The Cumulative Effect-for Jeff

Our hospital chaplain and I were talking earlier that morning about the effect seeing human suffering has on caregivers. Over time, it can change a person; seeing so much pain, fear, and death wears you down to the point that even the most joyous times (like watching a patient you never expected to make it walk out of the hospital) are just a little less fulfilling. Fortunately, for most of us, these feelings are cyclical. The pain subsides, the joy returns, and we go on…but you have to wonder about the cumulative effect. Who would we be if we didn’t witness all the suffering?

Yesterday one of our patients died. We tried to save her and we couldn’t. Every single time we have a code, I hope that it will be the last one I ever see…odds are it won’t be.

I was on the opposite end of the unit with a couple of the other nurses when we heard the code alarm. We rushed to the patient’s room where someone opening the code cart and CPR was in progress. As I took over chest compressions (I’m usually the one in that role first just because I’m tall), I thought of the many times I’ve had my hands on someone’s chest doing those same compressions and I prayed for the lady’s heart to start beating again on its own. It didn’t.

As charge nurse, by default I have to be the nurse leader during a code until we have a designated physician leader present; I don’t want to be the leader. It’s usually for only a couple of minutes but it feels like forever. I have to make sure someone is manning the cart and defibrillator, someone else is getting defibrillator pads on the patient, that we have working IVs, someone is recording, we have a backboard under the patient, and that someone is getting the meds ready.

When one of the young doctors took over compressions, I helped a nurse ventilate the patient while the anesthesia MD was preparing to intubate. I saw the panic in her face as she struggled with the ambu-bag initially then the relief as she got it right and heard me say, “Yes, sweetheart, just like that.” I’ve been in codes where people yell and it never helps anyone.

Real-life codes are not like the ones depicted on television. We are jammed together tightly around the patient and we are covered in sweat that is not just our own. Regardless of the outcome, everyone is shaken at the end of a code and there are some tears shed. We take it personally when a patient dies.

Dr. S was our physician leader; not only did he run the code perfectly, he was very calm and set the tone for everyone else. We gave numerous rounds of meds and performed CPR continuously. Everyone in that room worked hard to save the lady’s life. Several times, Dr. S had four of us do a final pulse check before he “called” the code; if one of us even thought we felt a pulse, we began the whole cycle again. After 46 minutes, there was nothing. He had to announce the time of death and one family was changed forever.

While we prepared for the patient’s family to see her, our chaplain met with her sons. I see death only occasionally; he shares others’ grief weekly- not just the patients and their families, but also our staff. Afterward, he updated me on the family while I was charting, then said he wanted to check on the nurse whose patient had just died one last time. As I watched him take the lonely walk down the then eerily quiet hallway, I thought to myself “But who’s gonna check on you, buddy?”

To Our Patients and Their Families- From a Transplant Nurse

We are often humbled by the grace and courage you display. We remember your words many years later as you affect us so deeply and we are honored that you allow us into your lives at the most intimate times. Because of you, we love harder, smile wider, and appreciate the little/big things in life that we used to take for granted. Thank you for that gift. You are our greatest teachers.
We don’t want you to be in pain and we feel frustrated when we can’t make it better.
When we have been off for a few days, then return to work and find out you were discharged home, it makes us smile and we wish we had been there to say goodbye.
We get excited when we see your labs before we enter your room knowing that ‘new’ kidney is working well and are eager to share that news with you. We also dread entering your room when your labs indicate no signs of improvement knowing we will see your disappointment.
Sometimes we think about you when we get home, wondering if you are doing better, and cannot help calling to check on you. Sometimes, too, we try not to think of you as we are reminded of our own mortality and that frightens us.
We are moved when we hear you speak with sincere gratitude about your donor and the donor’s family. We want to hear about how transplant will change your life and what you are looking forward to the most- walking your daughter down the aisle on her wedding day, going shopping with your friends without having to carry an oxygen tank, looking into your newborn grandchild’s eyes and feeling him grasp your finger with his tiny hand for the first time.
We love having you come back later to visit and giving us the opportunity to see you feeling well and enjoying life. You give us hope and that hope inspires our care of future patients.

A Tale of Two Patients

model cars

Sometimes we pray for signs from God giving us guidance, asking Him to let us know we are on the right path as we struggle with our own inadequate decisions. My answer was given when a bible literally slammed into my chest.

