When I met Mark, he was reading Deepak Chopra’s book, Life After Death. That was my first clue that he might be thinking very serious thoughts. I introduced myself as his nurse for the evening and conducted a physical assessment. Then we began to talk.
A hemophiliac, Mark, age 38, had been admitted to our unit after an emergency tracheotomy in the emergency department (ED). Routine dental care had left him with an abscessed tooth, and bleeding from the abscess had totally occluded his airway.
A few days had passed since his harrowing ED experience. His trach was now capped and would be removed soon. Although still weak, Mark was able to talk and eat solid food. He told me he’d been through many scary things, including a bout with cancer, and had made many ED visits for bleeding—but nothing had traumatized him like this incident. Although his condition had improved rapidly once he was treated in the ED, he’d requested and signed a do-not-resuscitate/do-not-intubate form there. He told me he was scared and frustrated, and never wanted to go through something like that again.
I acknowledged his feelings as valid. We seemed to connect well, and I served as his nurse for the next 3 days.
On the second day, I brought Mark a bookmark for Life After Death. I appreciate Dr. Chopra’s work on the body-mind connection and am familiar with many of his books. Mark and I talked about one of Dr. Chopra’s suggestions for people seeking ways to cope with change and life transitions: finding a positive mantra (a form of good self-talk) and using it to engage the mind in helping the body to heal.
Mark admitted that despite his improved physical condition, he was stuck in the angst of his ED trauma. All his energy was occupied in reliving it and dreading what might happen next. “That’s all I can think about,” he told me. “I feel like I’m drowning in fear.”
A timely interruption
In the middle of our conversation, I decided to use a technique some therapists call pattern interrupt to halt his negative thought pattern. “Are you a Monty Python fan?” I asked. “Yes,” he replied. “I love British humor.”
“Do you remember the scene from ‘Monty Python and the Holy Grail’ where the dead collector is pushing a cart and calling out, ‘Bring out your dead!’? When a passerby tries to load a body onto the cart, the body says, ‘I’m not dead!’”
Mark laughed and said, “Yes, I’ve seen it. It’s one of my favorite Monty Python scenes.”
“Well,” I replied, “that ‘body’ is you, Mark. You’re not dead yet. And you’re not dying. Not today. Don’t jump on the cart!”
Mark was stunned that I’d used the “D” word. But he got it—and laughed. Really laughed. Although he’d been journaling, reading, and taking notes on how to change his mind/thought pattern, it took laughter to interrupt that pattern and begin to bring him out of the fear he was stuck in.
After that, every time I went into Mark’s room, he greeted me with his new mantra, “I’m not dead yet.” Over the next 2 days, I could sense his angst and dread lifting.
A few days later, he went home. About a week later, I got a beautiful letter from him. At the top of the page, he’d written, “I’m not dead yet.” He thanked me for giving him hope and addressing his fears head on. “You took me from despair to hope to laughter,” he wrote. “Thanks.” His family also sent me a sweet letter of thanks.
Nursing is about supporting patients to find ways through the healing process that fit within their belief system. For Mark, a little laughter and a little hope were the ways.
Mary Delisle, RN, is a staff nurse in the Neurosurgery, Neurology, and Otolaryngology Unit at the University of Michigan Hospital in Ann Arbor.