Processing via Prayer

The past two weeks I have attended two sessions on  how to process and debrief difficult events. One of my processing strategies comes through prayer and learning how to let go of what I cannot control.

There are always those patients you remember and the ones you carry on your heart. For some, these are patients who passed in your care, for others, maybe the patient had a memorable story.  Then there are those who for no apparent reason just touch a special place in your heart. Recently for me my heart has been touched by several youth I have encountered. 

When I started in emergency nursing pediatrics terrified me, so I decided to join the peds team to overcome this fear. After several difficult cases and learning how to work with kids, that fear melted into joy and a better understanding of pediatric care.

There is something special about a child. Their openness to life, resilience, and their ability to see and tell the truth. Their personality shines through their words without fear of judgement for what they say because they only know how to be their genuine selves.

As a nurse I have a place to advocate for all patients, but especially those in the pediatric population who cannot advocate for themselves. Our education to the parents impacts the child and how they are cared for beyond the hospital doors. When treating sick adults with chronic diseases we often wonder:

Where was the fall out? Why didn't this person take care of themselves?  

Maybe from a young age they weren't taught how. It's not usually the kid's fault. Now this isn't to automatically blame the parents,  (I am not a parent and have no place to judge), but it is a realization that has helped me to recognize the importance of educating parents in addition to the kids we see every day. That much is in my control, while many times the situation back home is not. Those are the cases that pull on my heart...

It's the pre-teen boy who has the maturity level of an adult because he is the father role in the house and protects his siblings. He doesn't realize that the things he knows and the responsibility he holds on a daily basis is nothing he should have to do at his age. The genuine care and concern he holds for his siblings and his willingness to talk to the police and CPS reveals the heart of gold this boy holds. I go home and pray for him from time to time knowing he knows no other life but one of responsibilities. He does not get to be a kid, and I pray that one day he is able to have someone love and care for him like he cares for others.

Then there is the beautiful, intelligent young teen who had the courage to call for help after finding mom down and unresponsive. She hovers at the bedside with concern and care, and I wonder if she has  any knowledge that her mother tested positive for amphetamines. This strong, young girl has incredible potential and is mature for her age.  She watches over her younger sibling and carries herself with a humble confidence. My heart breaks for her and I pray that she finds a mentor who can be an example of a strong, driven, and inspiring woman to keep her from losing the potential she has to the same path she watches her mother walk each day. 

Then there was the young man so wrought with mental illness, anger, and sadness that he banged his head against the wall while crying out, "Just let me die, I'd be better off". It breaks my heart that his support system over time vanished and he has lost direction and purpose. My heart hurts for him because he is no longer in control.

There is so much brokenness in our world and as healthcare providers we see our fair share of the hard stuff, abuse, neglect, and brokenness in the streets just beyond the hospital doors. If I held on to every case I would lose my mind. I focus on how I can advocate and serve those patients in the time I have. I educate parents, I call CPS, and I offer compassion and kindness. At the end of the day I say a prayer and offer up those cases, because they are no longer in my hands. Some stick in my head, and when I acknowledge them I pray for each of these people and place them in Gods hands, praying they encounter special circumstances to overcome the odds life handed to them. 

I pray they find a way to move past survival and learn to thrive.

Privileged

I am privileged in many ways. I have a roof over my head,  a wonderful husband, a career I love, amazing family and friends...I really couldn't ask for more. These are things I try hard not to take for granted as it is so easy to do so. Last week I had the honor of reconnecting with a person I helped resuscitate at the gym in 2015 (see Dec. 2015 blog "How Faith Saved a Life").  We were asked to speak together at an educational event focused on cardiac arrest. The outline for my talk asked to share my story and to also address the following:

1. Why did you become a nurse?

2. How does nursing define you?

3. How does this story relate to your passion about nursing?

I gained a lot by taking a step back to ask myself these questions. Too often I fall in to the motions of life and forget that what I do for a living is something I love. I love people. Why did I become a nurse? ...that is another story for a future week...but, in short,  I was looking for a profession of service. I wanted my work to be meaningful to someone else. I wanted to leave my job every day knowing I made a difference in someone's life. My education path turned into nursing which has since revealed itself to me as a profession of caring in addition to teaching.

