Cynthia Stock

An amazing author for your soul!

Compound Fracture

by Leave a Comment

I am not a sommelier, but I know what wines I like. I am a retired nurse with forty years of experience in Critical Care. I believe I am qualified to discuss the broken state of our health care system. It suffers a compound fracture. Early in my career, Primary Nursing, a practice in which one nurse agreed to be active in the care of a patient throughout his ICU stay, was introduced on our unit. It facilitated a holistic approach to care. At least one nurse knew more about the patient than his diagnosis and room number and helped that patient navigate the trauma of critical illness. Primary Care did not last long. It was time consuming for nurses already working short-staffed. It was costly, as Primary Care nurses spent time away from task accomplishment addressing the total patient. Now, after a recent short stay in the hospital and a more recent health jolt, I realize things certainly haven’t gotten better. I have had MS for decades and have strived to maintain the highest level of wellness. My PCP encouraged me to go to a local MS specific clinic for care. I went every year. The providers watched me walk, checked my neuro signs, assured me exacerbations declined with age thanks to an aging immune system. I was trusting. I accepted what I was told.  I kept my routine appointments. When my knee began to bother me, I didn’t think about MS. I went to a knee specialist who watched me walk, did an x-ray, saw no arthritis, injected my knee, and sent me on my way. I followed up again when the pain recurred. Another x-ray, another injection. When that shot wore off, I learned to live with the pain. Then, after suffering a Closed Head Injury due to Covid induced hypotension, I switched neuro clinics and ended up at a clinic closer to my home. I saw a new MS doctor. In two visits, he changed my life. He watched me walk. I’d seen my gait in the windows as I walked into the gym. Aging I told myself. “You have footdrop,” the doctor said. Gutpunch. MS finally left its mark, less painful than my burning paresthesias, but so VISIBLE. Yet no one had told me. I bought an ankle brace online. I’ve learned to wear it on the treadmill. My knee doesn’t hurt. My leg is more stable when I walk. Where is the breakdown? The breakdown exists because there is a lack of collaborative practice. Just like the Primary Care concept in nursing, if my PCP, knee doctor, and MS doctor had even had a phone conversation, might I have learned of my footdrop sooner rather than later. Could this type of practice ever happen?  I doubt it. The other part of the breakdown: Who would get reimbursed? What would the billing code be? Who would lose money if I’d just bought a brace? How much is one phone call worth to the practitioner? To the patient? Has medical specialization destroyed the healing art by disallowing the opportunity for a patient to be treated as a whole? What professional do I see to answer these questions?

Collaboration might be needed.

A Slice of the Pie

by Leave a Comment

I retired from bedside nursing over five years ago. In that time, every medical journey with my body demonstrated to me how broken our health care system is. Medical specialization is one culprit in the fragmentation of care. When I go to my cardiologist, I am the heart with Sick Sinus Syndrome. When I go to my electrophysiologist, I am the dual chamber, MRI friendly, pacemaker. When I go to the dermatologist, I am skin. When I go to the joint specialist, I am the knee not wanting to have surgery, not the septuagenarian with MS who works out six days a week and walks funny. When I go to the MS doctor, nothing more need be said, except that I am blessed. For the most part, my disease is invisible. Maybe that is why it doesn’t come up often in a plan of care.

Every specialist gets a bit of me; no one cares for the “all of me,” I realized this when after working with the same Physical Therapist for several weeks, we discussed my Multiple Sclerosis, which suggested this wasn’t considered when the orthopod submitted orders to treat my bobbling knee.  The therapist didn’t know I had it.

Flash back twenty years and my diagnosis of pulmonary embolism. Although I saw a hematologist, the risk of clotting problems associated with autoimmune disease was never mentioned.

I have a dream for my health care providers. Once a year, I’d like a Zoom meeting, God forbid we could do it in situ, where each one helps put the pieces of the puzzle that is my body together and makes recommendations for my health maintenance. I would come with a list of questions about what the interface of body systems and health problems means for the coming year. I would come hoping I would be recognized in toto.

I See No Women Like Me on TV

by Leave a Comment

After surviving the scourge of cystic acne and seven surgeries for basal cell skin cancers on my face, I realized I don’t see women like me on television, that grand purveyor of what is stylish and acceptable. I see women portraying assassins who kill half a dozen men, are thrown against walls, break mirrors with their faces, marked only by a smudge or two of blood as badges of courage. I see talk show hosts with different hair styles every day, pristine cheeks, eyes lined and mascaraed, fashionable clothes, and manicured nails long enough to function as deadly weapons.

What I don’t see are facial scars, not invisible scars caused by rejection, bullying, lost love, not surgical scars in places that can be buried in layers of clothing. I am talking about a track in a cheek, on a nose, dividing a lip into asymmetrical halves, flaws of the flesh that detail the map of a life.

