One Day at a Time

I’m a new nurse.

I have to keep reminding myself of this. I’m new. I’m going to make mistakes.

Thankfully, none of my mistakes have resulted in adverse patient reactions. I haven’t overdosed anyone on their narcotic pain medication. If my assessment found an abnormality or something new, I reported it.

But I’ve been late on timed lab draws. I didn’t get a “Keep Vein Open” order with a patient controlled analgesia (PCA). I charted something on a patient, only to realize after signing that it was the wrong patient. And I’ve certainly handled a few interactions with less grace and clinical judgment than I would like.

I hate making mistakes; I hate knowing that I’ve failed or been under par. I worry that I will never get this nursing thing figured out. It’s these days that I cry.

But after a day or two off, I pull myself back together. Double check my care plan, make my list, and set out to improve one patient at a time.

And then I come home. And I’m new to marriage as well. We’re both new spouses. We’re going to make mistakes.

Some days, he’s helpful and a wonderful shoulder to cry on when work goes horribly wrong. Other days, he doesn’t see that I’m tired and asks for my help with tasks that, in my opinion, he should be able to figure out by himself so that I can sleep. There have been times where we are both oblivious to the ways we hurt each other. And then when the courage is mustered up to say, “____ really hurt,” it isn’t met with the response wanted but with more fuel for the fire.

Then the time comes where we say, “I’m sorry. Forgive me,” and keep working on this one day at a time.

When The End Comes

Sorry that I’ve been absent for so long. There has been so much to juggle the past few months, and since I have a few people with whom I can verbally process my life, I guess blogging hasn’t been a top priority. I have plans to fill in some of my thoughts and experiences from the summer, but they will have to wait.

The reason for this entry, however, is that last night I received word from Stewie that The Brain finished his battle/war with ALS.

While I hate that a terrible disease has taken yet another person in such a cruel way, my emotion is not so much based on anger or depression or bitterness. I am actually relieved to know that he fought his battle in the only way he could and was able to let go. I am relieved to know that Stewie will have the opportunity to sleep through the night for the first time in over 2 years. I am relieved to know that The Brain was able to let go of this life and not give up hope.

I’m sure there will be more writings and musings of my grieving. But they will be dampened as I do not feel my life will make as much of an adjustment compared with others.

I have been struck the past few months in how complete the prayers of Orthodoxy are for the human experience. When we let go of our pride that says only extemporaneous or spontaneous prayers are best, we find a vast wealth of wisdom. So, I leave you with several of the prayers available in the Orthodox Prayer Book published by Holy Protection Monastery in Colorado (aka “The Blue Romanian Prayer Book”)

Oh good Lord, remember Your servant(s) _______ and forgive them all in which they have transgressed in their lives, for only You are without sin and can grant rest to the departed. In Your divine wisdom and love for mankind, You bestow all things and provide for all the needs of man. O Creator, rest the souls of Your servants _____ who have placed their hope in You, O Lord, the Fashioner, the Creator and our God. Amont the saints, O Christ, rest the souls of Your servants where there is neither pain nor grief nor sighing, but life everlasting.

In one of my conversations with The Brain before I left for nursing school, he expressed to me his fear of being forgotten after his death. So, I now can pray the words I reassured to him that day: Memory eternal.

 

Complimenting the Choir

I have sung at the chanter’s stand and choir for about 5 years non-stop. In high school and college, my church and campus ministry had a rotation for people in the worship band or praise team, so there was no need for me to make a weekly commitment. Save August 2009, December 2011, and a few random Sundays of illness, I spend services as a choir member…or at some services, I AM the choir.

Yesterday, I got two lovely compliments that encouraged me more than any others combined. It was the Feast of the Dormition of The Mother of God, which is  the last major feast of the church year. Beautiful hymns encourage Christians to prayer. While in line to receive a blessing at the end, a woman approached me. “Your voice is so beautiful. It helped me to pray today. Thank you.

After the pitch-in breakfast, a man approached me as I got up to leave. “Thank you for singing today. It lifted us all up [to heaven].”

