In 2005, Steve Jobs delivered a commencement speech at Stanford University reiterating the importance of doing what you love and trusting your gut:
"Because I had dropped out and didn't have to take the normal classes, I decided to take a calligraphy class to learn how to do this. I learned about serif and san serif typefaces, about varying the amount of space between different letter combinations, about what makes great typography great. It was beautiful, historical, artistically subtle in a way that science can't capture, and I found it fascinating.
None of this had even a hope of any practical application in my life. But ten years later, when we were designing the first Macintosh computer, it all came back to me. And we designed it all into the Mac. It was the first computer with beautiful typography. If I had never dropped in on that single course in college, the Mac would have never had multiple typefaces or proportionally spaced fonts . . . Of course it was impossible to connect the dots looking forward when I was in college. But it was very, very clear looking backwards ten years later."
I can't help but to feel the same exact way as Steve Jobs might have felt right now. Today, I received news that I would be receiving an integrative nursing practice grant in the coming year to use hand-lettering as a form of therapy for oncology patients during disease treatment. Words can't capture how excited I feel! I still feel like it hasn't sunk in and decided a good idea would be to write it out so that it might materialize in my mind.
Ever since graduating, I've been learning more and more about the world of hand-lettering. I've learned new techniques, tried my hand at new programs, bought a new laptop, printer, camera, and studio kit to learn how to market my products well, and even considered quitting one of my jobs just to actively pursue it more. I challenged myself to try out new styles and followed countless hand-lettering artists on Instagram just to broaden my visual base. Needless to say, I was feeling super inspired in these beginning months. I knew I had challenges, having to put myself out there and never having any marketing experience. But I did it anyway. By now, you could probably predict that this endeavor failed. I made cards, took pictures, made shirts, took pictures . . and then made more cards! But my so-called Etsy dreams never really got anywhere.
It wasn't until one of my coworkers brought up the idea of applying to a practice grant that a light flickered in me again. For months, I'd been trying to find a way to merge my passion for nursing and lettering. I had tried to volunteer at Dana Farber's art center before but couldn't commit due to scheduling conflicts. Here was another chance, and I knew I would regret it if I didn't try one more time.
I felt silly applying for the grant because it is, at its simplest form, doodling. But I knew that if it could bring solace to me, it could bring solace to others during a time of immense need when they might be too apprehensive or anxious to express how they really feel to their loved ones. So I sent it. And I got it.
This is a huge deal to me. Two things I love in life, colliding. Two beautiful art forms clinking glasses. I can't help but feel like this is the reason why I stuck with hand-lettering all this time. For anyone unsure of how to make things happen, trust your intrinsic path. It's better to do what feels right for you. When you do what feels right for you, you feel better, happier.
And happiness attracts good energy.
I started a new job this month, meaning I left my job at Brigham and Women's Hospital. While I'm excited to be an infusion nurse at Dana Farber Cancer Institute, I'm pretty depressed at the idea that I will never set foot onto my old unit, 6A, again. It's being renovated and when the original staff return to their home base, it won't really be a home base anymore. So much will change, including patient population, staffing numbers, and unit layout. It will take months before home is truly home again.
Looking back on my experience on 6A, I feel so incredibly fortunate to have stumbled upon such an amazing floor. Like this new position, I have no idea how I got it. I feel sad and honored to know that I got a taste of what felt like the 6A legacy - quality care due to quality staffing numbers. A lot of other units abhorred us merely because of our numbers - how come we got an extra nurse while they had the heaviest patient on the floor meanwhile balancing their other three? They're right. How come? Why couldn't other units staff like us? I know I'm young and have much to learn, but if there's one thing that's crystal clear to me, it's this: it all comes down to the bottom dollar. Brigham slowly became all about the bottom dollar, beginning with the nurse strike, and then the later changes made on our floor. When I first graduated from nursing school, I had one clear-cut mission in mind: patient-centered care. With all the fuss and controversy swirling over my head about "Am I going to cross the picket line?" and "We asked for the extra nurse and couldn't get one," I didn't feel as if it was about patient-centered care anymore. I know what you're thinking: "Young, stupid nurse." And maybe I am, but isn't this what they teach you in nursing school? During orientation? What you see in the news? Isn't is all about the patient? And if it is, why are they suffering? And why are nurses suffering, bending over backwards just to get the resources they need to care for those patients?
