Veteran's Day

Last week I had a patient who was in the air force and was deployed to Vietnam during the war. He couldn't sleep that night in the hospital so we sat and talked for hours about life and the military and his experience overseas. He told me a story of a day when he wasn't feeling well and had to skip on a mission with the six guys he had been with the entire time he was in Vietnam. He was older when he went into the war and so he kind of took these guys under his wings over there. He loved 'em like family he said and when he woke up the next morning he discovered that the plane had crashed and every single one of them had been killed. To this day he wakes up with nightmares or dreams about them and he told me that every day he lives with guilt for not being with them on that plane. 

Today, I met up with a girl I happened to meet on a "what to expect" forum where expectant moms meet up online to share due dates and pregnancy joys and woes along this crazy journey. She happened to mention that she lived in my town and had just moved here cause her husband was stationed here with the navy for the next few years. We exchanged info and we had coffee today and walked around downtown. Her husband is currently gone for six weeks and she told me about all the moves they've had to make and the times he was gone for six months twice. How she is away from family and the support system she had built in their last base. I can't imagine. Sometimes we forget that the families of our soldiers have sacrificed so much too.

Life at the VA has been hard for me these past few years and I've actually been on the hunt for another job. Deciding whether I should leave or not has kept me up at night and has been the source of so much stress for me lately. I'm under appreciated and under paid where I work... my job is always exhausting and hard. The moments where I feel like I actually get to connect with these guys is rare and if I am really honest I feel like a lot of the work I do in the ICU is futile... often times these guys wait so long to get help that the chances of getting better are truly bleak. It's disheartening to say the least. 

Still, there is this place deep in me that continues to tug at my heart strings. I was telling my FIL yesterday about a new job opportunity and asking for advice on what to do. When I was explaining to him why I had always loved the VA I felt that familiar lump in my throat start to well up. What our soldiers do is incredibly difficult and what we offer is so very special. A place to be understood. A place where you can share about your time in Vietnam... and an ear to listen from someone who really knows just how PTSD impacts the lives of our service men and women. Some of these guys (and gals) haven't shared some of these stories with their own family even... and yet here I am at 2am hearing the heart of a man so burdened with guilt and sorrow over the loss he experienced decades ago. It is special indeed and I feel so very honored to be the recipient of that kind of trust... and a vessel for healing not only physically but emotionally too. 

I don't know where I will end up in the future but for now I want to thank you. Those of you who have given so much of yourself and the families who have sacrificed just the same. Thank you for being brave for us. Thank you for your sacrifice. Thank you for giving me the opportunity to serve you. If you know a veteran please thank them today... or tomorrow... or the day after that. Their sacrifice never really ends and I hope that our thanks never does as well. 

Happy Veteran's Day

Stay

The other day my friend sent me a link to one of the best nursing related posts I have read in a while... "Just a Nurse" written by Kateri. It is a concept I know all too well. I am often compared to physicians and nursing is ranked below the practice of medicine too often. The tasks I do on a daily basis are drastically misunderstood by the average person. I think if any one of my friends or family were to shadow me on a typical day in the ICU they would be shocked and amazed to see just what my job entailed.

I don't just pass out medicine and give bed baths... I help maintain the hemodynamic status of my patients. I take care of patients who are on multiple vasoactive drips, ventilators and highly complex machines to keep their heart, kidneys, and lungs functioning properly. I collaborate with the physicians and surgeons of all services and I have a valued opinion in the healthcare team and knowledgeable input into the lives of my patients. There are even times when I am the one teaching residents about the management of ICU patients. It's a shame that the few nursing roles people identify with are the ones on shows like Grey's Anatomy and such... and more importantly the roles for physicians on those shows are grossly exaggerated. Not saying that physicians aren't obviously vital members of the health care field but lets get real... most doctors I know aren't in the room long enough to learn how to operate the IV pump. (In my unit they aren't even allowed to touch our IV pumps!) Nurses are the ones at the bedside minute by minute.

I have been the last comforting voice to numerous patients... the last person they see as they transition out of this life. I have held so many hands through panic attacks and given CPR to coding patients who were on the brink of death. I have come home with blood and vomit and urine on my clothes. I have been kicked, hit, spit on, pinched and cussed at too many times to count. I have been apologized to for those same things but not often enough. I have had some wonderful conversations about life in the military and life on the war front. History through the eyes of a veteran is an interesting, inspiring, and heartbreaking thing to see.

I have sat through slow shifts and had the opportunity to connect with my patients on a much deeper level than just their health. I have connected with the daughter of an alcoholic who had to grow up way too fast. A man who lost his entire family to freak accidents and murders. I have had insane shifts where I was so over it at the end that I went home and had wine for breakfast.  I have been angry, frustrated, and am always exhausted at the end of the day.

I have had more than one friend and family member ask me why I stay. Why do I stay in such a difficult profession? Why do I stay in a hospital that pays the lowest salary in the area? Why do I stay in a hospital that has patients who suffer from PTSD and are combative and sometimes ungrateful.

Before I became a nurse I was planning on being a missionary in the middle east... specifically Afghanistan. Other than my family... everyone I knew thought it was incredibly noble and special. A calling so particular that despite the dangers and the difficulties of the task... it was a risk that was worth the sacrifice. A sacrifice that could have cost me my life.

But because I get paid to be a nurse I guess there is this sense that the sacrifice should not be so great? I consider this job my calling and in particular right now I consider veteran's to be the people I need to serve. I just wish people understood that just because my job is incredibly hard... doesn't mean I shouldn't be doing it. Cause seriously... if not me than who? If every singe nurse left because it was too hard or the sacrifice was too great we wouldn't have any left. Well... we might have the ones who only care about the paycheck left but what good does that do? No one really wins. This is why I chose to be a nurse and not a doctor or a missionary.

As a nurse I have this unique window into the lives of people who are incredibly vulnerable. I not only get to help save their lives by doing my job but I also get to be their comforter, healer, teacher, cheerleader, helper, advocate and voice. I love my job despite its constant sacrifice. The rewards are not always obvious but they are always great. And honestly... if you had a loved one in the hospital wouldn't you be glad to have a nurse who felt the same?

That is why I stay.

