To My Fellow Nurses

I have been sitting at my computer for over an hour now trying to think of what I want to say to my fellow nurses on "Nurses Week". It is hard to put into words just what a nurse does on a daily basis. If you were to shadow me on a day at work you would see that my day is very busy. From the minute I am done getting report my mind is already racing with the list of things I must accomplish. Giving medications, patient education, trips to CT scan and MRI, wound care and dressing changes, getting immobile patients out of bed, multidisciplinary rounds, assessments, charting, titrating IV medications to maintain hemodynamic stability, drawing labs, adjusting ventilator settings, monitoring vital signs, cleaning up every bodily fluid imaginable. We are the ones at the bedside 24/7. A bedside nurse is a very special person. We are there for the sickest patients in the most vulnerable state of being. We hold your hand, clean you up, hug your families, skip our breaks and our meals just to make sure you are stable and taken care of. We give up our holidays for our patients. We sacrifice time with our own families working nights, weekends, and overtime because we want to take care of people.

There have been many times that I wanted to quit nursing all together. Too many days I come home exhausted and spent. Physically hurting, emotionally drained and defeated by the system that often prevents me from connecting to the more "human" aspects of my job. I love the days that I get to spend a little extra time with my patients. Reassuring, helping, hand holding, healing, connecting. Those days are rare but the good nurses I know make every effort to fit that in when they can. The good nurses I know are the ones who are smart and work with integrity. They work tirelessly and selflessly for their patients. They teach and train newer nurses to be caring, thorough individuals who advocate for the patients even when it means you have to go head to head with the on call physician.

Nursing is anything but a glamorous job. It can be rewarding, it is rewarding but many times it is just hard. I am proud of what I do and I cannot imagine doing anything else. My job gives me meaning. I know that despite the lack of accolades we make a difference in the lives of those we treat and care for. To my fellow nurses, I hope this week you feel appreciated. I hope you stop and take the time to recognize all that you do on a daily basis. I hope someone hugs you and says "thank you" but if not I am saying it. Thank you. Thank you. Thank you. What you do is significant. What you do matters. What you do saves lives. For the people you touch, the families you support and the patients you heal, you deserve so much. For now I hope you hear me when I say thank you, you matter and please don't stop what you do. Your co-workers need you, your patients need you, their families need you and this world would be a lesser place without a nurse like you. 

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 :)

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.

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.

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

7 Quick Takes Friday

1. I DID IT! Marathon #2 is in the books friends! It was much harder than San Diego in many ways. My time showed it as I was a 8 minutes slower in this race. Can we says hills, hills, and more hills?! Parts of the course we're beautiful though and I loved the cool weather of Seattle.

 

2. Had a complete and utter melt down around mile 23 of the Seattle marathon and called my friend Tim to inform him that I would NOT be doing anymore marathons. He bet me ten bucks that in a few days or so I'd suck it up and decide to do the final marathon in SF on July 31st. "I feel like you're just intense like that Andi" haha thanks Tim... and he was right btw. I'm still planning on doing the SF marathon. This time I'll be doing some serious hill training before.... that includes a somewhat hilly half marathon race this weekend. Yay for having two marathons under my belt though! Isn't my medal pretty?

3. These past two months have been insane... between marathons and work and life in general I haven't had much time do anything... let alone blog. Today though has been good and I feel like for the first time in a really really long time I am pretty much caught up on stuff. I even spent the day editing Seattle photos... (all of which I love!) I will do a whole other post of them and the trip itself soon. :) sneak peek for now.

4. I have decided that July is officially the worst month in the ICU (at a teaching hospital). Mainly because everyone and their mom is on vacation = we are always short staffed. Also because medical school ends in June and residency starts up in July = folks who were medical students yesterday are now interns taking overnight call in the ICU the next. It's a scary time people... makes a nurse's job a lot more difficult when you deal with doctors who don't know anything but think they know everything. Luckily they aren't all like that but I have already had my fair share of run ins with people gettin' crazy. Post soon to come: How to survive July in a teaching hospital. haha

5. This week Chris had surgery. Somewhat an emergent one too. He's okay thank goodness but he tore the meniscus in his knee and hasn't been able to walk since Sunday. So that means this week has been full of doctor's visits, MRI scans, surgery and recovery time. I have been nurse at home and nurse at work. Truly "on call RN" is so fitting. I love being able to offer help and comfort in that way though. Now its just 3 weeks on crutches and a bit of physical therapy and he should be good as new.