I had enjoyed Vigil the night before and Liturgy yesterday morning – the people I was singing with were on pitch and we could trade harmonizing ad lib. As a musician, those are the service moments you love. When you aren’t just singing but making music and able to have a few moments of prayer yourself.

Many a dissertation is written on Orthodox services, and I have a very simple understanding of them. I can say, however, that the reason Orthodox Christians gather is to pray. Liturgy is a prayer. Vespers, Vigil, and all other daily services are for prayer. Everything in an Orthodox church is a call to prayer and to see as best we can with earthly eyes and hearts the Glory of God.

Yet, when you sing in the choir, you give up that freedom to pray. I have experienced so many, Orthodox or not, who view the choir or worship leaders as “untouchables” or that the work of a musician is so much more honorable than they in the crowd. My voice being audible during the service in NO WAY makes me amazing and you liturgical dust.

Complimenting your choir member or director with a “woe is me” or “Gosh, you’re important” tone is flawed. Please stop doing that.

The choir members have given up their freedom to pray because we have to think about other things – like staying in tune. This also goes for the opposite – to “mentally check-out” during a service is disastrous. And because Orthodoxy involves the body, we also give up the freedom to prostrate, bow, or even bless ourselves without whacking our hand or forehead on a music stand.

God has given us a gift. We are to use it, and most of us do with glad hearts! But it does not come without sacrifice. Knowing that you were able to pray makes my sacrifice worth it.

I have had people compliment my voice after it has sung both the sacred and secular. Very few have gone to say how it has moved them to better prayer. That sufficiently humbled me to know they were praying as I was singing yet thinking about whether or not I chose the most comfortable shoes for a 3-hour service.

When The End is Near

The past two weeks The Brain has been in rapid decline. I am thankful I was able to see him over Memorial Day when an hour-long conversation did not take all his energy for the day. Besides, since last Thanksgiving, I try to do most of the talking. He has recently consented to swapping out his usual king-sized mattress for a hospital bed and does not balk at any medication interventions to control secretions or pain. From what I read in updates, he is not uncomfortable but there is a huge battle with peripheral edema that refuses to go down. Edema, or swelling, is a sign that the kidneys are not motivated to keep filtering the extra water and usual waste products out of the body.

We talked about ALS our last day of lecture in Med-Surg 2 along with other “chronic neurological disorders.” I had to work hard to not dominate the discussion. The question was posed to the class, “What do you tell a patient who asks you if there is a cure for ALS?”

Under my breath I muttered, “You tell them to plan their last vacation.”

When going over some of the collaborative care for ALS, a group recommended Physical Therapy along with some other options. I spoke up and said that physical therapy is good, but the patient is not going to improve over time. Rather, massage therapy might be better as it had been beneficial for The Brain. Unused muscles cramp up and become rigid; if the patient will allow a massage therapist to work with the muscles early on, the later neuropathy due to muscle atrophy is greatly reduced. Having helped multiple people move or even roll in bed, those with loose muscles are MUCH easier than those with rigid and spastic muscles.

As I said earlier, hospice nursing is different. You know that your patient will not beat their disease or win the battle with their body. I knew when I first started working for The Brain and Stewie that there would be an end; I just didn’t know if I would be working for them when it came.

My prayer has not changed nor has my view of reality to the situation. Reality is merely coming into focus more clearly, along with the true reality that we are all given the gift of our lives, and we get to share those with others. I am continually thankful for Stewie and The Brain sharing theirs with me, even as ALS is sneaking around the back for its last hurrah.

Thus, as always, Lord have mercy.

Bullied: Part 1

Do you remember the first time you saw yourself in the mirror and finally had a shred of hope that you just might be physically attractive and desirable? That you were not the despicable and horrible human that others kept saying you were for so long?

It was the summer I turned 15; my family had moved back to Kansas the previous year after 6 ½ in South Dakota. While I had a minor disappointment with a boy the past year, I had been getting some attention from others and had successes in extra-curricular activities about my confidence. I was uncertain on what to do with compliments. If I said “Thank you,” I feared I would look like a snob, but if I ignored them, it would be rude. I think I usually stammered or tried to shrug things off.

