I’ll Always Remember My First

I’ll always remember my first.

It hurt. A lot. He was 87-years-old, and his name was Joseph. It was uncomfortable nearly to the point of unbearable, but I made it through the cold and gray afternoon. I survived the experience, and I was a changed woman because of it.

Every nurse remembers his or her first patient death. I’ve seen dozens and dozens of patients die since that chilly November afternoon, but I will always remember Joe as the one who shaped how I would respond to these moments in the future.

Most people don’t go to work and see dead people. Most people have careers that might be challenging and interesting, exciting and on the cutting edge, but generally speaking, nobody dies from an unanswered email. That is the thing about being a critical care nurse that has both helped me find perspective in some situations, and frustrated the hell out of me during others. You see, nurses are an odd bunch. There are so many different sectors of nursing: working in a hospital is just the tip of the iceberg. However, in my three years as a nurse – two of them in cardiac surgery intensive care – I have become keenly aware of the reality that most people don’t understand the importance of a nurse until they truly need one. Us nurses, we are not just an anomaly in healthcare: we are a unique brand of individuals in our personal lives, too. Though we have ebbed and flowed throughout the shifting undercurrents of healthcare as a whole, nurses are still attached to the antiquated and unrealistic Florence Nightingale dilemma: while we are highly skilled, educated, and seek professional equality, we are often our own worst enemies when it comes to professional progress. Nursing is a dynamic profession, one that has shape-shifted in its technological advances and evidence-based techniques, yet for as far as we have come, we all-too often insist on treating one another with disrespect and condescension.

Nurses are a**holes. Not angels. Not saviors. Not guardians. Many times heroes, yes, but all too often – a**holes. How is it that a workforce filled with millions of men and women touted for their code of ethics, integrity, and compassion, can be so damn mean to one another?

Well, I’m not sure. But it’s something that I’m working hard to figure out. And I must. Because for every life I have saved, and each I have lost, I have come to depend on my colleagues as though they are the air I breathe when I’m stifled by the circumstances of ICU. I truly believe that we have grown into a pleasantly dysfunctional group of type-A adrenaline junkies who would work through ninety-nine bad days just for that one amazing one. But much like every family, we experience drama. We see infighting, back-stabbing, and bullying of the schoolyard variety. What makes it so easy for us to write off this piss-poor behavior? Why do we enable, if not encourage, this vicious cycle that – I guarantee you – takes place on every unit in every hospital across the country? Are we so singed by the stress, so blinded by the chaos, that we must turn against our own to protect ourselves from the flames that burn around us every single shift? Nurses are a**holes – but is it because we have to be?

I don’t go to church. I know that I was raised as a Christian, and my fondest memories of Christmas and Easter as a child was a few presents and mass candy-consumption. I understand the gist of the Bible and its teachings, but I’m a bit fuzzy on things like actual scripture, who said what, the literal nature of things, etc. As a matter of fact, I could probably better quote lines from a late 90’s comedy than anything having to do with Biblical teachings.

But that doesn’t mean I am not a “believer.” As a matter of fact, I’m hard-pressed to find a nurse that isn’t. Because you see — what I’ve seen, what I’ve experienced, what I’ve lived through in my 13 hour days: those moments would shake the average person to their very core. I can’t explain why, but working in the intensive care unit has been almost a greater test of my spirituality than my academic competence or clinical prowess. Most people live their entire lives never seeing someone die. They may even live for decades before they see someone propped and made up in a casket at a funeral. And that’s only for a few minutes or hours at most. Yet what we do — every single day, in so many mediums across the country — what we do is not the norm. I don’t know exactly how many patients I’ve lost, partly because I refuse to keep track, and partly because it’s better not to remember. My first, though? Well, you get the point.

Let’s keep something in perspective here.  I’ve been a nurse for only three years. I know nurses who have worked in this field for more than three decades. What keeps them coming back? How do they sift through the slurry of emotions and pick out only what feels rational, reasonable, and still human at the end of it all? It’s a question that has plagued my mind since my very first shift in the intensive care unit. It’s an intricate piece to my “nurses as a**holes” puzzle.

As a new nurse, I worked on the floor as a cardiac nurse in a step down unit before working in ICU. Although patients were often quite sick, some decompensated and required higher levels of care — others even died — but the expectation, in general, was that we were preparing to get patients ready to graduate from the hospital and move onto their next destination: going home or to rehab. The mindset on the cardiac floor is one that everyone should make it out alive.

In the ICU, the mindset is that…perhaps no one does.

It’s unsafe to remain eternally optimistic in the intensive care unit. It’s simply poor practice to set yourself, your patients, and their families up for the belief that “everything is going to be okay.”

“They’ll be fine.”

“Surgery will go well.”

“I’m sure she will do beautifully.”

“I know we will get him a heart transplant soon.”

Could you imagine my own struggles, with my rose-colored lenses and obnoxious red frames, when I came to realize (sooner rather than later) that life in the ICU often ended there? Gone were the days of hugs goodbye and patient teaching — at least in the sense that I had known.  Now my job was to keep my patients from coding, bleeding, and dying. Or, at the very least, reviving them if they tried.

Talk about a rude awakening. My cheerful demeanor and positive spirit would soon be challenged, not only by the hard and hardened, bright and brilliant nursing cohort with whom I worked, but by the nature of the work I was doing itself.

How do you leave this at the door? How do you fight tooth and nail; push every drug under the sun; do compressions for two hours; open another mans chest; pour blood in as fast as it comes out – and be expected to go home and eat dinner and take a shower and act like a normal person? How are you expected to take in the sounds and sights and smells of the pendulum between life and death that literally swings back and forth throughout the unit without needing some time to just sit down, look up to the sky, and ask, “What the f*ck just happened?”

What. The. F*ck. Am. I. Doing. Here?

Nurses can’t help but to think this through when the bad days are especially so. What the f*ck have I done? What am I doing? Why am I busting my ass for this? Why did I leave my other career? How did I end up here? What makes me so freaking special that it’s MY job to protect the life and livelihood of another human being?