6. Had my annual performance review at work this week and it went really well! Yay for that. My manager wants me to take the charge nurse class this fall and she also wants me to start precepting nursing students. I'm willing to try it... even though I honestly don't think I'd be that good of a teacher. I try to be an encouraging person but I know I am also crazily Type-A and I have a tendency to be a micro-manager/control freak. Don't know how well those two things will go together. I guess stay tuned and we shall find out? haha

7. Happy belated 4th of July to my American readers! I spent it at work again. (dumb dumb here forgot to ask for it off even though it's one of my favorite holidays) Did anyone get to see any great fireworks? Even though I was stuck at work, I was thankful to be serving our veteran's on a day that celebrates our nation's freedom. One of my favorite photos from Seattle... part of the war memorial garden in downtown. 

Incredibly moving.

Have a good weekend friends!! Anyone have anything fun planned?

a moment

today every part of my soul feels weary. i have been walking in a sort of daze. a mix of exhaustion and sorrow and gratitude. there are moments in your life that change you. moments that give you such a clear view of your existence that you can never be the same. i made the choice to become a nurse because i knew that if i did my life would never be the same. 

it has been a long month. a busy one in our unit and it has taken a visible toll on everyone. lots of sick calls. lots of complaining. lots of very sick people who need a lot of care and not enough people to give it. emotionally we have all been drained. i am drained too. 

in the past month i have taken care of multiple patients with debilitating, chronic, fatal diseases. they teach you in nursing school how to have boundaries. how to let go and care at the same time. how to set limits with chronic patients without seeming harsh. i have never been good with that. i oscillate between the lines.

yesterday was my last night of a long stretch at work. i was tired and in pain. i had a very stable assignment. not a busy one by any ICU standard. just difficult. one patient on his 7th round of chemotherapy, suffering from a vicious cancer and a mild infection. i was thankful he slept for almost the entire 12 hour shift. thankful for the chance he got to rest and restore but thankful for myself too. thankful for the minimal interaction needed. 

my other patient, a man in his prime, suffering from the end stages of ALS (lou gehrig's disease). the only muscles left with any sort of function in his body were above his neck. he could not move, could not eat, could not speak. he couldn't even breathe without the help of a ventilator and tracheostomy that was placed. he could barely mouth enough words to ask for what he needed. his wife was there at the beginning of my shift. she wanted to make sure the night shift nurse was a "good one." that is always a bit of an anxious thing for me. the ICU is stressful and often times families of ICU patients are burdened with fear and sadness and an acute awareness of their loss of control. then here comes this 26 year old girl who will be taking care of your husband, father, brother... your son, who is on a ventilator and a plethora of medications that need titrating and managing. for them it is terrifying. which i understand. i do. but it is still hard.

it is hard to tell what they expect. what they want. do they want you to be happy and positive and cheerful? do they want you to be serious and somber and just down to business? or do they want you to be friendly with them and treat them like you have known them for years? i see some of my co-workers who are warm and friendly and smiley. hugging their patient's family members and chatting like they are bff's. i have never been good with that. i am not good at being smiley. i am genuine and hard-working and compassionate but i am not smiley. when i am at work i am serious and professional. i think some people see it as being cold and that is difficult for me. i want them to know that i am giving 100% of my attention to their loved one but it is hard when you don't know how that person receives that message. everyone is different. 

often times i am the one who relates to the few that everyone else has a hard time with. the quirky, walled up, introverted ones. the ones that take a little more time to get to know. i get that because i am that way too. maybe it is a trust thing. or maybe its just time. i find though that the ones with the hardest shells have the softest hearts. a lesson my mother taught me years ago and one that i never forgot. 

i knew this could be a difficult night. i was right. it was difficult. it was long. it took every ounce of energy left in my being to give the care i gave. it took a lot of venting sessions in the break room and hugs from my co-workers too. i am so incredibly thankful for them. they keep what little sanity i have left intact. 

i spent 90% of my evening trying to understand my patient's pleas for help. imagine what it would be like to have your mind fully functioning and completely aware of your existence but to have no way to connect that to your physical body. imagine having no way to move into a comfortable position. no way to wipe the tears from your eyes when you are sad. no way to scratch your head when it itches. or move the covers off of your body when you get hot. no way to eat or no way to communicate clearly that you've gone to the bathroom in your bed and need to be cleaned up. no way to tell someone you love them. or to say that you are in pain.

every time we had to do anything to my patient it required a 30 minute session after of discussing ways to reposition him. he would nod and attempt to mouth words but it ended up looking like the mouth of a puppet on strings. everything jumbled together and nothing was comprehensible. i resorted to head nods and one word phrases. 