Patient One, Sam:

Sam lived on our transplant unit for about six months some fifteen years ago awaiting a new heart to replace his own. He had dilated cardiomyopathy (in essence, a giant and floppy heart) and was dependent on two continuous IV infusions to keep that heart beating, in addition to a slew of oral medications. A magnanimous man in his 40’s, Sam was the kind of person others cannot forget. Always wearing a smile and having a great sense of humor, he was a born-again Christian who had remarried; he had one little boy from that second marriage in addition to several grown children from his younger and wilder days. I was his nurse most days I worked.

Passing the time at a hospital is challenging, particularly when a patient is there for a much extended stay. Sam built model cars during his days there. His family would bring him a couple of new ones every weekend, and he worked on them throughout the week. He’d sneak to the nearest stairwell, pulling his IV pole with him, to apply paint to his latest car; when administration happened to visit our unit, the other nurses and I would cover for him and deny that we had any knowledge whatsoever of just where that lingering scent of spray-paint was coming from.

As much as I loved Sam, I was very uncomfortable when he spoke of his faith and of Jesus; it was a time in my life I just wasn’t ready to hear about it. He would start talking and I’d try to change the subject. He would push, and I’d resist. He eventually won… I’m so glad.

When a heart finally became available for Sam after all those months of waiting, he decided against having a transplant. He was discharged shortly afterwards and died at home with his family by his side. Before leaving the hospital, Sam gave me a bible. I keep it at work, and have shared it several times throughout the years with patients and their families who have expressed the wish that they had a bible to read.

Patient Two, Lindsey:

Lindsey is a 24 year old beautiful girl that we have known since she received a liver transplant at the age of thirteen. Since that time, she has spent at least half of her life with us in the hospital. Most of her Christmases and birthdays have been at the hospital with our staff as her only visitors. We have seen her through multiple surgeries and recoveries, loads of new hairstyles, and a particularly difficult period of smart-aleck teenage attitude.

The last major surgery Lindsey underwent was about three years ago, and it nearly killed her. She spent weeks in ICU, hooked to machines, with no one at her bedside other than our staff. It is a miracle that she survived.

Lindsey’s mother visits once a month, on the first of the month, so that her daughter can sign over her disability and welfare checks to her. The only times that the visits last longer than 20 minutes is when the woman falls asleep on Lindsey’s couch in her hospital room. Lindsey’s siblings are the same way- they drop by to get their sister’s car keys.

The Moment:

I had a break from being charge nurse, and was caring for my own small group of patients when Lindsey’s nurse approached me and said, “Lindsey is crying her eyeballs out, and I don’t know how to help her.” When I went to her, Lindsey was crying hard enough to barely catch her breath. I held her as she sobbed that her family didn’t care about her- she’d finally had enough and had understandably reached the point of utter despair and loneliness.

We spoke of faith and how much God loves her. When she said that she wished she had remembered to bring her bible, I offered her mine-relief washed over her.

When I opened my locker, the bible immediately slipped quickly off the top shelf and hit me so hard in the chest that it made a loud thud! Two of my coworkers were eating lunch in the break room, and jumped at the sound, asking, “What was that?” They remembered Sam with great fondness from all those years ago, and we all shared a laugh as I briefly explained what was going on… Sam always knew I needed to be pushed a little (or a lot!)

Lindsey and I held the bible in our hands; when we opened it, we saw Psalm 40 and read aloud together.

A little side-note here… Just a few days before, my sister Mary had shared part of Psalm 40 with us as she offered an Easter prayer for our family. It was a beautiful prayer of love, hope, remembrance, and gratitude that felt like a new beginning of healing for our family.

Amazing how perfect God’s timing is…

Just a nurse

Yesterday was Transplant Nurses Day; as a charge nurse on our step-down unit, it is such a deep honor to work so closely with some of the best nurses around. Every single day, I am awed by the works of the nurses. We care for the types of patients who are considered to be ICU patients in other facilities.