It was a day I had very little planned. I was still in my PJs at the breakfast table when my brother came from the basement. He thought I was wearing a casual sundress for the day and is a pretty cool guy when it comes to his sisters. He asked, “Where did you get that dress?” in the way that men from my family say with uncertainty on how to word a compliment, yet in a way that the women know the men noticed.

“Um, Jeff, these are my PJs.”

Him: “Oh.”

After that comment and finishing breakfast, I walked back to my room to change into my real clothes for the day. At the end of the short, narrow hallway was an oval mirror. I caught a glimpse I had never considered before. It wasn’t an imaginary catwalk to my room, or a trial run of how I would saunter through The Mall. Just enough of a second glance to where I could say, “Maybe I’m not fat and ugly.” My self-esteem and self-perception were still hovering above empty, but there was something about those 10 feet down the hall that gave me hope. Not everyone was out to be better than me. My obvious features of height and hips were not necessarily a negative. And maybe my acne-prone face and shoulders weren’t as horrible as others made it seem.

I still had plenty of emotional breakdowns between that moment and now. I still considered shopping a war and personal assault. The number on the size was all-important as to how I felt about myself for the next month or so.  Some hurts have scabbed over, yet I’m reminded of their scars at the most random times. Just when I think that I’ve answered all the questions and satiated the emotional holes left from my middle school years, the emptiness slinks in the cracks on bad days.

The mid-90s seemed more concerned with sexual harassment and whether or not kids knew about HIV transmission. The line between “kids being kids” and bullying had not gotten the attention of the past 10 years. Sometimes I wonder how I would feel if I could have stood up for myself in the schoolyard. What if one day I would have just punched someone in the face? What if I could sue for the therapy bills not covered by insurance? What if I had taken a few more sick days or convinced my parents to get me out of that school?

What happened cannot be changed. But I have hope. Not because I saw myself as pretty one summer day, half my life ago.

Because I’m learning to forgive people that I will never see again and who will never know how deeply their words cut to my heart. Because I can look at the world around and know that God created things that are good. Because I am to look and myself and say that I am the chief of sinners and forgive others’ trespasses, debts, and sins.

It is not easy, nor should anyone be demanded to produce these results overnight. Be filled with Truth to combat the lies. That is the first step. The other steps will follow, but always seek Truth.

Hospice Nursing

We knew the discussion was coming based on our pre-class preparation videos.

My group was having a discussion on end-of-life care and how hospice nursing is different than other kinds of nursing. We delved into the ethics of giving morphine or other comfort measures that may or may not drop our patient’s O2 saturation lower. I was of the few students who had experience with hospice care and nursing. Caring for The Brain had been most of my formative hospice experience, however, I have had other family members in hospice care and a good friend described her experience with hospice in relation to her mother’s illness.

Hospice nursing is different.

Your patient will not get better. He/She will not walk out of the facility or their home cured and on the path to wellness. “Wellness”, for a hospice patient, is more based on their comfort and whether or not there is peace at the end of life. You meet amazing people with interesting lives, yet you are usually meeting them at the end of their life’s journey.

In describing the above, and using almost the exact words, I teared and choked up in front of my colleagues. I thought of The Brain and my aunt and my grandma.

It’s easy to feel defeated on the floors as a nurse – I didn’t get patient medications on time, I failed to call the nurse or someone about the patient, the patient did not get to walk exactly when s/he called for me, the patient bathed 2 hours after s/he asked for a set up because I was held up in other patient rooms or needing to get vital signs on everyone before the next rounds.

But how does a hospice nurse not feel defeated? Every patient is choosing to stop life-prolonging measures and has, to some degree, accepted death as the resolution to their disease. It is a different form of nursing to know that you have helped your patient live well and provided them with comfort and anxiety relief. You have given the patient utmost consideration, care, dignity and security. You assure them that their body will be treated respectfully when they pass away.

And until those final moments, you share memories. You swap recipes for favorite meals. You hear about the patient’s life, passion, and wishes for care. You look at their choice for a casket or urn. You ask what they need and what the family and caregivers need. You are a nurse that stares death in the face and tells it that just because it is lingering does not mean there is fear.