It’s a lot to consider, right? The things they never tell you about in school. The system educates us about generalizations and stereotypes and archetypes of the profession, but nobody ever tells you that seeing a wife collapse in grief over the body of her suddenly passed husband will send you rushing to the restroom to throw up your lunch. Nobody explains to you that everything is different now. Everything. You can’t have fun without the worry of consequence, yet you must enjoy yourself for time is fleeting. You must live a life of honor and virtue, yet you have to drink or smoke or make dirty jokes just to keep from cracking. You’ll pray that your services aren’t needed at the gym or the grocery store or an airplane, but you’ll be the first to respond to an emergency anyway. You’ll wonder why everyone worries about such asinine and meaningless bullsh*t every day — you want to take friends and family members and children and colleagues and total f*cking strangers by the shoulders and shake some sense into them: WHAT WORRIES YOU IS NOT AN EMERGENCY! What you’re stressing out about is meaningless in the grand scheme of things! Your priorities are completely and utterly misaligned, and someday on your deathbed you will realize this! You worry that others are too worried while you worry that others don’t worry enough. It’s the weirdest and most complicated explanation, and it’s a totally bewildering paradox that nobody seems to discuss unless they’re the ones in it. Nurses vent to nurses. Nurses shit on nurses. Nurses lean on nurses. Nurses cry to nurses. Because we cannot understand how anyone else could fathom what plagues our minds during those especially bad days.

(Nurses, and God.)

Maybe we aren’t really a**holes after all. Perhaps we simply need to feel alive when others aren’t. Perhaps we are pissed off about our professional purgatory. Perhaps we would never change what we do for the world, but we can feel ourselves change because of it. Perhaps with every one we lose, we lose ourselves. With every one we save, we save our souls. With every shift that the gray area extends from another life into our own, we are not so much mean as we are misunderstood. I pray for those charged with our care. I pray for those charged with caring. God only knows how we do what we do, and listens as we whisper in our own patient rooms.

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Wear the Pants Out of Life

  

 

What drives you?  What makes you tick? What inspires you? Engages you? Is worth fighting for?  Many days that I leave work, I often ponder these questions: what makes you do what you do, and why do you keep fighting for it?  You see, life could have been much easier if I stayed in my old career.  I could have achieved lots of success.  I might have made lots of money.  Maybe my work emergencies would have been concert tickets and television contracts and where to get cocktails after work.  But that world didn’t drive me.  It didn’t inspire me.  It didn’t engage me or incite me or invite me to sit down and stay a while.  And so when I leave work after those very long days – you all know them – the fourteen hour, forgot to eat, didn’t pee, never left your patient’s room kind of days – I often find that what drives me is sitting quietly in the corner of the room, hesitant to touch anyone or anything.  What inspires me is the terrified family member who is putting on a brave face, unable to break down and cry for the off chance that maybe their critically ill loved one can sense the tears streaming down their face.  What pushes me is the sheer reality that, on any given day, I could help save another human being from the end that seems so imminent, and offer them but one more chance to see the sunrise again.  What encourages me is that, when all hope is lost and all actions are futile, a dignified death can still be an attainable one.  

 

There are so many days when I live my life, floating through the day; existing; going through the motions; completely unaware of just how incredible the gift of human interaction can be, and how much we have to offer one another.  I feel guilty when I catch myself in those moments – those times when I breathe but forget to smell the roses; when my heart beats but my passion is not in the moment; when my brain is just a brain and not an incredible and powerful mind – because it proves to me that even witnessing the pendulum between here and the afterlife every day can become routine.  And so now I sit – with my coffee and my keyboard, staring out the window at a sun shining bright in the sky, contemplating all of the wonder and possibility that life can offer those who open themselves up to it, and understanding that what I do every day allows me relish in this moment. 

 

We are all so involved in our own hustle and bustle, the rat race, the nose to the grindstone side of life that we are often reticent to express how we actually feel for the sake of what we are literally doing.  I don’t want to know what you did at work today – tell me how it felt to be there.  I don’t care what you bought at the mall – show me how excited you are to have some “me time.”  The fact of the matter is this: we all have motives; intentions; inspirations; dreams and goals and aspirations.  But most of us fail to realize them.  We get clouded by the demands of responsibility and reality and we forget to ask ourselves one simple question: what…makes…me…tick?  Who makes me give a damn?  Why does any of this matter?  Who do I love?  What makes me happy?  How can I experience all that life can give me, and who can I share it with?  

 

This chain of reasoning may seem so illogically placed from a conversation about being a nurse in the ICU, but I’ll be damned if every single one of us hasn’t thought the same thing.  To work under circumstances that are defined by stressors, even on the most pleasant of days, predisposes you to moving in two different directions: you are either polished by the pressure, or you will crumble under the weight of it all.  I have been an ICU nurse for nearly two years, and I have had moments when I’ve been split right down the middle.  My heart has broken more times than I can count.  I’ve gone home and cried the worst kind of tears – the silent and streaming tears, the sort of cry that allows you to speak not with words but with a glazed look and reddened cheeks; the steaming hot shower that you never want to leave kind of cry that leaves you exhausted and exalted and cleansed all at the same time.  There have been moments when I’ve asked myself, deep down inside, if I believed that I had caused the death of another human being in some direct or indirect way.  I have struggled with the moral and ethical dilemmas that exist when providing Western medicine to a culturally diverse population, and the potential repercussions that come of it.  I have been pissed off – like, really, really, royally and irrationally fuck-this-and-that-and-them pissed off – at physicians and families and sometimes, even patients.  I have left my loved ones perplexed and appalled and amazed by what I do, and sometimes, have discussed my day with no more enthusiasm than describing what I’d eaten for lunch. 