Is it your head? no

Is it your arm? no

Is it your shoulder? no

Is it your hand? yes

Okay!

Is it too low? no

Is it too high? no

Is it your fingers? yes

Do you want me to spread your fingers apart? he smiles.

I fix his hands and he begins to nod his head towards his left and looks down at his hand.

Do you want me to fix your other hand too? no

Huh... try to mouth it to me.

Up? no

are you saying head? no

Im sorry but I can't understand. Try again.

I turn on the lights and walk around to the other side of the bed and begin again.

Is it your arm? no

Is it your leg? no...

I take a deep breathe in and proceed to look around for anything that looks uncomfortable.

30 minutes and 10 pillows later we have him propped up in a position that is comfortable.

an hour later the process repeats itself again.

by the end of the 12 hour shift i was translating to people what he was trying to say and dictating exactly where he wanted every limb of his body to be. down to every toe and finger... everything had its place. by the end of the 12 hour shift i had nothing left. i thought about his wife at that moment... and how she looked on the verge of tears when she left the night before. and how i thought that it was because she was sad that her husband was dying. and now i was wondering if it was also because a part of her was dying too. the life she once knew and the love she once had would never be the same. the dreams she had. the children they had. nothing would be the same. ever. and how she must feel so incredibly exhausted and drained after a year and a half long of this.

i wanted to weep for her. i wanted to tell her how sorry i was and how unfair it was and how i wished it were different. for both of them. i wished i could do more. make it easier some how.

i prayed at that moment that God would give her rest then. peace. that she would sleep well and heal too while her husband was being taken care of here. 

when i went into the room to say goodbye that morning he looked over at me and mouthed the words, "thank you. you're the best" and smiled so wide i could see the deep wrinkles form around his eyes.

i could feel the tears reach my eyelashes.
"no my friend, thank you" i squeezed his hand and smiled back.

there are moments in your life when you know that you will never be the same. and in that moment i knew that as i walked down the stairs to my car that morning, i would feel every step and inhale deeply every breath. that i would go home and tell the people in my life that i love them because i can. i also knew that this was one of those precious moments... a moment where i would surely never be the same.

Happy (Belated) Nurse Appreciation Day!

Did you know that May 6th is Nurse Appreciation Day?

From May 6th- May 12th it is National Nurses Week!

A picture of some of my favorite ICU nurses and I at dinner earlier this week. :)

A little history for you: In 1974, President Nixon proclaimed a "National Nurse Week." In 1981, a resolution was initiated by nurses in New Mexico to have May 6th declared "National Recognition Day for Nurses." This proposal was promoted by the ANA Board of Directors and in 1982, with a joint resolution, the United States Congress designated May 6th to be "National Recognition Day for Nurses." The proposal was signed by President Reagan, making May 6 the official "National Recognition Day for Nurses." It was later expanded by the ANA Board of Directors in 1990 to a week-long celebration (May 6-12) known as "National Nurses Week."

Found on: http://www.calendar-updates.com/

In honor of the nurses nation and world wide who tirelessly care for, advocate for, love on and save the lives of their patients daily. Thank you for being you and thank you for all that you do. I am so proud to be apart of such an amazing, giving, challenging and fulfilling profession filled with wonderful people like you!

Happy National Nurse Week!

Now if you know a nurse or have one in your family it is officially your job to go spread some love and some thank you's this week. I'm sure it will be much appreciated. :)

Happy Weekend Friends!

The Bigger Picture

I still remember the first time I encountered the "ugly cry" in nursing. 

I was just starting my clinical rotation during my first quarter in the program and we were working at the nursing assistant level in a local nursing home. I remember the first patient I had and I remember the day that she died. It was incredibly sad but that wasn't the first time I experienced the ugly cry. No, the first time I was overtaken by those debilitating tears was the day I met my first patient's roommate at the nursing home. She had been gone the first few days we were there because she was getting a procedure done and needed to be admitted to the nearest hospital. I had been taking care of my first patient for almost a week when she arrived and I remember being startled as I walked through the door that day.

