Best, Best Friend....

Best, Best Friend....

One of the joys of the work I do is meeting such wonderful people. They all have a lot to teach me, and learn from me, too. I am supposed to be there to offer nursing care, and I do, but there is always more to it. And sometimes, if I am really lucky, I get to share their sweet, sweet stories:

They were preschoolers when they first met. In a town nearby that is smaller, even, than Podunk.

There is a picture of them, chubby-cheeked little children, sitting in a Radio Flyer wagon. Sepia-toned, their clothing tells of the era of the photo: it was 1928. America was on the verge of economic disaster, but two little children, sitting in a wagon, only knew of the world around them.

He had sandy blond hair; hers was raven black. The innocence of the photograph is magnified by the years that have passed since it was taken. They were best-best friends.

They played together, went to grammar school together and, on Sundays, he walked with her to church. After high school, they both went off to college. When WWII broke out, they both enlisted in the service. He was a pilot in the Army Air Corps. She was a Navy nurse.

After the war, he came home and married a young woman from his home town. She married a man she met in the service during the war and they settled in the Bay Area of California. Several years later, she returned to her hometown, divorced, and with her five children.

He and his wife became close friends of hers again. Her five children and his seven children grew up knowing each other and spending time together. Once a year, they would all go to the Sacramento Delta and camp for a week.

Nearly a dozen years ago, his wife died. She was the first person he phoned. His wife had been her close friend for many years and they were like sisters. She went immediately to help him with the arrangements and comfort him as he grieved.

Two years later, at the age of eighty, they married. With the blessings of their children, and all of them in attendance, they tied the knot, more than 75 years after becoming best-best friends.

You would have to have seen her face, as she told it, to really appreciate the story. Her face was radiant, as she smiled and told me her story. Her eyes danced, looking first at his picture on the table, then back at me, and then at his picture again. I knew, even before she said it, that the years they were married were, as she said, “the best years of my life.”

He is gone now. They only had five years together as man and wife. But looking at her, and looking around her apartment, he is still there. Still making her smile, still filling her heart with joy.

And still her best-best friend.

Capturing the Moment...

I wonder how many people I've met in my life....

Most of them haven't had the impact on me that my parents, children and former husband have. Many of them are nameless faces in my head. Others are names and faces I will never forget, I hope.

I was trying to guesstimate today: how many people do I interact with in a normal work day? And, after careful consideration, I decided that it's probably two dozen people, at a minimum. That's a lot of people to meet, and try to remember.

I have been known to scribble names all over my patients' charts, so I don't forget the family members and caregivers. And I have seen people smile broadly when their name was remembered. That's important to me: remembering the names and faces of the key players in my patients' lives.

Working in home health, I have found that I need those folks, and their help, in caring for the patients. I try to form an alliance, of sorts, with the patient and family. Then we can all work together to reach the patient's goals.

I was thinking about all this after seeing a particular patient this morning and then, of course, hearing a song on the radio. It's that windshield time: it gives me time to ponder the mysteries of life. Or, my life anyway.

So, this morning I discharged a patient from home health services. He is a pleasant man, in his late sixties or early seventies. He has done well, and recovered nicely from the illness that necessitated home health nursing services. It was all very ordinary and rote: ”call your doctor if you have a temperature >100.5, difficulty breathing, chest pain, lightheadedness.......Take your medications as ordered by your doctor, and keep all doctor appointments.... yada yada yada.

I do it every day. It is the ending moment of the last visit. I ask if there are any questions and, if there are, I do my best to answer them. But this was different: he looked at me, and put out his hand, to shake mine. “Don't forget me....” he said, almost plaintively.

And there it was: a moment. Captured in my mind. And a lesson, too. I have always appreciated my patients for their kindnesses, and the lessons they have taught me. And yet, this person wanted to stay in my memories. “Don't forget me.” That's heavy.

Moments in time. Captured forever. Or not. They happen every day. Several times every day, actually. And, in the end, we have a cloth, woven carefully, with threads made of all those moments in time, captured throughout our years on this little blue ball.

