A Thanksgiving Memory

This is my favorite Thanksgiving Memory.  I post it every Thanksgiving to remind me of how truly thankful I am for all the wonderful people in my life!!

Vintage Thanksgiving Postcard

Vintage Thanksgiving Postcard

Dear Nursing Administrator,

Today I witnessed an act, which for the first time, made me grateful to have worked Thanksgiving Day.  Before I explain, you need to understand a little background.

For the past month or so we have been caring for a nineteen year old-young man in room 419, who is slowly dying from lymphoma.  Over this past month I have never looked after, nor been involved in this patient’s care.  In fact, I didn’t even really pay attention.  Why?  I’m not sure.  As charge nurse I was up to date on his name, age, room number and diagnosis.  I knew his mom was a nurse and his father was a New York City Police Officer.  I knew that one or both parents never left his bedside.  I knew I found it extremely uncomfortable to participate in his case, what I didn’t know was why; I’m still not completely sure.  Maybe it was his age, maybe it was because his parents were always there, maybe it was because I identified with this family on some level and steeled myself from getting involved.  My apathy, or perhaps cowardice, found it helpful that their room was at the very end of our unit, so far removed from the nurse’s station, that their daily story played out on what seemed a far away stage.

Our unit is a twenty bed Cardiac Care Unit (CCU), not a hospice ward.  I’m used to dealing with critically ill, older patients in cardiac distress.  Even when those patient’s are terminally ill, I somehow rise to the occasion to support their crumbling family.  But this boy, what was he doing here?  What did I know of caring for a nineteen year old?  Apparently there are cardiac complications that come from bone marrow transplants which led this boy to our unit, and subsequently into our lives.

So while my head was buried in the sand for the past month, there were several amazing nurses consistently caring for this patient.  But today, Thanksgiving Day, I would soon come to find out just what I had been hiding from, because today I was assigned to care for this boy.

What had I been hiding from?  His family was lovely; two devoted parents sitting vigil in their hopes and tears.  His nurse mother was someone I could have easily seen myself working side by side with, and his NYPD dad, well, I must confess was a reminder of my own NYPD dad.  But this boy of nineteen was so ill.  His body reflected the disease that had stolen his youth and replaced it with the frame of an old man’s.  Swaddled in blankets to fend off the cold, his face was the only piece of flesh I could see; though his eyes were pale and hollowed, a spark, still dimly lit, reflected back, and a smile slow danced across his lips from time to time.

Room 419 was where this family would spend their last Thanksgiving together.  No fancy table, no turkey, nothing to remind them of the holiday unfolding on most American tables that day.  No, this room was the exact opposite.  The only reminder of the outside world I could gather was the pile of soda cans collecting on the window sill.

Then lunchtime arrived, and with it came Emma, one of our nurses, (off duty that day), with a large bag in her arms, and a six-pack of soda in her hand, heading for room 419.  As I went to greet her with a confused expression on my face, and a ,”What are you doing here on your day off?”  She told me she was here to bring 419’s family Thanksgiving dinner before she was due to catch a train to her own Thanksgiving dinner.  You see, while I was flying under the radar where this family was concerned, Emma was flying high; high on her morals, her faith, and her uncompromising dedication of what it means to be a nurse.  There was no way she could sit down for her own Thanksgiving meal, without first and foremost providing one for this family she had grown so close to.  What a special moment to witness.

Thanksgiving is such an American holiday.  We all take pride in our heritage, our sophisticated menu’s, our high-end wine lists, alternately, we take such a twisted approach on sharing a meal with family we might not want to be sitting next to.

Ironically, Emma is not at all American, she is Filipino.  But somehow, she, more than any American I know was able to take this holiday, and provide one family with the gift of thanks, when they probably felt too weak to feel anything but the life of their core slipping away.  I know this family was truly thankful for this one gift, this one meal, that this one very special nurse provided for them on what would be their last Thanksgiving as a complete family.

