A Letter to my Patient

I know you don’t know me, how could you, we met while you were unconscious, so there’s not much to go on except for what I see and hear as I go in and out of your room. I catch bits and pieces of you from your family’s conversations, their obvious grief and concern over your well-being.   I am a complete stranger as far as your concerned, yet here I am caring for you in the most intimate way. Would you be embarrassed, annoyed…would you care at all? Can you hear me? Can you feel my touch?

Compassion

     As you lie there, I am like the ultimate puppeteer. Your tubes are my strings, and I carefully operate medicine, oxygen, and nutrition through the plastic lines running into your body all in a careful balance to bring you back to life. We spend twelve hours together, but you will never know me; even if you open your eyes, you will never remember me. I however, will always remember you. I take you home with me. I think about you in quiet moments. “Will you get better? Will you wake up?”

I have such a long list of things to do for you today. Your medication list is growing. You have an infection. Your lungs don’t look good. I must keep you asleep for another day to let you rest while your ventilator will continue to help you breathe. Your family is so nice.

I learned something about you today, and it made me laugh. Your friend stopped by. He was obviously distraught over your condition; he wanted to talk about you. I was so busy, but I stopped to listen to his stories. He told me you two were good friends, but that was obvious, then he told me you two smoked meat together. I was thinking “What??”   He said you had a smoke house, and liked to smoke meat. I laughed out loud. Not because I was making fun of you, but in all my years I don’t think I ever met anyone with a hobby of smoking meat. I was intrigued, and amused all at the same time. I’m glad I stopped to talk to your friend. He misses you in the smoke house. He’s a nice guy, which makes me think you must be too. Now I really want you wake up. Your family is nice, your friend is nice, you are surrounded by good people.

Deep down though I know you are probably too sick to wake up. Your infection is worse, and your body is dying. I’m losing control of the strings. I’m sad to see you go. You will never know me; you will never remember me…I will always remember you.

In Honor of Our Veterans

When I picture the image of a wounded soldier lying bleeding on a battlefield somewhere, I know close by a nurse is waiting in nervous anticipation to come to his aid.  I have always felt that nurses and soldiers go hand in hand throughout the history of war and peace.  They compliment each other in a relationship that cannot be defined.  I have never fought in a war, but I have spent time caring for our Veterans.  They are a unique bunch of people who I have had the privilege of meeting.

Of course it was our founding sister, Florence Nightingale, who rose to stardom through her bravery caring for the wounded of the Crimean war.  She set the stage for the war-time nurse, the lady with the light, going from soldier to soldier in the night caring for their wounds, reading them letters, or holding their hand as they passed from this world.  I know there were plenty of Florence Nightingales before the Crimean War, and plenty after, but it was she, who truly made the soldiers bedside nurse someone to be proud of.

Florence_Nightingale

Florence Nightingale Courtesy of Asli Kutluay aslikutluay.com

I don’t think there’s anyone braver than a U.S. soldier.  When this country goes to war, our men and women never falter.  Time and again we have watched so many go off to war, and only some return.  And even those that return are changed for life; whole on the outside, but somehow broken on the inside.  As it is a soldiers duty to go to war, and obey commands, it must be our duty as citizens to honor their sacrifice and their service.

I spent four years in the early 1990’s working for a big university hospital as a research coordinator.  During this time I was set up with an office in the Veterans Administration Hospital.  The majority of my work would be conducted there.  Upon entering the V.A. hospital I was greeted by security guards and asked to show my I.D., then I was shuffled through a subway turnstile type entrance into the main lobby.  Past that first checkpoint, as I made my way to the elevator banks, I remember so clearly seeing a man with no face, literally a hole where his face should have been.  I wasn’t sure how this person was able to get around, but quite clearly he was, I on the other hand was having some difficulty.

