A Patient Remembered

She had a small sore on the side of her nose.
I was a student nurse, working on 3-East of Easton Hospital when I was assigned to the patient, a young woman who had been admitted to have surgery on her nose. This was almost 40 years ago, when you were admitted the night before even relatively minor surgery.
I don’t remember if I prepped her for the surgery. I just remember having her for a patient. There was nothing remarkable about her, her nose or the sore – not at that time. The reason why I remember after 40 years is that I saw her again, years after our first encounter. And this time she had very little left of her face.
It seems that the sore had been diagnosed as cancer. I’m not sure what type. I was a student nurse and maybe wouldn’t have known anything about the type. I just remember that she had refused the surgery that could have removed all of the cancer. She may have needed a partial nose prosthesis. But she didn’t want that. She decided to go home and die.
Only she didn’t – not for many years. By the time I saw her again, I was a visiting nurse with a five year old daughter and my own possible diagnosis of cancer.
I had found a lump on my thyroid – did my own palpitation and discovered an unusual area. I had a history of radiation treatment as a child. In the early 50’s radiation was used as a treatment for enlarged tonsils and adenoids prior to surgery. At the age of six I had three of those treatments. At the age of 31 I could be diagnosed with thyroid cancer – the probable long term effect of those treatments.
A week before the scheduled thyroid surgery, I was asked by a social worker at the hospital to make a home visit. She had received a call from a man about his wife. He was having difficulty caring for her at home. He wanted her admitted to the local county nursing home, but she need a medical exam first. She hadn’t seen a doctor in more than 10 years. The social worker wanted me to visit her at home, get a medical history and try to convince her to go into the hospital for a complete work-up. I agreed to do it.
The house was a small Cape Cod in modest development. I parked my car and walked to the small stoop. Before I could ring the doorbell, I smelled it. The sweet-cloying smell of dying tissue, cancer, rot – almost the odor of decomposition – but not quite. Not yet anyway.

The husband answered the door and introduced me to his teenage son. He then led me into his wife’s bedroom. The smell was overpowering. The woman, now in her late forties, was sitting in a chair by her bed. She had a swollen belly, indicative of long-term alcohol abuse. She had a earplug in her ear; it was connected to an old radio. The husband and son had made a make-shift hearing aide for her. She needed one; the cancer had virtually eaten away at her ears.
And her face. Most of her face was covered by a flannel bandana, leaving only her eyes staring at me about the soft material. The flannel swayed in and out with each of her breaths and with each breath came another wave of the nauseating smell.
I smiled, took her hand, thin, bony with almost transparent yellowish skin and introduced myself. She could talk but she nodded her head. I took her blood pressure, pulse and listened to her lung sounds, all the while the soft sway of the flannel and the stink of death.
Then I asked her the important question – important to both of us. Would she let me see under the flannel? She nodded slowly, reaching up to lift the cloth.
From the base of what had once been her nose was only a gapping, dark red opening, her tongue partly gone, her soft palate eaten away. I took a penlight and examined the area – not wanting to offend her by immediately looking away and yet not wanting to se more. I clicked the light off, thanked her and slowly took the cloth from her hand and lowered it myself.
“You know it’s difficult for your family to care for you.” She nodded. “You know that you need a medical work-up before you can be admitted to a nursing home.” She nodded. “The best way to do that is for you to be admitted to the hospital.” This time she hesitated, but after a few seconds she nodded again.
I left my patient and went out to the living room to talk to the husband and son. I learned more about the woman in the room. She usually drank a half gallon of wine a day – for the pain. It was getting more and more difficult for her to even take blended foods. She slept sitting up in the chair. It was more than I needed to know but less than I wanted to know.
How did she let herself get to this? I wanted to ask. But I could see that the family was in more pain than my patient so I didn’t.
I called a physician who owed me a favor and made arrangements for the squad to pick her up and take her to emergency ward. I was adamant that she be admitted directly through the emergency ward and that she not be seen by every med student and intern in the hospital. That was her only wish – not to be put on display.
She was admitted that afternoon. She was placed in reverse isolation to prevent her from getting infected - because the huge opening in what was once her face could allow bacteria to invade easily. She was given pain meds, intravenous nourishment, antibiotics. Her family visited regularly and the nursing home application was started.
As the visiting nurses’ hospital liaison, I saw her daily – just to smile and wave through the isolation glass window – to let her know I hadn’t abandoned her.
The next week I was admitted for my thyroid surgery. The lump was cancer, the lobe was removed and I went home after a few days.
My patient with no face died in the hospital. All the precautions meant nothing. She developed an infection – possibly from the hospital environment itself – and she wasn’t strong enough to fight it.
She finally got her wish from that first hospitalization ten years before.