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Sometimes the Truth is Hard to Swallow

Despair

B. Betty, RN

Even with a support system, the darkness of despair is solitary. You may hear your voice being called, but it’s from behind locked doors without doorknobs  in rooms that lets in no light. Support, when you’re in a fetal position, is only support when you aren’t mandated to get up to receive it.

I have a friend currently intubated in the ICU for a suicide attempt.  She is a healer, stricken by the endless despair that we all bear witness to daily. She was either found just in time, or a few hours too soon,-the viewpoint dependent on how often one has fumbled for knob-less doors in frantic efforts to shut out the nameless voices who call out their own needs. “Don’t leave me. I need you. We can’t go on without you. Come back! Come back!” The words are prayed in a frantic eulogy, a chant of faith and superstition by people who have no realization these are the same needs that have deadbolted the door to the dark room, to begin with.

She and I have had long discussions of how the system breaks the healers. How we have become empty from our giving. We have cried in the telling of our stories-spoken in tear filled whispers, long jagged silences that crucify us as we grip each other’s hands.  We drip our anguish onto our fingers, mingled tears of grief in a kind of blood sister bond of understanding. Our tears have kept vigil for each others broken spirits. Our tears have salted our dreams. Our tears have been the nourishment of our friendship.

Another friend, also a healer, once said, “The strong are the ones who fall the hardest. The weak simply complain.” The institutional rhetorical response to the few who dare ask for help to keep going is always, “stop complaining-everyone else can do it.” and “Suck it up, buttercup, you signed up for this.” This kind of on going  shaming can only be ended by deciding to finally walk away. In some cases, permanently. Those who have been chased by that darkness don’t judge it. They know it is always on the horizon.

I suffered from excrutiating altitude sickness that included vomiting, vertigo, headache, numbness, tingling, dry cough and hallucinations when I hiked Mount Whitney in the Sierra Nevadas of California for my 40th birthday. At 14,505 ft elevation, it is the highest peak of the lower 48 states.

It was hard. There was a snow pack unusual for that time of year.  I was slow. I fell many times. I should have turned around, but I didn’t. It was a stupid, dangerous decision that could have ended up as a medical emergency of cerebral or pulmonary edema which, at its worst, causes death. I had summit fever which is much like being in the throes of despair. No amount of logic or any kind of reasonable voice can talk you out of either. I was going to do it even if it killed me.

Sometimes looking death in the face is seductive. Sometimes you must see her face to not be afraid of her call. Sometimes she’s the only voice that can be heard. She knows us each by name.

Eight of us began training a year before our ascent. Three dropped out before we could even apply for permits. Two of us in our party made it to the top. Three in our party turned back. The three that turned back said “we will conquer this damn mountain next time.” They haven’t won permit rights again. They’ve stopped trying.

Mountains, like despair, cannot be conquered. They are instead given reverence, as both will indiscriminately take you down without caring how strong or weak you think you or those around you are. You can only summit mountains and despair with fortitude and grace. You will remember standing with your face in the wind, breathless with weariness, fearful that your pride in that moment will jinx your descent back down to where you started. You will tremble, buckling at times to your knees with a deep appreciation of making it. You will remember those who helped you along the way and understand that they may not reach the top.

My tears fall heavily. They are solitary tears, falling this time  onto my own flaccid, open palmed hands. I watch them slowly make their way down my fingers, to fall away and be absorbed by the smooth cotton case on my pillow.

I’ve taken to bed as the horizon’s darkness is spreading. The room’s light is changing in the growing shadows. I can still see the doorway in the lingering light. I’m trying to keep it open for my friend. I’m trying to memorize its shape and place in the room. I am hoping of all the voices I may soon hear calling, one of them will be hers.

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Trauma

B. Betty, RN

I haven’t worked in Trauma for over five years. I’ve been out of acute-care nursing for 15 months. Today, while sitting at a cafe that is wrapped on three sides with glass windows and situated on a busy intersection, I saw a man stick his arm out of a car window.  The hair on his arm glinted copper in the afternoon sun. I couldn’t see his face in the glare between the window and the late July sunlight shimmering between us. He point that arm and held it horizontally in my direction.