The Art and Science of Nursing

When I was in nursing school my teachers would always talk about the "art and science of nursing". The marriage of scientific knowledge and the intuition we have as caring professionals. Back then I understood it on an intellectual level, and I saw it in the experienced nurses who, due to years of hands on nursing, had this way of balancing their care with scientific precision and  compassion that drove everything they did. Over the years I have learned it more myself but it wasn't until last night that I realized just what my teachers meant all those years ago.

When I walked into work last night and saw my assignment, I knew there was a potential to have a rough evening. My patient was a young man I knew well. A guy who had been diagnosed with ALS many years ago... a disease that slowly takes away all ability to move, eat, go to the bathroom and breathe on your own... eventually even takes away the ability to speak. It is fatal and it is characterized by this "trapped syndrome" where your mind is completely alert and aware and yet your body is a hollow shell of what it used to be. In all honesty... ALS is my very worst nightmare.

I had been told that my patient was at a point in his disease process where he was not willing to participate in nursing care. No turning, no bathing, no suctioning... basically we were there to give pain medicine and offer sips of water and such... but only when he asked. He was still able to talk through his trach, despite being on the ventilator and he would let us know what he did and did not want. Oh great.... I thought to myself... this is gonna be a fun night.

If I had been given this assignment four years ago when I began my nursing career, I would have had a large amount of anxiety surrounding his decision. As a nurse who knows the implications of not turning your patients (bed sores that go down to the bone) and not suctioning your patient (pneumonia that could kill you) and the list of other things that this guy won't let us do... how do you just not force it on him and take care of him the way I know I should? I remember having these dilemmas as a new grad.

Now... four years in, I realize that I have begun to understand that age old wisdom my nursing instructors were trying to impart in each one of us. This man that I cared for last night is a man who is dying... not only that but he is dying from a horrible disease that leaves you completely paralyzed. You can control nothing. Not your body, your environment, your position... everything in your life is in the hands of a health care professional that doesn't know you from Adam. And sadly... most of the time, with chronic patients... nurses and doctors avoid them because they can come across as being needy and demanding... all in an effort to cope with the loss of autonomy they have had. So... you are left with a grumpy, isolated patient who tries to demand even more as a reaction to his surroundings and refuses to do the things we know need to be done... and often times you have a nurse who just wants to get in the room and get out.

So, last night I knew that this is where I needed the art of nursing. Instead of explaining to him why I needed to turn him, I asked him when he wanted his pain medicine. Instead of running out of the room at every chance and trying to just get my work done and get on with my busy day... I sat in the room and watched Ricky Lake and chatted with him about his time in the service. We watched the news and talked about the recent CIA scandals and the depressing state of our government. We laughed over remembering the taste of dimetapp as a kid and I told him about the time I puked all over my poor grandma when she made me drink theraflu when I was sick.

The funny thing is that I can't remember the last time I had such a good night at work. It was peaceful and slow and it felt good to actually connect with this guy. At the end of the day I was really thankful for him and our time together and I could tell that he was thankful to have a nurse that didn't force him to have his sheets changed or try to convince him that he was getting too much pain medicine. In the end I have a feeling that our time together did more for the both of us than my turning him ever would have. He actually looked happy when I said goodbye to him this morning... and I think it was because someone sat and treated him like a person instead of a patient for once.

So... four years in I am finally getting it. I'm still learning it and will probably continue to fine tune that artful skill of knowing what lines are hard and fast and which can be blurred around the edges a bit. I will say one thing though... my nursing instructors would be proud :)

Note to Self: His mercies are new every morning...

Right now I am supposed to be reading “Ladies and Gentlemen, to the Gas Chamber” and every time I switch my browser to my school's page I just can't seem to get up the mental fortitude to go there. I keep thinking about the week that I had... four very long twelve hour shifts in a row. Lots of homework and lectures and tests and papers in between. Death. I am tired.

I have been a nurse in the ICU for four years now come this July. I still remember when I started this blog as  a new grad about three years ago. It doesn't feel like it has been that long but the weariness in me reminds that it has. 

I thought yesterday was going to be a good night. It has been a really rough week and my stress levels have been physically impacting me and I feel at my wits end. I needed it to be a good night. It started off with a perfectly wonderful conversation with my patient's family members about the perils of quitting smoking. We laughed over the crazy things we would all do during our peak addiction days just to get a cigarette. Laughing over things only an ex-smoker would be able to laugh about. It was nice to connect with the family, you could see that despite the severity of the situation... there was an ease. A trust that they felt things were moving in the right direction and knowing that their loved one was in very good hands. It was nice and despite my exhaustion I was thankful. 

Then not an hour into the shift I hear his wife yell out, "He's bleeding!" and immediately the flood gates open. Ruptured esophageal varices that eventually found its way out of his mouth and nose with force. The next four hours were a furry of attempting to get the bleeding under control with massive transfusions of blood products and a procedure to clip the bleed in his GI tract. His poor family was ushered out to the waiting room and I felt horrible. 

No, this is not a good night. Not for me... and definitely not for them. What is so difficult sometimes is knowing that despite how hard you work and all that we do to save lives... sometimes it fails.
Sometimes people die of lung cancer, probably from the 40 years of smoking a pack a day.

Sometimes people die from a GI bleed from years of binge drinking and a failing liver as a result. 

Sometimes death is peaceful and wonderfully fitting.... and sometimes it is not.

This week it was not. 

So for now, I just don't have it in me to read "Ladies and Gentlemen, to the Gas Chamber" or anything else that talks about death and sadness. Right now, I will stop and say a prayer for that family and I will spend some time here and I might also need to give these girls a call... their smiling faces and silly laughs always make the world a little better. 

Maybe tomorrow will be brighter and the world will feel a little less heavy and burdened...

Something good...

 This week... this week has just been too heavy. There has been this weight resting on my chest. Like a vice slowly closing in on my lungs. Each breath feeling tighter and tighter. I feel paralyzed by it sometimes. A hollow shell of exhaustion.

This week I helped try to resuscitate a code blue patient for nearly 6 hours. Blood products, intubation, lines.. the works. And then watched as his family stumbled into a room with trash strewn everywhere and every known machine in the unit packed into the room... and blood... so much blood streaming from this mans mouth and nose and all over the sheets... so much that 15 units of blood products didn't save him. His belly taut and distended, full of god knows what. I watched as the resident told them that their loved one was dying... and that we have nothing left to do. I watched as they sobbed and shook their heads in shock and disbelief.

