Sunday, July 27, 2014

An Important Few Moments in Time

It's one of those ultra crazy ER days with all the beds full, waiting room restless,  and the hallway filling up as well.  A rescue call comes in over the "bat phone" for an elderly gentleman needing assistance with depression and suicidal ideation.  Where can I put him to keep an eye on him and keep him safe? Which nurse can take another patient?  I wonder what medical issues he has as well?? I have no actual room to put him in.

The patient arrives, somewhat inebriated, with sad eyes and with oxygen on.  I'm told by the paramedic that his medical issues include COPD, hypertension, and depression.  He is placed on a stretcher in the hallway in between  my charge nurse station and another nursing station...the more eyes on him the better.  He is attended to by a nurse and my mind returns to the rest of the department. 

Hours go by with no change in the bulging at the seams ER.  I go to the bathroom and return to see our elderly, depressed gentleman making a beeline for the ambulance bay exit, minus his oxygen and shoes.  I take off down the hall after him and catch up to him as he reaches the outside.  He stops once outside.  I stand beside him.  "Whatcha doin?" I ask.

"I just wanted some air." 

"I get that, sometimes I come out here for a minute just to catch my breath too."

We stand still in the warm sun and take  a few breaths of gorgeous 75 degree air.
I turn to look at him and notice for the first time his ball cap...a veteran. 

We really need to get back inside.  I am the charge nurse and I need to know what's going on in there and you need to put your oxygen back on.  "ok"

I settle him back on the stretcher and put his oxygen back on.  His sad eyes pierce my heart.  I grab a stool and sit.  "So you are a veteran I see.  What branch of the military did you serve?"  He tells me.
"I was just a boy over there and I saw things that I never should have seen. "

His sad brown eyes bore into mine.  My heart cracked.  "I cannot even fathom what you saw."

"My best friend got his head blown off right beside me and I ran... fearing I was next."

I said nothing as my eyes filled with tears.  Our eyes never moved from each others.   "I see this happening over and over just about every day now and I want to die." 

"Is that why you are here today, because the urge to kill yourself is too strong?"

"Yes, I want to die...I don't want to kill myself because of my children, but I just cannot turn off my mind.  Please don't send me back home."

I sit with him for several more minutes listening to his thoughts.  For these few moments it was just he and I.  I was unaware of the chaos around me.  I just wanted to stay there and listen...stay present in that moment with him...the bat phone rings and catches my ear...and I have to go.  "I have to answer that phone, it's another ambulance call."

"Thank you for your time and for your compassion."

I thought about this man for most of the night.  I had to write about him today.  I pray that once crisis got to him they came up with a plan that would actually help him.  I may never know.  Those few moments of my 12 hour shift touched my soul, and I hope that I touched his.  It is truly sad to me that medicine has become such a business model that it takes nursing away from their patients!  We are so budget conscious that staffing is reduced~~ taking time away from nurses so that they can actually CARE for their patients.  We have just enough time to do all of the tasks required in the patient care (the IV, the blood draw, the EKG, the medications, the xrays...etc) but it is the time required to sit and be present that has been taken away.  It is not right.  That patient needed more of my time...and I wanted to give it to him...

Wednesday, June 25, 2014

Faith, God and the ER patient.

In the process of returning from taking my lunch break and walking through the front of the ER by triage I spotted one of my daughter’s friends sitting in the waiting area with her father.  I went up to them to say hello and noticed how pale she was.  "What's wrong honey?"

 “I have a headache and I’m a bit dizzy” she replied.

“She had a seizure and passed out while shopping,” her father interjected. 

After a quick triage of what had occurred I got a wheelchair, grabbed the beginnings of her chart and whisked her into room one. This beautiful, young woman, with no history of any health issues, was beginning a shopping adventure at Walmart when she woke up on the floor.  An attendant described to her what she saw happen to her and it sounded like a seizure.  “I knew something was wrong...I fell to the ground with no control of my body and strange things were happening with my mouth…It was embarrassing but I couldn’t stop it…I couldn’t control it…it was terrifying.” 