Vintage Thanksgiving Poem

I was thankful to have had the opportunity to witness grace in action.Several days later the boy in room 419 was granted his wish to go home to die.  His parents complied, and forty-five minutes after being laid to rest in his own bed, that nineteen year old boy died on his own terms, in his own way.

I will never forget this Thanksgiving as long as I live.  I am nominating Emma for the highest award we give to nurses in our hospital; The Daisy Award.  I’m sure every Thanksgiving I will be reminded of this family and be truly grateful for all the wonderful people in my own life.

Sincerely,

Jean

I wrote that letter over ten years ago, and I have never forgotten the family from room 419, or the nurse who made their last days bearable.  They make me thankful every year for the life I have, and the family I live it with.

Since that time I have become a mother myself.  Losing a child, any age, is unfathomable to me; it was my understanding he was their only son.

So on this Thanksgiving Day, don’t sweat the small stuff.  Who cares if the Turkey’s a little dry, or the company’s a little wet.  Be thankful to be together with your family and friends.

I know I’ll be!

Happy Thanksgiving Everyone!!

thanksgiving vintage postcard

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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

When the Nurse Becomes the Patient

Old Worm by Jean James

I work in the medical field, so I’m quite used to embarrassing things happening to other people.  I’m the first person to reassure my patient who just shit on the floor, “Don’t worry about it, it happens all the time.”  Anything to make someone feel better.  But what do you do when you’re the one with the embarrassing problem?

Three months after the birth of my second child I went to the bathroom one morning, and though I didn’t shit on my floor, I did have something very wrong with what came out of me that day.

Because I’m a nurse I have a tendency to examine the things that come out of my body.  Don’t get me wrong, I’m not holding a magnifying glass or collecting samples, but a quick peek just to make sure everything appears normal.

This particular day was really no different, a quick glance, followed by a second look, followed by a horrified stare, until it sunk in what I was looking at, or more clearly what was looking back at me…

“O.M.F.G., there’s an f’ing worm in my shit!”  As my brain was trying to wrap itself around what my eyes were trying to deny, I could feel the panic creeping up my chest.  The idea that a living creature just made its way out of my ass was more than I could digest.  And as I began to accept that this indeed was real, my next thought immediately raced to the question, “Are there more?”

I needed help.  I was sure this didn’t qualify for a 911 call, so I had no other choice than to call for my husband.  My husband is not a medical person, he’s not comfortable with excrement, vomit, or any other abnormal bodily fluid.  So believe me when I say calling him for help was truly my last resort.

Hmmm how do I put this, “Honey, there’s a worm in my shit”

His reply, “What!!? Are you sure?  How do you know it’s really a worm?”

Me, “Just look for yourself.  It’s a goddamn worm!  I know what a worm looks like and that’s a worm…in my shit!”

Him, “Well how’d it get there?”

Me, “I don’t f’in know!  How does any worm get in your shit!?  This is kinda of new territory for me.”

Him, “What are you gonna do?”

Me, “Jesus Christ!  Go get me a Tupperware. I’m gonna scoop it up, call the doctor and bring it in for testing.”

Him, “You’re gonna scoop up your own shit?”

Me, “Yes, I’m gonna scoop up my own shit!  How else am I going to prove a worm just came out of my ass?”

So the nurse in me kicked on and I collected my own stool sample, worm and all, and called the doctor’s office demanding to be seen immediately, which wasn’t a problem when I explained why.

Since I work in a small hospital, I know the doctors fairly well.  It’s rather incestuous how we nurses use our doctors as our personal physicians.  Normally I’m not bothered by this.  When I had my children I wasn’t the slightest bit embarrassed or uncomfortable carrying on a normal conversation while my doctor was up to his eyeballs in my cervix.

But like the rest of the animal kingdom, I tend to be a bit shy when it comes to number 2.  So carrying my own cup of shit with a worm sticking out of it to my primary care doctor/co-worker was nothing shy of mortifying.  Could either of us ever look at each other the same?

