Jasmine Bhatti PhD(c), MS, RN
This playful photo is one of the fondest memories I have. It sits on my fridge and reminds me of happy days on the beach, being silly and dancing under the stars, and driving with the ocean breeze blowing in my face.
It reminds me of Sophie- my maternal grandmother.
She is my “why”.
Sophie, aka Sofia, was as sophisticated, strong, and chic as they come. When I say sophisticated, I am not kidding. For her, even housecleaning required a button-down oxford polo with a popped collar, pressed jeans, and loafers. But being chic also drew her to the allure of smoking.
My grandmother was first diagnosed with cancer when I was in middle school. She had a solid tumor in her tongue that required radiation. With time, effects of the radiation began to appear. It became hard for her to swallow, and she relied on a diet consisting mostly of eggs, mashed potatoes, and ice cream (and of course martinis). Her jaw bone became brittle and needed reconstruction. Teeth were damaged, and special implants were needed. Her chin took on a new presentation; curved towards the right and with a slight concave appearance. Nevertheless, she was always strikingly beautiful.
This photo was taken long after those treatments, when I was in college and planning to study medicine. And then everything changed.
I remember the call from my parents. I was out to dinner with friends while they were in the Emergency Room at Mayo. They told me I needed to come right away.
I arrived just in time to witness the most extraordinary thing. The internal medicine doctor came in, knelt on one knee next to my grandmother, and held her hand. In a soft voice, he looked her in the eye and he explained that her cancer had returned. It is a moment that is seared in my memory.
The months that followed were a whirlwind. My grandmother decided to forgo extensive surgery, and focus on palliative care. To help keep her airway open from the tumor, the doctors placed a tracheostomy. To help with nutrition, they placed a feeding tube. She required so much care and attention.
When we were told it was time to think about going home, we were scared that we wouldn’t be able to care for her properly. So we went to tour skilled nursing facilities. All it took was touring one center for us to decide this was not going to be an option.
There was no way we could ever imagine letting her stay in a skilled nursing facility. So as a family, we arranged 24-hour supervision amongst ourselves. For months, one of us would always be with her.
This responsibility meant that we needed to learn to care for her and her medical needs. It was scary and overwhelming, but the nursing staff at Mayo patiently taught my family and I tracheostomy care. They taught us how to suction, how to clean, and what to do in an emergency. They diligently taught us all about tube feeding, managing wounds, and everything else we needed to know. They made the scary, not so scary.
With practice, our confidence grew, and we brought her home.
I stayed with her mostly at night time, which meant I was beyond sleep deprived. It was like I slept with one eye and ear open; always worried about her breathing or scared she may develop a plug in her airway that I would miss. There were days that my grandmother passed out while walking because she was so weak or dehydrated. There were nights that I would crawl ten feet with her on the floor for hours to get to the bathroom because she refused help and had to get there on her own. And then there were nights I had to call EMS because there was something so wrong that even I couldn’t manage. And they would make me ride the 1.5 miles in the ambulance because they didn’t know what to do either.
The last time I called the paramedics, was her last hospitalization. She woke me up with her coughing, and when I turned on the light, there was blood coming out of her tracheostomy with every cough. This was it. Her medical team explained that we should focus on quality of life, so we found refuge in the Sherman Home, the hospice next door. Although my grandmother wanted to be home, we needed a break from being caregivers, so that we could just enjoy the last bit of time left as family.
In true Sophie style, she was discharged on a rainy night, and was wheeled out in a trendy, white puffy jacket that belonged to my sister. From the moment she arrived across the parking lot, she bonded with a nurse named Laurie. Laurie could read Sophie like a book and she would jokingly called her “cheeky”. She helped Sophie process the last few things on her mind and settled her spirit. Laurie also helped the rest of the family process what was happening and helped us be prepared as things began to change. Somehow, in just days, Sophie and Laurie had developed the most extraordinary relationship.
Around 4am one cool February morning, Laurie called to tell us this was the day. Laurie waited with us for two hours after her shift, because she had promised my grandmother that she would be there when she passed. But Laurie had dogs and children and needed to sleep before coming back later than night. So we stayed with my grandmother all day, watching her take as little at two breaths every minute, all day long, until the sun was setting. At shift change, Laurie ran straight into the room, surprised that we were still there. She told Sophie to hang on a minute while she put her things down. She quickly returned, and with all of us by her side, Laurie whispered to her, “It’s okay, I am here now, you can go”. And with that, my grandmother took her last breath.
Until then, I had never known the power of a nurse. I never understood exactly what they did, and to be honest, I didn’t even recognize the deep importance of their role. This is exactly when I realized that being a nurse was my calling.
In the greatest irony of all, I have had the pleasure of being able to work alongside some of the same nurses who taught me how to care for my grandmother so many years ago. I can’t even begin to explain the joy that comes with this. I have also had the honor of being able to care for patients and families navigating similar situations. Being able to relate to them makes all the difference in our interactions. And finally, that internal medicine physician who knelt on one knee has since become one of my dearest mentors and supporters.