Hurricane Marge
Sometimes, caring is all it takes to calm a stormy patient.

By Jeannette McCain, RN, MS, ARNP-C
May 9, 2005

It’s been 26 years since I started my nursing career, and to this day I can still remember my first patient. Marge* was a 46-year-old female with new onset diabetes. Her constant screaming and bell calling over the previous four days had already alienated the nursing staff.

I was the new kid on the unit, so it was decided Marge would be a great learning “opportunity” for me. I was an RN with a bachelor’s degree, so it was assumed that I’d be up to the challenge. But no matter how many degrees you had, nothing could prepare you for Hurricane Marge.

With report under my belt, I set out to make my patient rounds. I wasn’t even out of the nurse’s station when the call light in 218 started flashing and the cries “Nurse! Nurse!” began. As I entered her room, I almost gagged — the stench was horrific. I quickly understood why no other patient was admitted to this two-bed room.

I introduced myself and asked what she needed.

“Not another new one!” she lamented. “Didn’t they tell you? I get to have a cigarette at 4 PM, as long as you stay. They’re afraid I’ll burn the place down!”

Sit in this room while she smoked a cigarette — was her doctor crazy? And I had way too much work to do! These thoughts must have been visible on my face because Marge quickly added, “It’s a doctor’s order, so you have to do it!”

I saw this was more than just a nicotine addiction: It was her way of exerting some control. Over the past six weeks, Marge had undergone multiple diagnostic and invasive procedures and treatments. She had gone from being an independent, healthy individual to being sick to finally being restricted by hospital rules for the terminally ill. As I scanned my patient assignments and medication lists, a plan formed in my mind.

Marge’s bladder cancer had metastasized to the brain, and the high doses of steroids she took as a result had caused her to develop diabetes. I noticed her last dose of pain medication had been more than six hours ago. I asked if she’d like a dose of pain medication so that we could go to the solarium for her cigarette.

“You mean get out of this stinking room for a walk, too? You bet!” she exclaimed. “I’ve been stuck here for four weeks and could use some fresh air.” We agreed that I’d return to gather her up for her walk and smoke 40 minutes after her shot. This would allow her to move more easily and give me a chance to take care of my other patients.

Forty minutes later, while my coworkers looked on in shock, we walked to the solarium. The nurse’s aide assigned to me had agreed to make straightening and freshening her room a priority while we were out. Fifteen minutes later, as we entered her room, the scent of vanilla greeted our noses. Her room was completely clean and inviting. The nurse’s aide was even able to convince her to take a bed bath, the first in a week. Soon after, she fell asleep and I was able to tend to my other patients.

As the dinner trays arrived, so did Marge’s family. They lined up outside her room, seeming to brace themselves for some kind of calamity. I went to introduce myself and check on Marge. As we all went in, I could see the shock on their faces. Marge was sitting in a chair eating, with her hair combed and in a clean gown and housecoat. “Mom, you look wonderful! Are you feeling better? The room smells so nice.”

A short time later, Marge’s eldest daughter said they were leaving to smoke, so I suggested they go with her to the solarium so she could have her last cigarette for the day. “My mom’s dying and in too much pain for that!” she exploded. I told her I would give Marge her pain medication so that moving would be easier and she could enjoy
visiting with them. And I added, “You don’t know how much more time your mom has. “ With that she agreed to try it, but warned me to be prepared to run if called.

All went well, though. Marge was even heard laughing and kidding with her family. Later, they kissed her goodbye, and Marge got settled into bed. As the end of my shift approached, 218’s call light came on. I asked Marge what she needed as I walked through the door. “To say thank you!” she replied. “You’re the only one who treated me like a living human being, who didn’t make me feel more stupid than I already do about smoking. You made me feel alive, not like I’m dying.”

In coming days, Hurricane Marge and I negotiated times for walks, cigarettes, and baths. She talked about her life and family — and her impending death. Marge’s biggest fear was dying alone. I asked her if she had told her family about this.

“No,” she said. “What can they do about it?” That evening, I told Marge’s husband and children about her fear and suggested dividing up and visiting in shifts so someone could be with her at all times. I got physician approval for extended visiting hours. Soon, Marge was rarely alone.

Returning to work after the weekend off, I found Room 218 empty. Marge had died the night before in her husband’s arms. On our message board were two envelopes for me. In one was a thank-you note from Marge’s family for taking such good care of her and allowing them to be at her side.

The other envelope held a cut-out magazine picture of an angel with my name above it. It was signed “Thanks! — Hurricane Marge.”

Jeannette McCain, RN, MS, ARNP-C, is a cardiology nurse practitioner at James A. Haley Veterans’ Hospital, Tampa, and a nursing instructor at the University of Phoenix, Tampa campus.