Dear Jakie

today i was sorting through old paperwork and files of cards that i keep, mostly from my mom and friends (you'd think emma and i were lovers. i save all of her cards because they are the best, kindest, most encouraging sentiments). and i came across an entire file of lovely reminders of the people i have cared for in my lifetime. some from even before i became a nurse.

a picture of one of my favorite campers (carol, the most special of women with downs syndrome) whose kiss would brighten anyone's day.

helen lahey's obituary - my church grandma, who befriended me when i was a kid. she sat in the pew in front of us and loved me as if i were her own.

a photo of dick brunell from room 21. he's flipping off the camera. he was one of my favorite's at Bailey Boushay. He pretended to dislike everyone. But he liked me. I was so young then I hardly recognize myself.

but the little scrap of paper that made me cry the most, that touches me every time i find it... a note to jakie. i don't remember jakie. he must have died while i was a nursing assistant. even then, it was my job to do post mortem care. to clean dead bodies and prepare them for the morgue. this note was left by his side (and i couldn't bare to throw it away). i share it only because i know you will honor it and cherish the words as much as i do.

dated march 19th, 2004

Dear Jakie,
What can I say? Jakie, I don't want you to die! Already, I feel as if an arm or a leg has been cut from my body. After being married for 55 years, it is hard to imagine continuing life without you by my side - but I will try to muddle on.
Oh Jakie, I am going to miss you so much!
All my love forever and ever.
Dear Sweet

a list of things

there is always so much to say about my job. and if i was better at this blog thing, i would say one thing each day that i work. one thing that exasperated me. one thing that made me cry. one thing that i found particularly interesting. or one thing that i learned. but instead, i let time go by. and the impact of these things that feel really BIG when they happen, lessen just a little bit. so instead of one powerful story, here's a list of some things about my job.

- i've been in charge now just three times. and each day, every patient on my floor survived. and only a few nurses hated me because of my assignment! i'm excited about this new role. it makes me feel important. my manager always says that being in charge is an extension of management. and in a way, i get it now. i make decisions on an hourly basis that effect our unit's budget. whether i send a nurse home or call one in on overtime, i not only impact the unit's budget, but also, the staffing, safety, and patient and staff satisfaction.

- i took care of one patient MANY shifts in a row. and on the day of his transplant, of course his cells arrived 5 minutes before shift change. instead of being annoyed that it would take extra time on my part to receive the cells and quadruple check them, i felt excited to deliver this gift to someone whom i had grown to really enjoy. i gathered a bunch of other nurses, who also had just worked 12 hours and wanted to go home, and we sang happy birthday to him (since transplant is a birthday of sorts - another chance at life thanks to a kind donor!). as soon as the first words came out of our mouths, my male patient lost it. he sobbed like a baby in his hospital bed, curled up to next to his adorable wife. and i cried too. i couldn't help it. it was a lovely way to end my day.

- i had the first of my teaching sessions last week. and i'd like to say, it was a BIG success. my two new nurses who had already spent a few weeks on the floor totally appreciated my welcome and the chance to go over material more in-depth without having to complete patient care at the same time. we have another session next week. what's really nice is i've received feedback from management and they are impressed too! thanks goes a long way at work. it's really motivating to hear you're doing a good job.

that's it for now.

oh. one more thing. i'm working on my non-resolutions. i have a cleaning lady coming on saturday (overtime money put to good use).

2016 non-resolutions

well, it's 2016...

i've never been one to make resolutions. especially because it's mid january, and if i was to make resolutions, i feel like i'm behind. and that i've already failed. in fact, that's why i don't make resolutions. i don't like to look back on a year and feel like i did something wrong. like i didn't succeed, complete, or perfect my goals.

but this year, i'm making a list. of suggestions (NOT resolutions). just ideas. far out dreams. plans. wishes. hopes. i'm putting them out into the universe (thanks to emma) to see what happens.

here's a few things:

