Dear Angela

Dear Angela,

I would never know how your own family feels right now. I just know this is a difficult time for them.

It shouldn’t be like this that our Elmhurst ED work family would see each other again. Not at your funeral. Old familiar faces returned to pay respect to you, one of our own. There was no joy at the unexpected reunion, just profound shock and melancholy at such a sad occasion.

It was tough to say Goodbye. You’re gone too soon. I have always thought of you as fierce, vibrant, and invincible. The soldier and the nurse; you’re twice a hero. I am heartbroken.

Wasn't it just yesterday when you came for your interview for an LPN position? I was impressed at how articulate and confident you were. Through all these years, you showed your strength, tenacity, and courage to finally get your RN license. As a soldier, as a nurse, and as a union representative, you were one tough cookie. I salute you. I just wish I had seen you one more time. Isn't it tragic that we always want to have that one more day to remember someone special?

Someone said, “Death leaves a heartache no one can heal, love leaves a memory no one can steal”. I have many fond memories of you, Angela. You were an excellent nurse, a straight-shooter (no pun intended), firm yet compassionate, and meticulous yet with a wicked sense of humor. You were there at our parties, baby showers, retirements, birthdays, and summer picnics. I heard you suggested a summer picnic before your untimely death. Maybe you missed the fun and games; maybe you longed to play with your work family.

Your Elmhurst “peeps” showed up in force, even those of us who have left to work elsewhere came back to share the grief. The White Rose Nightingale tribute was a poignant homage to your tremendous contribution to the department. After the nurses read the words to the poem "She Was There", they gently laid a rose on your reposed body. It was a touching image, especially with the nurses dressed in white and the military guards standing in attention next to your casket. You have made a difference in people's lives many times over, Angela.

We've lost too many through the years. Kathy, Angel, Beckley, Ruthie, Siony from PAC, Derrick, Timmy, Kettly, Jennifer, Phyllis, Brad, and Dr. Neil Oster. There were two more who we lost, their names forgotten but their absence was nevertheless mourned. One was a new nurse who was a victim of domestic violence. Another one was a PA who took his own life. With every passing, our hearts break not only for the family but also for the co-workers they left behind.

The ED is a challenging place to work at, but it has certainly brought us together. We struggled, we saved lives, we laughed, and we cried. We grieved for every single co-worker we lost. In the process of keeping our heads above water, we became a family. Nurses, doctors, PCTs, PAs, clerks, transporters, and many more. And Elmhurst, our home.

And now you... You will be missed. More than you will ever know. My deepest sympathy to the Palmer family.

The Heart Remembers

One New Year’s Eve many years ago, EMS brought an elderly man with dementia to the emergency department. The patient had become increasingly agitated due to the loud fireworks outside the nursing home. I have assigned a nurses’ aide to stay with the patient as we tried to sort out the bolus of patients who came into the ED.

At the same time, a “happy drunk” staggered into the ED. Thankfully, the patient, who was a regular in the ED, just wanted an audience for his singing. The “happy drunk” entertained the triage area with opera songs like Pavarotti. His impassioned O Sole Mio was surprisingly well-modulated and brought a smile to everyone, even to the ED staff who worked on the holiday, away from their family.

The elderly man stopped squirming in his stretcher. Somehow, the familiar melody broke through the cobwebs of his mind and he joined our happy drunk in total harmony. We later learned that he was an accomplished tenor in his prime. He remembered what he loved most.

I remembered the elderly man a few days ago when I accompanied my friend Anita when she visited her mother in the nursing home. Mrs. D. sat by the window, her stares focused at the gardens outside. Was she enjoying the beautiful flowers or was she lost in her own memories? Her gnarled fingers were gently caressing the lace shawl on her lap.

My friend Anita approached her mother. “Mom, I brought my friend today.”

Mrs. D. looked at us. I didn’t expect her to recognize her daughter’s friend from our apple-picking outings when we were still new in the United States. After all, she didn’t even recognize her own daughter.