I started to feel cheated, as if I signed up for one thing and got another. When you're a new nurse and you get your first nursing job and realize the power you have to influence peoples' lives, you don't take that task lightly. Being able to stand by people in the most trying times of their lives will forever be a gift I hope to never underestimate. Everything is good until you start to be able to look past the scope of your own patients and your own day, and take a glimpse at the institution around you. The fervor I felt when I first joined was dwindling, and if that meant I should leave, I was going to do it because I didn't want to lose my thirst for learning, patient advocacy, and true, patient-centered care.
Don't get me wrong, I loved my two years at the Brigham and would give so many things to be able to stay on the floor alongside the nurses entering this time of transition. There are some outstanding nurses with major backbone that have given me the guts to stand up for what I believe my patients need. Those nurses really showed me what the core of nursing was, and what it meant to build a connection, have your patients trust in that connection, and use that connection to turn medical care into something beautiful where they find themselves walking out the door and visiting you three months later during their check-up. I was very lucky to be a part of this magic, and to see the workings of what a floor should look like. The shit you read in your textbooks in nursing school.
But I do feel like now, more than ever, those skills are going to be paramount when I start my new position. I'm already being challenged in so many new ways. It's that familiar fear that reminds me that I'm doing something right. I'm comfortable being uncomfortable again, and I'm invigorated to be the stupid one again who has to learn everything over again, even going back to cancer fundamentals just to make sure I have it right. I'm sad, but so determined.
This space of fear between comfort and newness is such an exhilarating place to be. People hate it. People dread it. But if you really take a moment to understand the position you're in, you'll realize that it's the best place to be. It means that in this very moment, you are better than you were when you were standing at comfort. And that much closer to newness and the next step.
And when you're all done with that, you do it all over again. Newness becomes comfort, and you become.. well, whatever you choose to be.
I'm coming up on my two year mark and there are definitely some patients I already know I'll never forget. To celebrate my work anniversary, here are some patients (with HIPAA modifications of course) that have validated all the reasons I chose to be a nurse six years ago, not knowing why. I love my job and I love the people I care for. Getting to know their quirks and antics and making them feel cared for in moments of imperceivable despair, bottomless depression, intolerable pain, or simply moments of feeling nothing at all is a huge deal to me. I don't take it lightly. I'm so thankful that I never had the turmoil of figuring out what I wanted to do, or the anguish of not knowing what my passion was when all these graduation speeches and influential speakers have barked nothing but to "find your passion" and to pursue it with vigor. I'm thankful that one day it just clicked as I walked on the Boston College campus and decided to switch into nursing just because I happened to see the words "William F. Connell School of Nursing" posted up on a building and figured "why not?" Learning the miracles of the body and coupling that with the human faith we see everyday in terrifying situations has forced me to become a better person. Because of you, I am more tolerant. I am more compassionate. I am more loving. I am more human and experience more feeling, good or bad.
This is the secret to life, and I am so lucky to have learned this all before my twenty-fourth birthday.
"Manny." Thanks for letting me care for you the night before you passed. Thank you for your huge family, who made me feel oppressively anxious and eyed my every move each time I pushed more IV Dilaudid. Thanks for your beautiful daughter, who called the floor and thanked me for caring for you. As a new nurse, you just don't want to fuck up. I'm glad she saw more than that, because all we wanted to do was let you go comfortably.
George. The happiest guy on earth. A gleaming light and reminder that good energy attracts good energy. And apparently attracts good neutrophils, too.
"Mary." Whose husband I thought was going to cardiac arrest on me when she passed. The son whose tears landed on my forehead as I consoled him after she passed. Thanks for teaching me resilience and how to not cry on the job. Seeing how strong your family was during the dying process made me stronger, like I knew how to endure the death of patient. It helped a lot in the coming months.
"Melanie." The nicest lady in the whole wide world. Gentle, sweet, and patient even when she suddenly lost her vision and then the sensation in her legs altogether. Sometimes I don't understand why people are mean in general - dickhead customer service line agents, cashiers that ring you up at the grocery store, or people who wait in line for too long for their coffee. You lost your vision, your legs, and then your mind, and you never lashed out. Makes me think twice every time I get aggravated at somebody. You've taught me kindness and patience like no other. For that, thank you.
"Ron Swanson." You were an asshole sometimes and you knew it. You could be a real jackass, but I thought it was so cute how hard you tried to be sweet. Anyone could literally see that you were fighting with yourself to force a "thank you", or even a nice tone, for that matter. I took care of you on a twelve-hour day shift after what seemed like two hours of sleep and came in dead exhausted and drained. I honestly wasn't in the mood to take care of you. But I knew I'd regret not trying so I sucked it up and we had a good day together. You even tried some jello that day. You sat in the chair, watched some tv, smiled, and even called me "sweetie"! So many milestones accomplished that day. Made me realize that no matter how much of a douchebag someone can be to you, you should still try your best and be a good sport about it. Because when they go, you get so much fulfillment in knowing that you did everything you could for that person. Knowing you gave it your all for them in the final stages of life validates your character. Thanks for being the Grinch that you were. It's made me a lot nicer to the people around me.