- take on new challenges at work
- explore new things, near and far
- continue going to yoga
(turns out, the whole breathing thing is really good for me)
- read more books (start AND finish them)
- find a husband
- win the lotto
- organize my bills, papers, and documents
- decorate more of my white walls
- look into adoption
- inquire about school
- write in a journal, at least once per month
(it's good to set attainable goals)
- hire a cleaning lady every now and then
(let's face it, i'm a bad housewife even to myself)
- be less self conscious and more confident
- cook more
- be amazing

what do you think? attainable? certainly a list of things i can work on. daily.

my work life looks interesting this year. i'm already working on goal number one! i'm gonna be a charge nurse soon. should be interesting, taking on this leadership role. and, i've asked to teach more too. we need to hire 18 new nurses on my unit (it's complicated, but we're losing 23 nurses as our ICU beds move to another unit). and although i already precept A LOT, our orientation process for new nurses is less than perfect. i feel like some preceptors struggle with teaching. so, i've offered to teach two four hour classes to every new hire during their six week orientation. i've yet to develop a curriculum, but i'm excited. i'm passionate about teaching. and about helping a new nurse feel confident and prepared to be independent. i'm excited to impart some of my expertise and some of my wisdom, not just on how to care safely for patients, but also, on how to care for yourself as a new nurse. it such a hard job! one that i continue to love (for the most part).

a pat on the back

a letter sent to my manager...


I hope this note finds you well.

I’m writing today to share a comment from one of our transplant donor coordinators, Leah. This week, two of your nurses worked with us on a potential cornea donation and they made an impression on her.

Leah writes, “RN Christa and RN Lauren were both very proactive and pro-donation. (They) Wanted to support the family the best they could. They were great, despite their patient being a MRO d/t lymphoma”.

The decedent’s family was very interested in transplant donation but due to the patients illness, it was not possible. Christa and Lauren did everything they could to make donation happen.

It’s interactions with champions like Christa and Lauren that keep us excited about donation and happy to be working so closely with hospital staff, like yours. We can’t do it without you.

Please feel free to share this note of gratitude as widely as appropriate. They both deserve a pat on the back.

this was a nice thank you for just some of the hard work i put in last week.

he sails on

it's been a long time dear blog...

i could make excuses. but in reality, i've been avoiding this space on purpose. i haven't wanted to process work life or real life (and now more than ever, the two feel very connected). it feels too hard. so i've just been letting things mull over in my mind, wreck havoc on my soul. some days i show up at work, just because i have to. and some days, i do my best. my very best.

the last week i had more amazing moments that i can count. more than i could ever share in writing. how lucky am i? when i contemplate job changes and career goals, i feel blessed to have been a part of amazing nursing moments. life moments. that remind me why i do what i do. why i was meant to be a nurse.

on wednesday of last week, after a fantastic birthday celebration that included 30 miles of backpacking in two days, i arrived at work to find one of my favorite patients on comfort care. strangely enough, i cared for david for the first time exactly one year prior.

comfort care is a blessing and a curse. i love taking care of people on comfort care. for some reason, i feel at ease with people when they are dying. i enjoy participating in families biggest, hardest, sometimes most beautiful moments. but of course, comfort care is sad. there are usually tears. shared memories and the best of stories. there is noisy breathing. and morphine. endless questions with difficult answers. often of which i do not have the answer to. but i'm good at saying i don't know. i'm good at answering the questions i can. and my calmest and kindest self appears. and it feels nice (especially when lately i've been a grouch).

i spent much of my 12 hour day in david's room. his wife, daughter, and son-in-law were present. there were visits from social workers, palliative care physicians, and friends. and there were snuggles (i love when loved one snuggle with their family members as they are dying; it's the most beautiful intimate moment to witness). there were stories - boy were there stories. david had spent many a year on a sailboat. in fact, he and his wife raised their daughter on a sailboat i believe. they were adventurers. kind and giving people. the kind i would like to be when i grow up. seriously. i'd be ecstatic if i could impart just a little bit of david and a whole lot of barbara in my life.

