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  • Jun 17

    It reminds me of the query "what came first, the chicken or the egg." Do you become a good nurse because of your life experience, or does your life experience make you a good nurse? I just don't know. What follows is a bare rough draft of my feelings on the second anniversary of the death of my father. I share it because as a daughter and nurse, I often felt helpless and selfish when involved in his care. I say selfish because it is so painful to watch someone you love suffer horribly and there invariably comes a time when one has to acknowledge that you desire it to end because it is just too tough on you. That is a difficult thing to admit and once you do, you have to find a way to forgive yourself for feeling that way. Of course you want the person in pain to be alleviated from pain and despair, but nurses (and sons and daughters) are only human.
    When you are so personally involved with a patient or your own family, invariably the worlds of nursedom and daughterdom collide. There are difficult decisions and worlds of wonder to discover. The best advice or tip I can offer is to try not to lose yourself along the way.....Thank you for allowing me to share....

    I Hear Singing But There's No One There.....

    So it is just after one in the morning this November 21, 2007. I should be sleeping but I can't. Lately, sleep eludes me most probably because my body just has no idea how to fall asleep given my crazy night schedule. It doesn't really matter because I was always a creature of the night. There is something alluring about the solitude of night. I can't identify it but I've always felt comfortable with it. I call the night my blanket of safety. My dad felt the same way and I like to think, though I could hardly know, that I got that quirk from him.

    November 17th marked the second anniversary of his death. He died at home, which was in retrospect, so much better than dying at the hospital. I say that only as someone who has attended countless hospital deaths. However one spins the experience, it just doesn't compare with being surrounded and comforted by loved ones within the confines of ones own home.

    I think I knew the night before that something would happen. I wished it would. Though that is hard to admit to, it is true. Most of us would attribute that sentiment to wanting to end the suffering of the person who is sick. While that is certainly true, there is an element of significant pain of the ones left behind that just can't be ignored. It is so tortuous to have to watch your loved one suffer and decline. I guess that means it is more about the ones left behind than the one who is destined to leave. I hate it when they let us humans in.

    I gave my dad some morphine to help him breathe without pain. My brother told me dad had a good night after that, perhaps one of the best he had had in ages. I felt horrible about that. Why hadn't I pushed to get him some sooner? After all, who in the world cared if he became addicted? Why wasn't I more proactive in that area? Why didn't I do more? Everyone expects so much of me. I'm the nurse. I'm the daughter. I'm the one charged (even if only in my mind) of taking care of everyone. Why couldn't I help my father?

    The evening before his death, dad finally spoke to his doctor about his wishes not to be revived should things turn for the worse. I knew as soon as I handed him the phone to have that talk with the doctor regarding his living will, that he was not long for the world as we know it. It wasn't that he had given up. He had given in. I was, in a weird way, glad for him. I knew how much he had fought to keep the illness at bay. I knew how much he desperately wanted to be there for my mom and their fifty year anniversary. I knew that it was nearly over. I just knew.

    I didn't sleep much that night. I spent the majority of the night praying to God that I would be there when he died. I cried much of that time but not for dads passing. He was at peace with that. I had heard him say so. His words to his doctor were "I've had enough, I'm tired, I believe in God and me thank you for all you've done, but I'm through." He said it as though he were having an ordinary conversation so I knew he was at peace. When he had started calling out to his parents not long before I knew time was brief.

    In the morning my mother called. She needed help to change the bed because dad had been incontinent. I felt a pain in my heart unlike any I have ever felt, but I somehow managed to at least try to nurture my mother as best I could, telling her I would be right over. In the shower I wondered if I could be strong for her and everyone but most of all, for me.

    I remember thinking, foolishly and abstractly, that the fact I had gotten my period was not only inconvenient but kind of symbolic. In all my years as a nurse it seems that there are always signs of life when death is imminent. During the birth of my son Christopher, as his arrival was being announced to my dad upstairs from the labor room, dad had been struck by the fact that at the exact same moment, another family was sobbing in the halls over the death of a loved one. Back then I stored that tidbit in my mind but never really thought of a time when it would be such a poignant memory. Funny how that happens to us all. Stored snippets of memory that somehow jump to the surface as if we knew all along they would rise to the top.

    The morning of the seventeenth was beautiful. It was sunny and not too cold. Only later did I realize that I had put on a red sweatshirt. Red was dad's favorite color. I wonder if I somehow just did it for that reason. I don't know. I hope so.

