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...

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 family. I 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???

ER NURSING AND RAPE

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. 

  

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???? 

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?”

“Better.”

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… 

Exactly what does a nurse do anyway???

There we were, a bunch of people that I love, sitting around the table discussing our week, and the subject turned to jobs...then somehow it turned to college and why education was or was not important.  The subject then turned to nursing education and just how much was truly needed in order to "become a nurse." 

One of those people that I love (and of course still do) gave the opinion that "nursing education has turned into something so ridiculous and hard...mostly you just need to know how to follow doctor orders...it truly would only take half the time to educate someone to be a nurse"...and on and on it went. I will spare you all the "in depth" conversation that followed~~ BUT what this conversation did do for me was cause me to reflect on a lay person's idea of what the job of nursing entails...

Educating people to become a nurse entails so much more than teaching the technical skills required to be a nurse. 

Yes we teach them how to wash their hands properly (to not spread infection) take vitals signs (Blood pressure, pulse, temperature, count respirations, oxygen saturation and assess pain), insert foley cathetors, IV lines, nasogastric tubes, and trachs, give a bed bath and change linens, safely move people in bed and safely ambulate someone or move them to a wheelchair etc, to "wipe butts" and empty bedpans, hang IV drips and give medications in many forms...and on and on and on.

AND YES we could teach just about anyone to do these things.

BUT we also teach them anatomy, physiology, pathophysiology, biology, microbiology, immunology, algebra, chemistry, English grammar, sociology, psychology, developmental psychology, abnormal psychology, pharmacology, health and wellness/assessment across the life span, science of nursing, alterations in health/ illness, nutrition, nursing theory, research, informatics, clinical decision making, transcultural diversity and relations, ethics, professional behaviors, spirituality, death and dying processes, nursing management, leadership, community health, interpretation of lab values....and on and on. 

We also teach all of the above through concepts of human caring, basic human needs and teach the nursing process. 

We teach them all of these things in order to prepare the nursing student for the art and science of nursing. We educate them properly so once they are in the work setting and "following doctors orders" while performing their technical skills, that they will do so safely. The subjects that are taught give the nurse the ability to use the technical skills as a compass to asses the true health status of the patient. Without the knowledge base~~the technical skills would have no meaning.  

So~~ while the nurse is talking to their patient they are studying them and assessing their neurological status and assessing their oxygenation. During the communication with their client they are also assessing the patient for knowledge level, home safety, patient advocacy, illness insite, inside information to shed light on present situations and to develop a relationship of caring so that healing can occur. 

While the nurse is checking the patient's vital signs they are learning about their cardiovascular, respiratory and thermo-regulatory states.  

When the nurse is giving their patient a bed bath they are assessing their skin integrity, their ability to assist (their strength), fluid balance, nutritional state and infection/ skin breakdown risk. 

While assisting someone to a wheelchair the nurse is providing safety while assessing their patient's strength, cognitive ability, safety risk and spatial awareness. 

When inquiring about their patient's med list the nurse is assessing the patient's knowledge around their disease processes as well as their safety regarding how, when and why they take the medications. 

During the process of changing a patient's dressing the nurse is assessing the wound healing stage, the surrounding tissue state, as well as checking for odor/infection...they are also assessing whether that type of dressing that was "ordered by the doctor" is actually working.  

While "wiping butts" the nurse is assessing skin integrity, assessing the color, odor and consistency of the stool to detect disease states or healing. 

When a nurse is "following a doctors order" and medicating their patient, that nurse does 6 checks in order to ensure the patient is receiving that medication correctly~~ but more importantly the nurse has to know why that med was ordered, and they need to know if it is the right dose for that patient, and they need to know what side effects to watch for...and on and on and on.  

I could go on!!  The bottom line is that the nurse is with the patient far more than the doctor is. The nurse is the front line (bringing their thoughts, assessments, interpretations and communications to the doctor in order for the proper care to be given to the patient) and safety net for their patient (ensuring that the doctor's orders are indeed safe for the patient and not given if they are not!). If the nurse isn't educated but merely taught technical skills, then that nurse would not be able to do the above I just mentioned and the health of the patient would be in jeopardy. 

How educated do you want your nurse to be???? 

The wisdom of reflection

He sat on his mother’s lap clinging to her for dear life as he screamed in fear.  The hospital bed seemed to hug them as they sat in the center of it, leaning against the head of the bed that was at a 75 degree angle. His little body was shaking and his large dark eyes darted from one nurse to the other as they prepared to take out his existing IV and replace it with a new one. “No, No,” he cried. “Mom, mom,” he pleaded between screams and sobs.  His young mother was desperately trying to sooth his fear while suppressing her own.  She was tired, and her eyes betrayed her calm exterior as they were filled with sadness and protective instincts for her child. 