USAAF Flight Nurses in WWII. National Museum of the USAF

USAAF Flight Nurses in WWII. National Museum of the USAF

Russian nurse in a fox hole tending to a wounded soldier

Russian nurse in a fox hole tending to a wounded soldier

My office was on the fourth floor, but my clinic was in the basement, along with all the outpatient clinics that veterans attended; anything from gulf war syndrome to sexual dysfunction.  I felt like a fish out of water.  Not only did I know nothing about conducting research, I knew even less about working and caring for veterans.  As I slowly started to learn my way around this hospital with its rules and protocols, and constant stares, I also slowly started to learn my way around these men.  What I found was a cast of characters more colorful than any rainbow, but as solid as the colors on the flag.  I met men from just about every war, from WWII to Vietnam.  Some were demolitions experts, some were prisoners of war, others had lost their way and ended up in prison, or living in S.R.O.’s (Single Room Occupancy Housing).  But all had captured a piece of my heart.  And as the patient load grew, my best friend came to work with me and soon discovered for herself what a crazy, mixed up world the V.A. hospital was.

Even though we were probably too young for the responsibilities of a research job, we were not lacking in our responsibilities to care for and do anything for our Vets.  Kindness goes a long way, and that was one thing we could give unconditionally.

Like I said, nurses and soldiers go together both on and off the battlefield.  There’s a certain grit that comes off a Veteran, it’s something I trust and admire.  But then again it takes a certain grit to become a soldier in the first place.

So on this Veterans day this one nurse would like to thank all our soldiers who have sacrificed their time, their limbs, and their lives to support the freedoms that this country has provided for all of us!!

Thank You!!

Vietnam war memorial with nurse and wounded soldier.

Vietnam war memorial with nurse and wounded soldier.

The Syphilitic Whores of Georgian London

The Chirurgeon’s Apprentice is one of my favorite blogs to read. The stories are a walk down the dark path of medical history, disease, and archaic treatments…I particularly liked this post and thought you might too. If you have some extra time, check out this blog!

The Chirurgeon's Apprentice

harrisPeople think I’m obsessed with syphilis, and maybe I am. But it’s only because of my recent indoctrination into 18th-century history by aficionados of the period, such as Lucy Inglis, Adrian Teal and Rob Lucas.  I can’t read 10 pages of a medical casebook without coming across a reference to lues venerea. By the end of the century, London was literally crawling with the pox.

And it’s no surprise. Sexual promiscuity was as much a part of Georgian England as were powdered wigs and opium. For a few pennies, a gentleman could pick up Harris’s List of Covent Garden Ladies, or Man of Pleasure’s Kalendar—a pocket guide to London’s prostitutes published annually starting in 1771—and peruse it as he might do a fine wine list.

For three guineas, a man could partake in the pleasures provided by Miss L—st—r at No. 6 Union Street…

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The Sundowner: A Monster of the Aged

SunsetThere comes a time in the day when the sun begins to set, and the dark shadow of dusk creeps along the walls of all hospital rooms.  This is a capricious time that has some nurses counting on one hand the number of hours left in their twelve hour day, and other nurses crunching egg shells under their well worn clogs knowing those last few hours might be the longest of their shift.

Growing up I faced a cast of classic characters that ruled the night.  My demons included such greats as Dracula and The Wolf Man, Dr. Jekyll and Mr. Hyde, Frankenstein, and The Creature from the Black Lagoon.  In my teens I was haunted by the likes of Jason and Freddie, Micheal Meyers, and The Exorcist.  When I made the choice to go into nursing I didn’t realize that I would be facing other people’s demons as well.

Last Thursday started off like any other day.  With coffee in hand I headed to the nurses’ station, signed in, got my assignment, and took report on my patients.  As I’m getting report from the night nurse it’s clear she is exhausted, frustrated, and by all accounts finished.  I’d call it at least a two drink morning.  Her patient (soon to be my patient) wreaked havoc all night long, and it was obvious her patience was worn and tattered.   An 87 year old woman had broken her over the course of her 12 hour shift.  My patience however was fresh and new, and so I began my day upbeat, and optimistic.

Why so optimistic?  I had the sun on my side; nature’s way of soothing dark forces.  It wasn’t long before the cries of the night Banshee settled, and I could go about my day unencumbered…for awhile.