    I don't remember much of the ride over. How do you prepare for your fathers death? I do remember wondering if anyone was going to be strong for me. How is that for selfishness? Always having to be the strong one is not an easy role to play. There are times when you wonder who is going to be there for you. You have to be sensitive to the needs of certain family members but it feels as though no one has to be sensitive to you. No one understands or really even has an expectation that you are suffering too. They think because you are the strong one that you will sail through. They think because everyone expects them to be less strong or more affected in some way that you will understand. That is such a hard place to be. To have to try and weed through all the sensitivities and nuances of everyone but not to have them have the same expectation for you.

    Dad was confused. His feet were purple. Just to turn him caused him immense pain and when he cried out my heart ached for him. I wished that he would die because it was so hard to see him in that kind of pain. I wished I had figured out a way to talk with him at length, knowing that he understood how much I loved him. I was never able to have the in depth conversations with him my brothers had. As he gasped for breath after we finished changing his bed, I knew the mere fact that he had allowed me to assist my mother meant that he had truly surrendered to God. He had not given up; he had just accepted that it was his time. It was such an awful scene. I stroked his face and tried not to cry. I cried. Almost as difficult as watching my dad try to breathe was the sight of my mother in tears muttering over and over again, "It's OK Bobby, it's OK." I could see the years flash in my mind and could only imagine what was going through her mind. Was it the time her sailor Bobby had his necktie bitten by a horse? Was it that first meeting? Was it the birth of their children? Was it the difficult times? I imagine it was most likely a split second synopsis of their life together.

    I gave dad some of his medicine to help him breathe. It took a few minutes but his breaths became much less labored and he even looked peaceful. I don't know if he knew I was there. Mom took his hand and lay her head down on his chest, still moaning "It's OK Bobby, it's OK." For reasons yet unknown to me, as I stood at the door of the bedroom taking in the scene of my mother's farewell to my dad, I started singing a song he taught to me as a young child. "I hear singing and there's no one there, I smell blossoms and the trees are bare, all day long I seem to walk on air, I wonder why, I wonder why. There are times when I can't sleep at night. And whats more I've lost my appetite. Stars that used to twinkle in the sky now twinkle in my eye, I wonder why" I wonder why I sang that song, but now I am glad that I did. I like to think it soothed the both of us.

    It occurred to me as I was singing that I had to let my mother know that she had to give dad permission to die. So, I told her she had to give him permission. ""Permission for what?" she angrily spat my way..."Permission to die," I quietly replied in tears.

    "Bobby, it's time to go home." "We've been together for fifty years and I loved all the time we had." "It's time to go and stop suffering." At that moment I called my husband and asked him to come over. There had been so many occasions when we had thought the time had come only to have dad make a reprieve but this time I just knew.

    Dad was for once, breathing peacefully. He seemed calmer with mom...I left the room to call my estranged brother to tell him that dad was dying. I don't know if he believed me because he was short with me on the phone. Given our estrangement, I imagine that was to be expected. I was angry with him for not realizing the gravity of the situation. Dad had tried so hard to hang on for everyone and not show them the depth of his pain and deterioration. But, a nurse sees the truth. A daughter sees the suffering.

    Dad took his last breath when I was out of the room talking to my brother and I have to believe he knew that I wasn't there. People can and do choose the time and circumstances of their deaths. I have seen it hundreds of times in my career as a nurse. I have held the hand of people who had no one else to be there. I have hugged and held strangers who at the moment of their passing were closer to me than my closest friends or family. But, I wasn't there when my dad passed. I was talking to a brother who hates me. For some time that colored my thoughts and wreaked havoc with my emotions but then I realized that in an odd way, it was dad's way of at least bringing us a little bit together. And, it was his way of saving me from the pain of witnessing that ultimate moment from life to death. I know he was at peace. I know that in my heart and soul, so I accept that it might have been his last attempt at keeping some control in an uncontrollable situation.

    Since then, I have been preoccupied with my own mortality or lack thereof. When I think of how quickly the last twenty years have passed and how I may not perhaps, have much more than that time in the world, I am stymied. Life is short. I'm saddened that I no longer have a relationship with the brother I spoke of. I'm saddened at the loss of my youth. I'm amazed at the way time flies away when you are planning other things. There isn't any time to waste. \

    I wanted to be an archaeologist or an oceanographer. I wanted to write stories. I wanted to experience so many things that I was never brave enough to try. Why? If one single second of my life had been different I wouldn't have what I have now but still, I wonder.

    Lately when I am having a difficult time at work I have to laugh because I will always find a penny on the floor of the lounge or in my patients room. Walking into chaos is always difficult and on the nights I just feel it can't get worse, there will be a penny on the floor. Dad used to always tell us when we found pennies that they were pennies from heaven. That's why we place them on his grave....