"Ellen." I took care of you on the morning that you needed your thoracentesis. Your husband was at your bedside and I remember how uncomfortable and sad you were. It was a busy day, but one thing I learned in these two years is that checking up on your patients from time to time without them having to hit their call bell does wonders on building trust. Somehow we found a way to help you relax throughout the process and it went really well. You gave me movie tickets because you were so grateful after getting it over with. I watched the Good Dinosaur with those tickets! Thank you for being you and champing it out with me.
"Deb." I know I didn't make much of a difference with your care but I do remember you falling asleep for a solid thirty minutes after I gave you my first reiki session. You were nauseous out of your mind. Knowing I gave you peace of mind for just those thirty minutes was a big deal to me after learning that you passed because part of me didn't want to do it out of fear of doing it wrong. I'd only done it once officially on Mike before! But it worked and you were able to take a break from the agony. For that, it was worth it.
"Carmen and Rebecca." You guys were two of the sickest people I ever cared of. Being my age, it literally made me wonder how something so awful could happen to people so young. While I was at home showering, playing soccer with my friends on the weekends, and drinking my liver away (just kidding, Mom), you guys were in the hospitals fighting for your lives. I used to get really bitter about working Friday nights and weekends. After caring for you, those shifts were insignificant because they taught me to never take those Friday nights and weekends off for granted. People don't realize how lucky and trivial they are. I'm positive you guys both would have traded anything to just be able to go back to work to pay a bill again, or to walk to the bathroom to take a shower. I'm not rich and famous, I don't travel nearly as much as I wish I did, and there are things I wish I was better at. But you've both helped me count my blessings and love the ordinary little life I've been given. For that, I will certainly always remember you both.
Cheers to my third year!
Coming off three night shifts in a row and wanted to share a simple story of inspiring character and gratitude.
I had pleasure of taking care of a gentleman, who I'll call Rob, for the past few weeks. Rob works as an addiction counselor, but he didn't always have a controlled relationship with drugs and alcohol. Growing up, Rob had major anxiety. As a teenager, he was petrified to speak to girls. At school dances, he'd be the odd one out, standing in the corner watching everyone dance. It wasn't until he took his first sip of alcohol and all his worries dissipated that he realized the powerful effects of substance use. He started dancing without fear, spitting major game to these girls, and living with a confidence and security he'd never known before. His alcoholism spiraled from there. For a long time, he was frustrated with the world and often found himself blasting the band Earth, Wind and Fire's "That's the Way of the World," through his headphones (working with older patients puts my music game on point**), crying out of frustration at the lyrics and wondering why he'd been wronged with the life he was given. The meaning for that song transformed years later, as he danced with his daughters at their wedding to that very song with tears rolling off their faces. Except this time, they were happy tears. This time, Rob had overcome his addiction.
Fast forward to the present, Rob's fighting Non-Hogdkin's Lymphoma. When patients suffer the side effects of chemotherapy and hospitalization, their mentality and optimism can really deteriorate. Imagine being nauseous for days on end without being able to stomach anything, insufferable pain from sores that line your GI tract, or just being in stuck in the same room on the same floor for weeks isolated from humanity and all its commotion outside the hospital walls. It's prison-like. You can imagine it becomes challenging to stay optimistic in these hours, but Rob never broke face during the times that I cared for him. He constantly greeted me with a cheerful "hello" and never forgot to say "thank you." Heck, I even learned a lot about politics and our past presidents from him. Never passing up a moment to engage in a conversation, Rob constantly reminded me of the treasures of being a nurse - being given the opportunity to connect with genuinely good people while helping them in the fight for their life, so they can enjoy the rest of their lives.
Rob is going home soon and I don't think I'll be back on the floor before he leaves. When I stopped by his room to tell him goodbye and wish him good luck, he couldn't help but tear up at the fact that everyone who cared for him here had been so nice "from the people who take [my] food orders on the phone, to the nurses . . everyone." No one has ever teared up with thanks before in front of me, so I imagine it was a really big moment for him.
The idea that we could help good people at such vulnerable moments in their lives makes me remember why being a nurse is all worth it, night shifts and all.
