Endings

I wasn’t really in the mood to write tonight.  I just sat down to check email.  And then, just a few words from a friend triggered a reflective, sentimental, and peaceful feeling in me.  And of all things, that feeling is about endings.

It’s the start of back-to- school time around here and that is a beginning.  New beginnings, or even repetitive beginnings, can trigger those butterflies in the tummy, those sweaty palms, and the uncertain anxiety.  After that initial response, however, beginnings are generally regarded as good stress.  It’s how we move forward, how we grow.  Beginnings leave us with a positive image and connotation.  I think of new friends, new challenges, new opportunities, of firsts with my loving hubby and my kids, of all the places I would have never been without a beginning.

Tonight’s email was from a friend facing an ending.  A loved one is in hospice care and will not be with us on this earth much longer.  And aware of that, they struggle.  They struggle with how to balance the joy of a long, fruitful life with the reality of the infant this man is now.  The face the cold, hard job of taking care of someone that by nature, and position as father and grandfather and his other roles, was here to take care of them.

And I grieve for them.  For their upcoming loss, for the difficulty involved in watching it, for the logistics of trying to be many places at once, for the hesitation we all feel in knowing what to say or do or how to talk about this all.  I share my thoughts and prayers as support for them, as they support each other and complete the basic challenge of getting through another day like this and another, and another…And then enters guilt!  Just because we humans get tired and stressed and exhausted from the struggle – it doesn’t mean we wish that loved one wasn’t here.  No God, please don’t misunderstand – that’s not what we meant at all.  In an eyes-half-open moment while changing an adult’s diaper at 3 am and seeing him in pain – our reluctance wasn’t a wish for it to be over!  It’s just human nature.  The most fundamental and basic of human feelings and emotions – and a reminder that the only way to survive times such as these are by the Grace of God.

I have fortunately lost very few people that I had a close relationship with.  But fortunately (oddly enough I mean that), my work has put me in a place to have many experiences with death and dying.  I’ve come to find a beauty in it – a rhythm, or a peace if you will.  I’ve had the privilege of sitting vigil with families in the midst of saying good bye.  I really do mean privilege.  They’ve shared their most private, most difficult, and most hurtful moments with me, as a nurse, as a caregiver.  My position brought me into those situations.  The connection I felt in my heart has left me with a huge respect for endings and for assisting people, as I am able, to experience that ending in the most helpful and most healthy way possible.

I’ve watched cancer kids rejoice that one more vacation was accomplished before the disease took over – or a graduation, or the start of kindergarten.  I’ve seen families start to process their time with their children as a GIFT – a gift of all the days and hours they’ve had – instead of having life stolen from them.  I’ve wrapped up babies who’s little hearts have stopped beating and let mommies and daddies hold them until they can feel their goodbye are complete enough to make the next step.  I’ve been present when we tell parents a baby so young, born so early,  just couldn’t survive, and we are amazed it survived those first 48 hours – and it must have been because he knew what wonderful parents he had.  I can still hear a deep, strong voice reading the Bible to his 24 week gestation son in his last hours.  We all drew strength from that voice – especially the baby.  His vital signs changed when his Daddy read to him, and hung on a little longer while they had that time together.

On a personal note, those experiences like the ones above, prepared me for a couple of my own.  I’ve talked to a Youth Group on the night of the death of one of their own, about how we will still celebrate graduation – and Adam’s life – and how we will celebrate those last great moments with him and for him as we move ahead and keep him alive in us.  And, most preciously, I’ve bent down and kissed my grandmother while she took her last breaths.  As I kissed her, and hugged her, I told her that I owed so much of what I had become to her and the wonderful, beautiful things she had taught me to do and to be.  I put my tiny baby son up next to her and let him lay in the hospital bed with her.  I had watched my daughters just hours before bring her a photo for Mother’s Day and sing a song they had learned at preschool for her.  She told them she loved them, and they, having the honor of knowing their Mamaw Jackson, told her and loved her also.  She was buried with that photo.

I will never say I enjoy the experience of death – but I cannot say that I fear it.  I revel in it’s beauty and in the peace that comes after we fully love and fully engage ourselves and fully connect.  And in that most primitive of connections, we, God’s people, share also the ending, with help and strength from Him and through those he has placed with us.

The Art of Caring

Many of the blogs I’ve visited in the last few days and comments I have made have all related to healthcare in some way.  Following suit, my post today is pieces from an article I wrote several years ago describing what I do and why I do it in the nursing world.  It was designed for a “Teen Room” section on a promotional web page, giving teens the opportunity to explore different careers.  It still applies and speaks to the things I love about nursing.