My scars began to carve their presence in young adulthood when stress, hormones, and maybe genetics, ravaged my face. I went to a dermatologist who lanced and drained and prescribed antibiotics. After a tumultuous episode of sobbing in his office, so loud and uncontrollable the doctor insisted the office assistant stay with me, I managed to get back to my dorm only to have to eat dinner with my friends with my freshly assaulted face on full display.

I felt the throbbing pain, not from needles, but from the humiliation of being on the cusp of adulthood and cursed by a disease that presented itself in such an obvious place, a place there was no way to hide. I wondered what I had done to deserve such punishment, because that is the way young people think.

 

Things settled down for a while. I accepted the uneven landscape my face and labeled it dimpled, like a water puddle in the street being textured by raindrops. I knew in reality my face emulated the moon.

I graduated from college, married, moved, and started my first job, all things my parents’ core values and signs of approval taught me I should accomplish if I wanted to be considered successful. My husband subsumed himself in TA responsibilities, chemistry experiments, and mastering the new tech language of the flourishing computer age, FORTRAN.

In the small, college town ICU where I worked, I nursed a man who died from burns caused by a fan belt when he fell on his tractor with the motor running. I stared at the girl, almost my age, brain dead from carbon monoxide inhalation when she and her boyfriend parked in a cornfield for privacy, left the motor running for warmth, and failed to notice the exhaust backing up into the car. I watched the drunk leap over his side rails, fly through the air, and land in the arms of a diminutive colon-rectal surgeon. My face broke out, each bump a monument to the tragedies and surprises life presented.

My co-workers, the people who watched the same horror show as I, became family. We routinely gathered at the mom-and-pop pancake house for breakfast. At night, we went to movies or drank and danced at the nearest bar, which happened to be a gay bar. It didn’t matter. We felt safe until grief from the losses we shared challenged professional distance and dissolved personal boundaries. Dancing became experiments in tongues and hips and breasts and buttocks in a place where no behavior incurred judgement. I wanted to experience as much as I could before I died, because death, sadness, loss, seemed as prevalent as an acrid cup of crappy hospital coffee. I began to explore the things that might bring me from numbness and oblivion to hyperacute being. My face rebelled. Tetracycline became as routine as a daily vitamin to calm my erupting face.

Like many health care professionals, I believed the rules of well-being didn’t apply to me. I told myself that caring for sick people provided a protective barrier against the havoc nature could impose on the body. I read pages of warnings about the side effects of Tetracycline. Photosensitivity I interpreted as intolerance of bright lights.

 

I forgot those warnings when, after years of taking the drug on and off, a friend and I took a summer road trip to Galveston. A move inspired by my divorce had landed me in Texas. We left Dallas on a whim. When we arrived in Galveston, all the motels were booked, so we spent the entire day on the beach, until my friend noticed my face.

“You face is as red as a stop sign. We’ve got to get you out of the sun.”

We paid a ridiculous amount to a scruffy stranger in exchange for his cheap, dilapidated beach front room. Faded pastel prints adorned the walls. The bed was made with sheets that looked like they hadn’t seen a washing machine. I made ice packs for my face.

I had learned the magic of ice therapy when I pulled an unexpectedly heavy turkey from the oven. The roasting pan slid and grazed my forearm as I maneuvered to keep the turkey, drippings and all, from hitting the floor. I watched the blush of the burn, my arm, embarrassed by the heat. I remembered learning in my anatomy class how heat caused the capillaries to dilate and fluid rushed to the site causing blisters. Ice prevented blisters. That time, my skin healed without a blister or a scar.

On the way home from Galveston, my friend and I stopped at a drug store. I alternated ice and the commercial poultice of the day. My face peeled and healed. I thought I’d invented a cheap, natural way to exfoliate and never dreamed damage from the abandoned caution of one week-end when I was twenty-eight would hibernate, only to haunt me as I aged.

In a small college town, I could ride my bike anywhere and logged one thousand miles in a year. When I moved to Dallas, my body lost its tone and stress dominated my mind. I decided to start running. I bought the cheapest pair of running shoes in case my flat feet would betray me and force me to find another form of exercise.

I discovered I loved to run, especially in the heat of the day. A slick coat of sweat made my body glisten around mile five. I memorized the contours of hills, which streets had the prettiest yards, which yards had weather worn wooden fences from which their dogs might give chase. I learned to avoid cruisers who’d slow their cars and offer me rides. Seven miles left me roasted, inside and out. When I got home, hot and content, I glugged a half a gallon of water to replace what the heat took from me.

