Prayer for Fibby

It's been a tough month at work - a tough few months, really. Lots of complicated social situations. Lots of sad stories. Lots of heavy loads to help people carry...

There's an ongoing situation right now that eats away at me. It makes me sad. It makes me angry. It makes me frustrated. I'm mostly able to leave it behind when the work day is over, but sometimes it takes the whole walk home to fully shake it. And of course, it's always waiting for me when I return to work in the morning.

I knew that I'd have a day that centered mostly around this situation when I headed to work yesterday morning. I had checked email throughout the weekend and was aware that there had been some issues that would need to be addressed when I returned. I got to work, took a deep breath and plunged right in.

The "water" was deep, and the situation upsetting. I met with one person, I met with another, I organized a meeting of the care team, and then I documented in multiple places the plan to move forward. I stayed an hour late to finish all of this and was exhausted by the time I began my walk home.

It was a full-body exhaustion: physical, mental, and emotional. As I turned down my street, I was mentally preparing to leave the day behind when I walked through my front door. I spent the last few blocks taking some deep breaths in an attempt to let go of the day, but it was still hanging on.

Two blocks from home, I looked up and saw a few adults in their early 20s walking towards me.

"Excuse me," one girl said, "Do you have a second?"

"I might," I responded cautiously.

"It's not for anything weird... I mean... Well, we're with the ______ Church and I'm wondering if there's anyone you'd like us to pray for - maybe for you or for someone you know who is having a hard time?" She and her friend both smiled and looked at me kindly. "My name is Meredith," she said.

I'm of the belief that given the line of work I'm in and the challenges I so often witness there, I'm in no position to turn down prayer. Whether it be to a Christian, Jewish, or Muslim God, whether the god be male or female or gender neutral, if someone offers to pray for me or the families I work with, I won't say no.

So I thought for a moment, wanting so much to request a prayer for this family that is causing me so much heartache but not wanting to violate any HIPAA regulations. "Could you pray for the families at my hospital?" I asked. I told her where I worked and the population I serve, and tears came to her eyes.

She asked if she could put her hand on my arm, and when I said yes she began to pray.

I don't remember all the words of her prayer, but I do remember how kind and earnest she was. It wasn't a cookie-cutter prayer. She said "um" and "uh" as she strung together her thoughts into words. But her simple, honest prayer carried a surprising depth and weight. She praised her God for wisdom and love, and acknowledged that God's heart can break just as ours can. She asked for strength and peace for the families in the hospital. And she asked for strength and peace for me.

She finished her prayer and I thanked her. We chatted for a bit and then parted ways.

I walked home feeling lighter, less anxious, and relieved. Relieved in the realization that I am not carrying these burdens alone. Relieved at the idea that there might be some larger power that will help me through these difficult days - if not by solving the complex social problems I witness at work, at least by sending people like Meredith to pray for me when I need it most.

Pure Joy

Despite what you may think from reading through my posts, my job is not all doom and gloom. 

For over seven months, I've gotten to know a very special family. Our patient has faced more challenges in the past year than many people face in a lifetime. He has met some challenges with success, and has had some significant disappointments as well. Throughout it all - even at the lowest points -  his family has remained strong in their faith that he would be healed. 

Today, this patient got one very significant step closer to being able to go home. I can't share more information, other than to tell you that today's events are life-changing in a positive and nearly unfathomable way and I am so very happy for him and his family. 

Yes, sometimes my job is difficult and sad. But sometimes I'm witness to incredible miracles here on earth. I am so very lucky to do the work I do.

At the End of the Day

There are some days when I leave work feeling energized and elated, and there are some days when I leave work feeling as though I've been punched in the gut. Particularly difficult are the nights I leave work not knowing if patients who were in critical condition when I left will still be there when I return. 

In professions that deal regularly with matters of life and death, there is a significant amount of self-care that practitioners must do in order to keep from burning out. People often think of self-care as being something extravagant like getting a massage. But actually, self-care can be as simple as turning one's pager off and leaving work on time.

At the end of days like today, I have a lot of ambivalence about leaving my work behind. I know that the only way I can continue to do my job well is to take time away from it and all of the intensity and stress it brings, but I get so invested in the patients and families that it's difficult for me to leave them when I know they are struggling. Can they get by without my support? Of course. But if I can relieve their stress or ease their sorrow or help in any way, I want to do so, and it's difficult for me to walk away. But in order to have the energy and strength to return to work each morning, I must leave work at night and try to put out of my mind the scary and sad realities that these families are facing 24/7, with no option to escape. 

