Freudian Slippers

I am standing in front of a heavy brown door with a small window at eye level. Unlike a prison door, or the doors continuing down the hospital hallway, this door has a New Yorker Comic taped to the frame. The comic shows a Dr. Frankenstein image, a monster on a table, a humpbacked assistant, and a request from the doctor, “Bring me a stem cell.” Already I like the person on the other side of the door.

As a nurse administrator, I try to visit patients on our Bone Marrow Transplant unit once a week. As I round with the unit manager, I take my time getting to know patients, families and staff a little better. It’s my favorite part of the week. Double booked meetings and an overflowing inbox, can only be balanced by time on the front lines.

I peak through the shades in the small window and see a tidy room with a hairless patient sitting in a chair next to the bed. I have often thought about the hairlessness of the patients I visit. It is more than just being bald. The mixture of vulnerability, determination and courage that can radiate from a cancer patient is amplified without a layer of hair. It can be a very powerful image.

Knocking on the door and asking permission to enter, I first notice the slippers. I am used to seeing teddy bears, sports themed, or simply brightly colored slippers to keep feet warm, anything to brighten a day and define a personality. These slippers have crazy white hair, glasses, and a big nose, immediately recognizable as Sigmund Freud.

Over the years, I have perfected the art of walking into a room, cold, without a clinical reason to be there. As I introduce myself, I look for a way to connect with the patient or family member in the room, pictures, quilts, or an obvious sign of distress. Today I choose the slippers and ask of their significance.

As I had hoped, this produces an immediate smile. It takes energy to smile when you are fighting for your life. I’ve heard that old adage about taking more muscles to frown than smile, I would like to see the data on that research. I suspect the psychological energy needed is not factored into the equation. It is exhausting being a transplant patient and I don’t take smiles for granted.

Along with the smile comes the answer, they are “Freudian slippers.” I return the smile and try to come up with a “Freudian slip”, but my mind is not quick enough, and I have to settle for simple conversation. I learn about the website where the slippers were acquired by a friend, there is also a dedicated husband bringing in food every day, and that life could be worse, she has her support team.

Tied to the bed is a Mylar “Happy Birthday” balloon given to all transplant patients the day they receive their stem cells. It has lost some air and is a little wrinkled, but very much afloat. This tells me it’s been at least a week since the staff sang our “Happy Birthday” song and life has gotten more difficult. Very soon a miracle will take place and her stem cells will engraft and give birth to new blood cells. For now, mouth sores, diarrhea, and opportunistic infections are all knocking at her door.

I ask my usual questions, “are we treating her well, are we paying attention to those little things that make a big difference, and most important of all, does she feel safe here.” Patients are vulnerable physically and emotionally, it is overwhelming to think of all the potential “bad things” that can happen following a transplant. I seek the truth, but we are human and, as a rule, patients hesitate to complain. Today she is simply exhausted and appreciative of the nursing care.

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Over the weeks of visiting, the slippers, along with her resilience prevail through the bumpy road of this therapy. I never think of a comment to slip into the conversation that would go with the slippers. Honest communication is required even when humor is appreciated. She does well after transplant and eventually is discharged to home. We both move on with our lives.

Years later, I participate in a writer’s workshop and when asked to write about an experience at the hospital I remember the Freudian slippers. I still can’t think of a clever “slip of the tongue”, but enjoy the opportunity to reflect and share an experience. I also wonder if those slippers are sitting in the back of a closet somewhere.

Not long after the workshop, I went on a neighborhood website to advertise a canoe I wanted to sell. Almost immediately I am contacted by several people. One name sounds familiar and I reach out to give her more details. She and her husband would like to see the canoe, they only live a couple blocks away and walk over that afternoon. She has already connected my name with the hospital and when I see her, I make the connection as well. We laugh and make comments about the size of the world.

Strong and healthy, I can’t help but appreciate her new lease on life, with plenty of hair and normal blood cells. I wish I saw more patients after they have recovered from their transplant.

To make the world seem even smaller, I am hosting a medical student from India and we hear that my former patient and her husband lived in India for many years. My medical student is homesick for Indian food and is successful in receiving an invitation for the two of us to join them for dinner and some authentic Indian food.

At dinner, I let it slip that I have written a short essay about the Freudian slippers and I had finished it by saying that I envisioned them at the back of a closet, all dusty, and ignored. After dinner, she takes me to her room and into her closet to reveal the slippers sitting in the very back. Enjoying the moment, I take a picture to prove they are real. She also points out a framed original New Yorker Comic strip above her bed and tells us the story of how she found it.

As the medical student and I walk up the hill to home, we discuss what she knows of leukemia and she says, “It’s too bad other patients don’t tolerate “transformation” as well as our hostess did.” What can I say, but smile and agree.

Sue Childress is the Director of Nursing at Huntsman Cancer Institute. When she’s not annoying staff by taking their pictures for the nursing blog, she’s off exploring in her 1997 VW Eurovan.