musings

[ohhhhmycat]

stranger from afar

the paramedics scrambled out of their trucks with their equipment, where you waited for them, alone and scared, aware of your body giving into the earth. crowds gathered around and stared as they started compressions and giving you slow breaths of oxygen. someone shakes their head and murmurs a prayer for you.

they work on you for what seems like hours, hoping that you respond. but your frail body moves up and down with their hands, and bones probably begin to crack. your body screams enough, but they try because every life is a life worth saving.

minutes pass and they eventually stop. time of death is pronounced and they slowly cover your body with a blanket. crowds dissipate and although hearts hurt, no tears are shed.

another heartless day at the job? no, we force ourselves to become numb to protect ourselves and the future people we serve. this is the psychological trauma that is buried in the very back of our heads, locked away with a key that can hopefully never be found.

but we do not forget. because every life is a life worth saving. and every life is a life worth remembering.

rest in peace, stranger.

[ohhhhmycat]

this september, while healthy children put on their backpacks with their newly purchased stationery, please remember the little warriors who cannot attend school because they are bravely fighting their battles with cancer. please remember the families who coexist with their cancers, and cannot and do not get to clock in and out of the oncology world every day. 

september is childhood cancer awareness month. nobody wants to think of beautiful children having horrific, ugly diseases. nobody wants to know that these children suffer through gruesome treatments and sometimes aren’t cured. but people need to know, because children deserve better than 4% of medical funding and research. please remember and help join the fight. hug your loved ones and keep them close.

[ohhhhmycat]

100-something days of hope, suffering, triumph, and despair.

one initial diagnosis. two transplants. three life altering moments. this was not supposed to be the way you were supposed to leave us. we were to cheer you on and congratulate you with a medal of honour, the same as the other countless children who had been transplanted before you. this was supposed to be a miraculous, albeit risky, procedure to save your life.

as your parents walked towards us with bloodshot eyes and heavy hearts, no doubt from grieving all week long, my heart broke and tears began to stream. despite my best intentions, i fell apart against my own will. we hugged and sobbed together while others walked down their own paths, their own journeys, unbeknownst to what was happening in 105.

you and your family left without saying goodbye, and maybe it was for the best. i’m not sure if i would have had strength to carry on.

i have seen miracles happen before. and i pray for one for you and your darling family. but pessimistically and perhaps realistically, i know that a cure is not feasible. so if it is not possible, i pray for an easy passage and for you and your loved ones to meet again soon. i know they will spend the rest of their lives waiting for that moment.

good bye sweet baby girl.

[ohhhhmycat]

“bad things happen to good people, and it’s okay to cry about it.”

believe it or not, i mourn alongside you and your family every second of the way. i grieve the losses with you; the loss of your childhood, the loss of your innocence, the loss of what used to be “normal”. my soul aches when i cannot offer you what you so desperately want and need.

the problem with being a health care professional who is caring for a multitude of patients is that i cannot carry that burden to the next patient. i cannot weep on your behalf in the next room. i cannot expose my heavy heart anywhere else because i need to carry on for the next 12 hours. so i stay brave and i hold those feelings close to my heart and guard them so no one can see them. but those emotions i try so hard to stamp out eventually come flooding out because it is sometimes just too heavy to bear.

unexpected death is heartbreaking.

[ohhhhmycat]

thank you

we don’t expect fanfare, let alone gifts as signs of appreciation. gratitude is expressed few and far between. we are public servants who tend to the ailing and injured, and we are expected to graciously and nobly carry on our daily work as our duty to the public. we are more than willing to accept this role because it is ingrained in our souls to be detail oriented caretakers. intelligent healers. critical thinking nurses. but to be stopped and truly thanked once in awhile: what a feeling. what a rejuvenation. what a meaningful and soul filling moment.

thank you for reminding me what it feels like to be appreciated.

[ohhhhmycat]

toxicities

every day, we practice our golden rule and number one principle in health care: primum non nocere. first, do no harm. we are cautious and make sure that unwanted outcomes that occur with our medical interventions don’t happen, and if they do, we identify them and we put plans into action to fix them immediately. we are constantly monitoring to prevent things like drug toxicities, but what about our personal environmental toxicities in the work place? why can we focus on our patients and provide the best care that we can to them, but we can’t provide the same courtesy to our colleagues? why is it more difficult for us to identify and target what is going on with us as nurses?