    I play silly games with myself such as saying, "Dad, if you can hear me, let me hear a crow." And then, of course, I hear one caw at the moment in question. Real or imagined circumstance, it makes me feel better.

    When I was a young nurse, I was an attendant at the death of a well beloved person. I say well beloved because his family was all there and the death was both expected and accepted. We nurses were just there for support. At the moment of his death, another nurse and I witnessed a luminescent cloud of something leave his body and curl slowly up to the ceiling. I don't know if anyone in the family witnessed that. If so, they never spoke of it, but the other nurse and I looked at each other in both shock and amazement. We didn't really talk about it other than to wonder if that had been his soul. I will never know, but I have to believe my dad is in a better place, as cliche as that must sound.

    I have another brother whom I deeply love and respect. He is brilliant in so many ways. He contends there is no God, that afterlife is simply some sort of manifestation of energy. His explanation comforted my mother and really, it is all a matter of semantics because something happens which is beyond explanation. In my view, it doesn't really matter who is wrong or who is right, or even if there is a Heaven or not. If what we believe is strong enough to sustain us through life, that's OK with me.

    I'm not going rewrite this. This is my rough draft. This is how I feel. On this November seventeenth I thought of all my brothers and mother and children. Although my husband doesn't talk much about it, he also dearly loved my dad and was there at his passing. Dad loved him as he did his own sons and told him so. Who comforts him? People don't have to say anything. I know when my husband holds me or pats my shoulder, he is saying so much more than he could ever say with words.

    Not long ago I worked two difficult night shifts. The first involved a patient who had gone to a routine doctor's visit only to discover that her baby had no heart beat. She was to be my patient for twelve hours. She was in severe pain of cramping and contractions we had to induce so she could expel her dead fetus. She was still in the throes of doing that when I left in the morning. The next night, I had a labor patient who had lost her mother during the pregnancy. Her due date was November seventeenth. I was quiet that night but didn't speak of my own personal memories of that particular anniversary. She didn't talk much about her mother and I didn't press her, but at the moment of delivery, when she saw her baby, she burst into tears. I understood. Later, when all the equipment had been cleared away, she grasped my hand and burst into tears, with heaving, heart wrenching sobs..." I want my mom!" she cried with enough anguish to hurt my heart. "Will you be my mom today?" Fighting to hold back my tears, I told her of course I would.

    Later that morning when I returned home and helped get everyone ready for school, in the middle of a conversation (or gripe session) with my husband, I was suddenly overwhelmed with emotion, and burst into tears..."I want my dad", I cried every bit as sadly as my patient had cried out for her mother. I wasn't prepared for it. I never am. As my shoulders heaved with gut wrenching sobs, and the tears fell, I remember saying to my husband, "I hate it when this happens." I guess being a nurse doesn't always guarantee one can control their own emotions. But, it was a good thing that it happened. That morning I finally slept.

    I miss you dad. I want you to be here with us but not at the expense of you feeling the way you did. I honor you and I love you. I still daily review your voice in my mind so I won't forget it. And as much as you always said I needed to have the last word, I would give my life and everything I have for the privilege of YOU being the one to have the last word. I love you dad.......Night night......

    Love always,

    Martha

  • Jun 16

    It wasn't professional. It wasn't healthy. It wasn't encouraged and it certainly was not expected of a "professional" nurse. I probably lasted six months. Here is a true account of a patient I met (and was destined to meet) one weekend morning during clinical at a time when the last thing I needed was yet another distraction from school. What I began to learn that morning and continue to maintain all these years later, is that some people and patients are destined to meet with us at a pre selected moment in time (God, destiny, the universe) not only to learn from us but so we can learn from them. On my journey through the tangled forest of nursing, I have been graced to meet up with so many similar experiences and lessons along the way. I share the story of Jim with all of you who are in the beginnig of your "walk through the woods." May you meet as many spectacularly wise people as I did, and continue to meet, along the way. Have I been emotionally involved with patients and their families? You bet I have.....My tip is to note that fact is not necessarily unprofessional or wrong. It is what it is.......

    Some Kind of Friendship...

    I was totally bored that Saturday mid morning, but happy. Full time nursing school students working outside the scope of school rarely enjoyed downtime, so along with feeling bored, I was grateful.

    Sometime in 1980, I was cruising down the square framed halls of Boston's world renowned Joslin Clinic, attempting to find something productive to do.

    Mercifully, following a grueling week at school (New England Deaconess Hospital School of Nursing), I had been "assigned to glide"; that is, sent to Joslin on my weekend nursing assistant job. That meant no emptying bedpans or equally awful tasks. It was a good thing too. I needed the rest.