  1. A nurse is the first person to lay hands on a patient whose heart has stopped to initiate CPR.  When God saves a life, it is the nurse who feels that heart begin to beat again beneath her hands.
  2. A nurse is the one to recognize the earliest signs that a patient is having a stroke, to get the needed diagnostic tests ordered for a patient, and to administer life saving medication.
  3. It is a nurse who touches her patient’s cool skin when she hears the words, “I just don’t feel right,” and realizes her patient is having a heart attack. That same nurse sees a slight change in blood pressure with another patient, gets orders for a sepsis work-up, starts antibiotics immediately, and saves the patient a trip to ICU… or worse.
  4. A nurse is the one who catches an error in medication dosing before it reaches the patient.
  5. A nurse is the one who teaches a new doctor which medication reverses the effects of benzodiazepines with a patient who is barely breathing, gives the medicines, and watches the patient wake up.
  6. A nurse holds a 41 year old man newly diagnosed with end-stage heart failure in her arms and lets him cry big tears on her shoulder as he worries about what will become of his wife and three children.
  7. A nurse shows her patient who just received a kidney transplant the urine pouring into his foley catheter, sees the tears of joy in his eyes, and chants with him and his family that pee is beautiful.
  8. A nurse puts her stethoscope in her patient’s ears and lets him listen for the first time to the sound of the heart that was transplanted into his body a few days before.
  9. A nurse holds a ten-year old little girl’s hand as she whispers a final goodbye to her dying mother.
  10. A nurse cheers loudly with unabashed shouts of “Whoo-hoo!” as she watches a patient who wasn’t expected to live walk out of the hospital.
  11. Nurses are the ones who teach transplant patients how to avoid infections (which can be lethal) once they go home, and teach them self care so that they can enjoy their new chance at life.
  12. When there is no hope left for a patient and the family says, “There’s nothing anyone can do,” it’s the nurse who tells them “There is something we can do. We can keep your dad comfortable.” 

These are just a few of the things our nurses do…

Perfect timing

One of the best moments ever in my nursing career happened today.

We received a patient going for a lung transplant today. Shortly after Mr. W. arrived, I happened to be visiting with a patient  (Mr. L.)  who had the same surgery a week ago. After wearing oxygen for the past year and being unable to leave his home without that life-saving equipment, Mr. L is recovering well and is able to breathe on his own without any supplemental oxygen. He was bored today as his family returned home for a few hours, and asked if there were any other lung transplant patients on our unit.

The light bulb went on over my head like it does in the comics, and I said, “Oh, I think I know just the one- I’ll be right back!”

Mr. W was excited to be meeting him. Taking Mr. L into the room, I got to see both men grin simultaneously and enormously! Mr. W asked, “Hey, buddy! What’s it like to breathe again?” The two became fast friends, and even posed for photos taken by Mr. W’s wife. What perfect and divine timing to see a success story in person right before going into surgery!

I still have chill bumps as I’m writing this, and am so grateful for the opportunity to have witnessed it. Definitely an unforgettable moment!

Types of Nurses

Well, it’s a sad day indeed when I verbally acknowledge my own grumpiness and all of my coworkers agree! It’s a struggle to have patience… except with patients. With my patients, I give everything I have and am able to keep in mind that these are people who are loved by someone. They are fathers, mothers, sisters, friends, and sons and are dependent on us not only for medical care, but for preservation of dignity and independence. It is my goal to treat everyone like I treat my patients, but I fail…often…at least daily…sometimes hourly…
Thinking on this brought to mind the various types of nurses we have:
1. The Old Grouch: Sure, she has a lot of experience, but proceed with caution if you need to ask her anything. Approach only if her brow is unfurrowed.
2. Miss Sighs-A-Lot: She is productive and always busy. New tasks and assignments are taken on with massively exaggerated exhales of air and eye rolls. She isn’t mean, she just can’t help it.
3. The Martyr: She can frequently be heard in populated places making statements like these: “Ok, I’ll do the dressing change that no one else wants to do. Just let me take 30 seconds to shove my lunch down my throat. I wish I had time to pee.” Miraculously, she did have time all morning to conquer ten levels of Candy Crush Saga on her I-phone…
4. The Workhorse: This is the one who doesn’t take the time to pee because she is too busy doing all of her own work and most of The Martyr’s. Her patients never have to press the call light because she is always in their rooms anticipating every need.
5. The Savior: She takes her job very seriously, is smart, and wants the best for her patients. Unfortunately, her ego can get in the way as she thinks the unit cannot function without her. If you need to provide her with education on a better way to perform patient care, do so diplomatically and leave her thinking she came up with the idea. That’s a sure way to keep the peace.
6. Little Miss OCD: Her patient rooms are spotless with bandages and supplies arranged on the cart according to size…occasionally in alphabetical order. She hasn’t met a set of IV tubing she couldn’t untangle and label in record time. She NEVER leaves tasks undone for the upcoming shift; make sure you have all your ducks in a row if she follows you!
7. The Cheerleader: This one loves her job, wants everyone else to love theirs, and is consistently nice to The Old Grouch, frequently smiling at her when others slink away in fear. You’d like to be annoyed by her happiness, but you can’t…she’s too darn sweet.
8. The Professional: Nothing rattles this woman. Ever.
We work on a unit with critically ill patients whose conditions can worsen in an instant.
I was called emergently to a patient’s room. Thomas was a 32 year old man well known to us who had been admitted with post-op complications the previous night.
When I entered his room, I saw him pale and diaphoretic. His blood pressure was extremely low. As his eyes rolled back in his head, the Savior paged the physicians and started ordering blood, labs, and fluids. Thomas was bleeding internally. Rapidly.
The Workhorse and the Martyr worked quickly to obtain large IVs through which we could quickly give the life-saving blood and fluids Thomas desperately needed- they are two of our best IV starters. The Cheerleader scurried to get the code cart and raced back with it to the room. She’s fast enough to excel as a track star. The Professional and Miss-Sighs-A-Lot (both great nurses) manned the code cart, knowing which drugs were needed before the doctors even uttered the orders. Little Miss OCD was the one I wanted right beside me- we got the blood and fluids flowing into the patient as fast as possible. Within 20 minutes, Thomas was stable enough to go to surgery and have the bleed repaired. He has visited our unit several times since then, and is enjoying a productive life with his wife and two small children.
Though we may have conflicts because of our strong personalities, when emergencies arise, we come together and work as one to save a life. It just doesn’t get any better than that.

