Our Unforgettable Patients

If you want to find out what motivates nurses to do what they do every single day, ask them about some of the patients who made a difference in their lives…the stories that they tell will move you; they will make you laugh and cry, and they just may help you to understand the power of purposeful service to others. Every now and then, completely out of the blue, I am given a gentle reminder of the unexpected gifts that this amazing profession has given to me. Yesterday, while I was cleaning out my glass cabinet looking for my red Christmas wine glass that reads “He sees you when you’re drinking”, I came across my rather impressive collection of shot glasses, and I found myself thinking about a patient whom I had the privilege of caring for several years ago. Let me explain…

This young man was diagnosed with Acute Myelocytic Leukemia (AML) in his late teens; he had spent several years in and out of the hospital for chemotherapy treatments and subsequent admissions for fever/neutropenia, blood products, etc. He had been doing well; he was working hard and attending college on a full scholarship when he found out that his cancer had relapsed and he was going to need a bone marrow transplant (BMT). He stayed strong and optimistic; he had big goals and cancer wasn’t going to get in his way. He was turning 21 just before his scheduled BMT and he had plans to take a trip to Las Vegas with his friends because that was how he wanted to spend his birthday “sipping Patrón tequila and partying”. He knew that each birthday was a gift, but “21” was a milestone that he wanted to experience the most; he wanted to be like every other 21-year-old who got drunk on his birthday as a “right of passage”. This was amusing to all who knew him because this young man was the very last person you could imagine drinking tequila in Vegas! Unfortunately, due to an infection, he ended up having to spend his 21st  birthday in the hospital (in the very un-exciting state of NJ). Yes, he was disappointed, but he rolled with the punches that kept coming his way (as always).

I was working nights at the time, and at the stroke of midnight, on his 21st birthday, all available staff on duty that we could muster up for a few minutes, entered his room singing “Happy Birthday to you…”; we all had shot glasses (aka 30 ml clear plastic medicine cups) of apple juice in hand to toast the now “legal” birthday boy. I had a “real” shot glass from my one and only trip to Las Vegas and presented it to him for his “shot” of AJ, which he happily kept as a souvenir. As corny as this little make-shift party was, he loved it, and he talked about his plans for next year to (really) celebrate…I am certain that he never doubted for a minute that he would get to Vegas one day.

I would try to visit with him regularly to check-in and see how he was doing, and each time that I was there, he talked about his “Vegas” birthday party and smile. I didn’t fully comprehend until then how much this small gesture meant to him and that he would always carry that memory with him. Sadly, that would be his last birthday; he had fought so hard, and he never gave up. He taught me about courage and resilience, and accepting defeat gracefully. At his wake, his sister thanked me for taking the time to help him celebrate his last birthday. It meant the world to me that I could make a difference… showing someone just one small act of kindness could be that one thing that they need to get through a difficult time.

I cleaned out one of my glasses and drank a shot of apple juice in your memory today. Cheers my friend!

When you are a nurse, you know that everyday you will touch a life, or a life will touch yours.” – anonymous

enjoy the little things

Working on Holidays

I was at the receiving end of a comment recently, which was clearly intended to belittle, from an unlikely source… a parent of a sick child in the hospital… the remark was this “Who are you… you’re not important, you’re here working on a holiday”. In my nearly 30-year career, I can honestly say, that was a first. The world of healthcare is not a 9a-5p, Monday-Friday job… hospitals do not close down for summer vacation, snow storms, weekends, or holidays… they are always “open for business”. Nursing is a 24/7/365 job. In fact, during any type of disaster, emergency, or significant weather condition, nurses are considered “essential personnel” and are (strongly) advised to report for duty. While most others are warned to “stay off the roads” during a State of Emergency, we pack overnight bags in anticipation… and when the time comes, we search for an open stretcher in a quiet corner and (try to) sleep so we can work the next day in case others cannot make it in for their shift.

