Contemplations on Mourning & Why I’m a Nurse


I’m really horrible with dates, whether birthdays, anniversaries, or whatever, but when I was talking to my mom this morning she reminded me that exactly three years ago today my dear uncle Robert died.  I never knew my grandfather on my dad’s side of the family & because Robert was considerably older than all of my other uncles & because I spent a lot of time with him & my aunt Katherine, I always thought of him more like a grandfather than just an uncle (no to disrespect to uncles of course). special date

In any case, as soon as my mom reminded me of his passing, floods of memories came pouring to the surface.  Most intensely of course I remembered that day three years ago when I saw Robert for the very last time.  The circumstances under which that occurred were really quite significant.  Allow me to explain.  Robert had been in & out of the hospital for several months at that point, & the nurse part of me of course knew that his prognosis wasn’t very good.  I had seen him a few times here & there, but as it turned out that weekend I was scheduled to go to a Zac Brown Band concert in Roanoke, VA with a close friend of mine, so I was hoping to tag on a visit to him as well.  It just so happened that both NC & VA were subjected to a great deal of snow & ice that weekend, but I was determined to make it to VA.  So, quite foolishly I suppose, I left Raleigh in some of the worst freezing rain I’ve ever encountered.  It was so bad that I had to stop more than once to scrape the ice off my windshield just so I could see to drive!  After about an hour on the road it became clear there was absolutely no way I could safely make it to the concert in time.  My friend wasn’t so sure she could make it there either, & thankfully she was able to transfer our tickets to some folks who could go. freezing rain

Anyway, once I realized I couldn’t make it to the concert, I decided I would still go home & visit Robert & the rest of my family.  There was just a part of me that knew that this might be the last time I’d ever see Robert alive, so even though the roads were horrible & I drove by quite a few accidents, I was determined to make it home safely so I could see him.  What is normally just shy of a three hour drive turned into over a five hour drive; I don’t think I hit more than 40 mph the whole trip!  But my husband’s trusty little Chevy Cavalier, hardly the best vehicle for such dangerous wintry driving conditions, got me home in one piece, & I was able to visit my uncle in the hospital the next day.end of life quote

I still remember very clearly entering his ICU room & seeing him lying there intubated.  It hit me like a ton of bricks that, yes, this was definitely going to be the last time I ever saw Robert alive.  I’d been a nurse long enough at that point to know that this was it.  Even though it was a Sunday we were fortunate to have a palliative care doctor available to us, & I remember helping my aunt discuss various things with the doctor (e.g. whether to continue tube feedings).  In short, the decision was made to proceed with comfort care only, which was what I & the rest of us felt was best & what he would have wanted could he have spoken for himself.  When it came time for me to leave, I went over to the bed & looked my uncle in the eyes, & even though he was still intubated & fairly sedated at the time (the ventilator was actually off but the ET tube was still in place), he turned his head & opened his eyes & looked at me.  I kissed him on the forehead & told him I loved him but it was ok for him to go if he needed to.  I hugged the rest of my family & left that room knowing I would shortly receive the news of his passing.

As it turned out, it was just about an hour later that one of my cousins gave me the news that Robert had passed away peacefully.  I had to be back at work the next night I believe, so I was already back on the road to Raleigh at the time.  I will never forget pulling over on the side of 460, somewhere around Altavista, where I watched the sunset, a gorgeous one I might add, & cried.

I was put in mind of these events this past Fall when my grandfather was ill & the nurse part of me knew that he was dying as well.  For sake of time I won’t elaborate too much, but essentially the exact same scenario happened, minus the missed concert & the winter weather.  I’ll never forget kissing him good-bye & telling him I loved him but he could go if he needed to, then walking out of that hospital room knowing I’d truly just said our final good-bye.  I also distinctly remember driving home to Raleigh the next morning & pulling over somewhere in Charlotte County to watch the sunrise & cry.

P1110649

The sunrise I watched in Charlotte County, VA on the way home from seeing my grandfather for the final time

Now I’m fighting back tears of course, but I’m writing all of this to say not only that I miss these dear men very much but also that I like to think of a lot of my nursing care as being in honor of them.  Let me explain.

I’d only been a nurse for a few months when it became very apparent to me that I have a special place in my heart for palliative care & hospice.  Even though I was all of 22 when I became a nurse I seemed, even then, to have a particular affinity for working with patients & their families at the end of life.  Like many others of course, I got into nursing largely with the idea of saving lives. But it didn’t take much experience for me to realize that even with all of the advanced medical care available to us today, that doesn’t mean every life can be saved every time.  Furthermore quality of life is at the end of the day so much more important than quantity of life, at least in my mind, though I’m sure the vast majority of people would agree.  Even as a young nurse, I remember advocating for palliative care & hospice for several of my patients who clearly needed & desired that type of care to allow them a peaceful death.  I quickly realized that helping them achieve that goal & assisting their families in that process was, though difficult at times, the most rewarding part of my job.  Over four years later I still agree with that sentiment one hundred percent.hospice

In the past four, now closer to five, years of nursing, I’ve called families countless times to inform them that their loved one was in the process of dying & they needed to come see them if at all possible.  And countless times I’ve called families to say their loved one has in fact passed away.  It’s never easy, but it doesn’t scare me anymore either.