I remember my first death in the ICU... it was peaceful and uneventful compared to the usual in my unit. A simple transition into another world. I went home after that death and I cried and cried and cried. I couldn't grasp that this person who was loved and cherished and had memories and a life... that this person was just now gone and I had somehow witnessed this sacred passage. 

And yet this week, I came home and felt tired and alone. Knowing that there are very few people in this world who truly understand what it is like to do what I do. I felt like I had no words for what had just transpired and so instead I said nothing. I shed no tears. I posted a short comment online hoping it would make me feel better and it didn't. Then I turned on the news and continued to be barraged with the horror that has transpired in this awful week. 

This week has been horrible and I am tired and I don't want any more news of terror or death or fear and hatred. I want hope. I want joy. I want redemption... 

So as I drove into work last night and passed our flag at half mast. I paused for a moment and thought to myself. Today I will do something good. Despite the weight on my chest, and the pit in my stomach... I will still do what I am called to do. Because today... today is a beautiful day to save lives.

Black Hawk Down

I have been a nurse at a Veterans Hospital for almost four years now. It is hard to believe that it has been that long. I haven't hesitated to say, especially lately, that this job of mine is not an easy one. Most of the time the difficult moments seem to out weigh the rewards. Still, every time I think about leaving this place I hesitate, and there is this scared, sinking, feeling in my stomach that tells me not to go. This overwhelming sense that this is where I am supposed to be right now. 

Last night, Chris and I watched Black Hawk Down and there was this moment at the end where Eric Bana's character says,

"When I get home and people ask me,'Hey, Hoot, why do you do it, man? What are you? Some kind of war junkie? I won't say a goddamn word. Why? They won't understand. They won't understand why we do it. They won't understand that it's about the men next to you. And that's it. That's all it is."

That hit home for me. I have said that so many times when I talk about our vets. The patients that I take care of are often a messed up lot. They have substance abuse problems, estranged families and multiple diseases as a result of self neglect and risky behavior. Of course some don't, there are some who are amazingly healthy and well adjusted, but sadly those are rare occurrences. Especially now that we are heading into the Vietnam war era of patients. PTSD is a given and many of these guys have some horrible experiences that no one else would understand but the guy in the room next to them. 

One patient told me a while back that he didn't even know what the Vietnam war was really about until a few years ago. His job was to retrieve dead soldiers out of the brush after major battles had occurred. That same guy also had newly diagnosed paranoid schizophrenia that was so bad he later threatened me and told me I was trying to kill him by inserting poison into the air filtration system. 

That was a relatively good day on the job ...just to give you an idea of what I mean by difficult. 

My job is exhausting ...and it wears you down ...and makes you feel powerless a lot.

But when I see movies like Black Hawk Down ...and when I see the 25 year old with half of his skull removed from an IED blast ...that is when I remember why I do this job. I don't always love it but I am always proud of it ...I am proud to fight for the soldier who fought so bravely for the guy next to him. 
I sacrifice a lot of sanity and a lot of myself for this job but I wouldn't have it any other way right now. 
Right now, I am proud to be a VA nurse.

Hannah

It is my first day off so my sleep is broken and I am awake at 4:00am.

I tried to close my eyes ...willing my mind to rest

but all that could cross my mind were the events of this week.

This week I took care of an alcoholic of 40 years. 

He had come down with a horrible bacteria infection that rendered him too ill to drink. 

His estranged wife explained a little of what had led up to this point 

but she had been through this before and could not stick around.

His daughter however arrived at the unit in a fluster of anxiety and fear.

Shuffling from side to side, adjusting her Raiders beanie every few seconds.

Hannah was her name.

I smiled, "I'm a Raiders fan too. My name is Andi and I'll be your dad's nurse until 8:00am".

She smiled and then quickly began asking very specific questions about her dad's health.

She followed up the questions with an immediate proclamation, 

"I am the one who takes care of him so if you have any questions..."

she trailed off, still nervously fidgeting and shuffling her phone from pocket to hand and back again.

She began to tell the full story ...of how it all began.

She was adopted ...like me

He was sober briefly ...until it went sour around her 8th birthday.

She has been taking care of him since she was ten years old.

Her mother gave up and has been living in a different section of the house for years now.

Hannah knows every detail of her father's history because she has been taking care of him since she was ten years old ...ten years old.

He wanted to sober up after being ill so she had been managing his withdrawals at home.

Every time he'd shake she'd give him a shot or two of vodka.

But the withdrawals became unbearable and he began vomiting and soiling himself and passing out. 

So she brought him into the Emergency Room and here we are.

I looked this little girl in the eyes and asked her, "How old are you?"

"I'm 18."

I closed my eyes and put my hand on my chest and had to pause for a moment.

"Hannah, I don't know if anyone has said this to you but I am so sorry. You don't deserve this because he is a grown man and he is your father and I am so sorry." 

I couldn't hold it in anymore and I began to cry.

Partly because I am devastated for Hannah 

but mostly because Hannah has that oh so familiar look.
I know how far she has to go in order to be healthy and whole 

and just how painful that journey will be for her. 

She stopped for a minute and just gave me that smile that comes when you're trying to hold back tears.

That moment when you know that someone gets it and that someone sees you... and that small ache rises to the surface.

She quickly stuffs it all back into her neat little box and the subject is changed.

I talk to her more and I encourage her to finish college ...transfer out of here a.s.a.p.

She nods and agrees, so there is hope for her.

This week Hannah broke my heart and I am awake now at 5:30am praying for her.

Praying that she will someday overcome the co-dependency that has been crafted into her being. 

Praying that someday she might find faith in God and peace in His grace.

Praying that someday she knows the love of a father that she never had

Praying that she gets into college and runs away from this mess

and that she begins to heal ...deeply heal.

This week I am praying for Hannah to know truth

and I weep for her ...even now, I weep.

Rough Day

Today is one of those days where I wish I wasn't a nurse. I dream of having a job where life and death is not on the table. Where the pressure to be perfect and always "on" isn't quite so strong. Where family members aren't skeptical of you right off the bat. Where doctors talk to you like you are a human being and not a servant. There wasn't any one thing that happened that caused this horrible day... it was busy and crazy and exhausting as always. 

Today it felt hopeless though.... I felt hopeless. As in "what's the point?" hopeless. Two patients with metastatic CA that I am poking and prodding and watching everyone freak out about when really they should be on a morphine drip in the hospice unit.

