Nurse, Can You Tell My Story?

I write about Nursing because I am proud of the difference we make in our patients' lives. This is a profession that is definitely and infinitesimally life-affirming and emotionally rewarding. Then, on Thanksgiving day in 2015, I received an email from a patient. His story is unforgettable and inspiring. I will call him Mike to protect his privacy.



11/26/15

Hi Ms. Cerrudo,

On this Thanksgiving, I write to simply say "thank you'. I randomly come across your blog. I'm not in the medical field, but I know it well - as a patient. A few years ago, I was taken into surgery for an emergent surgery. The doctors discovered several masses. Unfortunately, the hepatic artery was nicked during the case, and I began bleeding profusely- I subsequently coded twice during the case, and it was a very skilled RN who helped perform open cardiac massage. After several weeks of intense recovery, I made it home.

I now face a second major surgery in a month to attempt to repair a thoracoabdominal aortic aneurysm that is pressuring both the spinal cord and diaphragm. Additionally, they will attempt to remove some metastatic lesions on the upper and lower GI tract. They have estimated a 16-hour case with a 70% intraop mortality rate.

I write to thank you for sharing all of your stories, which exemplify how important nurses are in the direst of situations. I was able to obtain authorization for an observer during my upcoming surgery and was wondering if you might want to observe. I think so much good could come out of you sharing my story and re-emphasizing that medicine is a balance of technical skill, compassion, and humanity. I could think of nobody better to tell that story.



11/27/15

Hi Mike,

My heart goes out to you. Despite all that you have gone through, you still managed to recognize the contribution of nurses to your care. I have never received a request from a patient for me to share their story. It will be an honor and a privilege to assist you in any way I can.

Let me know how I can help. When is your surgery? I will be leaving for a 3-week vacation in January. I hope I can see you before then. I would really like to meet you.


11/29/15

Hi Jocelyn,

Thank you for getting back to me. Would you be open to talking to me very soon? I would love to tell you of the many ways that the nurses made a difference in my care and how they comforted me when I was anxious or just needed someone to talk to. Can I send you my case study?


12/6/15
Hi Mike,

I read your case study. Words fail me because I cannot imagine how difficult it is for you and your family. If you want to discuss this with me, I am available this Saturday before the holiday rush. In mid-January, I will be out of the country on vacation. I want to speak to you by phone or in person if you're up to it. Your story needs to be told.


(In truth, I was so touched by Mike's trust in sharing his case study. He's not even thirty yet and has gone through a lot. The doctors removed some lesions on his gastrointestinal tract. The names of the OR staff were redacted in the operative report. The case details chronicled the whole session. The assisting surgeon prayed for spiritual guidance for the OR staff. She also prayed for the patient- for his comfort and peace of mind so that he would feel the “hedge of angels surrounding" him. She also prayed that the lessons from this case study will benefit others in the future.

Except for a month’s stint in the operating room as a nursing student, I have not known much about how stressful it is to work in the OR setting, how tenuous life is, and how, in one instant, the patient can bleed out from a ruptured artery. The attending surgeon stepped out twice to inform Mike's parents of complications during surgery. Each time, the attending returned with the family’s decision for a full code. The OR surgeons, physician assistants, nurses, and scrub techs all rooted for Mike, and he survived. No neurological complication from the two episodes of cardiac arrest- one from ventricular fibrillation and one from an asystolic rhythm.

He wants me to write about how the nurses cared for him. I should write about how he inspired me. I cried after reading Mike's OR report. I hoped and prayed that his upcoming surgery would be a success. With all that he went through, he still wanted to honor the nurses. I may not know him personally, but I wanted to reach out and hug him.)



12/10/15

Hi Jocelyn,

Was there anything particular about my case that resonated with you? Have you ever had to perform compressions on the table during a non-emergent case, both external and internal?


12/11/15

Dear Mike,

Several things that resonated with me about your case:
1. Your resilience. Your strength comes through loud and clear. The operative report was graphic and detailed, especially in the resuscitation efforts. Everything was so surreal.

2. Your spirituality. I did not even know that prayers are in the OR.

I have been an ER nurse for about 25 years. I spent the last 12 years as an educator. I have done my fair share of external cardiac compressions. When I was still doing trauma, I had assisted in cardiac resuscitation using the internal defibrillation paddles, but I have not done an internal cardiac massage. The closest I have ever come to seeing this was when the trauma surgeons opened up an eight-year-old boy who was hit by a baseball in his chest. To this day, I still get goosebumps when I remember the day the boy came back to the ED several weeks later, alive and well. I have never been so happy seeing the healed scar on his chest.