toxicity is defined as the degree in which a substance can harm an organism. when emotions run high and we are overworked, stressed, and fatigued, we become less considerate of others. we can become less compassionate and more judgmental. we instinctually change our frame of minds to a survival mindset, where we must protect ourselves. we look out for ourselves and we make sure we do everything possible to stay afloat and alive. we focus on “me”. unfortunately, sometimes, these can lead to negative actions, which in turn, can create negative consequences.

when factors of workplace toxicity such as gossiping, challenging each other with negative feedback, and petty internal politics occur, we hurt each other (hopefully) unintentionally. we become even more stressed out and even more fatigued, and it becomes a negative cyclical force that is difficult to stop.

but as health care providers, we should be constantly monitoring ourselves and our colleagues, and putting positive plans into action to fix our negative problems. we should be stepping up and working together, constructively. we should be doing what we do best: caring. so what happens when we don’t? how do we fix it?

i don’t know what the answer is to that, or if there’s even a singular answer to it. i don’t know if i’ll ever know the answer to fix it all, but i know we can all practice mindfulness and courtesy to our colleagues, friends, and even people we dislike.

please be the humanizing factor in a dehumanizing society.

[ohhhhmycat]

who’s responsible for teaching young mothers how to walk out of the hospital for the first time without their child in tow? which textbook are you supposed to read that explains how to deal with the grief of spending the first night alone in your house because your son has passed away? what guidance are you supposed to follow in making the toughest decisions for another human being - to keep someone alive or not? to sign that do not resuscitate form? to ultimately decide whether to let them suffer by trying to prolong their life because of your own personal wishes, or to accept the inevitable fact of life, and let them pass away as comfortable as possible?

how are you supposed to grieve as a health care provider when things like this happen?

[ohhhhmycat]

there’s a reason why i don’t normally watch medical dramas on television; they are unrealistic portrayals of the health care system that leave out fundamental parts of the organization, and glorify other parts to a whole other level. on occasion though, i do watch an episode here and there. and unfortunately, every single time, something can make my blood boil.

cue grey’s anatomy tonight where a certain african-american physician states that it is difficult being a black woman in this modern day “culturally tolerant” world, let alone the medical profession. it is difficult because when she boards her flight as a first class customer, she is automatically told that coach is not boarding yet. that she is not as well educated as her other white counterparts working in the hospital, especially if they are males. that she is automatically considered a nurse and never a physician. and the tone that she uses when she states this last comment clearly tells us as viewers that it is the last straw: to be called a nurse is absolutely offensive and despicable to her. 

wait, wait, wait, now. hold on. excuse me? can we please take a step back here in her monologue, and focus on the part where being a nurse is a second class profession and career choice in comparison to a physician?

let me tell you that i chose not to become a physician for multiple reasons. it’s not because i wasn’t smart enough, or that i didn’t want to spend that much time in post secondary school, or that i thought it was for males only. i became a nurse because a nurse is an integral part of the health care system. i became a nurse because nurses are the eyes, ears, hands, and feet of every other single health care professional, and they rely on our assessments, judgment, and knowledge very heavily to do their jobs properly. i became a nurse because i wanted to be the one forming a therapeutic relationship with my patient when i was caring for them, at all times of the day. 

i wish young adults would stop relying on medical dramas and physically step inside a real life, functioning and thriving hospital to see every nook and cranny, before deciding on becoming a physician. it might surprise them to realize that the interpersonal connections that you form with patients when dispensing medications or performing vital signs happen when you’re a nurse, because these are some of the basic skills a nurse performs every single day. not a physician, social worker, or physiotherapist. but what can i expect from a show that has no nurses present?

[ohhhhmycat]

oh baby jesus, i’m in a torture chamber

sometimes when you have a 6 year old screaming at the top of their lungs, “oh baby jesus, i’m in a torture chamber” because you’re trying to give them a bath, there is nothing else to do but laugh.

and sometimes we need that absurdness, laughter, and hilarity to help us break up the bleakness when we are constantly surrounded by grief and loss, and our shoulders are dragged down by the weight of everything. with no further context, you may find that it is absolutely inappropriate to laugh at this (and other matters) and it may even be insensitive and crude! but laughter is laughter and laughter is good for the soul.

so laugh away, as long as it’s not at the expense of others.