The Calm before the storm

The Calm before the storm

That “while” lasted until the sun began to set.  With the quickness of Dr. Jekyll’s potion, my quiet, frail, elderly patient began to morph into what I can only describe as a possessed soul.  Her paranoid eyes stared at me with the “I know what you’re up to” look, as I’ve seen this look many, many times before.  It is the stare of The Sundowner.   This phenomenon associated with the approach of night robs the elderly of their wit, and replaces it with paranoia, aggression, obscene behavior, and super human strength.

I couldn’t help but feel like a character in a movie, removed, and yet present at the same time.  I know this lady believed I was out to get to her, any convincing to the contrary only made me all the more guilty.  Her screams could be heard up and down the hallway as she shouted, “HELP…POLICE…HELP!!”

Damn you daylight savings time!

I was trying to help. I kept reminding her of the time, and place she was in.  I had her speak with her husband over the phone but nothing I tried was working.   Then out of nowhere SLAM and it was me screaming “Ow!!”  She launched her hospital telephone at me while my back was turned and it slammed into my shoulder with such force.  Several minutes ago this woman didn’t have the strength to roll on her side, and now she’s got the arm of Mariano Rivera, and it’s strike one for her!

I look at the clock.   It’s only 5:30p.m.  I need reinforcements, so I send out my own cry for help.  But it’s busy; it’s the ICU.  Reinforcements are slow to arrive.  I speak with the doctor, who orders a pill to try and calm her down…a pill?  This woman is spinning her head like the exorcist and he thinks I’m going to accomplish anything with a pill!

So like Nurse Ratched I approach with a calm, kind demeanor, offering her her dinner tray to eat, and hoping I might sneak in that pill, but she knows, she clearly knows I’m up to no good.  She looks at me with disgust, chuckles like the devil himself, then turns her head away.  “You’re a pig, you’re nothing but a filthy pig…get out of here.”  The words come out deep and low sounding.  Each syllable articulated so I wouldn’t miss a thing.  She is completely mad.

Heeeere's Johnny!!

Heeeere’s Johnny!!

She has beaten me at my own game, but I leave the tray of food as a peace offering and I move on to the other side of her bed. Out of the corner of my eye I see her reach over for her tray and with the spryness of a child propel it to the floor.  I’m running in slow motion to stop what I cannot get to fast enough and SLAM, food and broken glass explode over the floor leaving splatter debris clinging to my uniform…strike two!

When the Dr. finally arrives, his hubris preceding him, he asks me for the pill.  I point to the unopened package on the bedside table and he asks for assistance:  spoon…yes doctor…applesauce…yes doctor…crushed pill…yes doctor; he guides the spoon in for the final approach…BAM, the spoon goes flying and now she’s got Dr. Smarty-pants by his lapels, tears the glasses off his face and mangles the frames, strike three!

It’s at this point that Dr. Smarty-pants ups the ante and orders an antidote to Dr. Jekyll’s potion.  I dutifully administer the cocktail into her I.V.  It only takes a minute; she’s not quite the lobotomized McMurphy, but she winds down like the slow moving toy whose batteries are near the end.

Time for Nighty Night...

Time for Nighty Night…

It’s at this moment, when the chaos has quelled and everyone is pulling themselves back together that I can look upon this elderly woman and reflect on how such a sinister invader had taken over her body.

Why?

Why does this have to happen to people, and how can it take someone so frail and turn them into The Hulk?

Unfortunately it is still unknown what causes Sundowning to occur.  It is connected with people who may have dementia or Alzheimer’s.  It is also believed to be caused by a change in the brains circadian rhythm, a bundle of nerves that keeps the body on a 24 hour clock.  Whatever the reason, it is one of the more challenging and heartbreaking aspects of my job.

My heart breaks for these people.

My heart breaks for these people.

When 7p.m. rolled around I couldn’t wait to get out of there.  I too was now tattered and torn.  My night shift coworker greeted me with a warm smile and the same look of optimism that I had so foolishly worn 12 hours ago…

I think it’s going to be a three drink night!

I think that's me.

I think that’s me.

Dying Alone

River Running

Photo by Earnest B

Photo by Earnest B

Black water flows,
Circling in doomed
tide pools;
Awaiting the inevitable,
An unknown stream of unconsciousness.
River running fast but leading nowhere,

I wait.