They're called Life.....

The Legacy...

Recently, I have been missing my mother. She died too young, at 65, many years ago. I find myself becoming more like her, and I have to wonder what she thinks of me.

I have been thinking about how quickly life passes by. How it seems like just yesterday, maybe, when I was a child, running across this very same lawn, enjoying the stillness of a summer's eve.

We ate our supper on the patio almost every night. And my mother would pick a gardenia and put it in her hair. I can still see her beautiful, brown hair adorned with the white gardenia. Soon, the gardenias will bloom again, and their sweet smell will remind me, once more, of her.

She was in her early thirties when we moved into this house. It was a brand new house, just built, and it was ours. The house looked lost and alone, sitting in the middle of the huge, barren yard. There was a house to the west, and one behind us, and the rest of the block was empty lots. Across the street, there were grape vineyards.

The first order of business, besides moving into the house and painting and arranging things, was to put up a fence. I just vaguely remember going to the grape stake yard, and talking to the owners. It seemed like my parents were there for hours. In the end, they had purchased enough grape stakes to build our fence.

My mother had struck up a conversation with the owner's wife. It seems they both liked the same type of plants. And so, in addition to the requisite grape stakes, we came home with cuttings from the plants in their yard.

I don't remember how many plants, or what varieties. I just remember the twigs. They were long, and had buds on them, but no leaves. My mother put them in a coffee can full of wet sand. Every day, she would water the sand in the coffee can, and the buds turned green.

Four of the twigs survived, and were planted in the yard. There are three in the backyard, and one in the front yard, next to the carport. Currently, the one in the front yard has been overgrown by an opportunistic miniature rose. Soon, when both have finished blooming, I will separate them.

And now, as the lilacs bloom, it is a treat for the senses. The blooms are a beautiful lavender color: three of them are more of a purple lavender, and the fourth one tends toward a blue lavender. Craggy trunks, thick and wooden, support new shoots of growth. And the tips of most of the branches are a profusion of scented, lavender blooms.

In another week, the blooms will be past their prime, and I will come home from work each day and cut off those that have turned brown. For the rest of the summer and into the fall, the pale green leaves will provide shade for the dogs and the flowers blooming beneath them.

So, even though she left me nearly thirty years ago, my mother's legacy lives on, providing a glorious display of lavender blooms each spring. And a promise: she is gone, but she is not. Her lilacs and roses and gardenias are here to remind me how much she loved to work in her garden.

And so do I....

Musings of a Tired Nurse..

Even Pollyanna gets tired. Yesterday was a hard day, in many ways.

It started with the staff meeting. Our Director told us not to worry about the healthcare reform bill that passed. She thinks it will take quite a while for the politics of it to diminish and the real work to begin. I think we are all worried about our jobs.

After the meeting, I met with the student nurse who spent the day with me. Normally, it is fun to have a nursing student spend the day seeing what I do. They usually rekindle my enthusiasm for nursing. Not so yesterday.

Sure, she was interested in what I do, and how I do it. And she was comparing her skills to mine, as they always do. But, I always remind the students that I have a thirty year head start on them. And I do. Thirty-three years, actually.

I asked her where she wants to work after she graduates. I like to compare and contrast home health nursing with their chosen area of interest. I share with them the ways that home health can impact the area of nursing that appeals to them, whether it is OB or ER or the operating room. Or med-surg. I even get on my soapbox about working med-surg for a few years before moving into a specialty area.

Not so yesterday. She answered my question by saying that she would work “wherever I can get a job.”

For the first time since I have been a nurse, the new, graduating nursing students will not have a job already lined up. In fact, they are being told that they might have to work for an insurance company, “doing coding,” whatever that means.

The nursing shortage is not over. Nor will it be any time soon, as the Boomers move into their sunset years. The student told me that her instructors told the class that hospitals may need more nurses but they don't have the money to pay them. And so, they limit the beds they fill, so they will have the nurses to care for the patients they do admit.