 

But those times that polish you – the ones that shine your very soul – those are the moments that remind you why you ever chose Frost’s road less traveled in the first place.  I’ve come to understand that ICU nurses have very long memories when it comes to amazing saves or miraculous recoveries, because it makes dealing with struggle and strife much more bearable.  I have come to recognize that there is no sense of humor darker and dirtier than that in the nurse’s station of an intensive care unit.  I have learned that when shit hits the fan, you will never, ever be alone.  I’ve come across families who complain and nurses who bicker and patients who need their call buttons removed, but through it all, I’ve come to find laughter and positivity can shift the entire dynamic of a bad day.  I’ve held hands and had conversations with people that I hardly know, simply because they needed someone to speak to.  I’ve been involved in emergency pizza parties that feed the bodies and the souls of battle-worn nurses.  I’ve witnessed unspeakable love and humbling gratitude offered despite less-than-ideal circumstances.  I’ve helped young patients move on through critical emergencies, able to walk out of the hospital alive and well, dazed and amazed by what it took to feel a warm breeze again.  I’ve seen elderly couples carry on like high-school sweethearts.  I’ve heard gasps; I’ve seen collapses; I’ve choked back tears during moments of loss.  But when those bad moments end well, I’ve seen the possibility of eternal love evoked from feathery kiss or a soft, sweet embrace.  I’ve attended more funerals than I care to speak of, and every single one of them has happened while I’m on the clock.   But this…this is what makes us different.  This is what grinds away the grit and allows us to shine brighter.  To be a part of someone’s life in some meaningful way – whether they leave the hospital, or leave this world entirely – that is a humbling experience.  To enter a room quietly during the final hours or minutes or seconds of another human’s existence, and to do so with respect and decency and courage – that is what drives me.  To open yourself, if only by a sliver, to the desperation of perfect strangers who need you more than you could imagine – that is what encourages me.  To fight your ass off for another life, and win or lose that tremendous battle, maintain that human side of yourself – that’s what makes me tick.  Not every happy ending is a perfect one, and not every final goodbye is a sad one.  We are all just many shades of gray – it is the living part of life that gives us color. 

 

I have only been a nurse for three years, but it feels like since I started, I cannot remember what life was like before this.  I do my best to remind myself why I chose this path, but when I dig deep enough, I recognize that it was not I, but the universe that led me here.  Whether fate or destiny or happenstance and circumstance, I am forever defined by my craft.  And despite it all, here I sit – understanding that being pensive and reflective does not mean one cannot be the great and eternal optimist.  I have seen some crazy shit; I have had some hard days; I have run on fumes and wondered how I would ever survive through the day.  But more importantly, I’ve made amazing friends and lifelong colleagues.  I’ve connected in powerful ways with perfectly ordinary people, and have experienced ordinary musings with powerful ones.  I’ve learned – a lot.  About medicine.  About anatomy. About physiology.  About how to do and what to do, even sometimes what not to do.  About the art of intuition.  Mostly, about the human condition.  I’ve learned what scares us – fear of death, anxiety of the unknown, the prospect of pain in every form.  I’ve learned what comforts us – love and laughter coupled with compassion and the simplest acts of human kindness.  Most of all — and I’m still figuring this one out —  I think I’ve learned what drives us: not money or power or greed, but simply put, it boils down to just being happy.  How you define your happiness may be different from my own, but that doesn’t mean it’s not rooted in the same seed.  So at the end of it all, when you think long and hard about what brings you basic joy and simple pleasure: let that guide you.  Let that encourage you.  Let that inspire and incite and ignite you.  That moment between reason and responsibility – that fleeting blip in time when you’re distracted from reality and feel wrapped in the cloth of serenity – that’s what makes you tick.  Your options are to live, or to exist.  Take it from me – the richest life is torn and shorn, ragged and worn, ripping at the seams from all of that living it’s had.  You can’t take it with you, so you might as well wear it out.  

The Lost Generation & My Hope to Find It

There is never a good answer for the burning questions that we face. Life has a suspicious manner of forcing its most literal aspects from the blind spot into the foreground all too quickly and suddenly, we are forced with a split-decision: speed up or hit the brakes. The craziest thing that comes from such a mental traffic jam is the all-too obvious reality that we will far-too frequently stop and take a step back before we forge full-speed ahead. And so we sit and we question the goings-on of our existence: am I doing the right thing? Have I made the correct choice? When I lay old and gray, cold and still on my deathbed, will I be filled with regret or feel overcome with contentment? We live in an age that prides itself on the tingles and sensations of instant gratification. We swipe and we click, we clank and we text for an answer to the deepest questions and a reflection of our gravest concerns. And yet, at the end of it all, what have we earned? How far have we gotten? I live amongst a generation of know-it-alls who, as it appears, know abso-fucking-lutely nothing. It’s mind-boggling that our parents and our parents’ parents had to battle hardship; endure world wars; live meagerly and proceed practically because we are a generation of totally entitled self-inflated attention seekers. I place no blame on any of us – we were born with so much, and have been taught in various ways that “too much” is never quite enough. Yet what scares me most is that my long-standing desire to serve as a voice of reason among the hashtags and handbags, reality TV and another “selfie,” will come across as simply that: a desperate cry for the attention of those who are too busy staring at themselves to recognize the stark reality that surrounds them.

And as a writer who bleeds words, knowing not how to heal thereafter, I face an even deeper struggle: what can I say that hasn’t already been said? Do that’s not been done? In the modern day-and-age where one cannot wear the same little black dress more than once for fear of being noticed, imitation is no longer the sincerest form of flattery. Instead, many and most creative pursuits feel redundant; contrived; lacking genuine depth and unique form due to the problematic conundrum facing the world today – over sharing. What had once been private moments and personal intimacies are now public knowledge to sweeping majorities. And so when we consider creative pursuits that define human connection: music, art, literature and the like…it becomes damn near impossible to maintain the level of introversion required to convert a theoretical notion into a tangible masterpiece. By its very definition, authoring the written word is a deeply personal act. It’s like defecation or masturbation or any other isolated action that results in a personal release. And with that notion in mind, I would prefer publicly performing either of the former as opposed to sharing my sincerest personal written work with complete strangers. I would love for everyone to keep this candid (and it appears, disturbingly neurotic) fact in mind while reading any of the future stories, which I feel so deeply compelled to tell. I hope this personal musing proves to you just how deeply passionate I am about writing, and how genuinely mortified I am about being a writer.

