The stress of change

I’ve spent a lot of time feeling (very) comfortable in my role as a clinical Nurse/Supervisor for more than 30 years. I got to the point in my career where it felt like “home”, walking through the hospital, with cardiac monitors alarming and call bells ringing, and the hustle and bustle of nurses and clinical staff running into patient rooms responding to help. It’s a well-earned level of expertise that gives one a feeling of confidence that strengthens your spirit, and puts you in a state of catlike readiness to handle the unexpected crisis’ that occur when you least expect it. It’s what I know, and what I love; it’s my life… well, it was my life.

But now everything has changed, and I can’t remember when I’ve ever felt this stressed-out. Between a recent surgery, selling my house in the state where I was born and raised, building a new house in a different state, and changing jobs, sometimes I don’t know where to start on my colossal list of “things-to-do”. It’s overwhelming, and I just want to press “pause” on this big, blue marble called Earth, and basically just take a long nap. My confidence level at work is at an all-time low. My new job is so different from what I have known, it challenges me in ways that I never anticipated. Being challenged is not a bad thing, but it makes me feel very uncomfortable being so inexperienced, and dare I say, “stupid”? It’s a feeling of complete vulnerability, which is the absolute worst, at least it is for me.

We all make life and career choices every day; for better or worse, and sometimes, with just a leap of faith that it’s the right thing to do. What we don’t see when we are making these difficult choices, is the future outcome. I guess that’s what is so exciting. It’s a new beginning, and sometimes the hardest things in life turn out to be the most rewarding.

It’s so hard to say good-bye to yesterday (Boyz ll Men)

I left a really great job yesterday, where I worked with really great people… extraordinary, really. We all work really hard, with our own unique contributions (big and small), to get “our kids” strong(er)… to heal all that can be healed, to the best of our ability… and hopefully, we get to send them home to their grateful families, to carry on with their lives, and experience the gift of growing up. I will miss this special place, and all whom I was lucky enough to meet along the way. I gained so much from you Children’s Specialized Hospital, but best of all, I gained many cherished friends.

Friends make everything better… even when you’re working short-staffed, and have really bad days! I’ve worked with my great friend, Nicole, for over 21 years… we’ve seen it all, and have countless stories to tell about each other… and everyone else! She has been my one constant in every job since the year 2000. She made me a better nurse, and a better person. No matter what, she always sees the silver lining, and works tirelessly to lead by example. I will miss her the most.

It’s so hard to say good-bye. I am terrible at it. I am a cryer, so there is always an abundance of tears, and a red, runny nose, that requires fist-fulls of tissues to soak up the mess. How lucky am I that I got to work with such wonderful people, that it hurts so much to say good-bye to them?

Thank you to my friends at CSH for the beautiful flowers, balloons, and card. I love them… you are all very special to me.

On Monday, I will start a new job, with an old friend (Hi Aileen!), and I will be able to use everything that I’ve learned, in my 30+ years of nursing, to be able to advocate for the underserved, and medically-fragile, pediatric population in my (new) county, in my (new) state, of Delaware. I have spent my entire career committed to caring for children, and this new role that I have accepted will help me to take my expertise one step further, and meet the families where they live, to better assist them in getting the medical help that they need to live a healthy life, and hopefully overcome some obstacles that they may have. 

Wish me luck!

It’s so Hard to Say Good-bye to Yesterday” (Boyz II Men)

… How do I say goodbye to what we had?
The good times that made us laugh
Outweigh the bad… I thought we’d get to see forever
But forever’s gone away
It’s so hard to say goodbye to yesterday… I don’t know where this road
Is going to lead
All I know is where we’ve been
And what we’ve been through… And if we get to see tomorrow
I hope it’s worth all the wait
It’s hard to say goodbye to yesterday… And I’ll take with me the memories
To be my sunshine after the rain
It’s so hard to say goodbye to yesterday… And I’ll take with me the memories
To be my sunshine after the rain
It’s so hard to say goodbye to yesterday

Source: LyricFind

Songwriters: Christine Yarian Perren / Frederick PerrenIt’s So Hard to Say Goodbye to Yesterday lyrics © Sony/ATV Music Publishing LLC

The Kindness of Others… and by Others, I Mean Nurses

Life is hard; sometimes it can become very overwhelming, and can lead one to a feeling of indifference towards others. We focus so much on our own “stuff”, that we can’t see past it, to recognize when others may be struggling as well. Even those closest to us may not know the many burdens that we carry, because we hide it well, and often suffer in silence. 

This past year in particular, was relentless with tremendous loss, isolation, fear, and anxiety. It was the “perfect storm” for those who usually seek relief from stress by socializing with friends and family. Many of us lost that. I lost that.

We lost hugs. I am a “hugger” and I really missed hugging my friends! We even lost our smiles; they had to be hidden by a facemask at all times to protect us from a deadly virus. But smiles are so important to connect with others! We had to rely on our eyes to communicate our feelings, and that is not always easy to do. And we made mad dashes to the grocery store, dripping in hand sanitizer, hoping that no one around us dare clear their throat with a cough. (God forbid)!

But this is where I start bragging about Nurses. It’s Nurse’s Week, and this year we all deserve a damn vacation! We went to work every day to take care of our patients, just like always, as if there wasn’t a global pandemic that kept many others home from work or school. Our “business” never closed its doors. 

