The Woman with No Face

Sometimes a nurse doesn’t realize the results of her work. Sometimes she doesn’t want to know.

I could smell death even though I was still standing on the narrow stoop of the small Cape Cod. I hadn’t yet knocked and the smell, the cloying, sickening odor of someone dying of cancer, was almost overwhelming.

I’d been a nurse for more than ten years and I’d smelled impending death before, but never like this — always in a hospital room or, more recently as a visiting nurse, in the sick room of a patient dying at home — never while I stood outside, hand raised ready to knock.

In the few seconds it took for me to knock and the door to be opened, I wondered why I was standing there. What was I doing? Why, knowing what I might see inside, had I agreed to come to this house?

I was the visiting nurse liaison for the local hospital. I interviewed patients before their discharge and set up home care services. I was also a member of the Cancer Committee, started by a social worker and the local oncologist. Both had told me I was the perfect choice to make this home visit.

The social worker had received a call from a woman’s family. The family could no longer care for her at home and wanted her placed in the county nursing home. But the woman had not seen a doctor in a decade. Since she was virtually dying of cancer, the oncologist had agreed to be her doctor of record; however, the nursing home needed more — they needed a physical work-up and to get that, the woman had to be admitted to the hospital.

But she needed convincing. Her husband and son had been trying to get her to the hospital but she was refusing. She didn’t want strangers looking at her. She had told her family she didn’t want “to be on display.”

She didn’t want to be seen because she no longer had a face.

And I was the nurse who had to convince her to go to the hospital, a place full of strangers who would do nothing but look at her.

I knocked and the door opened, the smell intensifying. I introduced myself to the woman’s husband and son and they led me into the living room, a gloomy place with closed curtains and little light. I immediately thought about the life this family had led — gloomy, with little light.

The three of us talked briefly and then the husband led me into the bedroom where my patient waited. Her family had told her that a visiting nurse was coming to see her, to talk to her about possibly going to the hospital and then to the nursing home. I had imagined that talk, the guilt on both sides and wondered how I was supposed to allay those feelings.

As I walked to the bedroom, I took a deep breath, through my mouth, and tried to think about what I’d learned in nursing school, what I’d learned during my decade-long career. How could I do this? How could I make going to the hospital seem to be the best thing for this poor woman? She would be leaving her home for the first time in almost ten years, leaving her family who had been the only ones around her for those years?

She was sitting in an arm chair on the opposite side of the room next to the bed. The bottom half of her face was covered by a piece of soft flannel, slowly moving in and out with each of her ragged breaths. Each breath filled the room with the odor that was slowly becoming normal to me.

On a stand next to her chair was a large radio. I could see that there was an ear plug in her ear connected to the radio. Her husband, standing in the doorway, explained that the son had made a hearing aid from the radio for his mother as the cancer was beginning to destroy her inner ears.

As I knelt down beside her to take her hand, I saw her belly, large and hard, as if she were ready to give birth. The family had given us as much of a medical history as possible and the swelling was probably from liver disease. Without a doctor and with a large amount of pain, she’d been drinking half a gallon of wine a day. The cancer had started years ago on her nose and instead of having further surgery that could have saved her life, she had decided to “go home to die” — dying was taking a long time.

Her hand was cool and thin, the skin yellow and papery over narrow blue veins. She clasped my hand as if she didn’t want to let go. I looked into eyes of pale brown surrounded by yellow where white should have been. I introduced myself. I told her I wanted to take her vital signs. That was not really necessary but helpful as a way for me to get to know her and her to get to know me. A way to stall time.

I took her blood pressure and pulse. I counted her difficult respirations and listen to her heart and lungs. I could not take her temperature, at least not orally.

I talked all the while I did these mundane, nurse-things. She said nothing. She couldn’t. She had no mouth. During this time, I noticed that her husband was no longer standing in the doorway and the bedroom door was closed.

I talked about what would wait for her in the hospital, trying to make it sound as positive as possible.

Finally I screwed up my courage and asked if I could look under the piece of flannel. She nodded and I took my small flashlight out of my nurse’s bag. I waited for her to lift the flannel. I was sure that it would be easier on both of us if she were the one to make the decision when and how much.

My left hand held her right hand, as if I was trying to give us both courage. I held the flashlight in my right hand. Slowly, with a shaking left hand, she raised her makeshift veil. I’d already decided to lean in and not to back away. I leaned in towards her and clicked on the small light, illuminating what cancer had done.

There was little to see because there was nothing. She had no lower jaw, no upper jaw, no teeth, no nose. There were no upper and lower palettes. What was left of her tongue was a piece of beefy red flesh far back in the opening that had once been a mouth and throat.

The deterioration of her tongue had finally prompted the call to the social worker. It was getting more and more difficult for her to eat.

The lower half of what had been her face was nothing but a red, gapping maw, a thing for a horror movie. But she wasn’t a horror movie; she was a person — she was my patient.

I nodded to her, signaling that I was finished and she lowered the flannel.

“I know that was very difficult for you,” I said. She nodded to me and patted my hand, as if saying that she knew it had been difficult for me, too.

“Your family wants what’s best for you.”

She nodded.

“So you will go to the hospital?”

She nodded again, slowly, looking up at me.

“I’ll stop by to see you whenever I’m there.”

She nodded again.

I heard the bedroom door open. Husband and son were standing in the doorway.

“It’s okay. She’ll go.”

I left the house with a sense of satisfaction. I’d helped an entire family.

The woman with no face was admitted to the hospital the next day.

She was dead within a week — from an infection. She had been removed from her environment and even reverse isolation couldn’t protect her from an infection acquired in the hospital.

And I was the one who’d convinced her to go there.

I’d heard that my patient had died while I was a patient in the same hospital. My visit to her home had come a week before I was to be admitted for surgery on my thyroid gland. What had been thought to be a cyst was cancer, probably caused by radiation therapy I’d had as a child.

I had visited the woman without a face, knowing that I was to undergo neck surgery, knowing that I was likely to have a cancer diagnosis. That thought had always been in the back of my mind during that visit and now it had come true.

While sitting in my own hospital bed, I’d remembered her from years before. She’d been a patient when I was a student. I even remember the unit and the room. She’d been a young woman, a young woman diagnosed with cancer on her nose, a young woman who thought she’d been given a death sentence. Unfortunately she hadn’t died. She’d given the death sentence to herself.

It’s good thing to be a patient in the hospital where everyone knows you. Health care staff are supposed to treat all patients the same of course, but it’s human nature to be nicer to someone you know.

The day after my surgery, after my surgeon told me the diagnosis, I was leaning over the hospital room’s bathroom sink, looking into the mirror while I put on eye make-up. The thick bandage over my neck made that difficult, but I was determined. The charge nurse came in, stood behind me and just shook her head.

“This isn’t going to change my life,” I said. She smiled at me and patted my shoulder. I told her I wanted to walk down to the next unit to see my patient, the lady with no face. Her smile faded as she told me that she had died the previous day. My hand was raised, a mascara wand poised to darken my lashes. It stayed in that position for a few seconds. Then I finished and said, “I’m going to take a walk anyway.”

And I did — down to the empty isolation room.