Scars

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There was a movie I watched years ago about the Vietnam War. What sticks in my memory the most is seeing the actors who portrayed the soldiers at the end of the movie… there were ‘before and after’ photos and video clips of each one. They looked much older and worn. Some were lost, some changed for the better, some for the worse, but ALL were changed in their own ways forever.

Many of us ‘experienced’ nurses- I hate the words ‘old’ or ‘seasoned’ so ‘experienced’ will have to do- desire to mentor our newer and/or younger nurses. We have the expectation that they can learn from us… our mistakes, our successes, our years of nursing practice. We celebrate their growth and achievements while hoping we played a part in it, however small.

What has happened over the past few weeks is something none of have ever experienced before. I pray we will not witness it again in any of our lifetimes.

On behalf of us ‘experienced’ nurses, I’d like for my younger fellow nurses to know this:

  • We’ve seen your strength, resilience, and courage.
  • Nothing (not school, not experiences shared by other nurses) prepared you (or us) for this. You went all in anyway.
  • We are proud of and grateful to you.
  • We have much to learn from you.
  • We admire you.

Well done, angels. Well done.

 

 

For all nurses- with love, respect, and gratitude (in response to Senator Maureen Walsh’s comments)

“I’m sorry to inform you that your father has had a massive hemorrhagic stroke. His prognosis is very poor.” I was at work that day twenty-one years ago, summoned to the nurses’ station for a phone call in the middle of a chaotic shift. With the sounds of call bells buzzing,  telemetry alarms beeping, and my fellow nurses rushing to their patients’ rooms, I gave the physician consent for a DNR order and chose goals of care for my Dad. I was taking care of five patients that day, three of whom were recovering from major surgery, and carried on to ensure they received safe care until the oncoming  nurse could relieve me.

Dad had been a patient at a rural long-term facility in Northwest Louisiana, hours from where I live in New Orleans. When I left work to pick up my three-year old son, my Mom was already on her way from Alabama to my home; she didn’t want me driving by myself knowing that my Dad was dying. I made two phone calls to Dad’s nurse along the way… checking on his status, his vital signs, the medications he was receiving. The information she gave me during the second call let me know there wasn’t much time left, and I asked her, “Will you please tell him I love him? I may not get that chance.” Her beautiful response was “I sure will, sweetheart. I’m going in his room right now.” Knowing, truly knowing, that a nurse, a lady I’d never met but a nurse, would be with him in his final moments when I couldn’t brought immeasurable comfort and peace.

It was only by God’s Divine timing that I was able to be with my father one last time. I entered Dad’s hospital room and saw how very well he had been cared for… he was in a comfortable position, clean, had oxygen on, was being monitored, and was receiving IV medications to alleviate any distress. His nurse greeted me and then gave me privacy to say goodbye with the assurance that she was right outside the room if I needed anything. She came to me when the monitors alerted her that Dad was gone. Though I don’t remember her name, I will never forget her sweet face, the way her own eyes filled with tears, and how she hugged me tightly as she said, “I’m so sorry, baby.”

It’s because of Dad’s nurse and all the nurses like her that I’m angered by Senator Walsh’s comments:

“I would submit to you that those (small hospital) nurses probably do get breaks,” Walsh said. “They probably play cards for a considerable amount of the day.”

We nurses do put patients first, Senator, whether we work at a “small” rural hospital (the only place for miles patients have to go if they are involved in a major farming accident, have a baby with a 104 degree fever and seizures, or have had a hemorrhagic stroke) OR if we work in a hospital with the capacity for advanced care (like life-saving transplantation.) There is no sitting around and ‘playing cards’ going on.

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Whatever It Takes

 

photo-1484100356142-db6ab6244067 (1)It’s funny how our minds work, and the way we never know what random memory might pop up during conversations about something else. My nephew and I were talking about looking forward to seeing each other on Easter (we don’t get to be together often enough) and about music. In a family with some really talented singers, we always joke that we are the ones who can’t carry a tune despite never giving up trying… repeatedly…  loudly. I suspect he really can sing but holds back to spare my feelings! Talking with him reminded me of what happened with one of my patients years ago.

