Week Two or Weak, Too?

I have to admit that I was super apprehensive about making this career change.  Death is something that scares the bejeezus out of me.  As a critical care nurse for many years, death was often times an answer to endless suffering.  That doesn’t ever mean that I got comfortable with it.  But, because I never wanted to add to a family’s emotion at that moment, made sure to try and keep my emotions in check when the time came.  Now, that’s not to say that I have never shed a tear.

The unexpected deaths always got to me.  There was a woman once, in her late 40s, wasn’t feeling great, came to the ER and turns out that she had a rare autoimmune disease that caused her to bleed out.  She literally walked into the ER.  On her own.  Within 8 hours, she was no longer with us.  The intensity of the situation is burned in my mind.  Transported up to the ICU, her condition deteriorated by the second.  It was almost like we were all running on pure adrenaline.  Some of us were trying to get more IVs in her, while others were cleaning up the blood that just poured out of her body.  In a desperate final attempt to try and save her, there were two of us doing cpr, while blood was pumped into her.  Her mom was called to come in and watching her try and comfort her dying daughter caused just about all of us to break down.  There wasn’t a person that was not effected by that scene.  Afterwards, it was as if we all went from feeling numb to being so exhausted as we had just run an emotional marathon.  Are nurses supposed to cry?  Does crying make us weak or does it humanize us?

See, that is the crux of my problem with hospice. If I am called for an imminent death, will I cry as the family says their final goodbyes?  People sometimes feel somewhat relieved when the nurse cries.  Sure, we comfort.  But, when the end is near, our only concern is the comfort of the patient and family.  That checklist of things that normally dances through our minds when we are in save mode is gone.  It is almost as if we rediscover our emotions because we actually have a second to really feel.  Nurses are thought to be the humanizing element of medicine.  If that is true, then as humans, we feel.  Fear, joy, pain, loss, confusion and sometimes relief all accompany a death.  More often than not, we are not immune to those feelings.  It can be argued that what we feel are magnified feelings.  No one ever said nursing was easy.

My view?  It’s ok to cry.  That being said, don’t become a sobbing mess in front of the family.  We become attached, we care and we get involved on the most intimate of levels.  Let it out, but maintain composure.  When you are finished, find a positive way of releasing all of those feelings.  Whatever it is that you do to let those emotions out, do it.  You have to.  Eventually, that emotional roller coaster that is felt will start to take its toll on you.  It would be foolish to think that the human element does not feel.  Those feelings and emotions do not make you weak.  Arguably, those are the things that make nursing the remarkably strong vocation that it is.

Titanium Doesn’t Stand A Chance

“The human spirit is tougher than anything that can happen to it” C.C. Scott

There are so many medical mysteries that the brightest of minds have pondered and come up with no explanation.  How does a patient who has failing kidneys and called it quits on dialysis continue to survive?  The kidneys filter out all of the impurities that the body produces.  With kidneys that are not working  and no dialysis to clean out those impurities, the body is just over saturated with harmful toxins that would easily cause death in just a few days.  What is keeping this patient alive?  Did I also mention that she has been in and out of a coma and has not taken any food or liquids for 2 weeks?

The first visit with her, turning to a coworker, we both felt that this woman wouldn’t be able to make it through the night.  Her family is so amazing.  They act as if she is present and can hear everything.  Conversations continue to flow as she lays in the hospital bed which is situated in the small house’s dining room.  People come and go, they eat next to her happily telling her about their day.  She hasn’t been oriented, able to speak or move for a few weeks.  But, that doesn’t bother those that love her.  Talks sometimes find their way to memories of the past.  The rich tapestry of her life gets revealed bit by bit.

She was a nurse and sold Avon as a side gig.  Always a tiny bit vain, she loved to have her make up just perfect and her hair freshly done.  Her daughter keeps this up.  Her frail body gets washed daily with her favorite floral body wash, so every time she is repositioned the aroma of roses dances in the air.  Her vanilla body lotion mingles happily and her signature scents continue to permeate the air.  One glance at her and you will see her lashes, decked out in mascara, look always freshly done.  Her berry colored lipstick is equivalent to the cherry on the top of a sundae.  A white turban covers her short black hair.  Her look reminds me of those ever chic movie stars of the 40’s.  Polished.  Glamorous.

As great as she looks, it doesn’t hold a flame to the beauty of her soul.  Stories of her generosity are endless.  She lived in an economically depressed section of the city yet you could never tell how much she struggled based on how she was the first to help anyone in need. She was feisty and direct having raised 4 children alone after she was widowed at 38.  As fiery as she was, she was equally as kind and full of compassion.  When women wanted an Avon product so badly yet couldn’t afford it, she played make up Santa and quietly ordered and delivered the products.  Her neighbors were always on the receiving end of meals and food.  She didn’t have a lot, but what she had, she gave whole heartedly. Her soul was strong and beautiful.  Perhaps it is that strength that is keeping her alive now.