Black water flows carrying the tail ends
Of life.
Air above swirls through forced motion

I wait.

Decisions being made
Without action to follow.
Life and death swirl in dark water

And still I wait.

Life beats fast before
Closing its chambers.
Red rivers flow
Until merging with black water.
Time stands still momentarily;

I wait
I watch
I listen

Then it’s gone in one moment;
The tide pools quell
Waiting mysteriously with hidden messages.
Black water flows on
I’m finished waiting
It’s time to go home.

I wrote this poem over ten years ago while working the night shift in NYC.  My patient was dying from complications of Human Immunodeficiency Virus (HIV). I knew nothing about this woman except that she was a prostitute at some point in her life, contracted HIV, was on a ventilator, near death, and all alone.

When I walk into a patient’s room, I don’t always have the luxury of caring for a person who can walk or talk.  I may need to wear a mask to ward off Tuberculosis (TB), or gloves to protect myself from infected blood containing deadly organisms.

When I walk into a patient’s room I check my hang-ups at the door.  I’m there for one reason, and for one reason only…to take care of the person in the bed in front of me to the best of my ability.

I don’t care how you got there, what you did in your life, if you’re a prisoner or a prostitute, I do care; however, how I’m going to make a difference in the twelve hours I’m assigned to your care.

I think the saddest thing I’ve encountered over my twenty-five years of nursing is when I’m caring for a dying patient who’s dying alone.  Not all of us are fortunate enough to have an entourage holding vigil around the deathbed.  Some of us go quietly, slipping out before anyone notices we’re even gone.

It’s heartbreaking to watch a fellow human being die alone.  I try to be present when I can sitting quietly at the bedside to bid them farewell on to their next journey.

They say we come into this world alone, so leaving should be no different, but I beg to differ.  I know this is my personal belief and may not be shared by others, but holding the hand of a lonely soul as they take their final breath is the least I can do as their nurse, but more importantly is the least I can do as their fellow human being.

holding hands

Night Shift

List of common nocturnal animals:  Skunk, Badger, Raccoon, Bat, Owl, Cat, Beaver, and Nurse.

Night Nurse Vol 4 Marvel Comics

Night Nurse Vol 4 Marvel Comics

It’s true, I’ve made the list.  I’m officially a part time nocturnal creature.  I stalk the night, creeping quietly along dim lit corridors, treading lightly on wooden clogs.  My ears are alert to the sounds of my watch, my pupils the size of a Philippine Tarsiers, my blood coagulated with over brewed caffeine; these are the physical changes which signal my evolutionary adaptation that, like my fellow nocturnal brethren, give me advantages to nighttime survival.

Philippine Tarsier

Philippine Tarsier

It is not truly human to be nocturnal.  We are not born this way.  The fossil record will no doubt show how the night nurse evolved in order to circumnavigate her intrinsic circadian rhythm, and flip the switch on Mother Nature herself.

Like the grey wolf, we nurses of the night shift travel in packs; each pack leery of the other.  I belong to the ICU pack.  We’re a bit of a rough bunch, but you have to be in order to survive.  Getting through a twelve hour night shift requires certain skills not for the weak.  Our pack is smaller than the day shift, so we have to learn to do more with less, it breeds cohesiveness.

One key to survival is our food supply.  Dinner is important, but a steady supply of sugar is imperative.   4 a.m. is my breaking point.  If I don’t have a cookie and cup of coffee then there’s a good chance I might tear someone’s head off, or fall asleep at the nurses’ station.

Our risks are great working the night shift:  obesity, breast cancer, motor vehicle accidents, and excessive bitchiness.  Why?  Because we’re too fucking tired, (except for the breast cancer; I’m not quite sure what that’s all about…yet.)  Maybe our breasts are also too fucking tired, I know mine seem a little droopy by the time I get home in the morning.

Despite these risks, I carry on, skulking through the night, poking and prodding at my critically ill patients; if I’m going to have to be awake all night then so are they.

This my friends is why your loved ones are sleeping all day.