    With so many students vying for so few coveted positions, occasionally we were placed in plush assignments and I was thankful to have drawn such a lucky score on a rough week at school.

    There was not a whole lot to do in the way of patient care at the clinic. All patients were expected to care for themselves, learn how to manage their diabetes, do their own chores and get themselves to class. Nurses and ancillary personnel functioned primarily to teach and administer medications or treatments as needed. Patients were also expected to medicate themselves and do their own blood and urine testing. So what was a novice nursing student supposed to do under those conditions?

    I wasn't exactly upset at having been given the opportunity to socialize with interesting people of all ages and nationalities, and elected to make the most of my time. It had been a horrific week in my ICU rotation. Embarrassed, I had even been yanked out of class and personally quizzed, which was every nursing students personal nightmare. I was only just getting over the humiliation I felt over freezing when directed to orally trace a drop of blood through the body. All I was certain of at that moment was that any blood I had left had sunk to my feet, which felt like leaden weights. Needless to say, I needed a break from school.

    So, at the Joslin Clinic, where my most challenging task might be to ferry a specimen to the lab or sit in on a patient lecture where I might actually learn something, I was at that particular moment, utterly blissful.

    Just as I was thinking of taking myself to lunch and meeting up with unfortunate friends charged with the task of "really" working that day, I happened past the clinic cafeteria, where I spied a petite freckle faced little boy approximately ten years old, seated by himself. Something compelled me to sit down beside him, although to this day I can't come up with an exact reason why. I simply knew it was something I was supposed to do.

    He eyed me carefully while eating some crazy oatmeal peanut butter concoction. Long a veteran of attempted gross outs perpetrated by my four brothers, I quickly offered that as far as odd food combos I much preferred either mustard on potato chips or peanut butter and sweet pickle sandwiches. "You have to make the food interesting somehow," he giggled. We both erupted in laughter and he slid over to make room for me on the bench.

    The little boy, "James" seems lonely, but what a wit. We become fast friends and the rest of my day passes so quickly that I can't believe it is time for me to go. I want to stay and continue the visit, but he has class and I have homework so we have to say our goodbyes. Neither of us wants to. I tell James that my dad has a rule that we never say goodbye. We say so long because goodbye is too final. I think that is a great rule and tell James so. He doesn't say anything, but he does stare at me long enough to thank me for hanging out with him.

    I suggest we exchange addresses and keep in touch. I know as soon as I say it that he doesn't believe me. It becomes my mission to prove otherwise. There is a resigned edge to his voice as he quietly agrees to be my pen pal. As he walks away to the kid's nutrition class, I surprise myself with a loudly delivered, "Hey!", "You forgot my address." I press the folded piece of paper into his hand and tell him that my mailbox number at the school is 29. Although he is skeptical toward my intentions, I am acutely aware how his impish smile fairly lights up the room. It brings countless rays of sunshine to that cloudy Saturday afternoon. I have absolutely no idea of the adventures which will follow and connect us throughout the tangled mazes of our lives. I make a mental note to start a letter to James as soon as I return to the dorm. I keep my promise.

    All that year we exchange letters and pictures. We discover we both love to draw. Despite our considerable age difference of ten plus years, we also discover we are both possibly the two sappiest people on the planet.

    James's mother allows him to visit my room mate and me at the dorm during his all too frequent sojourns at the Joslin. He is the king of our dorm for those afternoons. We take him to the cafeteria to enjoy and experience the "delicious" hospital food. He teaches us about juvenile diabetes and seems to know more about the subject than most doctors. He definitely knows more about it than we do, which is something we noticed about nearly all the children at Joslin.

    James is no longer lonely during the times he spends with us. Neither am I. Until it is time to return to school and home.

    In the middle of the night sometime in the winter, I receive a call from the hospital. James has just been admitted in ketoacidosis with a blood sugar over 1400. Normal is 60-120. He insists that the staff call me not only because his mom had to return home to care for his brother and twin sister, but because he needs me. He wants to know why I am not already there. He doesn't understand that I don't know everything. He doesn't understand that I am just a kid too. In his eyes I am invincible. I have never been invincible to anyone before.

    Although we have clinical in a scant few hours and skipping it is not an option, my roommate and I throw on some sweats and race over to the all night pharmacy attached to the clinic, where I select a tiny stuffed dog. We have to pool our money to buy it. We hurry over to the emergency department and give the dog to James. I tell him its name is MarJim, after the two of us, so that he will never be far from me wherever he is. I want him to believe that he will not ever be lonely as long as he has a thought of me with him.