Adam was a 35 year old man who had received a transplant several days before I took care of him. He had been in relatively good shape prior to surgery so the team and I were eager to get him up walking. Unfortunately, he was not eager at all. He would walk once a day, sit in the chair for maybe 30 minutes, and then he was done. Finished. No more.

His sisters and I tried everything we could think of to make him increase his activity; they would plead, beg, threaten… I tried compassion, empathy, bargaining, and taught him about the risks of post-op complications until my mouth had gone dry every single time I went in his room. He’d laugh, blow us off, say “maybe later”, or sometimes just refuse to speak altogether.

By the end of my third shift with him, his sisters had gone home to take a much-needed break. I totally understood as my own patience was wearing pretty thin too. At 6:00 pm, armed with last-ditch determination and a co-worker by my side, I entered his room, saying “Okay Adam. The time has come. Up you get, we’re going for a walk. You had your pain pills a half hour ago, so let’s do this!” His response, as predicted, was a yawn, a stretch, and a “Mmmm, maybe later.”

“No! No later.”

He started laughing which led me to doing the unthinkable.

I said, “Adam, if you don’t get up right now, I’m gonna start singing. I’m serious. You don’t want that.” My coworker, always a great team player, jumped in enthusiastically and told him, “Yeah! We’re gonna sing Ebony and Ivory!”

I think it was pretty fair that we gave him to the count of three to make his move. When that didn’t happen, we burst out singing as loudly as possible with “Ehhhh-bon-eeeee and Eye-vor-eeeee, live tooooo-getherrrrrr in puhhhhrrrr-fect har-monnn-eeeee!” Before we even got to the word ‘Ivory’, Adam had his hands out scrambling to sit on the edge of the bed and pleading, “No more! For the love of everything good, please stop singing! I’m getting up!” When the three of us got to the hallway, everyone was gathered around wondering why we laughing so hard!

Adam has done great with his transplant and comes to visit me at the hospital a few times a year. It’s great seeing him healthy and enjoying life! For some reason he always declines my offer to sing for him.

 

 

Aftershocks

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Photo by Gabriela Palai on Pexels.com

This piece is dark and I feel like I should almost put out a disclaimer to anyone who might read it. Writing is cathartic; that’s what I needed.

I’ve been staring at this screen for a long time and still don’t know how to start. Though I can’t see myself doing anything else, sometimes being a nurse sucks. It just does. I know I should be sharing the good sides of nursing, and there are many- the honor of working with people who let you in at the most intimate times of their lives, being witness to miracles, seeing patients who were on the brink of death recover fully- but that’s not what this post is about. Today the well’s run a little dry and I’m praying for rain soon. It’ll come. It always does. Maybe even tomorrow.

Recently, we had a patient with end-stage lung disease. He’d been on our unit a few weeks, and we all had gotten to know him well. Early in the morning, his nurse called me to say he was having distress. We got him past the event with medications and a respiratory treatment; he had declined so much since I’d seen him last.

He asked me to stay with him after the others left so I pulled a chair up to his bed. He took my hand, looked into my eyes, and asked, “What’s going to happen to me?”

I said, “You’re very sick, Mr. Gandy. I know you’ve been speaking with your doctors about your options.” They had been discussing hospice and comfort measures but Mr. Gandy hadn’t made a decision yet.

“Yeah, I’ve been talking to them. I want to talk to you now. Please tell me.” He must have read my mind because the next words out of his mouth were, “I know you’re not a doctor and that’s ok. It’s just you and me in this room and you’ve been doing this a long time. Please tell me what’s going to happen.”

“If what happened this morning happens again, or if you get any worse, we’ll have to intubate you. If we do that, we may not be able to get you off the ventilator.” Saying those words out loud was awful. I don’t want to try to imagine how his hearing them must have felt.