I don't know what it was about today but I felt like a failure walking out of that ICU. Like I messed it all up... and honestly I think it is because I don't agree with what I do half the time I'm at work. Forcing procedures on patients who do not want heroic measures.... it just doesn't settle right with me. Nursing today is getting harder and harder. More responsibility, more expectation.... so much pressure and stress to never make a mistake. And for what? For a patient who is going to die in a matter of months... weeks or days even. We do all of this for what? Is it for the patient or for our own peace of mind?

In the end we all have to go at some point... at the very least we can go in as little pain as possible and with a bit of dignity left. A choice in it all. I never understood why people would want to become hospice nurses but now... now I get it. I have a feeling I might end up down that path someday myself. 

Right now, all I can do is go to sleep and hope that God will give me the grace to be an ICU nurse for a little bit longer. 

Life Lately

I should be doing my homework right now but my brain has turned into complete mush... so here I am catching up on a long overdue post. I am warning you now (husband this one is for you) that this post will most likely be full of grammatical errors. Last week I began my technical writing class and I have been completely overwhelmed with my lack of writing skills. I have always known that I am horrible with grammar and punctuation... writing etiquette etc. But what I love about this place is that I don't really care if I write incorrectly. Because this place is where I can write like I think and for me that is fine and dandy. Take that writing teacher! No APA format here, no sir.

On that note... school is in full swing and boy is it way harder than I was expecting. Every week I have a 5-10 page paper due, a quiz, a test, and loads of reading/research for each class and I am taking two of them. One nursing related and one writing class. It's exhausting. Hopefully this program won't completely run me into the ground. One thing I will say though is that so far I am actually enjoying the nursing class. The reading is interesting enough and the assignments aren't full of busy work... only slightly.

On the work front things are steady. Summer is here and so far *knock on wood* it has been survivable. I had my first solo night as charge nurse on the unit the other day. Minus a few documenting technicalities I did well and it was a good night. It was a nice change of pace actually and I am looking forward to being able to grow in that role. The night I worked was incredibly calm so we shall see how I handle it when we have multiple codes and admits. Let's hope my black cloud won't follow me as charge :)

Over the past few weeks Chris and I have made an effort to really start living a more healthy lifestyle. We both have diet changes that need to be made so we have been cooking and grilling at home more. I have been doing a daily food log with the "Tap n' Track" app on my iPhone. Counting calories and making better choices has resulted in apx. a 10 pound weight loss! Considering I gained nearly 30 lbs since I stopped marathon running... I've got about 20 lbs to go but yay for being a 1/3 of the way down. Running has been difficult at times but I am slowly building up my endurance. Right now I'm just focusing on training for my favorite half marathon coming up in October.

These days I am trying to remember to just take every day one step at a time... and that way when life throws me a curve ball... maybe I won't get so upset over it? Well... that's the plan at least. :)

How is life lately for you?

The Color of Humility

“Death opens a door out of a little, dark room (that's all the life we have known before it) into a great, real place where the true sun shines and we shall meet.”
― C.S. Lewis, Till We Have Faces: A Novel of Cupid and Psyche 

 In the ICU we are all about control. Almost every ICU nurse I know would agree with that fact. In death there is no control. I guess that's part of what I love about palliative care. In a world where you can't beat the inevitable... at least I can have some control over how it ends... I can offer some solace at the very least. The chaos stops and there is only the person... no IV lines, no balloon pumps, no chest tubes, no monitors. Just pure nursing care. Today I am taking care of a dying patient and for some reason, today has not felt that way. There has been no solace here. It has felt exhausting and uncomfortable. There is an unease to everything about this night. I couldn't put my finger on it but as the hours have gone by I have felt it.
That gnawing feeling in my stomach. It wasn't until I saw my patient's family react to a simple question that I was able to pinpoint the source. A simple, "Do you want to be called before he passes away?" and the whole countenance changed... I saw that smile turn into a stern, furrowed brow and that pit in my stomach grew.
They think their loved one is going to recover and so until the very last breath they will force every invasive procedure possible in hopes of prolonging life. From that point on I realized why I wasn't settled and I don't know why it didn't hit me sooner. This is not end of life care...
In the ICU we are supposed to save lives and many times we do. We use our medical knowledge and nursing care to fix people up so they can live again as they once did before. But the reality is that most often life will never be the same. We have patients here who have been in our hospital for over a year. They have gotten sick and gotten better more times than I can count and in the end they usually end up succumbing to the inevitable. They die here... sometimes alone and often times after a long and painful hospital course... and I think to myself. What was it all for?
And if we can't save their life... at the very least we can make them comfortable in their last moments on this earth, right? But, what happens to the patients who are obviously dying and yet the family just isn't ready to let go yet?
It is that grey area that I find hard to handle and this patient was the epitome of all of that. We have to poke and prod until the very end. We have to do things we don't agree with and don't like. We have to face the fact that we cannot save every life and that medicine has its limits.... and I have no control here...

and I hate that.

I hate that grey area between death and life... where we have to wait and see...to pretend it will all be okay despite what we know will inevitably come. It is in those moments where my hands are tied and I have to be the one to carry out the invasive procedures while the family is able to get the incredible, devastating courage to let their loved one go. It is in those moments where I have no control and if the only thing I can do to provide comfort to a dying man is to pray for him as I give him a bed bath and some new sheets to pass away in... well then that is what I will give.

This is the grey area of the ICU where my faults stare glaringly back at me and I am reminded of just how insignificant I am.... of just how selfish I can be. That when a family is battling with the fact of losing their father, brother, uncle, husband... all I can think is, "I hate this" It is the grey area that reminds me of how insignificant my needs are when in comparison to those of a dying man.
It is painful and uncomfortable and in the middle of all that grey it is incredibly humbling.

The Invisible Casualties of War.

It has been nice to see everyone acknowledging the true meaning behind memorial day. There were only a handful of the blogs I follow who didn't mention at least something small about our fallen soldiers and for that I am thankful. Memorial day has nothing to do with days off from work and BBQ's.
Being a VA nurse is not always easy. I see a lot of PTSD, addiction, alcohol abuse. I see a lot of homelessness and dysfunctional family relationships. I don't understand why so many of our nation's veterans end up on the streets with no adequate support system. Either way, I am glad that I can do my part in helping heal the wounds that being in the military has given them.