I watched them.  I prayed for them.  I desperately wanted to take this experience away from them.  This young patient is only 21 months old.  He is my grandson.  She is my daughter.  I was not there to be his nurse but to be their protector and guide through this experience and I felt like a failure.  I wanted to grab him and run away.  I wanted to cry. 

The nurses approached them cheerfully and tried very hard to sooth him by explaining things and by quickly and skillfully doing their job.  He would have none of it!  While he was a good trooper he was scared.  Fear is hard thing to watch your grandson and son struggle with.  The doctors were very good at providing us with timely updates and filled us in often of their concerns and thoughts as treatment progressed.  Added to the current fear of being in the hospital with a sick 21 month old, was the knowledge that the doctors were concerned that possibly our amazing little man “might possibly have lymphoma” because of his lab values…something they were looking into…

He was hospitalized after a week of strept throat that wasn’t treated or diagnosed by his pediatrician despite my daughter visiting the office 2x that week with her child who had a fever of 101 every day, consecutively all week.  As a result, he developed a large abscess posterior to his parotid gland that was drained of 15cc of bacteria after the second admit day.  He had to receive IV Vancomycin until they knew what the cultured drainage was growing.  He was sick of being sick and sick of being trapped in a small room with people accosting him! 

My daughter is a wonderful mother, she gets her protective instincts from me…anyone who knows me will know that I take protecting those in my care very seriously…as does she.  I watched her with awe and admiration as she loved, protected and cared for her son.  I watched in awe at my grandson who could still show curiosity, kindness and have fun during the times he wasn’t in pain or fearful.  The ability of being able to adapt to his situation was inspiring.  My son-in-law was equally strong as he provided his own brand of presence to the situation.  Watching them together parent their child in this very stressful situation gave me peace as I saw the strength and love they have for their child and one another.

Being an ER nurse I of course understood why all the medical interventions were needed.  As his grandmother, and my daughter’s mother, I was scared, angry and protective.  My husband and our family that was home in Maine were also sitting on pins and needles as they waited and worried about this precious little boy of ours. The experience reinforced a few things for me.  As a nurse it is our job to skillfully and compassionately provide our patients and their families with the treatment and care they are prescribed.  It is our responsibility to bring them accurate and knowledgeable information in a timely and routine fashion; giving them time to ask questions and to answer those questions without impatience or judgment.  It is our duty to care about the situation they are in and to convey that with a kind presence, a caring touch and to give them moments of our uninterrupted time to show them they are not alone. It is our calling to see the patient and the family as human beings in a scary situation.  There is also a piece that hit home for me…those family members and friends that continually come in to see their loved one are coming out of concern and they offer hope and distraction from fear for the patient and family. I challenge anyone reading this who is a nurse to reflect on your practice and be sure that you are truly the nurse you were meant to be.  Your presence is vital to the mental and physical wellbeing of your patients and their families. 

Lynchburg General Hospital in Lynchburg Virginia has an amazing pediatric unit filled with compassionate and truly skilled nurses who did all of the above with grace and humility.  The doctors were equally skilled at their job and also did it with much compassion.  My grandson fully recovered and is now running around at breakneck speed as usual!  He does not have lymphoma! Thank you Jesus.

 

An exercise of compassion

The ER is in total chaos today.  All 23 rooms are full, the behavioral health suite is full, the waiting room is full and even the hallway is full. Full of sick patients.  The nurses are frazzled, working as hard as they can delivering treatments, hanging IV medications, soothing fears, charting and carrying out each order on every patient. There are 23 rooms in our ER.  The waiting room has 12 triaged patients waiting for a room, the hallway holds 5 stretchers with sick patients on them and the behavioral suite has 5 patients in there (3 counted for in the room number).  We are currently in a crisis situation~ we have 2 doctors, a PA and 6 nurses.  Its only 9am. 

At this point another behavioral health patient is brought into our ER by the state police.  He is psychotic and half-dressed and screaming at unseen people.  He was found in the park yelling at a tree.  As the charge nurse I go out to assess him (the triage nurse is busy).  I find him to be completely in need of psychiatric help and not suitable to be allowed to stay in the waiting room, (as you can imagine the other patients and their families were getting an eye full!!) BUT where can I put him to him safe and to keep the staff and other patients safe???  Shuffling of patients begins…

Our ER, like every ER across the country is facing these situations every day.  The budget cuts to the mental health programs have resulted in catastrophic cuts in the community resources that our patients need to stay healthy and out of crisis situations.  The ER has become the place to send all of these patients. Once with us, the truly ill might be kept in our ER for days while waiting for a bed to open up in a psych hospital. 