[ohhhhmycat]

rest easy, beautiful

"do you ever think about patients at home?"

i read about your death through the magic of social media today, and was utterly heartbroken. we had known that it was coming, but that didn’t make the news any less surprising or less painful. and then the first thing i thought about was the abovementioned question that your sweet mother asked me one night.

nurses are given the incredible privilege of caring for and being involved with patients during the most intimate and vulnerable times in their lives. we spend entire days and nights serving and caring for people who are sick, and if we are lucky, we are able to build rapport and form positive relationships with them. we spend so much time together, that we are thrilled and are the first ones by your side to celebrate your triumphs and victories, and we hurt and suffer alongside you when you are in pain and are suffering. we breathe sighs of relief when tests, procedures, and treatment go well, and we ache and cry when we hear unwanted news. we get to know your siblings, parents, and grandparents, and you come to know us as people instead of just staff members.

fortunately and unfortunately, nursing is not a profession where you can leave your work at your office desk for tomorrow, the next week, or the next month. it is not something that you can switch off like a light. although we sanitize our stethoscopes and shoes, toss our scrubs to wash, and leave our charting at the hospital, we bring our thoughts and memories home. we wonder if you are having a good day: pain free, nausea free, and anxiety free. we wonder if you are sad or lonely during your nights alone in your room. we wonder if you had a great holiday break away from the hospital, surrounded with your love ones. it is not that easy to forget you... nor would i want to.

so the answer is yes, i think about my patients at home. i hope your sweet parents realize how much we loved and cared for you, and i hope they can be comforted by that. i hope that you are safe and sound now, wherever you are. i hope you are comfortable and free. and i hope that the burdens that were forced upon your shoulders, nine months ago, have been lifted. rest in peace, beautiful.

[ohhhhmycat]

self care

regardless of who you are, what you do, and whatever circumstances that you’re in: please remember to take care of yourself. please remember to take a step back once in awhile, even if it can only be a quick breath of fresh air outside. please remember to treat yourself to a vacation every now and then, because you deserve to rest and relax.

it’s a lot easier to care for others when you’ve cared for yourself. 

[ohhhhmycat]

you read letters, blogs, and feature stories on the news, all depicting the treacherous journeys that people must go through when they're diagnosed and fighting cancer. there are love stories that end tragically, children and parents losing one another, and families broken apart, and i don't blame people when they tell me that what i do for a living is, "so sad", or if they ask me, "how do you do it? i don't think i could". and every sad story that doesn't end the way we want it to tears at my heart and numbs my soul, regardless if i know the person or not. but i remember that there are hundreds of beautiful people who are cured and saved by the thousands of health care professionals who must do it. i remember that there is beauty in all of this, even when it looks like it's covered in thorns. i remember that there are scientific advances every single day, hoping to find a guaranteed cure, instead of what may be just a potential treatment. and that's how i do it.

[ohhhhmycat]

when nothing goes right

when everything i do to treat your son is wrong in your eyes, it is absolutely awful and it makes me feel miserable and hollow, down to my very core. believe me, i am the first person who wants to make the situation better so your child is as comfortable as he can be, so the two of you can finally rest and breathe. i am the last person who wants to inflict pain or harm to your child. but i am not a mind reader. i cannot tell that you want me to align your son's intravenous tubing lines against the crib rails, unless you let me know. i cannot predict where your son's nasogastric tube is precisely and protect your son from pulling it, when it is hidden away and covered by a blanket by you. i cannot anticipate when or how you want me to reposition or change your child, to your standards, when you don't tell me or care for him yourself because you are terrified of touching him. and i cannot care for your child safely and ensure that he is still breathing and that his heart is still beating when you don't let me monitor him. it is contradictory and confusing for health care professionals when you state that you want your son to be cared for in the hospital instead of at home or a palliative setting, but refuse care. i am trying. i am honestly trying as hard as i can. but it is not my fault that i am not able to be the nurse that i want to be with your child, when everything i do is wrong.

[ohhhhmycat]

90%

what are you supposed to say to someone when they were originally given the prognosis of a 90% survival rate, and after failing treatment twice, there are no other options? that you are the 10% that will not survive? 90%. a number that sounds like a promising statistic, a small beacon of light and hope when you are trapped in a landslide, drowning, and crying for help. but 90% is such a meaningless, arbitrary number, when you aren't guaranteed that you will be in that 90%. 