2. How does nursing define you? I don't think nursing defines me, rather who I am defines my practice. How I choose to interact with people impacts their experience. I strive to see the good in each person and treat them as if they were my family because I have a responsibility to provide the best care. I want to make a difference, I want to make someone comfortable and feel better, and I want to be a light on those dark days. Quite often there is a lot of darkness when someone is in the ER. It is not the place people plan to be when they wake up in the morning.

3. How does this story relate to your passion about nursing? My passion is for people. As I wrote my talk I realized that what I have is a gift. The knowledge, skills, and brain power necessary to practice as a nurse are gifts. But even more than being a gift, it is an absolute privilege. It is a privilege to have someone put their trust and confidence in me to care for their loved one. It is a privilege to have the skills to resuscitate or stabilize a patient. It is a privilege to be the hands and feet of Christ in my daily work. Yes, I am trained to resuscitate people and help bring them back to life. It's what I get to do on a daily basis, but it's not something that everyone is capable of doing or has the training to do. To not use my skills and to not practice to my full potential would be a rejection of the gifts I have. I have to remember that I don't "have" to go to work, but I am fortunate and have the privilege of serving my community.

Try viewing what you do as a calling and see how it changes your perspective.

I am privileged and honored to be in the profession I am. Thank you for letting me care for you.

How am I Supposed to Feel?

Our Father, who art in heaven, hallowed by Thy name. Thy kingdom come, Thy will be done, on earth as it is in heaven. Give us this day our daily bread...

This was the prayer my coworker whispered into my ear as she embraced me in my tears. I thought I had it together. I thought it didn't bother me. I thought I could just swallow it and move on. As I exited the room after time of death was called, all I could hear was the loud sobs of the family members present. I thought that patient wasn't supposed to die...the tears began to fall and I was overcome by the emotion I thought for sure I wasn't burying deep inside. 

I felt emotionally numb. There was nothing more than could have been done, yet I wanted nothing more than to see that patient breathe or cry out. The team was excellent, the interventions on point, and yet we still couldn't change the outcome. We still couldn't mend the grief of the family. What more can you do than be present, and ask if they need anything, or say, I'm so sorry...? 

After some chocolate, a long run and bike ride, venting to my best friend, and some writing, I developed some perspective on the event. I know some days will hurt and I know my job is emotionally, physically, and spiritually challenging. I know there are days when I'll feel like I want to cry and days I can't save people. There will be days I fail, and days I exceed expectations. Every day is different. I wake up and come to work every day because I have the privilege to be the hands and feet of Christ and touch people in a way many cannot. I have the ability to help save someone's life. I have the ability to educate those in the community about how to care for themselves. I have the ability to intervene, assess, and make a difference. 

In the ER we fight over the big cases, we live for the traumas and the high acuity patients, and we rejoice when we help them pull through and stabilize to continue their care as an inpatient...and then we are struck hard by the ones that don't make it. Those cases we try not to think about because they hit home and rock us to the core. Those cases humble us, are difficult to process, and leave us asking how am I supposed to feel? I have come to the conclusion that no matter what I do feel, it is important to feel it. Am I allowed to smile and move on? It is disrespectful to not mourn the loss I just witnessed? 

The charge nurse commended the teamwork and commented on how lucky the family was to have me as their nurse. I shook my head thinking, I don't know how to help them. I feel like I didn't do much for them. She smiled back reassuringly and said but they know that you did your very best and their family member had the absolute best care.

I honor that patient by feeling whatever feelings are aroused within me. I honor that patient by leaving everything I have in that room and knowing I gave my whole heart and soul. I honor that patient by saying a prayer for them and their family and processing the event the night after it happened. I honor that patient by putting my scrubs back on the next day, showing up with a smile, and once again giving 100% to every patient that walks through my ER doors. 

To my patient, 

I pray for you and I pray for those you left behind. I pray for all involved in your care and I pray your presence lives on in my heart as a reminder to always give my best. In your honor I will hold my head high, smile, and I will remember you. I pray that God is holding you tight tonight in a place better than the imagination can fathom. Thank you for letting me care for you today. 

Practice What You Preach

When you teach something it helps reinforce it in your brain. I tell my students this all the time:

Dictate your care to process what you're doing.
Talk about medications and side effects as you give them to educate your patient and help reinforce medication knowledge for yourself.
Sit down and discuss a patient's diagnosis with them. Print off guides and learn together about how they can better understand concepts and take control of their own care.

