Acknowledged, Invisible, Valued

We all want to be acknowledged, to feel that we are welcome and wanted, that we bring something to the table, that we have value. We want to be invited into community, to be accepted.

We fear being invisible, being ignored or dismissed, unaccepted, unwanted, and inadvertently devalued. We fear being overlooked and being pushed to the outside, forced to look in but not allowed inside.

It’s a simple act, to acknowledge someone: it’s a nod, a smile, a handshake, a voiced “hello” or “hi”. It takes little effort, but it in turn communicates acceptance, love, value. What begins as superficiality has the potential to bloom into an invitations of community.

We all crave intimate community. God designed us to be connected, to fellowship, to bear one another’s burdens. We were not designed to be alone or isolated.

So why, if it is so simple, do we hesitate to acknowledge? Why do we limit or deny community to those around us? Why do we stop short?

Sometimes we are too busy, sometimes we are comfortable in our own community and have grown complacent, and ironically, sometimes we are afraid to reach out in fear that we won’t be received.

We all want to be valued.

The last few years of my nomadic life have resulted in many social experiences. Some have left me feeling acknowledged and some have left me feeling invisible. In retrospect, I am grateful for all of them. Both the feelings of acknowledgement and the feelings of invisibility have taught me so much about the importance of healthy human interaction, about my own value, and the innate need for true community.

A Kindredness

The moment our eyes locked I felt a kindredness.

I did not know her. She was old and wrinkled, her hair was somewhat disheveled, her gait was unsteady, her pearly whites weren’t so much.

But the closer she came to me, the closer she drew me to her.

It was a soul connection.

She came to stand right in front of me. We smiled and then we embraced. In truth, it was the most genuine and uninhibited hug I have had in a long time. The kind of hug that warms you from the inside out; It was a whole heart hug.

And then I noticed her caretaker standing behind, “She has dementia. She used to teach at the school.” She said this to me apologetically, as if to dismiss any awkwardness that I had felt. I smiled. She was the only one with the awkwardness. “Oh” I said, “I didn’t know”.

My new friend and I smiled a moment more and then she went about her unsteady way.

I don’t know what it is with dementia, but it often has a way of drawing me in. There is a purity with dementia that is likened to that of a child; an uninhibitedness that leads to a  genuineness. It is a beautiful aspect to such a degrading disease.

I find it easy to interact with children, with elderly, those with dementia. I find it difficult at times to interact with adolescents, teenagers, and even peers.

We read in the book of Ephesians:

“¹¹ And He gave some as apostles, and some as prophets, and some as evangelists, and some as pastors and teachers, ¹² for the equipping of the ^[d]saints for the work of service, to the building up of the body of Christ

We further read in 1 Corinthians chapter 12:

¹⁴ Yes, the body has many different parts, not just one part. ¹⁵ If the foot says, “I am not a part of the body because I am not a hand,” that does not make it any less a part of the body. ¹⁶ And if the ear says, “I am not part of the body because I am not an eye,” would that make it any less a part of the body? ¹⁷ If the whole body were an eye, how would you hear? Or if your whole body were an ear, how would you smell anything?
¹⁸ But our bodies have many parts, and God has put each part just where he wants it. ¹⁹ How strange a body would be if it had only one part! ²⁰ Yes, there are many parts, but only one body. ²¹ The eye can never say to the hand, “I don’t need you.” The head can’t say to the feet, “I don’t need you.”
²² In fact, some parts of the body that seem weakest and least important are actually the most necessary. ²³ And the parts we regard as less honorable are those we clothe with the greatest care. So we carefully protect those parts that should not be seen, ²⁴ while the more honorable parts do not require this special care. So God has put the body together such that extra honor and care are given to those parts that have less dignity. ²⁵ This makes for harmony among the members, so that all the members care for each other. ²⁶ If one part suffers, all the parts suffer with it, and if one part is honored, all the parts are glad.

There have been times in my life which I wished that I could interact better with young people, that I understood more what to say, how to say, how to be. But even in wishing that, I wouldn’t trade it for my ability to interact with the child, with the elder, with those with the dementia. We are all called to something.

