Defending your Life: A Nurse’s Story

defending-your-lifeheaderI recently watched the movie Defending your Life (again, for at least the 10th time), which is a romantic comedy that came out in the 90’s starring Meryl Streep and Albert Brooks. In the movie, Meryl Streep plays someone who lived an exceptional life on Earth; she was brave and generous in her life, giving of herself, and her love without fear. Albert Brooks, while a good person at heart, was someone who made some bad choices because he allowed fear to rule his life. The concept of the movie is that all who pass (with the exception of children and animals), must stand trial in Judgement City to defend their actions in life; both good and bad. More importantly, the ability to overcome one’s fears was examined in order to be deemed worthy of advancing into the next phase of their existence… or, be sent back down to Earth for a do-over. The plot is complicated by both characters falling in love during their brief time in the afterlife; and Meryl’s character, who was brave and faced her fears in life, was judged to be able to move on; while Albert’s character, was not. Not to worry (spoiler alert), in the end, good ole’ Albert finds the courage to fight to join Meryl in her tram ride to Heaven; and those who had judged him not worthy, saw this act of bravery, and decided to let him stay with Meryl. The end.
This movie always makes me wonder if I would ever be deemed worthy enough to pass into the next phase of existence. I am basically a good person; I’ve made mistakes, sure, but let’s face it, who hasn’t? If I were put on trial today, would I be able to prove that I overcame my personal fears? I would say no, not even close. My fears and anxiety have only grown as I have gotten older. Let’s be honest, we are in trying times right now; between our twitter-happy commander-in-chief, the potential for war with North Korea, the questionable future of the Affordable Care Act in healthcare, climate change and the environment, and having to wait until the end of next year for season 8 of Game of Thrones, our future is uncertain. Of course I realize that losing sleep and worrying over these important issues isn’t actually solving any of those problems, just adding to my neurosis. The best thing that I have going for me is the work that I have done/do as a nurse. Surely, that has to hold a lot of weight for the big guy, am I right?
Nursing is a very demanding and sometimes, thankless job. We care for all patients equally, risking our own health (mental and physical) to work long shifts, 24/7/365; missing holidays/special events/dinner with our families/sleep/bathroom and meal breaks, etc… and that’s just touching the surface. Each day is an unpredictable adventure that brings new challenges and struggles: short staffing due to sick calls, train wreck admissions from the Emergency Department, patients “crashing”, c-diff, isolation precautions… fill in the blank. Are we perfect beings, no, but we work really hard and try our best every single day to care for those in need. Heck, just showing-up is half the battle and deserves some form of recognition; three 12-hour shifts in a row should be bonus points for earning a place in Heaven for sure. But are nurses brave? Abso-freakin-lutely! In New York and New Jersey, nurses were some of the first responders that were in a state of readiness after the 9/11 terror attacks at the World Trade Center; all employees were called into action, waiting for patients that never came; this realization was the most difficult to accept. We were greatly affected after Hurricane Sandy as well; many hospitals were running on generators and managing to run safely to care for patients with limited supplies that were delayed in being replenished due to the inability to receive new deliveries for several days. Many staff were unable to get to work; those who were already there, stayed, praying that their own families were safe and sound at home. A few years ago, nurses were trained to safely care for Ebola patients; that took a lot of courage. Many were nurses who volunteered to be trained, even after a nurse in Texas contracted Ebola after caring for an infected patient. That is what nurses do; we care for those who need us. We must always be in a state of alertness and ready to be called for duty to provide care in any situation. I believe that nurses overcome some degree of fear every day; you walk into your unit never knowing what the next 12+ hours will bring. It’s always a surprise, good or bad. I also believe that nurses help their patients through their fears; when patients are their most vulnerable, and most afraid, it is their nurse that sits beside them, holding their hand, and letting them know that they are not alone. Nurses truly defend and advocate for their patient’s lives every single day. I like to think that in the end, if and when we are called to defend our lives, that is what is most important.

