It's nice being not-alone

Sometimes life is long and wearisome, and in the midst, it's easy to get trapped in those thoughts. Perhaps because of this, I am thankful for those who walk beside me, hastening me on wards, grasping towards the same glory-- Christ. I am thankful for those who race before me, marking pitfalls, calling back encouragement, showing me the path that is best. I am thankful for He who ran first, told me the goal, levels the way, and leads me unto life as all nearby wastes away.

Here is the gentle way, difficult way, good way. "Walk in it, and find rest for you souls."

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105

I tried the hardest I've ever tried with 105. She was my age, and I wanted her to get better. Some patients I feel bland towards, no matter how much I try to connect with them, but not 105. From the minute I walked into her room and saw my own nerdy fandom posters on her hospital room walls, I wanted to hear her voice. I wanted her to get better, and go home, and mend all the torn pieces that come with a suicide attempt. I hoped this would be the dark time of her life, and that she would awake with fresh perspective and a thrill to live.

She had crazy strawberry blond curls.

Why do I connect with the people I do? In the end, it may simply be that I can identify with them...their interests, their feelings, their age, their backgrounds, etc. It sounds so simple minded, that like a baby I like those like me. But I do. Perhaps that's why 105 felt so devastating. I watched her for months, neuro storming, sweating, vital signs readings in all the wrong places, breathing jagged. I watched her wake up a little, attempt to speak, and then begin falling backwards into the world that exists between open eyes and the hurting mind. I watched her children trail in to giggle around her bed, I watched her boyfriend stand nervously in the hall wringing his hands. I saw as she turned from peaceful into restless. She would thrash in bed, and sweat through her sheets up to 2 times a shift. She started to cry and recoil at touch. She ground her teeth at any noise. And she stopped trying to speak.

Never have I seen anyone look so like they were being pulled under against their own will, being tortured by healing. Her entire look was like a scream. Eventually, rehab stopped. We began to give morphine, muscle relaxants, anything to quiet her body and mind. Her family did not calm her. Her children did not bring her rest. No music, no television, no poems, or positioning or environmental changes brought her peace.  When we gently touched her to clean her, she would bend and twist into a mangled shape, press shut her eyes, and scream open her mouth to a horrific grimace and plea. Her pain was in a place we could not touch, and in a realm we could not see. It hurt to even be in her room, to watch her helpless family try to talk to her as if everything would be fine one day.

Two weeks after leaving the hospital, 105 died alone. Her obituary is taped up in the break room, with details about an unfamiliar vibrant stranger I've never met. I find myself turning my chair away from it and the bitter taste it leaves on my heart. In the end, I did not know her more than her months as a broken body. Shoving down bites of lunch, I approvingly think how good it was that she had finally found a measure of peace, and then turn on HGTV to drown out my whispered doubts. I don't know if I'm telling myself the truth, but I don't think too closely. I don't know if I could bear it.  There is little escape from the shadow she left in her passing.

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Lloyd the Eternal

In nursing school, we learned about wholeness as a person.  We called it "shalom" and wrote hasty papers about the way that this new concept would change our practice forever. But a dry essay is nothing like the  man crying before me, confessing that he’d rather be dead than spend more years leeching off of others. Somehow we deceive ourselves into thinking that the elderly or disabled are perfectly content with their bed baths and 24/7 television, as though age and illness purifies us of our humanity. But here he sat, silent and trembling, wanting simply to be on the farm again, or actually visit his children instead of taking up their money and making them worry. "What good am I?" he asks quietly. My heart freezes. School does not prepare you to truly answer that question.  

Praying with Lloyd is the sweetest moment of the day. He reaches out his translucent and quivering hands (oh how like baby birds!) and grasps mine through once sterile gloves. It is a plain, calm prayer of thankfulness, asking for hope and purpose. There are things that hourly rounding, anti-anxiety medication, and psychotherapy will never be able to do. There are some questions that cannot be answered with words or therapeutic touch, or simply being kind.

A lot of the time, I'm just struggling to appear trustworthy, knowledgeable and professional. But the thing that people like the best is just carrying on a friendly conversation, and having silly things remembered about them. It's really not too extraordinary, I suppose. If I'm honest, those are the same things I want. My favorite people are those who make me feel like I belong in their lives, as though I'm useful, funny, respected, and important to them. I don't want sympathy or politeness, or flawless professionalism. I want to be seen for me, and to be liked for it. I want others to want the best for me.  I want my problems to touch someone else, so I feel less alone.