If you've never tried it, try it! I find when I study something and break it down to teach, I know the concepts 50% better than before, and I tend to retain that information.

Practice what you preach.

In educating about nursing practice and how to be a nurse I like to help students look beyond the diagnosis and at the whole person. Not the patient, but the person. This involves what my Jesuit schooling would define as cura personalis, or, care for the whole person: mind body and soul.

I was reflecting this week on how much I enforce quality time and connection with patients- Really getting to know them and understand something about who they are and where they come from. 5 minutes sitting and listening is all it takes. In addition, ask the patient what one thing you could realistically accomplish to make their day better and so they feel their needs were met. Integrating this in to a plan of care can be difficult with a large patient load, but intentionality and true care and compassion are recognized by a patient.

I love to see this put into action and was amazed by the kindness and creative ways each student helped their patients feel acknowledged and cared for. It's the little things. It's prune juice with butter, it's lotion to the feet, a shower, teeth brushed, a visit from the therapy dog, a warm dry shampoo cap...
What's beautiful, in addition to seeing and hearing appreciation and joy from these patients, is hearing how their joy invigorates these students and encourages them to make intentional care a core part of their practice. They acknowledge nursing is not tasks to be completed, but entering in to a person's health  journey and inspiring their healing through individualized care.

After days of enforcing intentional time and self care I found myself tired and working on my normal shift in the ER.

It's the little things...my lesson came ringing through my ears. This is something I strive to incorporate always in my practice, but I made it a goal to practice this more intentionally this day. I made it a goal to pay close attention to the little things. A chocolate chip cookie for the sweet patient waiting for a ride, warm blankets and water for family members. Extra timely and thorough updates while talking to patients. Finding one thing in common with them to recognize their humanity- (person, not just patient). These little things felt good, but even more they made the patients and their families extra responsive and grateful, which in turn made my day enjoyable with smiles all around. It reminded me why I love what I do.

Even the little things need reminders from day to day or they get lost in the hustle and bustle.

Practicing is an art and skills are lost when they are not practiced. As an educator I strive to continually learn so as to be a better resource to my students, but it is often the students themselves who teach me in addition to reminding me why I do what I do.

Not My Place to Judge

Working in the ER one encounters many types of people. Young, old, middle-aged, kids, black, white, male, female, Asian, Caucasian, Hispanic, Vietnamese...and the list goes on. Then you encounter all kinds of chief complaints: belly pain, sore throat, back pain, chest pain, headache, weakness, fatigue, nausea, vomiting, lacerations, broken bones, etc...again the list goes on. One encounters different attitudes in people: kind, angry, calm, anxious, expectant, worried, scared, mean, delusional, egotistic, respectful, rude, polite, etc...

All these and many more combined to bring in every type of patient imaginable from every type of background you could picture. There's no rhyme or reason to what bring any person in on any given day, but as a nurse I expect diversity. I expect to care for different types of people who come from different walks of life. This doesn't bother me. Rather, it is exciting to learn about different people and it is a challenge to meet each person where they are, help them understand their course of treatment, gain their trust, and assist in their healing. 

Who they are and where they come from doesn't really matter. What matters is caring for them to the best of my ability and knowing enough about where they come from to care for them with cultural competence and respect.

Then there are the patients who comes from jail, who caused the accident, who drank too much before getting behind the wheel, and who comes with a story. A story that is relevant to the mechanism of injury, a story that explains why police are there holding a ticket, a story that sometimes makes the providers shutter and judge. 

I had a patient with a story. This story was similar to many I had heard before and I didn't think twice about it. Injuries were significant and I diligently managed pain, comforted, and reassured. Police showed up hours later with a different story. A story that painted a new picture of the patient, a story that better explained the injuries as well as how the decision impacted others. 

My heart broke.  It didn't change my care for this patient, but boy was it a struggle in my brain not to judge. And it is so very easy to judge when in my line of work we see the impact of decisions every day. 

How would this had played out if I never knew that story? Probably in my mind a complicated case I had the privilege of being a part of...and what was it now? In that moment I judged and I struggled with the facts of the event. And now reflecting on it...