I flinched. I told my kids calmly but firmly to move their chairs away from the window immediately. When asked why, while noisily scraping wooden chair legs against well polished linoleum, (they know “that voice,”) I said, “there’s a man with a gun at the stop light. It’s pointed at the restaurant.”

They turned to look as I scanned the room for a quick, safe exit, or where we could shelter in place. My 16 year old said, “Mom, there’s no gun. He’s holding a cigarette.” They laughed and did that “mom is crazy” eye roll all teens do when they think adults are being stupid or over protective.

I distinctly know I saw a flash of metal. I got the same adrenaline rush I used to get when my patients were active gang members or on watch by border patrol, sheriff, or federal agents. I felt that same wariness and heightened awareness that comes with the threat of immediate danger. My ears were ringing which is my sign of impending chaos. In that glint of metal and sunlight coupled with an aggressive movement from an idling car, I instantly saw my gunshot patients. I smelled fresh blood and death.

I saw the faces of gang bangers and drug addicts. Prostitutes and border hoppers. Young boys and old men, shot by uniformed officers  in pickups as they attempt to jump or tunnel the border fence. Sullen wanna be’s and hardened gang members alike caught in the cross fire of affiliations or initiations that are rites of passage to the dark and gritty streets.

Drug deals gone bad, robbery, retaliation, love triangles-they’ve all played out and ended with boys and men assigned to me in the sorrow lined hallways of the inner city hospital where I worked.

I saw boys my own children’s ages crying for their mothers as I pulled rolls of blood covered gauze from their abdomens before methodically pushing medicated clean gauze back in. I heard nurses and doctors yelling in the chaotic dance of CODE BLUE with desperate attempts at sustainable CPR. I heard machines warning of flat lines that indicate the cessation of life. I heard the wails of family members as i unhooked lifeless bodies from the machines that failed to save them. I felt the helplessness of my inability to do anything to change it.

I was wrong. It was a cigarette. It’s been four hours since I thought we were going to die. My kids are at home watching crime shows on TV. My husband is washing the car. I can still smell their wounds.

For All of Us

For all of us.

Human rights violations happen daily to nurses and front line staff. “Suck it up, buttercup- you signed up for it.” That’s the general consensus.

We signed up to give. We didn’t sign up to be sucked dry and abused by the same system that is supposed to help the community. Am I not also part of the community I give to daily? Apparently not when I’m in scrubs.

If I kicked a coworker or spit on them or threw poop, pee, blood, or vomit, called them bitches and whores, backed them into a corner, threatened and said “give me what I want or I’ll slam your effing face into the wall!!” I’m pretty sure I’d get fired and possibly arrested for assault or intimidation. SO WHY IS THIS ALLOWED ON A DAILY BASIS IN ERS AND HOSPITAL FLOORS IN EVERY FREAKING HOSPITAL IN THIS COUNTRY?! The last guy who threaten to punch me in the face? I took my glasses off and said “do it. I need a workers comp vacation.” I meant it, too. How the fuck do I get out of this hell hole without losing a body part or my sanity?

That was the beginning of the break of willfully standing in harms way and thinking its NORMAL or ACCEPTABLE to be abused. You can only be bent so far until you are broken. There is an alternative option to being a victim or volunteer. It’s not suicide-although that can look pretty damn viable when it’s easier to wash off the c-diff than the hopelessness

Walk.away. If all we know is abuse, then anything else is easy. I guarantee you, you will never regret not fearing for your sanity, your safety, or your soul, again. I don’t know how long it will take me to stop cringing when I hear my name called by management. I still assess a room the minute I enter it to scan for danger zones and safe escapes. I am working on my eye contact w other humans on my days off. I have fewer heart racing 3 am wake ups in a sweaty oh shit I forgot to do 3 of those 394759667 million tasks i was told to do or fear for my job panic. I don’t cry every day from exhaustion or dread of another shift exercising my complete futility in a system that makes caregivers simply givers…or the sheer scariness of feeling nothing at all.