 

Truth and Courage

Someone recently asked me “How do you find the strength and confidence to trust what your gut is telling you…how do you decide what is the “right” thing to do”? It is a complicated question because what is “right” for me, may not be for you, but one thing that I am absolutely certain is that no matter what, you must always be honest and honorable in your approach to speaking up, and even more, standing up, for what you believe in. It isn’t easy; actually, it’s very hard to do. Sometimes you can feel alone out there on that ledge, and sometimes, you may even lose someone that you thought was a friend. But your real friends, who know and love you, will hopefully trust that you are doing what you need to do, whether they agree with you or not. Be aware that there are risks involved in speaking your truth, and the consequences may not always be the end result of what you intended. In fact, it takes a lot of courage to be willing to risk losing something, or someone, by standing up for your beliefs.

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Here’s a fun fact that you should keep in mind before you decide that you need to share your truth with others… take it from someone who knows all about this…make sure that they/he/she is open to hearing it. There is nothing worse than being vulnerable and putting your heart out there, and getting “things” off your chest, than finding out that your truth is not welcome, and is not something that they care about, or want to know. Then you just end up feeling like a fool, and it’s very hard to move on from there with hurt feelings, and resentment. To avoid this awkward scenario, I suggest finding out if the receiver of the information is open to having “the talk”. You can say something like this: “Can I be honest with you?” Simple as that; by asking the question, allows him/her to actively give permission to start the conversation. Or not.

Integrity

Integrity means taking the path that may not be easy, or popular, but it is always about doing the right thing. At the end of the day, the choices that we make help define us; they become our values and our purpose; they create our reputation, or what we are known for by others. We must live with our choices, right or wrong. It is only through reflection where we see what we could have/should have done differently. We all make mistakes and bad choices; I know I have made many in my life. I have learned a lot about myself through my failures, but the most difficult thing is to be able to pick yourself up, move on, and try again the next day.

If we have ever chatted about how unfair things seem to be, or how mean or hurtful some people are, you know that I will always sit quietly and listen, and then state the obvious: we have no control over what others do or say, only how we respond to it/them. How we respond speaks volumes. As Michelle Obama said at the 2016 DNC, “When they go low, we go high”. Respect goes both ways, and people will treat you how you allow.    So to answer the question “how do you find the strength and confidence to follow your instincts and do the right thing“: truth is a superpower that can help you to know what is the right thing to do. You must always trust your gut; when something doesn’t feel right, it usually isn’t. And when someone shows you who they are, by their words and actions, believe them. If you are speaking your truth for the right reasons, and are advocating for yourself or others…then you must “speak the truth even if your voice shakes” (author unknown).

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Bittersweet accomplishment

“What you get by achieving your goals is not as important as what you become by achieving your goals” – Henry David Thoreau

Today is my last official day of class for my Master’s program. My final assignment was to write a paper reflecting on my successes in the program, and discuss future opportunities that having my Master’s degree will provide. It sounds like a simple task, but I struggled with it for days. I am overcome with emotion, wishing that my father, who was so proud of me for returning to school, could be here to celebrate with me. My father was my biggest cheerleader, and he never missed an opportunity to brag about his daughter, the nurse, who is “getting her Master’s degree”. When he grew very sick, he would ask me how many weeks I had left until I graduated; the countdown began. Both of us acutely aware of the possibility of running out of time. In the end, he just couldn’t hold on any longer. With only a few weeks left until completion, I did my best to continue my school work while I grieved, and finish what I had started two years ago.

As I reflect on my experiences in my Master’s program, I realize that had it not been for the support and encouragement of my friends and colleagues, I might not have taken the first step to register and “see what all the fuss was about”. Making the decision to begin a graduate program as I was approaching my half-a-century milestone was not an easy one. It was something that I had been wanting to do, yes, but I didn’t have the confidence in myself to be able to return to school at my age. I was content in my job as a Nurse Manager and more importantly, after 26 years, I still loved nursing. That first step was terrifying, but it led to a second step, then another, and so on… We don’t always get second chances, but if you are considering going back to school (at any age), I would encourage you to do so; it will be worth it in the end. According to Sandberg & Grant (2017), we learn more from failure than from success; the bigger the failure, the more we learn because we scrutinize it more closely. As nurses, we will be faced with many challenges throughout our careers, and learning how to adapt to changes, and inspire others to do the same, will be very valuable to our future success.