    James is thrilled to see me and is conscious despite his life threatening high blood sugar. I fight to remain awake seated next to his stretcher and strain to keep leaded eyelids open as he chatters away. As the insulin drips into his system via IV, James becomes quieter and quieter, but continues to clutch my hand and hug MarJim close. He eventually drifts off to sleep. I have to leave but whisper that I will be back as soon as I can. And I am.

    As time passes, we are back and forth in touch, but as life intervenes, our worlds change and our contact lessens. Suddenly the little boy is 15. I am a young single mom, age 27. I can't recall how he found me, except that he remembered my hometown and somehow negotiated the right road back to me. It was not to be the last time. But, I digress.

    There is an anxious phone call asking me to pick him up at a bus station a town or two away. He is visiting friends, he says, and just wants to have an opportunity to see me after all this while. Maybe we could have oatmeal and chocolate he jokes with a not so innocent chuckle.

    Though I don't know the way and am more than a little terrified to travel to the area in question, which isn't in the best part of that town, I readily agree, scoop up my three year old son, and bravely risk the trek.

    Gosh, he is no longer a little boy, but a man child. A child/man actually, complete with multiple earrings and Mohawk hair. I am only briefly taken aback because it is the same old sappy Jim behind all that. He hugs me as though he doesn't ever want to let me go. I feel trembling and sense there is something I should know. I ask him if he is ok. He assures me that he is but I don't fully believe it. He swears all is well and he is simply visiting friends and away for the day to see me. I don't get a great feeling from his explanation but respect his reticence. I am just so thrilled to see him again.

    James shows me a notebook filled with poetry that is disturbingly dark and filled with pain. It hurts me that he hurts so much. He is fifteen after all, but I still wonder if he wants to tell me something, or perhaps hopes that I will simply guess.

    His work paints a picture of someone who is lost, confused, misunderstood and lonely. All the things both he and I sadly understand. I promise myself to keep in better touch.

    I can't know that I will not be able to find him. No one can know the depth of his pain. But I suspected.

    After dinner and a too short visit, my little son and I somehow brave the one way streets in an unfamiliar town to drop James off at the bus stop. "Where are your friends?" I ask, not wanting to leave him there alone. "You worry too much, "he counters. "I'll be fine." "They'll be here soon, honest."

    The sinking feeling in the pit of my stomach makes me wonder just how honest he is being with me, but against my better judgment, I drive off with a glimpse of him, all alone, waiting in front of the station. I have that sinking feeling again, but it isn't because I'm frightened that I am in a questionable area of town. It's for James. I plead for God to protect him, and drive away toward home. He is again part of my recent past.

    Jim often occupies my thoughts over the years, especially whenever I come across the provocative poetry notebook he unwittingly or knowingly left behind. I love him in absentia and keep him in my prayers. Sometimes when sifting through treasured memorabilia, I re read the little boy letters and touch his school photos. Every December on his birthday I send him a silent wish for goodness. I occasionally curse myself for not following my original instinct and keeping in better touch. I wish I had waited for his friends to show up before I drove away.

    More years pass and so many things happen to the good and bad. I don't think of James as frequently but he floats into my mind often enough to continue to be included in my prayers.

    One night in 2001 I can't sleep and decide to log on to the computer to do some writing. It seems to soothe me somehow. There is a foreign email from someone who identifies himself as that little boy from so long ago. He has been searching for me to no avail. Somehow he managed to locate me through an extensive search network and a smattering of good luck. He begs me to read his note. I am enthralled at what jumps back at me.

    The words in front of me blur through tears which cloud my vision. He hoped I would want to resume contact but would understand if I did not. After all, it had been such a long while. Whatever the outcome, his email continued; he needed me to know how much my presence in his life had meant to a frightened, lonely little boy. He still had Mar Jim. He still had hope and, he eloquently pleaded, he hoped he still had me.

    Through my tears I went on to read how the teenager who visited that long ago day was NOT visiting friends. He was a runaway. He had fallen upon unspeakably horrible times and had nearly lost his way and his life as well. Had he known the degree of danger he had placed me by asking to be picked up at that sleazy bus station, he never would have asked.

    Yet, I am so grateful and happy that he did.

    Since that meeting, James had admitted to himself that he was gay. He had undergone cardiac bypass surgery and not one but two renal transplants. He was now happily residing with his partner of nine years, which was longer than my husband and I had been together. He wondered if I could still care. I wondered how he could even remotely doubt that I would.