We wake their asses up every two hours to turn them, every four hours to get a temperature, every hour to check their vital signs, every two hours to check their neurological status, then there’s the pain check, pee check, poop check, skin checks, tube checks, breathing checks, and just when they look comfortable I’ll check that too.  Talk about iatrogenically induced ICU psychosis.

This is the night shift, and all for an extra $3.00/hour.  Well maybe all that extra money will help pay for my breast cancer treatments in the future.

So take care when you see us out in the daylight, like a rabid animal, you want to approach with caution.  Our cars may weave and stagger, there may be a little bit of foaming at the mouth, and a general sense of confusion on our faces.  Let us pass quietly by as we crawl into our dark dens, shutting out the light with thick paneled, black out curtains, and eye masks that read ‘do not disturb’ (and we mean it…don’t!).

When light fades to dark and the moon rises with the glowing light of a halo, it will be time for us to emerge once more, vitamin D in hand, we return to our nocturnal family where we begin yet again …the night shift!

Photo by Donna Andrews Managing Director/Bear Curator North American Bear Center

Photo by Donna Andrews Managing Director/Bear Curator North American Bear Center

 

Suicide…Nurses Who Take Their Own Lives

photo by Jean James

photo by Jean James

What drives a nurse to commit suicide?  In most cases the answer is simple; she or he has made a mistake, and usually that mistake has cost someone else their life or limb.  So why then did Jacintha Saldanha, the nurse responsible for transferring a hoax phone call to the Duchess of Cambridge’s nurse take her own life?  I’m not sure the answer is so simple here.

Jacintha Saldanha violated the British Department of Health‘s confidentiality code of disclosing information with appropriate care when she passed on an unconfirmed phone call made by two Australian D.J.’s posing as Queen Elizabeth and Prince Charles of England.  The D.J.’s, who were looking to solicit private information about the Duchess of Cambridge, decided to play a prank by placing a phony phone call to King Edward VII Hospital.  While impersonating the Queen of England and the Prince of Wales, they were easily able to deceive Nurse Saldanha into transferring them to Kate Middleton’s primary nurse, who then went on to divulge extremely sensitive medical information about the Duchess’ hyperemesis gravidarum while live on the radio.

Like all nurses who realize they made a mistake, I have no doubt Jacintha was filled with shame and embarrassment for the public spectacle that ensued after that phone call.  But was it worth taking her life?  Is any mistake worth taking your life?

The medical profession has one of the highest suicide rates.  The pressure to ‘Do no harm’ sits heavy on the shoulders of all who take that oath.  But what comes after ‘if harm is done’?  How do we counsel the person who may have made the mistake?  I know in America the answer is always the same, “You better get yourself a good lawyer!”  Then you’re dropped off at the edge of a steep cliff and left to fend for yourself.  Nurse Saldanha must have been dangling  precariously off the edge of that cliff.

According to news reports she did not share her mistake with her husband or two children.  I can only imagine the torture she put herself through.  You see, as a nurse, you don’t need to kill someone, or maim them, to feel you have done harm.  I’m guessing Nurse Saldanha felt betraying the Duchess’ privacy was harm enough.  Nurses are their own worst enemies  first.  What punitive damages come later could never possibly equate.

When a nurse or medical professional makes a mistake, immediate counseling and crisis intervention should be provided.  Nurses should not have to bury themselves in grief, fear, and shame.  No one wants to make a mistake.  Nurses work hard, are given heavy assignments, work long hours, are understaffed, expected to stay late, skip lunch, and rarely make it to the bathroom, all for the sake of caring for their patients.  We cater to abusive family members at times, abusive medical staff at times, abusive administrators at times and even abusive patients, and all the while we are expected to keep a smile on our face, and behave like ‘good girls’.

My heart breaks for Nurse Saldanha and her family.  Though I don’t know her professionally or personally, the reports I have read shed light on the kind of exemplary nurse, wife, mother and human being she was.  I’m saddened that her mistake and the insurmountable pressure that followed led her to take her own life.

Prime Minister David Cameron was quoted as saying, “There will be many lessons that need to be learned.”  This is true, but the one main lesson that needs to be learned is what drives a nurse to commit suicide, and how can we prevent this from ever happening again?