I will fear no evil: for you are with me
My words are what they are: the world as seen through the eyes behind the OR mask. Should you wish to peek over my shoulder and catch a glimpse of my interpretation of a turn of affairs involving end of life and advocacy, I welcome you. Should you choose to ignore these words, I pass no judgment and bear no ill will. I fear I am not one for summaries; I find it tedious to tell you what I'm going to tell you so then I can tell you what I told you.
Every now and again there is a moment in our jobs which lingers in back of our minds, niggling at our focus, bobbing on the outskirts of all other important thoughts and well, just generally being a royal pain.
I first wish to disclose that I do not oppose students of any variety. We all start somewhere. I just sometimes wish I understood them a little better. After all, the last thing I expected in answer to my standard, "So....any questions about what you saw today?" was....well.....the following:
Today a nursing student decided that the only question worth asking me was, "Don't you think praying with your patients is unprofessional? I mean, it's kinda pointless."
I wish I could make this up, but I'm not that creative. Of all the things to talk to me regarding....that is what the student wanted to discuss. Mind you, she had just gotten done observing a trigger-finger release turned code, and that is what she had as a question.
And I didn't have the time to answer. Something about transporting the patient to ICU and all that coming first.
So I find myself turning here, as I did the last time something at work was nibbling on the edge of my brain and toying with my frayed sanity, to babble until the voices are pacified and leave me in peace. You see, apparently I will not be granted rest until the answer to the question is given. I only hope that, in some way, some part of this makes its way to her.
And I sincerely thank you for taking the time to listen.
Dear Nursing Student,
I do not believe it to be inappropriate or pointless to pray with patients, regardless of personal beliefs. I believe prayer can offer us, as caregivers, a rare snap shot of the patient's concerns, hopes and well being as it is voiced in their prayer.
I agree that patients ought to be the ones to lead the prayer, unless they are too weak to do so. In those moments, I have offered to sit quietly with them, hold their hand, and allow them peace and silent reflection. I have never been declined.
In the world of surgery, a patient's desire to pray is quite common, and each and every time I find myself feeling touched when I am included in their prayer--when my patients take the time to request that God, under whichever name, in whichever form they personally believe, aid me to find peace and focus and to guide my hand and that of their surgeon.
Prayer is powerful for reasons beyond just basic spirituality. Prayer can soothe when nothing else seems to help. Prayer can offer a shred of familiarity and warmth in an otherwise alien and cold world. Prayer shows the power of hope and humility even in the face of something as bold and encompassing as death. I believe that prayer can ground, can aid in the process of grief, can open channels of communication among people, and can make even the battiest, crotchetiest patient seem that much more human.
And thus I pray with my patients.
Open heart surgery is not about a cure. It's not. It's about buying time. It's a gamble; a gambit; a spin of the roulette wheel with the stakes being at their absolute highest: life or death.
After all, it is one of the very few surgeries where we, for all intensive purposes, kill you and then, through the wonders of chemistry, physics, modern medicine, 20 J or so of directly applied electricity and a little bit of Pixie dust, coax your body back to self-sufficient life.
Let's just ignore the whole "there has been someone rooting around in your chest, rewiring your heart with various bits of vein and maybe even a mammary artery, with the same focused intensity as a bomb diffuser" factor. That just goes without saying.
So when my heart patients want to pray....I pray.
As with all things, there is always a story, isn't there? A moment, brought to the fore by a seemingly innocent interaction, which has become the representation of a personal, undeniable, defining truth.
There is always a story.
It was a standard pickup from pre-op: tearful family members doing their utmost to hide their trembling hands and force a brave, if not watery, smile all for the sake of the very calm....too calm....gently 67 year old woman on the bed. They bid their farewells--or as I call them "see you laters" as I don't believe goodbye is appropriate--each taking the time to cling to the woman and kiss her cheeks, forehead and even chin. She remains composed. Quiet.
I remain baffled.
You see, I'm used to the typical nervous babbling that eventually disintegrates into weeping or even sobbing. I'm used to the stony silences of people taking a moment to steel themselves against what is to come.
But this is calm.
And I am baffled.
It's easy enough to shrug off in the routine of dialogue, preparation and eventual departure from the pre-op area. We head back to the OR suite in easy silence. She doesn't seem to be one who wishes to talk and I refuse to force the issue. I know that in my moments of silence or reflection, I hate to be disturbed. I tend to project myself onto others.
The doors of the suite open and we are greeted with the usual hub-bub of too many people in the room doing too much all at the same time; perfusionists are talking with the surgeon who is simultaneously chatting on the phone; anesthesia is addressing the patient who is doing her absolute best to listen and follow his directions which are heard beneath the din of surgical pans being opened, a back table being prepped, scrubbers in conversation about instrumentation, the assisting PA speaking to me about a possible balloon pump and circulators chirping and cooing niceties and greetings to patient. Couple that with a chilly temperature and some brighter than bright lights and the environment is overwhelming, to say the least.
She is situated on the bed, still keeping her peace, scarcely acknowledging the team with anything more than a nod or shake of her head. She remains stoic as she lies snuggled in warm blankets, almost reminding me of a toddler seeking refuge from the boogey man. As I take my post to begin to assist with prep for intubation, she speaks for the first time since answering my pre-op questions.
"I wish to pray with you."
It has been years. Years. And I can hear her still. Her voice wavered a little and was muted from the dryness of her mouth. Yet her voice and words stopped the world.