He asked, “How long do I have? Is it weeks? Days? I’m not gonna make it out of the hospital, am I?” I answered honestly. His eyes were filled with tears; he squeezed my hand and said, “Thank you.” He asked me to call his brother for him so I did.

When the doctor came in, I told him what Mr. Gandy and I had been talking about. We discussed the progression of his disease and his prognosis with him. When asked about his goals, Mr. Gandy said, “My goal, what I want, is to be able to go home…but I know that’s not realistic.” What do you say to that? Sometimes, often really, there just are no words. He gave us an out when he said, “Tell me about comfort care.”

Mr. Gandy ultimately made the decision to be a DNR and opted for comfort measures only. He asked me to call his family again and I did. That too was tough.

I am very fortunate to have the best, most compassionate coworkers in the world. Some of the nurses got Mr. Gandy’s nurse to take a break and took over the care of her other patients. They also pitched in to perform some of my tasks so I could stay with the patient. I stayed with him until he died about an hour later.

We try everything we can to bring comfort to those suffering-giving medicines and treatments; most of the time it helps. Other times, we have to hope that our presence makes a difference.

My ego leads me to think I should be able to fix everything myself. It gets in the way and is unfair to others. One of my neighbors is a really close friend and is like a younger brother. His daughter is my favorite of all the neighborhood kids (https://awhitlow2.wordpress.com/2014/02/28/remembering-the-wheeeeee-for-hannah/). We were talking about Hannah one day, and Jeff said, “I’m just trying to make sure she doesn’t grow up to be an a-hole.” You’re successful, Dad, because she’s definitely not! Keeping his words in mind and striving hard to not be an a-hole either, I reached out to one of my brothers and one of my sisters about struggling with this death. Talking to them helped immensely.

Now I’m just waiting on the rain…

The Bedside Table and Rollercoaster Rides

Being a witness to true, pure, selfless, and unconditional love is so powerful that it can transform the soul and change a heart forever; I was blessed to have seen that kind of love a few days ago with one of my patients and her husband. God must have known my heart needed to be filled as He showed me the special bond between a brother and his little sister just the very next day.

Jo is a woman in her 60’s who has been a patient on our unit off and on for the past few months. She has a big heart, a dry sense of humor, and is well-loved by her husband, Robert, and their three adult children. Her liver is failing fast as she waits for a transplant and none of us know how much time she has left. Whatever her course may be, Robert will be right there by her side.

When I first entered Jo’s room that early morning just as the sun was beginning to make its appearance above the dark blue clouds, she was sleeping and Robert was sitting in a chair beside her bed. He was fighting tears as shared with me how scared he was because she’d become so sick very quickly. His voice cracked when he said, “Just a few months ago, she could do everything for herself. She was normal. And now…it’s just…I’m afraid of losing her.” I longed for the right words to say, something comforting…anything really… but sometimes there are no words and none came at that moment. All I could do was nod as we shared the silence that followed.

After I’d seen my other patients, I went back into Jo’s room. Robert had lifted her from the bed to the chair, and I found them sitting across from each other sharing breakfast on the battered hospital bedside table. Our tables are used for many things- a place to set medicine cups, water pitchers, procedure trays. This was the first time I’d seen one used for a breakfast date with a couple who’d been married 40 years and it was such a beautiful sight! A true gentleman, Robert made sure his bride was seated so she could look out the big window and have the best view. He told Jo, “I wish I had some flowers so you’d have something pretty to look at,” to which she replied, “I like looking at you.”

Jo left later that day to have a diagnostic test performed, and Robert finally laid down on the couch to rest. When she returned and I heard him snoring, I tried to be quiet as we moved her from the stretcher to the bed, knowing how tired he must be. As soon as he heard his wife’s sweet voice, though, he immediately awoke and jumped up to help. I wanted so badly to tell him, “It’s okay, we’ve got her,” but then remembered the words of a coworker far wiser than me caring for another patient near the end of life who said, “I used to think I knew what was best for patients and their families. I had good intentions but I was wrong. It’s not for us to decide what’s most important to them; it’s up to us just to honor whatever that is.” It was a gift that day to hear their lively banter during Jo’s good moments and see the gentleness between them during her bad ones- the kind of love that develops from spending a lifetime together.