She had someone call her father and he then went to get her and brought her here.  She and I slowly, but deliberately got her undressed and into a gown before positioning her on the stretcher.  She was her normal polite, intelligent self but she was very shaky and the answers to my questions were taking a second too long to formulate on her tongue.  I hooked her up to the cardiac monitor, started her IV, drew blood, did an EKG and covered her with warm blankets before letting her father into the room.  

I reported her event and condition to our ER doc as I handed him her normal EKG. “Twenty four year old healthy female with no medical issues that had a witnessed seizure at Walmart that lasted an unknown amount of time, no loss of bowel or bladder, but has resulted in a headache and dizziness.  She has a small forming lump to the back of her head but no breakage in her skin.  She is alert and oriented but slow to respond. Pupils are sluggish and more so on the left. No other neuro deficits.  I know this girl personally and she is off just a tad from normal in her response time of questions but otherwise normal.  She has not been sick, denies being pregnant or using any kind of drugs (knowing this girl I knew this was not the case but I knew the ER doc would ask) and says nothing has been out of the usual for her.”

I went back into the room to update her and her very worried father with what would be happening and within minutes had her into Cat Scan for a head CT.  As I pushed the stretcher to CT, she asked me if I was concerned.  Because I have known her since she was 5 years old… “Well… I’m trying not to be” I said with a smile. “Me too, “she replied.  After leaving her in the CT room I walked back to the ER, all the while praying, Heavenly Father…please let this Cat -Scan be normal, and if not…give me the strength to be strong as I help her with any bad news…In Jesus name.

I walked by room one on my way to the nurses station and I stopped outside the door~~ her father (an assistant pastor of the Pentecostal faith) was pacing in the room praying audibly in the his deep baritone voice~~ it brought me back to the pew I always sat in at church~~ Jesus Jesus Jesus, I place Emily before you Lord and I ask you to surround her in your presence during this test and I pray for my daughter to be healed of anything that may be causing her to be ill…Protect my daughter this day Lord… the tears that I had been fighting out of concern for Emily sprang from my eyes as the prayer of this father was being sent heavenward; it was beautiful and haunting.

Her brothers arrived and were in with their father as I delivered her back from CT.  They were visibly worried and hovering around her.  This family is tight and to watch the bond during a crisis is a very humbling thing. They gathered around the stretcher she was lying on, held hands and prayed. They prayed loudly, with heart and with conviction. They prayed the scriptures over her and did so with bold intention. If you have ever been in a Pentecostal service you would know what I am talking about. There is nothing more powerful to hear and it brought me to tears again as I felt the Spirit of Jesus in that room.

“A brain tumor”… the radiologist was on the phone telling me that my beautiful young patient had a brain tumor.  My heart was pounding wildly and my mind was furiously racing in prayer…Jesus be with Emily and her family as we relay this news to them. Provide comfort and strength to them as they process this information and deal with the next few hours of more tests and calling of familyI waited for the doc and together we went into the room to tell them the findings of the CT.  There were no initial tears; there were questions and stoic, worried faces. I went to her and sat down by the bed and held her hand. I answered every question I could and told them every step coming up as I knew it. Phone calls were made and more family, friends and church family arrived as we tried to arrange a transfer to a larger hospital for further testing.  As time went forward the large crowd of loved ones in with this beautiful young woman showed anyone involved in her care that day the power of faith, the place of religion in people’s lives and the amazing power of the Spirit of Christ as His people call on His name.

I share this with you because I recently had a patient tell me (after they asked my opinion) that there is no place for religion in the hospital and that it was on the level of separation of church and state… of course I disagree… I am a Christian so for me there is no separating “church” from anything but on a level of just health and faith… numerous studies have been published regarding faith, prayer and how they affect the patients outlook and overall health for the better.