I didn’t wear sunscreen, sun glasses, or a hat with a visor. I didn’t read about the damaging glare from the asphalt. My running became a habit as strong as nicotine. While I ran, I felt both peaceful and in total control.

One day I looked in the mirror, admiring my outrageously sun-bleached hair and the unexpected deep tan masking my usually fair skin. I saw a rough spot on my lip and scraped it with a finger nail. It pulled away leaving a perfect circle, as if I’d plucked a weed from the dirt all the way to the root. A minute bead of blood appeared. In a day the spot healed, but a dip no bigger than a pinhead remained. I made an appointment with my dermatologist, Dr. Cheek. I picked him because I liked irony.

Before the invention of the Mohs procedure, doctors cut by sight and touch. I trusted Dr. Cheek, a mild man who looked quizzical, not amused, when I asked if he’d ever received a STAT acne call. He numbed my lip, something no more painful than being given a local anesthetic by the dentist. I sat on the edge of the examination table. I sensed rather than felt the scraping begin. Time loses substance when a hand holding a sharp instrument pushes and rakes across the lip you no longer are sure is there, until the instrument hits a nerve and you shift with anxiety. “That hurt,” I said, “I felt that.”

“Not much more.”

The procedure ended not long after that. How long? I’m not sure. I left the office with a dime sized hole in my lip that made the worst cold sore seem like art. I learned basal cell tissue had a different texture compared to healthy tissue. When there was nothing left but healthy tissue, the excavation stopped. I suppose I was thankful the good Dr. Cheek hadn’t put a hole in my lip and that I had a few days off before returning to work in the high splash profession of ICU nursing. I suppose I went running the next day. I suppose I figured this would be the only time I’d have to endure such trauma.

Believers say “Make a plan and God laughs.”

What riotous glee must have echoed through Heaven.

 

Decades later, despite a solid marriage, a challenging job, and a new house, my plan unraveled. Had God been laughing all this time? It started with a small spot on my nose requiring a snip and a stitch. Then, a fleshy mole in the hairline of my left temple grew into a plump, textured monster taking over one side of my head. A general surgeon I worked with worked me into his schedule. I arrived for my appointment dressed in workout gear; I never dreamed of missing a workout.

Dr. Lewis numbed me and positioned me on my side. The paper covering the examination table rustled and sighed and reminded me it was my turn to be a patient. The local anesthetic given, Dr. Lewis put on his gloves and, using a scalpel, sliced away the creature claiming territory on my body. “You’re bleeding a bit, but I don’t think I’ll stitch it. I’ll bring the biopsy report over to the unit.”

Except for the wad of gauze on my head, I felt great. I knew eventually my hair would cover the scar. We shook hands. I hopped off the table and headed for the gym. Yes, I did go work out. It was a time before Dr. Google educated the general public about the community prevalence of Methicillin Resistant Staph Aureus, a time before I realized I was mortal.

 

By the time a rough spot appeared on my nose, Dr. Lewis had succumbed to Alzheimer’s. A colleague and fellow runner referred me to a doctor who ran a clinic like a car assembly line. Rooms with plastic flags, each a different color, lined a long corridor. I arrived for my appointment to find half a dozen other people waiting to be prepped and cut. The doctor impressed me with his efficiency, his ability to put me at ease, and, ultimately, his dismissing my surgery as no big deal. He lied.

A young woman with on-the-job training, no formal education, explained she was going to numb my nose. Nothing had ever hurt like the needle piercing and accidentally penetrating the entire thickness of the side of my nose. The woman sucked air, paled, and hurried her exit with a “I’ll let the doctor know you’re ready.”

Fortunately, I asked my husband to drive me. He ushered me to the car with a mound of gauze on my nose. I couldn’t see over the dressing. I paced around the house avoiding the bathrooms and their tempting mirrors. I paced some more. I went into our bathroom and stared at the mirror. What horror hid beneath the bulge of the dressing? I peeled back the tape as gently as I could and lifted the gauze. I don’t know what sound I made. An “oooh” or an epithet. My husband rushed in afraid I had fainted. A dark hole the size of a quarter stared back at me. Emergency reconstruction took place a few days later.

A plastic surgeon I knew and trusted did the repair. I didn’t know it would be a two-step process. The first surgery created a flap on my nose. The doctor retooled the blood supply by operating along the natural crease of my cheek. It was hardly noticeable. But the flap bloomed like the bloated cap of an earthstar mushroom. The mirror became my enemy. I was scheduled to return to work at a job positioning me up close, face-to-face, with patients.

For two months, I wore a flesh-colored oval Duoderm patch over my nose, all day, every day. Not one patient ever mentioned it. No family members ever asked me about it.  People spending days in an ICU, dependent on strangers, hooked to noisy machines that alarmed, rather than reassured, rendered my trauma invisible to them.

