A Home for Ruth

When I was in the first grade I had to start reading chapter books. I was afraid to read chapter books. Even at that young of an age, I was deeply afraid of failure. Chapter books were really long and I was afraid if I started a chapter book I wouldn’t be able to finish it. So, I told people I hated to read. But the truth was that I didn’t know if I liked it or not; I was afraid to try.

I had a chapter book though that I carried with me for months and I would stare at the cover all the time. The book was called “A Home for Jesse”. It was a book about a boy who found a little dog. I dreamed about being the one in the story, about Jesse being my dog. I dreamed about that for years. I did eventually finish the book, but the details of the story escape me now.

All of my life I wanted a dog. We were allergic. We didn’t have a fence. We never lived in a house that we owned; it was always the church’s house. Finally, the summer of my 13th year we got Belle. I loved her. I had always wanted her. But Belle was the family dog, more specifically, she was Mom’s dog. I also was young and immature and didn’t truly understand what it meant to love her in the way I should.

Time passed. Years went by. I kept telling myself when I finished school I’d get a dog (this was before I realized I’d be in college for 10 years!!). Then when I was finally done I started working odd hours and didn’t feel like my schedule would be conducive to raising a puppy. It seemed I would never fulfill my wish.

When I moved to Raleigh a lot of things in life began to change for me. Priorities began to be refocused. I started evaluating things from a different perspective. I began to put an emphasis on other things. Mainly me and what I needed. Some things I had neglected for a long time.

I still wasn’t sure about a dog. I knew that within time I would begin working 24h shifts. How in the world can a person get a dog, a puppy, and work for 24h?? I had no clue, but I began to look. I met a lot of people and met a lot of dogs, but none of the dogs were the “one”. I was almost ready to quit looking, but at the same time, I had such an intense desire. I had finally given true hope to a lifelong dream and it wasn’t going to let me give up.

I’d been to the shelter before; hundreds of dogs yelping in a large room. The smells, the sights (and this from a person immune to most smells and sights). My cousin Audrey decided to go with me. We walked around. I was really in a funk while we were there, I was never going to find the perfect dog. There were 4 criteria I was looking for: female, dark colored (I’m a racist), small, and doesn’t shed. Nothing seemed to fit what I wanted.

Audrey and I were laughing at so many of the names. They were funny and ridiculous. We walked and balked and looked and laughed and toured. Then there she was. I don’t know why or how, but I knew it was her, I knew it was my dog. I bent down to pet her through the chain link cage. She licked my hands and was so excited to see me. I was down there with her for awhile. Audrey was standing at my back. “What’s her name?”, I asked. “Um. Tara”. “What I said? Tara’s not a dog name!” I stood up, and there it was in black and white, her name was Tara. I laughed, but truthfully that was the moment I knew it was meant to be. God in his infinite wisdom had pointed her out to me.

I donned a gown and went into her cage. She smelled, she shed, she was going to keep growing, she was at least female and dark colored though. I loved her immediately. But my heart grew hard and after playing with her for a few more moments I left. I left without her.

I have a fear of intimacy, of commitment, of trust. I just couldn’t do it. I couldn’t let myself be vulnerable, even to an animal.

So I went home and took a hot bath and couldn’t stop thinking of my little dog. I got up and went to church the next morning. While there, I named her. The shelter opened at 12 noon. Church got out at 11:45 and I rushed there. I was afraid someone might have gotten my dog.

They hadn’t. I paid for her before I even went back to see her. I spent the rest of the afternoon shopping for her and getting ready to bring her home. Then, on Wednesday, I did. It was touch and go at first. We both had so much to learn about each other. I was afraid I’d never housetrain her.

She has done more for me than I could have ever known. I love this crazy little dog more than anything. I am so proud of her. She has blessed me in so many ways.


As a single person there are a lot of benefits to living alone. I drink out of the milk carton, eat out of the ice cream bucket, leave doors open when I should close them, and nobody cares what I do. But there are some negatives too: no one’s here when I get home from work, nobody ever fixes my dinner, and nobody cares what I do. Ruthie does though, and sometimes that makes all the difference.