When it came time for me to see her, it was kind of like talking to my husband all over again.

Her, “So, what’s going on?”

Me, “I passed a worm in my stool.”

Her, “How do you know it’s a worm?”

Me thinking “Is she f’ing kidding me.  I wouldn’t be here if I wasn’t sure.”

Politely I opened my brown bag and pulled out my Tupperware o’shit and showed her the forensic evidence that was my worm.  The look on her face was priceless; controlled horror, followed by the ever professional, “…hmm…wow…yup that definitely looks like a worm.”  And just for good measure she called in her nurse for a second opinion, as I shrunk lower in my pool of embarrassment.

Knowing she was way over her head, my doctor decided to send me to the Gastroenterologist (a.k.a. the ‘ass man’), as we were lacking a Helmintholgist at our small community hospital.

I vaguely knew who this G.I. doctor was; I hadn’t had a lot of dealings with him.  And after meeting him I realized his personality suited his profession.  Unfortunately for me, he was the only available G.I. doc at that moment.  He carefully examined the contents of my little Tupperware surprise and concluded there was a worm in my stool.  Well, thank you very much Captain Obvious!  Now that we were all in agreement that my worm existed, I more importantly wanted to know how it got there and if I had to worry about any more surprises on my next trip to the bathroom.

I had already done an internet search (because that’s the kind of crazy person I am) prior to coming to the doctor.  I learned more about parasitic worms that I ever wanted to know.  Their life cycle is so gross I’m not sure I can even tell you…okay I will, but I’m giving out one of those warnings:

This might be disturbing to children and people with weak stomachs, and everyone else in between.

In order to get a worm, you must first ingest something contaminated with fecal material (Ewww).  The eggs of the worm hatch in your stomach and migrate into the circulation, which then carries them to the lungs!  The larvae mature in the lungs then climb their way out into the throat where they are swallowed into the stomach, and make their way into the intestines where they develop into adults.  The adult worm can live 1-2 years feeding off of partially digested food.  I’m so going to puke just writing this.  Okay, so when I learned all this I counted back 1-2 years to try to figure out where the hell I was, and to my horror discovered I was in Mexico…on my honeymoon!  Feeling more like an investigator for the C.D.C. (Center for Disease Control) than a nurse, I relayed this information to Dr. Lackluster.

In return, he stoically tells me my worm must go to the lab for positive identification, and only then will we know for sure.  He remarks that parasitic worms are quiet common throughout the world.  Then he drops his bombshell theory as to how this particular worm came to find a home in my intestines.  He said I most likely got this worm from eating dirt as a child…DIRT!!!  So I quickly do the math in my head.  Kids eat dirt around the age of 2, I was 35-year-old at the time, so I just shit a 33-year-old worm.  Holy crap, no wonder that worm had a beard and a cane.  It didn’t come out on its own, if fell out, a victim of worm cardiac arrest.  Was this doctor sniffing too much methane gas?  It’s no wonder this doctor chose to be in a profession surrounded by assholes.

My mouth opened, then closed, then opened, then closed again.  My husband let out a chuckle, (like there was actually something funny going on) until I gave him that look that said, “Laugh again and I’m gonna shove my worm up your ass!”

I left there humiliated with my antiworm prescription and told to leave my specimen with his nurse.

Horrified, humiliated, and embarrassed, I handed over my worm to yet another set of eyes, and it was then that I felt a gentle hand touch my shoulder and a kind voice saying, “Don’t worry about it.  It happened to me once too.  Now every time my ass itches I think it’s a worm trying to get out.”  For the first time all day I laughed so hard, and felt so relieved to know I wasn’t the only one.  Thank God for that nurse,  I could’ve kissed her!

I’m happy to say I’ve been worm free ever since.  I’ ve learned a valuable lesson and am now very careful not to travel to third world countries…and have eliminated all dirt from my diet.