Alzheimer’s disease had robbed Mrs. D. of her memories. She looked at her daughter like a stranger. She didn’t even respond to her daughter’s embrace. Her lined face was raised in fear at the sudden intrusion into her physical space.

Mrs. D. used to be a human dynamo. After she was widowed, Mrs. D. ran her daughter’s home with such efficiency as her daughter and son-in-law worked hard at their careers as nurses. She was a loving but firm grandma to both of her grandkids. I remembered her humming her favorite songs whatever she was doing at that time.

Anita’s family had no choice but to transfer her to a nursing home when she started wandering away from home. Mrs. D. had been missing for two days until an alert hospital worker notified the police of an unknown woman who was dropped off at the emergency department. She was lost in her own world. Mrs. D. was now a shell of her former self.

The deterioration was slow but equally painful. What was once a vibrant woman was now profoundly changed. During the early stage of the disease, she expressed frustration for not remembering, and for being a victim of her forgetfulness. Now, she looked calm, probably because she did not even realize what she was powerless to do.

Anita was sobbing in frustration. Mrs. D. was not responsive to any of her daughter’s attempts at conversation. I remembered my old patient from several years ago and suggested to Anita to sing some of her mother’s favorite songs.

“Saan Ka Man Naroroon” (Wherever You Are) is a Filipino love song about a woman’s promise of loyalty to her loved one. This was the theme song of Anita’s parents. As soon as Anita sang the song, her mother’s face relaxed and her eyes focused on Anita. Mrs. D. smiled and caressed her daughter’s hair.

At that moment, with the sweet melody of a beloved song, there was a respite from the darkness in her mind. Her heart remembered, even for just a few minutes.

Thank You From Our Patients

I heard a voice behind me, “Nurse, nurse”. When I turned around, I saw an elderly man leaning heavily on his cane as he tried to get my attention. The ED was extremely busy at that time and the noise level was high but the gravelly voice had a desperate note to it that made me stop. The elderly man just wanted to thank me for staying with his anxious wife while he parked the car. It was just a simple gesture, just a few minutes of my time. To this couple, this meant that the wife’s anxiety did not unravel into a full-blown panic attack. I was just doing my job. But the appreciation from the couple made my day. The elderly man didn't know that just a few minutes ago, I came from assisting in a cardiac arrest of a young man who succumbed to an overdose. His Thank You was a God-sent relief for me.

In our nursing lifetimes, we treasure those moments that validate the reason why we stayed in this profession. The “thank yous” are our emotional rewards. The appreciation from our patients and from our peers lifts our spirits and keeps us going. How wonderful it is to know that we have made a difference.

The following are excellent examples of how nurses changed lives:

Renee, NICU nurse, received a wonderful surprise from the babies she cared for. She is a miracle worker.

Lawrence O’Donnell, a news anchor from MSNBC, delivered an emotional tribute to the doctors and nurses who cared for him after an accident.

Bailey Murill, 17 years old at that time, was paralyzed for 11 days after a freak accident horse-playing with her family at home. She landed awkwardly on her back and was unable to move her legs. Through all the harrowing experiences of finding out the reason for her illness, she developed a close relationship with her nurses at Zale Lipshy University Hospital. She came back from Rehab after regaining the use of her legs to surprise her favorite nurse.

Amanda Scarpinati sustained severe third-degree burns to her body when she was a mere baby. Just three months old, she rolled off a couch into a steam vaporizer. Over the years, she underwent reconstructive surgeries. She took comfort from a picture of her in the arms of a nurse at Albany Medical Center. Thirty-eight years later, she was able to reunite with Susan Burger, the nurse who took care of her.

"I don't know how many nurses would be lucky enough to have something like this happen, to have someone remember you all that time," Berger said. "I feel privileged to be the one to represent all the nurses who cared for her over the years." http://www.today.com/health/burned-baby-woman-finally-meets-nurse-who-cared-her-t47151

When things get rough, when the pressures of being a nurse threaten to overwhelm us, let us remember the special moments of appreciation from the patients and their families who deserve our very best to offer.