At the end of the day, my patients, coworkers, and family want the same things from me that I want from them. They don't care if I win professional awards. They want me to take a joke, give them truthful information, listen to their questions, and show up when I say I will. If I do those things in a decent, cheerful way, perhaps they'll feel  not only cared for, but worthy of being cared for. It's not because they're entertained, it's because I've become another human to them instead of a faceless professional. These actions say simply “As you wish,” which is, as we all know, the best way to say “I love you.” When we take time to kneel in the dust, to step inside another complicated life, we are often at our finest. Perhaps this is our true superpower.

                                                                                          

"Beloved, it is a faithful thing you do for these brothers, strangers as they are, who testified to your love before the church. You will do well to send them on their journey in a manner worthy of God." 

3 John 5-6

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People can be rotten...but take heart?

There are patients I am repulsed by at a gut level. No matter what they're like or why they're here,  we are supposed to take care of them and make them, get this, happy to have chosen our hospital. Some people don't want to be happy.  At the end of a hard shift with said people,  sometimes all that is left is simmering, empty, spite. However, something strange might also happen. Sometimes a family will visit and tell me about the patient- I mean really tell me about them- and spin amazing tales about who this person has been. I'm not always sure if the patients really are that much more wonderful inside, or if it's the persistent love that makes their dear ones see them that way. Either way, it presents them in a new light.  I become disgusted with myself for being so terribly dull and blind to the hurting soul in front of me.

It is simpler to dislike a person than have your heart break for them. Dislike denotes a distance, so if you can find a reason to criticize, you can usually protect yourself.  The offending being can be a patient, or or politician, or even a random person who cuts you off in traffic-- if you can dislike them, you can move on with your universe. Criticism turns them into an problem instead of a human, and problems... all they need is solving.

Many days all we see is the broken version of love, the selfish faux-gratifying pop song rubbish. True love is this: While we are still disgusting, Christ dies for us. (For us!) Oddly, it isn't the gems hidden in the disgusting, but the way we are loved which makes us worthwhile. Love does not salvage and rework us to be of value but more often it creates our worth from nothing. He says that you have value. You. Not because of who you are but because of who he is. We are because we are loved.

The truth is that love transforms my patients into what they are not on their own. It transforms me into what I am not on my own. And it has got to be a love from outside ourselves, because we can't create a love overwhelming enough inside that it can regenerate who we are or who we hate.We can't love enough on our own to transform those around us and when we try it boils down into anger and weariness. If I think that I can find a light spot in the lives in front of me that makes them "worthy", I am often sorely disappointed. They are worthy of care because of whose they are, not what they have done or will do.

Losing sight of this happens of course, and I become caught up in the inconvenience of people and a world which keeps me from putting neat check marks next to each item. Some nights when my car comes to a rest in the driveway I have to lay my head down on the steering wheel and groan over what an idiot I've been that particular day, how blind I've been to the flecks of immortality hovering in the halls and passages where I've tromped mindlessly. Christ's call to love as he has loved is such a vast command, partially because it calls me to care, and caring is not cool on TV, nor is it tidy.

 It is easy to lose heart in a world constantly breaking with people who are insatiable for adoration (like me, for example). Yet Christ says says my dumb daily tasks are worthwhile, because they are works of  love. They might go unappreciated, they might be faulty, but they are not for the flesh and bone I'm touching, but the soul and the one who created it. Do not let your days be simplified into meaningless tasks devoid because it keeps things from being complicated (I write that for you, Elizabeth-of-the-future).

Rumor has it that the peace He gives is worth all the break times in the world, put together.

                                                                                          

"Love is the expression of the one who loves, not of the one who is loved. Those who think they can love only the people they prefer do not love at all. Love discovers truths about individuals that others cannot see” 

 -Søren Kierkegaard

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DC comics and brave old souls

108 has a full thicket of white hair, a healing hip, and sassiness to burn. She looks deceptively prim, but only because her breathing has deteriorated to the point that she must be sitting straight upright to maintain her oxygen levels. I apologize that my morning assessment interrupts her Batman marathon, but she is almost 90 years old and replies that she is used to the unexpected by now. While I draw labs she pats my hand -as if to comfort me while she struggles to inhale- and reminds me that smoking is the stupidest thing I could ever do, so dear lord, would I please spare myself? I agree, then chart her lung sounds as coarse.