Now I’ve said all of that to finally say this:

Yes, I’ve been told by plenty of folks that I’m “smart enough to be a doctor.”  And, yes, I agree one hundred percent with that sentiment.  But let me tell you why I am so, so glad I chose to be a nurse instead.nurse pic

In case you didn’t know, doctors don’t round at night (& even during the day they usually only see each patient once or twice).  There are doctors on call at night of course, but they are there to handle admissions & emergencies.  Otherwise it is completely up to us as nurses to monitor our patients & advocate for them when the need arises.  If your loved one’s condition is deteriorating, believe me, the doctor isn’t coming around every hour to check on them.  That just isn’t feasible.  But the nurse is doing exactly that.  It is up to our eyes & ears & critical thinking to manage those patients & to know when to call the doctor & what to ask for when we do.  I can’t tell you the number of times I’ve quite literally saved a life by intervening on the behalf of a patient who had acute hypoglycemia, A Fib-RVR, SVT, acute respiratory distress, or any number of other life-threatening conditions.  Knowing I’ve been part of such efforts is of course incredibly rewarding.

smart nurse

But the most rewarding thing of all to me is when I help someone achieve a peaceful death.  I know that may sound very bizarre but it’s just the truth.  Though none of us likes to admit it, the truth is we’re all going to die someday, & I think all of us hope that when our time comes, it will be peaceful & as painless as possible.  So when I can be a part of making that happen, I feel like I’ve accomplished something truly meaningful in this world. hospice 1

Of course there are situations when patients & families are contemplating comfort care/hospice but haven’t quite made a decision yet.  And of course sometimes things change drastically overnight & suddenly that decision cannot be put off any longer.  Especially overnight when the doctors aren’t rounding, it becomes up to the nurse to advocate for that patient.  Though it is challenging, multiple times I have been the one who has called a family member to say that a choice needs to be made.  I have facilitated conversations between family members & doctors so that a choice for comfort care could be made official & we could begin to work towards a peaceful passing.  Yes, ultimately the doctor is the one giving the orders, whether it’s for comfort care or otherwise, but believe me, even the best doctors are relying very heavily on us as nurses to guide them.  This is especially true at night when we are quite literally their eyes & ears.nursing quote

Anyway, maybe this all sounds morbid & strange to you if you aren’t part of the healthcare field (or perhaps even if you are).  But when I care for patients & their families at the end of life, I think about my own loved ones I’ve lost.  I remember Robert & PawPaw (my grandfather) & Granny & their suffering & the relief I could see in their eyes when they heard us tell them we loved them but we could let them go if they needed to.  And I remember the nurses who cared for them during their last days & made them as comfortable as they could be. end of life

Yes, I’m sure I could have been a doctor & to some people maybe I’m “not living up my full potential” by being a nurse.  But the folks who say/think that have no idea what I do on a daily basis.  They have no idea the difference I’ve made in the lives of countless patients, both those I’ve helped to save & those I’ve helped to achieve a peaceful death.  As I’ve said, I’ve long since lost count of the number of times when I’ve been the one who has intervened for a patient & made a tremendous difference in their life, again whether it was helping to save them or helping them achieve a peaceful passing.  Particularly when the situation is the latter, I often remember my own loved ones who’ve passed away & I like to think I am serving others in honor of them.

In summary, yes, nursing is frequently stressful, overwhelming, & emotionally & physically taxing.  But every night that I work I know I make a meaningful difference.

And that, my friends, is why I’m a nurse.

Why Nurses Cry: Musings on the Loss of a Patient


Recently I found out that two of my former patients died.  Yes, like many other nurses, I scan the local obituaries every so often looking for names I recognize.  I don’t know why I do this because it inevitably leads to a few tears if I see the name of a patient I really liked, & this happens a lot more often than you might think.  But in an odd way I think reading these obituaries also brings me a bit of closure because it allows me to know that a person whose suffering I witnessed first-hand is now freed from their earthly turmoil.empathy

This situation definitely left me with a few tears in my eyes even though realistically I know that death was the best option for both of these patients.  I know most people view death as the enemy, but one thing I learned very early in my nursing career is that death is NOT always the enemy.  When people are suffering the way these folks were, death can actually be quite the opposite.  And what pains me more than anything is when patients are not able to experience a dignified death that is as peaceful & painless as possible.  Things are slowly improving but unfortunately hospice & palliative care services are still very under-utilized in our society.  (As some of you may know, I actually volunteer with a local hospice group because I feel so strongly about the importance of hospice.)hospice 1

Anyhow, all of this got me to thinking about the many times I have cried as a nurse, both on the job & at home when thinking about my patients after work.  It happens less frequently than it used to because I’ve learned to develop more of a “shell” to help protect me . . . This doesn’t mean I’ve become hard-hearted & insensitive (someone please tell me the day I do so I can turn in my badge).  But as a nurse I’ve had to learn to balance my own mental sanity with showing compassion towards my patients & their families.  Throughout my life I’ve often been told I’m “sensitive” & that I “wear my heart on my sleeve” (who comes up with these expressions?!), & while I certainly hope to never lose that side of me, I’ve had to learn to “buck up” & withstand a lot of things that I probably couldn’t have faced years ago. tears