That being said, life is too much of a blur that whizzes by far too quickly for me to sit back and ponder any longer. So if you know anything about me, you understand that I can only write when the feeling strikes. I fall into a zone that exists someplace between reality and another place and time. Inspire me. Ignite me. Convince me that we are a group of human beings whose voices deserve to be heard, whose stories must be shared. Snap away. Tweet your hearts out. Go viral and get digital and tell your tiny stories inside your bright-white boxes – but please…please…keep that morsel of your being that nobody else will know: and when you’re ready for them to hear it, don’t just say it: show it. Define it. And if you’re really feeling ballsy, allow me to show it for you.

Open Letter from a Nurse

To my significant other:

I can only imagine how difficult it must be sharing your life with someone like myself. I do my best to remain your truest friend and confidante in our relationship, but the biggest problem is this: I am a nurse. The day you married me, you devoted your life to someone who devotes herself to others. And while this quality is something that is often praised, I have no question that you must find it challenging to handle at times (unless, of course, you too are a nurse). You are patient and kind, and you work so hard to support me in my profession. The caveat, however, is that nursing is not simply a profession: once you become a nurse, you can never not be one. Every effort we make to separate our identities from our professions are rendered useless, because we remain at our very core nurses. And while we are commended and praised for all that we do, you, too should be commended for what you endure. I’m sorry for the days that I come home and dump my entire day on you before my keys even leave the door. I’m sorry for venting, and short of complaining, I apologize for making my greatest passion sound like something of a burden. For all of the countless times you smile at me and say “Hi honey! How was your day?” and I suddenly burst into tears, I’m sorry. Even more so, for the days when I greet you with silence, and I cannot collect my thoughts enough to create full sentences, I’m sorry. I thank you for listening to me when I throw medical jargon around and pretending like you understand. I thank you for laughing at what I consider to be funny, that most rational humans believe to be reviled. And I thank you for understanding, with nothing more than a glance…during those trying moments when all I could ever need is your open embrace – while you brush the fallen strands of hair out of my face – that by saying absolutely nothing your adoration is speaking volumes.

I know that there are times when I work too long; I think too much; I read too many journals and attend too many meetings and do too few dishes and laundry in return. But you have never once judged me for it. You have never once resented my commitment to what I do, because you understand that everything I give to my craft as a nurse I give to you ten fold. I think about you all of the time – the silliest notions remind me of you, but they do. I often brag about you to my patients and families, and they gush over photos and stories of our lives together. It is healing – for them and for me – to lead with distraction at times. And when I see the power of love in the form of wrinkled old skin and a tuft of white hair sitting quietly at the bedside, admiring the weakened other half as though they are foolish teenagers – I am reminded that everyone experiences love and loss: only few gain a lifetime. Thank you for being my lifetime.

To my (future) children:

I understand that I probably drive you crazy more often than not. It must be difficult to deal with a parent that plans for every worst-case scenario. What you do not realize is that I have lived through all kinds of worst-case scenarios, and I am not sure how I would bear being in those shoes. I know it must be silly that you only go to the doctor’s office when you are really, really sick. It must be incredibly annoying that I sometimes make you wash your hands before AND after going to the bathroom. And I’m sure that you are irritated when I am the only parent missing from holidays, sporting events, and weekend activities. Just remember that while I am sleeping – day or night – I am resting up to care for other people and annoy them just as much as I annoy you J You didn’t choose to have a parent who is a nurse, but I promise you, someday I believe that you will look to me as a valuable resource and, I hope, a wonderful parent. I may have moments when I am cranky and short with you, and I apologize for those times, but my days are very stressful and sometimes I may need just a few moments to recharge my batteries before continuing with my day. I work my hardest to provide you with more than just stuff – I hope to instill in you work ethic; compassion; curiosity; and a true passion for living every single day its fullest capacity. This may sound crazy today, but I hope that you someday look to others and say proudly “my parent is a nurse!” I love you more than anything in this world, and thanks to what I do every day, I am constantly reminded to soak up every moment I have with you before you pursue your own dreams and ignite your own passions.

To my parents:

I understand that you were at some point led to believe that the only two professions in this country are “doctor” or “lawyer.” Since you have evolved and grown older, you have since recognized the true value in what my profession is and just how much I do. You have both instilled in me such a strong sense of integrity and discipline that I pray that this inner strength translates to the work that I do. I know that there are some misconceptions about what it takes to be a nurse; what they do daily; the extent of their autonomy; etc. However you have never once questioned my decision to become a nurse and utilize my critical thinking skills and academic pursuits in professional practice every single day. As you both grow older, I hope that my professional life can guide you into the lifestyle choices and health decisions that will leave you with the highest quality and quantity. I often judge my patients based on the two of you – I will think, “Man, he is dad’s age!” or “She is younger than my mother!” What that means is this: I am thinking of you both even when I cannot come and see you. I cannot deny that I often worry about you and how you are managing, but I have come to trust that if you truly have a concern you will always come to me with it. I am a nurse, but I am also your child. I will do anything in my power to provide you both with whatever physical, spiritual, or emotional companionship I can come to offer. Thank you for raising me to become a person who will advocate for the safety and security of others. Thank you for letting me share in your life experiences, allowing them to shape my own. Most of all, thank you for leading as examples that would make for all the trappings of a nurse.