Will is a 20 year old young man who received a liver transplant after having developed an autoimmune disorder. He and his parents were so sweet and engaging; I loved getting to know them all. Will had become really ill right after he started college and had spent the past year living back at home. He has an older sister and brother who were able to take turns being with him at his sickest when his parents had to work. He also has a little sister. Because their home is out of state, his siblings had not yet been able to see him since his surgery but were making the trip the following weekend.

When the doctors made their rounds, Will’s mom asked them all the “important” questions- about medicines, follow-up appointments, wound care, etc., then said, “ I just have one more question. I promised his 14 year old sister I’d ask this. Will he be able to ride roller coasters again?” I’ve never seen the surgeon smile wider than he did just then! He was grinning when he said,” Yes. Not right now! But please tell her ‘yes.’ In a few months, he can definitely ride roller coasters again.’ We loved hearing that a little sister’s top concern was that her brother could do fun things again… with her.

Will was discharged later that day. I waited with him while his parents left to load the car and he told me how excited he was to see the rest of his family. He said, “I really love all of my siblings. My little sister and I are especially close and I can’t wait to see her!”

I have a shameful secret, one that’s very hard to admit. For much of my life when I saw two people in love, I was happy for them, but there was always the whiny and very selfish thought, “Why not me? Why can’t I have that kind of love?” There are a myriad of reasons. I’ve made poor choices and have lost myself before in relationships. I’m not social. I like people pretty well but am so much better with dogs. I’m stubborn. Fortunately I have a few good friends who know me well and love me anyway. They keep me grounded, ask the hard questions, and yell at me if I isolate too much. I may never have the kind of love that Jo and Robert share, and that’s ok. I’m grateful to God that they have it and all the selfish thoughts are gone for good.

Recently while my brother and I were talking about our father, he brought up some thoughts about my previous relationships with men. He’s always conscious about being tactful (his sister should try to be more like him in that way) and he was afraid of being hurtful but sometimes when you see someone you love making bad decisions for a long enough period of time, the words you’ve held back just come tumbling out. I’m so glad he did. It was a relief for both of us and has brought us even closer together.

I have two brothers. Though we didn’t grow up together, we entered each others’ lives when we were supposed to and with Divine timing. They show their love in so many of the wonderful ways that brothers do- through their words, actions, and the examples they set- and I couldn’t be more thankful to have them in my life. In addition, they have both gone above and beyond in unique ways: one has promised to intervene if I become completely crazy (it’s a slippery slope) and the other has promised to pluck unwanted facial hair if I’m ever in a coma! Both vows are of high value and equal importance.

For My Co-workers…with love

I think about you when I get home at night. I see the ways you impact our patients’ lives and because of that you also greatly impact my own.  Your teamwork and clinical expertise inspire me, your kindness humbles me, and your great compassion often moves me to tears.  There are no words adequate enough to express the gratitude I have in my heart for each of you.

This is what I hear your patients say to you and about you:

  1. “You really care,”
  2. “I wasn’t always easy to be around. You showed me love anyway.”
  3. “I’ll never forget you.”
  4. “This isn’t just a job to you.”
  5. “You make a difference.”
  6. “I know I’m not your only patient, but you make me feel like I am.”
  7. “You explain everything to me in a way I can understand.”
  8. “You really listened to me. I knew something was wrong and you got me what I needed.”
  9. “You made my pain go away.”
  10. “I was scared. More scared than I’ve ever been before. You stayed with me. That made it better.”
  11. “You treat me like a real person, not just a patient. You make me laugh and that helps a lot.”
  12. “You’ll always be family to me.”
  13. “You saved my life. Thank you.”
  14. “I love you.”

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

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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…

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.