This young woman went on to have her cancerous tumor (Oligodendroglioma) removed, go through treatments and rehab and is to this day still cancer free.  She is a nurse and a young bride that boldly lives her life for Christ… Thank you Jesus!!

What are your experiences with Faith in your job???

Tuesday, June 3, 2014


I know I’m sitting here on this stool because I can feel it under me.  I see my patient across the room but I cannot easily take in the image.  My brain feels like it has stopped functioning.  I can’t think and all I can feel is the stool and my heart pounding in my ears.  Somewhere in my brain I hear myself praying for wisdom, for guidance and for composure.  

I was called to the ER at 2:15 am by the nurse manager,  “There is a young woman here that appears to have been assaulted…the only details we have are disturbing.”  A sheriff met me when I arrived in the ER.  “She ran into the ER half naked, bleeding and disoriented…she has yet to tell anyone anything and when she was brought to this room she ran to the corner and sat just as you see her now.  We still don’t know her name.”

My patient is not a child, but yet not an adult.  She is on the floor, sitting against the far wall in the corner with her knees pulled up and her arms wound tightly around them.  Her face is buried in her knees and her long blonde, stringy hair is cascading down over her low legs.  Her dirt and blood-covered,   feet are exposed.  She has no shirt on and her shorts are ripped.  Her arms have scratches, dirt and dried blood on them. 

I have been sitting here on this stool for 20 minutes.  The clock is loud, each tick annoying me.  She hasn’t moved or even shifted her position.  Shock.  When I first entered the room, I did so very cautiously as not to scare her.  I told her who I was and then I sat.  I told her I would sit with her as long as she needed me to and that she could take her time in talking to me.  Time has brought me out of my initial fear fog and I am feeling more myself.

Just as I am about to speak I notice my patient is lifting her head to look at me.  Her hair is partially covering her face.  In a mere whisper she asks me, “Am I safe here?”
“Yes you are.  There is a sheriff right outside this door and he will NOT allow anyone in unless I, or you, say it is okay.”

Slowly she edged her legs out in front of her and covered her chest with her arms.  “May I move to the counter and get you a blanket?” I asked her.  A quick nod yes.  I slowly retrieve two blankets.  “May I cover you or do you want to cover yourself?”  No response.  I unwrap the blankets and go to her.  I cover her.  She then grabs the blanket around herself tightly.  “Thank you.”

“So, once again…“My name is Bobbi and I was called in to take care of you.  When you are ready I can help you off the floor and you can lie or sit on the stretcher…or we can talk while you stay on the floor, it’s up to you.”

She again is lost in her mind and doesn’t move or utter a sound for what seems like an eternity.  Finally she again looks at me and asks me, “Have you ever been raped?” 
I take a deep breath and tell her “no, I have not.”  I watch her measure her words as she shifts her eyes to the floor.  A giant tear escapes her left eye and misses her face altogether and splashes on the blanket, “I pray you never are.” 

I will not share the details of the heinous act that happened to this young woman.  My exam time with her was 6 hours. Her life touched mine in a profound and lasting way. She wrote me a letter 2 months after the rape and told me how grateful she was to me for my kindness and for my nursing skills. (Unknown to me at the time…she was a nursing student.)  She told me she had moved to another state with a relative and still wasn’t sleeping, but felt safe.  She asked me to pray for her. She had dropped out of nursing school for now and wasn’t sure if she would return.  

Today is the anniversary of that meeting…4 years ago.  I see it in my mind and feel it in my heart as if it were yesterday. 