Behavioral health/mental health patients are especially frustrating for us ER nurses for a few reasons.  We are not psych nurses, so many times we feel overwhelmed with how to help them, they are hard to manage both medically and emotionally and at times they have multiple outbursts that are unsafe and scary, they take up many of our limited resources (staff and beds) so we again feel overwhelmed, and the frustration level rises every time we present their situation to another hospital hoping they can be seen and helped in the fashion they need~~~ and they get declined due to “that patient just doesn’t fit our milieu.” 

With all of that said~~ how can we as nurses see these patients through a new lense??? Since we have no control over the red tape of the Psych world maybe there is something we can do to see the patient as we do the chest pain, the trauma and the septic patient; we might have less frustration and feel less overwhelmed.  I decided to try something~~ and it was an exercise in compassion. 

I decided to be a mental health patient to walk a mile in their shoes~~ to see how it feels on some small level.  With the ok from my supervisor and the help of the staff, I came into the ER and “signed in.”  At first it was silly and giggles erupted from myself and the triage nurse…but then as I was asked the multiple intrusive questions, and brought to a room to change out of my clothes and given the blue paper scrubs to change into, things were not so funny.  Out of respect for me the nurse didn’t stay in the room and watch me change~ BUT if I were truly in crisis she would have had to do that… once changed, all of my belongings were taken from me, bagged and locked up.  I had to be without my bra and undies…NOT COOL…and I couldn’t keep my cell phone either.  I was then moved into the behavioral health suite~ scary……….  I wanted the full experience so I was then put into 4 point restraints for “an unsafe outburst that put myself and the staff at risk of harm.”  At that point I was scared… something happened. 

I always knew that putting someone in restraints made me sick to my stomach…I knew on some guttural level how awful it must feel for that person.  Now, I know why we do it and I’m not saying we do anything wrong, I am just saying that it is WORSE than I ever imagined it to be.  I stayed in them for 15 minutes, and I was with people I trust… and at one point I had to tell myself to not freak out!  My nose itched and I couldn’t scratch it.  I didn’t like the way the shirt was slipping up off of my stomach… I felt so out of control… when I was released from the restraints I felt like crying.  I had the luxury of saying, “ok this little experiment is OVER!! I honestly can tell you that it was a good experience, in the fact that I got just a little taste of how the patient must feel…and it opened my heart as well as my eyes. 

There may not be anything I can do to get the mental health patient to a psych bed any quicker…BUT I can have a better understanding of their situation and a bit more compassion. 

Tears and being present.

The call came in from EMS as “72 y.o. man with end stage Lung Cancer in respiratory distress~ vitals stable~”.  Family requesting transport to the ER for evaluation. He is on Hospice~ the nurse tells us the family is no longer able to cope with him at home.”  I went to room 7 to prepare for my patients arrival.

My patient arrived 10 min later on the EMS stretcher~ His gaunt frame fought to hold up his head~ his skin was dry but pale, respirations were labored but controlled at approx. 32 bpm~ his eyes were open wide and they never left my face as the paramedics brought him into the room and moved him to the bed.~ The venti mask covered his mouth so I couldn’t quite understand what he was saying to me. The paramedic was delivering his report but I was so distracted by the look in my patient’s eyes that I went to him and removed the mask so he could talk to me. 

“My wife is coming (breath) with my son (breath) please let her (breath) in when she gets (breath) here…she (breath) has Alzheimer’s (breath) disease and she (breath) is easily scared (breath).” 

I placed the oxygen mask back on his face and reassured him “My name is Bobbi~ and I will be your nurse tonight~ I promise you I will let your family in the minute they get here.”  With just that simple promise I watched his shoulders relax, his head rest on the pillow and his eyes close.  As I worked to deliver a Nebulizer treatment to him, get him on the monitor and draw his labs I asked him some questions.  He nodded yes or no to most but did tell me “I do not (breath) want to be saved (breath)if I die here (breath) please just keep (breath) me comfortable (breath)…I have a DNR.”  He assured me that his family was aware of this wish, “all except (breath) my wife who (breath) just doesn’t understand (breath) what is happening.”

10 min later my patient was much more relaxed and breathing easier post DuoNeb, Ativan, Morphine and repositioning.  His wife, son and daughter had arrived and were now in the room. I found a rocking chair for his wife and brought her a cup of tea and a warm blanket.  As I talked with their children about what had transpired in the last few hours I watched his wife tend to her husband.

Her brow was furrowed as she moved to the head of the bed and rested her hand on his forehead.  He smiled at her. She said to him, “see… you’re okay now…” She picked at his blankets and smoothed out his pillow. 