To my family and friends:

As you may have figured out, “Sorry, I’m working that day” is a running theme, which you’ve come to encounter. It’s not that I don’t want to have lunch with you. It’s not that I would rather be at the hospital than at your birthday. It’s not that I am too lazy to make a schedule switch than to attend your barbecue. What it comes down to is this: when I became a nurse, I was obligated to the sacrifices that come with the role. Weekends and holidays at work are not simply endured by me alone – all of my colleagues must make choices that they sometimes do not prefer for the sake of our duties and obligations. We wish we could be there with you for every event that comes up; every phone call we’ve missed; and every group outing that arises – but that is simply not our reality. I thank you for continuing to reach out to me despite my often-busy schedule – there is no greater feeling than when we can connect and spend time with one another. I am so grateful for your camaraderie and for being there when I need you, despite having to listen to stories that might make you lose your lunch. I cannot tell you how much it means to me when we can sit together and laugh – truly laugh from the depths of our bellies and feel truly alive. Likewise, I cannot tell you how cleansing it is when we sit together in near silence and cry. What you confide in me, and many times, what I to you, are some of the deepest connections that we as human beings have to offer one another. Thank you for allowing me to remain myself while still evolving and growing. Your friendship is something that I always cherish, and while there will be weeks when I need nothing more than the sound of silence to center my balance, I will always hear you in my heart. Also, you should definitely have that rash looked at.

To my patients:

You have every reason to be angry with me. I may have been late with your pain medication. I might have forgotten an extra pillow. I likely asked your family to step out due to a situation that took place on the unit. But I assure you, if you only knew just how often I think about you, you would likely give me the benefit of the doubt. Because you see, in addition to ensuring that you are safe, stable, and comfortably taken care of, I am likely doing the same for others. What you might see as me taking my time to conduct a task is most likely due to some other priority that I had been forced to place above it. Whether you are a nurse with eight patients on a busy medical unit or you have one critically ill patient in intensive care, you are never truly free to focus on simply what is “yours.” While your family complained that I did not feed you, they may have misunderstood that the procedure planned for you requires nothing to eat or drink. While you angrily yelled at the nursing assistant for waiting on a bedpan, I was assisting with a cardiac arrest on the other side of the floor. And while you were concerned with the hold up for your pain medications, I was frantically connecting with the pharmacy to ensure that your pills could be brought to me as soon as possible.

And yet, despite the fact that you sometimes become upset and frustrated and direct your emotions at me, I know one thing for certain: it is not truly me that concerns you. You are exhausted. You are frightened. You are in pain and you are poked and prodded and asked a million questions. Every day you meet a different person with a different title asked to treat a different body part. Or worse yet, you are intubated and sedated and require life-sustaining medications to pull you from the cold grasp of death. You are a human being who is dealing with the fragility of your own existence, and it is no wonder that I am your moving target. Despite all of this I want to make one thing perfectly clear: you are my priority. You are my baby. You are my largest project and greatest concern. I want you to understand that you may claim to hate me, but I will still help you. You may cause uproar, but I will still calm you. You may keep me busy, but I will still choose you: over eating, drinking, peeing, and sometimes leaving. As long as your heart is beating – and often when it is not – I will fight for you. And after a long day of honoring the beauty of life by saving yours; after an arduous night of embracing the end by helping you transition; after an exhausting shift of scratching tooth and nail to keep you with us, but losing you anyway: I hope you realize that I try my damndest to leave work at the door, but I cannot help but carry you with me.

Thank you for trusting me to care for you. Thank you for being the eternal “patient patient.” Thank you for giving me a reason, every single day, to keep on fighting.

To the doctors and advanced practice team:

I understand that I can be a squeaky wheel sometimes, pushing a subject that was apparently addressed or had already resolved. It’s simply that my patient or family has a request to see you, and despite my consolation, they are anxiously awaiting your insights. Thank you for your collaborative approach to caring for our patients, and for seeking my input on matters of patient care. I understand that you are busy and have a packed schedule, but those moments when you make the time to really address my issues are always remembered. I apologize for questioning your judgment at times – I simply see my patient for extended periods of time, and I believe that I can help you guide his or her care. I make no apologies, however, in advocating for those under my charge – what good would I be to this team if I did not fight for those who cannot? Although there are moments when we do not see eye-to-eye, I respect you and appreciate your practice. During those moments when you compliment my care to patients and their families, I truly feel like a colleague that can be trusted with even the most complicated situation. Those moments speak volumes of why I work as hard as I do, and they fuel the fire to consistently practice at the highest level of my craft…even when it means a 3am phone call for stool softener.

Thank you for the coffee. Thank you for the bagels. Thank you for working with me, side by side, in making a difference every day.

To my fellow nurses:

It’s not that I’ve chosen to save the best for last: it’s simply that I have so many things to say to you and not enough time in the world to say it. You are my team. You are my posse. You are my family – an utterly dysfunctional one, but family at that. I believe that few professions exist where we can be grossly irritated by each other one moment, and start cracking jokes in the next. It has been mentioned before that what we do every day makes us the “Navy Seals of nursing.” That statement alone suggests that we are working in one of the most stressful environments while enduring the most intense circumstances that many can barely face in television dramas. What we do, every single day, is a labor of love. But we are all in on the real secret: nurses are not angels placed on earth to serve and lift. We are not diminutive and submissive and gentle souls that kiss boo-boos. We are not the starched white caps and perfectly polished shoes that history books portray. Nor are we fishnet stockings and naughty rendezvous in dark corners. We have been glamorized and fetishized and placed on a pedestal unlike any other profession, and yet the list of what we are is only surpassed by the list of what we are not.

Many will never understand the extent of what we do every single shift. They can only imagine that we work hard (though they might never feel the weight of our feet and the ache in our backs and the pain in our hearts at the end of it all). Some will say, “I wanted to be a nurse, but I could never do it.” We will smile and say something along the lines of, “Yup, it sure is hard work,” or “But I truly love what I do!” without a second thought, understanding that most people truly couldn’t endure what we face every single day. Others will tell us how intelligent we are, and insist that we go to medical school and become doctors. As much as we respect physicians, most of us do not want to become them. The connections we make and the difference we incite in our patients lives are worth the countless pitfalls we face and sacrifices we make.

They are not in on our secret, these patients and families; these husbands and wives; these parents and children and colleagues and friends; because while they try, they will never understand the depth and breadth of mind and body required to be a nurse. Some might question that statement – how hard could it really be? Isn’t it only three shifts every week? Don’t you make overtime and holiday pay and get bonuses every year? It is harder than they could ever imagine. It is more raw and real than they could ever have dreamed of. Yet when something truly incredible happens, and when we get to be a part of it, it becomes a drug unlike any other.