Saturday, April 5, 2014

The gift of Rose

The phone call woke me at 2am.  Being the hospice nurse on-call, it was my duty to be present for any patient’s death if I was needed by the family.  The daughter who called was hysterical on the phone, and even though “I’m sure she is dead…but maybe she isn’t…I think she is still in pain…please come.”  I dressed quickly, grabbed my nursing bag and drove to the tiny town 28 miles away. 
The odor of death met me at the entrance to the upstairs bedroom.  I had been prepared and spread a thin line of mint balm under my nostrils~~ but the odor seeped through it and entered my nostrils anyway.  That’s the way with death…its particles are alive and they cling to the tiny hairs in your nose to preserve some tangible element to remind you that there was once life there.
As I cracked the door open I closed my eyes and silently prayed for calm.  I desperately tried to breath as shallow as possible to quell the waves of nausea that began to roll in my stomach.  Smells of urine, feces and bed sores hung in the heavy, stale air.  One tiny night light sent out translucent beams of light toward the small twin bed in the center of the room.
Her daughter wept behind me.  “She’s gone isn’t she?” she whispered.
I didn’t answer her just yet.  I moved to the bed and sat my bag down with my right hand as my left hand turned on the bedside lamp.  Light broke the darkness and illuminated the tiny elderly woman’s frame lying on her back in the center of the bed.  Her skin was pure white and melted into her hair line. Her mouth was open, baring gums and blackness.  Her eyes were open, but unseeing….blankly staring at the far wall.  The multicolored quilt that covered her looked oddly out of place in the darkly painted room.
Her daughter sat in the oversized blue chair in the far left hand corner of the tiny bedroom. She rocked back and forth while mumbling an unintelligible prayer of sorts.  I took out my stethoscope and gently placed it over Rose’s heart and waited…nothing…only stillness.  I checked her carotid for a pulse and placed my face next to her open mouth to feel for any breath…nothing~ again only stillness.  I knew she was gone, but often times the family needs these tangible, observable assessments of life to assure them of the truth.
After the exploding grief of pain that accompanied the confirmation of death that I delivered to her daughter… I asked her if she wanted me to clean her mother up and ready her for the funeral home.  She told me she wanted to help me… “She was once so proud.  She hated the way she smelled and the way that our family stopped coming by.  She prayed that God would deliver her from her torture for 6 months.” 
As her daughter left the room to get a new nightgown and some towels, I took rose and spearmint essential oils from my nursing bag and put several drops in a basin of warm water.  I lit a clean linen candle that I kept in my bag and placed it on the bed side stand.  When she returned we slowly bathed her mother.  We started at her face and worked our way to her feet.  Several moments were spent in silence, and some were spent in the sound of her grown daughter’s tears.  We placed clean lines underneath her and covered her with a clean white sheet and the multicolored quilt.
While we bathed her, I learned that this patient was a ballerina and the she taught classes until she was 70.  She was married at age 18 and widowed at 30.  She had a master’s in music and played classical music every day as therapy for her sadness.  She never remarried.  Her daughter was an only child and her best friend.  She never ate meat and only drank once a year on her husband’s death anniversary.  She had 2 sisters that she adored, but then resented as they stayed away.  She never ate at fast food restaurants but she loved the smell of Pizza Hut.  She loved flowers but once she got sick she couldn’t stomach their smell.  As she grew sicker she never wanted to talk about dancing or listen to classical music.  She didn’t accept chemotherapy or radiation and she lived with her cancer for 4 years.  She was only in pain at the end. 
I wish I had known her in life.
That couple hours of time was one of the richest experiences I had in my years of doing hospice nursing.  Rose was not my patient so I had not met her before that night.  Her daughter needed me and I was so glad that I answered that early morning call in April.  Bathing her mother and readying her for the “last part of the journey” was such “a gift.”  I was honored to help and be present for this moment in their lives.  I have never seen the daughter again, but the memory surfaces during April every year…

What are your most treasured memories from your career???? 

Wednesday, March 19, 2014

Always listen to the heart

I slowly walked past the patient room and caught a glimpse of her.  She was gazing out the window with a fixed expression.  She wasn't my patient, but something about her gaze stopped me from moving on.  I leaned against the door frame and took in the sight of her.  The neatly made hospital bed swallowed her frail, aged frame.  Her long white hair was in a low loose braid, and the tail end of it draped her left shoulder.  Elegant crooked hands were clasped and cupped the bulk of a black rosary. 