She left me with a smile. This woman with dementia brightened my day. I do not know who she was, who she is. I do know, though, that for a moment she was simply a Christian sister and we embraced as Christian sisters should.

The arms of Jesus wrapped around me today.

Being Nice

When being in a position of authority, one is burdened with a great deal of responsibility.

You are responsible for your own actions and decisions and moves. But you are also responsible for things outside of your control, like people and their actions and decisions and moves.

When you are responsible for the care of people and for the people who care for them, it is important that you foster nurturing relationships, it is important that you always allow youself to be approachable.

As a nurse practitioner I had to know my patients so that I could make good decisions in caring for them, but I also had to know my nurses so that I could anticipate their decisions and actions in caring for my patients.

I’ve worked with a lot of great nurses, some good nurses, and some nurses who meant  well, but that I just didn’t trust. I found it important to foster relationships with all of them, but especially the ones I didn’t trust.

I found that some of my partners didn’t trust the same nurses that I didn’t trust. This validated my concerns. They, at times, treated them with frustration, anger, disrespect. I was not there, I did not know this. I learned this from the nurses themselves. They said, “Thank you for being nice and being approachable. I know I can always ask you questions and you won’t make me feel stupid.”

Thank you for being nice.

Being nice.

I would like to think that I’m just a nice person. I think, in truth, it started out that way. But in time, I learned that being nice actually allowed me to gain insight, gain trust with the nurse. The nurse could ask me questions without reproach. I knew what was going on. I knew how my patient was. I knew what the nurse was thinking.

The nurse didn’t talk when they didn’t feel safe.

After a few incidents, I realized that being nice actually had the potential to save my patient. My being approachable increased patient safety.

No one gets anywhere from yelling. If anything you go backwards and the patient suffers.

I’m learning the same is true with students. I want to be approachable. I want them to ask questions. I want them to feel safe. I want to save their future patients.

There was never any benefit in eating your young. The field of nursing was wrong in that. That is not who I want to be.

I want to be nice.

A Little Late, But Right on Time.

I moved from Nashville on November 21. Since that time there has been Thanksgiving, starting a new job, a major ice storm, Graduation, Christmas Break, the death of a friend, the beginning of the semester, and a weekend with DHS.

Despite being two weeks into the spring semester and despite having moved to start a new job over two months ago, I hadn’t lectured a single time until yesterday, January 27. I lectured twice, in the morning and in the afternoon.

I suppose I have been waiting for yesterday for years. Realizing as a college student that I eventually wanted to be back in the classroom, though, on the other side of the desk. I wanted to talk, to lecture, to engage minds in learning. But I wanted experience, I wanted time and personal investments to bring to the classroom. I didn’t want to be an inexperienced teacher who had little to offer.

There are some things that are second nature. Lecturing feels like that to me, but then maybe it’s just genetic.

I’ll have to admit though, I’ve had a lot of anxiety about walking away from the hospital, from the ICU. I frequently think about my “regular” schedule and still find myself trying to adapt.

ICU work is second nature, too.

I lectured yesterday. I taught students in a University yesterday. I did well. I enjoyed it.  

And no one died. Nice to have a job where no one dies.

Adaptation takes time, but all I have is time.

Blessed.

Granny Nanny

She’s been old all my life.

Funny how you see things, smell things, live things every day, but they don’t always directly affect you.

I don’t know my patients. They are who they are when they present to me, they are not who they were before they did.

Yet, today was different. She was not who she presented to be, she was the shell of the woman I have always known. The old woman who always had a smile and a twinkle in her eye, a twinkle that seemed to become more mischievous the older she became.

“She smells today.” My mother noted.

I know that smell. I smell it every day. But not here. I do not know it here.

She had trouble opening her eyes. When she did she couldn’t see clearly. Couldn’t hear. Couldn’t understand what she saw, what she somewhat heard.

She kept asking who I was, she thought I was Chara, the one with the boy. I didn’t correct her.