(In fact, I wanted to tell Mike how grateful I am that we could talk over the phone. I felt emotional hearing his voice, especially since I realized that his impending surgery was complicated. He expressed optimism, but I sensed that he was resigned to the fact that he might not make it this time. With the 70% intraop mortality rate, the odds are against him.

When I asked him why he wanted me to specifically thank the nurses, he said, "I thanked the doctors enough, but the nurses don't get enough credit."

He was not able to expound on his experience with the nurses. He was getting tired, so I suggested that we can just make another appointment to talk again. We did not have a chance to speak again since he was busy with more tests).


1/12/16

Mike,

In a few days’ time, you will undergo surgery again. I am sorry that I will not be able to be there for you because I am boarding the plane to see my family. I will pray for you. Would you email me back when you have recovered? Be strong.



1/20/16

Mike, I pray that the operation was a success. Please email me back.

(I called him from overseas. The phone just rang and rang, and I prayed that he was busy recovering.)



2/26/16

Hi Mike,

This is Jocelyn. It has been a while since we corresponded. I am not sure what has happened since then. Can you please e-mail me back?



3/8/16

Mike, are you there? I tried to call your phone, but it was not in service. I also tried to google your name for any news.


11/26/16

Mike, it has been a year since you e-mailed me. I fear it is not good news since I haven't heard from you. I do not want to intrude on your family's privacy, so although I know your real name, I couldn't contact your family. Are they even aware that you want your story shared with the world? I do not know you personally, but I am convinced that for whatever little time you have on earth (I feared the worst), you have enriched the lives of those around you.

I am humbled that you chose me to tell your story. You wanted to honor the nurses. Instead, I honor you.

Mike’s requested scripture readings before the surgery:

He heals the brokenhearted and binds up their wounds.—Psalm 147:3

Fear not, for I am with you; be not dismayed, for I am your God; I will strengthen you, I will help you, I will uphold you with my righteous right hand.—Isaiah 41:10

For I will restore health to you, and your wounds I will heal, declares the Lord, because they have called you an outcast: 'It is Zion, for whom no one cares- Jeremiah 30:17

Ignorance and Bigotry

Readers, this past week, I heard of two ugly encounters in the emergency department. Two patients disrespected the nurses who were trying to help them because of the color of their skin. Sadly, this is nothing new. I wrote this letter about 15 years ago after a similar experience. Somehow, the hateful vitriol is further emboldened by xenophobic rhetoric from bullies and haters. I have always worked with an exemplary diverse staff who see patients as human beings. I stand proud as an American citizen and as a nurse, even as we face all these challenges with professionalism and decency. As the incredible First Lady of the United States Michelle Obama elegantly said, "When they go low, we go high".





Dear patient,

I wish I can erase that hatred in your heart, that xenophobic attitude against anyone who doesn’t look like you. You cursed at me and told me to “return to my country”, even as I was just trying to triage you. I swallowed the bile in my throat as you ranted about immigrants who stole your job. I have two college degrees, dear patient. Based on your incoherent and ungrammatical ramblings, I am pretty sure you could not perform my job.

I knew you were sick so I ignored your blatant racism. I allowed my orientee to interview you just so I can get enough information on why you have tachycardia and back pains. I did not call security to escort you out because I realized that you needed medical help, despite the obscene gestures. You are ignorant and a bigot, but you are my patient.

You don’t know that I was the one who recognized that you were dying. You even refused to be seen by our Asian ED doctor and the African-American resident. But then, you collapsed in front of us. You don’t know that I was the only one who could insert a good IV line in your fragile veins. Now that you are unconscious, you would never realize that the emergency team who took care of you was a diverse group, a multi-colored group of professionals. If you knew you were dying, would you have accepted our ministrations?

The rainbow of ethnicities in our emergency team did not divide us but instead united us in our efforts to serve the diverse community. Our team of doctors, nurses, and other ancillary staff did not care about the color of your skin. There was no question about your sexual orientation or political and religious affiliations. All we were concerned about was to race against time to save your life.

You are our patient. If you are conscious, we would not tolerate your disgusting behavior. But unfortunately, you are now intubated and brain-dead. So we have to be blind to your faults. We will not respond in kind to your ignorance and bigotry. Despite your evil thoughts, we will remain true to our sworn oath to take care of you, as we do with all our patients. I see you as a human being. No matter what.


Your Filipino-American nurse




P.S. You signed an Organ Donor Card. It is great that you did not state a preference for the recipients of your organs. I'm sorry that you would not be able to read this letter. I was hoping this would open your eyes and touch your heart.

I am a Nurse

I am a Nurse.

Whether I spend most of the time at the bedside or in front of students, I am still a nurse. Every day, my goal is to influence a nurse to do her very best, as others have done before. I am but one of the fortunate ones given the privilege to serve and make a difference.

