Cynthia Stock

An amazing author for your soul!

An Interview with FloNi-2017

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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

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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

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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

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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.

 

 

The Language of Touch

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The Language of Touch

 

A piece of paper taped to one cabinet in the break room asked for items staff nurses would like to see in an admission package. I suggested a nice razor, one with more than one blade, one worth more than 29 cents and less likely to ravage the skin of someone sick enough to be in ICU, but well enough to feel better after a shave.

Later the same day, I walked by the break room and overheard two nurses, both who happened to be around thirty, ridicule two “seasoned nurses,” meaning over sixty, for making a big deal about shaving male patients. “I won’t do it. I just won’t do it.” One said.

I can’t imagine refusing to do any kind of patient care. I have been threatened, scratched, kicked, thrown up on, and sprayed with all sorts of body fluid. To me it’s part of the job. But I know times have changed. Maybe I AM out of step. So I looked up hygiene in a textbook called Fundamentals of Nursing. Shaving still appeared under the classification of personal hygiene and earned its own section with a “how to” discourse.

Two weeks prior to this I shaved a man days after an open heart surgery complicated by multiple co-morbidities. I asked his wife to bring in his shaving kit. It contained a nice four blade razor with Edge shaving cream, a brand I like to use on tough beards. I softened the whiskers with a warm cloth, slathered on gel that blossomed into an abundance of white foam, and shaved one side of the man’s face, then the other. When I finished, his family literally gasped with delight. The man they knew was beginning to look more like himself.

I sought out another experienced nurse. We discussed a scene from Out of Africa in which Robert Redford washed Meryl Streep’s hair. It didn’t overwhelm the audience with dialogue or sex. The mere act of washing hair epitomized the relationship between the senses and intimacy. To me it symbolized the universal language of touch. In the hospital setting, touch facilitates communication. It engenders a bond of trust that needs to be established between patient and professional, a bond that eases the distress caused by loss of control not only of the decisions of daily life, but also bodily functions. How do you make a person not feel ashamed when he knows he’s drooling because he’s had a facial reconstruction or when he loses control of his bowels and doesn’t realize it? It’s through a degree of intimacy and trust.

The senses connect us. They speak more articulately than words. It is not just a shave. It is a conduit that builds trust, creates a sense of safety, and makes a patient feel like he’s not just a room number, a diagnosis, and a daily weight.

 

 

The Unquantifiable Art of Nursing

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Yesterday my patient’s skin peeled and pulled away from her fingers and toes. In the past week she had gained twenty pounds from water retention. The swelling stretched her skin until it radiated a watery sheen. As the swelling began to go down, the skin rebounded, dried, and flaked. I took off her anti-embolism hose and her sequential compression devices and released the smell of dirty gym socks. She was depressed, withdrawn, un-communicative, because a surgery she expected to earn her a brief hospitalization had incurred Murphy’s Law. She entered her fifth week in ICU with a tracheostomy and a surgically inserted feeding tube. I understood her frustration.

After trach care, catheter care, blood sugar checks, and adjusting IV drugs to a prescribed blood pressure parameter, I wanted to do something for her, not to her. I warmed up lotion and lavished her hands with it. Every finger got special attention. I remembered how pressure to my fingers during stress reducing massages seemed to release the tension in every muscle of my body.

I dialogued in an effort to break her silence. “You know why I’m doing this don’t you? If my mother were in your place, I would want to come in for a visit and know someone had cared enough to do it.” I moved to her legs and feet. I washed them warm wipes, slipped the disposable cloths between each toe. I slathered lotion on legs where lines of dryness mapped her skin in white. She grimaced when I rubbed lotion into her right ankle. “That really hurts.” No response. “What about the left one?” She actually nodded in response to my question.

Then for a dignified, mature woman, whose best friend told me she was meticulous about her appearance, disaster struck. She passed an enormous bowel movement, something the general surgeon would celebrate. It added to the patient’s humiliation and loss of her sense of self. How could I convince this stoic, regal woman that just this once, normal human bodily function meant she was one step closer to getting well.

I gathered cleaning supplies, linens, and another set of hands. “Now I’m going to bore you with some stories.” I warned. Stool puddled between the woman’s legs and housed itself in any crevice it could find. I had used stories before with a young male patient to pass the time when he found himself in a similar situation.

I talked about my grandmother, widowed after World War I, she raised four children on her own. “My grandmother worked to provide for her girls. When I knew her, she never was in anything but a skirt, her strawberry white hair in a chignon, and her nails long and perfectly polished.”  I think grandmother resonated with my patient. I could tell she was listening. My helper and I started to mop and wipe and clean and contain the flood of excrement.

