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!!

Gone but not forgotten

The room was dark and quiet as I finished up my nursing note.  My patient was tucked into her own bed and finally asleep as her daughter slowly ran her fingers through her mother's white curls.  I nodded good bye and stepped out.  Once in the car I checked my phone and found a message from the hospice intake worker that I had another patient to go and see...and urgent open.  I read the directions and something tugged at my brain telling me I knew this address.  I ran into the office to retrieve the paper work.  Once back in my car I opened the file.  The name was that of my friend... my friend that was NOT in the end stage of breast CA with mets.  "what is going on?" I muttered to myself.

I called the intake nurse and asked about the call for this patient.  "I got an urgent call from her doctor telling me that she had just returned from Boston after recieving trial medications that failed...and she is days from dying~  and she wants to die at home...she asked for you."  My heart raced and my stomach clenched...tears ran down my face as I heaved in deep breaths...this cant be true...I just talked to her a couple weeks ago and she said how well she was doing...

I prayed for the 20 min drive for courage, wisdom and strength...I prayed it wasnt true. 

I arrived to be welcomed at the door by my friend's husband who was in tears.  "Thank goodness your here...she cant breathe!"  I rushed into the bedroom to find my friend gasping for breath.  Before I could even hug her and find out what happened, I turned up her oxygen (since when did she start using oxygen, my brain yelled!!!) to 5 liters and turned the fan onto her, then started talking softly to her as I stroked her hair off of her forehead.  "Just breathe in and out slowly...thats it, nice and slow...Im here now and its all going to be okay...slow in and slow out...thats it, just relax and let the oxygen reach your cells...its okay, its going to be okay."

As I comforted my friend I surveyed the room.  She was lying on a hospital bed, oxygen was being fed to her by nasal cannula from the compressed air machine and there were a dozen pill bottles lined up on the bed stand.  My eyes found her husband and I gave him a questioning look.  He motioned me to meet him in the other room.  I continued soothing and calming my friend until she fell asleep and then went into the living room.

Between great sobs of anguish he told me, "She was sent home last night by ambulance from Brigham's and Woman's...to die.  They set up the home 02 and the bed.  They ordered her lots of pain meds and stuff for anxiety...how are we going to do this?  She was fine last week and then she just got so weak and couldn't breathe...they xrayed her and said the cancer was all through her lungs now..."

4 hours later, after her sister arrived, I was driving home with an ache in my chest that truly felt like I would stop breathing myself.  I could not stop crying. I had prepared my friend and her husband as best I could.(she didn't have long)..I told her I loved her and that I was so sorry for what was happening.  I told her how much her friendship had meant to me and that she was a wonderful mother to her children.  I told her that she taught me how to relax and that she showed me how to laugh with abandon~  I told her she would be greatly missed.  She couldn't talk but she nodded with tears streaming down her face...she grabbed my hands and mouthed  "I'm not ready." 

5 hours after that I was called to the hospital to be with her.  She was too air starved to stay at home comfortably and her family couldn't take it.  I arrived to a room full of family~ her 2 children (my kids ages) and her husband, sisters and friends.  She was getting hooked up to a morphine drip and she was no longer in the present . Her eyes were closed but she gripped my hand when I knelt beside her and kissed her face...I wept.  I was no longer her nurse...I was just her friend... I prayed for her and her family.  I then did something Ive never done before... I just knew I was suppose to sing her favorite song...I softly sang to her, Jesus lover of my soul, and I watched as her breathing slowed and a peace entered the room and her faced relaxed.  I was aware that all eyes were on me but I didn't care about being embarrassed, I cared about my friends comfort...her soul.  I sang the song 2 times and by the end of it she was gone...

It was one of the hardest, saddest and most incredible days of my life.  My daughter and I sang that song at her funeral because her husband requested we do so. It was a privilege to honor her in that way.  I tell you all this because I have been thinking alot about her lately. I miss her and I honestly miss working at a job that allows me to connect deeply to a person and their circumstance. 