My life has been deeply enriched by Ruth. I will forever be thankful for her.

Living the Dream

“Living the Dream”

This is a phrase that is often stated by people who work in health care. There may be other professional arenas that say this too, but this is where I hear it, this is where I know it.

So, what does it mean? This phrase we use.

I think most people who start out on a career path in health care have an idea, a concept, a dream that positions them in such a way to be the hero, the savior. We dream of being in unbelievable situations and coming out heroic after encountering almost unconquerable circumstances. We dream of saving the day, saving the life. Maybe I really mean I, and not we.

After awhile reality overtakes the dream. More often than not, I hear “seasoned” (or jaded) health care workers saying this phrase in a more sarcastic, indifferent, more humorous way. Almost to laugh, as if to say that it’s no dream at all.

Events have occurred in my professional life as of late that makes me stop and think about this phrase.

I went to Duke recently and assisted in the OR on a neurosurgical case (this is brain surgery). As I drove in my car that morning and arrived at that colossal place, I said to myself “I’m living the dream!” and I found a smile in my heart. Assisting with brain surgery, it sounds quite intense, exciting, awing, powerful. But the truth is, I just did some preoperative work and then I left before the actually surgery got underway. I was invited to stay. The neurosurgeon was more than hospitable. But the truth is, I didn’t want to stay; brain surgery is boring, it’s hard to see, OR’s are cold, and I was just plain tired. So I did my part and left.

We idealize something sometimes and when the reality of the situation is fully embraced, it is at times not quite as gratifying as we had imagined. We find that we are left wanting and dissatisfied.

When I work, I respond to Code Blues. A Code Blue is called when a patient becomes unresponsive, their heart stops, they’re no longer breathing. I was in the call room the other night, had my shoes off, my pager on the night stand; a Code Blue was paged from overhead. “I’m living the dream!” I thought as I gathered myself and ran down the hall. The patient was the typical floor patient, a patient that I have seen so many times, not breathing, no heartbeat. We started compressions, we gave life saving drugs, we intubated, we did a lot of things. I knew we would not get them back. You can almost always tell by the eyes. As I stood at the head of the bed, with the laryngoscope in my hand, I stared into those eyes. After multiple rounds of resuscitation, two shocks, and some last resorts, we called it, the Time of Death.

Most the time there is no saving the day, no saving the life. When I walked into the Duke OR there was no cape on my back, I did not fly down the hall to the code. There is nothing heroic about it.

I spent some time tonight with the child of a patient. The patient is very close to death. Decisions need to be made very soon regarding the end of life choices. We talked about different options, different avenues of support, positives and negatives. We talked about how joyful the patient had been the other night after visiting with all the children and grandchildren that day. We talked about how proud the patient was of the family and how encouraged they were.

I don’t know when that patient will die or the avenues they will choose for the end of life treatment.

What I do know though is this, “living the dream” isn’t exactly what I thought it would be. I thought “living the dream” involved intense, exciting experiences, like assisting in the OR and running a Code. But what I’m finding is that this is not the case at all. “Living the dream” is making small differences, taking advantages of obscure opportunities, being real, being true. Finding a family member who has flown in from across the country, sitting in the parent’s ICU room, alone, in the dark, watching as the parent takes deep long breaths and engaging in meaningful conversation at 0130 in the morning, making a small differences to that child, that, that is “living the dream”.

I will have worked 78 hours for the week by the time I go home today. I’m living the dream.

Perception is Reality

Some people are so opposed to change that they inhibit themselves from growth, which in the end results in their own demise.

I’m not a fan of change; there’s no secret there. But I acknowledge the power it has and I am much more agreeable to it now than I have been in times past.

I went to a fancy dinner for work last night. It consisted of 9 courses (yes 9!); which surprisingly did not include dessert.

I was the only nurse practitioner sitting among a crowd of doctors and other hospital administrative staff.

The evening was nice. We ate. It was boring. We ate. There were some controversial discussions. We ate. We listened to a presentation. And then I had my food boxed up and headed out to get my car from the valet.