“For supper one night, the family enjoyed a roast, probably a rarity in that day. The oldest sister cut and served while the others ate. Before she could sit down to eat, one sister was back for seconds. The eldest picked up the roast and threw it at the offender.  All my grand-mother could say was: ‘Girls. Girls.’” What I was trying to tell her was that we are all human, subject to human frailties and that this moment would pass. She smiled.

A week before that I cared for an octogenarian who lived alone. He began to hallucinate and provided intricate details of what he saw. He realized he was seeing things. The anxiety left him restless. He hollered for someone to come and kept punching the call light. I knew his daughter was coming. I pulled up a stool and sat beside him. “Tell me what you see.”

“Right now I see you encased in a sheet of water. It’s all around you.”

“I believe that’s what you see.” I held out my hand, not to deny him, but to share what I saw.

“I know there’s no rain, but I see it.”

“What else do you see?”

For the next forty minutes he created what I interpreted as his view of Heaven. He detailed with the precision of an engineer, a lift. It had a broad platform and inched upward toward Infinity. He talked about pulleys and cogs and people. “You were there too.”

He looked straight at me when he said this.

I shuddered like I had has a child, when other children who noticed me shake, said: “A rabbit just ran over your grave.”

In all the time he spoke his visions, I just listened and wondered what it all meant. Then the man uttered the words that explained it all.

“I think I’m dying.”

I sat with the man until his daughter arrived.

It is a cliché to refer to long standing definitions, but Florence Nightingale defined nursing as “the act of utilizing the environment of the patient to assist him in his recovery.” (1860) I added the italics. Our patients come to inhabit bland, functional rooms, filled with outlets, equipment, monitors, electric beds, television, climate control, negative pressure, and, if they are lucky, a window. But they also come with an inner environment which constructs the essence of who they are. The greatest privilege in nursing is being allowed into that most private place. Entering there may be one of the most important parts of a patient’s survival. The ability to gain entry is one element of the unquantifiable art of nursing.

 

 

We need to talk about depression

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The other night I watched Birdman followed by updates about the plane crash in the French Alps. I read the analysis of the incidence of suicide among veterans and children who have been victims of bullying. Despite mass media, continuous connection via hand held devices, and information at our fingertips, I concluded: We need to talk about depression. How many people walk around with depression as their constant companion? How many control it? How many are controlled by it? Is any disease more insidious than depression? It seems to sneak by, undervalued, untended, yet with the potential for crippling, even killing, the person who suffers from it.

Years ago I read William Stryon’s Darkness Visible, a most personal journey. Then there was The Noonday Demon, detailing the complexity of depression in a more objective voice.  To understand the power of the disease, the individual experiences of depression need to be shared. It morphs, shape-shifts and lives in such a way that even the people closest to the depressive don’t recognize it. People need a safe, shame-free environment to talk about their private, darkest abyss.

I live with a stranger. It shadows me and usually cowers in my wake. But I am always on high alert, prepared to face-off when, for whatever reason, it gathers strength and threatens to push me into darkness. When it succeeds in conjuring black days, I must force myself to do the things I love because the stranger has stolen their luster, faded their colors, and turned satisfaction into a question of “Why bother?” I am unable to shed one tear over the loss of these pleasures. Apathy and numbness coat me with emotional Kevlar. Pain can’t get in, nor can it get out. Hopelessness percolates within the armor.

For some reason the stranger stays away from me when I work. I think focus on a task or a problem, disempowers it. My work keeps the stranger at bay. Whether I am at my job or writing, the stalking shadow disappears and I am free to stay on task, the best therapy. So I understand why, at the thought of losing his sight, a pilot succumbed to his depression. He lost his point of focus.

I have never taken drugs to kill the stranger. I feared clouding my mind and stifling my creativity. I didn’t want to jeopardize my ability to do the very things that kept me going. Do I keep moving, an earth bound fighter jet zig-zagging through the atmosphere to evade the enemy desperate to shoot me down? What happens when I sit still?

There is an upside to the stranger. I am never alone; there is comfort in that. The stranger keeps me piqued for action rather than reaction. Because of it, I experience the world differently. I weep over beautiful words, over paintings with brilliant colors and thick, textured strokes, over a rock formation in New Mexico shaped like a camel. But I also feel the pain when one pass with a wash cloth takes away a patch of skin from a critically ill patient. I choke when a patient chokes on his breathing tube. I feel the ground fall away when I tell someone a patient has died. Experiences in the day burn with a hyper-acuity. Perhaps I have achieved balance with my companion. It feels that way today.