I worked this memorial day and for the first time in a long time I felt proud to be a VA nurse.... and even though I ended up floating to a unit that wasn't my own I had the opportunity of seeing first hand what true sacrifice is. Memorial day exists to honor those who have fallen in combat... but what most people forget about and often times don't even see are those men and women who come home suffering from traumatic brain injuries or spinal cord injuries or combat related wounds. What about the men and women who die years out from deployment as a result of the injuries they suffered while at war.
Those are the kinds of soldiers I see. We have had more and more of our OEF (Afghanistan) and OIF (Iraq) soldiers showing up in our unit these days. Kids who are my age or younger and have suffered from devastating physical wounds and emotional scars related to the wars they served in. In our hospital we have phenomenal Traumatic Brain and Spinal Cord Injury Rehab units and yesterday there was a rapid response called to one of those units. Since I was in charge of the code pager I answered the call and lo and behold it was for a patient that had been in our unit earlier this year. A kid not too much younger than me who had suffered an IED blast overseas and had to have half of his skull plated and a shunt placed in his brain. His injuries are so extensive that he is virtually paralyzed and is completely non-verbal. When I saw him in our unit none of us thought he would ever make it out of the ICU alive. We watched as his wife dutifully sat at his bedside day and night, helping with his rehab and withstanding every surgical procedure he would barely make it through.
When I saw him yesterday he looked like a completely different person. Still non-verbal but looked much healthier and was even able to track you with his eyes when you called his name. When we were trying to assess his mental status the nurse who had been with him in the unit leaned over him with a tightened fist and said, "Hey man, give me a fist bump so I know you're alright." Surprised and somewhat confused, I looked over at the patient and watched as he slowly reached his weakened, contracted arm up towards the nurse. He clenched his fist and sure enough he gave that fist bump, confirming he was in fact okay.
Today, as I was spending time with Chris before I headed back to work, I was sharing with him about my night yesterday and I told him about this story. I didn't realize it until that moment but I understood it then... that patient was a gift to me yesterday. God knows, yesterday was a crappy day. I had to float to another unit and work has already been difficult recently. I was tired and overwhelmed having to answer the code pager for the hospital. In many ways I have forgotten what it means to be a VA nurse. I have lost that passion.
Yesterday though... yesterday was a gift. That patient reminded me of what it means to be a soldier and on a day where we are honoring the fallen soldiers of war... I was able to see the true sacrifice of the families and soldiers of those who have served. It gave me hope and it humbled me in ways that I can't quite explain. As I was telling Chris the story of this patient... tears began filling in my eyes and it reminded me of just how rewarding my job can be.

So today I want to say thank you to the men and women who have served...
Thank you to the families who have sacrificed their loved ones.
Thank you to the men and women who are the invisible casualties of war... the ones who die after they come home.
Thank you to the soldiers whose lives are forever changed because of the service they gave to our country and especially to the sacrifice they made for their fellow soldiers.
Thank you, it is an honor to be your nurse.

The World of Teaching

Most of the time I live by impossible standards and I know this. I tend to be meticulous about my environment and my work. I am detailed and methodical. I thrive on routine, I hate change and I don't do well with things that are abstract when it comes to many things in my life.
I am an ICU nurse... detail and a well controlled environment are things we tend to need to be successful at our jobs.

Last week I had the opportunity to stand in as a preceptor for a nursing student that has been on our unit for the past few weeks. It was an interesting experience. When I was approached last year about becoming a student preceptor I was hesitant about the work I would have to put in but also eager for the change and the experience. I remember what it was like to be a nursing student and the ability to be an encouragement to someone who was going through the hellish experience of nursing school was something I looked forward too.

Well let me tell you... teaching is not easy... at all. I have always known that I tend to expect a lot out of the people around me. I have to make a conscious effort to not only focus on the criticism but the praise as well. Now don't get me wrong, I love nothing more than to encourage people and inspire them in what they love doing. I do like teaching in the ways where you can see it "clicking"... that moment when you see the light bulb coming on. It's a great feeling to know that you've invested into someone in ways that are so rewarding. The thing with teaching in nursing though... (and this is probably true in the medical world too) is that we are dealing with people's lives here. It's not a normal educational environment.

You don't have the luxury of making huge mistakes. Especially in the ICU. It's a stressful environment and when it comes to being in charge of a student learning how to navigate that world.... man, is it ever exhausting!

After two 12 hour shifts of having this student with me I was completely worn out! I honestly don't know if it is something I would ever like to do on a regular basis. I will say though that I am thankful I was able to give her some great ICU experiences and it was a good lesson in learning to let go. Learning to step back and let someone figure it out without hovering and micro-managing. I guess we can't always be in control. Probably something I should remember if I ever want to be a mom, huh? :)

The Heart of the Matter

I've been tryin' to get down...

 to the heart of the matter...

 but my will gets weak...

and my thoughts seem to scatter

 but I think its about...