The story I didn’t want to write…

Though it’s been lurking inside my head and heart for a few years now, I’ve been hesitant to write it down for two reasons- both related to fear. The first is fear of not being able to find the right words to pay tribute to this man whose story I wish to share, and secondly (selfishly) for the emotions it invokes in me. There are parts of that day that still make me cry when I think on them… I guess we all have stories like that.  

Mr. L was a 56 year old man diagnosed with IPF (idiopathic pulmonary fibrosis) who came to our hospital to be evaluated and listed for lung transplant. A quiet and gentle man, he was married and had two grown children with kids of their own. When he came to the hospital the week before, he was able to walk from the parking garage to our unit with minimal oxygen support- the morning I took over his care, his condition had worsened so much that he required very high flow and high percentage oxygen.

As the day progressed, the doctor and I tried various medications, treatments, and tweaking of oxygen settings to ease Mr. L’s breathing; a couple of things worked, but only for a little while and his condition continued to deteriorate. We spoke to Mr. L. and his wife about the likelihood of intubation before the day was over- our goal was to postpone it as long as possible for we all knew that once he was intubated, his chances of ever coming off the ventilator were poor.

While I was in his room, Mr. L and his wife were having a discussion about their daughter; since it was her birthday, she and her children were planning to bring cake to the hospital to celebrate. Mr. L was adamant with his wife when she suggested telling their daughter to cancel, saying, “No! You let them come.” We spoke about his conserving energy, and he (at his wife’s urging) reluctantly agreed to set a time limit on the visit. As I watched this man with his family, it was hard to hold back tears- I think he knew this was his last chance to be Daddy to the daughter he loved.

Later that evening, after giving a final round of medications, I had to turn his oxygen up to the maximum settings and phone the doctor with the dreaded words we both knew were coming, “It’s time.” After Mr. L and his wife exchanged a kiss, another nurse and I placed the portable oxygen on his face and literally ran, pushing him in his bed to ICU. Even though the move had been as quick as possible, it had been taxing for Mr. L and it took about a minute for the high flow oxygen to kick in. I stood at the foot of his bed during that time so that at least he could see one familiar face in a scary room full of strangers.

When his color returned to normal and his breathing eased a little, I told him bye and said he was in good hands. As I turned to go, I saw him begin to pull his oxygen mask off and heard his quiet gasping voice say, “Wait!” He grabbed my hand with both of his, and said “Thank you.” I still get choked up thinking of that.

I was at work when I learned of his death two days later, and couldn’t allow myself to process it until I came home that night. Tears flowed as I prayed to God hoping I had been in the right place at the right time and hadn’t disappointed Him.

Sometimes being correct isn’t being right

Yesterday, I cared for a young man who had tried to take his life by way of an overdose. A delightful and very intelligent 19 year old, he had succumbed to worldly pressures and felt that he just couldn’t go on… fortunately friends found him in time.

In nursing school, we study therapeutic communication: asking open-ended questions, reflecting, using silence, restating, seeking clarification. The subject fascinated me all those years ago, as I sought to become a better nurse and studied hard to make good grades on the tests about this skill.