Nursing is a profession of dedicated service to the community in which it serves, just like police officers, EMTs, and firemen/women; and it’s not just nurses that keep a hospital running smoothly… it’s also the Doctors and Advanced Practice Nurses, Patient Care Techs, Respiratory Therapists, Security, Housekeeping, Food & Nutrition, etc. We all know the expectations going into our roles. I have worked many, many holidays in my long career…and yes, I still do. I worked on Christmas Day last year, and I will most likely need to do it again this year. I accept it, and I am grateful that I have a job that I love, with people that I have grown to love. We all have families that we would like to celebrate the holidays with… but if we can’t, we make the best of it; we post a sign in the staff lounge for a pot luck feast, and we all contribute to the festivities… we find ways to laugh through it, and we reschedule the time that we can spend with our own family so that we can take care of yours. Working on a holiday is not a measure of importance or title… it is just something that we know we must do to care for those who need us.

I wish that I was able to say what I was thinking to this parent, but I bit my tongue; I am in a position that requires me to de-escalate situations, rather than speak my mind. But I do wish that I would have pointed out that those he attempted to minimize (it was not just me), were there (on a holiday) taking care of his child… and that is not unimportant to us, and it shouldn’t be to him either.

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Suicide

We have all felt sad, disappointed, and alone at one time or another in our lives. Those of us who have struggled with depression, loss, pain, isolation, low self-esteem, failure, rejection, or financial/professional stress have experienced varying degrees of darkness and despair; it’s not a fun place to be, and not everyone makes it out alive. Some have been in such a low place that they feel their only solution to overcome this immense pain and suffering is through one final extreme act of choosing death over an unbearable life. Depression is an illness that often can be mistakenly viewed as a character flaw, a sign of weakness, or an inability to cope with everyday life. The American Psychiatric Association (2018) defines depression as a medical illness that affects how one feels, thinks, and acts. It is, however, treatable; but one must be able to ask for help.

Suicide is death from despair. According to the Center for Disease Control (2018), suicide rates in the U.S. have increased 25% in the past two decades and are increasing among adults aged 45-64. Among those aged 15-34, suicide is the second-leading cause of death (CDC, 2018). When we hear about someone we know (or know of), who has committed suicide, we are often shocked. We question why/how someone would feel so hopeless as to choose to end one’s life, while others fight so hard to press on through their own struggles to live another day, grateful to be alive. No one truly knows what others are going through; we all have our own inner demons.

Those of us in healthcare have seen the outcomes of an attempted suicide. My first experience as a young PICU nurse caring for a teenage girl who attempted suicide by hanging, was extremely difficult and heartbreaking; there was no happy ending or miraculous recovery for this young, troubled girl. This story was tragic, and yet it happens everyday. She had gone through a bad break-up with her boyfriend, and the pain and rejection led her to self-mutilation, which didn’t dull the pain deep inside of her, so she hung herself. Her sister found her, and called 911. She was brought back to a life of vegetation. She wore a haunted look of pure rage, which seemed to be her only facial expression when “awake”. She had just enough brain activity to continue medical interventions. I still think about her from time-to-time when I hear of another suicide in the news, and I wonder if she ever found the peace that she was looking for so long ago. I truly hope so.

What can we do to prevent our loved ones from choosing this ultimate act of despair? First, we need to be able to recognize the signs and symptoms of depression and not be afraid to ask our friend/family/co-worker if they need help, or want to talk….or even if they have ever thought about hurting/killing themselves. We need to support better medical coverage for mental health and pre-existing conditions. We need to prevent those who have mental health conditions from being able to legally purchase a firearm. And last, we need to open our eyes and recognize when someone that we love needs help; we need to support them and not judge them. “There but for the grace of God, go I”.

Linkin Park wrote a beautiful song about suicide called One More Light (2017). The irony that one of the writers, Chester Bennington, committed suicide a year later, speaks to his state of mind and intimate understanding of the effects of suicide for the ones who are left behind to try to heal from this great loss.

Video:

One More Light (lyrics)

Should’ve stayed, were there signs, I ignored?

Can I help you, not to hurt, anymore?

We saw brilliance, when the world, was asleep

There are things that we can have, but can’t keep

If they say

Who cares if one more light goes out?

In a sky of a million stars

It flickers, flickers

Who cares when someone’s time runs out?

If a moment is all we are

We’re quicker, quicker

Who cares if one more light goes out?

Well I do

The reminders pull the floor from your feet

In the kitchen, one more chair than you need oh

And you’re angry, and you should be, it’s not fair

Just ’cause you can’t see it, doesn’t mean it, isn’t there

If they say

Who cares if one more light goes out?

In a sky of a million stars

It flickers, flickers

Who cares when someone’s time runs out?