It has taken some time and practice, but most of the time I can do it. However, some days I find that my walk home at the end of the day has not cleared my head, and I am still weighted down with the reality of what I see every day. 

Last night, after a difficult day at work, I returned home and checked blog updates before I went to sleep. I clicked on flotsamblog - one of my favorites - only to find this post. It was a punch-in-the-gut reminder to me that even when babies survive through prematurity and families bring them home from the hospital - even when they are many months and even years out from having been in a hospital - they are still fragile, and there are no guarantees.

When I returned to work this morning that reminder weighed heavily on me. And as I saw my patients struggle with their individual battles, I said silent prayers for each of them that they might leave our hospital healthy and never return. 

I never knew Maddie Spohr or her parents, but from what I have read, there was a lot to love. The online community of Maddie's friends and supporters has raised over $22,000 in her honor for the March of Dimes as well as additional funds through PayPal to support her parents during this unthinkably difficult time. I am moved to tears when I think of the loss of such a small and joyful little life - and then moved to tears again to see the widespread reaction and incredible outpouring of support and love within the blogging world. 

Last night my work and my outside life collided, and at the end of today I am left still reeling from the impact. 

"The streets of heaven are too crowded with angels tonight... but every time we think we've measured our capacity to meet a challenge, we look up and we're reminded that that capacity may well be limitless."   -TWW

One of Those Weeks

I can't remember the last time I had a terrible, horrible, no good, very bad week. It's been a while. So I guess I was due? 

Monday brought a cryptic email from my supervisor telling me that she needed to meet with me regarding a "patient relations issue". It turned out to be nothing bad, but I spent the entire day with a knot in my stomach trying to figure out what I might have done wrong and/or what family might have had a complaint about my work. Not a great way to start the week.

Tuesday I was paged before I even got into work about a family situation that had escalated to a near crisis point. By the time I arrived at work (10 minutes early, thankyouverymuch), the family had already left, but there was much de-briefing to do about how this matter was handled and how to prevent a similar situation in the future. And though absolutely no one blamed me for what had taken place, I felt awful that I hadn't been there to help during an incredibly difficult situation. 

Wednesday, I started getting sick. The "oh no, my throat hurts and I know what that means" kind of sick where you know no matter how much zinc/vitamin c/echinacea you take, it's still going to get you.

Thursday I stayed home sick from work. I also received an unexpected email that has left me feeling unsettled and grumpy for the past 24 hours.

And today I realized mid-day that the grant proposal I have been working on that is due March 2nd is due on MONDAY because February is a short month. I also realized when I went to pay my credit card bill at 8pm tonight that it wouldn't get posted until March 2. It's due the 1st. And when I called the company to ask if there was anything I could do, and they said, "yes, go to this website and you can pay it until 11:59pm tonight and it will still post today", I then realized that the credit card with the number I would need to be able to pay it online, was on my desk at work.

So it's been that kind of week. A terrible, horrible, no good, very bad week.

But there have been glimmers of goodness in the week too: one of my favorite kiddos coming back to our unit for a few days, getting to hold that same kiddo's twin brother while he smiled at me with all his might, caring comments from friends when they found out I was sick, free lunch today (there IS such thing as a free lunch, people, there IS!), and an honest-to-goodness, rock-solid GOOD first date. Yes, you read that correctly. In the midst of my hellish week, I went on a date, and that date was good. 

Go in Peace

A typical stay on my unit in the hospital can last from a week or two to a few months. Rarely do we get patients who stay with us for more than that. Naturally, the longer a patient is with us, the more we all (nurses, doctors, social workers, etc.) bond with the family. 

One might imagine that the main purpose of ICU interventions is to do everything possible to save lives. That is true to a certain extent, but an equally important role of the ICU medical team is to decide when there is no longer anything that can be done to improve a patient's health, and to help the family through the difficult decisions and experiences that follow. Usually, this happens in a predictable way: families have been kept up-to-date on the patients' progress, and are not surprised when the medical team comes to them with a discussion about end-of-life issues. But there are some times when family members are not on the same page as the medical team... and some times when family members are not on the same page as each other. In those cases, it is our job as a team to help families get to a place where they are able to let their dying family members go. 