We save the world-who saves us? No one. That’s the most soul wrenching painful realization. Who will give everything to save ME, like I do to save others? Who will lose sleep if I don’t make it? No one. They’ll only notice if I miss my shift.

Except my kids. My husband. My widowed mother. My sisters. But no one I have handed my blood sweat and tears, my best youthful years, my back, my spirit, my naivety, my life spark, my love of humanity, my need to make a difference-not one of those mother fuckers will stop and assess my pain and make a plan of care to save me. Not.fucking.one.

Am I really contemplating increasing my life insurance so my husband can have a better nest egg before I off myself w a bottle full of prescription meds that I have received as consolation prizes for leaving the best parts of me in the wrong places? I want to die because I’ve given too much of me away!?

I can’t unsee or unfeel or unknow all I have witnessed in this profession. I can not have back the pieces of my heart I have willingly given to my patients. (Nor do I want them back-those were freely given, not taken.) What I can do is refuse abuse of my battered heart. My aching feet. My weary head. My sorry soul.

Part of nursing is saying no. No you can’t eat cake with a blood sugar of 500. No you cannot have sex in your bed with your boyfriend in a semi private room in the hospital. No you can’t lay in bed for days after surgery. No you can’t get up to go to the bathroom after you’ve had a heart catheterization and are at risk for popping in artery and bleeding out.

Sometimes saying no is saying yes. Yes you deserve better. yes you are worthy. Yes you can live. Just as surgeons pull out tumors and dying tissue, so must we stop allowing the cancerous culture of a predatory system from metastasizing. No you don’t have to take it. No you aren’t weak for saying you are hurt.
No. It is not okay.

We are so good at being patient advocates. Why is it so hard for us to advocate for ourselves? We are in doctrinated to believe that giving is selfless and taking is selfish, saying yes to ourself is selfish. It’s hard to say “I’ve had enough.” It’s easier to say it when it means taking a stand for others. So stand for the nurse on the other side of the bed helping you. Take a stand for the nurse in front of you at the Pyxis machine. Take a stand for that mother friend and all-around good person that resides within you. You are worthy. You are an excellent nurse. You deserve better. Bend but don’t be broken. Be the nurse you need. For you. For your family. For that patient in the bed who isn’t trying to bash your head in. (Security can deal w that other mofo.)
There is more to this nursing then just taking orders and chart checks and calculation titrations and IV drip double checks and charting in triplicate. You’re not a robot. You’re not supposed to be a robot. Bend but don’t be broken.

Do not let them tell you this is all there is. Thieves, addicts and patients lie. So do hospital administrators. Say no so you can say yes. You matter. You are not replaceable. You are needed and loved. You deserve to be the nurse you set out to be.

Care vs Cure

 

B. Betty, RN

A past patient of mine and I had altering ideas about his ideal state of health. He was an older gentleman in his 60’s but appeared much older because of his smoking, drinking and decades of self-neglect.  He was a wheel chair bound frequent flier back in the hospital for a second toe amputation with possible foot involvement  secondary to his uncontrolled type II diabetes, vascular disease and 100 pack year x 40 years smoking history. He was angry. He was angry that he was on a sugar-free and low carbohydrate diabetic diet, angry that he was getting another amputation because “the damn doctors screwed up my foot.” Angry that he was no longer allowed to go outside to smoke because of the hospital’s no smoking policy. Angry that he was ordered dressing changes three times a day to his legs and foot  that caused him discomfort. He was chronically short of breath and oxygen dependent. His blood sugars were baseline high 200’s, and he was completely non-compliant. He was abusive to staff-a total PITA (pain in the ass). For some reason, he was my favorite patient. He was a challenge. His chronic crabbiness reminded me of my dad.