If a moment is all we are

We’re quicker, quicker

Who cares if one more light goes out?

Well I do

Who cares if one more light goes out?

In a sky of a million stars

It flickers, flickers

Who cares when someone’s time runs out?

If a moment is all we are

We’re quicker, quicker

Who cares if one more light goes out?

Well I do

Well I do

Linkin Park (2017)

Songwriters: Brad Delson / Chester Charles Bennington / Dave Farrell / Francis White / Joseph Hahn / Mike Shinoda / Robert G. Bourdon

One More Light lyrics © Universal Music Publishing Group

If you, or someone that you know, are having thoughts of suicide, please seek professional help; call a friend or family member, or call the

Suicide Hotline: 1-800-273-8255

References:

American Psychiatric Association. (2018). What is depression? Retrieved from https://psychiatry.org/depression

CDC. (2018). Suicide rates rise sharply across the US, new report shows. Retrieved from https://washingtonpost.com

Linkin Park. (2017). One more light. Retrieved from https://youtu.be/Tm8LGxTLtQk

Celebrating Nurses

Every year around this time I receive a “Happy Nurse’s Day” card from my parents…today, my card came from my Mom; she always remembers. She reminded me how proud she is, and how proud my Dad was, of me being a nurse. The loss of my Dad always sneaks up on me. It is that constant flow of support and love that has been the driving force throughout my career, and completion of my Master’s degree. The journey that I have been on has not always been smooth sailing; there have been more than a few bumps and sharp turns (and U-turns) along the way, which have led me to where I am today…which is mostly a good place.

Nursing has been the one constant in my life. This amazing profession has helped me to grow in my career and overcome many challenges. It allowed me to support my daughter as a single parent, buy a home, and basically make “ends meet”. We are not paid nearly enough for the work that we do, but we get by.

I have worked with amazing nurses in my long career and they will always be my forever friends; the “job” connects and bonds you in a way that most other professions do not. We share similar stories, frustrations, heartbreaks, and challenges. Nursing is hard work and often we do not get recognized for having sharp instincts, endless patience, strength, and resilience…all with the sole purpose of keeping our patients alive!

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Nursing Supervisors    

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As a nurse leader, it can be challenging to perform your role while walking the line between Nursing and Administration; the rules change. We are held accountable to strictly adhere to staffing guidelines, ensure patient and staff safety, consider patient acuity with staffing that is balanced with expert, competent, and novice nurses so that those with more experience can teach and develop new grads. In most hosptials, there is an abundance of upper management/leadership support and resources for patients and staff during the weekdays; on the off-shifts (eves and nights), weekends, and holidays, the responsibility of “steering the boat” changes from “many” to “one”; this singular, fearless leader is the Nursing Supervisor, who has to make difficult decisions and know when, and who, to call for help. They are called to respond to patient/family complaints/concerns, patient and non-patient emergencies, and occasionally discipline/coach staff… all while knowing that some of the choices you have to make may not be popular or well-received. I try to make the best decisions that I can, with the information that I have at the time. I am imperfect. I have made mistakes. I have miscommunicated via email, and I may have been too busy to remember to count to 10, and think before I speak during a particularly stressful moment. I am acutely aware that during every shift, I have a ton of responsibility to many: patients, families, staff, colleagues, and administration. Not everyone can appreciate that perspective…some can only see what is happening in their own area, and not the other things that may be going on in the rest of the hospital that can sometimes take precedence. We only know what we know.

Several years ago I worked with a really strong and brilliant Nursing Supervisor, Jackie; she did not mess around….she knew everything that was happening in the entire (very large) hospital, even if she wasn’t covering those areas. She could work the staffing numbers like a mathematician, and quickly move people where they needed to be to balance the numbers. In a crisis, she was calm, cool, and collected. She taught me a lot and never gave up on me, even when I made the decision to return to staffing and not stay in that role; I just wasn’t ready at the time.

We all have our own leadership styles, but the most important thing is that we lead with authenticity; we do the best that we can, practice the values of the organization, develop trust, and show compassion for others.

Happy Nurse’s Week! Enjoy the recognition from your family, friends, colleagues, and the organizations in which you work. You have earned it! It is the best job in the world!

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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 on (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 2019 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”… 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.

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. I like to think that in the end, if and when we are called to defend our lives, that is what is most important.

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 last breath taken 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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