We all have bad days. I swear, at one point I believed that my life was cursed with bad days immediately following good ones. Nothing goes as we planned or something downright awful happens. Working in the hospital and coming home to people bitching have made me realize how ungrateful and unappreciative people are, and how poorly we cope when something bad happens to us. I'm talking mostly about stupid small mishaps - our coffee spills all over us in the morning just as we're getting out of the car, we get stuck in traffic after a dreadful day at work, we don't get the weekend off to enjoy with our friends (talk about serious FOMO, welcome to the life of a nurse). Things happen. We don't always like what happens, and as a result, we're unhappy.
But what if I told you that at some point in your life, you would kill to have another one of these shitty days? What if you looked back at the end of the day and realized that, more than anything, you just wanted a normal, shitty day again? A day where the worst thing that happened was your coffee spilling or getting stuck in traffic after getting into an argument with a coworker?
One of my patients, whom I'll call Sally, is unbelievably sick with acute graft-versus-host-disease (GVHD). She had a stem cell transplant, and her donor's immune system is attacking her own. As a result, her skin is covered in what looks like total body burns, her gut is bleeding, and her liver is failing. She writhes in agony everyday. Every turn she makes in bed comes with unbearable discomfort and it takes tremendous energy to even take a sip of water. To make matters worse, she has children who she can't see because she's been too sick to raise them.
I was taking care of Sally last night and it was probably one of the worst nights I've ever had with her. Sally could be a tough cookie - she'll tell it to you like it is, she's vocal about what she wants, she could be stubborn and particular about her care, and she requires a lot of patience. Every nurse has had this type of patient at some point in their careers. I remember being so mad at her one night for refusing to do something I thought was important for her that I had to leave her room until my frustration passed (I took many deep breaths that night). I stood in the back room and felt my eyes fill with tears of rage (remember how I told you I cry out of frustration easily?). I couldn't even go back into her room until I felt okay myself, and despite much convincing and support from my coworkers, she still refused to participate in her own care . . didn't she want to get better? It was menacing, but after seeing her deteriorate last night, I realized I would give anything for her to just bitch at me again. Because at least then, I'd have the comfort of knowing that she energy to do something.
This thought was immediately followed by a memory of weeks back when she was still incredibly sick, but still talking and interactive enough to press my buttons, kill me with kindness, and make me want to punch myself in the face. Isn't that interesting? The idea that I wanted something that was still bad? She was, by no means, in good condition then, but at least she was better than her current condition. I would rather have that than this. Suddenly, this very idea that I was asking for a bad day dawned on me. When people are given three wishes, they ask for 1. a million dollars 2. to travel the world, and 3. for more wishes obviously (duh), but no one ever asks to go back to a shitty day.
I realized I was asking for this shitty day because Sally wasn't as sick. They say life is made up of moments that take your breath away, but what they seem to forget is that it's also made up of moments that break your heart. Seeing her so sick broke my heart, and at least a few weeks ago she didn't break my heart just yet. It made me think about my life and how one of my most heart-breaking days was the day my grandfather passed away with his entire family at his side. Or the day I had to be the one to tell my mom she had breast cancer and she grew silent, hung up the phone, and wouldn't pick up for several more phone calls. I remember thinking in those situations that I would kill to have a regular-bad day where I failed a test, got into an argument with someone I cared or about, or where I just thought I had it bad. I would go back in an instant.
Taking care of really sick people makes me think twice. It's helped me become more patient with shitty life circumstances. It's made me grateful to be fully capable of doing anything I put my mind to, apart from swimming (I don't think these lessons are helping). It's helped me become resilient and has taught me tenacity because if you could get through a heart-breaking day, you could damn sure get through a good-old bad day. Next time you have it bad, just think.
You really have it good.
I had the opportunity to attend a nurse recognition dinner last night in honor of a fellow co-worker, Nancy Kelleher, who was accepting the Essence of Nursing Award. This award is given to a nurse who epitomizes the values of a great nurse.
Nancy works in care coordination, which means she helps patients navigate the course of their hospitalizations and facilitate the discharge process. Some patients go home while others go to a rehabilitation center, hospice, or home with services. She's pivotal in helping patients get to where they truly want to be - home. I only had the chance to work with her for a year, but I will always remember how helpful she was guiding me as a new nurse by asking all the right questions about barriers to discharge. I will also never forget a moment we shared together in the room of a patient who was CMO (comfort measures only), which means you no longer continue interventions to keep someone alive but, rather, keep them comfortable to ease them through the dying process with as little pain and distress as possible. This patient had been on the floor for months and was dying - we always thought he would go faster than he when he did but to our surprise, we'd always come back the next day to find out he was still on the floor. It wasn't until a few days after Nancy stepped into the room with me and grabbed this patient's hand, stroked his hair, and expressed her best wishes for him that he passed. This moment was emotional for us both because in his long months in the hospital, no one had ever come in to visit.