    That is why after a particularly horrific night shift, after nearly a year of James and me reconnecting over computer and phone, I did not hesitate when notified that he was scheduled to receive a pancreas transplant on Nurses Day, of all days.

    A donor pancreas had become available. This meant potentially, if successful, that James juvenile diabetes could be eradicated. The hospital beeped James to travel to the hospital immediately. In the mix of family and friends he wanted and needed to be there, I was top on the list.

    He was afraid. He wasn't sure that he could do it. "It's Nurses Day, "I reminded him, "and you are going to be on the floor that I was first assigned to when I graduated." "If ever there was an omen, this was a good one. "The Angels are watching over you, "I added.

    Still, we both knew we had to see each other "just in case," so with a mixture of my husbands concern and blessing, I showered off much of my night shift fatigue and anxiously drove the seventy or so miles to see James.

    The massive, all encompassing, lingering hug he delivered dissolved our years apart. "You are my angel," he whispered, and then, as now, I voiced a silent prayer of thanks to God for keeping us, if not always on the same path, then similarly aligned so our lives were destined to touch when necessary.

    There is no one in my life quite as special, unique or as beautiful as James. He is a deep, silly, crazy, kooky, wild, sweet, risquE, amazing person whom I somehow managed to affect and effect in some poignant way. I still don't know why, any more than I know why I chose to sit down next to him all those years ago. The remarkable thing is that he still hasn't realized that it is he who is the treasure.

    Thank you God, for gifting me with his friendship and love; for directing me to sit next to him all those years ago, for sending him back into my life when he needed comfort, but most especially, for keeping him safe and warm as I have always asked.

    Sometimes, nurses really can have it all...

    For James, with love and admiration, for always...

    Written by: Martha, RN

  • Jun 16

    What follows is a true account of my relationship over many years, with one such physician and when he retired, we both finally figured out just how special we had been to each other all along the way.

    Time for a Gentle Exam

    Just over twenty years ago one icy February morning, a frightened young woman trudged ominously into the office of a local doctor, knowing absolutely that he would tell her exactly what she didn't want to hear. He was randomly chosen to deliver the untimely and expected news, as if not being acquainted with the physician could somehow minimize her fear and shame. She had essentially just begun her adult life in the real world and this was most certainly to be an event up to the challenge of the yet to be explored realm of difficult decision making. "Welcome to reality" was the annoying snippet of thought entering her mind upon crossing the threshold of the office.

    The woman, a girl really, noticed the cheery decor less than the faces of the office staff twisted in disdain at her situation. Real or imagined, the embarrassment was an ever present stinging reminder of a choice not wisely made. She was certain the doctor would be, at best, the clinical confirmation of what she already knew. At worst, he would deliver a stern condescending opinion, as so many already had. She was poised to accept his wrath.

    It never came. Instead, as she walked past an animated group of excited, happy mothers to be, the doctor greeted her warmly, with his hand extended toward hers. Sometime afterwards, he instructed her to relax and prepare for a "gentle exam." His exact words are as clear to her now as they were then. "Congratulations, you are roughly two months along." (Impossible, she thought, as there was only that one time...) Visions of her brand new career and soon to be ruined life tumbled into her unsettled head. Earlier that morning she had been irrationally angry at an anonymous lab tech who cheerfully confirmed the pregnancy results over the phone. And now this doctor was also blissfully unaware of her plight. Explosions of thoughts consumed her to such a degree that she had to ask the doctor to repeat what he had just said. "Dear, there is something extraordinary about this news," he offered quietly, his hand tenderly descending to her shoulder. Sad, angry, scared green eyes glared back in disbelief. He knew she was unmarried so she could not comprehend the depth of audacity of his comment. Softly he continued, "At least now you know you CAN have children." She exited the office as soon as she could and commenced her unplanned journey into the unknown, his words licking at her mind from time to time in the years to follow.

    Eleven years later, the same woman accepted a staff position in the Obstetrics department at a local hospital. She was no longer as young, angry or sad. Coincidentally, or perhaps simply by fate, her premier patient was a young devastated girl who wouldn't speak to anyone for fear they just wouldn't understand. But this nurse DID understand and was able to offer much needed empathy at a crucial time. She recalled those words by the doctor a decade earlier and finally realized their significance, fully understanding why the young patient could not. Not yet...