Using talents to care for children
 I have always known I wanted to work with children. Some of my first memories are playing “mommy” and “daycare.” At first, I wanted to be a kindergarten teacher, but over the years I explored other careers in child care. I was strong in math and science, so I started to explore careers that would use these talents. I decided I wanted to become a pediatrician, but after two years of college, I realized this was not the right path for me.

I still wanted a career that would combine science, math and my love of children. Nursing seemed like a natural choice, so on a leap of faith I dropped all my other classes. Two years later, I graduated from the University of Tennessee with a degree in nursing.

While I was in school, part of my training included rotations, which allowed me to experience nursing in different environments. I was able to do my pediatric rotation in a children’s hospital, and I fell in love with the children, the organization, the place and the philosophy of care. I can honestly say I have used part of the mission statement, “Because children are special,” as a personal theme for the past 13 years.

After receiving my degree, I began a job as a graduate nurse in pediatrics. I am so grateful for that opportunity to fulfill my dream of working with children. The pediatric hospital is a cheerful and pleasant environment, even though many of our patients are very sick. We have a philosophy of specialized care for children, and we create a special environment where children get unique physical and emotional care.

A typical day for a pediatric nurse might consist of caring for four to five patients ranging from infants to teens. A nurse will make sure patients and their families understand the care they are receiving and any procedures they may have. It is important to continually educate patients to make sure they feel comfortable while visiting the hospital. A good nurse is a figure of trust, knowledge and communication for patients and families.

I love the relationships I am able to form with the children and the great trust they have in those caring for them. I firmly believe in maintaining a respect for how much control patients and their families give to us. I always try to think of what might be scary, confusing or unknown. My patients challenge me, and I enjoy my time with them.

One of my favorite groups of patients to work with is the pediatric cancer patient. I have come to love their little bald heads, their big shining eyes, and the great strength and hope they show in fighting their battle. I find a measure of beauty in how these patients and families “dance” through the difficult and confusing situation of cancer. I say dance because that’s how I think of it. You never know what song is next – is it a sick day or a well day? Or what beat or tempo you will have – is the chemo going to make me sick or not? Or what steps your partner will take to lead – what decisions will my parents and doctors make? And they dance it beautifully. The steps they choose are the right ones for them. I have the privilege of being involved in their care and watching, assisting and at times, “dancing” with them.

Nursing as a career has great benefits. It is enriching, challenging, uses your brain and heart and leaves an impression on you forever. I encourage anyone interested in working in health care to explore the field of nursing. It is a job that will both stretch you and make you smile. Most importantly, nursing will allow you to help others in need.

Pass the Baby

“This one time…at band camp.”  Actually, it goes more like, “This one time, at work…” 

Just the other night a nursing colleague brought over a sweet little wide-eyed baby to her good friend to feed.  Common practice.  

 “I’ve got two feedings at the same time.  Can you feed her?” 

And then the transfer of cute little baby girl in the lavender sleeper takes place.  From one friend’s arms, to another friend’s lap.  The buddy system.  We do it all the time.  You can’t feed two babies at once, after all.  

  “She has wet burps.” 

And then nurse friend number one vanishes, quickly. 

“What does that mean?  Every time I get a “wet burp” baby, it ralphs all over me!”  

Cute little brown eyed baby eagerly begins to eat.  Nurse friend notices wet sensation on her scrub pants.  She seeks assistance of yet another nurse friend.  I, fortunately, am still a by-stander. 

“Here take this baby for a second.  I’ve gotten something on me.” 

Baby handed off.  She did not wait for approval.  Nurse friend now holding baby had little choice.    

“Well, if she got something on you, why are you handing her to me?” 

“Ahhhhhh” (small scream from the sink area)  “It’s poop!  It’s poop!  She’s pooped all over me!  It’s running down my scrubs!” 

“And you handed her to me?”  

 Nurse lifts up baby and discovers, that she, also, is now covered in poop.  Two nurses and one baby covered in poop.  Original “friend” who requested assistance and warned only of “wet burps” is nowhere in sight. 

The two nurses now involved in this situation and sharing the common bond of body fluids, begin the decontamination process.  Wipes are flying.  I went only near the situation to double check a medicine.  Somehow, I had a trace of poop on my hand.  I scrubbed again.  My water bottle was on a table nearby the scene.  I took it home for sterilization.  The poop was spreading quickly.   The cleanest of the two goes to retrieve the nurse who has apparently fled the scene.   

“She’s a crazy crack whore!”

That and other terms of affection fly.  It’s the way we show love in an NICU.   