He was a personal lesson for me about being in the moment, being non-judgmental, allowing others their own story. He was a reminder about  how to be present without being controlling and  honoring other people’s truths. He pushed my buttons. He yelled and was mean just to watch the nurses jump and get flustered. I smiled and gave it right back to him. He respected me (sort of) for not kowtowing to his roar. I discussed the WHYs of no smoking, food choices, diabetes, amputation, smoking  effects on vascularity and  all their roles in both the diabetic ulcers and the need for amputation.

He knew all this in an intellectual way but his heart wasn’t in it. I gently (in my blunt way) told him that if he continued down this road, he was going to die from complications from his bad habits. He stopped being snarly for a few moments and teared up. He cleared his throat and said, “Yea, so? I have nothing left to live for since my wife died. My kids hate me. They blame me for her dying. She’s didn’t want to keeping going to the doctor so I didn’t make her. The kids won’t talk to me, so who the F*ck cares?”

That was it. That was the defining moment for both of us. He was busy fighting us so as not to have to feel his own grief. We were too busy trying to get him to comply and labelling him a difficult patient that we all forgot why he was there, or humanity behind the disease.

Healthcare is completely ‘goal’ and “outcome” based.  Because reimbursements are dictated by the Joint Commission’s set of standards and goals, we have lost sight of the complicated humans in our beds. Humans cannot be algorithm-ed into compliance. There is not a holy grail of health, no matter how nicely we try to tie it up in bows or threaten monetary punishment to institutions. We have made institutional goal attainment the ONLY outcome allowed.

Not every patient wants to be wholly well. Not every patient is whole enough to achieve such an outcome, to begin with. One’s health journey is just as spiritual as it is physical. Our spiritual pain can cause our bodily disorders, more likely thus than the other way around. Until we adjust our own sights  we will not get our patients to see the facts or truths of healing “our way.” We must be in tune, unrushed. We need to  truly understand perception, social conditions, environment.  We must SEE our patients in all their glorious, messy, complicated, unscientific impracticality if we are to be any help to them at all.

Sometimes we will simply be the face of kindness that becomes the seed for wellness. Sometimes we will be the hand that guides them forward. Sometimes we will be one more person to whom they lash out. Never the less, our goals for their health cannot be pushed or forced, no matter how much our institutions will try to do so. We can assess, we can recommend, we can evaluate. We will never be able to strong arm humanity to do our will, whether it’s ‘best’ for them or not. Sometimes, the most therapeutic option is to listen and validate. We touch lives by touching souls.

 

A Normal Nurse

By B. Betty, RN

Many of us leave acute care hospitals in part because the treatments we are required to administer often prolong suffering, and the suffering  becomes too much to bear.  We do what we can to  prolong life-sometimes simply because a misguided loved one can’t let go or come to terms with their own mortality.

Daily we see and witness grief and pain. When the body fails, there are those left behind who fall apart; raw humanity left to be gathered and gently pieced back together by a nurse’s competent hands.

I no longer go home with an adrenaline rush from straddling unconscious patients on moving gurneys, pound chests with rhythmic abandon in synchronized thumps while another nurse runs next to me desperately squeezing the oxygen bag that is attached to the breathing tube the doctor just shoved down a dying man’s throat. We hope this death is one that will not linger. We all know this rarely ends well.  We know futility when we see it. And yet, we proceed.

These moments are followed by calls to weeping families, disease process assessment and clincial discussions with doctors, mind numbing charting in triplicate, and always an incident report for “internal tracking purposes.” There will not be any time for reflection or debriefing, just quiet and brisk efficiency.

So many of us are soul weary from being around humanity at its most vulnerable  We can’t unsee or undo the years of tending to the core of life. All those souls that have passed through our care leave their mark on our psyche.

We are all witness to bad deaths, bad lives, bad choices, bad resuscitations that just prolong suffering and the inevitable. We can’t continue and we can’t stop either. We  know too much. It affects our view of life and living, of dignity, of dying. It is a constant war.

I know now, why soldiers come home from warzones and land-mine strewn wastelands full of suffering and death, and why they request to go back. There is no “normal” that will be comfortable, again. Being affected by extreme life events most people never see make it impossible to be around “normal” for very long.