“My mother is in and out with her thoughts…she has Alzheimers but all in all she is in the present moment lately,” her son told me.  “Our sister died of a rare lung disorder when she was 40 and my mother has never been the same. I think my father’s breathing issues are reminding her of that because she is talking about her a lot.”

As the evening progressed my patient grew more agitated and anxious with his increasing respiratory distress… despite our interventions.  The doctor and I talked with the patient and family and the decision was made to increase his morphine for more comfort.  My heart ached as I watched his wife struggle with the information…she understood in one minute but in the next minute she did not…she paced and cried…she tended to him by readjusting his blankets, offering water, kissing his hand. She on several occasions would get up close to her husband’s face and cry to him, “don’t leave me…please don’t leave me…”  His daughter left the room often in tears and his son tended to his mother.  He reassured her often with his hand on her shoulder, “Ma, it’s okay…dad isn’t in any pain and the nurse is helping him…don’t be afraid.” 

Two hours later my patient passed away~ more peacefully than when he arrived…His family struggled to let him go and to be present for one another.  His wife at first didn’t believe what she was seeing…she begged me to help him…how could I make this woman understand that I couldn’t…tears fell from my eyes as I watched her son hold her as she cried for her husband.  She came to me and put her arms around me and I hugged her back…she cried long deep cries of sorrow~ My heart broke. 

As I write this I continue to cry for this woman.  They were married 50 years and now her husband is gone. Her house is empty and her mind is clouded…what will become of her?  My best friend lost her husband to cancer 3 months ago and I know the pain she is in…deep dark pain~ I pray for them both. 

Being a nurse is at times a painful job…Even though I know that giving a patient and their family my heart is needed; it at times is overwhelming.  I saw this patient’s son yesterday in Subway~ he approached me and thanked me repeatedly for the care I gave to his father and his mother.  He told me that my compassion was worth more to them than anything else I did that night… I guess for the families being present is exactly that….a present!

Transpersonal caring relationships in Nursing

I walked into room 15 to introduce myself to my new migraine patient and I found her rocking back and forth on the stretcher.  Both of her hands were firmly pressed into her forehead and covering her eyes.  The chart says my patient is 17 years old but her tiny frame all curled in a ball made her look 10 as she rocked in pain.  An older woman sat in a chair in the corner of the room and looked at me with pleading eyes. 

I quietly closed the door and moved to the stretcher.  I sat the chart down on an empty chair and softly introduced myself to my patient and her mother. 

“Hello (name), I am Bobbi and I will be your nurse today…I promise I will get you feeling better soon.”

“Please help me,” my patient answered without moving her hands from her head.  I asked her to rate her pain on a scale of 1-10 with 10 being the worst pain.  She whispers “9”.  I asked her an acceptable level of pain and she whispers “not a 9.”

Her mother informs me that my patient has a 4 year history of migraines since suffering a major trauma…she mouths what the trauma was to me with a look of great distress.  I nod to her that I understand and move to my patient.  I tell her that I will start an IV and hang some fluid to get started while we wait for the doctor to come in.  I turned the light off as I left the room.

I put her chart in the doctor’s rack and went to gather supplies.  My patient was fourth in the rack to be seen~ hence about an hour.  I had one other patient at this time so I went to check on them and then returned to my little teen’s room. 

I entered her room and softly told her, “I need to turn the light on while I start your IV but I will turn it off as soon as I’m done.” I covered her with warm blankets and put my supplies on the bed. 

She continued to rock back and forth without answering.  I quickly started her IV and hung the saline wide open for a 500cc bolus.  I got two washcloths out of the closet and ran them under cold water.  I placed the cloths on her forehead and the back of her neck.  Tears leaked from her eyes.  I went to ask the doc for some orders for pain meds… the doc said, “I have to examine her first.” 

I went back into her room and asked her permission to give her a hand massage.  I explained to her that it would help relax her and ease her pain. I asked her if she was allergic to the scent of peppermint and if she minded me using the essential oil while I massaged her hands… She agreed.  Her mom remained sitting in the corner watching my every move. 

I slowly and deliberately massaged each of her hands for 10 minutes with the peppermint oil.  After the first few minutes she visibly relaxed and tension began to release from her body.  After the first hand was finished I moved to the other side of the bed to massage her other hand~  she was completely still and her face was relaxed…her mother patted my shoulder as I sat down in front of her and whispered “thank you so much” into my left ear.  I finished the massage of her second hand and just sat quietly for a moment observing my patient.  She opened her eyes and smiled at me.