david's wife is the epitome of an angel. i can't imagine a better wife. she lived and breathed for david. his every pain was hers, and his every success was celebrated (i will never forget one time i was caring for david and he successfully pooped in a bedpain; barb celebrated as if he had won a gold medal in the olympics. and david, in his most cynical, dry voice said, "barbara, anyone can take a shit?!? but to her, it was noteworthy. celebratory. if she had had balloons, they would have been blown up. if there was cake, she would have lit a candle). barbara told me that over the course of the last year, david had been in the hospital 173 days. and while he was out-patient, there had been 150 clinic appointments. she was there for every one. every day. she never left his side.

david died peacefully in his sleep the evening after i cared for him. he and his family have touched me. deeply. if they are able to carry on with such grace, so too must i.

the BIG stuff

i participated in a beautiful thing today.

most of my patients are bald. it doesn't even phase me anymore. i don't expect to see hair. when i have patients with full heads of hair, i think it's weird - like something is wrong with them.

but every now and then, i am asked to shave someone's head. maybe she had some hair; short hair that has grown since her last round of chemotherapy. or stubble that seems to itch as it too falls out. but rarely, maybe never, have i shaved someone's head who has NEVER lost their hair. never have i shaved someone's head and made them cry.

and today i did. my patient is a sweet, very sick woman. and her husband loves her like nobody else. he came to me today and said, "i think today's the day. can you shave Ts head?" i responded with an of course. and then he surprised me. he said, "when you're done with her, will you shave mine?" i chuckled a bit, awkwardly, because i've never shaved anyone's head who doesn't have cancer. but why not? what a loving, kind thing to do for your wife - to show solidarity in the hardest of situations.

we took selfie's before. and my patient cried. and as the buzzer buzzed, she closed her eyes. her shoulders heaved. and her sobs were audible. it took me a while to complete the task. she had beautiful, thick hair. and to my surprise, i killed the batteries in not one, but two of our automatic razors. which meant, i couldn't complete Ts husband's head. which was okay. because he left for an hour and got a barber to do a better job that i ever could have done.

but the best part was the reveal. my patient stood up and faced the mirror with courage. she held her husband's hand and she looked and touched her fuzz. and she cried again. i watched as she and her husband cried together. and i cried too. for getting to witness such love. for being a part of peoples' lives during such BIG stuff.

grief and loss

i've been having a rough time lately. like really rough. and although i don't really want to discuss it, i do want to discuss how my experiences with anxiety, sadness, and depression may have benefited a family member of one of my patients.

yesterday i had the honor of caring for a 47 year old woman dying from her AML. she had had one transplant with relapse almost immediately following. despite more chemotherapy, donor lymphocyte infusions, and radiation, medicine could not cure her. even her second transplant failed to deliver a miracle.

by the time i got to work yesterday, my patient, her husband, and her mother had decided to change their goals of care from cure to comfort. what that means to me is - they made a good decision. a brave decision. the most loving and respectful decision for a very sick and tortured body and soul. by the time i met my patient, she was unable to respond. her drug-induced sleep looked peaceful and her expirations made soft sighs. as her fingers and toes turned blue, her husband sat beside her, holding her hands and whispering into her ear. it was a beautiful thing to witness. that is the beauty of my job. sometimes i am fortunate enough to watch death approach peacefully and for loved ones to grieve and cope in beautiful ways.

as the three of us watched a woman get closer and closer to her last breaths, we talked about the pain of losing a loved one. about how to cope with that loss. and her husband asked me what i do after hard experiences. it was so interesting - the timing of this patient and his questions. i am experiencing loss now. i am in the midst of BIG grief. and so i was candid. i told him to find healthy coping mechanisms. to try any and all he knows of. to be open to the love and support of friends and family, even when it feels foreign to accept it. to try therapy. massage. acupuncture. hypnotism. whatever works. can trying new things to be healthy ever be bad? try writing. exercise. support groups. church. reading.

my patient's husband and i came up with a good list. and i think we're going to use them all...