At this point in my career, I’ve lost track of the number of times I’ve seen someone die.  I’ve lost count of the number of dead bodies I’ve touched & cleaned up to send to the funeral home.  Since I’m not an ED or ICU nurse I don’t see a whole lot of codes but even so I’ve still lost track of the number of codes I’ve assisted with.  And I could probably write a whole book about the number of times I’ve helped prevent a code from happening, for example by recognizing that a patient was dangerously hypoglycemic & giving them D50 (sugar water) in their IV to raise their blood sugar or by recognizing that a patient was in pulmonary edema & needed IV Lasix STAT to pull the fluid off of their lungs, just to name a few . . . Notice a pattern here?  Nurses really do save lives, y’all.  Doctors are great & I have a huge appreciation & respect for the work they do.  But seriously, until you’re a nurse you have no idea how important nurses are.  There is a reason we are called the backbone of the healthcare industry.  We as nurses are the ones watching your lab values, your vital signs, your telemetry (heart monitor), your I&O (fluid intake & output), & your mental status (among other things) like a hawk.  More often than not we are the ones recommending/telling the doctors what needs to be done . . . Again, I am not trying to take away from the important work that doctors do.  I’m just saying that one of the biggest reasons I do not regret choosing nursing school over medical school is that I see on a daily basis just how big of a difference I really make.

Despite the challenges & frustrations of my career, I'm still glad I chose nursing over med school.

Whew, that was a tangent that I wasn’t intending to go on, but, hey, it happens sometimes.  Anyway, when I see that one of my former patients has died (or when a patient dies under my care), there is always a small part of me that feels like all of our hard work to save them has been in vain.  Realistically I know that most of these patients are coming in with so many different medical comorbidities that the chances of them surviving, or at least surviving with any real quality of life (which is after all the more important factor), are low.  But every once in a while I find myself thinking “Gosh, so much of what I do is just keeping people alive for a few more days, weeks, or months, usually with a great deal of suffering involved, until they inevitably die.” nurse pic

But then I remember that maybe in those last few days or weeks or months they might have gotten to see their grandson who lives all the way across the country for one last time.  Or maybe they got to witness another grandchild get married or graduate from college.  Or maybe they just had enough time to adequately say good-bye to all of their loves ones (as best as possible) & vice versa.  And maybe in the midst of all off their suffering, pain, & fears I was able to provide a calming presence, a small balm to ease their wounds.  Or maybe I was able to help their family understand their loved one’s disease process & how to prepare for their loved one’s death.nursing humor 1

All of this brings me to the main point of this post.  As long as I’m a nurse, my sincerest desire is that I never lose that sensitive soul, that compassionate drive which inspires me to do my best for my patients.  I know at times I am not able to grieve for my patients the way I want & need to because I just have to keep on moving to take care of the rest of my patients.  And I know at times I may seem hardened or callous because I don’t cry every time a patient dies or receives a bad diagnosis or because I laugh at things that non-nurses would find revolting.  But as I said, as nurses we do have to harden ourselves a little bit so that we can make it through our shifts.  Trust me, it’s a fine line, a very fine line, we walk trying to maintain our own sanity while still providing truly compassionate care to the patients & their families entrusted to usempathy

My challenge to myself & to anyone who’s reading this who is also a nurse (or any kind of healthcare worker) is this: next time you’re caring for a patient, particularly if they are “challenging” or “difficult” for whatever reason, take a moment to consider that there is probably a higher chance than you’d like to admit that the time you’re spending with this patient might be some of their last days on Earth.  With that in mind, may we all strive to be the best advocates we can be for our patients & to provide the most compassionate care we can, knowing ours could be the last voice they ever hear, our hand the last they ever hold on this planet.

Life Lessons From My Grandfather


It’s probably been close to three weeks since I’ve blogged anything, but I spent the last weekend of August in Boston visiting my college roommate (which was awesome, except for the part where I ended up in the ER at Mass General after passing out on the street), & then just a few days after that my grandfather was admitted to the hospital on comfort care & passed away a few days later.  So needless to say my life has been a bit of a whirlwind, both physically & emotionally, these past few weeks.tears

Ever since my grandfather died, I’ve been tossing around the idea of writing a blog post in honor of him & the things he taught me, but it’s taken some time for the pain of loss to ease enough for me to be able to write about this without dissolving into a mass of tears.  Just to be clear, the things I’m writing about today are not necessarily things PawPaw taught me in so many exact words but rather things I learned from him by watching the way he lived his own life . . . As has been said many times before by folks much wiser than I, actions truly do speak louder than words.grief quote

  1. One of the greatest things I learned from my grandfather was the value of hard work. PawPaw worked as a lineman with the electrical company in his area for many, many years.  He took turns being on call on nights & weekends & many times went out in storms, snow, & ice to help restore electricity, not only in his own community but sometimes in other parts of Virginia or even West Virginia.  Additionally, up until the last maybe five years of his life, my grandfather planted & tended to his own garden, growing everything from potatoes & corn to tomatoes & beans.  He was also an active member of the local Ruritan Club & his church.  One of the greatest lessons PawPaw taught me was that there is no job beneath me.  It doesn’t matter if it’s scrubbing toilets, flipping burgers, or shucking corn, whatever I’m doing, I better do it to the best of my ability & take pride in the fact that I’m providing for myself & my familyhard work