According to Psychology Today (2021), altruism is helping others at some cost to ourselves. It is showing empathy, and purposefully acting in a selfless way to help others. Nurses are the definition of altruistic! During this pandemic, nurses gowned up Every. Single. Day. They wore restrictive and uncomfortable PPE for 13+ hours until their faces were bruised. They washed their hands and uniforms as if hoping they could be sterilized, so as not to pass the virus onto ourselves, or others. Nurses kicked ass this past year, but there was a high cost to be paid. Too many lost their lives in this battle, and on this week of celebrating nurses, please take a moment to remember them, and their families, in our prayers. They were brave and kind and altruistic… and they paid the ultimate sacrifice in this Covid war.

Please take care of yourselves this week, you deserve it! Thank you for your kindness, love, and friendship; thank you for being you!

Happy Nurse’s Week!

Reference:Psychology Today. (2021).  Retrieved from https://www.psychologytoday.com

Birthday Girl

Today is my Birthday! (yay!) It’s not exactly a big milestone, more like a half of one, but the number does frighten me a bit. Honestly, I should get a “do-over” because 2020 was such a dud.

As I reflect on these fifty-five years (holy crap-oly!) that God has given to me, I see an abundant view that is a privilege denied to many. I have much to be grateful for, and I try to remember that, even through the bad days. 

Life, in general, can be complicated… it’s a day-to-day rollercoaster ride of ups and downs, until it’s over… which is something that I’ve actually been thinking about a lot lately; maybe it’s my age, or this past year of such devastating loss due to Covid… and the isolation, of course. The isolation has been really hard. Fortunately, I’ve had so many wonderful friends in my work “pod”, at least that part of my life hasn’t been lonely. Nurses are essential after all, not to mention, “superheroes”!

But I’ve gotten stronger and bolder as I’ve aged; I think that’s how it’s supposed to be. You become less worried about what others think (of you), and focus more on the important things, like being true to oneself. 

I (almost) always say what goes through this busy mind, for better or for worse. That’s why I write in this blog; it may seem silly to some, but it helps me to just sit still and thoughtfully think about what I want to say. It can be very scary to open up and share yourself with others, mostly because people can be so judgmental, but experience has given me confidence, and a feeling of self-worth and courage, that I didn’t have when I was younger.

Thank you for letting me into your lives, listening to me, showing me love and kindness, and laughing with me, and not at me.

Today is my birthday! I will celebrate life, and all that it has given to me, as I imperfectly live it, one day at a time. 

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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Depression. Despair. Suicide.

I originally wrote this post about suicide two years ago after several incidents of “jumpers” from a nearby parking garage occurred within a short time frame, and I couldn’t get past the sadness and horror as I walked past it everyday. It touched me deeply, and I didn’t even know them… but I knew of them, and seemed connected to them in some way. Each time it happened, it seemed like a dark secret no one would talk about. There was minimal information in the newspaper, and I had so many unanswered questions. There is a stigma that comes with mental illness that many do not feel comfortable talking about. So we don’t.

Now, I’m going to open up and get very honest and personal. My cousin committed suicide when I was young… it was something that wasn’t talked about in my family, and I am still not certain of the specifics and I wish I knew more. A dear friend’s son committed suicide last year… it has been absolutely devastating for her, her family, and Alex’s friends (my daughter was one of his friends). They will always mourn his loss… he was gifted, and kind, and successful, yet he couldn’t ask for help to get out of the darkness.

Something happened recently that shook me to my core; my daughter attempted suicide. She became so overwhelmed with her work in the news industry, with this relentless cycle of negativity and civil injustice, that she quite literally “broke”. Her compassionate heart could not continue to write (and re-write, and re-re-write) about the horrific acts of violence and sadness in the world…. that, and the tragic loss of life with the global pandemic, and the isolation of being in quarantine, was too much for her to bear, and she lost something that keeps most of us moving forward… hope. My own beautiful daughter became so depressed that she didn’t want to live another day. That shocking realization is something that I was not prepared for… not my sassy, funny, bright, strong, successful daughter…. that can’t be… under my own eyes, in my own house. How did I miss this? I felt like I had failed her. In hindsight I did see some subtle changes, but she was good at pretending she was ok… she stopped working-out with her virtual trainer because it was so hot outside. She stayed in her pajamas all day because didn’t everyone who worked from home do that? She wasn’t sleeping because she was working so hard writing for the news show that she produced. And me…. I am a Nurse, so I went to work like I always did, even under the stress of Covid… I came home late, sore, and tired… and I missed it. But thank God, I was able to stop her in time… and I got her help. Yes, we have guardian angels among us.

We have all felt sad, disappointed, and alone at one time or another in our lives. Those of us who have struggled with depression, or other high risk factors such as loss, low self-esteem, rejection, or 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. We all have our own inner demons that come out when we are at our most vulnerable.

Depression is an illness that often can be mistakenly viewed as a sign of weakness, or an inability to cope with everyday life. This is just not true. The American Psychiatric Association (2018) defines depression as a medical illness that affects how one feels, thinks, and acts; it can lead to thoughts of suicide if left untreated with the right mix of therapy and medication.

Suicide has been described as 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. These are scary statistics…especially when they hit so close to home. 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; 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 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 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, and most important, we need to support them and not judge them. “There but for the grace of God, go I”. Timing is everything, and if the pain and despair are recognized early enough, perhaps a life can be saved.

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    

nurse supervisor

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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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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