How does your job allow you to connect to another human being???  Are you using your talents to make another person more comfortable??? What is your story of human connection???

human connectedness

I sat in the back row of the large Catholic Church and watched the young people and their families file in.  Most heads were bowed but some were looking around with sad eyes.  My heart was racing and I physically felt uncomfortable as I fought to not let tears escape my eyes.  The open casket at the front of the Church kept calling to me but I couldn’t look at it…not yet.  Her family was escorted in~ mom was crying and her little brother appeared fearful~ no father…they sat next to an elderly woman in the front row that I hadn’t met before. 

I have no idea what the priest said that day because as soon as he started talking my mind went to the images I knew of this amazing young woman.  Her room was painted in purple.  Let me rephrase that~  her entire room was painted in purple…including the ceiling!  The walls were lined with teenage posters and Polaroid pictures of her and her friends, trees, fish and her family.  She took Polaroid pictures of everything!! She had a huge fish tank on top of her dresser that held a multitude of fish that she cared for.  Each time I entered the room I was taken aback by the amount of clothes that could be found on the floor J.  She would always say with a giggle, “my mom is going to be so pissed that I didn’t pick up my room before you came over.”

She was obsessed with death and what happens after one dies.  Each of my visits would end with her asking me, “Before you go…tell me one more thing that the Bible says about heaven.” I would then tell her another fact from the Bible that I had looked up prior to going to her home…she would get quiet and just think it over.  Sometimes she asked about hell…I would answer that as well.  She often asked me about Jesus and how I was so sure that He was real…I answered her ~ 

I was this amazing young woman’s hospice nurse.  She was 13 when I met her and she was enduring end-stage leukemia.  I was responsible for administering antibiotics via her PICC line for the pneumonia she had contracted.  She lived with her mother and 6 year old brother in a third floor apartment.  Her mother worked full time and she babysat her brother during the summer…it was summer.  She was like any other 13 year old who had to stay home and babysit her little brother~ annoyed.  She was far too weak to leave the house and do anything else but she still was annoyed.

Her mom’s shaky voice pulled my mind back to the present…to her funeral.  Her mom talked lovingly of her 14 year old daughter whom she would miss terribly.  She told of her bravery, her passions and her fears.  She thanked all those that had helped them during the last 6 months of her life…and then she lost it…and we all lost it….

The funeral ended and I felt sick…my head hurt so bad from trying desperately not to cry…I felt strange, like~ I was just her nurse and I only knew her for 6 months…I figured I didn’t have the right to feel so sad.  I now know how wrong that was but at the time I didn’t realize it was ok.  As I walked to her mom to give her a hug I prayed for strength.  Her mom hugged me and cried…she asked me to wait a second and she went to her purse and came back to me.  She handed me a Polaroid picture of her daughter and I…the picture she had taken of us the first day I met them.  The tears wouldn’t stop.  The Polaroid picture is in my Bible…

We nurses do make a difference and we do have a right to feel and experience things with our patients.  It is when we let the patient into our hearts that they then feel the care we have for them.  A relationship can then form and that is when a shared human connection can happen.  Not all patients want that and there are patients that are so difficult that it just won’t happen…but on any given work day there is someone out there in patient land that needs their nurse to connect with them…believe me~  it is worth it!!

Releasing some pain

Her tiny, delicate face haunts me

Perfect round structure

Purple bruises line her cheeks

Closed eyes, left one black

Wild dark brown hair

Fine and Full

Flat in the back

Long, wispy and straight out

Red lips in a perfect pout

Closed mouth

What truth is trapped inside?

No more breath

Creamy white skin

Limbs that lay limp

Ten fingers and toes

Soft and cold to touch

Metal and Plastic equipment

Mucous and blood

Sea green sheet

Everything lifeless next to her

Photographs and swabbings

Gloves

Police and investigators

No family

Nurses, EMT’s and techs

Anger, frustration and sadness

Tears that won’t fall

Tightened throats

Hold her tight Lord

Kiss her tiny, delicate face

Heal her bruises

Give her life