Beyond Hope

CHAPTER 1

The strident ringing of the agency phone tore me from my otherwise peaceful sleep. A call-out for a nursing supervisor is usually one of distress. Some worse than others. I pulled my uniform over my head and placed an old and cold cup of coffee into the microwave for about a minute in hopes that it would sustain me through this call-out. I had no inkling of the medical emergency I would be facing and certainly not the ramifications of my assignment.

I had been a registered nurse for many years and figured I had seen it all. Until that night. I had seen a lot, but when I had made my decisions and exercised my judgment, I had always had the last word and managed to get through the crisis unscathed. Now I was about to face something so bizarre that nothing in the medical books, law books or nursing protocol could guide me or make the decisions I was about to make any easier.

When it comes to saving a life, decisions become critical. When we stop and think about losing someone we all become less rational. Like trying to find some way to stop the Titanic from sinking. As we attempt to bail out the sinking ship sometimes we find help or we may be put in a position, which creates even more danger than taking on seawater.

As a nurse I became accustomed to people fighting the wreckage of their health. I saw them struggle to walk, see, and hear or to regain a function that makes life on this planet feasible. I have always believed there is a time to step back and simply walk away. I also believe the patient himself has the right to make that decision whenever he’s capable and willing.

Stephen Milford Hastings was thirty-one years old when his entire world suddenly crumbled before his eyes. The reason for this train wreck was a derailment of his general well being that appeared to develop over a number of years.

This boy became my friend in my sophomore year. We were like buddies even though I was a girl. I heard some of my classmates call him a 'fag', but that never bothered me. He was just my best friend. The other girls thought he was cute and so did I. We graduated and went our separate ways. It wasn’t until years later that an incident happened during my nursing career that changed my attitude toward him and toward life in general. This close brush with the grim reaper altered my professional decision- making and my attitudes toward saving the lives of patients.

Harmony Lodge was a dim memory of my life growing up in Pasadena where I met Stephen. This was the house where I took my first piano lessons on a piano considered the gem of its day. A senior in our high school, a fellow we called ‘the maestro’ whose real name was Edward Jennings, lived there with his family and his Steinway piano. In those days any real pianist saw this instrument as the only piano. When I entered the eighth grade Edward was in the twelfth and had many younger students. I begged my mother to send me to audition for him because I had been playing piano for five years and felt like I was stuck at a level I couldn’t advance from.

The first thing Edward did was to introduce me to an advanced course in the classics, which took me from those silly little pieces to Claire de Lune inside of a few weeks. It changed my whole feeling for music and when I thought of that wonderful old house and that beautiful piano it bought a tear to my eye.

The house had been abandoned just before I started nursing school, sitting empty and sad looking as the weather and time had their way with it. The gutters sagged and paint peeled from the French door and window frames. The ceramic tile on the large wraparound veranda cracked and chipped randomly. The Spanish tiles on the roof were cracking and some missing tiles added to the derelict appearance of the once-stately structure.

The house was never locked and provided a refuge for various groups of street people retreating from the weather and cops when night approached. The strangest thing was the Steinway that sat majestically alone in the sunroom, possibly never to be played again. It didn’t seem to age. Perhaps it was the only form of joy the old house still knew.

Years later, when I walked home from nursing school, I would sneak into the back door and look around the house remembering when it was full of life and times were better. The strangest thing was that the old piano never moved from its original spot in the sunroom and I would be inspired to sit down and play as though time had never passed. I could still imagine myself being a classical musician some day. That was before scholastic achievement and professional duty became the divergence. I took the road offered to me as a professional nurse.

The rain came down in a deluge that was typical of California’s fall storms. The traffic was light, which was the only thing I could find to be thankful for at that point. It was a long drive to the old mansion whose demolition had been given a stay of execution by a health care franchise that then converted it to a care facility. Its historic stature protected it, allowing it to remain a part of the new residential facility. It was a beautiful and stately relic - at least a hundred years old - that clung to a forgotten corner in downtown Pasadena. The stark structure stood sentinel in an atmosphere full of sadness, garnished with an air of melancholy and pouring rain.