The time came to debulk and revise the flap. After surgery, I could look in the mirror for the first time without wanting to die. My grief lingered, coupled with a twinge of shame. I longed for the face of the young woman I used to be. I was ashamed of my failure to take care of myself. And the doubter in me, the part of me who questioned the existence of a higher being, again wondered what I had done to deserve such torment.

My most recent biopsy has healed. I await another Mohs procedure. This time the diagnosis is more ominous, squamous cell. It is a frightening diagnosis, but what frightens me more is the new path that will be carved in my face. While I wait, I’ll workout, play with my cats, write, drink wine, and watch television, where I see no women like me.

 

Has Medical Specialization and the Business Model in Health Care Given Rise to Google, MD?

by Leave a Comment

 

As a nurse, my family sought my advice over the years. I never practiced medicine without a license and stuck mainly to my specialty, Cardiovascular Nursing. If people asked me about pregnancy, I used the line “I don’t know nothing ‘bout birthin’ no babies.” I learned more about labor and delivery from Call the Midwives than I did from a clinical rotation forty some years ago.

With time, my advice took second chair to a new pundit, the internet. My mom asked me things, I advised, she argued. She would quote something she “Googled.” When a close relative developed cancer, she prepared for long distance care at a Cancer Treatment Center she read about until I reassured her that for her type of cancer, therapy at home would be more than satisfactory.

I agreed with the doctors at work who disdained Dr. Google or Google, MD. But then I had easy access to talented professionals amenable to “curbside consults.” I felt light-headed at work one day. I mentioned it to a colleague, a cardiologist. I had a stress test within a week.

Now that I have retired, I experience patienthood in an entirely new way. It started with a little light-headedness. No. Not a little. A lot. Bad enough to call 911. The red ambulance rolled up with lights flashing. I never felt so relieved as I did when the gurney rolled into the foyer of the fitness center. By the time they did a blood pressure, a blood sugar, an O2 sat, and looked at my EKG, I felt better, well enough to go to the bathroom and drive myself home.

I did what I would have told anyone. I went to my PCP the next day. He drew labs and did an EKG. My heart rate was, hold it, take it in, thirty-six.  My heart had been bradycardic for years, but a rate below forty scared me. I’d been to a cardiologist before, so I called his office to schedule an appointment. When you imagine your heart might slow to a stop, you don’t want to wait around.

This is where the fun began. Despite the fact that I had seen this doctor and had a near “syncopal” episode, I hadn’t seen him often enough, so I was considered a new patient and couldn’t get an appointment for a month. Imagine me going to sleep at night with my index finger palpating my carotid artery to make sure my heart was still beating. Yup. That was me.

Thanks to Facebook and a few good friends and the fact that health care professionals treat each other like family, my appointment got moved up. I only had to wait a few days. My heart had to behave for a little while longer. However, I was warned that the doctor was extremely busy and that sixty patients were scheduled in the office that day. Whether you’re a nurse or a lay person, when it is your heart that is thinking about quitting, retiring from the rat race, going on hiatus, you don’t give a damn about anyone else’s problems whether it’s a cold sore or an office trying to make a buck.

When the doctor with whom I had worked for years walked in, I knew he recognized me, although he wasn’t sure from where. Yeah doc, I was the one who took care of all your very sick, high risk patients who agreed to participate in the trial of the procedure that revolutionized aortic valve repair. I worked hard with the unknowns and celebrated successes that changed the horizon for cardiac interventions. Guess what? I don’t give a damn about all that. I want you to NOT diagnose me in a five-minute office visit and exam. I want you to let me know you know all of my history, my MS, my anti-phospholipid syndrome, my meningioma, my very bad reflux, my hiatal hernia, the fact I have engaged in some sort of physical training since I was six years old. not just my heart history. But he chose the five-minute route. So, I went home and chatted with Google, MD.

Dr. Google mentioned sometimes a hiatal hernia can cause the exact same symptoms I was having, which was a relief, except it made me wonder if I should visit my GI doctor. I wondered if my meningioma was getting bigger and causing increased intracranial pressure and bradycardia. See my neurosurgeon? I wondered if I had thrown a clot to my lung again. Oh, did you not know about that? It’s on the paperwork, initially labeled incorrectly with someone else’s name. Call the pulmonologist. I had already done that.

You get my drift. In a perfect world, maybe all involved in my care could conference call and coordinate a plan. Since all my health care problems reside in one body, mine, maybe it would be helpful to consider them all before proceeding. Thanks to medical specialization and the business model of medicine, that will never happen. To be the best advocate for myself, I will draw from my experience, consult Dr. Google, and hope I make the right decisions.