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Reference

Sandberg, S., & Grant, A. (2017). Option B: Facing adversity, building resilience, and finding  joy. New York, NY: Alfred A. Knopf

Nursing…for better, or worse

Working in the pediatric intensive care unit (PICU) and the pediatric hematology-oncology unit, I have grown very close to many of my patients and their families. When kids are sick, they can be in the hospital for extended periods. It is inevitable. The timing of illness is never “perfect”. So, in a way, we become one another’s extended family, and we find opportunities to celebrate and plan special parties for “our” kids; we throw birthday parties, play Santa on Christmas, dress up in costumes for Halloween, and we even have an annual prom, where many of our patients dress up in fancy gowns and suits, and dance the night away (like a “normal” kid).

We celebrate the happy events when we can, because the sad ones are all too common. Loss is hard. Some of us are able to put up a protective shield so we don’t “get too close”; we try to protect our hearts and our soul from the pain of bearing witness to life and death on a continuous basis. But there are always those patients who break through that shield and you find yourself attached, whether you like it or not. This has happened to me many times. My first experience with losing a patient was when I was a young PICU nurse. Rebecca was 10 years old and had fanconi’s anemia; she was not an easy patient to care for, and she hated taking her medications. She basically gave me a hard time for every thing that needed to be done (to/for) her… bath, dressing changes, oral care, vital signs, etc. We worked through our challenges though, and we compromised when able; yes, even at 10, she was quite the negotiator. After she passed, I went to “sit shiva” with her parents; it was the first time I experienced a Jewish “wake”. I remember her father greeting me saying “finally, I have someone to drink with me”. I wasn’t sure whether to take that as a compliment or not, but dutifully accepted the large glass of vodka, straight up, no ice that he shoved in my hand. I would have preferred ice, and maybe a splash of cranberry or orange juice, but he never asked, and I didn’t have the heart to object or refuse. He seemed so proud and happy that Rebecca’s “favorite” nurse came to sit shiva with the family; we quietly spoke about her, and our time together. Rebecca’s parents looked lost and broken, and I remember feeling so guilty. I was the nurse that couldn’t save their child. I felt like we failed her, and her family. There were a lot of mixed feelings that were hard to work through for a young nurse. The vodka helped a bit with that…from what I recall.

After awhile, we try not to attend the shivas or wakes or funerals of our patients; it can be heartbreaking and can sometimes be a slippery slope with crossing professional lines. But self-preservation aside, I have never had an experience where a patient’s family did not wholeheartedly welcome their child’s nurse at his/her funeral. It shows that we care, that their child made an impact on us; they were special.

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My father passed away last Saturday. While I knew that his time on earth with us was coming to an end soon, it still seemed sudden to me. The days leading up to his passing have been the worst days of my life. I can’t get his pleading voice, “Debbie, please help me” and “let me go” out of my head. No matter how much pain medication I gave him, he woke up soon after in even more agony.  By Friday, he was getting Morphine and Ativan on an hourly (sometimes half-hourly) cycle, and it still barely kept him comfortable. I tried so hard to save him from the only thing he feared in the end…a painful death. Finally, on Saturday morning, we seemed to reach that peaceful period when he no longer needed medication. We had a brief moment alone when I was making sure that he was comfortable, and put some Chapstick on his lips… he opened his eyes and looked at me and I said “I love you Dad”, and he said what he always said to me, “I love you more”. Those were his last spoken words and I will forever cling to them. Soon after, his breathing was slowing down, and he was fading away from us. I could almost see it happening. He passed away peacefully. It was a relief that he was out of pain, but the most heartbroken that I have ever been at the same exact time.

My father’s hospice nurse, Patti came to his wake. When I saw her, I immediately understood what it meant to see your loved ones’ nurse paying their “respect” to the family. Patti is a pro; she doesn’t go to all of her patients’ wakes I am certain, but she said she really liked my Dad; he was a good patient, with a great sense of humor. He bravely accepted his prognosis, and made peace with it. My father made her laugh. She would care for him, and talk him through what medication he needed to take, and when, and he would say “whatever you say kid, you’re in charge”. She would gently correct him and say, “no, you’re in charge”. She gave him back what he lost, which was control. He was unable to walk, or do many of the things that we all take for granted, but he could still make decisions about his care, and how he wanted to pass. Patti made sure that his wishes were honored, and for that, I will always be grateful.

Rest in peace, Dad. I love you more.