Those controversial discussions were personal; they are ignorant, they are consistent, and quite frankly, they are not grounded in fact, and yet they continue.

Some people see what they want and the reality which they dwell in is no reality at all. Things change.

A few have an appropriate reality. I thanked them for that. “Nicely done” my Attending said. I shrugged.

Sometimes you fight a fight until you cannot fight anymore. Sometimes you fight a fight until you realize it’s not worth fighting for anymore. Sometimes it’s hard to tell the difference.

Next week is my long work week; 72 hours. I will live in that place and dwell in those halls and work and function and exist.

My patients will get good care. But as for the politics, I wonder how much fight I will have.

36 in 48

A few things have changed at work as of late. Most of which I’m not overly excited about. These changes have resulted in significant changes to my schedule.

My previous schedule consisted of working one 24 hour shift for 3 weeks of the month and working one hellacious 72 hour work week for the 4th week of the month. The 72 hour week is rough, but for the most part, that schedule was very doable.

Now, every time I work, I do 36 in 48. That means I’m on 24, off 12, then back on for 12. Having done it for 4 weeks now, I’d have to say it’s killing me.

I spend a lot of time sleeping during the day, and frankly, that’s hard. I spend a lot of nights that I’m off awake, unable to sleep. I have trouble getting personal business taken care of because I’m asleep during the day and awake during the night and the rest of the world does not function on an upside down schedule. I’m finding that I don’t really either.

People often say I’m so lucky because I have so many days off, but the truth is, I spend much of my off time sleeping or staring blankly at the television because I’m so exhausted. Sleeping has become my part time job, only I don’t get paid. It’s hard working a week’s worth of hours in a couple of days. Generally by the time I’m feeling “normal” or recovered, it’s back to work.

Sometimes work feels like water-boarding, only I choose to be here. Hmm?

It’s funny really. I wanted to have a grueling tasking schedule that was awing and daunting and strong. You can only do that for so long though. I would still say it’s grueling but I am not at all awed or feel strong by my schedule anymore. It’s amazing how something can look so enticing at one point and look so horrific at another.

The census has been low and slow lately too. There haven’t been many patients and they haven’t been very sick. This makes for long boring shifts and I find myself wondering what I’m even doing here.

I suppose I’m at a moment of frustration, exhausting, irritation, confusion, and discontent.

It is said that growth comes from chaos. We shall see.

Happy Anniversary Raleigh!

Today marks 1 full year that I have been actively employed at Duke.

In so many indescribable ways this past year has been one of the most monumental years of my life. The depth of change that has occurred is almost overwhelming. I have done and seen and learned and have been given so many things since that time. The place I was in compared to the place I’m in now is absolutely worlds apart. I’ve grown so much. Yet things are as they always have been.

Life has a funny way of giving you what you need when you need it, even when you didn’t know you needed it. But maybe that’s not life, it’s God.

My time in Raleigh has been both rewarding and frustrating, encouraging and heartbreaking, uplifting and challenging, amazing and ordinary, pleasing and disappointing, privileged and humbling, shared and lonely. I’ve been forced to grow and reach and develop and mature, to face fears, acknowledge burdens, and to acknowledge life in a way that I had not before.

And I’m not just talking about professionally but personally; maybe the latter even more so.

Life, however it comes, is a blessing. Each day is filled with opportunities to choose either happiness and contentment or misery and gloom. We make that choice. We build our days, our weeks, our life.

I went in an empty hospital room today with a friend. We pulled the ultrasound in the room with us and closed the curtain. We turned it on. She gooped up her belly. We looked at life. We looked at the beautiful 16 week old baby growing within her. We saw the tiny heart beating fast. We saw the arms moving. We saw the baby repetitively hiccup. We watched as the baby brought its little hand to its mouth.
I blinked the tears away, but they were there, they stung. Life is so beautiful.

I do not know what this next year holds for me. Not professionally or personally. I do know that I am blessed. I know that I will forever be thankful for the changes of this past year, for the personal growth, for the opportunities to learn. I’m thankful for the people in my life who have blessed me beyond words, people who have loved me all of my life and people I have never met.