What a miracle! Families will shout.

The work of modern medicine! Physicians will declare.

And yet those who are in on the secret, or at least are suspicious of it, understand that it was no miracle that saved your loved one, but rather, the intent and vigilant care of a critical thinking, intuitive, experienced, and fiercely devoted nurse. Our secret is that we save more lives than we are willing to admit; we catch more errors than we hope to share; and we sense subtle shifts more often than we take credit for. The nursing profession is oft touted as a humble one – a life of service to others through altruistic compassion. Yet here we are, with our dirty little secret; our filthy mouths; our dark humor and our sarcastic sensibilities; snarky and sassy and smart – can you sense that? Oh no, we are not all nuns in nurses’ clothing. We can be vicious. We can be vile. We can devour our young and destroy our reputations – we are not some perfect pictures that you had envisioned – far from it.

We are human. We make mistakes. We pick fights. We become emotional. Because we must. Because every single day we must grapple with our own identities, not only as men and women but as nurses – defined by a role that we wear as a badge of honor, yet has the potential to be our own demise. We are in a constant state of battle: with the establishments; with disease; with matters of life and death; with our colleagues and our families and with ourselves. What we take on when we clock in every morning or evening is far more powerful than just a job – it is a struggle to give 99% of your being to others while never releasing that final 1% of yourself. We are human. We are not infallible. We drink too much. We smoke too much. We eat candy bars for dinner. We take it out on you because there is nobody else to punch with our sack full of baggage. We are in one of the few businesses where an emergency is genuinely and truly an emergency – everything else is just details. And so while we apologize for our shortcomings; and we are sorry for our attitudes; and we are hopeful evolve into more compassionate and patient people every single day – yet we make no apologies about being nurses. Take us as we are – all of us – the beauty, the burdens – every ounce of us…because we did not choose to be this way. Somehow, even if you fight against it, becoming a nurse will find you. It will seep into your bones and sink into your soul and you will understand that sacrificing parts of your own being to protect strangers with whom you may never share another moment is a totally rational thing to do.

It is not rational. It borders on crazy. We’re all a touch too neurotic; a smidgen too type-A; a little too caring and bit too self-invested. I walked away from a 9-5 corporate career to pursue what was calling me. I ignored it, I fought it, but the nurse in me started from within and enveloped herself around me. And now? I will never be the same. I border on crazy. I’m slightly irrational. I’m absolutely neurotic. I’m completely invested. I’m a woman. I’m a wife. I’m a daughter. I’m a friend. I’m a colleague. And through it all – I am unapologetically a nurse.

The Business of Being a Bitch

It goes without saying that being a female has its challenges.  Sure men struggle at times, but the ladies win all sorts of “what the hell did I sign up for” battles: bleeding, birthing, and the uncanny ability to mutate emotional states without even a warning.  Through it all, however, there comes a distinct irony that has plagued my mind for nearly three decades: how can we, as women, instead of supporting one another through the daily struggles we each face, attempt to tear each other down instead?  Now, I’m not very much of an expert at anything at all.  However I do have twenty-eight years of bona-fide life experiences that lead me to the following conclusion: women are hard on themselves, and often times, even harder on each other.  As a Registered Nurse with a non-traditional background to entering my current role, I can state with full certainty that being a woman requires balancing your strengths and weaknesses at the appropriate moment and with the correct audience in a manner that simply isn’t necessary for men.  Before moving on, I want to make one thing perfectly clear: my intention is not male-bashing, nor is it glorifying women and all that we do.  Contrary to popular belief, women are human too!  We neither operate through voo-doo and trickery, nor should we be touted as perfect angels, absolute dolls, or any other bullshit hyperbole that places us at extreme spectrums of the estrogen scale.  And yet what I often wonder, in the interactions I have with both men and women regularly, is what makes it perfectly acceptable for a man to think only for himself, while a woman feels obligated to please everyone along her path?

I would like to start out by defining the semantics of my verbiage: bitch is not a bad word.  Bitch is a word that has become loaded with negative connotations and imagery, and we throw it around at every chance we get.  To call somebody a bitch is very different to say they are “being a bitch” or “acting bitchy.”  The two latter phrases are a temporary state – something that implies “at this moment I believe you are acting in a manner that complies with my standards of bitchiness” while the former – flat out BITCH – is something very different.  You see, to be a bitch is to be empowered.  I understand that this topic has been beaten to death, and that men and women alike have their own positions on the matter, but to be a bitch as a woman is equivalent to being a boss as a man.  If I were to consider for my own sake, what qualities make somebody a bitch, that list would contain the following:

–          Smart

–          Fiercely independent

–          A leader

–          Doesn’t take shit from anybody

–          Assertive

–          Willing to take charge

–          Courageous

When you consider those terms and phrases, and an image comes into your mind’s eye, what do you see? Is it a man? A business executive? Somebody who appears powerful and assertive?  The President of the United States? If you separate those very terms from the word itself, it appears that what makes a woman a “bitch” is the same thing that makes a man a success.

Now let’s take this consideration one step further: when you meet someone who possesses those qualities – and they are, indeed, a female – how do you respond?  Do you feel comforted and secure?  Or do you feel uncertain and weary?  Think of every female in a powerful position that you’ve encountered in your life, and start way back: your mother.  A school principal.  A colleague or a manager or some women you’ve passed in the hall.  Maybe even a friend or a lover or a total fucking stranger.  What do you feel when you think about a female Chief Executive Officer? A woman as a dominant figure in both male and female dominated arenas?  A female as the next POTUS?  Do you think she is smart?  Is she independent?  Does she take charge and lead and not take anybody’s shit?  Does she have the courage to be doing whatever it is she set out to do?  More importantly, do you see her as a bitch?

