Faces and grace

Well, I'm back in Vancouver now and back to the cold and back to paperwork and the hospital and decisions and most wonderfully, my mom's cooking. Sometimes I forget how great it is to have someone make dinner for you.
Last night I was working at the hospital (nursing, not as a medical student- it's harder and harder to keep the roles separate), and because I knew that most of my patients had nothing better to do than lie in bed all day and stare at the wall, I decided to take my time looking after them. Of course there are important things that need to be done on time and there is lots of work and it's usually pretty crazy, but honestly, taking an extra minute to listen to someone's story instead of having that minute for my break is no great sacrifice.
I walked into Mr. K's room and the smell hit me like a wave. There were pictures in his chart of a sullen man with bandages covering half his face, and the description said 'inoperable cancerous facial tumor', but I wasn't prepared for the real thing. He had been refusing to have any medications or dressings put on the wound and I had gone to try to convince him of the necessity of both.
Half his face was eaten away by a fulminating mass of rotting flesh. His right eye had almost collapsed and his mouth drooped down on the right side and he could barely speak around it. The wound was oozing purulent yellow drainage and the smell was intense. Someone had placed a plastic sheet over his pillow and it was streaked in blood and pus. He looked like a figure out of a horror movie- the ones you say 'oh, they did a good job with that makeup!'. I was reminded of the phantom in phantom of the opera- only I was at the side of his bed, not on the other side of a tv screen.
“How are you, honey?” I put a hand on his leg and sat down on the edge of the bed. He looked at me with his hostile blue eye.
“What do you want?”
They had referred him to palliative care, partially because no one knew what to do with the wound encompassing half his face that was slowly eating his life away. He was skin and bones. Can you just cover it up? Maybe he wanted it open, to wallow in his suffering, to see the people around him flinch at the gruesome sight, to see if they could look past it and still see a man in need of love.
“I've brought you some pills.” I said to him. “And I wanted to ask you if it would be all right with you if i put a dressing on your face?”
“Leave it alone.” He glared at me. He reached for the pills and I held a cup to his lips for him to swallow.
I kept my hand on his leg and kept smiling at him, looking him in the eye.
“do you want me to open the curtains?” I asked him. “It's lovely outside today.”
“The light hurts my eye.” He said, struggling to form the words through his drooping mouth.
He glared at me. “I bet you wish you didn't have to work here.” He said.
“I love working here.” I told him gently. “I grew up with five brothers and I like the fact that it's almost all men here. Besides, most of the guys here are really sweet. Just about every day I get told I'm pretty.”
A hint of a smile tugged at the corner of his mouth and then disappeared again.
“It also reminds me of my grandfather.” I told him. “He passed away here. He served in the military and he would always tell me stories of his work as an aircraft mechanic. Towards the end of his life he'd tell me the same stories over and over again, but I didn't mind hearing them because they were good stories.”
“Was he a frame mechanic or an engine mechanic?” Mr. K asked grudgingly.
“I think he was a frame mechanic.” I said. “what about you? You sound familiar with it?”
He began to talk, slowly and haltingly, and as I nodded and asked questions he talked more. He told me how when he'd been brought to the hospital his daughter had taken all his things and thrown them out, burned them, including the one memento from the war that was most precious to him. It was a photograph of him in the trenches in France, that a young red cross man had taken of him after he'd been blown half-apart by shrapnel and his baby finger was hanging off by a piece of skin. He showed me where they'd reattached his finger and I felt the knobbly bone under his smooth skin.
He told the feeling of lying there waiting for a German sniper to run out of ammunition before it was safe to leave the trench and go after a fallen comrade. He told me of lying in a field hospital and then being transported by train to the main hospital and begging one of the nurses to loosen his bandages so that the jarring train wouldn't hurt so much. She had refused to take his bandages off and in the end he convinced the young red cross man to cut them off for him.
Now he was lying here as an old man, dying, refusing to be wrapped up in the bandages that for him represented a loss of control. He had already lost everything that meant anything to him. His anger and hostility were part of the dignity he was trying desperately to maintain.
When I got up to go he looked at me with that piercing blue eye. The smell of his wound was overpowering and I fought the urge to gag, and even more importantly, I fought to keep my visceral reaction off my face.
“If you need to come back to tell me anything,” he said haltingly, “I don't mind if you just tap me on the leg to wake me up. It doesn't have to be really important, but if you want to, you're welcome to.”
“Thank you.” I said to him, smiling. “Sleep tight, honey.”
There was a smile lit in his blue eye. “You're a lovely girl.” He said. “Thank you for talking to me.”
And I walked out and he was staring at the closed curtains and I looked at the clock and had missed my break but I didn't even care.