Walls and a Blue Ribbon

By Leah Alair, BSN, RN

I arrived at work on Tuesday morning to find my charge nurse handing out blue ribbons, beads, and bracelets to staff.

"March is National Colon Cancer Awareness Month,” she said. “Put on the blue, we're promoting awareness and encouraging people to get their screenings!" I stared at some of my coworkers with ribbons tied neatly in their hair.

It’s important to know that I routinely have to field the question, "Are you sure you're old enough to be a nurse?" I had a feeling the ribbon wasn't going to help my credibility. This was also my second day of caring for a patient struggling to cope in a very tough fight against colon cancer. Would she mind? Would it be insensitive?

I decided to wear the stupid ribbon and beads that prompted countless Mardi Gras jokes, as an expression of support for her, and I hoped for the best.

"You've got more bling on than I do." She talks with a straight face from under her nasogastric tube.

"Colon Cancer Awareness Month," I say. "We're supporting those who fight and encouraging others to get screened. You want some beads?" I try to sound as bored as her.

"I'm perfectly aware, thank you."

"I figured you would say so."

Far from rude, she was just brusque. Didn't elaborate. Never answered questions about how she felt or if she peed or how much ice she'd had except with, "I don't keep track, you can read the records." She didn't even bother to open her eyes to hold a conversation. Her door was laden with signs saying, "No visitors," "Keep door closed," and "Ask nurse before entering."

It made staff think a physically or psychologically unstable patient dwelt inside and intimidated any who wanted to enter. In reality, she was stable, and very grateful for the care, but felt safe behind walls. It's probably nice to have some walls when you're battling a disease that invades without warning or permission.

We walk laps around the floor, one of my hands supporting her withering frame, the other carting her IV pole adorned with bags of parenteral nutrition. For being so strict about visitors and privacy in her room, I think she's very brave to walk the halls with a bile-stained tube dangling from her nose.

To most healthcare professionals, the two give away her current diagnosis: bowel obstruction. We treat it by pulling out the gastric contents via the tube, and providing nutrients intravenously while waiting and hoping for the bowel to work itself out so we don't have to do surgery. It's not the kind of treatment that instills much confidence.

"I like the ribbons," the respiratory therapist, Joe, compliments from another patient’s room.

"Thanks, Joe. Colon Cancer Awareness Month. Get your colonoscopy!" His smile retracts a bit as if he wishes he didn't start the conversation. My patient keeps up an impressive pace.

"You're faster than you were yesterday," I observe.

"And you're just as squeaky," she nods toward the IV pole.

"I'm sorry I forgot the WD-40 today."

When my aide and I get her back into bed, she halts us, "Hold on here, my trunk is caught!"

I'm looking at her behind, her caboose, but nothing is attached. "Your trunk?"

"Yes, my elephant trunk!"

She holds completely still awaiting our help to untangle the nasogastric tube from the sheet. For the first time that day, we laugh together.

People cope with a life-threatening illness differently. Correctly perceiving that method is crucial to how we provide care. Some people cope with the anxiety by asking questions about every aspect of their diagnosis and treatment. Others prefer to ride the terrifying rollercoaster with eyes shut, just hoping it will be over soon. I bet you know which method my patient elected.

Eight hours into my second shift caring for her, she asks her first question. "How long do you think it'll take for this thing to resolve?"

I stop fussing with the IV tubing. A wall is coming down.

"There isn't a way to know," I sigh. "You starting to worry?"

"You have no idea how excited I was last week. The diarrhea stopped. I thought we could resume my chemo. And then they find this obstruction." For once her hardened voice breaks and those deep-set eyes hold tears. "It's been hard," she confesses. “I don't know how I can gain enough weight to take the treatment."

Then she sets her jaw, and her facial bones gain prominence in her sunken cheeks. She looks me straight in the eyes and says without a quiver in her voice, "But you all have been so good to me. And for all your care, I thank you."

Proof that she wasn't rude. Proof that she was normal—and scared.

"You know this 'bling?'" I ask her. "The blue ribbon in my hair? I don't put ribbons in my hair. I think I look about 12 years old. But I thought of you and how hard you fight, and I wanted to tell you that we are in this with you. I'm fighting with you. And we all consider it a privilege. So, I thought, I'll wear the stupid blue ribbon for her. I put it on for you. Because I can't fix the obstruction or make the cancer go away, but I will do whatever I can to help you fight it."

She's smiling again. The tears well up again.

"Well thank you, I very much appreciate it."

"You're very much welcome."

I mean it. I'm a sensitive person. I thrive in those touchy-feely moments at work amid the busyness and intellectual stimulus of oncology floor nursing. When my patient's wall comes down, it's my job to treat the fragile person inside with gentleness. But I realized in the brevity of that vulnerable moment how close this woman is to despair, how rapidly hope can slip between the weak grasp of her bony fingers if we dwell on the severity of her illness. She can't afford that. So it's also my job to help my patient put that wall back up again.

"And tomorrow you are walking nine laps instead of six," I command her. "Because we are going to get you stronger and work out that bowel obstruction."

"That sounds good," she says flatly with eyes closed. "Make sure you pull the curtain and shut the door on your way out."

One week later, I saw one of our aides carry a lunch tray through that door covered with signs. I saw a smiling woman emerge from the room with no tube hanging from her nose. She laughed and joked as I celebrated with her during her walk around the unit.

She was still severely underweight. The cancer was still growing. In light of this, the resolution of an obstruction seems trivial. But for us, and for her, it means progress. Another chance. It means taking pleasure in food, reclaiming her dignity, gaining independence as she becomes less reliant on medical intervention to make up for her body's insufficiency.

Above all, it means hope. The fight isn't over yet. I'll wear a blue ribbon every day in March to celebrate that.