Moonlight, Trains, and Sudden Naps

He arrives to your floor, stooped and hunched even while sitting, paper-thin skin pale in the sunlight attempting to sneak through the small hospital room windows. You worry at first that he won't be able to make it from the ER stretcher to the bed without help, but he pulls out a cherry-stained cane from beside him on the gurney, swings his legs over the side, and takes small but sure steps to the side, where he perches carefully at the edge and looks up at you, eyes bright and blue despite the 92 years his chart claims he has.

He laughs through most of your questions as you get him settled, putting a new hospital gown on, getting vital signs, making sure his request for a Do Not Resuscitate is accurate. He didn't really fall at home, of course, he just woke up and found himself sleeping on the carpet rather suddenly, because didn't it seem like the place to be in the afternoon for a nap? His wife sits in the chair across from the bed, her own cane matching his held across her lap, shaking her head at his answers, a small smile at the corner of her eyes nearly obscured behind thick glasses.

You've already called the representative for his internal defibrillator to come in and assess the small device implanted in his chest, and she walks apologetically in to hook him up while he continues to elaborate on his story about the entire event being planned, of course, to get him and his wife out of the house to socialize for their 62nd anniversary; it's quite the anniversary, he says, and that calls for some adventure.

The representative (you think her name is Jessica) prints off history from the pacemaker and pulls up the current settings. She confirms that yes, it looks like he had a shockable bad rhythm about the time he decided to take his sudden nap, but it had been set to wait to shock a little longer than it should have. She adjusts the time, then frowning, asks him if he's feeling okay. Still smiling, he tells her that her lovely personality is making him lightheaded, that's all, but what else could we expect from a sappy old soul like him? She lightly smiles, but tells him that he might want to brace himself, because he's going to end up getting a shock for the same rhythm.

The jolt takes everyone by surprise, and the smile fades from his face quickly as his entire body stiffens and jerks once with the charge from the pacer. His normal rhythm quickly returns, though when he shakes his head as if to clear it, some of the sparkle is gone from his eyes. You see him gaze behind you, and turn to see his wife attempting to hide tears quietly sneaking down the sides of her face, leaving small traces in her foundation. She shakes her head and quickly tells him off for always making her cry with worry, that in 62 years he can't go a day without doing something to scare the living daylights out of her; he grins like a schoolboy, looking ridiculously pleased with himself.

*  *  *

Hours later, after you've started an IV with medication to prevent further dysrhythmias and shocks from his pacer, the doctor makes rounds, discussing goals with the patient and his wife. No, he is pretty clear, he doesn't want major interventions. 92 years is a long time to have been causing the kind of trouble he has; he's met all 26 of his grandkids and can name each of them; he still has every single model of every train engine that he operated when the train station in town was booming and he first met his wife, and didn't all those models need to go somewhere good soon, anyway?

He sits quietly as he decides firmly to go home once the medication works. His eyes are still bright, though perhaps not quite as bright as that afternoon when he first arrived, hands folded in his lap with the fading sunlight illuminating the myriad of blue veins on his arthritic knuckles. His wife still sits across the room, wiping small tears and shaking her head, though perhaps more in accepting sadness now rather than simple amusement.

After the doctor leaves, you sit and listen to him tell you about the town 60 years before when he met his wife. Wasn't she pretty, working at the switchboard overnight when he drove the trains in? She always wore such lovely dresses, but she'd take her shoes off when he walked her home, and be barefoot in the grass in the summertime. That was when he fell in love, he said, seeing her under the moonlight with bare feet, when the entire rest of the world was sleeping and couldn't interrupt.

He asked her to marry him at 3am one morning when they both were off work, after he'd known her a bare six weeks, because the moon, he said, never lied. And wasn't he right of course, because 62 years later, she still walks barefoot outside under the moon with him and listens for the trains.

*   *   *

You send him home the next day, new medication in hand, after shaking your hand as he takes his cane and walks himself downstairs, refusing the wheelchair because that's only for really old people, after all.