So, Happy Anniversary Raleigh! And from the bottom of my heart, thank you.

Words

I have never experienced such extreme frustration in all my life as I did this past winter.

A patient was admitted with a severe exacerbation of a chronic illness. She was young, very young.

I was on night shift that week. The patient was admitted during the day and I came in for my first shift that night. She did okay that first night. I was concerned about her, but there were other patients that were sicker and she was not my primary focus.

During the day on hospital day 2, she got worse. So when I came in that night I spent a lot of time with the patient and her family. I did my best to educate them regarding her chronic illness, but this was not an easy task. The patient and her family didn’t speak English. Unfortunately I am monolingual. The nurse had already had some communication issues with the family. There were also legal issues. The patient was living with a man, who we thought was her husband, but turned out to be her boyfriend, so legally he wasn’t the power of attorney and everything had to go through her brother. So the boyfriend couldn’t give consent, he couldn’t sign any papers, he couldn’t help us. The brother was very involved, but he worked and wasn’t a constant presence like the boyfriend.

Throughout the night she continued to get worse. In the early morning she began what we call “crumping”. I needed to explain a lot of very serious medical things to this patient quickly. I needed to place a central line, an arterial line, start her on some heavy medication, and I had very little time before it was going to be too late. The problem though, was that I needed consent. She was wide awake and I can’t do any of these things to her without permission. And I can’t get her permission because I can’t talk to her. Only the boyfriend was there and he can’t legally help me. We tried and miserably failed at using the interpreter phone (I loathe this machine!!).
Anger consumed me. This patient was going to die simply because I did not know the words to save her.

I spent an hour trying to converse with the patient and her boyfriend through that blasted blue phone. Finally, she was so sick that she became delirious and was now mentally incompetent to make a decision and I could do to her what I wanted. But by this time, it was almost too late. I called my Attending doctor for that week, and at 4:00 in the morning he came in to help me.

Not ten minutes after the arrival of my attending the patient coded. We had to emergently intubate her, place a central line, begin pressors, and pray to God it wasn’t too late. She had a little baby.

She stayed with us for over a month. During that time she coded 3 more times, ended up getting a trach, developed many infections, and just didn’t seem to be making the progress we wanted. She transferred to a larger hospital and stayed there for an additional 6 weeks.

I do not believe in miracles, but somehow, this patient beat the odds.

I’ve been on nights this week, so I slept all day. When I came in to work tonight they said she came back today to visit, to say thank you. They said she looked wonderful. She was strong and healthy. She said her baby just had a birthday. The attending doctor who came in that night was on today and he saw her. He said it was amazing. He said the moment he saw her he was sad that I wasn’t here. He said we saved her that night.

Tonight I again find myself without words. But tonight it is not anger that consumes me.

I'd like to take a moment...

One of my favorite books is written by Dr. Seuss. It’s one of his less popular books, but in my opinion, it’s one of his best. It’s called “Did I Ever Tell You How Lucky You Are?” If you haven’t read the book, I’ll loan you my copy, it’s definitely worth the read.

I suppose I’ve been somewhat overwhelmed lately. I don’t always handle stress and change well. I get easily frustrated when things aren’t just so-so. I want everything to be in its place and perfect and right. I’m grounded in structure, routine, consistency. So, despite the fact that I’ve spent the last 29 months in perfecting the art form of moving, it still upsets my balance.

And yet, amid the chaos, amid the turmoil, amid the commotion, there is one consistent presence. A presence so powerful that she can calm inner-emotional storms, so powerful that she can face obstacles that I turn away from, so powerful that a simple apartment can be transformed into my home in less than 12 hours.

I am faced with situations everyday that remind me how lucky I am. Even still, I grow complacent and take for granted the amazing blessings that I’ve been granted.

So, I’d like to take a moment and say that I am blessed beyond words to have Jackie Dodgen Sanders as my mother. From the day I was born until this moment and beyond, I have always been received with love and encouragement and compassion and joy. She has always been there for me and that alone is priceless. She has been a best friend, a confidant, a cheerleader, a champion, a mom.