Her hospice aid, Gigi, came and bathed her and gave her excellent care. She knew her. She said she was her pal.

Funny. I take care of perfect strangers all the time and here was my own, lying in her bed, on hospice, and I was watching her pal, Gigi.

I went to the kitchen and listened as the hospice nurse explained to my great aunt about the medications in the hospice kit. This is for this, this is for that, this helps with this.

Funny. I was hearing a lecture about medications I give regularly.

It was time to leave.

I went and sat on her bed.

“I’m ready to go, but I guess the Lord isn’t through with me yet”, she said. I smiled.

“Are you Phil’s?”

“Yes,” I said, “I’m Tara”.

“Oh, you have a boy”.

“No, that’s Chara, I’m Tara”.

“Oh”. She smiled. “That’s right, that’s Chara”.

And there was that twinkle. And for a moment she knew who I was. For a moment I was Tara.

I rubbed and patted her back.

“Oh, that feels good. I may go back to sleep,” she said.

I kissed her head and rubbed her back and looked at the body of my 104 year old great-grandmother.

Funny when the patient is yours. When the patient isn’t a patient. Funny to know who she was and not who she is.

“I’ll see you later” I whispered.

And left her for probably the last time.

Beginning and End

I found myself standing at the foot of the bed, wondering about the day of their birth.

I wondered what the mother thought, how she felt as she held that new life in her arms. I wondered if she was full of joy and hope and excitement for this new life. I wondered if she, like Mary, had a song in her heart.

I wondered if there was a father in that room, smiling at the scene. I wondered if he bent down to kiss the crown of that head. I wondered what he felt.

I wondered because I found myself standing at the foot of the bed on what would be the day of their death. There was no mother, no father, no siblings, no children. There was no family for this life, this soul.

We waited until our shift was settled and then we went to our work. We: the nurse, the respiratory therapist, and me. We were the sole people surrounding this life who now lay in the bed.

I took the tube from the mouth and we stood there. We watched the rise and fall of the chest. We watched the monitor reveal the heart beats. We didn’t want her to be alone.

We waited.

My phone rang. Another patient needed something and I left the room.

I became busy.

My phone rang again. It was the nurse. The patient was no more.

I again found myself at the foot of the bed. I donned the stethoscope. I listened a final time to the chest. There was no rise and fall, no heart beat. I pronounced the patient, reported the time of death.

And then it was done. The life was over.

I stood alone in the room with the patient and wondered the course of their life. Wondered where the family went. Wondered where this body would go.

Hours later I passed the room: it was clean, the lights were on, the bed was made. It was waiting for the next life to come, as though the other had never been.

But it was. I remember.

Combat Zone

We were trying to do emergent procedures in two rooms, three other rooms were actively crashing, and a patient down the hall was in acute delirium.  The night was hellacious.

It never stopped.

It has been like this the last few weeks.

One moment we were coding a patient, the next I find myself alone, with their child, in a waiting room, telling them that they had died.

Another moment it seems like a blood bath. Attempt after attempt after attempt after attempt and then finally success at the Seldinger technique.  

Blood pressures bottoming out – pressors, fluid, pressors, fluid?

Rising lactate levels: 11, 14, 7. Mortality risks rising comparatively.

Rapid Response. Rapid Response - ICU Transfer. Rapid Response. Rapid Response.

“X wouldn’t want to live this way”. I find myself standing alone with the family. We withdraw heroic measures and introduce comfort care: ativan, morphine, extubate, pressors off. Death rattle, death rattle, death rattle. . . . death.

I’m not sure whose blood is on my scrubs.

At times, I find myself under such physical, mental, and emotional stress that it is like I’m in a combat zone.

When I was done with work on that third morning that is exactly how I felt: as though we had been in combat all night.

The stress can be addicting. I was off that fourth night, but I offered to work. I didn’t, though.

After hours of day sleep I was relieved; the extreme exhaustion had finally hit. It was a church night anyway. I got dressed. I left the house with my exhausted mind and body to be around “normal” people and smile and be polite and sing. But I found myself driving to the grocery store, buying milk and heading home. How can one be around “normal” people when they don’t feel “normal”.