"I didn't realize there were two people staying in this room." I thought to myself as I backpeddled out the door to check the name on the plate near the entryway. 

I read the name and smiled to myself "That's the same name as my youth pastor from highschool. How funny!" I thought.  It was a common name with a unique spelling and as I walked through the door I instantly realized who I was walking towards. 

It was my youth pastor's mom. I knew he lived in the area and I remember the stories he would tell about her during sermons at youth group or on mission trips to mexico. She had a degenerative disease called MS or Multiple Sclerosis. It's a chronic, incurable, autoimmune disease that affects the central nervous system and causes the person to eventually lose almost all control of bodily functions. Walking, talking, sensation etc. It is a devastating disease and is heartbreaking to watch unfold. 

I remember my youth pastor, Steve telling us about the time his mom wasn't able to make it to the bathroom during one of her most severe MS attacks. She had soiled herself and was trapped on the bedroom floor until Steve came home to find her. Steve had to pick his mom up off the floor and proceed to carry her into the bathroom to clean her up. He described how incredibly humbling it was for them both and despite the awkwardness of the situation, they both chose to laugh about it and make the best of what were awful circumstances. But that was the day they both decided that she would need to be put into a home. I believe she was in her early forties at the time. 

Now here I am, years later, a college student walking into this woman's room, knowing the history of her disease and the affect it had on her family. I felt the air in my lungs starting to escape.

I introduced myself as I walked in and her face completely lit up. She threw her limp arms into the air and reached out to hug me. We proceeded to talk about her son Steve and how much he had impacted my life. I told her about my journey getting into nursing school and my dreams to become a missionary someday... partially inspired by the mission trips I had taken with her son in youth group. 

She was such a beam of light in that room that day. Here I was, this terrified nursing student, dressed in this hideous blue vest that was big enough to fit two of me in the waist but was so tightly wrapped around my hips the bottom buttons were about to pop off. The pockets stretching as they were stuffed with medication guides, notepads and a blood pressure cuff. I was awkward and tired and yet so thankful to finally be in the program after a two year wait. Nursing school was horrendous though and I felt very alone most of the time and was in survival mode all of the time.

I was broken then and on that day, Steve's mom was a ray of hope. 

She was so positive and kind and encouraging. She congratulated me and said I was doing a wonderful job. She even started giving me tips about my patient. Her roommate was a much, much older woman with severe Alzheimer's who would repeatedly whisper, "Where are we?" and "Where are we going?" throughout the whole day. As our conversation carried on I began to take in my surroundings. This was her life. Every day she would wake up to this woman next to her asking, "Where are we?" and she would kindly respond, "We are in our room, my dear." Occasionally she would tack on a chipper, "And in a couple of minutes we are about to watch Jeopardy!"

But that was her every day and it had been her every day for years and will continue to be until the day that MS completely takes over her body and runs its course. 

I finished up my conversation with her and said that I needed to go check in with my instructor.... finding any excuse I could to leave the room before those debilitating tears made their way to the surface for all to see. 

I made my way out to the gardens of the nursing home and managed to make it to the edge of the property where I was invisible before the flood gates hit. I sat there and sobbed uncontrollably for what felt like an eternity. I don't think I can even tell you to this day what it was that triggered that ugly cry. I think it was a combination of things really... the knowledge of Steve and the struggles he went through in putting his mom in the nursing home. Remembering the tears he shed while explaining the difficulties of that decision. The relief I had of finding someone I knew in such an unfamiliar and terrifying place. The release of fear and stress I had been carrying... doubting whether I was really cut out to be a nurse at all. 

Or maybe it was the realization that the world I was in wasn't nearly as bad as I thought. I had my health. I had people who loved me a lot. I had a job and was on my way to becoming a person that could make a difference in the lives of people like her. I was incredibly lucky. 

And yet somehow she managed to be my light that day. She managed to give me hope and encouragement. She made my day infinitely better. She made that clinical rotation infinitely better. In the midst of incredible pain and devastation... she managed to show me the bigger picture that day. 

That no matter what the circumstances... you can choose to have joy... you can choose to be joy.

And really... in the grand scheme of things... life is just too short not to have joy. 