[ohhhhmycat]

over one and a half years ago, you were admitted with indescribable flank pain. your parents stood by you terrified by the confirmed results, while we started chemotherapy treatment on you immediately. your father showed me photos of the gorgeous, dark black locks of hair that you were born with. the natural curls that fell by your shoulders; a mini teenage-heartthrob in the making. i confirmed that your hair would thin and fall out, and there was the high possibility that you would be bald during treatment. your father had tears in his eyes and shaved his head in solidarity. your mother wept in pain and sorrow, and she shared her fears of how she wasn't sure that you were going to make it through this. how your family wasn't going to make it through this.

i remember telling your parents that this would be one of the most difficult times in your, and their, lives. that it would be terrifying and difficult, and that the hours would extend into days, and the days would blend in together. i remember telling them that we would work together every step of the way to cure you, that you would never be alone, and that we were available to help 24/7. that we would keep you comfortable in our vastly large selection of medications and complementary, therapeutic treatments.

you tolerated your first round of treatment well and were given the thumbs up to have the remainder of your treatment in the outpatient clinic. you left the ward before i could say good bye, and i didn't expect to see you again.

yesterday, you walked in to our unit for a quick visit with your family. your parents lit up when they saw my face and the emphasis on "it's so good to see you" warmed my heart. your parents informed me enthusiastically of how your most recent post treatment scans were all clear, and that your disease was gone. your nephrectomy went amazingly well; they were able to preserve so much more than they anticipated. you went on your make-a-wish trip to disneyworld and saw all your favourite characters. you hid behind your mother shyly, while we laughed about how your golden brown locks of curls were down to your shoulders again. a mini-heartthrob in the making.

i felt blessed to be able to see you and your family. it was a beautiful reminder that there is good in all this evil.

[ohhhhmycat]

angel

i remember the night that you arrived, 20 minutes before i was supposed to be leaving for my break. you brushed the rain off of your pink petticoat, and removed it to reveal a white, full dress. your long dark hair fell against your smooth, white skin. you were a beautiful porcelain doll. you settled into your small room and fell asleep immediately, while i showed your mother a tour of the unit. i remember her nodding numbly, unable to speak, unable to grasp the long journey ahead of you.

i remember when you would sit in your bed, in your beautiful pink and purple dresses, painting and making colourful crafts one moment and then bouncing off to the playroom the next. you refused anti-emetics when you were starting to feel nauseous, and denied anti-pruritics when you were feeling itchy. you were a stoic child who didn't believe in drugs. you wanted to fight everything off naturally, by yourself. you were determined to win the fight. myelodysplastic syndrome and acute myeloid leukemia would not overcome you.

i remember the days that you watched your favourite movie on repeat. hours would extend on to days and you would lay in bed, closing your eyes, listening to your favourite characters navigate through their icy expedition. the cancer was attacking viciously and your family was preparing to venture through your own dangerous journey. 

i remember when you were transferred into the isolation room where you would receive your bone marrow transplant; the same room you were first admitted to. you received your treatment silently, without asking for any of it. anti-rejection drug after anti-rejection drug, you struggled and developed graft versus host disease in multiple organs. i watched you fight from afar, and it looked grim. but the day came where your bone marrow started to develop its first neutrophils! magical neutrophils that would help your immune system grow and flourish. it was the first time that we thought we saw the light at the end of the tunnel.

i remember when you were moved into a "bigger and better" room, as you didn't have to be isolated anymore. the blinds were drawn down to eliminate any light. the arts, crafts, and toys were untouched in their packages in your room. you asked for silence, while you were clenching your stomach, bending yourself in unrecognizable and unmimicable poses to help alleviate the pain that nothing else would or could. you requested anything and everything to take all of this away. your face was gaunt and your body, thin and frail.

and i remember the last time i saw you and cared for you. you had relapsed and your family didn't want to alarm you with the news. we focused on keeping you comfortable and at peace. it was a beautiful wednesday sunny day; your pain was well controlled and you wanted to leave your room for the first time in weeks. i dropped everything i had to do to be with you, to do whatever you pleased. you smiled and we walked slowly, and even though you didn't physically end up with anything, you seemed satisfied with the journey. i was convinced that you were feeling better, that your body was feeling better, and perhaps, there would be a miracle.

i remember the shock and utter disbelief that filled my heart when i heard of your passing, days later. what are you supposed to think, feel, or say when something that was expected to happen, happens unexpectedly? what are you supposed to do when a young person loses their battle against cancer, and her family is lost and empty? this is the hardest part of my job. i can usually compartmentalize different emotions and remove them from my immediate vicinity, to focus on what i need to do. these can be absorbed, analyzed, and reflected upon at a later, more convenient time. but death and suffering are concepts that i still cannot grasp and control yet, and i ended up walking around that entire day, restless and with a hole in my heart.

i remember approximately three months after your passing, i had a dream that you were in the hospital again. you had an iridescent glow, in your pink petticoat and white full dress, long, dark, silky hair, and porcelain white skin. you were laying peacefully in bed with a golden retriever, curled neatly beside you. but this time, you were disease free. pain free. and you were beautiful. the way i imagine you to be like in heaven.

rest in peace.

[ohhhhmycat]

september is childhood cancer awareness month