As the Lodge came into view, I couldn’t get my mind off the message I had received from the agency nurse, Get over there, stat! As I carefully threaded my Ford Focus between a Cadillac SUV and a Dodge Ram crew cab truck in the Lodge’s parking lot, I saw the exterior side door of the building at the back of the old mansion fly open. From where I was sitting, I could get a glimpse of the hall and a male nurse picking his way between the rain drops to an old Volkswagen Beetle parked on the far side of the lot. This area has been part of the old mansion’s ground and, even though it was now paved, the pavement still yielded part of its integrity to the roots of ancient trees left to guard the house. The man lit a cigarette after he climbed into his car and sat frozen in the front seat puffing away. The lit end went from gray to red and back every few seconds.

As I approached the small area, which had been a butler’s pantry, now a nursing station, I could see my agency nurse, Nora Blake, sitting in front of a little table, now functioning as a desk. It was an old Duncan Phyffe folding table, with drawers at each end that, in its day, held silverware. Now it was used for all manner of writing equipment, Post-its, staples and paperclips. I could see the patient call bell monitor, blinking away down the hall. As soon as Nora saw me, she jumped up and began striding toward me.

I’m so sorry for calling you out in the middle of the night like this. I just didn’t know what else to do! If we weren’t agency nurses, or I was more familiar with this place, I wouldn’t have called.

Nora seemed somewhat shaken. I had never seen her so disturbed by a medical emergency.

Don’t worry about it, I said reassuringly. I’m sure I would have done the same thing. Do you have the chart?

Nora fumbled as she handed me the chart from the rack. I looked it over, but didn’t see anything I recognized. I hadn’t heard Stephen Hastings’ name since high school. It never dawned on me that this patient could be someone I knew.

I wasn’t really familiar with this particular care home. I had been the supervisor for the nursing agency for some time and Nora and I had both worked sporadically together over some twenty years. I usually went to the larger facilities on a regular basis. Not the little ones like this. Especially not in the middle of the night.

Nora fumbled with the computer keys, pulled up the information and turned the screen toward me so that I could see it better.

Mr. Hastings’ chart is very complicated, Nora said. They’ve been treating him for over twenty years.

But look here! I immediately saw the reason for her anxiety. His chart has a Non-Intervention coding on it, a Living Will. I don’t know what you can do about that, I stated calmly.

Add to that the fact that his call light has been on for at least half an hour now, Nora said.

When did you last check on him?

About forty minutes ago, but I didn’t like what I saw, if you know what I mean.

So what does the facility supervisor have to say? What’s her opinion?

You mean his? That’s the problem. I think he’s hiding somewhere.

Really?

I don’t think he really likes Mr. Hastings too much, if you catch my drift.

No, I don’t really know what you mean, I said. Come on, what’s going on? If you think this guy’s life is at risk you have to tell me now! What do you think the problem is?

I can’t tell you exactly what’s wrong with him, but he spiked a fever over 104, about three hours ago. Then he started shaking like a leaf. The next thing I knew, he was soaking wet, dripping in perspiration. I can’t get him to drink anything, but he keeps trying to tell me how sick he is.

He’s going to get dehydrated without an IV and his electrolytes will go out. I remarked.

Yes, and that will kill him, even if the fever doesn’t.

OK, give me your flashlight. I need to be able to see what he looks like if he’s not conscious and I don’t want to turn the light on in the room.

Here you go. Nora handed me her light.

Just cover the desk. I’ll go as quickly as I can.

OK.

I still remember the intense feeling of gloom that crept over me as I walked toward Stephen’s room, hoping not to be alarmed at what I saw and sensing the threat I knew would be waiting for me once I crossed his threshold. When I reached the open door of his room I hesitated briefly, listening for any sound of the life signs I knew. All I could hear was rapid breathing even from as far away as twenty feet. A low gurgling accompanied it. The sound is well known to nurses as the 'death rattle'. It usually means, not only is the victim in great distress, but also carries with it a mandatory sentence. Mortality prevails.

Stephen, can you hear me? I called gently as I moved quietly toward his bedside and I could see that his eyes were open.

What’s wrong? Please, please tell me what’s wrong with me? he pleaded. His voice was shaky and it sounded like he was on the verge of tears.

