The Importance of Best and Worst Days

Close your eyes and think about the worst shift that you ever survived; I use the word “survive”, because after such a shift, one can feel like they have been through hell and back in what seems like a never-ending 12.5 hours… who am I kidding, we are nurses, it’s more like 13-14 hours! My worst shifts weren’t the “busy” ones that happened because we were short-staffed, didn’t get a break, or got swamped with admissions; those happen all the time and we (just) “get through” them. No, the worst shifts stay with you; you remember how they made you feel… sadness or regret, self-doubt, anger, or frustration… or all of those things piled into one really crappy day.

We remember the painful things; it’s not by choice. As nurses, we often bear witness to horrific things that occur every day, in every city or town. We see car accidents, victims of violence, drownings, child abuse/neglect, etc. We try to help in any way that we can; when we can’t, our heart breaks because of our limitations. My worst days still live within my mind; I remember the bruised, emaciated body of a little boy who was kept in a cage in his adoptive parent’s basement as we tirelessly worked to resuscitate him; we did everything that we could, but it was too late. I remember caring for a teenage girl who attempted suicide by hanging, who was brought back to a life of complete debilitation. I remember providing end-of-life care to a young girl who fought a courageous, but impossible, battle with cancer, and once she peacefully passed from this life, with her parents and siblings at her side, her mother’s heart (literally) stopped beating, and we had to immediately go into life-saving mode, call a “code blue” and start CPR on mom, right outside of her deceased daughter’s room. We brought her broken heart back, whether it wanted to continue to beat or not. I still think about that family many years later. I will never forget that worst day and the lesson it taught me that one can truly die from a broken heart.
Now…take a breath, close your eyes, and think about your best day at work…did it inspire you to be a better nurse, or a better colleague…or a better person? The best shifts are not the ones that are uneventful, or dare I say, “quiet”. No… the best shifts are often unexpectedly extraordinary. A best shift is created when you are working with a great team and all the stars are aligned in your favor for a positive outcome. I remember one of my best days; I was an active responder during a Rapid Response that turned quickly into a full code. We did everything in our power to re-start a life, but we soon became acutely aware of the high probability that we may lose our patient. During the final pulse check, we all looked up at the monitor in complete silence…a rhythm suddenly appeared, and pulses returned. We were all in utter disbelief, but we gratefully accepted the gift from above that will sustain us for an entire career. The best shift becomes that “crazy, unbelievable” story that you share with one another, forever bonded as witnesses of a true miracle.

The best and worst days are important because they make us who we are; they define our actions, attitudes, and our experiences. We learn from them; they make us (more) human, and better nurses. They also create stronger and more united teams because best and worst days connect us in a way that most other professions simply cannot.
I wish you all best and worst days that will give you the strength and empathy that you need to be compassionate, grateful, and kind to one another.

 

nursing inspirational quotes Best of 50 Nursing Quotes to Inspire and Brighten Your Day NurseBuff

 

My article was published on Allnurses.com:

https://allnurses.com/general-nursing-discussion/the-importance-of-1169317.html#.W1eJt0Etm0E.link

Last Time for Everything

When I heard the song “Last Time for Everything” by Brad Paisley on the radio, it brought me to tears because I clearly remember the last time that I spoke to my Dad on the morning that he passed away; I told him that I loved him, and he responded as he always did, “I love you more”. At the time, I had a strong feeling that it was the “last time” because he was so ill, but just two days before, when he was having a good day, we sat in the living room together and talked about the usual “stuff” and ate dinner together…I had no idea that it would be the “last time” we did those simple, everyday things. “Things” that later end up becoming cherished memories. The regret is that you wish you said more, stayed longer, and listened closer. The moment when I remember that I can’t pick up the phone to call my Dad to share some news, or talk to him about my day, ask his advice, or laugh about something funny… makes me miss him terribly. Those “last times” become exponentially important when they are no longer a possibility. That’s when it all becomes very sad…and very final.

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Nurses are acutely aware of how, in the blink of an eye, a life can be taken, often without any warning. Terrible, tragic things happen all the time… being involved in a car accident on the way to work, enjoying an evening out at a Jason Aldean concert, dancing in a nightclub, even just walking around town… the world can be an unpredictable, unsafe place. Our country is experiencing trying times, and anyone who watches the evening news knows that no one is safe from the potential of harm. Life is cut short for those who are lost, but it is the survivors who have to learn to cope with a new reality and resulting pain. While it is difficult to overcome, it is also a sad fact of life. “No one gets out alive” has been quoted often. The meaning is that we all (eventually) die, and the advice shared is to “not sweat the small stuff”, or not to take things too seriously… which is really hard to do. There are those who are lucky (or maybe more enlightened people of faith?), who are able to not waste time or energy on the draining, exhausting act of worrying; I’m sure they are (much) less burdened with stress, negativity, and insomnia!

Nurses, in particular, are faced with the difficult task of providing comfort to those who have lost someone. They become the survivors…the obituary reads “he is survived by his wife of 55 years, his children, and grandchildren”. Nurses are at the front lines; they know the words to comfort and console. And sometimes there are just no words to be said, and a hug or a kind gesture are the only thing we are able to give to those whose lives are forever changed. What words can ease the pain of a parent who loses a child? There are none that exist. It is unspeakable; unimaginable. Nurses stay strong in times of pain and grief because they must; it is a part of the job. Our patients and families look to us for support and guidance to help them through the worst day of their lives.