I’m not a big fan of country music anymore, although there are certainly exceptions to that rule (namely Eric Church, Kacey Musgraves, & Brandi Carlile), but there is a Montgomery Gentry song that came out when I was in high school that has never failed to make me think of PawPaw, especially these words right here:

That’s something to be proud of
That’s a life you can hang your hat on
You don’t need to make a million
Just be thankful to be working
If you’re doing what you’re able
And putting food there on the table
And providing for the family that you love
That’s something to be proud of

And if all you ever really do is the best you can
Well, you did it man

Here’s the video for the song if you want to check out the whole thing.judge quote

  1. One of the other biggest lessons I learned from PawPaw was to never judge someone’s intelligence based on their level of education or their manner of speech. For those of you who don’t know, my grandfather was from Shenandoah County, a rural area in northern Virginia close to the WV border.  Most all of his ancestors were poor farmers & almost no one in his family attended college, & there were probably plenty who didn’t even finish high school.  In any case, my grandfather was one of those people who legitimately said things like “crick” instead of creek & “pi-an-y” instead of piano (although the latter was possibly a joke).  But despite his countrified accent & lack of college education, you didn’t have to talk to my grandfather for long to realize what an intelligent man he really was.  He had a great deal of historical knowledge, not to mention practical knowledge regarding farming & electrical work, & he had traveled to all but three states by the time of his death.  Though I certainly value education & elocution, I always strive to remember, largely thanks to PawPaw, to give everyone the benefit of the doubt & not judge anyone’s intelligence based solely on their manner of speech or educational attainment because such things are not always the greatest predictors of intelligence as one might naturally assume.generosity-quotes
  1. Another great lesson my grandfather taught me was the value of generosity. Ironically, when I was a young child, to be perfectly honest I was a little afraid of PawPaw.  He was a big, tall man with a fairly deep voice who didn’t shave every day & could come across as a bit gruff.  Since I was used to my dad who is considerably smaller, shorter, shaves religiously, & is very soft-spoken I guess it’s not too surprising that as a young kid I was a little intimidated by PawPaw.  However, over the years I realized what a truly kind, generous man my grandfather really was.  I’ll never forget the time he was working at a bottling plant after retiring from the electrical company & he brought in some clothes & such things to some of his Hispanic coworkers who were clearly in need.  My grandfather was also a very friendly, talkative person who could strike up a conversation with most anyone.  A great example of this is a story that one of the pastors told at his funeral.  Many years ago my grandparents were driving through Montana on one of their many road trips across the country.  At some point my grandfather started waving at a farmer who was in a field beside the road.  My grandmother asked him if the man was a friend of his since he was waving at him.  His response was “No, but he’s gonna be.”

    Most recent good picture I have with my grandparents is from our wedding 4 years ago.  Photo credit to Triskay Photography.

    Most recent good picture I have with my grandparents is from our wedding 4 years ago. Photo credit to Triskay Photography.

I never heard this story until PawPaw’s funeral, but it was so powerful that I feel compelled to share it.  One of my uncle’s friends who is now a pastor spent a lot of time at my grandparents’ house as a kid/teen.  This man’s own father was not very involved in his life, so he cherished the time he got to spend with my grandfather.  As it turned out when he went home to his own house & began talking about all the things his friend’s dad did with them, his own father eventually became inspired to take a more active role in his son’s life.  As I said earlier, actions really do speak louder than words & I’m so glad my grandfather lived a life in which his actions were proof of the love he had for his friends & family.

 I’m going to close this post by sharing one of my favorite Black Stone Cherry songs, Things My Father Said.  The song is written from the perspective of a son whose father has died, but the emotions it portrays are relevant for anyone who’s lost someone they love & is trying to carry on the lessons that person taught them.

Below are the lyrics:

“The things my father said would make me a better man
Hard work and the love of friends, a woman that understands

I hope my father knows the seeds we’ve sewn still grow
At night I go to sleep and pray he’s watching over me

Somewhere there’s a star that’s shining
So bright that I can see you smile
And all that I need is one last chance
Just to hear you say goodbye

Sometimes I remember, when you taught me to tie my shoes
One thing I will never forget, is the day that I lost you

I hope you always know the car that we built will always roll

Somewhere there’s a star that’s shining
So bright that I can see you smile
And all that I need is one last chance
Just to hear you say goodbye

And if you have a dream you better hang on for dear life
And when that cold wind blows, just let it pass you by

The things my father said

Somewhere there’s a star that’s shining
So bright that I can see you smile
And all that I need is one last chance
Just to hear you say goodbye”

I Cry When I’m Alone


As I wrote about a few weeks ago, my grandfather has not been well for about 6 weeks now.  Yesterday he took a serious turn for the worse & has now been admitted to the hospital for comfort care (essentially hospice).  I absolutely believe this was the best decision, as he was clearly not getting any better & we all know he would never want to live the way he’s been forced to live since his fall earlier this summer.  He has had very little quality of life ever since his fall, & that is always paramount, no matter how much we all of course wish he could/would get better & return to his previous state of health.  But none of that makes the situation any easier.  grief quote

As I prepare to go to work tonight, I feel like I need to share this poem which I composed last night as I was going to sleep & on the drive home from Virginia to NC this morning.