As a seasoned nurse, if someone had told me that she would have lasted this long, chock full of toxins and without food, I would have never believed them. There is no logical and medical explanation for how she has made it this long.  There is only her never give up spirit that is doing just that, never giving up.  Perhaps all the good and compassion she sowed into the world is now being  reaped in her superhuman spirit.  When one’s soul isn’t ready to let go, medical truths be damned, it holds on tight like fingers tightly clenched around a rope that is preventing one from drowning.  Yet she doesn’t appear to be struggling at all.  Her face isn’t furrowed in pain and suffering.  Her skin, the color of milk chocolate, is as creamy and smooth as that melted chocolate.  It is almost as if she is glowing from the inside out.  I truly believe that she can hear and sense everything all around her.  That being said, her soul and spirit are probably rejoicing in hearing how her family waxes so poetically about her.  It’s as if she is caught in the eye of a storm.. her body is chaotically failing but somehow she is so joyfully calm in the center… seeing and hearing all around her.

The soul is strong… The body is frail and breakable yet the spirit impenetrably tough. It orders the body to keep holding on and the body obliges.

Man never created anything as resilient and as powerful as the human spirit.




The Least and The Most

I once read something that said that the rich stay rich by never giving anything away.  Does that mean that the poor remain poor by giving everything away?  Is generosity a trait that is only possessed by those with less?  I’ve thought about this a lot… It seems that those with the least are more apt to give more. But, why?

The most adorable elderly woman offered me some of her cup of ice cream today.  Her worldly possessions were so few.  She is living out her days in a facility, her clothing obviously second hand and her only access to food is what she is given.  Yet, as she smiled at me with biggest toothless grin, she lifted up her white plastic spoon and offered me a few bites.  She seemed so disappointed when I told her that I was ok.  My friend with her disheveled white hair and trembling hands was more upset with my rejection of her food than she was with the cup load of pills that her nurse brought in.  While I was not there to visit her as she is not a hospice patient, she became the subject of my thoughts.  Why is it that when you have nothing it is everything that you want to give?

His apartment was so sparse.  It was in a neighborhood that even during the day most would be scared.  The furniture consisted of a cot and two of those hard plastic chairs that could normally be found on a porch.  The windows were so old that as the wind blew, the whistling melody echoed.  He had become a hospice patient because for years he was unable to pay for his medications and his condition deteriorated to an irreversible state.  The irony is that now that he is in hospice, all of his medications are paid for.  His long hair was tied in a pony tail as he sat shirtless on his makeshift bed.  

As I sat on the cold chair, I noticed a small kitten eating from a worn plastic container on the windowsill.  The matching plastic container was filled with water, which the kitten enjoyed soon after.  The patient started telling us about how neighborhood kids found sport in tossing rocks at the numerous stray cats.  His stories were stopped only by his need to catch his elusive breath.  He talked about how he doctored multiple cats back to health because they would come to his window crying.  The heartbreaking part was that he admitted that there were times he would forego buying food for himself in order to be able to provide for all of the homeless pets.  “At least I have a roof over my head, ” he said nodding his head, “my belly might grumble, but it does it indoors.  They have no food and no shelter.  I can go a night here or there without food.”

Perhaps it is because those with little know what it is like to have nothing and they want no one else to feel that way.  It was like a video I recently saw… a man was conducting a social experiment and gave a homeless man $500.  He stealthily followed and captured his moves on video.  Fully expecting the man to go to the liquor store and buy mass amounts of alcohol, the cynical man was speechless when he saw the events.  The homeless man went and bought food, drinks and shirts for his fellow homeless folk.  He literally spent all of the given money taking care of others.  People talk about charity and write a check, but charity is what this man with nothing actually did.  If you have nothing, you can’t miss what you do not know about, but, you do know the pain of not having.  It’s just so ironic and painfully beautiful that those with nothing are willing to give everything.

The birds and the eel

It’s funny how life comes full circle.  Think about a young child – we love to take them to the zoo or to the aquarium in order to be amazed with what they can see.  We feed them to make sure they don’t make a mess.  We toilet them to make sure that they go.  Songs are sung to comfort them.  Sometimes, a bear or a blanket become the safest and most comforting things.  With all of those descriptions, one would think that I was really into pediatrics.  Sadly, I’m not.  What I have described are the exact things done and given to the elderly in many facilities.