From the outside looking in

I have one of those jobs that makes people often say, “Oh, I could never do that…”  I work with sick children and have now for almost 16 years.  My first years as a nurse were spent working with pediatric cancer patients.  It even makes me have an awestruck response every now and then, but more about that later.  Now, I work with sick babies in a Neonatal Intensive Care Unit.  Most folks associate this with preemies, and while that’s true, we get critically ill babies, early or not.  Sometimes it’s a full term baby that just had a rough delivery, or sometimes, it’s a 24 week pregnancy with a baby just over a pound, teetering on the edge of life.  It has its variety and it has its challenges.   I continue to say that “Real Nursing” is the kind where it’s not so much about the paycheck, but much more about real life.  Dealing with genuine people in true crisis and having empathy and respect for them.  Trying to see if from their side of the bed, or isolette (incubator to most of you), if you will.  That’s the part I really love – trying in some small way to help other humans through this craziness.    Moms start motherhood with concern for everyone else.  They’ve been pregnant for up to 9 months, with many rough days.  They’ve just contracted, pushed, delivered and are completely worn out.  They are still bleeding, often in the process of being sewn up and they are instantly worried about everyone else, baby first.  I have the privilege of working with Moms and babies in a couple of different roles.  In one, I assist midwives with healthy baby deliveries in an alternative birth-center setting.  Those moms are all low-risk and are on the really healthy end of deliveries.  They’ve had to endure very few medical interventions and as a result, recover quickly.  Actually, they go home as soon as 6 hours later.  They are amazing!  They start telling Dad their sorry he’s been standing so long or that he had his hand squeezed too tight.  They tell the midwife they appreciate how long she’s been laboring with them.  They inquire if friends and family need food, drink.  They say things like “it’s been a long day for all of us.”  The experience that woman has just been through and there she is, nurturing everyone around her.  She shows very little concern for herself, other than a shower and a trip to the bathroom, and now it is all about taking care of baby.  It’s beautiful.  I cry a lot!   The downside here is that when anything goes different than planned or expected – who does the mother blame?  Herself.  It’s a really flawed system, but it’s inborn.  Moms have the gift of guilt and it is the gift that, unfortunately, keeps on giving.  I’ve been trying for a number of years to figure out how to take it away from them, but that’s the cruel irony, no one can take guilt away from another.  It’s an individual process and the only person who can free you from guilt is…you.  I’ve come to accept that and to understand that I cannot remove guilt.  My role is to help them process and work through it and hopefully increase their own strength enough to overcome their own guilt.  It’s complicated.   Just a few days ago, I watched a mom weep at her infant’s bedside.  He was born at almost 32 weeks, with full-term being 40.  He will likely do well, we just have to help him grow outside of her for several more weeks.  He’s around 4 pounds.  He can’t yet breathe well enough on his own to maintain oxygen for his little body.  We have a tube down his airway to help and he’s hooked to a machine, the ventilator, that breathes for him.  We control how fast, the amount of oxygen, how long a breath lasts and how much pressure each breath provides.  His tummy and intestines aren’t developed enough yet to eat.  We have mom save her valuable breastmilk in the freezer while we feed him with fluids into his bloodstream.  We use the vessels in his umbilical cord as IV’s.  There are tubes coming out of his belly button and that’s where the fluids and nutrients go in.  We also draw blood out of those lines, so we can accurately measure oxygen and other lab values from his blood.  While pretty standard for a neonatal unit, it can be scary to see.  I imagine that as a parent, it’s terrifying.  I’m fortunate to have only experienced it from the nurse side.    His mommy, the one who took such good care of him, agonizes and cries over what she’s done to him.  Her heart hurts and it hurts mine to watch her.  As tears roll down her cheeks, she keeps one hand on him.  She can touch him gently, but she won’t be able to hold him for days.  She talks about her blood pressure and that she tried to keep it down.  She did everything they told her to – bedrest, diet changes, frequent visits, restricted activity.  So why?  Why must her son now struggle so?  Could she have done something different?  How could I do this to him? – she asks herself and she says it aloud.  She talks about the two healthy babies she’s had previously.  She’s trying to prove she’s done it right before.  And now she’s trapped herself…if she’s done it so well before – why this, why now?  It’s painful to watch and more painful to imagine her misery.   I take a deep breath and say a silent prayer for her and one for me, that I might have some words that provide some bit of comfort.  That I might be a part of her healing process.  And then, I reassure.  I listen and let her get it out.  I hug her or touch her hand.  I congratulate her on a beautiful baby that is working very hard to get healthy.  I talk a bit about guilt and tell her I would take it away if I could.  I share with her that most moms, including me, are prone to guilt.  I offer her support and re-affirm for her that she did everything she could for him, and most importantly, it’s not her fault.  They are, true, just words.  But I mean them.  And maybe between she and I and all those others that support her, and this little baby that is working hard to get well, and God up above – those words will help a little in that process of removing her guilt.