Don't ever let your hands get too hard, he says, grinning once again like a schoolboy, because the world needs more nurses with soft hands to deal with the hard heads of the world like him. You watch as he shuffles out with his wife, still shaking her head behind his hunched back as they disappear around the corner.

You can.

I can't be sure
If you will ever call me yours.
I can't be sure
If you would ever really want to. 

Because I don't know
Exactly what I need
In this moment of ours.
And I don't really know you
At all.

But I know
When your eyes find mine,
Your hands unbury my bones,
This time, for a moment,
I don't mind.

And so you can
Find your release in me.
Stay for the night to ease
That pain.

Use this body of mine
To disguise those faults
For a time.
Bury yourself in this skin
I wear so carefully.

Just for the night, well..
You can.

Dear Patients:

I am your nurse. I am a professional.

I have been trained for years, logged hundreds of hours in the classroom as well as on the floor and in clinical hours, to be able to keep you safe. I have spent many hours critically thinking, soul searching, and personally reflecting to give you the most humane, decent, and respectful experience that you can have at your time of need. I have a vast body of knowledge that I draw from to help me evaluate, anticipate, and act to maintain the best possible outcomes for you.

I don't care what your body looks like. Generally speaking, you have all the same parts as anyone else, your blood is the same color, and you pull your pants on one leg at a time, just like everyone else. You, in the medical sense, are not unique to look at, for the most part. Don't  focus on being embarrassed because very few people have seen you naked except in a sexual sense. It's a difficult thing to get over, this impression that being naked to another person means you need to worry about their sexual attraction to you, but rest assured, it has never and will never cross my mind.

I don't care about your background. I don't care what your orientation is, what your race is, or what you did to land yourself in the hospital bed in my care. To me, you are a human in need of attention, and you have my undivided attention for 13 hours at a time. You have a unique experience as an individual, and while it's scary connecting with someone else who knows everything from your social history to your bowel movements, sometimes that's what you really need to heal and move on to the best outcome.

I am your biggest cheerleader. I will advocate to the doctor for you for pain control, for home health assistance, for entrance into a drug program, or for whatever you need to help you be the best you can be. You likely won't see any of that, but trust that I'm doing it, and trust that I can do it.

I can seem like your biggest obstacle and nuisance. I will make you stand after surgery when you feel like you just want to never move again. I will make you wait for certain foods or force you to go without eating before a procedure to keep you safe during and after that procedure. I will ask you what drugs you've taken, and I won't be fooled when you try to lie. I won't judge you for lying, but I won't let you believe that you are the victim you sometimes believe you are.

Sometimes you'll be frustrated with me. Sometimes I'll be frustrated with you. It's a frustrating experience, to try and be human and find meaningful connections in healing when the rest of society has told us that those connections can't and shouldn't happen unless they encompass other complicated things like sexuality, romance, and love. It's hard to sort out everything amongst fear, pain, and sickness that happens at the worst parts of our lives. It's always just kind of hard.

We're only human, we'll make mistakes. You may leave my care and end up coming back because you couldn't, for whatever reason, manage to take care of yourself. I may sometimes not always be able to get past my own feelings, and have moments where I do not always give you my absolute best. That is our right, as humans, to make those mistakes.

But at the end of the day, I am your nurse. Try to remember all the things about me that don't always get respect, and I will always do my best to remember all the things about you that don't always get respect. We're really just two people, trying to make the best of things, and at the end of the shift, that 13 hours will have made a difference to us both, no matter what happens.

Sincerely,
Your Nurse

The Patient and the Grave

"Student, you do not study to pass the test. You study to prepare for the day when you are the only thing between a patient and the grave." - Mark Reid
--------

One day, you will have a patient that you will keep for weeks from going into that grave. You will see him through multiple bleeds post-operatively related to his cancer and chemotherapy and tissue weakness. You will transfer him from the floor to ICU to step down and back, and you will keep him from that edge, time and time again.