Work gets busy, stressful, and chaotic for us all. At some point or the other, we just want to pull our hair out and walk out of the office. Many times we need a mental health day, but events like last night really help to remind nurses what it means to be a nurse, why they chose this profession, and also gives us the encouragement and appropriate thanks to continue doing the work we do. A lot of people and patients always ask me, "Why don't you become a doctor?" I know it takes a very smart person to be a doctor, but it takes a very particular type of person to be a nurse, and a good nurse, at that. I wouldn't trade the work I do to do any other job. The dinner last night confirmed that all the night shifts barely staying awake at four in the morning, stressing over your patient with acute GVHD for the duration of your twelve hour shift, and the heartache from patient's deteriorating is all, in the end, appreciated.
This event also made me reflect and remember what my values are a nurse. A year and a half out, I've learned a lot but also still have endless amounts to learn. These are a few pillars of my practice.
Science. Know your anatomy and physiology. When you go into an assignment knowing how a disease progresses through the body, you feel much more confident about the type of care you can give for that patient. Every patient and disease comes with their own set of specific interventions, and the more you familiarize yourself with certain conditions the more you'll be able to predict what that patient will need. Reading and understanding the disease will also help you anticipate complications and emergencies that you can prepare for and catch early on to treat. I still find myself looking up acronyms of conditions I'd never heard about before (I swear people make up their own acronyms all the time), and that's okay. Even for illnesses that I've studied a thousand times in nursing school - it's really okay, and it's safer for the patient, too (I will never ever remember they kidneys and what happens once you get to hose tubules . .)! The nurses I look up to are constantly assessing their patient and understanding things in the context of their current health problems and health history, whether they're just laying in bed or walking on the floor. It's part of getting a well-r0unded picture of what's really going on in the context of that individual that makes patients so unique. You know all their nuances because you're at their bedside the whole day - and that information can really serve as gold when talking about things like medication compliance, understanding health materials, and helping the medical team make decisions that will work for that patient.
Heart. I've always said nursing is just as much a personality as it is a profession. If you don't care about people, you can't be here. The best nurses are experts at navigating tender patient situations through careful understanding and appropriate responding in a way that is meaningful, and ultimately, efficient for a patient. In other words, you communicate in a way that gets through to the patient, in a way that works for them, in a way that lets them know that you care. Whether it's a person who's actively dying, a trauma, someone who has a bad prognosis, or something totally unrelated to medicine, it's important to understand what's going on in a situation and how to respond to it. Not everyone can do this.
Being a team player. I hate when nurse's see a call bell going off right next to where they're sitting and just stare at it. With that being said, it's simple. Help out. If you have free time, ask if someone else needs help. And if it clearly looks like they do, don't ask - just do. With all the commotion going on in a hospital, you never know just what the simple act of emptying a foley or giving PRN pain meds will do to ease a coworker's day. Get to know unit staff including housekeeping, the secretary, pharmacist, and doctors. You'll need them.
Don't just stay on your floor. Get out there. Nursing is way more fun when you're off the unit and have time to hang with coworkers in a new environment. I don't mean get wasted (although a few drinks never hurt anybody!), but go to conferences, dinners, and talks that allow you to see the people work with in a different light and educate you about the world of nursing in general. It's necessary for me to stay updated with current events and to not have my head in the clouds, solely focused on my one unit in my one hospital. Nursing has come such a long way since Nightingale. To know the profession is to push it forward, too.
You'll always be a novice. I truly believe that twenty years from now, I'll still feel like a new nurse. I say this because I'll always have something new to learn. Be humbled by the people you encounter and the new cases you take on, as they are reminders of all the potential you have, how much smarter you can be, how much better you can handle a patient scenario, and how much more prepared you'll be going into the next case to make sure someone's stay in the hospital is as comfortable as you can. Sometimes I still do the NCLEX questions of the day to jog my memory about foundational concepts I learned back in nursing school. They remind me that there are other fields out there outside of my comfort zone in hematology/oncology/bone marrow transplant. And I'll never know all of them.
I'm giving blood products to one of my favorite patients. I know I shouldn't be picking favorites, but I can't help it. There are people you have the pleasure of taking care of and even if it means you have a busier night, it's worth it because you want to take care of them.
