by Courtney Polimeni
1st Place Award winner in the 2023 Hope Babette Tang Humanism in Healthcare Essay Contest
“It won’t be long now before the leaves begin to change.” I told her, looking out the window as I stood by her bed. I turned toward her and pulled up the folded edges of her crisp, white sheets, tucking the ends of them neatly under her chin. “When you are feeling better, I’ll take you outside so you can see for yourself. The trees here are beautiful.” Amelia was 47. She had been 47 for just a few days, but she did not celebrate her birthday through any traditional means. She passed into her 47th year of life in the ICU at the level one trauma center where I worked. She was intubated and sedated following a high-speed motor vehicle accident in which she was the driver of a head-on collision. I had never seen Amelia with her eyes open, nor had I ever heard her voice. She was not, as we might colloquially consider her, “awake”. It is said that the last of our five senses to fail us is our hearing, and I could not bear to think that she was trapped in silent darkness, so I spoke to her. Since her arrival days prior, I spent many hours caring for Amelia, but I like to think she appreciated it most when I told her what was going on outside. The world does not stop for the sick and the dying, you see, and it is easy to feel left behind.
The practice of nursing, when you love it, is an art. There is a tranquility that can exist in the ICU, a state of healing through which patients learn to cope with and to experience the tenuous nature of the human condition. To bear witness to and to facilitate this process is a blessing beyond words, beyond understanding. And so it was that I found myself caring for Amelia, day after day. I cleansed her skin, and I combed her curly hair, braiding it together with a band I bought for her at the hospital gift shop so that it would not become knotted and unkempt, and I wondered at who she was before all of this. She was, according to the brother who came daily to visit her, an energetic, wonderful person. I believed him. She could have been my mother, my sister, or my friend. She could have been me.
“You should see the moon tonight, Amelia. It’s a harvest moon, big and orange and blazing so bright in the sky there are shadows on the ground in the dark.” The nights were getting longer, the days shorter, and Amelia’s brain was swelling dangerously within her skull. Her neural activity spiked at night. She “stormed”, as we call it, and she needed additional sedatives to maintain normal vital signs. Her intracranial pressures were extremely high, and her neurological exam was steadily declining. Her brother spoke to the ICU intensivist earlier that day and agreed that if Amelia did not begin to show signs of improvement soon, we would begin to transition our goals of care to keep her comfortable. This was never the easy part. There is so much we can do, after all, to save someone. From the very edge of death and beyond it, we can maintain life. With the best of intentions, we do what we can, and we’ve gotten so good at it that sometimes we don’t stop and ask if we should. But Amelia was not living. At least, not in the way that she had been before. She was simply persisting, now, with our help. The leaves were changing to a russet, burnt orange, to yellow and cinnamon and amber and red until they finally let go of their branches and fell softly to the ground below. Amelia was waiting to let go of her branch as well- or waiting for us to let her.
The day Amelia died, we made sure that she was clean. Her brother said she liked Fleetwood Mac, so with “Dreams” and “Go Your Own Way” playing softly in the background, we made sure that her hair was combed and that her crisp, new linens were tucked softly under her chin once more. Her brother was there beside her, and I beside him. Sometimes, you feel like a stowaway passenger in someone else’s story, showing up in the very last chapter where you don’t belong. How odd it was that I, a stranger, should be here to bear witness to one of the most important events of Amelia’s life. But I had just spent some of the worst days of Amelia’s life with her, too, through her worst pain, knowingly or not, and I had cared for her as if she were my best friend. When I left the room to give her and her brother privacy, I pulled the curtain and slid the door shut softly behind me. I took one last look through her window, a corner room on the third floor of the medical tower. The view outside her room was blocked in its entirety by the drab, red brick wall of the building next to it. I wondered then if she would mind that I had made it all up, but I don’t think so. When we really love it, we lend a little bit of ourselves, a little bit of our souls to the work that we do- to the art of nursing. If it is not us today, then it may be us tomorrow, and I hope that someone will be there to tell me what my view is like outside my window, too.
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