Forgiveness

The Heart of the Matter  

Don Henley

 I woke up early on Monday and as my eyes slowly let the light seep in a sadness washed over me. I looked at the clock just as it turned 6:00am. My stomach began twisting all sorts of ways, knots starting to form.
For a brief moment I panicked thinking that I was coming down with something. A stomach flu of some sorts... until it hit me. Today is my sister's birthday.
I haven't spoken to her in years. I wouldn't even know how to reach her at this point. This is not uncommon in my family. We are disconnected, broken and dysfunctional. The few of us that actually have communication with each other are a tiny handful and the times we actually see each other are few and far between.
I have faint memories of childhood where we celebrated holidays and birthdays... all one cohesive bunch. It seemed as if things were okay... happy even. Maybe that was simply due to my innocence or maybe it was just the inability to see the truth of our family dynamics. At that point I guess anything was better than the abuse I had endured in my previous home. Eventually the facade broke down though and reality set in. There hasn't been a holiday in years that wasn't filled with anger and fighting and frustration and plastered on smiles.
This is why we don't speak... this is why my interaction with my family is minimal and surface level if that.  
If I am being truly honest, it is for the best. I read a blog post recently on the difference between forgiveness and reconciliation. Reconciliation is a two way street filled with repentance. There is little if any of that in my family.
So... I forgive but I do not reconcile.
Fast forward to the next day... work is hectic and busy so I hurriedly settle into report. As I sit there listening to the typical rattlings of the ICU... Intubated 2 hours ago... tachy to the 120's, septic and febrile... I hear "Registered Sex Offender."
My fist clenched around my pen and I took a deep breathe in.
Not today... I don't have it in me to do this today. I have taken care of child molesters and sex offenders before but today, I just can't do it. As I look around the unit and see the chaos... our charge nurse scrambling around like a chicken with her head cut off, I realize that I won't be able to switch assignments and my stomach begins to twist and turn... here we go again.
He remained on the ventilator the entire night so luckily I didn't have to force any interaction. I took care of him to the best of my abilities and went home the next morning exhausted.
I come back to work the next night and I have the same assignment... only this time he isn't on the ventilator and now he is surrounded by his entire family. For the first 2 hours of my shift I was on the verge of tears. Face flushed with anger and fear and disgust all rolled into one big, emotional ball. I tried to busy myself in my patient's room next door, hoping to get the composure to be this man's nurse. Praying to God that I would find someway to detach my own experiences with the horror of what this man had done. Eventually, I knew I couldn't avoid it any longer and I went in to do my assessment. He was a little disoriented but pleasant and joking with his family. I went through the motions and when he was unstable I did everything I could to be reassuring for him. After we got him settled and his vitals were stable he looks at me and says, "You know what... you're a good nurse. I'm really starting to see the skill level of people here and you are a good nurse. You have a very bright future, Andrea. Thank you for taking such good care of me."
It might have been the way he said it or the fact that I was so emotionally drained... or maybe it was the sense of relief I felt knowing I had managed to hide the truth of what I felt towards this man. All I know is that in that moment all I felt was sadness. The only thing I wanted to do was run out of that room... away from him and away from it all. Away from thoughts of anger and abuse and my sister. I wanted to be at home in the arms of my husband where it was safe. Where I could cry and cry and cry... all night long if I needed to.
Instead I just smiled at my patient and said a very quiet, "Thank you." I finished what I was doing and I went into the bathroom and cried. I cried and I prayed that God would give me the strength to forgive.

This Week

This week has been strange. It started off with what was undoubtedly the most insane night shift I have ever encountered. 2 code blues, two e-teams, admits from the ER, emergency intubations,  people pulling out lines, bleeding from all sorts of places.... all in the span of about four hours. It was crazy, but our crew banned together and managed to hold down the fort and make it through the night in one piece.
Two nights later it is about as slow as it gets and I am bored out of my mind. Dealing with a patient who is about as looney tunes as they come. It's 5am and he finally falls asleep... now that it's time to wake up. Awesome.

I applied to school this week. I will hopefully be starting my RN-BSN program come this summer. I need a change. Work is work. It's gotten better for the most part but it is still work. I just feel stagnant. Hopefully school will be a good change of pace.

For the first time in months I started running again. After multiple rounds of antibiotics, steroids and lots of doctor visits I am finally feeling healthy enough to start training again. I have missed this. I have missed that time to myself. I have missed feeling strong. I have missed that burning in my lungs. I am a runner and I have missed it dearly. I'm glad I have it back.

I finished The Hunger Games trilogy over a week ago and I still am actively sad on a daily basis that I don't have it to read anymore. I attempted to find another YA dystopian book to read but haven't been able to get into it like THG and it just makes me more sad. Yes... I am pathetic, I know... but I still miss THG. Anyone else out there feel me on this one?

People have been asking me a lot lately, "How's married life?" to which I reply, "It's good" because the real answer is just way to long and in depth for most people to hear. The real answer is that yes, married life is good but it is also hard and fun and frustrating and challenging and tiring and wonderful and confusing. It is so many things but I think more than anything what I have realized these past few months is that I have absolutely no clue what I am doing. I mean no one teaches you how to be married. People give you advice but you never know what it will be like for you. And what works for other people may not work for your marriage. I have found that more than any other piece of wisdom I have been given... the one thing that has been the most valuable is, "Be gentle with each other... especially during that first year." Thank you Kris for those words of wisdom. It has been a life saver.

It ain't about me... or is it?

Warning: I'm about to get brutally honest here so hang in there with me... this won't be one of those mushy "nursing is so great!" posts.... cause truth be told, nursing has not been so great recently. In fact it's been tedious at best. I have not been at my best recently either. I'm tired and to be honest I'm a little bored these days. I find myself counting down the minutes until my shifts are over and my fuse has grown short with people.
I have to say that there are a lot of times in my job when I take things personally even though I have no business doin' so. In my line of work you deal with people at their worst. Sick, broken and teetering on the edge of life and death.
For some reason, recently people have been straight up crazy though. Like kickin', hollerin' and bein' down right mean -crazy. Most of me gets it. I get that when you are at your worst you don't have much to give, especially if you really aren't in your right mind... which happens a lot in these parts. There is a reason ICU delirium is a legit diagnosis.
Most of the time I'd like to think that I handle these situations okay. I see what happens when people get defensive and try to argue instead of understanding. It just doesn't work and usually it just makes the patient angry and you more frustrated. If I was in that hospital bed who knows how I would be? Just take a look at me around 4:00am on any given night shift and you'd probably have a slight clue.
Lately I have been in this weird place. Apathetic in a sort of way to what goes on around me. You see sickness and death all of the time so when a patient comes in with cancer that has ravaged their face you aren't moved the way you once were. Or when a patient with severe pulmonary disease is throwing the biggest fit in the world because they have to be on an obnoxious bipap mask all night... you tend to not have as much sympathy as you once did.
No... now I find myself annoyed at every call light I have to answer. Tired of the same old routine that doesn't challenge my brain but injures my back and zaps every ounce of energy I have left. Frustrated because I can't understand what my patient is trying to say... it's difficult when you've had half your tongue removed, ya know? That is not what crosses my mind though... the fact that he is angrily pointing at these scribbled, jumbled letters on a piece of paper like I am supposed to magically understand them... that is what I see. Frustration and pain and exhaustion... from both parties.
Finally I discern what he is trying to convey...

"It hurts when I swallow... is that ok?"

"Yes, that's totally normal." I nod my head eagerly. 

Relieved to finally be able to communicate, the man breaks down in tears and starts profusely apologizing.
"I'm sorry. I'm so sorry." he mouths as he lays his head back on his pillow.
The floodgates have now opened and I instantly feel like a horrible person.
He knew I was getting frustrated too and I probably could have done a lot more to hide that fact. To have patience and understanding for a man who is battling the big C and now has a very long and brutal recovery ahead. Today I will go home and I will crawl into bed a healthy person... sleeping in my own house peacefully.
This man will not.
He will not have anything close to that and the least I could have done was given him a little room to be frustrated without me being annoyed or inconvenienced back.