    Throughout her numerous years in maternity, the woman heard the doctor announce, "Time for a gentle exam" on countless occasions. Some patients might certainly have disagreed with that assessment, but such is the stuff of labor and delivery. Each time the nurse heard those words, she was briefly catapulted back in time and her own experience. The memories, however fleeting, were never far from the surface. When patients were in tears over losing children or discovering they were unable to conceive, the nurse saw the doctor in an entirely new light. Whenever she held her tiny son or shed tears over the perfection and joy in simply watching him sleep, she realized just how gentle her original exam had been. Sometimes people consider the physical aspect of an exam and forget that it is a special doctor indeed who is able to incorporate the emotional aspects as well. Perhaps, this nurse realized, that was the reason the doctor's patients were fiercely loyal to him and began sentences commenting how much they loved him.

    Often she and the doctor were at odds over decisions involving patients. And there were times when stressful situations brought out the worst sides of both. Such disagreements were usually brief and quickly resolved. After all, no one can be perfect, and thankfully, even a doctor must be human. Interestingly, it was just that fact that made the doctor so well beloved by his patients. The nurse was struck by how kind and big of heart he was. It was always clear that he was extremely empathetic and sympathetic. Then too, he readily and excitedly discussed topics which were of interest to her, such as his varied travels and her love of anything having to do with Pitcairn Island. That alone intrigued her, as probably only the two of them had ever heard of the place. If she professed an interest, he sought out an article or book and brought it in for her to peruse. She never had to ask him to do so. A ham radio enthusiast, the doctor was fond of regaling everyone with tales of who he had contacted. Many were polite listeners but this nurse eagerly awaited his stories. Once, upon learning that her son coveted an interest in ham radio and without being asked, he brought in an older model of one and gave it to her, with instructions that the boy should contact him with any questions, as if his schedule were in some way flexible. The woman would not forget that he remembered every nurse genuinely and generously every Christmas, and was the only doctor to lavish such attention and appreciation upon them. It was such a simple but thoughtful thing to do. He never forgot to say thank you; something so important when others rarely did.

    Flash to the present. The woman in question is married, with four children. The oldest, who is twenty two and on the Deans list in college, was the unexpected baby the doctor said would be an amazing reminder of her future. He was correct a thousand fold. Ironically, and possibly prophetically, since all the nurses can attest to the doctor's not so alleged psychic ability, the woman was told she was infertile, and was then sad for the opposite reason of her initial office visit with the doctor all those years before. At that moment she TRULY understood the wisdom for the comment given by the doctor to the shell shocked young girl that day. She had to smile and marvel at his wisdom.

    These days, that not so young woman has three young children under the age of seven. She has few free moments and an ongoing respect and admiration for the doctor who kept the importance of life and wonder of birth alive in her mind and heart both personally and professionally throughout the years. Upon his retirement he will be sorely missed. And, the other nurses tell me, and I concur, so will his early morning check in phone calls. The doctor made life interesting in many respects and the maternity department will not ever be the same without him. He is wished only laughter, love and good health from all his nurses, colleagues, patients, staff and the community as well.

    Dr. F., THIS woman and nurse says thank you so much for the words you compassionately delivered all those years back, and I assure you I held them snug in my heart and mind all along. Please know that I won't ever forget the countless kindnesses you offered along my journey to the present. It was a bumpy ride, but well worth the trip. Lastly and most importantly, thank you, most sincerely, for my own "gentle exam."


    By..Martha RN

  • Jun 16

    It can be worse because not only are you charged with caring for older people and their physical, emotional and psychological changes; you are tasked with dealing with some of the same issues WHILE caring for others.

    The other night I drew some blood from a patient with routine orders post partum.

    I got as far as the desk and forgot the tubes were in my pocket.

    I forgot them (albeit briefly) because someone had the audacity to call me in to an emergency situation while I was enroute to the lab.

    Imagine that!

    About ten minutes later I happened upon my lab slips and WHAM, a lucid memory of having drawn the blood came rushing to the forefront of my brain. I sent the labs and they were fine. Thank goodness.

    Another time I was staring at the patient addressograph and couldn't remember the name of the thing. That is, of COURSE I was aware of its presence and function; I just couldn't form the word "addressograph" in my attempt to tell another nurse where her patient stencil was. We both laughed at that and compared mutual forgetful moments, but in the back of my mind, I wondered what it must be like to have receptive or expressive aphasia following a stroke. Now that I'm older I have to think and differentiate between the "elderly" moments and real cerebral danger. How scary is that?

    If you have never experienced those sorts of events (either one), please be grateful.

    It teaches you to be even more patient than you hopefully already were.

    It can be humorous but also humbling.

    It can be a pain on so many levels.

    I thoroughly hate it, even when it happens only once in awhile.

    I try to make light of it but it is a uniquely valid concern.

    I need to be there for my family.

    I need to be there for my patients.

    I need to be there for my co-workers.

    I need to be there for me...

