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I liked to take care of my younger brother and he cooperated with my schemes in make-believe which meant he sometimes had to drink whatever “medicine” I came up with and submit to a variety of bandages made from scarves or my mother’s sewing scraps.
Over time, I became an avid reader and enjoyed adolescent fiction about nurses as well as biographies of Florence Nightingale and Clara Barton. In high school I started reading nursing journals that a nurse friend shared with me and took all the science classes my tiny high school could offer, begging our teacher for independent study so I could learn more about biology.
The idealized version of nursing that made up my early dreams gave way to reality as I launched into the true study of nursing and put in all the long hours to make my goal a reality. It was harder than I had anticipated, and I had to study hard to make it happen and to pass the terror of the boards. While in school, I started working as a nursing assistant in a children’s hospital and as a personal assistant to a handicapped student. All of this gave me a little taste of what would become a lifelong vocation—helping others and working to provide healing or comfort any way that I could.
My formation as an RN, a Real Nurse, started small, with the little ones in pediatrics and went on from there. I remember how hard those first few months of night shifts were. As a charge nurse on a pediatric ward, I struggled to learn and to be a professional, quickly realizing that this job might not have been the best choice for someone just learning the ropes of the profession. I didn’t know how much I didn’t know. I don’t remember doing a lot of great things during that year—in fact, it was really a divine grace that I didn’t make some egregious mistake! The memories of that time flash by in black and white like a dim slide show: the child with asthma who nearly arrested before I could get the resident to come, the toddler who was a “failure to thrive” for whom I bought a small toy, the angry mother that didn’t like my attitude, the commute to the downtown hospital late at night, the wards with 8 kids each…
From peds I found a different calling with adults on a general medical/surgical floor. There I learned to balance time demands and prioritize my work, honing the skills needed to be efficient, and cramming my brain with some of the more practical knowledge that doesn’t always get included in the general nursing curriculum. The slide show continues, picking up more hues as it moves forward through time: the man bleeding out that I transferred to the ICU in a big hurry (and I ran over someone’s toe with the bed on the way—and no, they didn’t get seriously injured but I was horrified!); my first time doing CPR and feeling the elderly lady’s ribs cracking under the pressure of my wrists and then the tears later in the locker room; being asked to teach a group of peers about acid/base levels in a staff meeting—all of these blend to make a picture of years that added up to a satisfying experience and made me much more competent as the RN I longed to be.
The step into home health in a backwoods town in Tennessee brought me out of the hospital and into living rooms. Pulling from past experiences, I was able to build higher on that wall of competence, again starting at foundational principles and learning from others as well as from my own interest. The interactions with people in their own settings brought with it the realization that the patients are ultimately in control of their own bodies and their own decisions and it was my job to help them have the tools they needed to maximize their own goals for health. This ability to see the limits of my own interventional care brought a new dimension to nursing and gave me a greater respect for my own limits and the boundaries between medical care and the individual’s choice. In the hospital setting, it was so much murkier as patients submitted (mostly) to what the doctor prescribed and adopted a more passive role of recipient, blending back into the whiteness of their crisp pillowcases with resignation. At home, even the very ill patients were more likely to express themselves, to be comfortable in their own choices and to challenge the edicts handed down by medical staff. Over the years of traveling through t the hills and hollows of mountain villages, the slide show becomes brighter, clearer but also holds the shadows of difficult days replete with defeat: the elderly man in the overalls, living in a hermit's cabin, legs swollen with cellulitis, stasis ulcers draining, who proudly proclaimed, “I ain’t movin’” and pointed to a shotgun to emphasize his statement; the bed-bound woman whose bed sat smack dab in the middle of the living room as family members rotated sleep so they could keep her turned in a timely fashion; the mouse that ran under my legs while I sat perched on the edge of a dirty couch causing me to leap up in a most unprofessional way; the edentulous woman, mouth stuffed with snuff who unexpectedly sneezed—I had to change uniforms!