“I didn’t believe that was going to help but I feel so much better!”  She then rated her pain a 5 on the pain scale.  I smiled, refreshed her cold cloths and told her, “I will let the doctor know what we have done and he will be in soon.”  I left the room and went to doc…I informed him of my nursing intervention…he looked up and said, “Cool.” 

The end result of this encounter~ a happy patient~ hugs from each lady in room 15~ and a satisfied nurse~ a patient who only required a bolus of fluid, hand massage and an injection of 30mg of toradol before going home a very happy girl.  For me ~ another example of the power of nursing presence, alternative therapies and transpersonal caring relationships!   

Holistic Pedi care in the ER

Her little blue eyes darted from her mother to me repeatedly as tears built up and dropped onto her cheeks. I smiled at her and set my equipment down on the counter.  Her little chin quivered with fear as she struggled to compose herself.  Her mother quickly rushed to her side on the stretcher and held her tiny body close as she explained, “I’m sorry honey but we have to do this.” 

I sat on the stool near the counter, a few feet away from the stretcher, waiting for this little girl’s mother to finish consoling her child.  I was well aware of the fact that this little one knew all too well how painful things were about to get and she was trying so hard to be brave.  (2 months prior to this date this child came in and had to have a large MRSA boil lanced and the IV didn’t go so well so she was drawing on the only experience she had and FEAR was very palpable…)

“Do you have to do the IV?” she pleaded with her eyes for me to say NO.

“I’m sorry honey, but Yes, I do have to put in an IV…BUT I’ve been doing this for 23 years and I promise you I will do it quickly!!” 

“The other nurse last time didn’t get the IV and someone else had to do it…it hurt as bad as when my brother hit me in the head with his body on the swing set and knocked me over.”

I tried not to laugh but she was being so cute!!  I smiled and said, “I can only imagine how bad that must have hurt~ But I put that numbing gel on you so this needle won’t hurt so much.”

“Okay I guess I’m ready…but I might still have to cry.” 

Sympathy gripped my heart as I gathered my things and moved to the stretcher…I sat down to her level and let mom adjust herself to a holding position.  Little sniffles echoed through the small room.

I explained each step and then I explained that, “If we sing Rudolf the red nosed Reindeer this won’t hurt much at all.”  On the count of three we began singing~~~ loudly.  J

By the time we got to “very shiny nose” the INT was in place and I was drawing blood…we kept singing and by the time we reached “All of the other Reindeer…” I was done.  Her tiny little eyes grew large as she excitedly exclaimed, “I didn’t even know you did it~~~ the singing worked Mom!”

An hour later we were finished with the minimal conscious sedation procedure of lancing 3 large MRSA boils and my little Pedi patient was waking up nicely.  Her mother hugged me tightly and thanked me repeatedly for my nursing care.  “You were an expert with comforting my daughter and I’m so thankful for your IV skills!  Thank you so much.”

As I reflected on that experience I realized that often times I get thanked for things of comfort provided but today I was thanked for both my comforting of her daughter, the distraction techniques used AND for my nursing skills… As nurses we have so many responsibilities and requirements of knowledge~ but it truly is our total package of experience, knowledge and caring that give the patients and their families what they need.  It was a good day.

holistic nursing and the surgical patient

A category 2 abdominal pain patient was brought into room 5 from the waiting room of my ER…She was an early 20 something who happened to be 17 weeks pregnant…she was complaining of diffuse belly pain, fever and nausea that had escalated over 48 hours.  I watched the tech wheel her by the nursing station to go into room 5.  She was petite in stature, and even smaller in appearance as she hunched forward guarding her stomach with her arms.  A very worried looking older woman accompanied her. 

I quickly exited out of my charting on the computer, grabbed her triage information and scanned it.  I went to the med room and collected an IV tray, saline, and a Doppler.  As I entered the room I quietly laid my equipment on the counter and walked to the stretcher.  Worried eyes looked at me from the face of this attractive young woman.  She sat on the stretcher in a semi-fowler position with her knees drawn up to her stomach.  She held the older woman’s hand and barely changed expression as a tear fell from her left eye. 

I outstretched my hand to her as I introduced myself to them both.  “My name is Bobbi and I will be your nurse tonight, I promise to take very good care of you and make you more comfortable as soon as possible.” 

“Thank you…and my name is ***** and this is my mother….I’m pregnant” she tearfully answered.

After she finished telling me about her abdominal pain I examined her, assessed her vital signs again and started an IV, drew blood and hung NS at 150/hr.  Using the Doppler I found her baby’s heart beat to be a bounding 176…this brought a fresh tirade of tears from both women as they visibly exhaled with relief that the baby was okay.  Her temp was 102, respiration's 22, heart rate 122 blood pressure 126/70, lungs were clear bilaterally with a room air sat 100%.  Her skin color was pale and very warm to touch.  She rated her pain 8/10.  She had positive bowel sounds all quads and was extremely tender to the slightest touch with positive rebound tenderness. 