All that training was for naught when I entered his room and saw huge tears running down his precious face after he had spent the afternoon alone and isolated from family and friends. I asked if I could sit on his bed with him, and we talked for a long time. As his tears kept coming, turning into sobs, I could no longer be a nurse; the only thing possible was to be a Mama. I cradled that boy in my arms and let him cry it out until all the tears were gone. It may not have been the ‘correct and professional’ thing to do but sometimes we have to love them like they’re our babies.

He was discharged from the hospital today. Tonight I say a prayer for him that he will know when bad things happen, the feelings don’t last forever.

A second chance at life

After working solely in a charge nurse role, today was the first day in at least six months that I took a full patient assignment; I was riddled with anxiety upon awakening this morning, hoping I would remember what to do and how to keep my patients alive for the upcoming 12 hours, being absolutely ridiculous… and then I read the poem sweet Claudia had shared with us all.  Anxiety dissipated as I pondered the meaning of these words:

Our Greatest Fear
It is our light not our darkness that most frightens us.

Our deepest fear is not that we are inadequate.
Our deepest fear is that we are powerful beyond measure.
It is our light not our darkness that most frightens us.
We ask ourselves, who am I to be brilliant, gorgeous, talented and fabulous?

Actually, who are you not to be?
You are a child of God.
Your playing small does not serve the world.
There’s nothing enlightened about shrinking so that
other people won’t feel insecure around you.

We were born to make manifest the glory of God that is within us.

It’s not just in some of us; it’s in everyone.
And as we let our own light shine, we unconsciously
give other people permission to do the same.

As we are liberated from our own fear,
Our presence automatically liberates others.

—Marianne Williamson

One of the patients God placed in my path today received a liver transplant two days ago. From Arkansas, he was transferred to our hospital in an acutely ill state. His wife is a nurse and made plans to be at the hospital for his liver biopsy which was to take place this past Monday. Mr. M shared with me that his wife said her prayer would be that they would receive news his biopsy was cancelled due to a liver being available. When her husband placed a phone call to her early Monday morning to deliver that very message, it took several minutes for him to convince her it was true.

As he shared his story, Mr. M cried for the donor family expressing sadness for their great loss and enormous gratitude for the second chance he had been given. We spoke about the greatest gift to them being his living his life to the fullest.

When his extended family began to arrive from Arkansas, the love in the room was immense. Mr. M was again moved to tears when his pastor made an eight hour drive to be with him.

Each small step made today was a celebration of life. He and his family were simultaneously nervous and excited as they watched the progress. He had his first meal since his surgery, had his catheter removed, worked with therapy, sat in a chair, and walked in the hall. When I prepared to start an IV in his arm, it took about ten minutes to convince him to let me stick the vein. He made me laugh as he kept asking, “Are you sure? You really think this is a good place for it? I just don’t know…” Everyone in the room erupted into laughter when I was fortunate enough to hit that vein with one stick and he said, “Wait… it’s in?! That wasn’t bad at all!” One of his daughters inherited her father’s gift for making others laugh showing it when I pulled his central line out. She asked if she could watch, then said, “I think I want to watch. But wait, maybe not. I’ll just cover my eyes a little… but I really do want to see. Kind of.”

Tonight, Mr. M’s daughters left the hospital to begin the long trip home, fortified by the knowledge that their father was going to be okay and comforted by the strong bond of family. His wife embraced the children she had not given birth to but loved as if she had. She spoke to me about their marriage. They are still newlyweds, having married last September after both being in tumultuous relationships in the past. She said that she never thought she would remarry, but God had given her time to begin to live for Him when wondrous things started to happen. When her husband got sick, she said that he was so strong in faith, telling her, “God wouldn’t have put us together only to have us lose each other so quickly. He has greater things planned, and we are about to see His greatness.” This lady’s light was described in the poem shared by my beautiful sweet sister, whose light has touched and changed us all forever.

As nurses, we are invited into people’s lives at the most intimate times. We share in their triumphs and heartbreaks, and must never forget what an honor and privilege that is. I remember some of my own darkest times in nursing, when I’ve felt discouraged and overwhelmed. It has been those times when God has sent me angels, immediately and with His perfect timing, to remind me that He places people in our lives at just the right moment. Our patients that He sends to us are our greatest teachers.

As I close my eyes to sleep tonight, it will be with gratitude for the Light I witnessed today, and with prayers and love for all of you. Thank you, Lord, for the miracles you are performing for our family and for second chances.