Please… he begged. Please, please don't just ignore me. I need to know what's wrong with me.

I stepped back into and maintained my silence for a minute. When I knew I could take charge of the situation I approached and pulled the bedding off of the patient. Just as I had suspected, his body was covered with scars and sores, the ravages of his illness were starkly visible, even in the dimly lit room.

I hurriedly covered him back up and moved the flashlight to get a clearer look at his face. I felt myself gasp as I suddenly realized that this was no stranger. It was Stephen Milford Hastings! My dear old friend!

CHAPTER 2

I stood there for a moment trying to gather my wits so I could make my best effort to be professional. I needed to calm Stephen down first, and then figure out what my options were if I were going to take proper care of him. I had never taken any liberties with my nursing practice before this night. I found a loose sheet at the end of the bed and covered Stephen as best as I could to try to preserve his dignity.

I knew that doctors felt it was unethical to treat family members and usually close friends. They always sent them to someone else, another doctor, usually one of their colleagues. Most often a buddy from medical school so that they could maintain some level of communication. They settled for this to make sure their family’s health was treated more objectively. This was meant to be what was best for the patient, of course, which all sounds fine in theory and usually works. Not this time though.

I was caught up in the reality of the moment. I knew there was no one but me there to do anything, and I knew if I waited even just till morning, which was Sunday, no help would be available and he would be dead. I pulled together all the courage I could muster and tried to think of how I could give Stephen what he needed and still maintain my professional status.

Stephen, Stephen, listen to me. I know you, Stephen. We went to high school together.

I paused to let him answer. This would give him the time he needed to regain his composure and the time I needed to continue my professional assessments. He didn’t reply, instead he moved jerkily back and forth in the bed in a jagged pattern and groaned softly.

Do you remember me?

By this time I was sitting on the side of the bed and I reached out, grasped him on either side of his shoulders, and gently lifted him just high enough off the pillow so that he could see me. I knew many years had passed, but I hoped for some sense of recognition in his voice. If not, maybe in his eyes. I could detect that they were beginning to focus on me. He looked as though he was seeing someone he thought he recognized. Now, it was still hard to tell, but I was hoping against hope for that light to dawn.

It’s me, Stephen. It’s your old friend Katherine. Katherine Gilchrist. Don’t you remember me?

Katherine? he asked incredulously. Katherine. He paused. "Katherine Gilchrist! I can’t believe it’s you. It can’t be. Is it you? It is you. Oh, thank goodness, you’re here! My goodness, can you help me? No one will help me. You can! Can’t you?"

Stephen started to cry and as he did he began to hyperventilate. His breathing became so heavy and labored I was worried again that he might have a seizure. He suddenly grabbed the sleeve of my nurse’s scrubs, and looked me right in the eye. I felt an immediate sense of discomfort. Again, I had to clear my head and try to be as professional as I could. He had always had a piercing gaze. This certainly had not changed over the years.

I don’t know, I answered. I can only do so much. What can I get you? Is there anything you need?

I was running out of suggestions. His eyes deflected away from mine. He looked down and around the bed as if he was trying to find something he had dropped earlier.

Here. I held the glass up to his mouth. Try to drink some water so that you don’t get dehydrated. Can you drink this? I asked again.

I put the drinking cup with a straw in his open hand so that he could control his own drink more easily and hopefully not choke on it.

Thank you, he managed to say between gulps of air and sips of water. What’s wrong with me?

He had calmed down enough that I hoped he would finally be able to answer my questions. That was encouraging. He paused again trying to get his breath and bearings. He continued in a softer voice.

"I know you know. You’re smart. You’ve always been smart. We’ve been friends a long time, you and me. You know, we’re old friends."

He let go of the cup and flung himself back on the bed in an act of desperation. I grabbed it just in time to keep its contents from drenching him.

He breathed deeply and hesitated again.

I’m so scared.

He gulped for air spasmodically and almost rhythmically. Between sobs he blurted out his deepest fears.

Am I going to die? I feel like I’m…

Now with every breath he became more and more distraught. He was fumbling with the words, having trouble even forming them.

I… I feel like I’m going down into a black hole.