I'm not sure that is the case. At least, not everywhere. I do know that, here in Podunk, there have been no raises for the past year. Most of us don't mind not getting a raise, as long as the cost of living doesn't increase. But most of us work because we need to, not just for the pure joy of giving nursing care to the sick and infirm.

As the day finished, the student was chattering away about what she saw and heard. There was the patient whose foley catheter was changed, the wound vac patient, the heart attack patient who needed labs drawn, and the ostomy patient who is doing well and was discharged yesterday. She was amazed by the variety of patients, and the work that home health nurses do.

Most of the students who come through home health during their clinical rotation like what they see. They like seeing patients in their homes. They like the challenges. They like the freedom: no staying put on a nursing unit in the hospital. We are mobile, we are resourceful, inventive, confident, and kind. We morph from home to home, being the kind of nurse that each patient envisions. Not an illusion, but a method of relating to each patient in their most comfortable way.

As I dropped the student off at her car, she thanked me for a nice day. I told her to keep studying, keep learning, and keep hoping for that dream nursing job. It's out there, it has her name on it, and it will be just what she needs to be happy, healthy, and fulfilled.

Just like me....

Musical Chairs...

I finally figured it out. My chair, that is. The chair I sit in, five days a week, at work. True, I'm only in the office for about an hour and a half each day, but still. I would really like to have a chair with hydraulics that work.

I have long legs. I like the chair to be as tall as possible, so I move the lever and pull on the chair seat. Up it goes. And then I sit down. And down it goes. Just once, I'd like to sit at the proper height. Just once, is that asking too much?

I guess I could “trade” chairs with somebody else, when they weren't looking, but none of the chairs are particularly worthy of being stolen, or even used. And absolutely no two of them are alike. Some are similar, but none are alike. They are old, and dirty, and broken.

We have an email system that serves the hospital district. People are always “advertising” office furniture that they want to get rid of, in case someone else can use it. “For Hospital Use Only” of course. You can't take the stuff home and use it in your own home office.

But, you have to be sitting at your desk all day, with a computer in front of you, and your email box open, in order to take advantage of the giveaways. Otherwise, you can only read about them after the fact.

By the time I have a chance to read my district email, I usually have at least 1200 emails in my inbox. Perhaps 1% of those emails have any meaning to me, working out here in the hinterlands. The rest are for folks working in the hospital proper.

I have to wade through hundreds of emails such as “the ________ system is down” followed quickly by “the ________ system is back up” ad nauseum. And the furniture ads, too: “bookcase available for district use” followed within thirty seconds by “the bookcase has been claimed.”

Somebody here in home health must have responded to an email about chairs. The response must have been something like “sure, send us all your old, mismatched, non-working chairs. Our nurses are only here for a few hours a day. If they want to be comfortable, they can go sit in their cars.”

Actually, the ugly old chairs match our cubbyholes perfectly. We have three drawers, no shelves, and a surge protector that is so far under the desk that you have to crawl on the floor to plug in your laptop. It's not inconvenient, really. It's good exercise.

So today, when I put together the chairs I ordered for my home office, I was wondering what to do with my old office chair, at home. It's blue/gray, fairly comfortable, and the hydraulics still work. And it dawned on me: I'll take it to work!

So, I stuck it in the back of my car. It will accompany me to work on Monday. I even labeled it, with my name on the back. And a message from me:

“Please don't take my chair, I brought it from home.”

Finding Balance....

What do you say when someone looks up at you and says: “I don't want to die”? I wish I knew the answer to that question. I could have used it this morning.

I was standing in her bedroom, in the dark. Her sister woke her up and turned on the overhead light. The room is small and cramped. There is no closet, so her clothes hang on a rack at the end of her bed. And the bed was covered with a lovely, silken quilt in purples and greens. It has been washed so many times that it is threadbare.

On the wall, behind me, is her calendar. She always asks me to put my name on the date I am coming back to see her. She says it helps her remember things if people write them down for her.