And now take a moment, and really reflect on this – if you encounter a bitch in the form of a female who is engaged and excited, passionate and committed, utterly insatiable in her goals and aspirations: do you support her?  Do you provide her with your assistance as a valuable resource?  Do you publicly endorse her and make others aware of her ambitions?  Or do you speak one way, and act another?  Where men have the absolutely baffling ability to remain emotionally net-neutral in these types of situations, relying on facts and figures and performance as a barometer for success, women have a tendency to emote and then vote.  As I mentioned earlier, this is not some scientific fact: it is simply an observation of my own experiences through personal endeavors.  However, if you ask a room full of women why a beautiful woman is successful, they may attribute it to her looks.  If you ask them why a powerful woman is successful, they may call her a tyrant.  If you ask why a compassionate leader has climbed the ladder, it is perhaps because she pleases and panders.  And if you ask why an independent woman is successful, they may say she is catty and cut-throat.  It seems to me that the very people who should be utilized as a catalyst for change become a place for comparison.

What is the root of this distrust and dismissal of one another?  Why are we as women so determined to fight for our own rights and freedoms and privileges, yet so quick to discourage those examples who fight for us?  As a Registered Nurse, my career exists in a microcosm of this very point of contention and issue of concern every single day.  Historically a predominantly female field and still heavily dominated to this day, it seems that the more traditionally “feminine” qualities – nurturing, caring, and quiet stoicism – are still viewed as the norm by patients and colleagues alike.  Once I entered the world of the Intensive Care Unit, I was exposed to a very different variety of female values: critical thinking, aggressive action, and a level playing field were touted by my peers, and despite my initial fear of being drowned by a sea of judgment and misunderstanding, I quickly realized that being a “bitch” was an asset.  By serving as a fierce advocate; through intense knowledge and understanding; by leading change through collaboration with others; this world demonstrated precisely why women were not the stereotype of a delicate and fragile feminine presence to be seen and not heard.  These women were loud, and they were clear, and although they are certainly not perfect, they are a prime example of why being a bitch means so much more to me than simply being a bystander.

We as women have come a very long way, yet we still have so far left to travel.  Until we can come to a place where we promote growth over gossip and inspire instead of incense, we will never find the same level of success in male dominated arenas as men achieve.  This is my challenge, to myself and to all of my sisters, who blame themselves and doubt their abilities and downplay their accomplishments: stop making excuses, and start making a difference.  If you want to advance in the corporate world, get yourself an MBA and the appropriate network and work your ass off.  If you want to raise your children and be a mother, instill in them the courage to endorse their own thoughts and feelings while challenging the status quo.  If you want to be an author, write about what feels right (not just what sells books).  And if you want to be a nurse, make sure you know how to be a bitch when the time comes.  What we become depends on how we choose to overcome our obstacles and approach our aspirations.  We can stand together and create the variety of change our future daughters will feel proud to see, or fall apart and watch the pendulum swing backwards once again.  Sell yourself.  Be your own commodity.  And raise the standard higher.  You are the single greatest asset in the business of being a bitch.

“A Hospital is Not a Hospital without a Nurse”

I left my corporate career nearly four years ago in hopes of seeking out a sense of purpose.  Talks of “going lean” and “trimming the fat” and “synergistic” or “dynamic” poppycock became redundant and mundane and left me feeling like I was driving full-speed ahead while running on fumes.  I no longer wanted to cruise down a freeway of potential success but inevitable emptiness.  So I took the long and winding road, went off the beaten path, and simply quit.  When I came to the emotional and visceral realization that all of my life’s ebbs and flows had pointed me towards nursing, I was renewed.  My passion to delve into a career that was challenging and rewarding and truly had purpose was ignited from the first moment I walked into the classroom (again) to get my Bachelor’s (for the second time) despite slinging cheap bar food and booze (check please!) to achieve my goal.  How incredible it felt to learn so much about human beings, from the microscopic physiology to the existential dogmas.  Nursing, it felt, was this intoxicating combination of medicine and spirituality: I was drunk on the profession and its addictive properties.  Perhaps becoming a nurse really is a calling, and not everyone is chosen.

Or perhaps it’s just as much a business as a major media company…except, as a rule, nobody dies if you don’t show up to work for an email emergency.  I’ve been a  Registered Nurse for 1 year, 8 months, and 13 days.  I’ve been responsible for patient care for 1 year, 7 months, and 1 day as a gainfully employed Registered Nurse.  I’ve never once regretted my decision to make a monumental change in my career and lifestyle (barring the occasional poop-filled shift or pang of star-envy at the MTV Music Awards).  I truly love what it means to be a nurse; how it feels to make an impact on human lives during their most trying times; and the joy that comes from connecting with others when they overcome obstacles large and small.  And yet I find myself experiencing a vivid sense of deja vu when I walk by posters touting lean strategies and streamlining and other buzz-words from my corporate days of yore.  I am wise enough to understand that every healthcare facility is a business; without a profit, no hospital could sustain and therefore without a profit, I couldn’t provide my flowery candy-coated warm-and-mushy nursing care at all.  I am savvy enough to know that the healthcare landscape is ever-changing and perhaps unsustainable, requiring some serious intervention to allow facilities to function at the highest level.  And perhaps I’m naive enough to believe that a facility could exist symbiotically, providing the greatest advancements in medical and nursing care and yielding a fat bottom line all while keeping patients and employees excited, engaged, and satisfied every step of the way.

Ahh, but how green I must appear! How foolish I must be!  How stupid of me to think that the nursing domain and the corporate sector would remain mutually exclusive and not intersect daily in my professional life.  Because when a patient is no longer a patient, but a client; and a hospital is no longer for the medical care, but for the overall hospitality experience; and when the customer is always right (so long as the customer is alive) – 100% of the time, and even when the customer is completely and totally wrong on all accounts…this tends to muddy the cup of nursing purity from which I’d been drinking.  Today’s healthcare economy is a buyers market, and the quality of care is for sale.  What was once a warm and loving home filled with adequate staffing, a free-flow of supplies, and lengths of stay that foster patient growth and healing has become a market littered with sprawling McMansions that are quickly fashioned to appeal to the masses while lacking the structure and foundation needed to provide protection, warmth, and sustenance.  And although the former came at a price, the silly little nurse in me believed there was no price tag on human life.  Medicare disagrees.  Medicaid disagrees.  Private insurance companies disagree.  And by default, healthcare facilities are forced to jump on that bandwagon.