I'll call her Melanie. Melanie's oxygen level keeps dropping on me and it's the saddest thing because Melanie had great lungs. She has lungs built for hiking, cross-country skiing, and the dozens of mini triathlons she's run over the course of her lifetime. Her husband tells me she was part of the Four Thousand Footer Club - a group of people who climbed the less known mountains of four thousand feet or greater - because she loved hiking so much. She's also part of the reason I decided to take swimming lessons. Before she was diagnosed with aplastic anemia, she lived the fittest lifestyle. She's the type of patient that reminds me of how fortunate I am to be able to wake up every morning, roll over on my stomach, walk to the bathroom, get myself dressed, and maybe get my lazy ass ready for a run. She's one of the patients that reiterates the importance of not taking your legs, lungs, strength, and energy for granted. Because one day you might not be able to do those things anymore.
Melanie came in for chemo/immune/radiation therapy for her anemia. She was doing well and was getting ready to go home. The treatment itself was hard - that's one of the reasons I feel like cancer is one of the saddest diseases out there (it's takes third place after Lesch-Neyhan disease, and then muscular dystrophy for me). Not only is the disease itself hard on the body, but the treatment is, too. The side effects can be awful, namely graft-versus-host-disease (GVHD), terrible mouth sores, intractable nausea, hair loss, and neutropenia that can turn into a medical emergency if you develop a fever. These patients are vulnerable mentally, physically, and emotionally. Melanie had powered through her immunotherapy before she started developing these crazy complications. First it was Afib with RVR in an otherwise sinus heart (a condition where the atrium of your heart fibrillate or wiggle instead of contracting and getting blood out to the rest of your body properly), then an oxygen requirement from fluid overload and pleural effusions requiring a tap, acute kidney injury that required dialysis, and now, the worst of them all, suspected neuromyelitis optica (NMO), an autoimmune disease that can paralyze the limbs and turn a person blind. Now, take a once strong, independent, healthy, active, and happy human being and strip the strength, independence, health, and activity away from her. What do you get?
Anything but happiness.
Melanie was a champ before the last on her laundry list, NMO, hit. The oxygen requirement alone was enough, in my eyes, to put a conditioned athlete in distress. How would you feel if one day you could hike Mount Monadnock, and a week later realize you couldn't even stand to put some pictures up on a wall? I was getting ready to take care of someone teary eyed and hopeless, but to my surprise, Melanie champed through her breathing problems and faced me with a smile. I was surprised she wasn't depressed. Then came the dialysis . . no one wants to hear they have to go on dialysis. And so, again, I went into work expecting to take care of someone who was just fed up with disease and what it had done to her. But no, she was chipper, happy, and optimistic - again making me feel terrible about myself for not only not knowing how to swim, but not being able to be nearly as happy even without a disease like cancer (seriously - how do these patients do it? I throw a BF when my stomach hurts and here they are battling cancer, able to crack jokes and ask me how my day is). This had to be the end of the line. How was it that she was actually worse off than when she came in - were we making her better, or worse? As if anything else could go wrong. Then it hit again. This time with leg paralysis that started off with unsteady gait, then weakness with a bedside commode, and now total dependence and bedrest. Oh, and she can't see either. Blind and immobile. Probably the best way you could completely demoralize a person and strip the dignity from his or her life.
So now she can't breathe like she used to, walk, see, or even use the restroom like she used to. Her optimism carried her far, but tonight, for the first time since she's been here, I've seen her falter. And it's the most heartbreaking thing, seeing good people suffer. People who genuinely deserve the best, who see life through the best lens, who go into its hardest experiences with the most gusto but lose. It sucks. It's the most deserving people who break, and sometimes I think to myself that it would almost be easier if it was someone I didn't favor because it'd be a little easier to watch her go through this hospitalization. Everyone on our floor hates seeing her the way she is. And don't even get me started on the husband, it'll make you cry (unless you're a man).
Watching your patients lose hope is one of the hardest encounters as a nurse. You don't know what to say sometimes and sometimes the best thing to say is nothing at all. I don't think she will understand the magnitude of how much I respect her outright tenacity, but part of me likes to think she feels it when I ask her what's on her mind, and when I tell her she's inspiring and if that if anyone had the strength to go through this, it's her.