Criticism and Failure

The past two months, I’ve had a multitude of opportunities to fail and/or receive criticism in various situations. Work, school, home…and on really good days, I have received it in more than one place!

failureI do wish I actually had some words of wisdom to pass along for those of you who feel down due to your professional or personal shortfalls. Wouldn’t it be lovely if, in the multitude of personality inventories, we were also given hints on how we best receive confrontation and others noticing our flaws.

The word “failure” seems so final. Maybe because it’s associated with tests and information that you’ll never see again. You have no other opportunity to prove yourself capable. Situations are eased if you can call something a flaw, short-coming, fault – but never failure.

Some things, such as burnt cookies, I can look at and say, “It’s fixable. No one got hurt.” But if I make a mistake at work, I might not be told about it in front of a patient, but I do have to make it right and go back in their room to do whatever is needed. Or I need to come back later and fix charting, etc.  And it always seems that all my mistakes happen with one patient or one nurse each shift.

Then there’s school. I have yet to “bomb” a test, but there have been many times that I did not process the material well enough to get the grade I wanted. Or I didn’t do my paperwork well enough. There’s definitely an internal pressure that I have to make nursing work. I should be a good nurse. Good nurses are good students. Well, I haven’t exactly felt like a stellar student this semester. I love the patient interaction. I loathe the books. But I need the books to improve my patient interaction.

And at home, when I’m forgetful of my jobs and duties, I want to make excuses or cower in my room, fearful of others’ disapproval until I can prove that I am responsible. Well, at least until the next time I royally screw up.

With both self-imposed and other-imposed expectations, it’s been rather rough. Then to top it off, my finals week coincided with Holy Week. Great. Now I’m academically and spiritually mediocre.

I needed Pascha. Not just so Lent and the fasting could end. Rather, I needed to reminder that everyone needs to come to Pascha. The point of Pascha is to celebrate our Hope that Christ has Risen, He has defeated Death. No one, not even the strictest of monastics “does Lent well.” Regardless of your short-comings, your faults, your lack of virtue or sense, your failures – you come and receive the light.

I fear how many times I will need this lesson re-taught to me. Yet, thankful that God’s grace and mercy will be a constant presence as I am criticized or as I fail. It won’t be pretty. It will never give me a feeling of “Joyous day that I am told how I let someone down!” But I’ll take what I need to the cross and rest in the Hope of Christ.

What I Miss from My Protestant Days

So, it’s the week before Easter! (I love saying that to make people’s heads turn!) Yes, it’s one of those years that “Greek” Easter is WAY late. Oh well.

As I was experiencing Palm Sunday on April 28, I realized something for the first time since converting: There is only one thing I miss from my Protestant experience. Being a pesky convert to Orthodox Christianity, I have 25+ years of low-church Protestantism to frame my religious education and lay theological training. When I was still in my inquiry and catechism into Orthodoxy, I was answering a lot of questions from concerned Protestants, such as:

  • Now that he’s dumped you, will you still go to the Orthodox church?
  • Do you feel God is less approachable in prayer?
  • Where is ____ in the Bible?
  • Are the Orthodox Calvinists?

I attempted to answer these and many others with as much sense and grace as possible. I don’t miss the debates over Predestination/Calvinism vs. Free Will/Armenian. I don’t miss how some churches try to spice up their church service with new stage lights, decorations, a sermon series or bible study on the most recently published book, etc. I don’t miss the sanctuary being renamed to “Big Church” or “The Auditorium” or “God’s House” etc. I don’t miss the debates over “seeker sensitive” vs. “feeding the sheep.”

I definitely do not miss “P&W time” that is filled with repetitive words and bland music. (This will be its own post in the future).

I miss having a cup of coffee and breakfast before going to church.

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Especially this last Sunday, I was seriously wanting pancakes and coffee with real cream. Between all the times I sang, “Lord, have mercy” or “Grant this, O Lord” and the longer hymns – I kept trying to focus on Christ triumphantly entering Jerusalem, “Hosanna in the Highest” … Coffee. Pancakes with eggs over easy.