The victims of rape have been urged to come forward and speak about their violation as a step in healing and self-affirmation. Depression feels like an assault from within. At a time when both real life and art dissect the complexities of mental illness, it is time to speak openly about depression.

 

 

 

 

 

We need to talk about depression

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The other night I watched Birdman followed by updates about the plane crash in the French Alps. I read the analysis of the incidence of suicide among veterans. Despite mass media, continuous connection via hand held devices, and information at our fingertips, I concluded: We need to talk about depression. How many people walk around with depression as their constant companion? How many control it? How many are controlled by it? Is any disease more insidious than depression? It seems to sneak by, undervalued, untended, yet with the potential for crippling the person who suffers from it.

Years ago I read William Stryon’s Darkness Visible, a most personal journey. Then there was The Noonday Demon, detailing the complexity of depression in a more objective voice.  To understand the power of the disease, the individual experiences of depression need to be shared. It morphs, shape-shifts and lives in such a way that even the people closest to the depressive don’t recognize it. People need a safe, shame-free environment to talk about their private, darkest abyss.

I live with a stranger. It shadows me and usually cowers in my wake. But I am always on high alert, prepared to face-off when, for whatever reason, it gathers strength and threatens to push me into darkness. When it succeeds in conjuring black days, I must force myself to do the things I love because the stranger has stolen their luster, faded their colors, and turned satisfaction into a question of “Why bother?” I am unable to shed one tear over the loss of these pleasures. Apathy and numbness coat me with emotional Kevlar. Pain can’t get in, nor can it get out. Hopelessness percolates within the armor.

For some reason the stranger stays away from me when I work. I think focus on a task or a problem, disempowers it. My work keeps the stranger at bay. Whether I am at my job or writing, the stalking shadow disappears and I free to stay on task, the best therapy. So I understand why, at the thought of losing his sight, a pilot succumbed to his depression. He lost his point of focus.

I have never taken drugs to kill the stranger. I feared clouding my mind and stifling my creativity. I didn’t want to jeopardize my ability to do the very things that kept me going. Do I keep moving, an earth bound fighter jet zig-zagging through the atmosphere to evade the enemy desperate to shoot me down? What happens when I sit still?

There is an upside to the stranger. I am never alone; there is comfort in that. The stranger keeps me piqued for action rather than reaction. Because of it, I experience the world differently. I weep over beautiful words, over paintings with brilliant colors and thick, textured strokes, over a rock formation in New Mexico shaped like a camel. But I also feel the pain when one pass with a wash cloth takes away a patch of skin from a critically ill patient. I choke when a patient chokes on his breathing tube. I feel the ground fall away when I tell someone a patient has died. Experiences in the day burn with a hyperacuity.

The victims of rape have been urged to come forward and speak about their violation as a step in healing and self-affirmation. At a time when both real life and art dissect the complexities of mental illness, it is time to speak openly about depression.

 

 

 

 

 

My Heaven

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I dreamed about heaven last night. Not Heaven, but my heaven. Some might call me a heathen. Questions and doubt gnaw at my beliefs. I know there comes a day in everyone’s life when they ask “Why?” or “Why me?” The days I ask myself those questions I surrender to faith in the inevitable, which may or may not involve a supreme being. I liken death to sleep. Except for nights when dreams unearth what’s really in my head, I slip from wakefulness, with my mind working at warp speed, jettisoning me into scenes or characters or action for the next story I want to tell, into nothingness. Black non-existence.

 

A young friend of mine, Amy, died this week. I think the loss of her made me dream of a heaven defined by more than a vacuous empty place. A hospital building housed my heaven. After forty-plus years of nursing that makes sense. I stood peering down a long hall of rooms where light spilled from the doorways and beckoned me to take a peek.

 

From one room I heard disco music and saw Rudy, a nurse who died from AIDs before it became a chronic illness. Rudy defined bling, not because he wore a lot of jewelry, but because he sparkled in life. He lived with an intensity from which a person who didn’t know him might have had to back away. His confidence, sense of humor, and frenetic energy rubbed off in a good way. I watched him dance in his pink uniform and thick soled white nursing shoes. He tossed his head back and a disco ball peppered his face with flickering freckles of light. I remembered the day Rudy confided in me about a patient who had commented on his sexual preference. “I told him at the end of his stay if I wasn’t the best damned nurse he had, he could say what he wanted.” When he was discharged, the patient praised the care he had received. I envied Rudy’s courage.