Today, after months of medical updates, ethics consults, and intense conversations, we managed to get two family members who were not on the same page about how to care for a patient to agree on how to move forward. And though I think many of us on the medical team (and some family members) felt great relief to know that the family and the medical team were finally in agreement about what was best for this patient, there was also a great feeling of sadness to realize what that meant. 

There are many sobering moments in my line of work, but none so sobering as when we see families make the selfless decision to let go of a loved one who is suffering. The "easy" choice is to keep a loved on alive at all costs. It is much more difficult to recognize when the pain and suffering felt by a person being kept alive by artificial means outweighs the pain and suffering that the surviving family members will be left with after that person's death.  

These next few days will not be easy. For the first time in this job, I have offered to come into work over the weekend if I am needed. I do not pretend for a moment that this family with whom I have spent at least an hour every working day for the past few months will go quietly from my mind after their loved one has died. They have become a part of my daily routine, and I can already imagine the tug I'll feel at my heart when I walk by their room and it is empty or occupied by a new patient. But as I came to accept long before the family, this patient is ready to go, and will find peace soon in a way that was never found in this lifetime. 

Go in peace, sweet one. Go in peace.

A Day in the Life

6:00 - alarm clock goes off. hit snooze once, then get up, shower.
6:35 - stand in the middle of my room for a ridiculously long period of time wondering what to wear
6:50 - outfit decided, change out of "work top" into "walking to work top". fold work top nicely and put next to bag. blow dry hair.
7:05 - make and eat breakfast
7:20 - transfer all items from yesterday's work purse into today's bigger work bag (thinking ahead for when I have to carry home the rain boots I left at work yesterday)
7:25 - start thinking "I should leave now or I'll be late"
7:35 - actually begin walking to work
7:50 - realize I have left my "work shirt" neatly folded on my bed. grateful for the fact that I've done this once before and have an emergency shirt stashed at work. appreciate the irony of all the time I spent picking out an outfit this morning.

8:05 - arrive at work. change into emergency shirt that smells strongly of mint, due to being stashed in a drawer next to some seriously strong mint gum
8:10 - check email, read electronic chart notes to catch up on overnight updates
8:45 - head up to the unit with a to-do list
8:55 - fill out timesheet, cross one thing off list
9:05 - accidentally stumble upon the medical team rounding. stand in for a while to see if they say anything interesting. they don't.
9:35 - am told of birthday tart in the break room. go to check out birthday tart. decide that a birthday tart from shop 'n save is not worth splurging on and do not partake.
9:45 - socialize with ladies at the front desk
10:00 - leave meal vouchers at bedside for a family. check another thing off list.
10:10 - once again stumble upon medical team rounding. decide again to sit in. regret decision again.
10:30 - realize i had promised a family i'd meet with them at 10:30. leave rounds. hear sounds of breast pump from behind curtain where parents i am meeting are sitting. decide to return later.
11:35 - back down to my office to eat lunch. starving. inhale all food leftover from various lunches packed throughout the week. wonder if food purchased from whole foods deli on sunday should perhaps be eaten before friday but am too hungry to worry much.
10:40 - mom still pumping. go to meet with another family to share some information they had asked for. hear pumping from behind their curtain.
10:50 - mom from family #1 is ready for meeting. we meet.
11:30 - meet with family #2 to share information. sound like useless loser when all i can say is "sorry, there appear to be no support groups that would suit your needs in the entire metro-boston area" feel stupid saying it, but know (after two days of research and phone calls) that it is true. promise to continue to look.
11:45 - realize i still haven't met with charge nurse who will share with me information regarding high-need families and information about scheduled family meetings. meet with her. wonder how i feel i've been so busy all day and still feel as though i've got just as much work as i did this morning.