It is now days later. I went to church this morning. Time allowed me to be “normal” again. I’m going back in tonight, re-entering the combat zone, or maybe just a quiet boring night.

Oh the ebb and flow of the ICU.

Someone Will Always Be There

It never stops. They are always there: the patients, lying in their beds; the nurses, caring.

There is never a time when someone isn’t there, never a time when the unit isn’t fully employed with people actively caring.  

When I’m away I sometimes think about the unit, the patients. I wonder how they are, how they’re doing.

Every unit I have every worked in has patients lying in beds at this exact moment with a full staff of nurses caring for them. They have never stopped.

It’s daunting sometimes to think about, to know that it will never stop, that they are always there, that there will always be a need.

Weekends, night time, holidays, Saturday morning, Thursday afternoon, Monday night, Halloween, Thanksgiving, Christmas, the Super Bowl. There is never a moment when there is not a need.

There is a responsibility of those who know to teach those who don’t know, this ensures that someone will always be there.

Teaching allows me an opportunity to always be there without having to always be there. Teaching provides an opportunity to create a legacy.

Teaching bridges the present with the future.

So, I find myself coming to a new bridge to cross, a new challenge to meet.

My goal has been to learn and experience and grow so that I would have a deep wealth of knowledge in varied areas of healthcare to share when the opportunity approached and the time was right.

The more I’ve learned, the more I realize how very little I know.

I’m excited about the coming months, the coming semester. I look forward to the spring of 2014 and the promise it brings, the opportunity it holds, the changes it will yield, and the new bridge to cross.

Caffeine and Diphenhydramine

Caffeine and Diphenhydramine

I look forward to the day in which these two agents don’t dictate my sleep/wake cycle, but the sun and the moon do, days that aren’t slept away and nights that are for resting.

It seems as much as life has continuously changed the last few years that it really hasn’t changed at all. For all my doing and traveling and going and learning I’ve really stayed in the same place.

Around the world and back again. But was I orbiting the world or was I allowing it to orbit me?

We had a retirement party for a coworker the other day. I watched the video of times gone by and remembered some of those times from my previous time at Vanderbilt. I wondered what it would be like to be somewhere for so long? I remember what it was like to be somewhere for so long.

I never imagined that my work would become my life. I thought my children would. But my child is furry with four legs, not a red head with two. I so deeply love her, though.

I’m excited about the future, about life, about work. I’m excited about the paths coming up. I’m excited for new experiences, new horizons, and new challenges.

Life is such a gift and I’m so thankful for all that it brings, and all the amazing opportunities I've had.

I am truly truly blessed.

Diary of an ICU Nurse and Why Doctors Die Differently

There are a lot of truths in this article: Diary of an ICU nurse.

And this one: Why Doctors Die Differently

I suppose there are moments when each of us who work in the intensive care setting has to ask ourselves what we are really doing for, or more appropriately, to our patients.

Dying is hard. Watching a loved one die is harder, it hurts.

We are all going to die. How do you want to die?

It really isn’t a joke. We all say we are going to tattoo DNR (Do Not Resuscitate) to our chests. We all tell each other to not let “them” do this to us. Funny though, we are “them”. We tell each other not to do what we do to other people to ourselves. And the saddest part of all is that we mean it.

We don’t want 911 called. We don’t always choose chemo. We don’t want CPR or ACLS. We all would choose to die.

We all would choose to die.

Choose.

There is no failure in death. There is no failure in allowing the natural to occur. There is no failure in receiving one’s fate. Yet we fight it.

Life is a beautiful and most precious affair. The goal is to not demote or negate its beauty. But death is a part of life. And believe it or not, there can be great beauty, great comfort, great peace, and even great joy in a quality death.

Hospice and Palliative care are greatly needed and greatly underutilized options that can help achieve a quality death.

Please talk to your family. Please talk to your ICU team. Please ask the hard questions. There is no reason not to and so many reasons to do.