Still a complicated case, and still one I feel privileged to be a part of. Why? Because I had the opportunity to treat this patient the same as I would treat any other patient. I had the opportunity to show compassion and grace in a time where it would have been easy to tell that patient to deal with the consequences. We all make mistakes in life. Some that affect the lives of others and some that stay hidden behind the doors of our homes. At the end of the day is there a difference? We all struggle with different things, but not all those result in physical damage. 

If I made a mistake that landed me in the ER with a story, I hope I would receive compassion and the benefit of the doubt. Maybe I would deserve it, maybe I wouldn't...but whose place is it to judge?

Not mine, I remind myself each day, not mine. 
 

What is Your Expertise?

I take my car to the mechanic when it's not working because that is their specialty. I have full confidence in the shop to change and rotate my tires and diagnose the reason my blue tooth won't connect or why my heater doesn't want to blow heat when it's less than 20 degrees outside. While I could open up a book about cars,  my car's make and model specifically, and follow the YouTube video about how to check out the engine and heating systems, I choose to go to an expert. Why not put trust in someone who works with cars day in and day out? Lazy? I prefer to think of it as a wise use of resources. I could learn to change my own oil, but when it comes to the engine function I'm leaving that to the people who know what they are doing.

I often forget that is how the world sees us as healthcare providers. Doctor or nurse, I hear frequently:

But you've seen this before? 
And you know it works?
And your confident he/she will be ok?
Did others make the same decision? Are we making the right decision? 
What would you do if you were us?

I encountered two different families last week asking these very questions. They were asking about quality of life for their loved one and if they were making the right decision. I humbly listened to each group feeling honored that they asked for my professional opinion and advice while I felt somewhat naive to the emotional weight of such decisions, seeing as these people were old enough to be my parents! And yet, young or not, they trusted my expertise as a nurse, and as a person who understood the circumstances and cared.

Knowledge is a privilege and one that should not be taken lightly. I am blessed to be in such a position each day at work, and moments like this remind me to use the gifts and experience I have. I cannot tell someone what they should do, but I can offer pros and cons to each side and help them understand the options and fill in the knowledge gaps to make the picture a little clearer.

Sometimes we forget that others look to us for advice on the things we're used to seeing and doing every day. Embrace your gifts and talents in what you do, no matter what that may be. It takes all kinds to make this world go round, and if we all knew the same things it wouldn't get us much of anywhere.

Recognize your daily value and share it with the world.

Quality/Quantity

Living his life without a care in the world and out for a ride on his bike. One minute the breeze blowing through his hair and the next thing he knows there's a car, he's on the ground, and he can no longer feel his legs.


He has been playing his instrument since he was a little boy, this talent marking his career path. He lives for the rhythms and sounds he plays from church to church. Then, in an instant, the physical ability is gone. He cannot move his left arm and is left to listen to the sounds of the music he once played.


Nothing makes you appreciate the little things in life more than losing them for a period of time. You cut your finger and forget how much you actually use that finger in your day to day activities. You have knee surgery and forget what a blessing it is to be able to run around for a 12 hour shift until it hurts to walk 20 feet.


Every day at work I encounter people with a significant diagnosis that changed their life forever, and I am reminded to count my blessings. While my functionality is crucial in my line of work, I wonder what would happen if I lost the ability to work? Does my work define me, or am I defined simply by who I am?


I encountered two souls whose lives were altered by life circumstance out of their control. One struck me with his kindness, openness, humbleness, and strength. It wasn't about what he couldn't do or feel, but about what he could still do. It was about the love and commitment he shared with his wife. It was about the life he still had left to live as opposed to the function he had lost. The glass was half full and he was delightful to be around.

How did this man see himself? While I know little of the path that led to our encounter that day, I do know there was a peace and contentment that radiated from him and a comfort he had about himself. This man did not measure the value of his life by what he was able to do, but by who he could be. How beautiful. Isn't that how it should be? What if we stopped focusing our societal value on what we can do, earn, and cost, and valued people for being their authentic selves?

This man made me stop and think. If I lost the ability to move my legs I could not function as a nurse in the capacity I do now. This thought devastates me, but while my work is a part of who I am, does it define who I am? Or am I defined by how I carry out this work from day to day? Am I defined by how I treat others and the intention and meaning behind my words and actions? I hope it is the latter. 

Life is about the quality of how you live it, not the quantity of things you do, and every day is a gift and an opportunity to live to the fullest.

Live intentionally.