    When I was a younger nurse it didn't often happen that I would lose track of my mission on the way from a patient room to the supply cart. These days, however, if I am interrupted on the way I sometimes stare at the cart for several moments before I remember what the heck I am in search of. It would be laughable if not for the fact that it occurs to me that must be what confused patients feel like. How frightening for them.

    It can be scary and concerning and down right inconvenient.

    How is it that one nurse can make an excellent cheat sheet and then lose the darn thing more than once a shift? I have to make copies just in case I lose the first one. That's a lot of work for a harried nurse. What else might I forget? Will it happen during a real emergency? Will I make a med error or put a patient in jeopardy?

    Yes, it is true that with age and fatigue comes forgetfulness.

    Marry those facts with menopause and it brings on a new appreciation for estrogen

    And definitely a desire for restful sleep.

    The other night I was in the middle of patient teaching with a first time mom with marginal support at home. By the luck of the draw I was also the charge nurse. That meant I was interrupted several times to intervene and investigate other matters. It was probably two hours later when I realized I had not been back to finish my teaching. I was horrified because I had told my patient I would be right back. She was very understanding but it caused me to wonder what it must feel like to patients who have to wait for long periods of time to even see a nurse due to the business or skill of the nurses working on the floors to which they are assigned.

    By now many of the nurses reading this have identified with the loss of thoughts that happen every once in awhile and later, often.

    Some are smiling or even laughing.

    But I am not....

    You see, I'm afraid.

    I'm afraid when those moments happen because I have been a nurse forever and that is what I do.

    That is who I am.

    What happens when or if I can't be a nurse?

    What happens when I NEED a nurse?

    Those moments of forgetfulness may very well be benign side effects of aging, working twelve hour night shifts, chronic sleep deprivation and co existing and caring for a husband and three young children.

    What if it isn't?

    Nurses need to remember that they are people first.

    They (We) are not invincible.

    We definitely aren't perfect and we are subject to all of the fears and concerns any one else faces.

    We are a single part of the "every" one who co-exists with us.

    Losing ourselves takes on an entirely new meaning when considering that fact.

    Here is what I would like should the reality of my forgetfulness become more significant that the usual things that happen post the infamous fifty year old hallmark.

    I want a nurse to care for me who sees me for who I am, even if I am confused.

    I want a nurse who makes me laugh by laughing at him or herself.

    I want a nurse who establishes a rapport with me and my family and involves them positively in my care.

    I want a nurse who holds my hands when she talks with me, or if I cannot reply, to me.

    I want a nurse who looks into my eyes and sees my pain.

    I want a nurse who searches for whatever sparkle I might have left and nurtures it as far as it can go.

    I want someone who won't laugh at my confusion, or ignore me in the hallway in the Geri chair because I am annoying him or her. I want a nurse who on the busiest of shifts tries to remember that I would not be screaming or soiling myself if I had any control over that.

    I want a nurse who is aware that could I do so and they were in a similar position, I would care tenderly and fiercely for them.

    I want a nurse who recognizes that I love hugs, and who is willing to give one.

    I want a nurse who tells me over and over again that I am safe and not snarl at me or resent that I am causing a scene. If I am doing that it is because I can't help it.

    If I am angry and not confused, or somewhat confused, I want a nurse who will limit set with me appropriately and not worry about his or her job when they do.

    I want someone to talk to me and not over me if I am in a comatose or vegetative state.

    I want a nurse who will read to me if I can't see or for any reason not be able to do so myself.

    I want nurses who will talk to each other while they are tending to me but say so and include me by doing so if I can't respond. I can hear you.

    I want a nurse who respects and works with my family and understands that I am not just a patient to them. I am (or was) their life. I am (or was) their mother or wife. I am (or was) just a person like them.

    I want a nurse who understands that I may be in pain even if I can't talk or ask for pain medication.

    I want a nurse who can see pain in my face or in my actions and doesn't leave me without pain medication because I can't ask for analgesia.

    I want a nurse who pays attention to subltle nuance...

    I want a nurse who doesn't dismiss me or my importance in the world simply because I can't talk, see, relate or care for myself.

    I want a nurse who will wonder and honor who I am and who I used to be.

    I want a nurse who will constantly search for signs that my mind is functioning even if and when my body is not.

    I want a nurse who will advocate for me and my familyI want a nurse who is not afraid to touch me.

    I want a nurse who is not afraid to cry.

    I want a nurse who is special...

    In other words, I want to be cared for the way I try to care for others.

    There are so many other things I need.

    There are so many things I want.

    I would tell you what they are

    But I forget....

    Written by...Martha RN



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