If only there was a way of “knowing”. I think that there should be a text message notification from God giving us a heads-up to pay close attention and take it all in, because that’s all we will have left… memories. White Light Alert:This will be your last day with your father; make it meaningful“. Most times we aren’t aware of the timing and significance of a moment that could be/is “the last time” for something….last time speaking to your loved one, last photo, last Christmas, last birthday, last time saying “I love you”… fill in the blank. There are so many “firsts” and “lasts” that we rarely recognize it until it’s too late. There are many “things” that Nursing has given me, but the most profound has been the gift of perspective. Whenever I have had a rough day, or feeling bad about something that hasn’t worked out the way that I wanted, I walk into my job on the Pediatric Hematology-Oncology/ Bone Marrow Transplant unit and I am suddenly reminded that my life really isn’t that bad afterall… my child (who is now an adult) is happy and healthy, I am physically and mentally able to care for those in need, I get to leave the hospital at the end of my shift, and I have a great job that constantly challenges and inspires me to come back for more the next day.
Reference
Paisley, B. (2017). “Last Time for Everything”. Retrieved from Youtube.com

 

This article was published and featured on Allnurses.com:

http://allnurses.com/general-nursing-discussion/last-time-for-1132195.html#.WebPJt2icLs.link

 

What to do when you question why you became a nurse…and you will

I remember the exact moment I knew that I wanted to be a nurse. It was Career Day at my High School. Junior year, 1983. I walked into the building not knowing where to start, feeling completely overwhelmed with rows and rows of tables with feathered-out brochures displaying a variety of options and fields of study. There were smiling college recruiters promising success, and colorful poster displays showing happy, culturally diverse students hanging out at the Student Center, engaged in thoughtful discussion, books in hand. Many of the parents who attended this event seemed more excited than their offspring; each believed that their child was destined for greatness, hoping that at the very least, their child would exceed their own career choices.

It was during a mad rush of well-meaning parents, teenagers in tow, proceeding with focused determination to interrogate a recruiter from a nearby Ivy league university, that I was literally shoved into the corner of one table that was repeatedly being passed by, without even a second glance. (It is important to point out that back in the day, and by “day”, I mean, the 1980’s, there was a nursing shortage; it was not as popular of a career choice as it is now.) This table that I “found” had a sign that simply said: Be a Nurse. I remember thinking “OK, sign me up!” After all, I spent so much time in the school nurse’s office, she was on a first name basis with my parents; she always came through in the clutch when I needed a break from my classes and/or wanted to go home early. Call it fate, luck, or literally being pushed into a career; it was, as Oprah would say, my “Aha! moment“. I made the decision right then and there, and never looked back.

To this day it has been one of the best decisions of my life. It has been a job that has professionally sustained me for 29 years (and counting). But to be clear, it hasn’t always been smooth sailing. Yes, making the decision was easy; nursing school, not so much. The harsh reality of nursing was even harder. That first year after graduation was downright painful at times. As a new graduate nurse, you literally leave nursing school/college feeling on top of the world, thinking “I’ve got this!” (insert the laughing-out-loud with tears flying out of your eyes emoji here).

Then, you are “lucky” enough to get a job right out of college, working on the night shift, and your entire body, mind, and spirit are mercilessly handed to you on a silver platter (or bedpan, in this instance). You think that you are prepared to share your “gift” with those in need; heal the sick, save lives, cure cancer, maybe even meet a nice, handsome doctor (bring back that laughing emoji)…but soon, you realize that you are working with people who easily make Regina George from Mean Girls look like a Disney princess. Oh, and that handsome doctor is the one yelling, and hanging up on your for asking a “stupid” question. “Excuse me Dr. McDreamy, did you mean to order 500 mg of acetaminophen for a child that weighs 10 kgs”?

Yes, there have indeed been a few times (maybe more than a few) when I questioned “Whyyy am I doing this”? But here’s the thing, nursing is one of the best jobs in the world in my humble opinion. I can’t imagine doing anything else. Every time that I am asked what I “do” for a living, I am filled with complete pride when I say “I am a nurse“. For every challenging and painful shift, I have received tenfold in amazing moments. I have patients and families that will forever be engrained in my mind as my “favorite”. I have learned about compassion, courage, strength, empathy, hope, faith, and love almost every single day in the patients that I care for, and in the nurses who care for them. They are my colleagues. My friends. My brothers and sisters in healthcare. Yes, there are bullies, but they are small in comparison to the amazing nurse heroes that I have come to know and love. We share similar stories, and it connects us in the same way that brings sports teams to championships, and war heroes, solidarity.

So when you consider leaving your job as a nurse, and you will, it’s ok. We have all been “there”. To paraphrase Teddy Roosevelt, “nothing worth having comes easy”. Tomorrow is another day, and if you still feel that way, consider this: “If you don’t like where you are, move; you’re not a tree” (author unknown). Just don’t give up on nursing as a profession. Nursing is the gift that keeps on giving, there are so many different career paths that you can take; try them all if you so desire! Please don’t focus on the bad shifts; each shift is a lesson learned and presents you with opportunities for greatness, I promise you.

This article was published on Allnurses.com:

 

http://allnurses.com/general-nursing-discussion/what-to-do-1126354.html#.WdrmeyONkoZ.link

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 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; I cared for a 10 year old little girl who 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, 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 had ever 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 into 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 their daugther’s “favorite” nurse came to sit shiva with the family; we quietly spoke about her, and our time together. Her parents looked lost and broken, and I remember feeling so guilty. 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, 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 nurses 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, Patty 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. Patty 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. Patty 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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