As the next couple of hours went by with tests and the diagnosis of appendicitis ~ I carefully took care of this patient as we awaited her trip to the OR.  She was quiet but strong…she was childlike when the pain intensified and somewhat soothed by her mother’s reassurance.  I administered morphine often in small doses to alleviate her pain…I gave her cool cloths for her forehead, dimmed the lights and sat with her.  I offered her constant reassurance that her baby would be okay~ when my interventions for her and my other patients were completed,  I was able to give her a hand massage and Reiki as we waited. 

What I noticed, as did her mother, was that during the hand massage and during the Reiki treatment her pulse significantly lowered and her breathing slowed as her face relaxed.  The pain meds helped of course but the visible transformation of her facial and body features during the relaxation therapies was so obvious that her mother commented on it several times.  As I wheeled her to the OR she again asked me for reassurance of her baby’s safety…I gave this to her.  Before I left her in the care of the OR team she tearfully took my hand and thanked me for caring about her and her baby…she thanked me for the way I cared for her in the ER… “the touching therapy helped me so much…thank you…Can you come and take care of me when I’m in labor? She asked with a grin”…

Walking back down to the ER I felt so thankful that I was able to take care of this patient in her wholeness…body/mind/and spirit.  I have been blessed these last few years to have my nursing skills enhanced with the knowledge of holistic care and the learning of alternative therapies like hand massage and Reiki.  My BSN classes included a Reiki course to which I became a level 2 practitioner… I now have the awesome pleasure of teaching Nur. 101 and I’m able to pass on the teachings of holistic care with real life examples of what it looks like.  Being able to nurse someone holistically positively affects not only the patient but me as well… I have a very grateful heart.

past and present reunite

I could hear her crying and screaming in pain as I entered the ER for my evening shift.  The door to her room was closed but the bone chilling cries echoed out beneath the wooden door and filled the airspace of the nursing station.  I inquired of her... “She got here almost an hour ago and we cannot seem to get a handle on her pain…”  I looked at the board to see her name~  I knew her…  My heart raced and I felt a lump gather in my throat…I hadn’t seen her for almost 9 years now.  My mind sped back to a time that our paths had crossed. 

I was doing home health nursing then and she was a teenager with a newly diagnosed sarcoma…I was to care for her while she received treatments.  I was in her home several times a week for a several months…we bonded and I cared about her.  She knew my daughter~  I wanted her to live…I prayed for her day and night.  She was tough…strong and determined.  She had spirit and spunk far beyond her years…I wanted to take care of her… her case brought out the best in me but also that part of me that wanted to take over and do it all…  I struggled with my sense of ego and pride…I struggled to not let her into my heart…it was a losing battle.

Life changed for me and I took another job~  I left her in the hands of my co-workers and I cried for days…I battled with the feelings that I had abandoned her … I had crossed the line with her~ I knew that my feelings for her were deeper than they should have been.  I took on more of her care than I should have or at least more than was professional… when I left it broke my heart.  I did not know that it broke hers too….

I was pulled back to the present by the day nurse wanting to give me report…I would be getting this girl that so long ago claimed a piece of my heart…  I listened to the report and then went in to meet with her.  As I opened the door the crying and begging for pain relief hit me in the heart.  I looked at her and saw a grown woman whose pale face was contorted in pain. Tears soaked her face as she twisted and rithed on the stretcher.  “Please help me, I can’t stand this pain any longer…”  I left the room, went to the orders and saw she could have another dose of dilaudid now…I retrieved it from the med room and quickly returned to her. 

As I sat on the stool next to her bed and injected the pain medicine I prayed for relief for her.  Her mother sat close by holding her hand.  I introduced myself as I cared for her…she looked at me and started a fresh tirade of tears… “Oh my god, is it really you Bobbi?” 

“Yes it is” I replied with a smile. 

She reached across the stretcher and put her arms around my neck and pulled me close as she cried into my neck.  We stayed like this for several moments.  I let myself feel the heart wrenching feelings that I had let go so long ago.  “I think of you so often,” she said between sobs.  “you were the best nurse I have ever had…I measure everyone next to you.” 

I smiled and let the compliment enter my heart.  “I missed you terribly when you left,” she said.  I told her that I had missed her as well and so often had prayed for her.  I told her that I watched her in the newspaper and from afar at school…I told her that she was one of those patients that never left my heart. 