Miss Responsible:

As long as I can remember that’s always been me

Or Mrs. Responsible now, as the case may be

But anyway, what I’m here to say

Is this:

grief

If you think I’ve got it all together

If my face should hide my fears

If you find yourself surprised

At the absence of my tears

The truth is

I cry when I’m alone

tears

Cocooned in my sheets in the dark of the night

Or sitting on the couch, hiding from the light

The truth is

I cry when I’m alone

tears quote

So if you’re shocked by my composure

Or my apparent lack of grief

Trust me, it’s there; you know

Some wounds run more than surface deep

A Veil of Sadness


If I have any regular followers on here, I apologize for my sudden absence.  I realize it’s been over two weeks since I’ve posted anything; indeed I had to actually pull up my own blog to even remember what my last post was about.  My life has just been a whirlwind these past few weeks between general insanity at work (including doing some overtime) & my grandfather being sick.

I'm including some pictures from our recent vacation to Asheville, so this post won't feel overly pessimistic.

I’m including some pictures from our recent vacation to Asheville so that this post won’t feel overly pessimistic.

To elaborate on the last point, I rarely post such personal things on here, but my grandfather had a bad fall about a month ago & spent several weeks recovering in UVA hospital.  He was finally released to rehab only to now end up back in another hospital with aspiration pneumonia.  Over the past few years I’ve noticed that his memory has been slowly worsening, but ever since the fall in addition to his injuries & subsequent surgeries, he’s had a lot of confusion & restlessness.  As a nurse, of course I know this isn’t uncommon in someone his age who’s been hospitalized, especially after such a traumatic fall.  But nonetheless I can’t shake this horrible feeling that he’s never going to recover to his baseline.  Statistically speaking, the odds really are against him, as I well know from the many similar patients I’ve cared for over the past few years.

Wildflowers at Mt. Mitchell, highest point in NC & on all of the East Coast

Wildflowers at Mt. Mitchell, highest point in NC & on all of the East Coast

This is one blog post I kind of hope my family doesn’t see because I don’t want them to be disheartened.  I really don’t want them to know how negative I feel about this whole situation.  But at the same time I feel like I really need to express the sadness I’m experiencing right now.  I know it doesn’t make any sense, but I am terrible at expressing emotions around my family, at least so-called “negative” emotions, that is.  For example, it’s very rare that I cry in front of anyone other than my husband.  I just hate for even my own family to see me being “weak.”  I know that’s ridiculous & totally unhealthy, but it’s just the way things have always been for me.  At times like these, I realize how much harder that makes things because in the end I’m just bottling things up which is never, ever a good idea.  So that’s why I’m writing all of this, in an attempt to be more honest about how I feel & not just try to put on a brave face for everyone.  In the end I don’t think putting on a brave face helps anyone.  It’s better to just be honest & say how we really feel.dr seuss quote

I guess since my grandparents on my mom’s side are so much younger than my dad’s parents were I’ve always taken it for granted that I’d have them around for a really long time.  I never really doubted that they’d be around to see me graduate from college, get married, & have kids someday.  As it turns out they’ve seen the first two of those things & for that I’m eternally grateful.  But I just keep having this horrible thought that even I if I got pregnant tomorrow (which is not going to happen, just to be clear) my grandfather might not live to see that child.  Or even if he does he might not have the mental capacity to really understand & appreciate the experience.  And my future children might not have the blessing of getting to really know him as the man he really is.  And that breaks my heart.

Most recent good picture I have with my grandparents is from our wedding 4 years ago. Photo credit to Triskay Photography.

Most recent good picture I have with my grandparents is from our wedding 4 years ago. Photo credit to Triskay Photography.

Of course it’s possible that I’m being fatalistic & overly negative here.  But the fact of the matter is that as a nurse I see a lot of similar cases & I can’t deny that the endings often aren’t pretty.  One of the first things I learned as a nurse is that merely surviving isn’t enough.  Quality of life is everything.  I know my grandfather would never want to live the rest of his life in a nursing home, so even though he’s made a lot of progress, for which I am very grateful, I still fear that he’ll never make it back to his baseline & thus his quality of life will suffer greatly.  I really do hate to sound negative, but I’m speaking from experience here . . .

The truth is I’ve never seen the point in being overly positive or overly negative in life; I just strive to be realistic.  I learned a long time ago that sometimes it’s best to have low expectations for the things in life which you can’t control . . . I find this prevents a lot of disappointment & quite often leads to unexpected happy surprises.  Maybe some people would say that’s a negative way to live, but it works for me.

As I finish this the same way I started it, with tears in my eyes, I guess the best I can do is prepare for the worst & hope for the best . . .