 

 

 

A letter to the DNC and all potential Demeocratic presidential candidates

by Leave a Comment

An opening platform of “Beat Trump” is not enough, Mr. Biden, and stoops to the pep rally antics of Mr. Trump, well illustrated by Ben Fountain in Beautiful Country Burn Again.

If you want my vote, regardless of your gender, faith, or sexual orientation, these are the problems I want addressed in your campaign:

  1. Clear distinction between pro-birth v. pro-life. It is not the physical act of bringing a child into the world that forces women to consider termination of pregnancy, it is the provision of food, health care, education, shelter, and emotional support. If a woman is a criminal for terminating a pregnancy, why isn’t a man criminalized for not taking responsibility for his off-spring. It takes two to conceive.
  2. In a wealthy, industrialized nation, health care is a necessity and a right. If this country is to maintain its place of leadership in the world, affordable, accessible healthcare and medications should be available for citizens. Conscience must come before capitalism and profits.
  3. A clear-cut plan for the humane management of immigration must be forthcoming, not in a few years, now.
  4. Proactive action must be taken to preserve the environment for future generations.
  5. Politics must maintain a modicum of civility and address issues rather than using name calling and obscure allegations to incite voters.
  6. Term limits must be considered so those who govern are in touch with the present, not languishing in the past’s quagmire of social mores and standards.
  7. Elected officials must be held accountable to the people who elected them.

 

 

Just a few thoughts for the day after my morning coffee.

 

 

Multiple Sclerosis-The Monster

by Leave a Comment

My feet woke me up this morning, burning hotter than a pig on a spit. I knew not to expect blisters. The sheet billowed when I yanked it off with the flourish of a matador. MS. I have referred to it as “my MS.” I hate acronyms. They reduce the horrific to the mundane. MBC. Does that make Metastatic Breast Cancer any easier? Only for drug companies advertising treatment. COPD? Does that make it easier to breathe when you have Chronic Obstructive Pulmonary Disease? I have Multiple Sclerosis. It doesn’t deserve a nick name. If I refer to it as MS, you might think I am talking about a Masters degree. Although I have one of those, “my MS” refers to the disease which has been my master, as both a blessing and a curse, for forty years. I haven’t talked about it much. Call me a private person. But after joining a writers’ group on Facebook, I found out two things. The first? Nothing is off limits. The second? Talking about living with a monster may help someone else living with one, whether it is an abusive partner, a child in trouble, or Multiple Sclerosis. Be advised. This is not a forum for whining or self-pity. I worked until retirement, work-out six days a week, enjoy good eye sight, and seem to be a thinking human being. Many are not so lucky. That does not mean I haven’t faced the monster on a daily basis and trembled in its shadow. More to come.

An Interview with FloNi-2017

by Leave a Comment

When did you realize you were meant to be a nurse? My first student experience was in a nursing home. The team leader confessed they had a patient who earned the title “Most Difficult” I chose her, thanks to my arrogance and innocence, because I thought I could reach her. Through her morning care she hollered and complained. When I didn’t rush her through her lunch, she began to talk about her life and the limited choices for a smart woman in the early 1900s. By the end of my clinical days, she called my name as I walked down the hall to leave. Sally B. didn’t just reach me; she touched my soul, and I still hear her haunting voice calling me to come back.

What do you think is the greatest part of being a nurse?  Nurses bear the responsibility and privilege of entering the lives of patients and their families when they are in need and most vulnerable. The constant change in technology challenges, but it is learning to provide the best, personalized care in a corporate model that demands vigilance, commitment, and persistence. I remind myself of this every day.

How has the profession of nursing changed over the years? When I first started nursing, autonomy and clinical decision making advanced exponentially. To nursing’s detriment, litigation, the imposition of bureaucratically driven policies and procedures, and the layering of the health care team with yet another interface between the patient and the physician is undoing the autonomous growth bedside nurses enjoyed. Lack of autonomy will reduce bedside nurses to automatons.

You said you are changing careers. When you speak of nursing, your voice fills with awe. What has happened to make you want to leave?

It’s a symbolic, most basic illustration, but it depicts the root of why some nurses leave nursing. A group of nurses formed a committee, reviewed the literature, and revised a policy decreeing it was not harmful for nurses to wear nail polish as long as it was well maintained. The same nurses who celebrated this win refuse to shave, or don’t see the necessity of, shaving a male patient. Both things address personal hygiene. It’s just that simple.

Nurses now work in a world where initials in boxes on a paper taped to a patient’s door mean more than the documentation in the nurses’ notes detailing hour after hour when the nurse hasn’t left the patient’s bedside, not even for a bathroom break.