At least, that's what it felt like.
I have never seen so many people freeze so quickly. I have never seen my surgeon hang up in the middle of a conversation before that moment. Words died on lips, scrubbers abandoned their field to draw close as each member of the team, with exception of our sterile comrades, came up to her and placed a hand on her in a silent affirmation:
We are here and we are listening.
What she said in her prayer will not be repeated. Not because it is not important. Much to the contrary, I feel a need to protect her words--what may have been her last conscious conversation with God-- and honor them as the private moment they were and are. They are not my words to share.
But from those words, I can tell you I gained an understanding of this woman that I otherwise would have been denied. I learned something of her and recognized in her, in that moment, a kindred individual.
I understand in hindsight that somehow, in some small way, she knew. She knew and rather than fleeing from it; she embraced it.
We fought for her as we battle for each and every patient. I shall omit the details, suffice to say, her passing was not pretty--I hate to be the bearer of bad news, but it seldom is in our world.
I like to think that her moment of prayer in the arms of the surgical team gave her peace and resolve to face whatever afterlife she believed in. I like to think that her prayer lives and breathes in the memories of those that were present, even if they do not recognize it. I, myself, feel humbled and blessed to have born witness to a moment that united people from all walks of life, from all backgrounds, from all belief systems.
No, I am not a religious individual. My beliefs are private as they are mine, and I guard what is mine with keen jealousy.
But I do believe in the power of prayer.
Forgive my half-baked rambling. Now that I have purged, I find myself tired and ready to attempt to sleep.
Thank you, once again, for listening.
Your Friendly Neighborhood Sociopath
Any typos and errors are indisputably the result of my own ignorance. I do not deny it, but I am currently too exhausted to care.Last edit by Joe V on Jan 9, '15
One article written during a fit of pique post drawn out shift riddled with emotional highs, lows, and psychological boxing matches. I do not claim to be a writer, or someone of great dealings with the ways of a wordsmith; however, I felt that there was a story to be told and a message to be relayed. These are merely one nurse's disjointed, rambling reflections on life, death, prayer and the power of advocacy to trump personal belief systems.
Joined: Jan '12; Posts: 241; Likes: 2,374
OR circulating/scrub nurse; from US
Specialty: Sleep medicine,Floor nursing, OR, TraumaMay 1, '12unbelievably eloquent and wonderful story. To say more would diminish how I feel in some way-just know that I was truly touched by your story and your experience.May 1, '12Wow, just wow. Thank you for taking the time to write this, especially when you were exhausted. Keep writing! I like your style....May 1, '12Y'know, I don't think I've ever heard "it's all about the patient" said quite so profoundly before.
Thanks very much for sharing this.
----- DaveMay 1, '12Thank you for posting this because this is a question that many of us (as students) really struggle with at first. We know that the right thing to do is offer yourself to pray or be in silence with the patient but we are taught in school that it is unethical. Although her question may have not been asked at the appropriate time great things have come from her question. Thank you for your post it was beautiful and gave me cold chills.May 1, '12I am an atheist and I applaud your kindness when helping this woman. Prayer is about more than just a higher power. Its optimism, acceptance, and is personal to all who use it. I hope if I ever have to serious surgery like that, I have a nurse like you, that when I am a nurse that I will BE a nurse like you. Not for the prayer, but for the comfort that you gave her, what SHE needed. I recently searched all over the hospital my last clinical day this semester for a bible for my patient becuase we couldnt comfort her like the bible she has relied on her whole life. On a side note, your writing is excellent....
"As with all things, there is always a story, isn’t there? A moment, brought to the fore by a seemingly innocent interaction, which has become the representation of a personal, undeniable, defining truth." Cheesepotato
(the name makes it a little funny, but you get my point )May 1, '12Many, many years ago, this Jewish nurse worked at a Catholic hospital. Every morning, during report-time, a prayer came over the P A system. Most mornings, it was the 'Our father'. After a few months, a patient asked me to pray with her, not uncommon in this particular place. She started the 'Our father' and I said it right along with her! I was amazed that I knew almost every word!
But I said it, she squeezed my hand, and was restful. Since then, I have stood by many times when patients or their families have asked me to pray. It may not be 'my' religion, but I nearly always feel calmer after the brief interlude.May 1, '12Ohh one time I looked for a bible for my pt too. I couldn't find it anywhere. I called hospital chaplain service but somehow no body was in. I felt bad for her since she really wanted it. I didn't know what to say at that time since we don't have the same believes. Good thing her mom came to visit her with the bible.
I got to look for praying sentences(?) in many beliefs to comfort my pts.
This article is so nice. Thank You.May 1, '12Thank you for sharing. Prayer gives hope and sometimes that is what a patient needs the most.May 1, '12I will never forget the face of the OR nurse I had when I needed emergency surgery 1,200 miles away from family... There were no conscious prayers said (by me, anyway), but I felt SAFE with her and that made all the difference.May 1, '12Not only prayer but I've seen where Catholic Last Rites (they call it something else now) bring relaxation and a peace to even the marginally responsive residents. When I know about services, I will always accompany the priest into the room if just to join with a reverent Amen. It too is very moving.May 1, '12I must say you made me reflect on times when I was with a resident/patient and sat with them or prayed. It is something that one can never forget. I had shivers the whole time I read your entry and it was very touching. Thank-you.