Misty morning at Mt. Mitchell

Misty morning at Mt. Mitchell

PawPaw, I love you so much.  Every time you hug me I can see in your eyes how much you love me & how proud you are of me.  I’ll never be able to say how much that means to me.  I want you to recover & get back home to the life you knew before all of this.  But if that isn’t possible & your quality of life is such that you don’t feel you can take it anymore, I want you to know that we love you enough to let you go.  Please don’t hang around being miserable just for us.  More than anything I don’t want you to suffer.  I love you.

In conclusion (for real this time), I’ll end with a few Pema Chodron quotes because her words always bring me a sense of peace & calming, no matter the situation at hand.pema chodron quote 2

Rather than letting our negativity get the better of us, we could acknowledge that right now we feel like a piece of shit & not be squeamish about taking a good look.”

“We think that the point is to pass the test or overcome the problem, but the truth is that things don’t really get solved. They come together & they fall apart. Then they come together again & fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.”

On the Meaning of Suffering & the Uncertainty of Life


My career as a nurse affords me a lot of opportunities to encounter suffering in all of its many forms.  Primarily of course I deal with physical suffering, but by its very nature physical suffering leads into any & all other forms of suffering including both spiritual & emotional suffering, particularly as people confront terminal illness & death.  As many other nurses will tell you, helping people to work through emotional & spiritual suffering is actually much more challenging than dealing with physical suffering.  Additionally I serve as a family service volunteer with a local hospice group which of course brings me even closer to those dealing with their own impending death or the death of a loved one.  People are always shocked that I would choose to spend additional time around those at the end of life, but despite my young age I’ve always felt a special connection with those facing the end of their life or the life of a loved one.  Unlike many people in the healthcare profession, I’ve never viewed death as the enemy but rather as the inevitable conclusion to life, which sometimes can actually be the respite a person needs when they’ve truly suffered long enough.  Indeed I learned very early in my career that there are fates far, far worse than death.

pema chodron quote

Being surrounded by so much suffering in life can be a bit overwhelming at times, & it certainly leads me to think about my own beliefs & ideas regarding suffering & the uncertainty of life.  The older I get & the more experiences I have, the more I’m learning that the only thing of which we can ever really be certain in life is that it is always uncertain.  Indeed, the only thing that never changes is that life is always changing.

Many people say that God allows us to suffer so we can grow closer to Him.  And that God chooses to heal some people while He also chooses not to heal others (for reasons that we, of course, can’t understand).  I just believe that some people get better & some don’t.  However, I do think that “mind over matter” can make a huge difference in how people handle both physical & emotional suffering.  There may very well be some scientific reasoning for this that we don’t yet fully understand, but regardless I don’t think it changes the fact that having a positive but realistic attitude really can change how we experience this life.

pema chodron quote 2

For thousands or perhaps millions of years, humans have struggled with the question “Why do bad things happen to good people?”  I honestly thing it requires more mental gymnastics to believe that God has some elaborate plan we can’t understand to explain our suffering than to simply believe that bad things happen because of scientific reasons such as bad genes or bad timing.  But that doesn’t mean that our suffering has to be pointless or that we are alone in this world.  I just think the only meaning to suffering (or really anything in life) is the meaning we assign to it.  We can choose to allow our suffering to teach us to be a better person & to reach out to others, or we can wallow in misery & cut ourselves off from any happiness that is left to us.  The latter response is only natural & perhaps healthy at first.  But we do have to move past it or we will be miserable forever.  The best way I can sum up my feelings on the meaning of suffering is by sharing a quote from the Buddhist writer Pema Chodron:

Life is glorious, but life is also wretched. It is both. Appreciating the gloriousness inspires us, encourages us, cheers us up, gives us a bigger perspective, energizes us. We feel connected. But if that’s all that’s happening, we get arrogant and start to look down on others, and there is a sense of making ourselves a big deal and being really serious about it, wanting it to be like that forever. The gloriousness becomes tinged by craving and addiction. On the other hand, wretchedness–life’s painful aspect–softens us up considerably. Knowing pain is a very important ingredient of being there for another person. When you are feeling a lot of grief, you can look right into somebody’s eyes because you feel you haven’t got anything to lose–you’re just there. The wretchedness humbles us and softens us, but if we were only wretched, we would all just go down the tubes. We’d be so depressed, discouraged, and hopeless that we wouldn’t have enough energy to eat an apple. Gloriousness and wretchedness need each other. One inspires us, the other softens us. They go together.”

kahlil gibran quote

What is boils down to is this: at the end of the day, you & only you are responsible for your choices in life & how you handle the things that happen to you, both good & bad, even those that are beyond your control.  This is both terrifying & empowering.  It’s terrifying because it forces you to realize that you cannot just blame your parents, the economy, your spouse, your children, your friends, your boss, or anything or anyone else for your own unhappiness or inability to achieve your dreams.  But it’s also empowering because it forces you to realize that you & only have the power to change your life.  Of course there are always some things beyond our control, but our attitude is never one of them.

change your life

I realize this might not be the most upbeat, encouraging post I’ve ever shared but it’s something that’s been close to my heart lately.  Trust me, there are days when I really struggle with the unfairness of life.  I’ve seen patients younger than me with cancer & other chronic illnesses who have died.  And I am only 25!  Seeing young people suffering with illnesses that are completely beyond their control is incredibly difficult, regardless of your beliefs.  The only conclusion I consistently reach is that life is both beautiful & terrible.  And the best thing any of us can do is to appreciate the beautiful parts as much as we can.