 

Amy had her own brand of endless energy. She engaged in everything she did with a full court press. She lived with joy, selflessness, compassion. She organized and commanded and executed any task at hand. She was both a jester and a fixer. When I moved into my new house, Amy suggested we have a pajama party. She appeared on my doorstep in flannel pajama bottoms, over-sized squishy slippers, and with rollers in her hair. She also brought the biggest margarita glasses I had ever seen and a pair of flannel pajama bottoms for my husband that said “I love chicks.” Hatching eggs with chicks peeping from the cracks dotted the fabric. I appreciated the time she took to share with us that day.

 

I’ll remember Amy for the night she saved my husband, Dalt. Hospitalized with tonsillitis, he received a huge dose of steroids for tonsils enlarged enough to compromise his airway. I settled him in bed and went home after a long day of waiting, tests, and more waiting. I had just arrived home and dried off from a shower when the phone rang. “There’s something wrong. Something’s happening.” I recognized the panic in my husband’s voice. I knew Amy was working in CVICU that night. I called her and told her the situation. “Can you check on him? I’ve got to get dressed and then I’ll be there.” I never expected her to say “no.” That just wasn’t how Amy treated people.

 

I anticipated a floor nurse in crisis mode when I arrived. But I walked in to find my husband smiling. What he said epitomized Amy. “Amy fixed everything.” During my twenty minute drive she had come to the room and discovered that a new graduate was taking care of my Dalt. “She made him check my blood sugar, my blood pressure, and made him give me some Xanax. She showed that new nurse a few things.”

 

Amy showed us all a few things. And we are better for it. Now Heaven will be, too.

 

 

 

 

 

Nurturing a Culture of Violence

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Since the birth and proliferation of rap music, the negative references to women and the outright violence espoused against law enforcement have been highlighted as reflections of the violent nature of that particular art form. I don’t need to pick on rap music to open a discussion about the cultivation of violence in our society. Time after time the media provides examples where cruelty and disregard for another human being occur without consequence.

Ray Rice cold-cocks his girlfriend and drags her from an elevator. Video tapes document the assault, yet he faces no jail time. Ndamukong Suh stomps on Aaron Rodgers’ leg without repercussion. Only Adrian Peterson has experienced a detour in his life journey, because society views children as the most trusting and most vulnerable when it comes to families and child abuse. George Zimmerman has been arrested once again because of some sort of aggressive behavior. When the publicity and accompanying storm subside, how will the lives of these people really be affected?

What disturbs me most is the trickle-down effect of societal norms that allows extreme behavior to go unchallenged. A patient threatened to punch me in the nose if I didn’t turn him from his side to his back. He had no extra “meat on his bones” placing him at risk for a pressure ulcer near his tailbone. He also had what’s called atelectasis or areas where the lung had collapsed. I didn’t take his threat seriously; but I took it to heart. I explained the importance of protecting his skin integrity and changing position to expand his lungs.

Once I got away from the bedside, I asked “What makes a person, even in jest, fear, or frustration, think that sort of threat is legitimate or reasonable?” The patient wasn’t drugged. He clearly made eye contact. He effectively communicated his needs. At some level, he believed it was okay to use a threat of violence to get his way. Has our passive acceptance of violence committed by certain somewhat “untouchable” members of society become equated with condoning it?

A threat of physical violence accompanied by a smirking grin does not lessen the threat. In some jurisdictions, third degree assault is defined as when a person injures another person, just not physically. Did the patient frighten me? A bit. Did he make me cautious the next time I approached him to provide his care? Yes. Does that constitute injury? Perhaps not. But with someone less experienced, it might change that person’s ability to perform his job, and that is an injury.

Later the same day, I prepared to give the man a shave. I told him how my husband told me over and over that even when men are very sick, they enjoy a good shave. He whispered “Thank-you” and proceeded to contort his face, jut his chin, pull his upper lip taut so I could get the sprinkle of white stubble growing there with his Ultra-Fine Hydro 3 razor. Not one nick from this nurse, thank-you very much. I got through the day with no more threats, but found when I got home that his words flayed my professional armor and gutted me. It hurt to think someone for whom I cared, a person I monitored for every change in heart rate or oxygenation, a person I knew as a complex and amazing individual, could threaten to hit me. The behavior fell outside my frame of reference and left me stunned.

After I started thinking about violence in modern society, the assault at Charlie Hebdo occurred. When did a different opinion or an offensive political satire become an impetus for murder? Has society become so infected with the virulence of violence that people will soon be walking on eggshells with every thought, word, and deed for fear of mortal retaliation? Just as bacteria has evolved into superbugs, will violence grow exponentially and influence progress, creativity, and innovation? Will freedom no longer have meaning?

 

 

 

 

 

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