I know these words won't bring her legs or vision back, but it has made me reflect a lot on how lucky I am to be able to be completely handicap-free (aside from being vertically challenged). I think most of us take these simple, unconscious actions for granted. What if you had an itch on your ankle and couldn't even bring your leg up to scratch it? I'm usually pretty good about leaving work at work and taking a deep breath once I leave the hospital doors, but I have been finding myself thinking about Melanie more often. So that's why, next year, I'm hoping to run the Boston Marathon. Because if a man with muscular dystrophy can practically limp across the finish line, and Melanie did a trillion triathlons in her life, then I can sure as hell run it once. It's people like Melanie that make me want to put my legs, body, and entire being into full, good use while I still can.
So be thankful of the body you were given and the fact that you are able. Even if you're fat and unhappy or whatever or don't have that six pack you've always wanted . . at least you know you still have the capability to get it if you tried.
I was so sad when I heard that you passed. The only relief I got was in knowing that you can finally breathe easy in heaven. You were easily one of the most likable people I have ever met. Seems like you were able to form a friendship with anyone you encountered, which is evident by the story you told me about how you used to work with a Vietnamese lady and she taught you how to count to ten in Vietnamese. It was a night shift and I told you I'd check on my other patients so that you'd have time to refresh your memory and recite the numbers you learned. When I came back with your insulin and antibiotics, you were able to count from one to ten in the best Vietnamese I had ever heard any Italian recite! It made me so excited because you took the effort to get to know someone like me, and my culture. I will always remember your sleek, white guitar, your espresso machine, and how much you hated that Church closed down near my apartment because you thought it was one of the coolest places for live music. I regret not being able to attend your fundraiser and not visiting you in time on 14AB and the MICU. I'm happy you're in the best hands you could possibly be in, and that you handled the inevitably of death with such strength and humor that only you could pull off. You've touched the hearts of so many lucky people in your short life. You'll never struggle for another breath in heaven. Have fun up there, buddy, :).
April 7th, 2016 Update: Had the pleasure of going to a spin fundraiser event for Jay this past Sunday with some old coworkers. I'm usually awful at spin but the venue was fun, my coworkers were super motivated, and I ended up having such a good sweat. We're putting these lungs to good use for you down here, Jay! Thanks to Whitney for organizing!
George Miller was one of my patients on my new home on Brigham and Women's 6A, Hem/Onc/BMT. George first rolled up to our floor on a stretcher, slightly zonked on Fentanyl and Versed after getting his central line placed for chemotherapy. I was fortunate enough to be able to care for him during his stem cell transplant admission. Before I start, I should include that I am posting with permission! He even asked me to tag him, :).
I've been really lucky in my short time as a registered nurse to encounter patients who really reconfirm all the reasons I decided to be a nurse five years ago. George was one of them - it's hard to be optimistic and cheerful when you know you have cancer, but George was one of the happiest patients I've ever cared for. I don't have cancer, and I don't think I'm as happy as he is. What the hell. While caring for him, it made me wonder "How could someone who has cancer be so happy and appreciative of the life he's been given?" I don't have any huge, pressing issues in my life. I'm in debt from school loans, but who isn't these days? That's about it.
Cancer knows no boundaries - literally. It's not racist, sexist, elitist, or anything you can think of. People who have cancer can have genetic predispositions, but you can never predict or control it. There's genetics and all the stuff you've been exposed to and your lifestyle, but no can tell you with 100% certainty that so and so percentage of your cancer is from this and another percentage is from that and so forth, even if it boils down to genetic mutations. I've read of stories where patients question "Why me?" And I'm not sure if George ever asked himself that question, but this is how he approached it. He didn't blame himself and, instead, was powering through this his hospital stay. The way he explained it was that he had done nothing wrong to put himself in the position to get cancer. Then we got onto the topic of worry, fear, and anger. He told me had studied and read about Buddhism and how fear and anger were the two worst emotions you could feel. Now, I'm young and I don't know much about things. And the only real loss I've had was losing my grandpa to colon cancer a few years ago. But I couldn't agree more. And here's why.
Fear. Anything can happen. Think about it. People say we're so safe in the States. Is that true? What about all these school shootings? The Marathon Bombing? The art teacher who died when a highway manhole flew through her car windshield? People were scared for my safety when I traveled alone to Iceland, but if you really think about it, I was just as "safe" traveling alone in Iceland as I was walking down a street in downtown Boston. Worrying about something that hasn't happened yet - and might not ever happen - is such a huge waste of time. You're given one life - why should you spend half of it with a cloud over your head? Doesn't it get hard to breathe sometimes? And think of it this way . . if you spend all that time worrying and nothing happens in the end, it was (actually) a huge waste of time. You could've used that time catching up with a friend over lunch, trying out a new hobby, hiking (!!), or just lounging on the sofa laughing out loud to Ellen. There's a quote I read when I was younger which still rings with me to this day: "Worry is like walking around with an umbrella waiting for it to rain."