From an old feminist perspective, the clock is swinging backward. I worked through a time when MDs were held accountable for inappropriate work place touching and venting of anger at nurses.  Because younger nurses don’t realize how older nurses fought for simple respect, they contribute to the devolution of professional boundaries.

Corporate health care mandates doing more with less. Decades ago we planned care before a patient arrived. In one instance, due to the emotionally complicated situation of one man, nurses volunteered to be primary caretakers throughout his hospital stay. The clergy and psych staff became involved. Everyone invested in the plan followed the man through his surgery, his stay in ICU, telemetry, and finally his discharge. When he returned, he told us we changed his life. A bitter, angry man was helped by a simple plan. How does insurance reimburse for that? How do staffing matrices account for that? Nursing organizations prattle on about “best practice.” Who defines that? The man whose life we changed, of course.

More often than not, I go home from my shift feeling I haven’t done enough. And thus, it’s time to go.

 

 

 

 

 

 

A Ghost of Christmas Past: Dec. 1973

by Leave a Comment

The year I graduated from nursing school I knew very little about nursing except what to wear.

My white uniform, designed with a bib of crisp pleats across the bust, tented into an A-line skirt. The hem fell exactly to the middle of my knees. White stockings and utilitarian shoes worthy of a convent exemplified my look of a novitiate. Infection control and the influx of men into the profession eventually rendered the winged-white caps obsolete. I pulled my long blonde hair into a pony tail, stuffed it into a crocheted “snood’” and secured it with bobby-pins. For convenience I always stuck a few pens in my mound of hair, Geisha hair sticks by Bic. I never wasted time looking for a writing tool. My favorite offered three colors of ink, red, blue, and green, to accommodate each of the eight hour shifts in a day.

Three hospitals provided services to my small college town in the Midwest. A five bed surgical intensive care unit became my basic training camp. Monitoring EKGs and frequent vital sign checks were considered state of the art. On days when less than three patients required this vigilance, I functioned by myself in this new, specialized area of the hospital. I documented changes in EKGs, electrolytes, vital signs, and pain control, and established standards of care. I initiated calls rather than depending on a “head nurse” or supervisor to speak for me. Intensive care necessitated eliminating time delays and the middle man; I answered directly to doctors and the demand for accountability fell on and appealed to me.

Of course I worked my first Christmas on the job. Christmas 1973 gifted me with insight into my career choice and the ever-present threat to ICU patients known as death.

My patient looked like Alan Bates, the actor. Roguish, with curlicues of black hair slick with sweat and oil, the man reclined in a rickety framed gurney. He angled his elbows on the metal frame like a king holding court He strained the cloth restraints that secured his hands to the side rail. With each effort, his biceps bulged and trembled. Shaking his head side-to-side, he uttered incomprehensible sounds and marked his territory with a circle of spittle. My immaculate uniform meant nothing to a man wallowing in a reality fragmented by the effects of alcohol withdrawal and hypotension.

I fantasized about Alan Bates ever since the movie Women in Love, where I watched Mr. Bates and a young, though semi-portly Oliver Reed romp in the first nude male wrestling scene to appear in a mainstream film. The full frontal male anatomy fascinated me. How could I imagine in five years that career experience would reveal every variant of the mysterious penis and turn it into nothing more than a delivery conduit for the precious measure of renal perfusion, urine?

I nicknamed him The Professor. I can’t remember his real name. Today HIPPA would demand I protect it. He epitomized my ideal of an English professor complete with perfect, albeit, slurred diction and a penchant for whiskey. I imagined him fully functional, both cavalier and cerebral in a tweed sports coat with leather patches on the elbows. College girls flocked to his classes, his office, even his apartment.  And I, fresh enough, inexperienced enough, thought like all novices with addiction, that a little love and attention could cure alcoholism and all the underlying problems that caused it. I’d say the right things, and The Professor would quit smoking, quit drinking, eat right, and publish a book dedicated to me. I also thought medicine could save him from the massive gastro-intestinal bleed channeling life from his body. In one day I learned what little power altruism, innocence and science wielded.

It was just he and I. The day nurse dashed away as soon as she finished report. Short and to the point: “ 34 year old white male. Bloody emesis with clots in his stool. Found unconscious at home by a neighbor. Two units of blood given in the ER. No family. Sinus tach on the monitor.”

There it was. The security of what I then believed was the pinnacle of technology. In just a few years to merely monitor the EKG would be comparable to using a squirt gun against a light saber.

“Dr. Reisman said there is nothing more to do.” Today it seems there is nothing we can’t do. There are no rules about when to stop.

I picked up my stethoscope to start my assessment and stopped a moment to shift gears. Looking around it disappointed me to see no one had decorated the unit for Christmas. Through an expansive fifth floor window, low hanging clouds rolled over the trees and houses. Smokey mist covered every building and obscured the lights and decorations heralding the season. Loneliness accompanied the focus required for my work.