You will keep his blood pressure high enough, his output adequate enough, you will make sure he’s safe walking to the bathroom. You will keep a hawk-eye out for him eating or drinking, making sure he doesn’t aspirate, especially when his newly-established PEG tube feedings start. You will keep his non-skid socks on, keep him in a room across from the ICU nurse’s desk, and always educate and remind him that yes, that button with the nurse’s hat is the button he needs to press for help.

You’ll sit with him for nights in a row, or go in multiple times to help him even when he’s not always assigned to you, and listen to his stories. You’ll get called “darlin’” a whole lot, get some kisses on the hand, and laugh while giving him a hard time about being a “crusty old man who just won’t give up.” You’ll watch him carefully get everyone’s name down on a list, and stay up in his chair for hours, hand-writing cards to everyone on the unit who has taken care of him.

But one night, while you sit in step-down ICU with a new nurse after a stable night with him getting ready to go home the next day, you will suddenly hear him yell for help. You’ll walk in, thinking it’s the urinal again, and you will wonder if you stepped into the wrong room.

There will be blood everywhere, on the wall, on the bed, on the telemetry monitor, the call light, and him. This crusty old man who just won’t give up, will be retching, gurgling, coughing, and hacking up more blood than you’re sure you’ve ever seen in one place, and you will be rather shocked he isn’t swimming in it already. The new nurse you have with you will freeze, and give you the widest eyes she’s probably ever had in her life, and you’ll hope that yours aren’t that big, because you know that you’re it.

You’ll hand her a basin, grab the suction off the wall, double check that yes, he’s a DNR, and start paging everyone you can think off. People will run in and out, trying to help your crusty old man to breathe, and he will look at each one in sheer panic, and continue coughing and gurgling and retching and yelling for help, all while putting out clots the size of softballs and adding enough blood to the floor and your scrubs to make it look like the scene of a horror film.

He’ll make 10 minutes of this before he gradually slows, his efforts to breathe become agonal, and his eyes no longer open to look into yours for reassurance, just down to tiredly spit out more and more blood that still comes. You’ll see that line before the grave come up, and you’ll know that you can’t get him back from the line this time, that nothing you’ll do will bring him back. So you will override some verbal orders for morphine and Valium, and get them into him as quickly as possible, watching his eyes close and his efforts soften as they both hit his system.

15 minutes after you entered the room, he fades away, with three nurses holding his hands and hoping that the Valium they managed to get in did something for him to perhaps not have been quite as panicked. You will look around, and wonder what war zone you’ve managed to find yourself. You’ll start to automatically think of the checklist you now have to do with the body, but you’ll look down one more time at his face, all the wrinkles and the missing teeth and the laugh lines, and you’ll ache so much for someone who did not get to die peacefully.

You’ll also feel with that relief for him, relief for his wife, that she didn’t have to experience what you and all the nurses around you did. You’ll all team up to wipe down the walls, floor, monitors, bed, and him. You’ll pick up the stack of cards, so white and crisp before and now covered with spatters of blood, and you’ll hold them gently and reverently before throwing them into biohazard bags.

You will call his family, finish charting, and make sure everything is taken care of. You will tap the shoulder of that new nurse, and walk with her to the staff bathroom to wash blood and clots off her arms, because she’s apparently forgotten that her arms still existed.

You’ll leave the hospital, and it will be peaceful, pretty even, outside. The sky will be blue, the drive home will be quiet, the world will be moving on. You’ll go home and try to sleep before your next shift, but your dreams will be filled with codes and blood and yelling and panic, and you’ll wake up after three hours and give up on the return to sleep.

Yet you will still show up to work that night, walking slowly past the room that’s now clean and sparkling and no longer smells of iron and copper and death. You’ll start the shift, and it won’t be any different than any other shift.

You will be different, though. Your dreams will be filled with blood and panicked eyes for a long while, and you’ll carry that with you, even though no one else will see it. Your other patients won’t notice, and will make it home, away from their own graves, to stay on earth a bit longer, thanks to your work on that shift.