Casual conversation is tedious and trite.  Everyday troubles are no longer relatable. The ability to make small talk or smile is strained  and mind numbing at best.  My mind wanders to my patients. The dead ones I tried to save. The ones still alive being held in limbo by machines. Being around “normal” makes me feel like a freak. It makes me anxious and negative. Pessimistic and jaded. I’m overly jumpy, constantly scanning for danger. I’m short tempered and easily annoyed. This mundane routine is too hard to take.

Death and dying are sacred moments that should not be witnessed by strangers. We are privy to them because we are  “Nurse.” Darkness and tears are our normal. Intimate moments of bodily function, fear, illness and the unknown we maneuver with ease. It is both a blessing and a curse to bear witness to other people’s pain. We do it well. It is all we know.

We see suffering every day. The smell of human blood and feces comes home with us more days than not. We break ribs doing CPR, cause bruising by jamming needles into veins and arteries so we can administer serums with their promises of life and hope. We prep bodies for the morgue, go to lunch with the smell of  plastic body bags still clinging to our nostrils. This is our normal.

Once a nurse, we can never go back. No matter if we want to, or not.

For All of Us

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Betty B. RN

Human rights violations happen daily, probably hourly, to front line staff and nurses.  “Suck it up, buttercup- you signed up for it.” That’s the general consensus.

We signed up to give. We didn’t sign up to be sucked dry and abused by the same system that is supposed to help the community. Am I not also part of the community I give to daily? Apparently not when I’m in scrubs.

If I kicked a coworker or patient- spit on them or threw poop, pee, blood, or vomit, called them bitches and whores, backed them into a corner, threatened and said “give me what I want or I’ll slam your effing face into the wall!!” I would be fired and possibly arrested for assault or intimidation. SO WHY IS THIS ALLOWED ON A DAILY BASIS IN EMERGENCY ROOMS AND HOSPITAL FLOORS IN EVERY FREAKING HOSPITAL IN THIS COUNTRY?!

The last guy who threaten to punch me in the face? I took my glasses off and said, “Do it. I need a workers comp vacation.” I meant it, too. How the fuck do I get out of this hell hole without losing a body part or my sanity?

That was the beginning of the break of willfully standing in harms way and thinking it is NORMAL or ACCEPTABLE to be abused. You can only be bent so far until you are broken. There is an alternative option to being a victim or volunteer. It’s not suicide, although that can look pretty damn viable when it’s easier to wash off the c-diff than the hopelessness

Walk away. If all we know is abuse, then anything else is easy. I guarantee you, you will never regret not fearing for your sanity, your safety, or your soul, again.

I don’t know how long it will take for me to stop cringing when I hear my name called by management. I still assess a room the minute I enter it to scan for danger zones and safe escapes. I am working on my eye contact with other humans on my days off. I have fewer heart racing 3 am wake ups in a sweaty oh-shit-I-forgot-to-do 3-of-those-394759667-million-tasks-I-was-told-to-do-or-fear-for-my-job panic. I don’t cry every day from exhaustion or dread of another shift exercising my complete futility in a system that makes caregivers simply givers, or even worse, the sheer scariness of feeling nothing at all.

We save the world-who saves us? No one. That’s the most soul wrenching painful realization. Who will give everything to save ME, like I do to save others? Who will lose sleep if I don’t make it? No one. They’ll only notice if I miss my shift.

Except my kids. My husband. My widowed mother. My sisters. But no one I have handed my blood, sweat and tears, my best youthful years, my back, my spirit, my naivety, my life spark, my love of humanity, my need to make a difference-not one of those mother fuckers will stop and assess my pain and make a plan of care to save me. Not.fucking.one.

Am I really contemplating increasing my life insurance so my husband can have a better nest egg before I off myself w a bottle full of prescription meds that I have received as consolation prizes for leaving the best parts of me in the wrong places? I want to die because I’ve given too much of me away.