He paused for a few seconds, then grabbed the top edge of the sheet in both his hands and tugged hard on the corners. His face was contorted into a knot of skin, muscle and water.

Am I going to die?

He paused again to get his breath and then became more alert. He lay there poised to receive the verdict. It seemed as though he might have gained a little strength from some of the water he drank diluting his frustrations. Then he repeated himself in desperation. I’m not going to die, am I? That’s why you won’t tell me, isn’t it? You know I’m going to die. You know it don’t you?

He looked at me with that same old look I could remember from our years as young teenagers. That searching look, full of innocence and trust shone from his face.

But you can’t tell me. That’s it, you can’t tell me because even though you’re my friend, you can’t tell me because you’re not allowed to.

I couldn’t take any more. I was human too. I felt my professional armor being stripped from me as if it were a paper sack dress being torn from my body.

Stephen, you have to try to calm down.

That was all I could think of to say. It seemed so trite, impersonal, and inappropriate, but completely necessary at a time like this. I was being forced to treat him just like I would have treated a small child.

This isn’t helping you and, if anything, it could make you sicker!

I know, I know.

His voice rose in decibels and to a higher pitch. I watched him begin to choke as his arms flailed in the air as though he was trying to chase more oxygen and grab it somehow with his hands. He began to sob even harder as he continued his fight to breathe.

My…my…condition! What’s wrong with me? Please…please tell me…. I’ve got to know. Am I...Am I...?

He swallowed very hard as though he was about to throw up everything. I grabbed a towel and managed to get it under his chin and around his neck. Then he blurted out his sentence.

I am going to die!

With this he sank back onto the bed and started reeling aimlessly amid the scrabble of sheets. My brain quickly went into emergency mode, which was a combination of years of training with all my human instincts to protect and support him.

I grabbed him firmly by the shoulders again and with all my strength lifted him up in the bed as rapidly as I could into a sitting position. This made it easier for him to get his breath and I hoped that, by changing his posture and helping him to breathe it would prevent him from becoming frantic or precipitating a grand mal seizure.

He suddenly became hyper alert. His eyes focused clearly on me for the first time since I'd come into the room. As his eyes met mine there was an instant of complete recognition between us. The energy that captured this emotion of trust and empathy was reflected on our faces in the dim light sifting in through his window from the parking lot outside his room.

Listen to me., I said sternly, but with as much charity as I could muster. You are going to die.

I watched him stare at me, motionless in the half-light of the room. I looked directly back at him. My heart filled with human empathy as I felt the tears well up in my own eyes. I watched helplessly as the tears streamed silently from his. I fought these emotions back as best I could. I pulled him closer and held him tightly to my chest. He was so frail, so light it made all my feelings so much harder to control. I kept telling myself I had to be professional…for Stephen’s sake.

I felt some of the tension releasing from his muscles as though he’d taken some kind of sedative. I’m sure he felt some kind of release from the bondage of his worries and misery. He was aware that he was safe for now. He knew he was with someone he could trust, who really cared for him and about him.

As he slowly regained his composure, he started pushing me away. I could feel he still had some of the necessary fight to live left inside of him. He looked at me with a fresh look of self-determination. He still had the look of desperation in his stare, but something about the way his eyes were focusing had changed.

I knew I had to get past the damned Living Will and Do Not Resuscitate order hanging over our heads if I was going to do anything for him. With these two documents filed at the nursing station and the attorney’s office, Stephen and I had no rights of any kind. I had no professional judgment or help to offer him either. I couldn’t put words in his mouth. This was the hardest part. I had to think quickly, and legally, about what I could or couldn’t say if I was going to get us through this thing. I returned to my former assessment techniques, which I knew met the current requirements of medical protocol.

Do you want to die, Stephen? I inquired as clearly and clinically as possible. This time I asked the question with a little more emphasis, then fell silent hoping for a controlled response from him.

I said, do you want to die? You have to answer me! If you want me to help you, you have to answer my question.

His eyes began to clear further. I could see increased strength returning to his whole body, despite the streams of perspiration that trickled unrelentingly down his face and chest.

No, he said softly. No…No. The timbre of his voice strengthened. He paused to catch his breath. NO! You heard me, no!

He stopped speaking and gazed across the room as though he