“No…., stop!” Feral screams sent shock waves through my body as I unlocked the door to the twenty-eight-bed patient unit where I had just started my new job as a nurse practitioner.

“What’s up?” I trotted alongside the nurse sprinting to a patient room.

“That’s your new patient, Terry.”

She lay tangled in yellowing sheets, the feet of her long body hanging off the edge of the bed, her head thrashing, no, no.

“Terry,” I spoke her name.

Skin pulled taut, like a raisin, her eyes scrunched open to take me in. “Leave me alone,” she whimpered.

My new patient. Terry, 42-years-old, lived at the public health hospital.

 

She’d begun her odyssey twenty-eight years earlier lying in a similar bed at the city hospital, her bones broken after her father shoved her down a flight of stairs.

Even in the hospital, she couldn’t escape the tentacles of his abuse. She answered the phone by her bed to his slurred words, “I want you to have your mother’s jewelry.”

Those were the last words he spoke to her.

What she found when she unlocked the door to the family home two days later sent her into an abyss of psychiatric and medical care from which only death would release her twenty eight years later.

The bloodied bodies of her five siblings, mother, and family dogs on the living room floor, her father nearby, dead from a combination of pills and alcohol.

“He killed everyone when I wasn’t home because he wanted me to suffer,” she would tell me years later, “that’s how much he hated me.”

She was the oldest of six children, his punching bag, the one that stood between him and the others to protect them from the fists, pots, pans or the broomsticks he regularly used to strike them. He’d even brandished his gun at all of them, threatening to kill them.

Terry became a ward of the state, sent to a private psychiatric hospital in a bucolic setting upon acres of lush grounds. When the ink on the headlines dried, and funding became short, she was transferred to a state mental hospital. A few years later, she moved into community housing when the state implemented deinstitutionalization, but she had grown accustomed to the structure of hospital living and unable manage the freedoms of the group home, she ran away.

The only place left for her was the secure mental health unit at the public health hospital.

Over the years, she was tried on multiple treatments: electric shock therapy, counseling and new medications as they came on the market, but nothing quieted her screams.

An adverse effect of one medication left her with kidney failure and she started dialysis three times a week to stay alive.

She hated dialysis. Hated sitting in a chair, for five hours, hooked up to a machine, watching the blood flow out of her body, into the machine, and back into her body.

I can still hear her cries as she was taken from her room on my floor to the dialysis suite, “I don’t want to go!”

Dialysis left her bones brittle, and one day when she was out on a smoke break, she took a soft fall in the hospital parking lot and couldn’t get up. A broken hip broke sent her to the acute care hospital for a total hip replacement.

She came to my floor for rehabilitation. And that’s the first time I met her.

My new job, a job I took because I was a new nurse practitioner and wanted to hone the medical skills I’d learned in nurse practitioner school. What better way than to care for the sickest patients in the state, I thought. I worked on the medical behavioral unit, a care model for people with serious mental illness and acute medical problems.

I hadn’t fully factored in the impact of her mental health issues and fumbled her post op care. I assumed it was routine— pain management, physical therapy, and continued dialysis, but she developed one complication after another under my inexperienced care-a blood clot, an infected incision, and an open wound. What I thought would be a two week stay, turned into six months.

She continued to scream through each complication, wanting only to go outside and smoke, or drink a can of the forbidden Pepsi. I’d approach her softly, drawing on communication techniques I’d learned in school, “I can see you’re upset…how can I help?”  None of it worked.

She only responded to one person, Joe, her mental health counselor.

I observed him work. Quiet, soft spoken, he went about his job, managing patients on the 28-bed unit with gentle competence. Some of the staff called him Uncle Festa, a reference to his resemblance to the beloved Addams family character; short and portly with a shiny bald head and a penchant for black turtlenecks and pants; a persona he embraced.

I watched them enter his office, listened outside the door to the pitch of soft voices. I strained to hear her whimpers or tears, but there were none.

I knocked on his door later that day. “How did you do it?” I asked, pulling up a seat, looking him in the eye, I whipped out my notebook and prepared to take notes, expecting a response peppered with psychological jargon.

“I told her about my mother. She died a few years ago. Told her how much I missed her.”

“And??”

“That’s it. I know how she feels.”

My mouth dropped open, wow, I thought, so simple. Everything I learned about professional boundaries and avoiding personal disclosures had failed to address the power of human connections.

Joe pulled me into his care circle and the three of us met daily. Following his example, I began to wade across boundaries. I gave her samples of make-up, sitting with her while she applied pink color to her cheeks, a blue tint to her eyelids. She basked in those girlie moments of adolescence that had been stolen from her.

 

When her hip finally healed and she was able to get outside for her smoke breaks by herself, she returned to her home upstairs. It wasn’t the last I’d see of her though. She’d return to my unit for medical care many times over the next few years, always under my care.

##

During one of her stays, I noticed a soft, fluffy stuffed German Shepard toy in the middle of her carefully made bed. “It’s Captain,” a replica of the German Shephard the family had owned, the one her father shot, sobs erupting from her, “He even killed my dog.”  Her references to that his violence always carried the note of how much he had hated her.

My heart dropped and I mourned that dog along with her. I had two dogs of my own, lively Boston terriers with big round eyes and erect Yoda-like ears giving them a permanently startled look.

I’d tell her about their antics, Sophie winning at tug of war, pulling the toy so hard that Boris fell off the couch, or Boris springing loose from his leash, running off like a fugitive. She’d hang on my every word, ask, what happened next, and we’d laugh together.

I gave her a photo of them in a decorative, ceramic doggie frame. They sat side by side starring up at a treat I held in my left hand, ready to lunge as I snapped the camera with my right hand. She sat looking at it for a few moments, a smile spreading across her face, before lifting it to her chest, raising her eyes and muttering, “thank you Peggy.”

