. I hesitated for a moment, but needed to hear for myself.
My grandma looked up at me suspiciously, but did not seem to mind my exam.
I listened first for the murmur, a wave that rushed after the soft lub of her valves. She
leaned forward to my touch and I listened to the clear sounds of rushing air transmitted
through her tissue paper skin. She looked up at me as I listened; I imagined she was
trying to place me. I saw so little of the glorious painter in her face that it is difficult to
know how much she could understand. I hope she imagined I was someone kind.
The reality was that I wasn’t quite sure how to place myself. I was playing doctor with
real equipment and recently acquired medical knowledge. I was exercising my clinical
judgment about a common problem in a very unfamiliar setting. I expect I will get used
to balancing my new role as clinician, but it was easier before when I could just be
family. I squeezed my mother’s hand. I wanted to hug my grandmother, but I knew she
would recoil. I smiled at her reflexively. Her eyes focused on mine for an instant and I
placed my stethoscope in my purse.
I wish we were pleased with our exam findings, relieved that this was not our goodbye.
But she has been sick for so long. My grandfather left us years ago and her life seems so
small now. She passes her hours by staring at parakeets in a tall glass case and sleeping
next to television sets with game shows blaring. I wish her clear lungs meant the same
thing for her as it did for that little blonde in the Emergency Room. Instead of going
home to play, she will continue to plod along in her wheelchair, grabbing at aids hands
for company.
We stayed awhile. I fed her bites of pureed entree and held the grape juice straw to her
lips. She drank all three cartons. My mom and I chattered at her about my upcoming
graduation, her new job, and their old clock that chimed birdcalls to herald each hour. I
told her about my fiancé and how my mom and I both envy the satin shoes that peeked
out below her wedding dress in photographs. I told her that one of her paintings hangs in
my bedroom. She joined us in conversation in her way, expressing sounds that resonated
in a conversational tone. I suppose it was a lovely visit.