12:00 - return to office. see that i have voicemail. listen to 4 voicemail messages and wonder how two of them are from yesterday but did not show up until now.
12:05 - detective work. research what it takes to establish residency in massachusetts, more support groups (of a different type this time), and book a room in the sleep space for a mother coming in to spend the night with her baby after being discharged from a local hospital. call and/or email people to tell them all these things have been done.
12:55 - head back upstairs to the unit. meet mother for whom sleep space has been obtained. offer to walk her there to show it to her. do so.
1:35 - check in with parents throughout the unit. discover one family will be moving to the floor in a few hours. offer to give them a tour of the floor. give tour and become jealous that the floor has a large selection of bread and english muffins in their kitchen that my unit does not.
2:00 - check in with father (husband of mother #1 i met with in am). he wants to meet, but cannot now. promise to return in an hour or so.
2:10 - chat with mother who is returning from grabbing some breastmilk identification stickers from the staff closet. think mom has been here too long if she's breaking into the staff closet. chat with mother about yesterday's family meeting.
2:35 - realize that my goal is to leave on time (4:30) today and chart as many notes as possible so they will not keep me at the end of the day.
3:15 - receive phone call from social worker at referring hospital letting me know that we will be getting a child who is in the custody of the state. obtain contact information for state worker. call state worker to clarify custody arrangements and parental rights.
3:35 - run into father (of the "afternoon mtg with father") in the hall. sit down with him to talk because they will most likely be transferred to the floor before monday and he would prefer to talk to me instead of monday's new social worker. wonder how long this will take because i have to work on state custody case. think i'm a bad person for wondering this when dad is pouring his heart out to me. decide to focus on being with him in the moment and worry about the other case later. within two minutes of sitting down, his wife calls and wants to speak with him. we chat briefly. he returns to his wife, and i return to...
4:00 - make multiple copies of official custody letter and distribute to appropriate people. while distributing note, run into another father who i've been seeing daily. say hi and pass on information he had asked for, but then rush off to...
4:15 - send out alert to relevant weekend workers about this family. wonder out loud how i will write a note in the pt's chart about these arrangements when pt does not yet have a chart. person who overhears me wondering out loud tells me to check the "temp" chart and - voila! - a place to write a note. note written. attending doctor notified.
4:35 - finish writing notes for the day. recognize that there is at least one family i should have seen but could not, and give self permission to follow-up on monday.
4:45 - run back into the unit to apologize to the father i had said a rushed hello to. wish him a happy weekend.
4:50 - head down to office to change back into "walking home from work top" (same as "walking to work top")
4:55 - walk home
5:25 - purchase burrito to go for dinner

5:35 - arrive home, change, eat dinner
5:55 - drive to babysitting job, play with two tired but happy kiddos
7:25 - begin bedtime routine
7:55 - both kiddos sound asleep. begin typing blog entry.

Matters of Life and Death

After 3.5 weeks of relative quiet at work, the end of last week brought some pretty intense situations. I sat in on my first family meeting at which the medical team told the family there was nothing left that could be done. I watched another family struggle to come to grips with the fact that their child was not going to live. And I witnessed intense grief of a family going through an unthinkable tragedy outside of their hospital stay.

All in one day.

It was the kind of day in which I kept feeling heavier and heavier with the weight of these families' stories, and that ended with me sobbing in my office at the end of the day. This is my dream job - helping people through impossibly difficult times and helping them navigate the delicate balancing act between heartache and hope. It is everything I want to be doing, but sometimes, like last week, it becomes difficult for me to separate a family's grief from my own.

And yet, I returned.

I spent the weekend practicing some self care, hanging out with friends and babysitting, and then returned to work on Monday. Yes, I was a little bit scared of what would be waiting for me, but I was also determined to find new families to remind me of the hope and resillience that can be found on my unit that can help to balance out the tragedy.

So "balance" was the key word of the week, I guess. This week, I supported another family through the death of a patient. I also made dedicated time to support the staff, who are impacted by these losses (both individually and cumulatively). And in the middle of all the grief that surrounded me, I found hope. Hope in some of the new familes who have arrived on the unit. And hope in the patient who moved to a non-ICU floor and who is now one step closer of returning home with her family.

Every night, I am exhausted when I get home. Every morning I'm nervous about what the day may bring and my capacity to handle it. But multiple times a day, without fail, I am honored and humbled to work in such an incredible place.

It's the Little Things

When one works in a hospital, there are many alerts and codes to learn. There are alerts for spills and security and other such emergencies. There's "Code Red" which indicates a fire, or "Code Pink" which indicates a potential patient/child abduction, or "Code Brown" which may or may not be an official code, but the nursing staff can tell you you most definitely don't want to have to deal with one.

I was browsing through the internal hospital website today and came across a page describing this alert:

Linen Service / Lost "Lovey"

Purpose
To alert the individuals who can activate a well organized search for a patient's item of significant emotional attachment ("lovey"), which is believed to have been mistakenly removed with the soiled linen.


I love where I work.