I managed to get her pain under control with meds, hand massage and presence…and we enjoyed catching up with one another.  She was admitted and I went home …  As I thought about the encounter I realized that as a young nurse I tried so hard not to let anyone into my heart for fear of being unprofessional… I knew she had entered my heart deeply and it scared me.  I always thought of her, prayed for her and worried for her, and struggled with the feelings that I had abandoned her…as I let myself feel the rush of emotions that occurred when we reunited I realized that I was wrong all those years ago… It wasn’t the fear of being unprofessional; it was the fear of not being able to help her that kept me bound…

Jean Watson’s theory of human caring talks about caring moments and allowing our hearts as nurses to be present with our patient’s heart.   I did not realize what was occurring way back then BUT I do know the power of presence now.  Being present with this patient gave her and I both healing that night in the ER… allowing myself to care for her all those years ago touched her and in return in touched me.  As we reunited and told one another the power and effect the other had on our lives…healing happened.  Watsons theory came alive for me that night in the ER and I will never be the same.

The mind/body/spirit connection

I went to room 13 to check on the patient I had just received report on… the ER was CRAZY but for some reason I felt the need to check on him first.  Late teens, sick for 3 weeks with diarrhea, waiting on a stool sample (all other labs were back and relatively normal), loss of 20 pounds… I found him asleep on his left side with his left arm outstretched to expose the 18 gauge needle in the anticube with IV tubing attached to NS running at 400/hr (second liter).  He was a handsome boy but pale and thin with dark hair all messed up, skin was dry and monitor showed a normal sinus with a rate of 96.  His oxygen sat was normal at 99, blood pressure also normal at 120/76.  The room was empty except for him of course and a purse…pink with brown trim (I’m assuming not his). 

History was that he had been experiencing diarrhea several times (5-8) a day for 3 weeks, no fever and no vomiting.  Pt. does however have pain in his lower abdominal region that is intermittent but ranges from a 7-8/10 on the pain scale.  Pt. had a prior bout of this diarrhea last year around this time.  No other medical history…otherwise healthy.  Pt. comes from an intact home of original parents and he is the oldest.  

I went into the room and tidied up.  His mother arrived and I introduced myself.  She told me that she was concerned her son was dehydrated.  I reassured her that his vital signs were now normal (he was tachy upon arrival at 126)and that his orthostatic vitals revealed he was a bit dehydrated to start but that this liter of saline hanging was the second one and we would assess those vitals again shortly to show her his improvement.  I told her I would be back and left to check on my other patients.  She thanked me and sat down next to him.

After I finished my rounds I returned to room 13 to check on my boy.  He was awake and in fact had just returned from the bathroom where he had left me a stool sample.  “Oh joy,” I remarked with a laugh and went to collect the sample… I’ll save you the details but I will say it was very foul smelling and it left me suspicious of C-diff.  I brought the sample to the lab and returned to the room.

My boy needed something for nausea and pain so I checked with the Doc in charge and then medicated him with Zofran and morphine.  As I sat on the stool to the right of his bed and slowly administered his meds, I began to ask the questions that nagged at my brain.  “Tell me about the day this diarrhea started…” 

After several minutes of talking I found out that this young man was under tremendous stress at home and school…he was the oldest of 3 and his dad was out of work…his mother tells me that he is “OCD” about stuff and “worries about everything”  to which he agrees with her.  He tells me that he lies awake at night worrying about the family with money…that he is afraid of not measuring up at school and in sports…about how his dad is angry all the time now that he isn’t working and how he fears that they will lose their house…I also find out that for several months he has been taking Advil, 600mg twice a day for headaches… I bring this info to the Doc. (The Doc addresses this with them in the seriousness of such a dose so often and how it may contribute to his issue and instructions are given to not take any more for now). 

After his second IV has finished I cap the INT off and sit down.  I tell my patient that his labs are normal and we want him to come back for a follow up in 2 days if he is no better.  His mom begins to cry… “So what is wrong with him?” she asks.

As I looked into the eyes of this mom and then her son I saw fear…We talked for the next 15 minutes about the stress going on in the home and how her son was internalizing it…and now the compounded fear that her son has about having to start school and play golf with the added pressure of having diarrhea multiple times per day~ he then began to get teary.  He told me that he just felt sick all the time lately and his stomach was in knots when he thought about the family and school issues… I told them that of course stress is very real and it can turn into illness in the body because we are made up of mind/body and spirit not just body..., but that they of course needed to come back for a follow up if he was no better in a couple of days…

I remembered what helps me to get problems off my mind…writing…I offer some advice ~ “carry a small notebook around and leave it on your bed at night~ write all your worries and concerns in it as they float into your mind…when your mind relaxes close the notebook…do this as often as you need to and if you are a Christian you then can ask God to take that notebook full of fears from you and carry the load himself.”  My boy…the patient and his mother both thank me through tears.  “We are Christians and that advice is well received I can assure you” she said and “I’m going to do the same thing myself.”   