She is not getting worse, but after 16 days she isn't getting better. She doesn't complain much, but I know she's miserable and her mind is always roving outside the walls. When I chart in the room she tells me about her garden, and what she likes to cook, and the places she's traveled. Her dream, she says, is just to go back home and sit by her flowers, and have her children come to visit so she can make them dinner. It is a simple dream, but as she plateaus her hope in it fades. She becomes quieter about what she will be doing in a month, and starts giving me her favorite recipes to try out on my own family. When I mention to her that it takes bravery to be sick, she smiles her slightly mischievous smile. It does, she says, but all of life takes bravery. 

She closes her eyes then, takes a rattly breath, and surprises me. "I don't know what comes next for me or if there will be much at all, but I know what has come before, and it was good. I was given the future I dreamed of when I was your age. I don't have to worry about it anymore, because it's permanent for me. Sometimes I wonder if I'll ever go home again, or sit in my garden, or make dinner for my children. But I can remember having done it before, and I know that even if it never happens again, I have been able to do it once, and it can never be undone. It is a gift, to have a past like mine."

Planning for the future is really the hope to create a past.  It's beautiful the way she says it, but she brushes off my wonder by reminding me that she's had almost 90 years to come up with all her lines.  On my break I come back to watch The Dark Knight with her, and she says the Joker is her favorite character, but Batman is her favorite person because "he knows what's up with how people really are." We laugh and disagree, and are glad that we happened to meet for just a tiny while. Lives overlap in time and space, and I do not think it is an accident. She agrees. 

"'Instead of possibilities, I have realities in my past, not only the reality of work done and of love loved, but of sufferings bravely suffered. These sufferings are even the things of which I am most proud, although these are things which cannot inspire envy.' "

-Viktor Frankl, Mans Search for Meaning

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Posted in future, identity, nursing, the past

Blessed be the shimmers

There are mint plants twining next to my window, and on sunny days I like to toss up the dash so they can become better acquainted with the sun. The lingering aroma of fresh mint permeates everything, and it  would be easy to imagine (unless your imagination is paltry) that you were relaxing in a tube of toothpaste, or possibly dozing near the edge of a tea vat.

It is these wonders of life ( the fresh mint moments) that add together to overwhelm me with his grace. Frequently they sneak between the cracks of mention. It feels incomplete to hear of happiness without background, like skipping to the last page of a book. Yet, in spite of it all, there is joy and undeserved, inexplicable glints of More.

This quickly wells up into awe: I have done nothing extraordinary but been given such goodness on earth.  I live in unearned safety and plenty with those I love, which is such blessing beyond what I could dream to attain. What grace to experience his goodness in my present life.  

He is so good to us, to me. There are some days when you have to stand near the window, close your eyes, and just marvel that he has blessed you with sweet mint plants. These are just one good little shimmer midst the dark, the chaos, the decay. It is simple for me to lose sight of the vastness in these daily blessings.

“Now it is a strange thing, but things that are good to have and days that are good to spend are soon told about, and not much to listen to; while things that are uncomfortable, palpitating, and even gruesome, may make a good tale, and take a deal of telling anyway.”- J.R.R. Tolkien in The Hobbit

"He leadeth me beside still waters, my cup overflows." Psalm 23

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Posted in joy, nursing

Sometimes the hardest thing is to quit

102 was the first patient I cried over at the hospital, which is strange when I think about all the things I probably should have cried over and didn't.  I have worked with him dozens of times. Yesterday, he looked at me for the first time. Not through me, not glazedly forwards, but at me. I checked his eyes- they reacted to light, briskly, round 6mm pupils that shrunk equally under my penlight. I was taken aback. I spoke his name. He raised his eyebrow. The facial expression made no sense, but it was there, movement. It felt, I imagine, like seeing the first smile of a baby. 