For those of you unaware as to why this is a craving: If an Orthodox Christian is to partake of communion, he/she is to fast from bedtime/midnight until partaking of communion during Liturgy. There are other fasting guidelines during Lent, however, it still stays that if you are going to take communion, you should fast the night before and morning of. Some mornings, I feel fine. I make it through everything no complaint. Other mornings, there is a twinge, but I power through. The mornings like this past Sunday – I got to experience the grace of God and know that in my weakness he is strong. Mind you, I wasn’t all happy about this.

I was hungry. My back and knees hurt. (Lord, have mercy) I was sore. (Lord, have mercy) I was tired.  (Oh, thank God! We’re at the Creed.) I wanted nothing more than to cry and whine (When will I ever get to be parishioner that can sit whenever I want). My throat is drying out. (My help comes from the Lord who made heaven and earth.)

Yet, even on these “bad days” where I long for my simple cup of coffee with a crossword before church, I’m reminded that my inner struggle is exactly why I need The Orthodox Church. One of the prayers for the Eucharist (Communion) asks that it be given to each according to his need. As I partake, I’m reminded again that the Eucharist is given “for the remission of sins and everlasting life.”

Some days, my prayer is that Christ continue to refine me. Show me where I need to forgive and love more. Other days, my prayer is that I be reminded that I need Christ more than coffee and comfortable Sunday mornings.

Fortune Cookie Predicts Lent

Today, I attended a Health Literacy in-service. While there are plenty of things I could blog about from my 6.25 contact education hours, I would like to focus on my fortune from lunch.

A WISH WILL BE GRANTED AFTER A LONG DELAY.

I didn’t think that Chinese restaurants and fortune cookie companies knew about Lent. I have been wishing intently for cheese and meat and bacon and… …

6-ish weeks of Lent. Yep, I’d say that’s a long delay.

Still Going, Still Waiting

I woke up Saturday morning thinking about The Brain and Stewie. It has been a while since I wrote an update on his condition and life in their house. Stewie keeps me and a few other close friends posted on their daily activities and The Brain’s downward progress. Until medical research gives the world another picture of disease progression, there’s only one way for a person with ALS to progress  – downhill.

Saturday, shortly after I woke up, I thought of The Brain and all that has changed for him and Stewie since I left them in August. And I finally did something I’ve been needing to for about a month – I cried. The Brain is such a fighter, and if it weren’t for BiPAP machines that help him breathe, I am certain he would not still be alive. The news of this last week is that The Brain is losing more control over the last of his voluntary muscular functions (I’m toning this down for those of you more squeamish). He’s also battling over-production of saliva along with less ability to swallow. The risk of him falling out of equipment to help transfer him in and out of his wheelchair grows everyday. What he can eat without choking is a dwindling list. When he sleeps, his breathing pattern changes.

Someone asked me recently what I thought his timeline was, beings that The Brain has outlived every one of my guesses. I could only respond by saying the disease is a waiting game. Lungs with less than 10% of their usual function that are hardening will eventually stop oxygenating his body. For now, only one day at a time.

I’m heavily distracted tonight. Some of it is Lent (Remember, I’m Orthodox. Easter/Pascha hasn’t happened yet). Some of it is school – Oh, the guilt of my studying doused with heavy distractions never being enough. But I know part of my mind-wandering is The Brain and wondering how he is really doing.

How odd to be in the midst of Lent with The Brain and Stewie always in the back of my mind. This is a time of spiritual refocusing that culminates in the proclamation that “CHRIST IS RISEN FROM THE DEAD TRAMPLING DOWN DEATH BY DEATH. AND UPON THOSE IN THE TOMBS BESTOWING LIFE!” So, here I am to be celebrating the Risen Christ and the Hope he gives us over death, yet, each day greets The Brain with the reality that he is closer to death. While each of us is closer everyday, how much more sobering to see a person for whom it is a present reality rather than a passing thought.

During the Paschal service, we are reminded of the power of our Hope in Christ. “O Death, where is thy sting? O Hell, where is thy victory?”

It still doesn’t mean that while The Brain is alive I don’t feel the sting of his or Stewie’s suffering.

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