Anger. I don't know about you, but when I'm angry - and I mean really angry - I cry. It takes a lot for me to cry out of sadness, but not much for me to cry out of anger. Anger is like a black hole that doesn't stop sucking you in. It's a vacuum in the center of your soul that doesn't stop consuming, making it impossible for you to fill the other parts of your soul with meaningful experiences, people, and things that make you happy and your life fun and worthwhile. I hate being angry. I feel like when I'm angry, I can't be anything else. A good example is a girl that I hate. I hate that I hate her. There are so many feelings in this world to experience and it's so unfortunate and shameful for me when I reflect and realize half my day or, worse, half my year, was spent angry at someone. This person never wronged me personally, but wronged someone I care about. For a long time, and still a little bit to this day, I still feel anger when I think about her. But I'm so sick of knowing I get upset over someone so distant from me, who doesn't even care about me, who is so little involved with my life. I'm sick of knowing that she can get me so worked up - and literally over nothing. Because she literally didn't do anything to me! So I've learned to approach it a different way: "She's wronged someone I love. But she hasn't wronged me. What happened between this person and the person I care for is their's, and that should stay in the realm of 'them'. My relationship with her should be based on my interactions with her, and not on her relationship with another person." It's helped.
Anger is so hard to let go of. I know my situation isn't as strong as others' experiences, but I can't even imagine what other people suffer with. It's senseless to feel angry if there's a way you can let go of it.
And so in my ten minutes talking to George, I realized two really important things. And they were to not be fearful and to not be angry if you could help it.
George is fighting cancer. And kicking ass at it. What are you fighting?
Thanks for helping me reflect so much on my experience, George! Your strength inspires others. I will be forever grateful to have had the chance to be your nurse, care for you, and listen to all the wisdom and power you share with the world and the people around you, :). You make the world a happier place.
A few days ago I watched an episode of The Doctors that feature a young boy, Justin Smith, who was found frozen on the side of a road. He appeared to be dead, but the doctor who has handed his case refused to declare him dead until he had seen the patient because he had been in the same situation years ago himself on the same day, where his daughter had passed. Miraculously, the medical team performed CPR and used ECMO to revive him back to life. ECMO, extracorporeal membrane oxygenation, is a method to provide adequate oxygenation to the body used in lots of heart and lung surgeries. I think of it as like dialysis for oxygenation - a machine circulates your blood, taking out the carbon dioxide and returning oxygen to supply the body during intensive surgeries, and in this case, life support. What surprised me most about this story, on top of the boy surviving with minor amputations, is that during his coma his mother stated that she never lost hope and that the family would "take him any way [they] could." Even if he was a vegetable. Really? Would I do that?
Part of me is inclined to think that part of the reason the mother said this because 1). She's his mother and naturally, why would she want to let go?, and 2). This took them by surprise and happened unexpectedly. If someone you loved was suddenly yanked from your grasp and hovering over the pits of death, you'd want to be able to have them back too, wouldn't you? But what about a few years from then? Would she still want her son "any way [she] could?"
I'm not criticizing her because I would probably do the same thing, but I wonder if she's ever seen a vegetable. And I mean a person-vegetable, not the ones I liked to eat but haven't been able to stomach since coming back from Iceland. I once took care of a patient who was in a persistent vegetative state due to an anoxic brain injury from cardiac arrest. All day, everyday, he laid in bed seemingly unaware of who was in the room or what was being done to him. He sweated profusely constantly. He couldn't speak. He couldn't even turn, and if he had an itch on his nose he couldn't even scratch it. But wait, he actually couldn't even process that his nose was itchy, for that matter. Do you know how annoying it is to have an itch and not be able to scratch it?! I'm sure we've all been there, but that was the best case scenario in his list of problems and things he couldn't do. I'm sure you guys can all imagine the other things he couldn't do - the things he couldn't even think to do, for that matter. And just a side note*: that's why I feel so grateful everyday to be able to wake up, be able to think out and plan my day, and (usually) go out and do it. This man couldn't.
And yet, his health care proxy still wanted him alive.
I'm sure there is research that shows, and I strongly believe, that he was still aware to some degree. But really, where's the quality of life in that? To be confined to a bed everyday, having people cater to you, unable to do something so much and as simple as pulling the blankets up over you if you're cold?
Just makes me think. I don't know.