With that in mind, when you’re driving down the road & the beautiful Fall leaves are swirling around you, take time to notice how magical that is.  If you’re taking a hike, take time to soak up the enchanting, intoxicating smell of the forest.  Allow yourself to be caught up in the beauty of music.  No matter how hard life gets, don’t close yourself off or refuse to try new things.  As cliché as it sounds, live every day as if it were your last so that whenever that day does come, whether today, tomorrow, or fifty years from now, you will be able to face death with peace & without regrets.

020

10 Life Lessons Nursing Has Taught Me


It’s probably been said a million times before but it’s worth repeating: nursing isn’t just a career; it’s a profession.  Some would even say it’s a calling.  In any case I can’t believe that in just under two months I will have been a nurse for three years.  It’s absolutely mind-blowing to think of all the things I’ve learned & experienced in just three years.  But it’s not just “nursing knowledge” that I’ve gained.  The things I’ve learned as a nurse are just as often lessons about life itself.  These lessons are actually very universal but I feel blessed to have chosen a profession that really does MATTER, a profession in which no matter how stressful or busy my shift may be, I still know I did at least a few things to make someone’s day a little better.  And I feel blessed to be in a profession that because of all these things brings continual growth to me as a human being. 

Today I would like to share the ten most important life lessons I have learned in my first three years as a nurse.  In ten or twenty years I’m sure I’ll have plenty more to add to this list & then it will be even more interesting to look back on these.????????????????????????????????????????????????????????????????????????????????????

1.  Life is way too short to do anything but have as much fun as you can.  I’m not trying to say we should just party it up all the time & neglect our responsibilities in life.  But what I am saying is that NONE of us, no matter how young or old, is guaranteed tomorrow, so no matter our current circumstances we need to truly make the most of every single day we’re alive.  Whatever goals or dreams you have in life, chase them NOW because you never know when you might not have the opportunity again.  If your current circumstances in life are making you miserable, find a way to change them, & if that’s impossible then change your attitude.  Life is far too short to be miserable all the time.

2.  On a similar token, life is often cruelly unfair.  Bad things happen to good people ALL the time.  It’s horrible & it can & will make you question everything you’ve ever believed, especially when you’re still young & vulnerable & trying to figure out life.  But that’s ok.  Question away.  Just don’t let bitterness take over or you will be of no use to anyone, including yourself.  At the end of the day if there is a purpose to life, it’s very simple: the purpose of life is to live it, to soak up as many experiences as you can, to have as much fun as you can, & to give & receive love as much as is possible. 

3.  Life is what we make it.  As mentioned above, circumstances are often unfair & not entirely within our control.  But our attitude about them can make a world of difference.  It’s perfectly normal & acceptable to experience sadness & anger when bad things happen, whether in relation to our health or otherwise.  But if we never move past this stage, we will be miserable forever.  We have to learn to process our emotions & move forward in life no matter what hardships we’re facing.  As Pema Chodron so wisely stated “Nothing ever goes away until it has taught us what we need to know.  If we run a hundred miles an hour to the other end of the continent in order to get away from the obstacle, we find the very same problem waiting for us when we arrive.  It just keeps returning with new names, forms, manifestations until we learn whatever it has to teach us…”  For example, I’ve seen diabetics on dialysis in their 20’s & 30’s because they have refused to deal with their disease in a responsible manner & have continually not taken care of themselves at all.  These people are often obviously in denial of how sick they are but this “protective mechanism” of denial does not protect them from the physical consequences of their disease.  I’ve also seen diabetics who are in better shape & better health than most non-diabetics because they have a good attitude & take care of themselves, even though it is not easy.  Please don’t think I’m saying those who suffer negative outcomes, especially at a young age, DESERVE those things.  Of course not.  I’m just saying we cannot always control the cards we’re handed in life, but we can control how we play them.end of life

4.  Tragedy will prove the mettle of a family.  Families who are close are better able to handle tragedies because they have made plenty of good memories together & have actually had those difficult conversations about end of life issues.  Families who aren’t close will be completely ravaged by tragedy & are often unable to let go because they realize, far too late, what they’ve neglected.  It can be gut-wrenching to watch families break down during tragic experiences, but what we as nurses learn from this is that we need to have those difficult conversations with our own families.  No matter how awkward it may be, we have to talk to our loved ones about what they would want done if they had a massive stroke, car accident, or some other tragic injury in which they become incapacitated & unable to speak for themselves.  Whether you’re in the medical field or not, please think about these issues.  I don’t care if you’re 20 or 50 or 80.  You NEED to think about these situations & make your wishes known.  And you need to know the wishes of your loved ones.  God forbid you should face such a horrible scenario but if it should happen, it is better to be prepared & have some kind of plan than to have to bear the responsibility of making those decisions without knowing what your loved one would want done.