The attraction to hospice nursing should have been clear from the beginning but didn’t come into stark relief until a beloved sister-in-law lay dying at a hospice house from the ravages of ovarian cancer. I admired the care, consumed the comfort greedily and promised myself that as soon as I could, I would pursue this new passion. Hospice nursing also took me out and about and again placed me squarely in the center of the patient’s own domain. Clearly, in rounding the bend and heading toward home, the patient and their family were firmly planted in the driver’s seat and I sat behind, offering simple suggestions to help make the way less confusing and to shine a small light on the path ahead. I learned a lot about the blessing of using my skills quietly and respectfully, always trying to be aware of who was really in charge and fitting in without imposing my will.
My knowledge and skill set continued to expand as the dying required creative and caring solutions to all the myriad ways the body can break down at the end of life. Defeat was not an option, and working with the team at hospice, we worked hard to circumvent the impossible and to find a way toward our ultimate goal which often included making the passing as easy and as peaceful as possible.
In this new setting I learned the truth of the maxim: “People don’t care how much you know until they know how much you care.” (attributed to T. Roosevelt). My technical knowledge and nursing skills were all tested and tried and sharpened but the “soft” nursing skills grew even more as I learned to communicate better, to “read” the situation in the room, to help patients and family move to a new place in their view of their situation. In this expanded nursing theater where life and death live intertwined and the distance between them grows smaller, I learned to respect the limits of my skills and to understand that sometimes the gift of presence was all I could offer. Coming to the end of myself as a nurse gave birth to a more profound respect for my work and my colleagues. The team approach of hospice helped me to broaden my horizons and see up close and personal how the social workers, aides, chaplains and physicians all worked in a fine concert to play the music the patient wanted to be played, as they directed the symphony from their place on the bed or the couch or the front porch. As nursing butted up against the hard wall of death, I found myself with renewed courage to face the unknown and to help others prepare for that same encounter someday.
The slide show from the years in hospice is bright with the edges tinged dark from the sadness of loss as patients transitioned on from us to their next stop: the elderly couple who held hands and looked with longing into each others’ eyes; the young man surrounded by his boisterous friends who slipped away peacefully right in the middle of their conversation, surprising us all; the humor of knocking on the door of the wrong “yellow house on the left” and announcing that I was the hospice nurse; the occasional families whose motivations and possible drug diversion made our jobs difficult; watching youtube videos in the car to refresh my skills in changing specialized dressings; the long drives following GPS instructions into rutted roads that gave way to dilapidated, thrown-thrown-together houses with a dozen dogs; the sometimes angry family who saw us not as angels of mercy but harbingers of death; the exhaustion of caregivers etched with stark clarity on pale faces that mixed resignation with relief and grief.
Faith Community Nursing was simply a logical next step, blending those carefully practiced assessment, teaching and leadership skills into a position of trust within the staff of my local church. Over the years, things have changed as the moniker Parish Nursing has given way to the more inclusive “Faith Community Nursing” but the work itself has remained unaltered. Being an FCN is a natural morphing for a nurse who sees the intersection of life and death as not an end point but as a transition and as such, a call for us all to do what we can to make the most of every day on this side, living well in the body we have for now. As an FCN, I work to help people maximize health through interpersonal relationships, increased activity, medication management and mobility protection. Assessing, teaching, visiting, planning, coordinating all come together as a lifetime of nursing experience coalesces into work that uses all the collected ingredients to make a work of nursing art, not perfect to be sure, but blended nicely and resulting in a worthwhile final product.
Here, the slideshow glows with the brightness of an updated powerpoint: opening the door of an independent living to see an elderly man with a rapid respiratory rate and probable pneumonia and getting him to the hospital; teaching CPR through fatigue; organizing a group walk/hike; participating in advance care planning by teaching about “5 Wishes;” helping coordinate volunteers to visit the homebound and let me know of any needs; working to organize food delivery to those experiencing times of illness or grief.
The beauty of a career in nursing is the variety that is possible. Every experience, every position, every shift brings new insights and learning. As nurses, we walk through the department store of experiences and fill our buggies with patient encounters that help shape us, with responsibilities that stretch and grow us and eventually with the wisdom to practice our profession well, becoming a credit to our peers. As we all take stock of our practice and celebrate the nursing profession, let us encourage each other along the way: it won’t all be good, but through perseverance, our slideshow of memories can be bright.