Her smile

short-story-thumbsIt was her smile.

I will always remember it.

Her teeth weren’t perfect, but they didn’t need to be. When she smiled, her eyes laughed, challenging the world to try and bring her down. Her smile revealed her positivity. Her strength. A power unique and untouchable captured in one simple gesture.

It was my final year and I was on my last clinical placement. She came into the ward from the Emergency Department, a brief handover to prepare her for theatre. I didn’t understand – or I don’t remember – exactly why she was presented to Emergency, but it was already five o’clock in the afternoon and she was being readied for surgery, so it must have been a threat that required immediate intervention. I thought to myself: surely she understands the seriousness of the situation. Surely the doctors have advised her. But still she continued to smile.

To be honest, I can’t even recall her name. I’m sure she introduced herself to me, or I heard it during the handover, but so captured was I in her positivity that I must have forgotten shortly after.

It was another busy shift on the ward. The nursing staff was stretched thin and there was always more work that needed seeing to. After the hand over was completed, the RN I was paired with had to move on to other patients and duties while I continued to prep her for theatre.

“Where are you from?” She asked cheerfully.

I started; I had been in the process of helping her take off her necklace and hadn’t expected her to initiate discussion so readily. No doubt she had noticed my accent.

“California.” I replied, cursing myself for not being proactive enough to start the conversation on my own.

“I’d love to go to California.” She said wistfully, staring off into the distance.

“You should. It’s such a beautiful place.”

She smiled again and something deep inside of me somersaulted. Why did such a routine conversation, one I had had with countless patients before her, hold so much weight within me.

“How long have you been a nurse?” She asked while I helped her into her gown.

“This is actually my last year of study.” I confided, proud to share my achievement with her. “Nearly there.”

“Congratulations. I’m sure you’ll do well.”

I smiled back at her. She was ready for theatre now and I was unsure what else to say.

“Take care.” I finally said, lamely. But she smiled, nonetheless, and laid down to wait for her surgery.

I quickly moved on to help my RN with her other patients, all the while thinking to myself about her positivity; her bright, bubbly and upbeat nature. My brief time with her, in the midst of the busy day, had been a moment of joy and relief. She was so unlike any of the other patients I had ever prepped for surgery. She didn’t look like she had pain, didn’t even seem uncomfortable. In fact, much to the contrary, she seemed quite content.

But it was a busy ward, and there were more patients to attend to.

It was only a mere ten minutes after I had spoken to her last; I walked past her bed and noticed her tears.

Her smile, so brilliant, had suddenly been replaced by a fear so real and tangible I could feel it in myself. Still, she was fighting it. Fighting and struggling with everything she had. But the tears continued to shine on her skin. She stared blankly up at the ceiling, her forlornness as beautifully terrifying as her smile had been uplifting.

I froze, my previous tasks forgotten in the blink of tear stained eyes. I was confused. For the first time, I looked around the room and noticed that every other patient was surrounded by family, friends and well wishers except her. Where was her family? Her children? Her husband? Did they exist? I had never asked her and she had never made mention of anything along those lines.

Unable to stand frozen any longer, I abandoned my long forgotten responsibilities to return to her bedside.

“Are you ok?” I timidly asked, immediately regretting the coarseness and insensitivity of the question. She jumped; no doubt so overwhelmed in her emotions she had not noticed my approach.

“I’m ok.” She lied, turning her head to spare me the sight of her tears.

I continued to stand by her bedside, awkward and unsure of how to proceed. The seconds stretched out for eternities while I frantically tried to come up with a response; some magic remedy to alleviate her of the distress she was denying existed. But I had nothing. No classroom had fully prepared me for the confronting reality of this situation. A seemingly endless river of good wishes, pure in intention but lacking of any substance, raced through my head and were immediately discarded, and still she lay with tears she couldn’t resist filling her hazel eyes.

Suddenly, in a flash across my mind, I recalled my first nursing facilitator responding to a similar situation. She had shown that human touch could exhibit a care that words could not. Touch would go deeper, where words, well meaning but ultimately useless, would only scratch the surface.

With no more hesitation, I reached out and grabbed her hand, squeezing hers in mine. I didn’t say anything, and neither did she. Words were suddenly useless, a fleeting meaningless entity. The touch of our hands was genuine in a way that words could never be. She looked at me and I smiled, and, chasing away the tears, she returned the smile back. In that moment I felt a connection with the patient I had never experienced before, an affection that no one outside of the nursing world will ever understand or grasp.

The wardsman arrived and along with the RN, we escorted her to theatre. It was a long, quiet silence, but no longer awkward or gloomy. After handover to the anesthetic nurse, I turned to her and simply wished her all the best. She turned back to me and smiled before they wheeled her away.

Her smile was the last I ever saw of her. It wasn’t the smile of a defeated woman. It was her old smile, the smile I had first seen. It was the smile of a strong woman ready to face her journey.

I will never know what it actually was that made her breakdown and silently weep at the ceiling. Was she alone, missing her family and wishing she had them nearby? Or simply was it the fear of the unknown, the fear of the surgery? Sometimes I worry that I am just a student nurse, green and naïve, walking into a world of smiles and tears, fear and joy, life and death. How do I find all the clues to figure out exactly what a patient is feeling? Sometimes, I don’t know what to say. What are the right questions? I stumble and struggle to find a way to prove to patients that I am there for them, that I care about them in ways that they might never understand or appreciate. I can’t answer all of the questions, but I can help them know that they are not alone in their fight or their journey.

I will never know exactly what she felt from my hand, but I know that in that moment, it was appreciated. My shift ended not long after walking her to theatre and I never saw her again. But there was a connection, a deep intimacy that will linger on in my memory throughout the rest of my career. In that brief moment I was her family, her support and her rock – and in a strange way, she was mine. That moment is why I am a nurse, and why there is no other career that could suit me so perfectly.

I hope she never forgets me, because I will always remember her. And her smile.

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