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The “pros” & “cons” of cancer

Cancer sucks. No doubt about it. While there are many new and innovative advancements in the evolving world of healthcare, increasing the chances of remission and recovery, there are still many whom do not survive; who can’t “win” the courageous battle. I know those people well… they were my beautiful, vibrant cousin, Michele, who passed away much too young from brain cancer. They were my grandmother, who was so full of life until she was diagnosed with lung cancer with mets to the bone; she died within six months, her death merciless and painful on New Year’s Eve. They were my many brave pediatric patients who didn’t stand a chance against the cruel, non-discriminatory disease. Most recently, it was my father, whose cancer was so relentless that it laughed in the face of chemotherapy, immunotherapy, and radiation. Yes, the “cons” of cancer are many, and their faces are forever in my memory and heart. But are there “pros” to cancer? I believe that there are some. The gift of cancer is that it gives us time to prepare, to let the inevitable sink in. It allows us the opportunity to go down fighting; to try everything that is available, from research studies, to proven protocols. Mostly, it gives us the gift of hope. And when we can see that the hope is fading, and our arsenal of medications are no longer working, it gives us the gift of saying a proper good-bye; saying what needs to be said before it’s too late. The closure that it can bring is the only thing that makes it bearable. Traumatic, sudden accidents or events, such as a heart attack, 9/11, or a car accident, do not give you closure; death is unexpected. No one can possibly be prepared. There are no “good-byes” or “I love you”, or “I’m sorry”…. there are regrets. And to me, that is even worse than a prolonged battle with cancer.

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On the other side of the bed

Today has been a really rough day. It is not easy being on the other side of the hospital bed; as a patient, or as a family member of a patient. We are at the mercy of healthcare providers for pain medication, water, oxygen, blankets… basically everything. When you press the call bell for assistance, and nothing happens, it can be extremely frustrating. Especially when you see that staff are sitting at the desk on their phone, appearing to not notice the call bell, and when asked for assistance, we are told that “your nurse is with another patient, I will send her in when she is done”. I’m sorry…. are you physically incapable of helping me, or is playing Candy Crush more important than my father who is writhing in pain?!? Is it too much to ask for you to do your damn job? Please just act like you give a shit. It is very disappointing when I don’t trust the nursing staff and medical team to take care of my father, and I have to sit by his bedside all day and night to make sure that he is getting pain medication when needed (even though it took over an hour and a half to get a dose of morphine for a patient who is at end-of-life with stage IV bladder-lung-and bone cancer). Have some compassion people! I should have just brought his pain meds from home and administered them myself, but I knew that was not allowed. But I should have anyway. That old saying “if you want a job done right, do it yourself”, or something like that, is very true.  So if you are a nurse that is reading this, please do not ignore patient call bells. Please don’t roll your eyes when your patient’s daughter (or son) is a nurse, and please help a patient in need, even if he/she isn’t assigned to you. It is very hard being on the other side of the bed. One day you will know. Treat your patients the way you want your loved ones to be treated. callbell

The gift of a dog’s love

Anyone who loves dogs as much as I do knows that they have a special gift of “knowing”. They instinctively pick up on how people are feeling; they know joy and sadness, and everything in between. Without saying a word, they have the uncanny ability to be able to just sit beside us in silence and solidarity as we navigate through difficult times; their presence is comforting, and it reassures us that we are not alone. We can say anything to them and they will never fault us for our honesty and moments of weakness; they do not judge, only love without condition. I can’t imagine my life without a dog by my side. Every single failure and heartbreak that I have had, I’ve gotten through it with a loyal best friend to give me strength and purpose.

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A dog has a gift of knowing when someone is ill, and even near death; they can sense it. There is scientific evidence that therapy dogs provide both mental and physical benefits to those that are in Hospice care; their presence has a calming effect. The soft texture of their fur can provide warmth and comfort to those who are in pain and feeling anxious. My father loves having our family dogs visit; they are a welcome distraction to our new reality. Watching our golden retriever, Riley, play with a squeaky toy, or gently drop a tennis ball into his lap, brings a smile to his face that is usually grimaced in pain. His moans become chuckles as he throws the ball to watch Riley run after it with pure focus and intensity; sometimes bringing it back for more, sometimes just chewing it for awhile to revel in victory.

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The love of a dog is the gift that keeps on giving.