I prayed for them several times that night and again the next day as I felt so heavy hearted for them both…Another day with another patient I just knew was in my path for a reason.  J

A vessel of Hope

She came to the ER for complaints of dizziness, intermittent nausea and fatigue x 5 days.  She denied vomiting, diarrhea or pain. She told me that she is never sick and that this is “really bothering me because I play field hockey and I have to be able to practice…preseason.” Her skin was warm, dry and pink and her eyes were bright. Pretty girl… I evaluated her in the routine way…heart sounds, lung sounds, and vitals.  I put her on the monitor after doing posturals and then had one of our techs do an EKG.  This patient’s mother was glued to her side, so I asked her to leave the room for a few minutes of what I assured her were just routine questions we ask every teenager.  Her mother reluctantly left the room.  I sat on the stool to the left of the stretcher and asked the routine questions regarding drugs, alcohol, abuse and sexual history.  Pt. has a new boyfriend and yes they had sex, “but only once and with protection.” I collected a urine sample and left the room after I let her mother back in.

An hour and a half later after all test results were back, the only thing that was “wrong” with my little 17 year old girl was that she was pregnant.  I sat at the computer and tried to gather my thoughts. The PA on duty was not a usual for us and he was being quite flip about the fact that this young woman’s life was about to change…big time.  His answer, “you play you pay.”  I told him I that he was being as ass and that I would go and talk to them if he wanted…”ya, sure, whatever.”  I took her chart and went to the far end of the hall.  I leaned against the wall and closed my eyes…I was cheering at a tournament game for basketball and my boyfriend was playing.  I was 17 years old as was he.  The next day I was going to take a pregnancy test…the memory hit me hard, and I knew this girl was already concerned she may be pregnant and she was scared. 

I asked God to meet me in this patient’s room…to comfort this young woman~ and her mother ~as this news was going to change lives today.  Taking a deep breath I opened the door and went in.  I once again took the stool seat to the left of the stretcher.  I again asked the mom to step out of the room…(now this was difficult for me because I know that as a mother I would have wanted to be there…but far too often in this job do I see parents that do not support their children in these circumstances~  and the patient by law has a right under these circumstances to privacy.) I knew in that moment that this mother feared that I would be saying her daughter was pregnant…I saw it in her eyes and in the way she got up to shaky feet and left the room~ just before closing the door she told her daughter she loved her and in that moment I knew she would be a help to this young woman.

Her eyes were fearful as she sat there biting her fingernail…she looked so young in that moment.  I told her everything was medically fine but that the blood and urine samples confirmed that she was about 3 months pregnant.  Tears immediately filled her eyes and sobs escaped her mouth.  I sat on the bed and held her…she clung to me tightly and continued to cry.  I rocked her and just let her cry…I knew this pain and I knew the fear that was now slithering into her mind.  “thank you,” she said as she reached for a tissue~ when she stopped crying and blew her nose I asked her if she wanted her mother.  “will you stay in here with me?” 

I went to get her mother and we went back into the room, “Your pregnant, aren’t you?” she asked hesitantly… “yes,” she answered with her head down.  I stood off to the side and prayed.  “This is going to kill your father.”  A tirade of tears assaulted my young patient and I tried desperately to stay silent.

“Mom…please, don’t you think I know that…” she cried.  In that moment the mother began crying herself and went to her daughter and gathered her in her arms and wept with her.  I started to leave and my patient asked me to stay.  I stopped and just sat on the stool.  I took a deep breath and cleared my throat…I, in that moment, told them my story~ My teenage pregnancy and beyond.  The fear that turned to joy as my daughter blessed my “husband” and I’s life in ways that we never thought possible and how God used her to grow us into the people he wanted us to be…I told them that it was painful, embarrassing and life altering BUT that it was truly a blessing and I wouldn’t go back and change one bit of it…I told them they had many options to consider and that I could help with anything they needed.  They thanked me and I was thankful that I had that story to share, because in that moment their lives looked black and fearful~

Sometimes I wonder why I stay in bedside nursing…the hours are long and working every other weekend gets really old…the ER is a beast that just roars continually with pain and suffering ~~ but every once in a while I know that I was placed in a patient’s life that day for the purpose of hope and healing.  I received a thank you card yesterday from this patient…she was keeping her baby and going to go to a local college and stay home to have help.  Her parents are being supportive and she has hope for a nice future…Amen!!