*All pictures taken on the coastal highway in Northern Ireland

7 Quick Takes Friday

1. First things first. TGIF! I think that statement is sufficient in and of itself.  :)

2. This weekend I am running a race in Big Sur! It will be a 9-miler, training race. I am really excited because this is undoubtedly one of the most beautiful places in the world and I will most definitely try and take a ton of photos along the way. Just as an example for you... a photo I found on flickr of the Big Sur coastline. Gorgeous, right?!

Big Sur, California, originally uploaded by ` TheDreamSky.

3.  Two weeks ago I did a 23 mile run. I could probably do an entire post just on that run because it was so. flippin. hard. BUT I will spare you all the torturous details of the 5 1/2 hour endeavor. (Yes, I ran for 5.5 hours) What I will share with you though, are the photos of what happens when you decide to run for 5.5 hours without sunscreen.

This is right in the middle of the peeling stages. It was so awful I had to sleep with ice packs on my shoulders for days and couldn't lift my arms above my head. I also have lovely burn lines on my calves from the capri pants I was wearing. Not cute. Moral of the story: wear sunscreen.

4. I might get to meet a fellow blogger next week from one of my favorite blogs Be Still and Know! This will be a first for me and I am very excited. She feels like a bit of a kindred spirit with her journey into becoming a missionary in Africa and it will be awesome to meet her and her husband if it all works out :)

5. One of the perks of working night shift is that you get to catch things like the royal wedding on TV because I am essentially on Europe time. Even though I am not a wedding person at all, this wedding was actually pretty amazing and fun to watch. Kate was absolutely stunning with such poise and beauty and grace. Didn't expect to care at all but when I watched it I ended up feeling incredibly nostalgic and happy for the two of them. Best part was definitely her dress. Just gorgeous.

 

Image credit

6. Next week I will be running 26 miles. It is my last long training before my first marathon. This is essentially a marathon actually since a marathon is just .2 miles longer and I'll probably just end up running the extra .2 miles so I can say "I ran a marathon!" Especially since I have to work the next day and I'm pretty sure I am going to be incredibly miserable and sore.

7. Funniest thing I heard this week at work. Actually I didn't hear it but someone told me about it and I was dying of laughter. Ok... picture a guy who looks like he came straight out of the 1970's with slightly shaggy hair and a crazy thick mustache who is just in general a pretty goofy/funny guy. This is one of our ICU fellows and during rounds after apologizing for his phone ringing he says, "I take that back. Never apologize for White Snake." hahaha  That is just awesome.


Happy Friday Friends! Yay for the weekend!!!

Joy

Waiting for a particular turn of events is a good way to head yourself into disappointment. Depending on anyone to make you happy, make you feel good or lift your spirit is a sure way to place yourself in isolation. When your joy is dependent on people and conditions, it is restricted. Joy must spring forth from you before it can surround you. Joy must be the way you walk and the way you speak to those who come into your realm. Joy is knowing you are doing what you can, the best you can, and you are feeling good about it. Joy is knowing time is on your side and wherever you are, you are the joy. Joy is taking a moment to say thank you, a day to do for self and an energy of sharing what you have. Joy is not what happens to you; it is what comes through you when you are conscious of the blessing you are.

 -Iyanla Vanzant-

 I read this quote on Yolanda Holder's blog this week. She is the "walking diva" and currently is the Guinness world record holder for "most marathons run by a woman in a calendar year." I believe she actually even tied with the male record and did 104 last year. One of which I did a 5 mile run during!

She is incredible and inspiring and I just love that she posted this Iyanla Vanzant quote on her blog. Iyanla Vanzant is one of my favorite authors as well... gotta love such women of strength, wisdom and grace!

This week I have been feeling strange. Oddly detached from everything and just kind of feeling a little emotionally lost or lack luster in a sort of way. Not particularly sad or upset or worn out.... just kind of floating through the motions. You know what I mean? 

This quote came at such a perfect time. I want to have joy. I want to be joy. In my line of work joy is a commodity. I have some co-workers who are those types of people... they exude joy in everything they do... even when they are completely livid or frustrated or exhausted.. they always have a smile to share or a hug to give. I want to be like that more often. 

Joyful.

Earlier this week I read an update on caringbridge.com from one of my old nursing instructors who is battling cancer. She wrote a simple story that stuck with me...