I told him that he did not have to ever apologize to me for something like that. I held his hand and told him that I was sorry too.

The worst part of it all is that I don't really know what to do from here. I come to work every day. I do my job as best I can but I'm realizing that my best sometimes just isn't what it should be. I am tired... all the time. I am bored with my job and don't feel challenged but I have no desire to change. I am holding it together on the surface just fine but inside I feel like something just isn't right. And I can't help but wonder if the problem is everything else or if it starts right here... with me.

Happy Veteran's Day

 To all of the veteran's out there who have fought and sacrificed for our country. The service you have given us all never ceases to amaze me. Thank you from the bottom of my heart. I appreciate you.

This week was crazy and like very other week I had the privilege of caring for some of our nation's veterans.

After a long and tiring week where one of my patient's got a total of 2 hours of sleep and was teetering on the edge of health... he looked at me, tired and struggling to breathe and says,

"You know what Andi? You are a darn good nurse."

It made my day, knowing I could be there for a man who was probably at his worst and it's moments like that where I would not trade my job for any other in the world.

"You know what?" I said, "You're a darn good patient."

 

If you see a veteran or a soldier today... thank them. They absolutely deserve it. 

Have a fun and safe weekend everyone!

Blessed

Today I am tired. After a four day stretch of 12 hour shifts your emotional and physical stores are virtually non-existent. They are worn thin at best. Working in the ICU is hard. It is draining in ways that I cannot fully explain. I have learned that because of my profession my life is different than most.

 This week I had the privilege of taking care of arguably the sweetest and dearest people I have ever met. A husband who is dying and a wife who has a love for her husband unlike any other I have seen. Everyone who had contact with them instantly fell in love. I know I did.

I have sat here at my computer for an hour trying to put into words what it was like witnessing that kind of love between two people but I have failed. There was a sweetness to them… an aura of the deepest type of caring. In the way she would smile at him and kiss his forehead… the way he would reach for her hand. How she would lay her head at his bedside for days on end… supporting… hoping… caring.

In the way they both decided that now was the time. That this man had lived a life full of joy with his person at his side… the woman he knew he would marry the second he laid eyes on her. And that now it was time to let go. Time to make that transition that all of us will eventually have to make.

Every morning before I would leave work I would stop by their room to say goodbye… just in case. I would hug them both and tell them that I loved them and he would kiss me on the cheek and she would squeeze me tightly and walk me down the hall. And every morning she would burst into tears.

One morning she came down the hall… tears streaming down her cheeks.

“How will I know?” she said. “What do I look for? He isn’t really talking much.”

So we went into the room together and we talked… I told her that it wasn’t time yet.

And right then and there she fell into my arms.

 “It’s like coming to the end of a jail sentence.” She said… the fear and pain was visible on her face.

Today Bethany and I went upstairs to the hospice unit to say hello and we talked… we looked at old photos of him in the service… of their life together. It was a perfect ending to a long week.

The first night I took care of him, when we decided it was time to stop heroic measures, he told me, “This is the best night I’ve had here yet… talking to you.”

I smiled and held his wife’s hand.  And as I said goodbye that morning he grabbed my hand tightly and smiled, “ I hope you have a blessed life dear. A life full of love like I have.”

And as I walked out of the hospital that morning, exhausted and teary eyed… I knew that my life had been touched. And that I am truly, truly blessed. 

A Welcome Surprise

Right now there is a patient on our unit that I can safely say everyone... and I mean everyone dreads taking care of. He is one of those typical VA patients I speak of so often. He decided to get open heart surgery despite having active substance abuse problems. Can't quite remember if he actually told his surgeons about it before he went under the knife but all I can say is that as a result this man has been in the hosital for a long, long time. I'm talkin' months here. This man has been intubated and extubated and re-intubated multiple times. He has fought through multiple infections and bouts of sepsis. He has been so close to death and come through to the other side and is now on the verge of actually being transfered out of our unit. It's kind of a miracle, as a matter of fact.

He has also been one of the downright meanest people I have ever taken care of. He has called me and every other nurse who works with him pretty much every name in the book. He swears at you constantly and has even spit at people and tried to kick and hit them also. I'm tellin' you... this man is a real gem... and get this... his family members are even worse. These days people dread taking care of him more because of his family members than him and that's saying a lot! I even heard one of the nurses say today, "I would pay charge nurse $100.00  not to get that assignment!" I have to admit that I completely agreed with her.  

For the past two weeks I have had an assignment that was next door to his. I would walk by the room and politely smile and nod to him and his family... trying to have as little contact as possible while still remaining professional and courteous. Well, today as I passed by his room I saw him sitting up in bed, smiling and talking to his wife. Side note: he has not been able to talk the entire time I have taken care of him, he was either intubated or had a tracheotomy (which he still has). So I have never heard his voice. I have just read his lips this entire time because that was his only way of communicating.

When a patient has a trach they can't talk unless the tube that you see in this picture is able to be capped off and the patient can breathe on their own. It is a long process for someone who has been so critically ill to get to this point and it takes a lot of speech therapy and rehab too.

So back to today... As I pass by his room, I smile and wave at him and his wife. Then suddenly, just as I step out of his sight, I hear this deep, raspy, "Hello!" in response. I stopped dead in my tracks and backpedaled to his room, "Whoa!! Mr. X, I've never heard your voice before!!"

Something in me jumped at that moment and I knew he could see the genuine surprise on my face. Instantly, all the feelings of frustration and annoyance with this patient dissipated and I realized how much I actually cared about this man. He smiled at me like the Chesire Cat from Alice in Wonderland and we began to have an actual polite, civilized conversation about how much better he is doing and how exciting it is that he can actually talk now. Seriously, I just could not believe how different this man seemed. I have heard stories of recovered patients who come back to the unit as completely different people. People who were once horrible to their care givers are actually really wonderful when they aren't in the hospital. I know that people are often the worst version of themselves during times of sickness and severe stress but I just have never seen it in such a clear way.

