Hospital Weekend Day #2

Coming home after the second of two 12-hour shifts is a special kind of weary.  Not only does the body rebel after that much labor—especially, let’s face it, on the weekend—but the mind and heart are just about tapped out too.  It’s good tired, though.  All the emotional fluctuations of the day were copacetically matched with hard physical labor, keeping a sustainable balance between attention and fatigue.   Good vegetarian food from the cafeteria, strong coffee to combat the afternoon slump and a peaceful drive home in the dark all add up to deliver me home in a near-perfect state of fuzzy, peaceful happiness.  A glass of wine, a fuzzy bathrobe and a warm bed?  Heaven.

Tomorrow I have to switch gears and resume my weekday lower-middle-management job.  But for tonight, I share a bond with every nurse in the world who worked a shift today.  For tonight my tender feet and aching back unite me across years and miles with the countless women who have tended the sick since time immemorial.   As my thoughts gradually slow and coalesce towards sleep, the faces of my patients float before my eyes and I hold them in my mind, repeating their names silently as I wish them well and let them go.  It’s a ritual I share with many nurses, one of many ways we try to keep our hearts open and honor those we are privileged to serve.  Tomorrow, next week, next month, there will be other patients who need us.  But for tonight, it’s just these ones that we celebrate and call by name, the querulous, demanding, confusing, complicated, beloved crew that held the reins of our attention from dawn til nightfall.

The best-kept secret of nursing is that we benefit far more than our patients do from the exercise of our profession.  By caring for others, by putting our personalities and intellects and hearts at the service of needs more immediate than our own, we reap the rewards of expanding our selves to include the existence and meaning of others.  We walk our paths with a little deeper understanding, a little more compassion, maybe even a little more tenderness towards the human race.  And we are blessed with the gratitude of those whose pain we are privileged to ease, whose fears we are allowed to comfort.  When our private worlds are complicated by the host of dramas and obstacles that life can throw at us, we have that to hold on to.  We can console ourselves that between waking up and falling asleep we were able to do something truly useful.  Overworked, exhausted, cranky, frustrated though we may be, at least we managed to step up to a challenge worth facing.  And while we can’t work miracles, any nurse can tell you that there are days when the great mysteries swirl around us and we recognize that we are playing a part in the greatest drama of all.

In a few minutes I will be sound asleep, and when I wake up this day will be only a memory.  I’m proud and grateful to have been a bedside nurse today, and I am already looking forward to the next time I work a hospital shift.  These long, weary days replenish my soul even as they make my feet hurt and my ankles swell.  I tip my hat to the nurses and nursing assistants who share them with me, and to the patients who make the entire thing worthwhile.  I am honored to be one of your company.

©Mary Braden 2013

Hospital Saturday

A 12-hour hospital shift makes for a full day, face-to-face with the most stark and immutable truths; yet the satisfactions are enormous.  The war against disease, ignorance and despair involves endless lost battles and missed opportunities.  People make mistakes, lose faith, trust bad judgment and reject sound wisdom.  Bodies fail, minds waver and ebb, and hearts overflow or freeze with fear.  Working in a hospital throws you right into the middle of that war, with all the adrenalin that war entails.

With the enemy confined to bed, it’s not a war that requires much travel; the combat happens in the space between clinician and patient, between comfort and fear, knowledge and questioning, hope and despair.  The weapons are mostly words, backed up with the cavalry of therapeutic procedures, medications and other therapies that we level against the dreadful spectres of illness and death.

Today I was the assigned nurse for 5 patients, each of whom had his or her own story to tell.  As I entered each room I had to pause and sweep my mind clear—because for this patient on this day I am the only nurse in the hospital, the only clinician with the specific charge of shepherding him through the wilderness of his own fears, the only fully-visible warrior in his army.

As I stepped into the room of the courtly elderly gentleman whose kidneys had surprised everyone by suddenly shutting down and leaving him to the mercies of dialysis, I had to detach from the garrulous, orange-haired woman of the same age who, next door, required my assistance to get to the bedside commode every few minutes as her intestinal infection raged against the antibiotics.   My young father who had just found a non-narcotic solution to a decade of intractable back pain by having a spinal stimulator surgically implanted was grinding his teeth in frustration because the device had proved a magnet for infection and had to be removed.  My Vietnam veteran, now nearly-bedridden with COPD from smoking and metastasized prostate cancer, had to give way to the sweet, albeit nonverbal woman who needed to get some dextrose added to her intravenous fluids so that her blood sugar wouldn’t drop dangerously low while she was too weak to swallow.