I don’t want to become a jaded and bitter nurse that dreads waking up to go to work every morning.  I want to love this profession every single day like it’s a soul mate that I cannot bear to live a moment without.  The day I passed my licensing examination, I believe I became married to nursing, and I’ve been a damn-good wife.  But in order for any good marriage to last, both parties must be willing to contribute.  Both sides must do their fair share.  Nobody in their right mind would ever choose to give over and over again until there is nothing left to give.  Yet I do.  Every single day, I do.  Because this is what being a nurse requires.  The unyielding desire to give your body and mind and heart to your patients every single day without asking for anything in return…sometimes, without even asking for a meal or a moment to pee or an opportunity to break down and cry.  All that I could ever ask as penance is the support and resources to give my patients every last drop of myself without questioning whether something could have been done better or differently or more effectively on my account.

In the words of a great nurse, “the staff and the stuff.”  Those two components are undoubtedly all any good nurse requires to breathe literal and figurative life into a patient: in all levels of acuity, in every type of unit, in every facility of care.  It is such a simple concept that has been modeled and remodeled and built up then stripped apart into something less focused on what nurses do for patients clinically and more on how they serve customers corporately.  Whether a patient came to the hospital inches from death and makes a full recovery seems to be less of a concern than whether the patient thought his or her garbage can was emptied or his dinner tray arrived on time.  The nurse can no longer serve as a respected member of the medical team without also serving as a butler and a teacher and a beautician and a cheerleader.  You see, what is so baffling about this shifting paradigm in the healthcare industry is that it steers away from the main reason why people go to a hospital anyway: for the nursing care.  People don’t go to the hospital for a doctor.  They need a doctor – a team of them – that’s for damn sure.  But the doctor has no focus beyond just the diagnostic and intervention-filled relationship to the hospitalized patient.  The doctor is present as a title on a paper chart and on a written order, but the nurse is ever-present.  24 hour nursing care.  This is the gold the rich road to recovery is paved with, worth its weight indeed.

One of my nurse colleagues and mentors said it best as our group caught up with one another over dinner this evening: “a hospital is not a hospital without a nurse.”  Despite the trends in the meteoric collision between the business world and the healthcare industry, the work of a nurse never can and never will become mechanized.  A nurse can never be replaced by a software system or a robot or a fancy new piece of machinery.  As long as nurses remain true to their craft and adhere to their values, they will adapt to this evolving work environment and continue to produce miraculous mountains out of molehills of resources.  Because what we do – in addition to the incessant paperwork in a litigious atmosphere; in addition to the stressful care under a management microscope; in addition to the teaching and the cleaning and the healing and the smiling – what we do is lift others out of the doldrums.  And when we cannot lift them up, we slump down and join them.

While we should have been enjoying coffee and dessert this evening, my seasoned veteran colleague detailed (tears in her eyes and a quiver in her voice) the experience of frenetically coding a critically ill patient in a hospital elevator with an attending physician…cursing and sweating and pushing and fighting to bring him to life…and losing him in front of his loved ones.  The imagery stuck with me.  In between worlds.  On the brink of life and death.  In some state of literal purgatory amid the hellish scene.  Crying on the floor with a family that has already been through so much, and could not possibly bear any more.  This story will remind me, in those moments when I need a dose of reality and a shred of humanity, why nurses are a chosen group…a special breed…a commodity unlike any other.  Why a hospital is not a hospital without a nurse.

In Spite of All We Do

Six weeks.  That’s how long I’ve been caring for the sickest patients in the hospital as an ICU nurse.  Six weeks, and I’ve experienced a roller-coaster of emotions to make you realize you’re human twice over.  And yet my six weeks of excitement, adrenaline, confusion, concern, hopefulness, hopelessness, and faith that it all somehow matters pale in comparison to thirty-plus years of exhilarating and excruciating bedside experience.

So when my preceptor – more of a mentor, really – informed me that she had spoken on behalf of our unit at a Moral Distress Committee meeting that would seek to improve end of life care in an Intensive Care setting, I was curious to hear what she had to say.

What could a calm and collected, all-knowing and ever present ICU veteran have to say about living and dying, after having been exposed to both ends of the spectrum and everything in between for over three decades?  Her words summarize exactly why this job is so damn cool and so painfully complicated in the exact same breath.  As I read the introduction to her lecture – twice, because it had to really sink into my head – I felt a greater sense of obligation to the patients under my care.  Because whether they should fight to live or die with dignity, it would be the nurses caring for them that carry the brunt of the burden.  Of course families suffer.  Certainly physician’s are concerned.  Yet it is the ICU nurse, whether tough as nails or still timid and learning, that bears witness to a patient’s final breath…be it a peaceful transition, or a tumultuous battle.  (Below is what she had to say:)

 

Moral Distress
I am a nurse in a cardio thoracic ICU.

After surgery, patients come to our unit. Our team works together to help them recover. We are good at what we do. We take care of some very sick patients. We have participated in some miraculous recoveries. We are proud of our successes. We don’t easily accept failure.

And yet, in spite of all we do, some patients die.

Sometimes they die after a frenetic, no holds barred attempt to save them.   We try. We try everything. Everything is not always enough.

Sometimes patients die after a long battle. When the effects of what we do to sustain life seem worse than allowing death to occur. When we know its time to stop.  When death will be a relief. From more pain. From more suffering.

Sometimes we deal with families who confuse life support with life. When the tests reveal that the patient is brain dead. To us it is clear. It is definitive. Brain death is death. We discontinue life support.  Perhaps we can refer for organ donation. Another life is saved. But our patient died.

Death Is always hard. It is never simple.  For our patients, in our unit, patients are supposed to recover, and death feels like we somehow failed. If would feel wrong if it was easy.

 

Best we can do is take a seat, buckle up, and hope that we get off the ride with two feet on the ground, itching to get on the next one.