Nursing is not for the faint-hearted. It is not for those who expect a calm and uncomplicated journey to retirement. This profession does not promise a day free of stress and challenges, nor full compensation and even appreciation for services rendered.

It is for those men and women who recognize the difference they make for those patients faced with the uncertain and sometimes the inevitable. Their hands are there to support the weak and to provide dignity even during the most unfortunate times.

Nurses have to cheer their patients up, to encourage and nurture them, but sometimes to hold their patients' hands when everything else had failed. They touch lives every time, every single day.

Nursing is for those who share a special place in their hearts for those struggling with pain, those who need a gentle touch, or those who need a willing listener to even the most mundane of complaints.

Nurses accept the call for compassion and grace. The rewards are emotional and spiritual, probably some extra points in heaven.

Nursing makes me a better person. That is why I am still a nurse.

Nursing, Thirty-one Years Ago…

Nursing, thirty-one years ago…

Like a cliché, it seems only like yesterday. But one only has to look at the hands wrinkled by countless handwashings, it orientates me to the fact that “Man, I have been a nurse for a very long time”.

I am a nurse educator, so I welcome new nurses to the fold. I do not get threatened by the generation gap because I am energized by new knowledge and technology. It is an exciting time for a nurse today with advanced medicine, electronic documentation, and nurse empowerment.

But I do feel protective of the special gift that senior /seasoned nurses bring to the table. The experience of thirty-one years has not only made me stronger clinically but has also given me a better perspective of the impact of these nurses on the patients who will only benefit from knowledge earned through hard work and determination.

I truly support the tremendous contribution that the seasoned nurses have given to the profession, and they will play an important role in guiding the new nurses today to realize their full potential. Sadly, there is a sense of "entitlement" on both sides. There should be a better way to bridge the gap between generations. Patients do not really care what the nurse's highest academic degree is as long as they get compassionate care from the nurse.

Having learned from my mistakes, I respect myself even more today. Unencumbered by false modesty, I can proudly and humbly say that I am a damn good nurse, not because of any advanced degree but because I learned patient-centered care long before it became a buzzword.

Thirty-one years ago, I stepped into Coler Memorial Hospital on a cold January morning. Our group of young Filipino nurses newly flown to New York was culture-shocked. I thought that our patients spoke with difficult accents, all slang yet full of grammatical errors. I was convinced that the doctors misspelled their orders and were insulted when we questioned duplicate medications.

Our nursing supervisors towered over us with doubt written on their faces. They probably were wondering how these naïve, young women could stand up to the bossy LPNs who used to rule the roost. We were usurpers to the throne. We didn’t know any better and how dare we come to this place expecting to find our way into their nursing world.

But dared we did. We held our own, learned the slang, and worked our way to earn the respect. Not only by our supervisors but mostly by our patients who delighted in our enthusiasm and compassion. My supervisor Ms. Covington used to challenge me to go beyond my comfort zone. Somehow the patients who were abandoned in our care became our own grandparents. We held their hands and listened to their nostalgic remembrances of lives spent caring for their loved ones. We dried their tears just as we dried our own tears of loneliness for families left behind in the Philippines.

“You’re my favorite, Cerrudo.”, one of the chronic dialysis patients rewarded me with this one day. I quickly bragged to my friends about how I finally won over the most difficult patient in the unit. My friends did not even give me time to relish my victory; Sessa told them the same thing last week. I was Sessa’s favorite at that time because I had given her an extra ice cream.

My first unit was the Medical ICU. One part was the chronic ventilator unit where patients remained attached to ventilators; we became experts with trache care, suctioning, and communicating with our patients the best way we could.

Mr. Alston used to clench his jaw and blink his eyes three times if he wanted things done. One bedridden patient could only give a lop-sided smile if we positioned him right. Mrs. Richards frowned if we didn’t tuck her bedsheets right and gave us thumbs up when we did. Young Alli smiled at everything we did for her, as we wiped the drool on her neck, cleaned her trache, and brushed the tangles on her hair. I massaged the contracted feet of my ALS patient who continued to have a vibrant mind while his body wasted away.

The patients were our family… and every time one passed away, we cried with the rest of the staff. Most of the time, the nurses were the only ones who grieved their passing because the families had long abandoned them.

Two years later, I was promoted to a head nurse position in a general med-surg unit with 40 patients. I took my share of duties as part of functional nursing. There was usually one medication nurse who started and finished the day by giving meds with printed medication cards; from the back to the front of the unit where meds were given through gastrostomy tubes. Another nurse and I worked with a group of two nurses’ aides as we fed, bathed, exercised, and walked the patients. At 3 p.m., we started our narrative charting, our notes the same every day except for the vital signs and whether patients had bowel movements or not.

