Clinical narrative in nursing practice

Nursing

When I first met Dan (not his real name), I was a shift nurse filling in for a colleague. I had never before worked with a bariatric patient. His size shocked me at first. What we colloquially call "morbidly obese" certainly applied to Dan, who had to have an emergency tracheotomy due to his hypoxia. Dan was closer to death than he realized when I first encountered him on my rounds. As he came to work with us, he gradually started to fathom the seriousness of his situation. I would say that Dan was in denial when I first met him. Through the course of knowing him, I saw this patient change and grow in dramatic and inspiring ways.

Dan has a super sense of humor, which is the feature that most stood out about him when I worked. It became so that I looked most forward to the time I spent with Dan, because the laughter he brought to my heart and to my colleagues was a salve that carried us through the toughest of days. Dan is one of those patients we all love: good-natured, respectful, kind, and patient. When he had bad days -- and there were many -- Dan still managed to smile and tell a small joke.

His condition ebbed and flowed. When I first met Dan he weighed over 400 pounds. Special equipment was needed to help him. Special chairs were used, and nearly every aspect of our work from transfers to IVs had to be adapted for his large size. The bariatric surgery was the first of many procedures to help save Dan's life. After the surgery, he started losing weight gradually. By the time he got to 350 pounds, the weight loss was noticeable. Yet I started to wonder what Dan would do once he was discharged. Would he be able to live a normal life? Would the surgery encourage Dan to adopt healthy living habits that would ensure long-term success?

As I got to know Dan better, I shared stories with him. My sister has struggled with weight loss for some time. She never became clinically obese to the point of needing bariatric surgery, but she did fluctuate in ways I knew were unhealthy. Her binge-purge cycles frightened me, and I urged her to seek help. Because I knew what she went through, I was able to apply this knowledge and empathy with Dan. Dan was more stubborn than I initially gave him credit for; he hated hearing about diet and exercise regimes and balked when I mentioned Overeaters Anonymous. Yet by the time Dan was discharged from the hospital, he had started reading books about compulsive eating and developing sane habits that could last him a lifetime.

The hypoxia and the obesity both made Dan more self-conscious than he would admit. His humor was a veneer. Dan would tell a joke, but I knew that deep inside he was crying. The times I walked by his room, Dan's face looked noticeably sad. He never showed that side of himself to me, or any other nurse. You had to catch him at a candid moment to see that he was not happy with himself or with his life. He wanted to change; I believe that sincerely. Dan did not have many friends or relatives. I think that those who came to visit did so more out of obligation than of genuine caring or love. He actually received more visits from colleagues than from his own family. I got the sense that his sister and her children were ashamed of Dan because of the way he looked. This hurt him deeply.