I worked with 102 again today.  He looked at me, those clear green eyes that last week had been looking at things unseen to us. He looked like he knew what he was looking at, and he moved his face with expression, the face that has been droopily absent of movement beyond a grimace for months. His family told me that they were changing his code status to Do Not Resuscitate, and moving him onto hospice care. I wanted to grab a hold of them, to make them look into his seeing eyes, to watch him slowly squeeze a hand, but I couldn't do more than suggest and support. The Wife had sat with him for 3 hours that afternoon, just quietly holding his hand on her day off work. She told me that she didn't know if she was doing the right thing, but she had decided, because it seemed like the only thing to do, what he would have wanted. She said they'd been there for  months, and seen almost no progress, and had taken the suggestion of the neurologist to move to comfort care only. Insurance coverage for their stay runs out in 3 days, and they do not have money. They do not have anymore energy for hope. 

The mother of 102 is less sure. She thinks her son might be responding, and she gently suggests tests, more tests. She can't believe a perfect body can be vacant of life while it breathes on without aide. Maybe they were doing the wrong thing, maybe...

Maybe, I had seen that neurology exam. I watched her come into the room, wave her hand in front of his face and tell him to close his eyes, wait 3 seconds and then leave. She had not watched his pupils, held his hand, taken into account his napping. I had stopped her in the hall to beg for a further assessment, but I was brushed off. There was no change, she said. She had seen it in her exam. And now, he was leaving, stopping therapy, to fade. I suggested a second opinion is always within their power when they feel unsure, but I can say no more.  They are the decision makers, the family. They know 102 in ways I do not understand. There is nothing I can do about it.

The spunky little blond daughter doesn't know yet that we're letting her father die. She is making plans for when he gets better. They won't tell her the truth until she finished the school semester and participates in her soccer competition. In the meanwhile, she introduces me to her dad's distant friends on skype, and tells me about what she and her dad are going to do over the summer. I am to remain silent about reality.

That is my job, to be quiet, caring, confidential.

But they can't keep me from crying in the medication room.

102 is only in his 30s, so young young young. And he is alive inside, I see it peeking through, like a branch in winter waiting to burst once more into the foliage of spring. If only they could wait. But the world does not fall asleep until my patients are ready to ride off into the sunset.  Healthcare plans and insurance are not Prince Charming. They wait for no one: not dead branches, not unsure mothers, and definitely not nurses wiping away angry tears as they dispense Tylenol into med cups. 

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Posted in ethics, nursing

Working in The Pit

It has been quiet on the home front, where I split my time between sleep, commuting, and work. In some ways, I am as tired as ever, but the RN job has given a meaning to tiredness in a way that television shows, studying and long walks cannot.

The inpatient unit electrifies me, so choc-full of tales just pulsing away under my fingertips. I've been meaning to sit down and write more of them out before I forget, because they make such wonderfully complex characters, these people. However, it's difficult to a) get the time and b) respect the ever looming threat of HIPAA. I end up having to fudge and reinvent everything so that the people I talk about are not the people I see, which is a little sad, because eventually I forget the real details. In retrospect, I don't know if the reality is more important than the feel of their stories. I can't preserve history, but I can memorialize moments, problems, emotions that are common to more than one person.  Perhaps they both have their places.

The work is difficult, and busy, and I don't always care for it, but those stories are what make me want to stay. I want to know what happens next, and it's frightening to know that I influence the plot. There is so much more weight to a story when it involves a soul. 

It puzzles me to think that my daily tasks occur in the defining events of people's lives. The people I meet are those who are questioning themselves, their loved ones, their purposes. They are trying to reassemble shards of lives unready to be interrupted. These humans are fragile. They hold me in awe. Yet we have the audacity to push them forwards, to wash their changed bodies, to chart the fluctuations in the endless taking of vital signs.

 The simple collection of human experience on the unit takes my breath away. It is the non-glamorous plodding to clean up train wrecks, suicide attempts, accidents, attempted murder, strokes, surgeries gone awry. These are not people who expected illness at all. They were people  on vacation, making dinner, visiting grandchildren, driving to soccer, having babies, performing at concerts. 

They are not always good people, or good situations or good endings, but they are good stories. Beautiful stories. 

As C.S. Lewis says, "There are no ordinary people. You have never met a mere mortal. Nations, cultures, arts, civilizations, these are mortal, and their life is to ours as the life of a gnat."

I look at my patients, and I know this is quite true.

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Posted in ethics, faith, nursing, storytelling, writing

Slightly dour holiday thoughts.

I’m not big on judgment, which is a little bit of a lame thing since I suppose no one is when it comes to themselves.  No, my Christianity has rather been formed around a holy but loving/grace filled God who is  not permissive, but slow to anger. However the Bible says that God does judge, and we are guilty.  I am guilty.