Thankfully, the technology and staffing got much better. The suction EKG bulbs were horrendous and left their distinct marks on our patients’ frail chests, the yucky gel too difficult to clean off. The manual mercury sphygmomanometer is now a thing of the past, now it’s just a button to push on the automatic cardiac monitor and we get veritable data of riches: BP, HR, oxygen saturation, MAP, endtidal CO2.

Gone are the medication cards, those 2-by-2 index cards with hand-written transcription of medication orders, and the dosage times written in black, green, and red. Gone are the Kardexes with nursing diagnoses that never changed. Gone are the hand-written doctor’s orders that were meant to confuse.

Back then, I was new, nervous, and unsure of my place in this world. Thirty-one years after I first stepped on American soil, I am still convinced that Nursing has given me valuable lessons along the way. That the rewards of nursing far exceed the material blessings. The compassion I have shown my patients was the greatest gift I could have given them.

And now, as a clinical adjunct professor and a clinical nurse specialist, I try to impress my students and nurses to remember why they chose this profession. I celebrate their need to explore new boundaries and to push the envelope but I remind them, as well as the seasoned nurses, to embrace their similarities and learn from each other.

When the patient needs a hand, it doesn’t matter if the hand that is offered is that of a baby boomer or a millennial. At the end of the day, the patients will remember a nurse who gave them the respect that they deserve.

Through the nurses I teach, I wish that a compassionate nurse lives on.

"My Firsts... as a Nurse in the US"- http://jcerrudocreations.blogspot.com/2012/03/my-firsts-as-nurse-in-us.html

My Emergency Nurse Hero

My emergency nurse hero is Jennifer Whalen.

In the clinical setting, she was an ER nurse par excellence. Her intelligence and compassion shone through in her work. A self-confessed Type A personality, she quickly became the epitome of what an ER nurse should be: smart, focused, driven, determined, and with a kick-ass attitude with the goal of giving her patient the best care ever.

And then she became the patient. With the shocking news of her Stage 4 pancreatic cancer, Jennifer rallied her friends and her co-workers as her Hermione army; to support and to cheer her as she tried to apply that same determination in the fight of her life.

She was incredibly strong and amazingly positive. In my work as a nurse, I have seen extraordinary acts of courage and heroism around me. But I have never seen anyone as inspirational as Jennifer.

After the diagnosis of the Big C, she used her second chances. To mobilize her army of supporters. To reconnect with old friends. To mend broken fences. To share her incredible optimism. To find love again.

Here was a woman who bared her soul and selflessly shared her journey with the rest of us. She left her own legacy of strength and fortitude. And she taught us all valuable lessons in life. She was a master educator and her fight for her life was her lesson plan.

Jen passed away today, Dec, 21, 2013, finally pain-free, in her sleep surrounded by her loving family. In the hospice where she finally accepted the path she was to take. I wish that there was no doubt in her heart of how she had forever changed us, that she would know that she is much loved and admired. Not just by her own family and close friends, but even by those who had seen from afar how special she truly is. In her last moments, she was not alone.

We are forever changed. Jen had left her footprints in our hearts. She had been courageous more than I can ever hope to be. Among the hardworking nurses of Elmhurst ED, she had excelled.

Jennifer Whalen, RN, BSN, CEN, she was a gift to all she touched.

Till We Meet Again

What a journey it has been.

I said I will only be staying for two years. Like all others before me, I stayed longer and now it took twenty-one years for me to leave this place that I have grown to love. Elmhurst grabbed my heart and refused to let go.

It is a lifetime of memories. Through the years, we've created a kaleidoscope of special moments and bonded with a team of nurses, doctors, and support staff. Together, we've pulled through stressful times of overwhelming patient volume, poor staffing and personal differences.

I looked around the ED and marveled at the changes in the landscape, both in the physical environment and in the personnel who staff the ED day and night. The ED had changed but what remains true is that we are entrusted the responsibility of caring for others who are more vulnerable and unfortunate than us. To be able to spend your life in service of others is a blessing.

I started as a novice ED nurse who trembled every time I heard the red EMS notification phone ring and evolved to be a confident and knowledgeable nurse due to my multi-faceted Elmhurst experience. What's more important to me is the knowledge that I have made a difference.

Thank you for being a part of my journey. I will forever treasure the shared reminiscences and your kind words and expressions of support. It makes me happy to be appreciated by those who matter.

And now it is time to explore the world beyond these four walls and to create more memories in another hospital as their new clinical nurse specialist. Although I will be leaving a piece of my heart, I know that this new road will bring new opportunities for professional growth for me. If I made it here, I can make it anywhere.

To paraphrase Oprah, No sadness from me, I look forward to the next chapter in my life.

And when our paths will cross again, I expect to get a tight hug from you. Till we meet again.