So thank you.

Thank you for always loving me, always believing in me, always supporting me, always being proud of me, always listening to me and trying to understand me, always encouraging me, always championing my cause. Thank you for building me up and teaching me to be who I am today. Thank you for the life you created for me. Thank you for the warmth you create in the home you’ve always made. Thank you for the confidence you instilled in me. Thank you for the Godly example you’ve always been. Thank you for your strong work ethic, your giving spirit, and your selfless attitude. Thank you for being my mother.

Aim High

Ever since I was a small child I have been fascinated, entranced, and captivated by the military. I wanted to serve my country, do my part, be an American.

The older I became, the more paraphernalia I got in the mail: information packets, posters, postcards, t-shirts, key chains, bumper stickers. I kept a lot of that stuff, decorated parts of my room with it. There was one postcard in particular that seemed to stare at me every day. It was simple, it didn't say much, it was just two words: Aim High.

But as life occurred and choices were made, the military was not a part of them.

I went to college, graduate school, an internship, night school at a community college, and then back to graduate school. And with each degree I earned I continued to be haunted by thoughts of the military. I continued to get e-mails, postcards, and letters. I would travel to conferences for work (Los Angeles, St. Louis, and Honolulu), and the haunting would continue. I would see professional peers in uniform and find myself feeling envious and disappointed that it wasn't me.

A year ago I was talking at length with a recruiter. After much study and research of the different branches, the Air Force was most complimentary to me as a person and to my profession. I was very close to signing, to joining up, to being all I could be (except that's the Army). If I hadn't moved to Raleigh last summer, I was going to join the Air Force. So, why didn't I? It wasn't the right time. Various circumstances surrounding my enlistment, pay, rank, etc. weren't quite lining up. My lack of work experience combined with my advanced education made for difficult placement.

So I moved to Raleigh. I'm pursuing my goal. And despite all of that, the haunting continues. It reemerged while I was in Chicago a few weeks ago. While at the conference, I attended a lecture conducted by USAF Colonel Elizabeth Bridges (RN, PhD, CCNS, FCCM, FAAN) and it was absolutely amazing. The work the Air Force is doing in concert with our other military branches on the battlefield is truly outstanding. At the end of the 1 hour and 15 minute presentation I was ready to sign up, ready to go to the front line, ready to Aim High. I left the lecture and walked around in the expo and who did I run right into but Colonel Elizabeth Bridges. We talked. I told her how much I appreciated her service and her lecture and her work. I told her I had wanted to join and time and circumstance just hadn't worked out. She said it was the best decision she'd ever made. She said it with such certainty that I didn't question. I was in awe.

I came home from Chicago and thought about this recent haunt, but as the days turned to weeks and I reengaged in my own work, the haunting subsided. And then I got an e-mail from the Air Force saying they needed Health Care Providers; it was generated from CareerBuilder.com, but still. And then I became aware of a 19 year old man who was serving in Afghanistan. The exact account of the story is unknown to me. He was going to help a fellow soldier and misstepped. This misstep cost him both legs and an arm. They flew him to Germany and then finally to Texas, to the hospital I would be working at had I not come to Raleigh.

I've thought so much about that young man, that boy.

I do not discredit the work that I do. I do not belittle or minimize the importance it has or the families I interact with.

But I am still haunted to serve.

As the 4th of July, my favorite holiday, approaches, I have to ask myself, am I Aiming High?

Rodents

My friend Claire called last night. Claire's a nurse; we work together.

She was calling to see if I was watching the show “Hoarders”. I wasn’t, so I switched over to see the chaos. We both enjoy watching this show, but this particular episode topped all the episodes we had seen before. The man on the show had such a dirty house, that it was infested with rats. The rats lived in the walls of his house. The man knew the rats were there, he said, “they were his friends”. As they cleaned they found ~2000 rats living in his house. 2000 rats!!

Needless to say, we were shocked, horrified, and disgusted. But as with any car wreck, we couldn’t look away; after all, we are nurses.

Our disgust of the rats led us to discuss other topics associated with rodents. We talked about turtles. We talked about snakes. We talked about patients.