I approached The Professor with caution. His gown gathered in folds across his abdomen and groin. The monitor electrodes glared white against a thicket of chest hair. Small halos surrounded each electrode where the hair had been shaved. A small slash of dried blood marked a path down his chin. He sat in a smear of maroon with a clot the size of a plum mashed against one rail of the gurney. His writhing agitation caused his blood pressure cuff to slip down his arm to the restraint. I could see his pulse on the monitor and count his respirations. I needed to check The Professor’s blood pressure.

There is nothing more gag-inducing than stool from someone bleeding in the gut. It blends the smell of fresh blood, rotting meat, and swamp gas.

When I started to examine The Professor, I didn’t know this. The odor surrounding him forced me to breathe through my mouth. I stepped closer and started a standard script. “I’m Cindi and I’m going to be your nurse today. I need to listen to your chest, heart, and abdomen.” I said abdomen because he was a professor. A whiff of his body odor reassured me I could have said “gut.” After holding my stethoscope between both hands to warm it, I placed the diaphragm on his chest.  I heard the familiar squeaks and crackles of smoker.

“I need…I need…”

I heard his voice drone as the sound traveled through his chest and the diaphragm of the stethoscope, up the slick black tubing, and through the ear pieces into my head. I pulled back. “What is it that you need?” Pompous satisfaction. I was making progress with the man. He trusted me enough to ask for something.

“I need…” A blast of red erupted from his mouth and landed in an abstract design of spatter on my uniform. I looked at the chrome paper towel dispenser and saw nothing on my face, but from mid chest down I easily could have been mistaken for a gunshot victim or a Pollack. I washed and dried my forearms and returned to The Professor.  Before AIDS and public awareness of the dangers of hepatitis, it never dawned on me to be afraid of exposure to body fluids.

The Professor’s head dropped against his shoulder. His heart beat twenty beats per minute faster to compensate for the loss of blood from his system thus maintaining his blood pressure. I sped up his IV fluids and paged Dr. Reisman.

When waiting for a physician to return a call, when it feels like all the responsibility is on you, time shows no mercy. My heart pulsed in my temples. Sound amplified. The Professor’s sonorous breathing seemed to roar through the unit.

The monitor warned of irregular heartbeats. Unable to hear a blood pressure, I palpated one with the systolic throb recognizable at 45. The phone rang.  I reported the events of the past ten minutes and hoped some new medical development had evolved in that time.

Dr. Reisman was as new to his medical practice as I was to my nursing practice. When we worked with patients and each other, two pairs of fresh eyes explored changing professional roles, planning care with new knowledge and inspiration, reshaping old traditions. I represented a new breed of nurses with my four year degree. Just starting his practice, he seemed to approach me differently than the older, well-weathered MDs. Or perhaps he simply heard the uncertainty, the disbelief, and, yes, the desperation in my voice. “I’m on my way.”

The Professor rallied and resumed thrashing about the gurney. His heart rate remained high. A pallor circled his mouth. With a violent twist of his head, he resisted the green plastic prongs for supplemental oxygen. He repeated the move when I tried to wipe his mouth and wash the blood from his chin.

A small man with thick, pre-maturely silver tipped hair and an earnest demeanor, Dr. Reisman arrived. I noticed the five o’clock shadow of his beard. He noticed my uniform. “Did this just happen?”

I nodded.

“There really is nothing more we can do.”  Dr. Reisman stroked his chin and walked over to The Professor.

“Can you hear me? You are really sick. At this point we can’t get you better. Is there anyone we can call? Is there anything I can do for you?” He rested his hand on The Professor’s forearm.

The Professor stared across the room and said nothing. Guttural sounds rumbled in the back of his throat. Watching a man’s demise, tethered to a bed in my ICU, gobsmacked me.

“Call me when something happens. I’ll be in the ER.”

I admired tailored slacks and polished shoes as Dr. Reisman stood at the elevator. In a time when patriarchal practice dominated medicine, Dr. Reisman showed me a glimmer of the collaborative practice of the future. That day I sensed something about the potential of my profession that would come to fruition many years, many patients, and many challenges later.

“Doc.” The Professor sputtered in a coarse whisper. “Doc, can I just have a cigarette?” His head lolled to one side. The monitor warned of disaster.

When I looked up at the small black screen, three to four beats of wide amorphous conduction, the kind that drop cardiac output and blood flow to the brain, interrupted the rapid, but regular white P-QRS pattern of tachycardia. The Professor lost consciousness. The irregular rhythm looked like a child’s drawing where a tiny hand zig-zagged a crayon across a piece of paper. More and more clusters of chaos appeared. Finally chaos reigned.