I don't care if you are Mother Theresa... when someone calls you horrible names and swears at you and tries to physically assault you when all you are trying to do is take care of them... its hard not to build some apathy towards that person at the very least. I mean we're all human and even the best nurses have their limit. I definitely hit mine with Mr. X. Yet today none of that mattered. Today all I saw was a beautiful smile from a man that was finally able to use his voice.

It truly was a breath of fresh air and if I'm being really honest this guy totally made my day. It definitely was a welcomed surprise. :)

Grateful

Working in a veteran's hospital you see a lot of things. A lot of substance abuse, mental health issues and alcoholism... PTSD is rampant in our patient population. It can be a rough place to work sometimes. It wears you down. People are bitter and angry and broken... lost and many times forgotten. 

It is not uncommon to have patients in our unit that have no visitors during their entire hospital stay. It is also very common to have families with very complicated backgrounds and delicate family dynamics. Often times we are not only caring for our patients but we are caring for their families too.  I think one of the reasons I fell in love with the VA is because of the people. One of my deepest passions in life is to show people their value and their worth. I think that is one of the things I have always valued about my faith also. Jesus was a man who loved people... the worst people too. The rejects and marginalized people that no one else wanted to fight for... he fought for them. 

If anything I hope that would be the one thing I can show people. That they are worth it. That they are valued... but most of all, that they are loved. 95% of the time it is not easy working with the patients in my hospital. There are moments though where it clicks and the 5% makes up for the rest. The moments where I am able to step outside of my own crap and realize that these guys are just hurting, broken people who need good care... those are the moments that matter.

I had a patient last week who was unlike the others. This patient had a large, close family. This patient did not have substance abuse in his background. He was a physician and a professor at a very prestigious medical school in the area. Still he chose to come to the VA for his care. His wife was saying how much he appreciated the care he received at the VA and she expressed how grateful she was too. Through foggy, tearful eyes she stroked her dying husband's hair and told him to keep fighting... and that she loved him more than anything in this world. She said that he was her best friend and that she was so grateful for everything he had given her in their life together. The love she had for that man was pouring through every tear she cried and the pain she was feeling was tangible.

It broke my heart and I had a hard time holding it together as I managed the care of this extremely sick man. She asked me how long I had been working in the unit and asked if I liked my job.

I stopped what I was doing because I wanted her to know how much I meant what I was about to say. 

"I love my job. It is an honor to serve these guys. They truly have given so much and the fact that we are able to cater to our veteran's in such a specific way really is so special. I love knowing that we can give back in that way... and especially that we can give such good care to people who often times are not appreciated or understood. I really love what I do and even on the hard days I am still grateful that I have a job where I can show someone that they are valued by the care that I give."

She looked at me and smiled ever so slightly as tears began to fall down her cheeks. 

In the midst of an incredibly exhausting week it was a 5% moment and even now... days later it brings a bittersweet joy to my heart and it reminds me of just how lucky I am.

 

Image Credit

Welcome to the ICU... the end

It is now day three of my week. I haven't slept much and the last 48 hours have taken a lot out of me.

I wake up to a text message from a fellow night-shift co-worker who was working a day shift. 

Things were not going well... my patient was not doing well.

They were about to transition him to comfort care.

I read those words and my heart sank. It hit me like the weight of an elephant on my chest.

I stepped out to my balcony and began to pray.

"Lord please give us a miracle. Be with his family now. Be with my patient... please Lord."

Tears begin to fall and I feel a deep sense of loss. 

I have never been impacted by a patient this way. It is hard to explain.

As a nurse your job is to heal people... in any way you can...
but this time I had no answers... this time I had no control and I felt helpless.

I go to work and he is still alive. 

Things are worse now... I have never seen lab values like this. 

I have never had a patient as sick as this. 

There are no answers... 

Just sickness...

I began my shift with his minister at the bedside. Reading him the Psalms...

"The LORD is my shepherd, I lack nothing.

 He makes me lie down in green pastures,

he leads me beside quiet waters,

 he refreshes my soul.

He guides me along the right paths

   for his name’s sake.

 Even though I walk

   through the darkest valley,

I will fear no evil,

   for you are with me;

your rod and your staff,

   they comfort me.

  You prepare a table before me

   in the presence of my enemies.

You anoint my head with oil;

   my cup overflows.

 Surely your goodness and love will follow me

   all the days of my life,

and I will dwell in the house of the LORD

   forever."

I go through the motions... his family is there... his grandson asks me,

 "How long would he have lived if he didn't get the original surgery."

I take a deep breath.

"My dear only the Lord knows the answer to that."

He nods and grabs his grandfather's hand.

"I love you papa" and he leaves the room.

A while later his wife has a discussion with the ICU team.

It is time. He is not getting better... she wants him to be comfortable.

We give everyone time to say goodbye and I explain to the family what to expect.

And then... one by one... I proceed to remove the medications that are giving him life.

At the end he is left with sedation and pain medicine only.

His family joins in a circle of hands... praying and singing over the man that they have known for years to be grandpa, dad, brother, husband.

Within minutes the monitor shows nothing but a ragged line... he is gone.

He has passed.

I enter the room and find his wife...

"I am so sorry but it looks like he has passed. I will call the physician to come in and confirm."

She begins to cry harder.

"I am so so sorry for your loss." I place my hand on her shoulder.

She waves her hand as she covers her mouth and I step away to inform our ICU fellow that he is in asystole. 

After some time... after his family have said their goodbyes... they leave in a state of shock.

I am left with this man that I have to clean and take the morgue.

My patient.

A man that I have cared for and fought for. 

A man that I don't really know... but a man that I desperately wanted to live.

In that moment I feel lost.

I feel like a failure.

I am confused and frustrated.. but most of all I am devastated.

We are supposed to save people. 

We are supposed to heal them...

but sometimes the Lord calls us home... sometimes medicine is not enough. 

Sometimes we don't have answers...

and sometimes it just isn't our fault...

it is just their time.

As I prepare my patient's body for the morgue... I grieve...

I grieve for his family... I grieve for the loss of life.

And in that moment I realize that I have experienced the truth depth of nursing...

 in a way that I never have before.
I begin to feel the tears of the ugly cry and I have no reserve to hold back. 

My charge nurse encourages me and thanks me for caring so much for this man.

With help from co-workers I get my patient in the body bag and begin the trip up to the morgue.
I am silent and somber and as I walk the empty halls of the hospital all I can think is, 

"Welcome to the ICU dear... 

Welcome to the ICU."