Every patient has a story. Every patient found themselves involved with a set of circumstances that resulted in their admission to the hospital. These stories are often intriguing, humorous, and shocking. Claire told me the story of a patient she’d taken care of when she worked at John Hopkins who had an exotic snake in her home and was bitten. It was a poisonous snake which led to a critical care admission to the ICU until the anti-venom could be administered. (http://articles.baltimoresun.com/2010-01-27/news/bal-snake0127_1_snake-antivenom-cobra)

Crazy times!

This made me think of another story I’d heard when I was at Vanderbilt. A nurse who worked in the SICU there told me the story. It was about a snake.

A couple she knew had a pet snake. They loved the snake. It was out in the house, not in a pen, not in a cage, not in an aquarium. In fact, the pet snake slept in their room with them at night. They loved the snake.

One day, they started worrying about the snake. The snake had stopped eating. They tried everything to get the snake to eat and nothing worked. Days turned to weeks, a few weeks turned into a couple months and finally the couple took their beloved snake to the vet. The vet evaluated the snake, assessed the snake, inspected the snake. To the relief of the couple the vet proclaimed that nothing was wrong with their snake.

“Then why”, asked the couple, “is our snake not eating?”

“Well”, said the vet, “your snake is fasting.”

“Fasting!” said the couple. “But why?”

And to the horror of the couple the vet replied, “your snake is fasting so that he can eat you.”

My Short Shift.

I'm laying in bed, Ruthie is softly snoring at my feet. I'm thinking about my day, my short shift at work and the events that occurred.
I now find myself in the position of the patient (minus the snoring dog): laying in the bed. I suppose it is a perspective I don't always think about.

My perspective is generally at the foot of the bed, looking down at the patient.

I stood at the foot of a patient's bed for a long time today. Had lots of conversations with the family.

They asked what the chances are. We him hawed around the question. I finally told them that they would probably die before the weekend was up. I hate that question. Who really knows? They thanked me for my honesty. It was just the facts.

The family talked. We talked with them. They talked with an additional service that was concurrently managing the patients care. The family talked again. And then the talking was all done.

They decided to withdraw.

I hate this term "withdraw". Generally we say we are going to "withdraw care", but this isn't true. If anything we heighten the level of care so that the patient will not suffer. What we withdraw is aggressive intervention, resuscitation, powerful medications; but not care.

We wrote the orders. Discontinued all the interventions. I called the respiratory therapist. We asked the family to briefly step out. The respiratory therapist pulled out the endotracheal tube. The patient coughed and sputtered and we cleaned them up. We made the patient look pretty. The family came back in. The spouse and child flanked the patient, each holding a hand. They kissed the loved one and said sweet words. We provided suctioning, morphine, ativan, and peace. The monitor was turned off. We do that so the family can concentrate on their loved one and not watch the monitor. We can watch the monitor in the hallway. The nurse kept me updated on the blood pressure and heart rate.

It was a typical death. Deep shallow breaths, a fast heart rate, low blood pressure. Then, the heart rate begins to fall and there are long periods of time between each breath. Then the heart stops and there is no more breathing.

I put my stethoscope on. I listened to the silent chest. I took my stethoscope off, nodded my head, and said the words the family had feared all day, "they're gone". There were tears, but they had peace. The patient had fought a long time and didn't want to suffer anymore. Now, there was no more suffering.

I don't know why I stand there, but I always do. The nurse in the room is more than capable of handling the situation without me. All the orders are written and she won't need anything more from me. And there are other things I could be doing. But I almost always stay and observe.

Maybe it's morbid of me to say, but there is something...... I don't know the word. I'm not sure of what the word is. But there is something in that moment when death occurs that is somewhat awing, so extremely surreal yet unmistakably absolute. There is a deafeningly quite peace that falls.

I suppose it is easier to watch death when I don't know the person, when I'm not the one suffering a loss.

So that was my day, my short shift in the unit. The one thing I accomplished today.

I don't know why I always talk and blog about death. Maybe it's simply the avenue I use to release the events of today so that I can encounter the events of tomorrow.