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