A blind boy sat on the steps of a building with a hat by his feet. He held up a sign that said: "I am blind, please help." There were only a few coins in the hat.
A man was walking by. He took a few coins from his pocket and dropped them into the hat. He then took the sign, turned it around, and wrote some words. He put the sign back so that everyone who walked by would see the new words. 

Soon the hat began to fill up. A lot more people were giving money to the blind boy. That afternoon the man who had changed the sign came to see how things were. 

The boy recognized his footsteps and asked, "Were you the one who changed my sign this morning? What did you write?"
The man said, "I only wrote the truth. I said what you said but in a different way. I wrote: 'Today is a beautiful day; but I cannot see it.'"

 My assignment this week was a tough one... a patient with severe necrotizing fasciitis (trust me you don't want to know more... it's a bacterial infection that eats away at your skin, muscles and bones and causes painful, awful looking wounds.)

Another patient with a severe poly-substance and alcohol abuse history and 3-4 different mental health disorders to boot. Came from our blind rehab unit as a code blue from a narcotic overdose. Now I get him a week after he assaulted about five of our nurses, (including an attempt to kick me in the face while I held him down so that our charge nurse could give him ativan) sending one of our nurses down to the ER after he kicked her square in the chest.

Yeah... not fun. 

So, two days in a row I am buried in dressing changes and drip titrations, hoping to eventually wean this guy off sedation for possible extubation in the morning. The man is on enough sedation to knock an elephant out (7mg versed, 250mcg fentanyl and 0.4 of dexmedetomidine) and is still awake, restrained and agitated... attempting to talk around his ET tube and thrashing all over the place.

Magically, by the end of the first night he mellows out and we end up spending the morning rocking out to Journey and Pink Flloyd on the classic rock station. I am pretty shameless about singing while I work. I grew up in choir and I miss singing so I love it when I have a chance to sing with/for my patients and luckily it didn't bother him at all. The day was busy but it ended well.

The next night it was the same thing all over again.... dressing change.... drip titrations... argue with the interns about getting something other than fluid for my patient's bottoming blood pressure and begging for  basically every. single. thing. I needed to make my patient stable and comfortable.

He was still agitated and nervous... suffering from paranoia and anxiety most of the night.

But then again.... morning rolls around and he is starting to mellow out. I sat at his bedside, holding his hand in an attempt to offer some comfort and he motioned for me to sing for him.... pointing at me and then pointing at his ear... waving his hand in the air like a conductor. I had the song "Landslide" by Stevie Nicks stuck in my head that whole night and knowing he was a classic rock type of guy I figured I'd just sing that. So, I pulled up a chair and began to quietly sing...

"Well I've been afraid of changin' cause I've built my life around you... 

And if you see my reflection in the snow covered hills
Well maybe.... well maybe...

The landslide will bring you down"

It's almost 6:00am now and I can see the sun start to peer over the hills... I finish the song and he motions for me to sing it again. I look at the clock and despite being behind on charting I figure I can spend an extra few minutes here... hoping he'll fall asleep for a little while.

And suddenly something changes... his grip on my hand relaxes and he closes his eyes. Tears are falling down his cheeks and I can see he is in a bittersweet moment. Pain and peace and fear, all wrapped into the same space. 

6:20am now and I look out the window again... this time being greeted with one of the most stunning sunrises I have ever seen. I immediately stood up and snapped a picture with my iPhone... hoping I could show it to my patient since his bed was facing away from the window.

"You have to see this! The sunrise is absolutely gorgeous!" I hold my phone up to his face and instantly realized what I had done....

how could I forget? 

He cannot see it.

This man is blind.

He tries to smile around the ET tube and motions for me to hold the phone closer.... he has a tiny amount of residual sight in his right eye. My heart sank as he squinted and pulled the picture about an inch away from his face. 

"Can you see any of it? Can you at least make out the colors?"

He turns towards me and shrugs with a slight nod and a small smile.

In that moment... that story became so incredibly real to me.

'Today is a beautiful day; but I cannot see it.'

I wanted to cry... I wanted to crawl into a hole and hide from the world, I felt so awful for being so insensitive to my patient... but instead I decided to have joy... I decided to be joy. I described the sky in detail to him and then proceeded to sing to him once more. I sat next to my patient... his hand in mind and I soaked up that sunrise for every minute it had left. I silently prayed... thanking God for the ability to see such a beautiful day.

It is one I definitely will never forget.