And she is right: she is dying. Organ transplants have failed and been rejected. The row of medication bottles on the nightstand grows longer and longer. She spends less and less time out of bed. And she cries. A lot.

I didn't have a pat answer for her this morning. I could only hand her a kleenex to wipe away her tears. And stand there. Listening. Available. And she cried softly for a few minutes, then regained her composure and we finished our visit.

Those visits are hard on me. True, I am not the one who is dying, nor am I in pain. But it is painful to stand there and feel so helpless. So bereft of something to say to console her. As she pointed out, all her physicians keep telling her to “hang in there” and she hates hearing that. She doesn't know what that means.

Really, who does?

And tomorrow, I have another difficult patient to deal with. It's a completely different scenario, but it's still hard on my stomach. I seem to know how to deal with difficult patients but, I internalize my own feelings. And in turn, those feelings eat at my stomach.....

So, seeing my other patient today was a real treat. She is delightful, upbeat, and positive. She has a horrid wound on her scalp, in the back. Part of the wound care I did was to shampoo and condition her hair. In 33 years of practice as a registered nurse, this was my first time to shampoo a patient's hair.

As it turns out, she and I go to the same hairdresser. Podunk is a small town, you know. And she is going to tell our hairdresser what a good job I did, too. After washing her hair, and combing it out of the way, I was able to do the wound care. And we finished off her coif with a beanie made out of stockinette, to hold the wound gauze in place.

She was thrilled to have clean hair again....

It seems we also both knew a certain local physician. She worked for him, in his office; and I worked with him, in the operating room. He was known to all as Uncle Harry. No finer physician ever lived: he cared about his patients and he cared about the people who helped him in his medical practice. We both smiled and laughed as we regaled each other with some of his adventures. And we had to admit that we miss him, too.

Bitter and sweet. And bittersweet.

As I sat in the office, finishing my paperwork, I had to answer the phone when it rang. A patient's husband was concerned about her. Things are not getting better for her, with her new medication. He wondered what he should do. And I told him. It was simple, straightforward stuff: signs and symptoms to watch for and report to her physician, and when to take her to the Emergency Room, if things didn't improve.

You would have thought I told him the secrets of the Universe. He was so happy and so grateful just to be able to talk to a nurse on a Sunday. Without getting out of my chair, or saying anything particularly brilliant, I made his day better.

Balance.....

Farmers' Market...

Today, I finally remembered. Well, I remembered in time, that is. It is usually Sunday night, at the end of the weekend, that I think about the Saturday morning Farmers' Market. And by then, it's too late, of course.

Not so today. We were there by 10 this morning, walking along the rows of tables laden with fresh produce.

The Market is bigger than I remembered it. Or more popular. Or better-attended. There were lots and lots of people enjoying the Saturday morning sunshine in Podunk. People walking along with baskets full of delicious, organic vegetables and fruits.

As we walked past one table, someone said “here...” And, as I looked around, a woman was handing me a clementine tangerine to eat. “A little walking food for you.....” It was delicious. I should have bought some from her, but I didn't.

The sound of little girls “doing a yell” attracted me. It was a Girl Scout troop, selling their famous cookies. One of the troop leaders is a friend from work. She walked up and said hello to us. She has a new baby, which she was carrying, and with that look that mother's have, she gave me permission to hold him.

Henry is delightful, with a big smile, two front teeth, and endless energy. After a couple minutes of holding him, I gave him back in exchange for a box of Thin Mints. I will freeze the cookies, then break them into pieces and serve them on top of ice cream. Not organic, not particularly healthy but, definitely yummy.

Another couple from a town in the nearby foothills was selling spices and herbs. They had red potatoes simmering over a Sterno flame, bits of french bread for trying sauces, and little cups for samples of their spicy mustards. I tried everything and it was all delicious, especially the “mojo” spices on the potatoes.

Of course, I bought some, and supper is planned: spice-rubbed chicken and mojo potatoes!