Driving in to the hospital before a shift is always a breathless time, torn between dread and anticipation as 7:00 a.m. approaches.  Will the unit be understaffed?  Will the patients be alert and oriented? Combative? Terrified? Dying? Will I be able to assume and maintain the right assortment of multiple personalities to suit each patient and their family members? Will I be able to remember which personality goes with each room?  Will the patient I had yesterday be stronger or weaker today? Will the doctors listen to me?  Will I remember everything I need to remember and document everything that I did?  These are the questions that shape our approach to every day that we work, and that engage us until the moment we clock out.

The joy of nursing is that it strips away the barriers between people and leaves us in the most human of situations—the strong helping the weak.  We get to laugh with our patients, and to embrace them.  We defuse the crippling chains of embarrassment and dispel fears with words of encouragement and clarification.  We bring giggles to the lips of the frighteningly ill, and peace to those whose battle is nearing its close.  There is no substitute for it.  It wrings our hearts because that’s what hearts are for.  It taxes our minds and makes our backs and arms ache because we are made to help one another regain our strength and independence when we are brought low.  Nurses are not made accidentally.  One doesn’t end up doing this on a whim or by chance.  We do it because we get to see the battles first-hand, to fight on behalf of those too ill or weak to fight for themselves, and it fills us with life.

As I sit here with my glass of wine and my weary feet, I can’t think of any more rewarding way to spend a day.  Sisters and brothers who were nurses with me today, sleep well. We earned it.

©Mary Braden 2013

Nursing in the Cave (no pictures)

A 12-hour hospital shift can be an infinitely fertile experience for a student of humanity.

Take the alcoholic patient who ends up in the hospital after 2 hours in rehab because her liver is failing. Her shame and fear fill the room like a cold wind, her jaundiced eyes plead for understanding as her shrunken arms and swollen belly announce the years of self-destruction that she has yet fully to acknowledge. Alone with her nurse, she swings between heartbreaking bravado and unnerving stillness. When family members come to visit she lapses into tears, or shouting, or melodramatic embraces. This is a soul in chaos, body and mind at war, paralyzed between exhausted denial and intolerable hope. No one can fix this; it’s an existential struggle in which the outcome depends not on strength or intelligence but on whether the suffering creature in the trap will find the door in time, providing that it ever becomes clear where creature ends and trap begins

Medically the patient is stable; she’ll go back to rehab today. The nurse is only waiting for confirmation that her bed is still available. The phone rings, and the plan changes; the rehab facility can’t accept the patient back into their program until she is re-assessed by their nurse as a viable candidate, and their nurse won’t be available until tomorrow to perform the assessment. The doctor postpones the discharge, and the patient is informed that she’ll have to spend another night in the hospital before beginning her program.

This change of plan is too much for her. She’s already dressed, has called her family to pick her up, can’t bear the thought of another minute where she is. She springs to her feet, weeps, curses the hospital, the rehab staff and the moment of weakness in which she reached out for help. She threatens to leave and go to a bar. Her diatribe ricochets from how the rehab facility has betrayed her to how the hospital is trying to dissuade her from recovery. Her emotional pain is so real and so immediate that her body responds as if it were physical: grimacing, rocking back and forth, punching at the air.

This is where it really helps if the nurse has read Plato and can conjure up the mental picture of men cowering from shadows on the wall of a cave. Or the Bible, where Jesus himself believed that his own Father, the Almighty, had forsaken him. Or Shakespeare, where Lear is driven mad by his own despair and self-loathing. Because this patient, on this day, in this hour, is all of these, the paradigm of a person trapped by who she is, a tragic hero.

It is to that tragic hero that the nurse reaches out her hands. It is to the infinite sorrow that accompanies our capacity for joy, the darkness which swallows some of us up despite every advantage, every natural gift, every opportunity for happiness. And when the nurse reaches out in that spirit, when she is present to and humbled and awed by the magnitude of what stands before her, the patient reaches back and the connection is made.

Then the emotional spiral decelerates and the way to peace re-opens. The nurse can hold a hand, offer a tissue, speak the words of courage and empowerment that we are trained to speak. It doesn’t always work. There are abysses of misery that are too deep for any mind to encompass. But it worked today.