My eyes swept the room.  Her monitor registered stable vital signs.  Sun spilled in from the large window and blanketed the floor, the bed table, and the end of her hospital bed.  Books were stacked neatly on the bed table. A large, half-filled water bottle sat in the center of the table. Evian. The T.V. was off. 

A movement from the woman drew my eyes back to her.  She slowly and deliberately brought her rosary filled hands to her mouth and kissed the cross.  As she did this my heart tightened.  I didn't know what her mind was thinking, but the sight of this simple gesture caused me to enter her room.  She looked at me with large blue eyes but with no change of expression.  I went to her.

“Hello, I’m Bobbi.  I am on this floor today as a Nursing Instructor for UMA, and I was passing by your room and just felt the need to come in.  Is it okay if I sit with you for a moment?”

I watched my words register and a small smile tugged at the corners of her mouth.  “Yes dear, that would be nice.” 

She continued to hold the black rosary between both of her hands and rubbed the beads with her right thumb.  “The sunlight coming through this window is amazing,” I remarked.

“This new hospital is pretty fancy,” She offered.

“Yes it is,” I said with a smile.  She watched my face but didn’t speak.  I probed, “How are you feeling today?”


I wasn't sure if I should stay…I didn't feel unwelcome, but I got the feeling I was intruding somehow.
I stood to go, “Well, I just wanted to stop in and say hello…something about the way you were staring out the window just caught my attention and I felt drawn to you.  I will leave you to your thoughts.  It was so nice to meet you.” 

I watched her blue eyes fill with tears, “stay.”

I sat.  I watched her gather her emotion and stuff it back inside.  My heart was beating rather fast and I couldn't shake the feeling she needed me.  My eyes watched the monitor register her pulse speed up and I waited.

She slowly began speaking in a soft, but strong voice, as she stared past me out the window, “I am alone in this world.  I live alone.  I eat alone.  I pray alone. Oh I know that I am technically not alone because I have my faith and it does comfort me…but I am physically alone.  I came to the hospital because I felt terribly afraid that I might die…today, at this very moment as we are speaking my husband and my only daughter died in a car accident 10 years ago.”

She let that hang in the air as she continued to stare out the window.  One tear escaped her right eye and weaved down her lined face.  Time seemed to stop as I watched that tear and silently prayed for guidance.  The tear got trapped in a wrinkle and stopped by the corner of her mouth. She didn't wipe it.  She sat there enveloped in the bed and just stared out the window. 

I fought tears.  I fought the urge to talk.  I normally talk…I normally try to comfort people with words…But I felt God’s hand over my mouth.  I just prayed for her pain.  I waited, it seemed like hours passed by in that 2 minutes of silence. 

She pulled herself out of the memory she was lost in and looked at me.  “Do you have a family?”
As I told her of my family I watched her smile.  We talked about family and some of her memories for quite some time.  As I stood to go and check on my students, she reached her right hand out to me.  I walked to her and took her hand.  “You will never know how God used you today,” she tearfully whispered. 
I smiled as tears of my own formed.

“I was silently begging God to send me someone to just sit with me as the moment I heard of the car accident approached.  I didn't want to be alone…just this once as the memories crashed my soul.”
I couldn't hold the tears…they burst from my eyes and dumped from my cheeks.  I couldn't speak.
I moved to her and sat on the bed, and then I hugged her.  She hugged me back. 

It’s a beautiful thing to know that you were used by God.  Being a nurse has so many responsibilities attached to it.  Let us not forget that we are first and foremost gifted with the responsibility to be human…to be a vessel of healing in ALL ways.  I will never forget that woman nor will I forget those moments in time every year from now on as I will lift her up in prayer so she will NOT be alone.  What a gift to be a nurse~ To be able to be present with a patient…