The Patriarch

Before I even knew what the word feminist was, I was pretty sure I met all the criteria.  I grew up in a patriarchal house, that was immersed in testosterone, having five brothers.  I watched my mom do everything for my dad, and somewhere along the way I found that role uncomfortable.  My mom would never consider doing anything without my dad, and I felt women should be way more independent.  So you can imagine my shock when the one piece of advice I clearly remember getting from my dad was ‘to make sure I went to school and got a career before I got married.’

So what career choice do I go and make with his savvy piece of advice?  Nursing!  A seemingly subservient profession.  I substituted one patriarchal life for another.

This was so apparent to me when I was in nurses training for my L.P.N.  I had two old school nurse instructors who were strict and smart, supportive and tough.  The first time they took us to the hospital for our clinical rotation, I remember the gentler of the two teachers looking panic-stricken in my direction, as she charged towards me, shoved me out of the chair I was sitting in, ripped the chart out of my hand that I was perusing, and practically curtsied to the doctor who was looking for it while offering him my chair!!

Why was it more important for him to have that chair than me?  Whatever happened to ladies first?  I made a mental promise to myself that would be the last chair I would ever give up (as long as my teachers weren’t looking.)

Over the past twenty-three years I’ve managed to keep that promise for the most part.  I have met some amazing doctors over the years (mostly young) who don’t expect me to get up, but there are still those old dinosaurs who walk into the nurses station, give that authoritative look, and expect us all to jump up and say, “Yes doctor, what do you need doctor, can I suck your dick doctor?”  When they realize none of the above are ever going to happen, a dark shadow passes over their face as they long for the days gone by.

As a nurse I’ve come to a place where I’m comfortable in my own skin, never afraid to speak my mind and still never willing to give up my chair, but as a married woman with three children I find my mothers reflection hauntingly looking back at me in the mirror.  My list of domestic chores is enough to give my inner Gloria Steinem a twitch.

I continue to have my estrogen to testosterone ratio outnumbered in my current family, but unlike my mom I do get out without my husband once in a while.  I often think of the advice my dad gave me so long ago, and appreciate the career choice I made because it’s given me the flexibility to be with my children and be in the workplace at the same time.  I plan on passing this advice to my one and only daughter and hope her future battles with testosterone are played out on a more even playing field than mine were.

Dead Bodies

Night Nurse Warner Brothers

Night Nurse Warner Brothers

I don’t think you can ever prepare someone for the sight of a real dead body.  I say real because the kind of dead body you see at a funeral home, with all the makeup, hair, jewelry, and fancy clothing looks nothing like a freshly dead corpse.

So, when I encountered my first dead body, I realized that not even nursing school had prepared me.  All that C.P.R. (Cardiopulmonary Resuscitation) training on a healthy looking dummy became a foggy memory when I was called to the bedside of my first dead patient.

She was a lovely  woman who had undergone hip surgery earlier that day. Other than a little indigestion, she had no complaints.  I set her up for dinner thinking that would help soothe her stomach, then went to the nurses station to chart.  Sometime later, her grandchildren came to the desk to tell me their grandmother ‘didn’t look right’, and could I come down and check on her.

Obviously they too had never seen a real dead body.

I walked down the hall to the last room on the right, entered, and to my horror I realized indeed, she was dead!  I panicked.  I ran out of the room, and back up the hall to find the R.N. I was working with (I was an L.P.N. at the time and less senior.  I was also seventeen years old, and just out of school.)  When I finally found her, the R.N. refused to leave her patient to come and help me.

“What the fuck?!!”

I ran to the next hallway, saw another R.N. I was friends with, grabbed her by the hand and said, “Run!” Hand in hand we ran back to the room, confirmed the patient was dead and called a code blue.  Unfortunately my patient died, and I went home and cried myself to sleep that night.

Many years have passed, and I’ve since become an old hand with dead bodies; I’m more shocked looking at dolled up cadavers in caskets, than bodies of the terminally ill.  But at some point in life we will all have to come face to face with a dead body and nothing can really prepare us for that moment.

We just have to experience that for ourselves.