Some facilities are nicer than others.  There are activities, outings, a low patient to caregiver ratio, the halls are decorated and they don’t feel so clinical.  As I was typing, I realized that those are some of the same things that I would look for if I was investigating a preschool for my child.  Will they be mean to my loved one?  Will they be able to watch over them when I cannot to ensure that they don’t get hurt?  Will they be able to continually stimulate their mind or will they get plopped in front of a tv?  See what I mean?  Very similar concerns.

This one Cadillac of facilities has several fish tanks with gorgeous fish.  There are floor to ceiling bird cages with all sorts of delightful birds.  There is a massive aquarium with the largest eel I have ever seen.  Now, to me, that eel is what nightmares are made of.  But, if I think about it from an elderly person’s point of view, it’s something that they can see, it’s large and bright and maybe they get lost in thoughts of freedom, just like that eel swimming so freely.

Sometimes, as I am assessing a patient, our eyes meet and it’s almost like I am pulled into their world.  Perhaps it’s my own worries and fears, but, it feels like I lose my breath thinking of the frustration and anguish they must feel.  Their bodies have betrayed them.  Those once nimble fingers that threaded needles are now bulky and awkward.  The feet that once held them up for hours as they worked in the mills now collapse with the slightest weight.  The loss of dignity.  The loss of identity.  The loss of control.  The loss of humanity.  The thought is searingly bad.

I guess that’s maybe why certain facilities have the things they do.  The ability to express themselves is gone.  Locked in a body that is steadily falling apart, perhaps the fish and birds grasp their attention enough to forget about their world for even just a moment.  Distraction.  Just as a toddler is distracted when they are in the midst of a tantrum, so too are their counterparts.  I guess the circle of life really is just that… a circle.  Keep them safe, keep them distracted and keep them….

I Wouldn’t… Would you?

Everyone talks about the benefits of a long life.  You get to see your children and your grandchildren grow and flourish.  But, is there such a thing as too long of a life?  I do believe there is.  Imagine seeing those around you disappear… You would be the only one of your siblings still alive… Your circle of friends has dissolved… Funerals are your opportunity to socialize because it seems that you attend them on a regular basis.. Get the idea?

There has to be a sweet spot… the length of life that allows you to fulfill all that you’ve wanted, but not so long as it would feel like death forgot you.  Living life depends on what one qualifies a fulfilling life to be.  Would being unable to complete daily activities be considered living?  Would you be happy with moving into a facility because it would be unsafe for you to live at home?  What about losing loved ones – spouses, children, siblings and friends?  Would you want to be the last one standing?

A patient who was over 100 years old looked at me today and said that he “just keeps living.”  With no local family and a declining level of cognition, he doesn’t really know how his life is right now.  There is not much that he can do for himself.  I found myself wondering, especially with his comment, is he really living?

If the days just blend away and you are unaware is that considered a life?  Some of my patients are so declined that they are almost waiting around for death to remember them.  A patient today told me that she was seeing “angels with horns”… Whatever the visions she was seeing, it was almost like her unconscious self was just calling her season of change to come.

People say that there is no beauty in death.  Think about the trees… they are arguably their most beautiful when the leaves are actually dying and falling to the ground.  The death of the leaves gives us such a glorious kaleidoscope of colors that causes us to step back and marvel at the beauty of their last chapter.  I am learning that this also happens for people.  The beauty lies in a life lived.  The beauty lies in the completion of a life cycle.  The beauty lies in their pain and agony of waiting for death to be gone.

A Few Days

Would think that a few days away and I would be able to not think about work.  That’s the thing about nursing though – there is always something… that takes you right back into your work world.  Not that these past days have been any sort of vacation, but, other times, I would be able to keep the lid on the vase of my work thoughts somewhat closed.  I find myself getting lost in memories of faces, reminders of details and then drawn back in.  I guess hospice will be just like that for me.

Was talking with a fellow nurse who I have known for years, but, lost touch with.  We worked together for a good while and spent a few moments catching up.  She told me about her hospice experiences.  “I couldn’t get away from it”, she said “I would go home and cry every time I had a death”.  Her hospice career lasted 6 months.  It was a great experience, but not one that she would ever be able to resume.

I happened to be at my former hospital unit a few days ago.  My husband was with me and saw all of my past coworkers.  Everyone was enthusiastically asking me how I liked my new job.  I am pretty certain that I said “It’s ok”, or “I am getting used to it” as my stock answer.  My husband, who is so sweet, told me that if I was so uncertain of the new position then I should head back to the hospital.