##

One day, Joe stepped into my office, his dark eyes blazing, beads of perspiration coalescing on his forehead, uncharacteristically angry, he slammed his hand on my desk, and in a raised voice, “Terry’s never been to the cemetery!”

“What?” I asked.

“The family grave! She’s never seen it.”

“Let’s take her,” I offered.

Joe set a plan in motion. Memorial Day, flowers, ice cream cones.

The family was buried in an unmarked grave in a barren, brown field, its topography scattered pebbles, the potter’s field section of the cemetery where the city’s poorest citizens were buried in numbered graves.

Joe had located the grave and planted a plain wooden cross engraved with the family name on the site, the only adornment in the cemetery in that section.

Soft, warm winds blew through the trees, as we watched Terry limp across the field, a bouquet of flowers in one hand, a cigarette in the other. She laid the flowers down as Joe and I stood by, sentinels, my breath still, my mind blank.

She turned toward us, silent tears streaming her cheeks, and smiled.

Something shifted that day.

##

I was entering my fifth year at the hospital. A job I’d only plan to keep for two years to get the hands-on experience I desired. But I’d gotten much more. I’d made connections. Connections with Joe, Terry, other patients.

A week before Halloween, I made my daily coffee stop at Joe’s office. By this time, we had become good friends, his “work wife,” he called me.

I opened the door and saw rolls of black and orange crepe paper strewn across his desk, along with shiny plastic pumpkins and decals of ghosts and witches. Joe decorated the unit for holidays, adding color and glitz to the dull bilious walls that surrounded us. Halloween was his favorite holiday, and he’d been planning the design for weeks.

“You home?” I called out.

No answer.

I scoped the unit, looking for him. No one had seen him. We were all mystified, he was the guy who always showed up early. Concerned, his supervisor initiated a wellness check.

I made my rounds, looking over my shoulder for him, listening for his voice, checking his office repeatedly.

That afternoon, his supervisor came onto the unit. Her pale, expressionless face held the stillness of bad news.

He’d been found dead by the police on the floor of his apartment. His big heart had given out.

##

The hard wooden bench pressed into my spine as I sat listening to the somber strains of the church organ, the faded aroma of incense lingering in the eaves of the ornate Catholic church. In the heavy silence, I heard the words that his supervisor had whispered to me and began to sob. A cold, gnarly hand softly covered mine. It was Terry. My sobs grew louder.

She became my comforter during the weeks following Joe’s funeral. A gentle knock on my office door, “It’s me, Terry, how you doing?’

She sat quietly, the big sister who had protected her younger siblings and mother, waiting for me to speak.

##

The following May, I watched Terry limp across a lush green lawn adorned with granite statues of saints and angels, a sharp contrast to the potter’s field, toward Joe’s grave, clutching a bouquet of flowers in her hand.

A scented breeze blew, Joe’s shadow beside me.

As we drove towards the ice cream shop, I glanced over Terry, watching her blow smoke out my car window, and thought about our first meeting, me– naively confident in my crisp white lab coat buttoned to my chin, thinking of post-operative hip repair practice guidelines, Terry crying, pushing me away.

She felt the shift too, and our eyes met.

“You’re like a mother to me,” she said.

“We’re the same age!”

“Okay, a sister.”

Our eyes held, expectant.

“No Terry, not a sister, a friend.”

“Yeah, that’s it!”

I turned up the radio, and we both sang along to “Kung fu fighting,” a hit song of our shared era, the wind blowing our hair through the open windows.

That autumn, as a few leaves lingered among the birches and oaks, Terry was admitted to my unit for the last time. Years of dialysis had kept her alive but taken a toll on her body. The shunt that connected her to the big machine had become infected and she needed a new site. She’d been through this before, so many times in fact, that she was running out of sites. The only place left for the shunt was in her neck, a tenuous and risky spot.

When the doctors told her where they planned to place the cannula that would allow them to continue dialysis, she yelled, “Stop torturing me. “

She’d rather die she told them.

Refusal was a big decision and could only be made by her guardian. Would the guardian uphold her decision or insist on the procedure?

Hospital staff debated whether she should be allowed to refuse, and were split fifty-fifty, those saying treatment should continue, court ordered if necessary, and those who said she had the right to refuse.

In the end, her guardian, a former nurse turned lawyer, took her off hospital grounds for a few days away from the noise to discuss her options.

My unit was eerily quiet during those days. We moved about our work silently, as if already mourning.

Terry came back with her decision. No more. No tubes. No needles. No cardiac resuscitation. She wanted to go to sleep and wake up in Heaven with her mother.

She was transformed. The harsh lines in her face relaxed, her eyes took on an incandescent glow.

She planned her own farewell party at the ice cream shop we had visited after our cemetery runs.

I pulled up to the curb, balloons tied to railings, swinging softly in the breeze of a sunny day, a line of guests waiting to greet Terry, as she took each hand in greeting, “thank you for coming.”

I caught her eye, “thank you,” I mouthed.

A few days later, she closed her eyes and went to sleep.

She was waked in a casket lined with purple velvet, like she wanted, in the hospital chapel.  Cigarettes and cans of Pepsi were tucked in with her, those items that gave her comfort in life.

She was laid to rest in the family plot.

Laid to rest, finally.

A few days after her funeral, the social worker from her floor handed me the photo of my dogs in the ceramic frame.

“I found this under her bed in a box with her treasures.”

Margaret Ann Ackerman lives in Nahant, Mass. Her writing has been published in the Boston Globe, Candlelight Magazine, Disordered Writing, Pulses, Clinical Advisor and elsewhere. She is a retired nurse practitioner and professor emeritus at Salem State University.