Consequently, I sort of dislike reading about judgment in the Bible, although I’m simultaneously fascinated with God’s wrath. I've been reading a lot about judgement lately in the Old Testament prophets, partially because this makes me uncomfortable. This leads to the following verse about Sodom, of Sodom and Gomorrah fame, which was wiped from the face of the earth after abominable sin without repentance:

“‘Now this was the sin of your sister Sodom: She and her daughters were arrogant, overfed and unconcerned; they did not help the poor and needy. “ Ezekiel 16:49

I can’t get this verse out of my mind. It’s running tired little laps around the edge of my skull. I’m not sure what to do about it, or why, aside from that I means something (Deep, I know.) Being a selfish poor steward was reason for annihilation—not any number of sins I had imaged cause for a severe judgment. They were rich but self-absorbed. 

Forgive us, Lord.  I am guilty indeed. 

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Posted in conviction, mortality, redemption, verses

Mind Games

HA! I've invented a game. Or probably re-invented, since it is suspiciously similar to classic “pretend” except there is acute illness involved. Maybe it’s just a plain old coping mechanism. But really folks, who wants to say “Hey look! I've invented a Coping Mechanism!” when asked what they've been up to? Humor me. I need humoring.

I ache pretty constantly, and now, as the sprinkles on top, there is sharp random pain to accompany nausea and tachycardia.  This is where that elusive Game comes in (you thought I’d just used the word "game" to trick you into reading this depressing post, didn't you? No fear, it’s real). Stabbing pain has made it deliciously easy to be the Little Mermaid (Not Disney’s, but the original story). Close your eyes. You have feet that feel like knives are cutting them because of the deal you made with Ursula, but you attempt to move gracefully so that the prince realizes you were the one who saved him and doesn't marry that  fake princess thus leaving you to be turned into sea foam. As you can see, this game of pretend can be a little involved…but hey. My mind. My rules.

Another symptom is transient lower extremity numbness and tingling.  For this, it’s insanely helpful to be a war veteran with a wooden leg. However, he continues to walk tall and proud because he lost his leg in a noble cause, and apparently sometime in the 1800's before we had any good prosthetics…

I haven’t yet figured out what to pretend when LE numbness and pain occur simultaneously. Maybe if Ariel  didn't transform into a human completely and was left with only 1 leg, and thus had to build a peg leg out of drift wood? As stated, this scenario is still in need of refining.  

When I have insufferable fatigue for no good reason, I’d like to believe that it’s because I’m walking through a field of enchanted poppies right outside Oz.  Body aches are leftovers from blows sustained while cavorting about in clunky armor, or surviving a plane crash. Grinding headaches are hangovers from getting drugged by enemy spies—work through it, Love, you've got a mission to accomplish.  Nausea is because you've been climbing Mount Doom, just had your finger bitten off, and can’t even remember what strawberries taste like.  Don’t sweat it. You’ll get back to the Shire eventually.

Most of all, that’s what helps: I’ll get back to the Shire eventually.

The imaginative buffer helps give purpose to what my body feels, keeps me living life even though I just want to curl up in my bed and not move for hours on end.  In the meantime, I need to get more reading done so that I can keep on with literary allusions to sustain my increasingly ravenous mental games.

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I'm thankful that I'm not stalked by paparazzi.

          "Human nature is displayed in every word and action. When I do something wrong, I can't honestly say, 'Oh that's not really who I am! I don't do that kind of thing! " Obviously, I am wrong, because I just did do it. It is precisely in these moments of unexpected actions that I really am me. Not a "perfect" me messing up a little, but the real me walking out of the look each of us put on. It is my real heart, acting in human sin (or conversely in the overflow of God). Often, there is more revealed in one unexpected action than in many expected actions together."

         This is an "old" thought from 2008, but I stumbled upon it again today.  I have a shamefully human habit of judging others by their actions, yet measuring  myself by my intentions. It's uncomfortable to remember that others may judge me only by my actions. Even when my actions and words are not what I was intending, they are nonetheless a reflection of my heart. I would do well to examine their source.

        Also, I'm glad that tabloids find me too boring to thoroughly investigate.

                         
“Our life always expresses the result of our dominant thoughts.” -Søren Kierkegaard
Keep your heart with all vigilance, for from it flow the springs of life. Proverbs 4:23 

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Posted in faith, identity