Without a regular heart rhythm, the heart failed to perfuse. Within minutes The Professor stopped breathing.  A white line, as clear and sure as a jet stream, crossed the monitor screen. The monitor screamed its proclamation of death with a continuous high-pitched alarm.

What happened after The Professor died, I don’t remember. I knew the mandatory procedural rituals performed after a patient’s death. In 1973 plastic body bags didn’t exist. I assume I wrapped The Professor in a sheet. Today I sing Native American chants to patients as I prepare their bodies to be taken away. There was no singing for The Professor. I had much to learn about what was right and proper and comforting to me when working with the dead.

Nor do I remember what I did that Christmas night when I got home. Until I owned a house with a fireplace, I made one out of construction paper and corrugated cardboard painted like bricks. The felt Christmas stocking my mother made me hung by the faux-fireplace on a tiny nail. Mom decorated the stocking with symbolic cut-outs. Beads and sequins sparkled on a candle, a train, a ball, and other various mementos of childhood. There was no nursing cap; that identity had not entered my being when Mom created the stocking.

For many years, the memory of The Professor’s last words, the loneliness of his death, and my feeling of inadequacy stayed with me. I saw myself, like a candle in an infinity box, as a myriad of nurses expanding in many directions, burdened with the responsibility for another person’s life, alone to experience the loss of a man who, at first glance, seemed a person of looks and intelligence and potential, but who was simply a man I tried to help and failed.

I could have changed jobs, gone to work in the newborn nursery or a doctor’s office. I could have quit nursing altogether. The Professor would have no second chance, but I continued nursing in search of my mine.

Part 1: The Golden Age of Nursing

by Leave a Comment

I graduated with a BSN in Nursing in 1973. My four year degree was the exception, not the rule, at the time. I received no extra pay or recognition. As with so many careers, training really began my first day on the job.

I learned about the demands of the relatively new hospital concept called “intensive care.” There was no internship, no syllabus, just flying by the seat of my support hose and white down-to-the-knee uniform. I pulled my hair into a bun and stuck my pens there, a sort of nurse’s kanzashi, to keep them handy. Charting consisted of half a page of lines and dots for vital signs and no more than eight lines for patient notes. Back then I documented drug infusions by flow rates, drops per minute, not dosages. I can’t remember how we documented medications. Self-edification drove my critical care learning. I enrolled in EKG classes, had the privilege of spending two days listening to Dr. Marriott explain the most complex arrhythmias, attended respiratory care seminars, and took advanced physiology to have the academics to support my practice.

Along the way I mastered how to finesse shaving a man with a heavy beard, how to navigate delicate family matters like a wife bumping into a girlfriend at the bedside. I learned a farmer rested better if I read him the bean futures or told him what I’d paid for a dozen eggs. I watched a learned professor die from his addiction to alcohol. I worked in a small unit where the patient was barely an arm’s length away. What happened to my patients I carried home, tucked in a portfolio of images, smells, and sounds. No escape, no mercy. I took every day personally.

Looking back on a forty-three year career, I evaluate myself and my profession. I ask, as Dr. Paul Kalanithi posited to himself in his book When Breath Becomes Air, did my life, my work, matter? I grew up in the Golden Age of Nursing. Before JCOH. Before computers. Before order bundles, protocols, and health care framed itself, first in a corporate model, now in a hotel management model. Before what was documented became more important than what actually happened.

I mourn its passing.

Just a Nurse

by Leave a Comment

One Christmas Eve Day I extubated a patient who had open heart surgery the previous day. A few hours after removing the breathing tube, he went into a pulseless ventricular tachycardia. I was at the bedside, called a Code Blue, and shocked him back into a regular rhythm before his surgeon arrived on scene. His family thanked me for giving them such a gift. I am just a nurse.

Another day our shift received a patient from the operating room who started to bleed faster than we could replace the blood. Without hesitation all but one nurse (and she was unaware of the crisis) stayed over to run to the ER to get the rapid infuser, to run to the blood bank, to support the family, to call in the OR team to take the patient back to surgery, to coordinate care until transport, and to help the next shift cover the rest of the patients. We are just nurses.

A woman came in to speak with the doctor, who had to tell her that her husband had just died. She did not collapse until she looked at me and asked me if it was true. I nodded, hugged her and lowered her to the floor. I am just a nurse.

A patient sat in a chair in distress. While I spoke by phone to the doctor, the patient had a respiratory arrest. Six people lifted the patient back to bed and started CPR. Before the end of my shift, although intubated, the patient woke up and was neurologically intact. A few weeks later the patient visited and said: “I didn’t understand about the job you do until now.”

We are just nurses. Proud is an understatement.