5.  Nursing has taught me that I can handle WAY more than I thought I could.  I can be up all day & work all night with no problem (not every night of course but sometimes).  I can take care of between 3-5 sick patients & still get my charting done & leave on time at the end of my shift (most of the time).  I can start IVs on people who have almost no veins to offer (not always of course, but more often than I ever dreamed possible).  I can help families process the impending death of a loved one.  I can hug & cry with family members when that death occurs.  I can clean up any & all body fluids without feeling nauseous (at least 99% of the time).  I can call a doctor at 3:00 a.m. & know exactly how to sum up the situation & what orders I need in two minutes or less.  I can leave my lunch to go collect a stool sample, wash my hands, & go right back to eating like that is completely normal.  I can be hit, kicked, & scratched by confused patients without losing my temper.  I can be yelled at by angry patients or family members without wanting to run out of the room crying (ok, sometimes I still want to but I don’t).  I can call a family member in the middle of the night to tell them their loved one might not make it till morning without breaking out in a cold sweat.  I can make patient assignments for the next shift even though I know that no matter what I do there will always be someone upset with their assignment.  I can listen to all kinds of crazy stories from patients, some confused, some not, without batting an eye.  Basically I can do so many things that I never thought I could do & this gives me the confidence to know that I can accomplish just about anything, at work or at home, if I work at it hard enough.  Some things will be incredibly difficult at first but practice really does make perfect, or at least close to it.

6.  Sometimes people can be incredibly stupid.  If you’re not in the medical field, you would not believe some of the crazy things we see & hear in the hospital.  Sometimes it’s enough to really make you question humanity.  But as nurses we have to learn to let it go, to remember the patients who make it all worth it, & to understand that the stupidity we see is often rooted in ignorance & lack of education.  Some of this is willful ignorance for sure, but some of it is not.  If I ever become so jaded & cold that I cannot see the good in others, I pray someone will tell me STAT so I can leave nursing because that is the point at which I would be useless & no longer worthy of this profession.  But I hope that day never comes.

7.  If you don’t take care of yourself, you cannot take care of anyone else.  Yes, as nurses we all have shifts when we go 8 hours or more without using the bathroom, eating, or drinking a sip of water.  But we can’t let this become the norm or we will burn out completely.  This concept is why I only work OT once a month at most (occasionally more if there are special circumstances but those are rare).  I know that no matter how good the money is, working OT every week is just not worth it.  I know I need my days off to relax & recharge in order to be mentally & physically capable of being the best nurse possible, not to mention the best wife, friend, daughter, etc.  Nursing may be a calling but it isn’t our only calling in life.  If we let it overwhelm us & take over our whole lives, we will soon find that the joy of it has been lost anyway.burnout

8.  There are a lot of people who love to complain but don’t want to actually do anything to effect change.  This is applicable to coworkers as much as it is to patients.  We all have to vent sometimes, especially in a profession as busy & stressful as nursing.  But we need to be conscious of how much we’re just complaining without actually accomplishing anything.  Trust me, I see things that anger or frustrate me all the time.  But I try to come up with practical solutions to as many of these problems as I can.  Otherwise I know I’m just spreading negativity & bringing everyone down, including myself.

9.  Change is hard.  Whether it’s a new computer system, a new policy, or a new piece of equipment, there is a learning curve for everything in nursing.  As human beings none of us really LIKES change.  It’s hard for everyone.  But if we want to survive as nurses we have to learn to adapt constantly & the same can be said of life in general.  In nursing, as in life, there is always something new to learn & that is part of what makes this such an exciting & interesting profession.  Not a night goes by that I don’t learn something new & I love that.  It’s what keeps me engaged when I’m exhausted & wondering why the heck I chose this path anyway.walk two moons quote

10.  Going back to the first point, life is way too short to stress about things that really don’t matter.  As one of my favorite books (Walk Two Moons by Sharon Creech) put it, “In the course of a lifetime, what will it matter?”  I try to ask myself this question when I find myself stressing about something that I know probably isn’t worth the anxiety it’s causing me, whether at work or at home.  This is exactly why our house is usually a wreck & I’m chronically behind on housework.  I realize that at the end of my life, whenever that may be, I’d rather have spent my free time cuddling with my husband & my puppy or making memories with my family & friends than obsessing over having a spotless house.  Trust me, I’m not living in a pig-sty, but our house is far from super organized & I could not care less.  Our house will never be featured on some kind of interior decorating blog or be filled with Pinterest-inspired crafts.  But it is full of love & affection & that is what matters in the end.  By all means, if having a spotless house brings you joy, feel free to keep it up.  I’m just saying we shouldn’t waste our precious time on things that really don’t matter if they aren’t also bringing us joy.  When I’ve cared for patients at the end of their lives I’ve never once heard someone say they wished they’d spent more time cleaning or organizing their house or working or doing any of the mundane things that so often stress us on a day-to-day basis.  Instead what I’ve heard is “I’d wish I’d spent more time with my friends & family.”  Or “I wish I’d learned to play the piano like I always wanted.”  Again it comes back to what I said at the beginning: life is far too short to do anything but have as much fun as we can. 

If you’re a nurse (or anything medical) & you’re reading this, what life lessons do you think our profession has taught you?  I’d love to hear your thoughts.