I also stopped to see my friend who makes olive oil. It is marketed under her family name and it is quite delicious. She remembered me and was glad to sell us a large bottle. I will use it with one of the spices I bought for a dipping sauce for bread sticks.

Just about the last stop was to buy tomato plants. We picked out the two very best plants, painstakingly selected from a couple dozen pots' worth, and brought them home to set in terra cotta pots on the patio. Perhaps they will be the best tomatoes we ever ate. Or perhaps they will just taste that way because we bought the plants and grew them ourselves.

In any case, I'm hungry now.....

A Joy Forever...

A thing of beauty is a joy forever.........” John Keats

It's hard to believe that it happened nineteen years ago today. I remember it as if it happened a month or two ago. I guess that's the nature of a mother's memories, isn't it?

I was in orientation in the Operating Room, scrubbed in and assisting an orthopedic surgeon with a back surgery. That's how orientation goes in the OR: first, you learn to scrub in and hand instruments, then you learn to be the circulating nurse.

We were in Room 5. No, I don't remember that specifically, just that that surgeon did all his surgeries in Room 5. It was the orthopedic room, with all the orthopedic equipment in it. I was learning the specialty instruments used for a back surgery referred to as a laminectomy. It was intense.

The door to the operating room opened and the unit secretary whispered a message to the circulating nurse: my son was on the phone and his wife was having their baby. Upstairs, two floors above the operating room where I was learning about instruments.

Of course, the surgeon wanted to know if this was my first grandchild, and it was. No, I didn't know if it was going to be a boy or a girl because the young parents wanted it that way: they wanted to be surprised.

Not long afterwards, the operating room door opened again. This time, it was the OR Supervisor, and she was not smiling. There, in front of everyone in the room, she told me: “your shift is over at 3:30 this afternoon. I expect you to remain in the OR and do your job until your shift is over. If you leave the department before then, you will be disciplined.”

After she left, you could have heard a pin drop in that room. Well, except for the ventilator on the anesthesia machine, rhythmically breathing for the patient. No other sound pierced the silence. I was numb. I wanted to be happy but I was afraid I was going to cry.

The surgeon broke the silence: “gizzy, please.” Yes, a gizzy is a surgical instrument. It took me a while to accept that they were serious and not just teasing me. I handed it to him and he proceeded with the operation.

Before we were finished, the phone in the room rang. It was the unit secretary again, transferring my son's call: “Mom, we need you!” and I didn't know what to say. My younger son was on the speaker phone, pleading with me to come upstairs for the birth of his first child. I couldn't help it: a tear rolled down my cheek. Fortunately, I was wearing a mask and no one could see it.

After another awkward silence, the surgeon spoke: “You go be a grandma and we will finish this up without you.....I think I know how to do the rest.......oh, and I'll cover for you if the Supervisor comes back.”

I didn't need any more encouragement to fly out of the room, discard my gown, mask and gloves, and race upstairs to OB. My son was very glad to see me, as was my daughter-in-law. I have told the story of Dylan's birth in another birthday blog, so, suffice it to say that I was allowed the honor of delivering my grandson.

And today, as I look back on the events of that day, two special physicians make me cry tears of gratitude. The orthopedic surgeon who, true to his word, told the Supervisor that I was running an errand for him, and the OB/GYN who allowed me to participate in my grandson's birth.

Both men were really quite special to me. The orthopedic surgeon probably never told another lie in his entire life. He was a man of honor, a fine surgeon, and a good friend to all. He was willing to tell a lie so I could be where I needed to be.

The OB/GYN was special in many ways: he took my daughter-in-law as a patient even though he was not accepting new Medicaid patients. He treated her with kindness. And, on his own birthday, he delivered my beautiful little grandson.

Both physicians are gone now. One died of cancer and the other died tragically in an airplane crash, with his wife and four of their children. Even though they are both gone, I still owe them both a debt of gratitude for their caring nature and willingness to help when I needed it.

As I think about my sweet Dylan today, I also have to think about those men who made the day so special for me....

Happy Birthday, Dylan Endymion!