Kady (The Last Baby Boomer)

By Harry Leeds

At first, you spot a bloody pillow stain.
“Hi, I’ll be your nurse, are you having pain?”
But Kady begins right up with the sass.
“Hi, nurse! I’ll be your pain in the ass.”

She’s trying to be funny, or is she?
You know her history to some degree.
She pees her gown, her sheets sop up the blood,
her stool’s a chunky, turbid c diff flood.
She doesn’t use her call light as appropriate.
She’s dying, her liver labs can prove it.
There’s talk of “you youngsters” and she’s told
every nurse, “You’re gonna die, but don’t get old.”
Though she’s trying to be fun, you’re sure,
you let her know, you’ve heard that one before.

“To start things off, I’ll have to check your skin.”
“Fair warning, nurse, I pickled it in gin.
What once was my foot now has turned to rot.
My liver’s gone, both my kidneys shot.
My lungs are crackling, my heart enormous.
My skin’s gone yellow, that’s the jaundice.
Despite all this, I want to have more fun.
For the love of God I’m only 61.”

Her notes reveal a lick more nuance.
It’s not alcohol. It’s Hepatitis.
She endured the “cure” in late 2006.
But, woe for her, an unsuccessful fix.
Now her blood serum’s packed with viral load.
With no transplant she’s bound to croak or code.

Palliative care dropped by to consult,

which Kady took as a callous insult.
The NP put mercy on the table.
Bottomless fentanyl. No vegetable.
She knows to live would be a heavy climb.
She even understands, “If it’s my time, then it’s my time.”

Some people need help ordering their dinner.
But Kady’s blood’s as thin as paint thinner.
Dialysis, they couldn’t pull a thing.
Her vessels parched, the fluid third-spacing,
trapped between veins, arteries, and tissue.
This is but one of her major issues.
None of which seem to faze her except
that humor’s her defense, and she’s adept.

“I like being handled by a guy like you.”
“Don’t, you’ll bite off more than you can chew.”
“It’s a compliment, you shouldn’t scoff.”
“You ain’t yet seen me with my mask off.”

This sexist banter is her epitaph
and her main goal now is to make you laugh.
Good thing you’re too overwhelmed to shame
her. Still you don’t want to play this game.

So though you briefly catch a caustic waft
of shit, her pressures all shift have been soft.
The doctors left, you’ve tried pushing fluids.
But she wants to discuss the Brewers.
To hide your fright, you talk food, you wing it.
“I ordered you scotch, but doubt they’ll bring it.”
No beds on the unit. She chomped midodrine.
You’re quite worried her vitals will careen.

She laughs at her own joke about Woodstock
and blood spurts from her PICC site, no shock,
but a fright. Now you think her end is near,
and, you get a chill, as it becomes very clear
she’ll die on you. It sinks you to a stall.
But still, you call the resident on call.

She’ll be your mirror, repeat what you know.
The trouble is you’ve got nowhere else to go.
“Kady’s coagulation factor peters out.
Dialysis pulled 0 liters.
Today’s most recent INR was 5.
Her creat’s off the chart, but she’s alive!
Per the notes, her wayward sons are thrifty.

What’s worse, her fibrinogen’s sub 50!

This baby physician calls back. With no boss
to double check with, she’s at a total loss.
This resident, whom the patient’s never seen,
says to do, like, what you’ve already done.
“Any treatment would be an illusion of treatment.”
“Then, Kady’s done for?” She’s in agreement.
“Even a blood transfusion would be a waste.
What she really needs is two fresh kidneys.
Though, didn’t the GI doctor say, ‘Oh,
maybe you could find a bed at Mayo?’”

A shock, at 9 at night on a Sunday
a call comes from Mayo. “Hi, this is Kaye
from social work. I see Kady needs a bed.
Are you her nurse?” Then, a question you dread:
“What are her social determinants of health?
What’s the family sitch? Where is her wealth?”

“This is the worst part of it all,” you retort.
“I’ll give you a glimpse of what I got from report:
She’s saved a little money over time
but her sons scheme to commit a crime.
The one demands an advanced directive
so that they won’t have to play detective,
in search of, and battling for, her, estate,
Which recently has been a big debate.
He drew up a contract and put her in a bind,
her sons will be rich once the paper’s signed.

She explicitly okayed one visitor,
her ex, though her sons came to visit her.
Kady has had herself estranged
told them to not come, they did, and exchanged
words and fists with our security.
The floor isn’t where they were supposed to be.
They had to be forcibly removed
by a sheriff’s deputy and his buck toothed
trainee. Frankly I’m embarrassed I could
not protect her, had she been my mom, I would–”

“I just need to evaluate with nursing
if she’s a good candidate. Her purse strings
aren’t really the issue. Acuity
is the name of the game. Yes, and safety.

But I’m a social worker and can’t help
but notice your attachment to her. ‘Welp,
it’s out of my hands now,’ you gotta say.
She’s not your mom, you’ll turn your hair gray
getting worked up about every patient
you’ve got to learn to be complacent.”

“I don’t need a lecture,” I say. “So when
can she expect to bust out this pen?”

Kaye, social worker, doesn’t have a clue
if there’s a bed, but he’ll see what he can do.

The next day Kady’s gone. You ask the charge,
“Hey, did Mom go to Mayo, or did she discharge?”
“Mom? What exactly do you mean?
Oh, you mean that lady in 17.
I suppose her fate remains unclear,
because she didn’t die, and she isn’t here.”

You’d like to read all her progress notes
and scour the lines for revealing quotes.
Patient information’s basis is need-to-know
like what treatments Kady might undergo.

When you stalk a patient, the admins fuss.
But you pray she caught the 1-passenger bus.
Every click you execute in the chart
flags leadership, who audit and outsmart.
You’ve got new patients and you can’t often
dwell if she inhabits a zinc coffin,
tinged at the edges with a smelted seal
and a chiseled tip: transference is real.