The problem is, I am uncertain.  It’s an entirely different nursing experience.  I can feel my heart still beat out of control when I think about how I will react to my first death.  Having been a hospital nurse for so long, it’s such a different perspective.  I did not always think about death, because I was too busy doing everything in my power to prevent patients from slipping to the other side.  It was a duel with death, but, it always seemed that if I thought too much of it, that I would be giving it some sort of advantage.  Now, it’s all I think about.  How will I help a patient face it?  Will I support the family in the right way?  The path of thought is different….

I’m not thinking about being on the winning end of the death battle.  I’m thinking about how I can help my patient courageously transition into the unknown.  Will I be strong enough to help them?  Can I honestly be that guide for someone who is still trying to keep one foot in this world and one foot in the other?  People say that death is just a season of one’s life.  Would have to say that I do believe that for most people, it would be the winter of their lives.

Normally, I would try to bottle up these types of feelings … stuff them away until the cork of the bottle precariously held on.  I keep mentioning how I am next to patients and families helping them face the unknown future.  My big secret is that they are also next to me as I face uncertainty.  It’s something that I fear.  They just don’t know that they are, while my role is so clearly defined to them.  The question I still don’t have the answer to is, who is carrying who to a better place?

Among The Thorns

There are people ailing everywhere.  In the rich part of town, in the poor part of town, in the city, in the country… you get it.. Everywhere! People are also able to stay in their homes for longer periods of time when they are ill.  Medical professionals travel to them and provide the best care possible.

Over the past couple of days, I have traveled to a more rural part of town and to the grittiest area of the scariest neighborhood.  Walking into a run down apartment building, with graffiti on the front door and what looked to be years worth of dirt on the floor, I was not sure what to expect.  Still orienting, was super glad to have another nurse with me.  I’m not normally scared of places like that.. When I was 18 and a know it all, I moved to NYC and lived in an apartment building that wasn’t far off in appearance from the one I was walking into today.  The subway tiled white portico heavily spider webbed in grime and debris.  The hallway walls were once white but have since grown to be a yellowish color from years of cigarette smoke.  Apartment doors were missing numbers and a few looked like they had been attacked by hungry beavers… shards of wood left in the place of a once sturdy door.  Luckily, our destination was on the first floor because the steps leading up looked to be straight out of a haunted house.

We were greeted by our patient.  You see, not all hospice patients are laying in bed and on their last breath.  Cheerful and pleasant, he invited us in and motioned for us to sit in the two plastic lawn chairs.  As my preceptor did her assessment, I began looking around the room.  It was a tiny little place.  Most decent closets are bigger than the living room was.  The patient’s glasses reflected the two sources of light in the room – the TV and a string of Christmas light surrounding some Native American art.  There were no doors separating the rooms and I could see through the makeshift curtain that a tiny kitchenette and the bathroom could be found on the other side.  The air in the room was heavy with the smell of cigarettes – so heavy it felt like it made its way into your pores.  Hey.. I guess if you are on hospice, there’s no reason to worry about the dangers of smoking.

As the patient talked, I was struck by the kindness of this man.  He spoke of taking care of neighborhood stray cats – he would put out food and water.  You could almost feel his sadness as he told us stories of people being evicted and they would just toss out their cats.  This man, who had really nothing, was feeding these poor animals.  This man, who didn’t have enough money to pay for his medical care, was taking what he could to help the animals.  His sadness was halted abruptly when the topic of conversation switched to his grandson.

His face lit up as he talked about babysitting the little toddler.  The child and pap would dance and eat Popsicles together.  He talked about seeing the little guy grow up and how great of a man he would be.  As if he had a crystal ball, he knew that his grandson would go to college and that he was trying to put away what he could for it.  In that moment, sitting in that tiny apartment in what most consider the worst part of town, I realized that people who have so little material possessions are the first to want to share them.  It’s almost as if compassion and sharing diminish with the more we get.  This man really had nothing, but was giving everything.

He knew his prognosis, yet, he was worried about those around him.  He worried about who would take care of his cats and all the strays.  He worried about how his girlfriend would survive without him.  Not once did the talk about himself.  Not once did he try to illicit sympathy for where he was living or for the road that he was walking.  He didn’t miss things because he had never had them.  The more we have, the more dependent we become on things for happiness.  The more we have, the less we give.  It is sometimes the poorest people who are the most generous and the happiest.

As we got into the car, the other nurse was complaining about how she had to get home to change her clothes because they were pungent with the smell of old smoke and a thick musky odor.  Crazy as it may sound, I wasn’t so much in a rush because the smell was of a man who reminded me that being generous isn’t about how much you have but rather your willingness to give.