You will do all that, and you’ll really see, more clearly than anyone, that keeping patients from that gray line isn’t always the most important goal; sometimes, it’s seeing the line coming up and doing everything you can to make that leap off the edge a little bit better than it could have been.

You will feel more than know, as you walk through the beautiful sunshine outside into a world that doesn’t know the death you just faced down, that the power you hold to help someone die is just as beautiful and important as your power to help someone live.

You’re a nurse, and that is, after all, just what nurses do.

[We that used to be]

We lie together in the night
Face to face
Side to side
Heat rising beneath
Our backs.
Groping through the dark
Crying at the climax
Bitter tears blinding
All our lies.

You inside
And nothing to say.

I miss the we
The entity that used to be
The ease of our duality.
Ask me again
Plead into my ear
Let me believe
The we that used to be
Exists still in you
Still in me.

We part gradually
Taking waking slow
My foot in front
And yours behind.
You take your tea
I the morning coffee
Sitting closely
Thighs caressing
And nothing to say.

And there, I dream
Is where we let it be.

I miss the we
The entity that used to be
The ease of our duality.
Ask me again
Oh, plead into my ear
Just let me believe
The we that used to be
Exists ever still in you
Still in me.

I see him behind my eyes
Every time I come
To the edges of your skin
And back again
To the limits of the
Guilts ignored.
The tingling thrill
Of all our sins.

Everything exposed
With nothing to say.

I miss the we
The entity that used to be
The ease of our duality.
Ask me again
Please, plead into my ear
I can’t believe
I won’t believe
The we that used to be
Exists no longer in you
Not still in me.

The last time I saw you

Small hours and moonlit streets
We wandered,
Avoiding going home
Until the sun
Awakened once again.

You bought French fries,
And I stole them,
Secretly
Though I know you saw
And didn't say anything.

The last time I saw you,
My friend
You let me warm my bones
Next to your bones
For a second,
An eternity.

Before I went home
To walls I wouldn't paint,
Furniture that wasn't mine.
A life empty
As the four walls around it.

That last time,
Slightly drunk on the moon
And stars.
I saw those fries
But in that soft light
I saw you, too.

I wish I could see you always
Like the last time I saw you..

When You Send Someone Home to Die

Many hospitals have little cards they send home to patients after they’re discharged, where everyone on the unit or anyone providing care signs with little things like “Good luck!” or “Take care!” Or, a lot of the time, they just write their name and call it good.

But what do you write on the card of the patient that you’re sending home to die? 

You spent hours talking with him at 3am while he told you how he nearly became a professional boxer before a car crash took out his shoulder and forced him into trucking, and about the love of his life, a feisty little Dachshund named Jasmine who was a “one man kinda woman”, and wouldn’t hesitate to serve him divorce papers, if she got the chance.

You chased his blood pressure at 1am with Dopamine, watching like a hawk as it ever so slowly crept back up, watching everything about him even when he was too tired to sit up and stay awake and keep an eye on himself.

You noticed that the as needed Roxicodone made him super drowsy, so initially you considered only the 5mg, but he hadn’t slept in three days because of the pain in his lungs from the cancer, so you gave him the full 10mg when he can have it and listened to him snore the night away. 

He offered you his apple and orange when his appetite for dinner never really came, because he noticed you sitting the other night charting without food, and wanted you to have food while you had to be stuck in front of the computer.

He told you a few times that your husband was a lucky man, and spent the night ending every thank you with very genuine “darling”, “dear”, and “sweetheart”.

 You know he’s going home with hospice care to a house with no family, his neighbors are his power of attorney because he doesn’t have family, and he’ll barely have enough money to get his new prescriptions for Oxycontin IR. The discharge papers given him less than six months to live, if that. 

You’re happy, in a way, knowing he’ll be able to go home, in his own bed, with his best girl at his side, and not have to die alone surrounded by cold machinery at the hospital. You’re relieved, knowing he won’t have to suffer that.

But you still don’t know what to write on that card, how to sum up a lifetime and no time at all within four white corners. 

And really, you probably never will.