I can’t unsee or unfeel or unknow all I have witnessed in this profession. I can not have back the pieces of my heart I have willingly given to my patients.  What I can do is refuse further abuse of my battered heart. My aching feet. My weary head. My sorry soul.

Part of nursing is saying no. No you can’t eat cake with a blood sugar of 500. No you cannot have sex in your bed with your boyfriend in a semi private room in the hospital. No you can’t lay in bed for days after surgery. No you can’t get up to go to the bathroom after you’ve had a heart catheterization and are at risk for popping in artery and bleeding out.

Sometimes saying no is saying yes. Yes you deserve better. Yes you are worthy. Yes you can live. Just as surgeons pull out tumors and dying tissue, so must we stop allowing the cancerous culture of a predatory system from metastasizing. No you don’t have to take it. No you aren’t weak for saying you are hurt, weary, and in need of your own good care.
No. This cancer taking over our professional and spiritual life is not okay.

We are so good at being patient advocates. Why is it so hard for us to advocate for ourselves? We are indoctrinated to believe that giving is selfless. Taking is selfish. Saying yes to ourselves is selfish. It’s hard to say “I’ve had enough.” Why? Why is it easier to say it when it means taking a stand for others? We are we so uncomfortable to do for ourselves what we would advocate for our patients!

So stand for the nurse on the other side of the bed doing compressions with you. Take a stand for the nurse in front of you at the Pyxis machine taking out her hourly morphine dose for the drug seeking patient who is verbally abusing her. Take a stand for that crabby burned out nurse who will never look you in the eye, but is a well full of information, if you just get past her self protective snark. Take a stand for that mother-friend and all-around good person that resides within you.

You are worthy. You are an excellent nurse. You deserve better. Bend but don’t be broken. Be the nurse you need. For you. For your family. For that patient in the bed who isn’t trying to bash your head in. (Security can deal with that mofo.)

There is more to this nursing gig than just taking orders. More than chart checks, calculations, titrations and IV drip double checks and charting in triplicate. There’s more than meetings on your day off about productivity and why you suck because patient satisfaction scores aren’t in the range the CEO you have never seen thinks they should be. There’s more than being shamed for not getting your 19284 administrative tasks done-those same tasks once delegated to ancillary staff so you could do patient care. Now, thanks to “budget cuts,” your patients lives and their properly filed chart are of equal importance. You’re not a robot. You’re not supposed to be a robot.

Do not let them tell you this is all there is. Thieves, addicts and patients lie. So do hospital administrators. Say no so you can say yes. You matter. You are not replaceable. You are needed and loved. You deserve to be the nurse you set out to be.

What Nurses Know

Once you’re a nurse, you walk the halls and sidewalks of life in that foggy place between tragedy and peace. Miracles and failure. You are stuck between the living and the dead.

The dying are glad you’re there. Your efficient normalcy is comforting and safe. The living keep you at arms length, however. Maybe you do the same. The living talk too much and are full of pride and ego. There’s no time or place for either in our work.

You look at us with incredulous suspicion. We look at you warily, as well. We notice your habits or physical signs of ill health like others notice designer shoes and purses. We know what to do when you’re dead. We will comfort your family. We will wash your nude body before zipping you up in cheap plastic. Death is the great equalizer. You may get a fancy casket, but everyone first gets that  same cheap plastic bag.

In response to your question of “what do you do for a living?” I respond “I tend to to the dead and dying.” The small talk sputters to a halt. You laugh nervously. Now you know why I don’t care about the famous people you know, or how much money you make. Your kids scholarship to MIT and your latest trips don’t affect me. I don’t care about purses or tv shows or the latest trends.

Your jewelry isn’t going with you. Nothing you say to try impress me, will make me think better of you.  I’m a nurse. I know what you look like dead.

Signs of a Toxic Work Environment —

You flinch when someone says your name. You only see management when something goes wrong. It’s all about blame versus problem-solving. You have diarrhea before your shift. You have diarrhea  after your shift. You fantasize about ways you can get hurt and file a Worker’s Comp claim so you don’t have to go […]

via Signs of a Toxic Work Environment —

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