Happy Emergency Nurses Week to all the courageous nurses at the frontline of our emergency departments.

Addendum: 9/17/2016

Gary Bentley held on to a photograph of him and a nurse named Kathy for 40 years. In 1975, Gary and his siblings were placed in foster care because of an abusive father. He also underwent open heart surgery at that time. In those difficult times, Nurse Kathy made a long-lasting impression on young Gary. See the emotional reunion.



http://www.littlethings.com/nurse-kathy-reunion/?utm_source=ftap&utm_medium=social&utm_campaign=dad

Stethoscope

Dear The View hosts,

That was a token apology. In fact, your misguided attempt to explain made your original ridicule even much worse. That was a prime example of ignorance and disrespect about a profession that deserves much more recognition.

Flashback to last September 13, 2015, in the Miss America pageant. For the talent portion, Miss Colorado opted out of a gown and proudly wore her nurse’s uniform with a stethoscope draped around her neck. Kelley Johnson offered an impassioned and heartfelt monologue about her experience as a nurse to an Alzheimer’s patient.




The View hosts proceeded to ridicule her choice of talent presentation. Michelle Collins remarked, “She came out in a nurse's uniform and basically read her emails out loud and, shockingly, did not win.". Joy Behar, who just recently returned to the show, wondered "Why does she have a doctor's stethoscope on?". A female with scrubs and a stethoscope. The implication is that a nurse does not have the right to use a stethoscope.




Of course, the backlash from the nursing community was explosive. Social media erupted with rightful indignation from the nurses, the doctors, and the general public.

And you call that an apology? Thanks, but no thanks. Joy Behar said that she “was not paying attention”. Did the neurons misfire and you were not able to associate the scrubs with a healthcare worker? Aren’t you being paid to know what you are commenting on?

Michelle Collins profusely praised the nurses, even asking our “bosses” to give us raises. Poor Michelle, her statement was just “misconstrued”. Whoopi accused nurses of taking things out of context and of not knowing that the stethoscope statement was just a joke. Raven Symone called out the nurses for not listening to the intent.

No, I am not too sensitive. I listened to everything you said in defense. And I do have a sense of humor. At this point, you should have been educated enough about the many uses of the stethoscope in the nursing world. The internet is full of stories about how nurses make a difference every day. Even better, you should realize why the outrage from the nurses is justified.

How about spending an hour or two following an emergency department nurse around? And then maybe, you can try another apology.

Vintage Nurse Fiction

Vintage nurse fiction is addicting. It crept up on me when I least expected it. Growing up in the Philippines, I have not been exposed to Cherry Ames’ and Sue Barton’s books. As American girls were reading about the adventures of Cherry Ames, I was fascinated by the adventures of Nancy Drew, Heidi, and the Bobbsey Twins. It was only recently that I managed to read through some of the books that featured nurses as heroines in the mid-20th century. And I discovered, albeit late, the inimitable Miss Pinkerton from Mary Roberts Rinehart.

Cherry Ames starred in 27 novels that traced her journey as a nurse in the 1940s, mostly written by Helen Wells and a few books in between by Julia Campbell Tatham. As a nursing counterpart to Nancy Drew, Cherry Ames (also called Charity) used her nursing assessment skills to solve mysteries along her many assignments around the country. The books also served to inspire young girls during the wartime period to take up a nursing career. The historical perspective was interesting to follow. The books provided great insight into the way we nursed on days bygone. The arcane nursing procedures and the hierarchical relationships between doctors and nurses made me appreciate how far the nursing profession had become.

Before Cherry Ames, the Sue Barton 7-book series was written by Helen Dore Boylston from 1936 through 1952. Sue’s professional career started when she was a student nurse in different fields like obstetrics and psychiatry. The stories showed Sue Barton’s heroics as an amateur detective throughout her nursing journey.

There were many other nurse romances that featured nurses in various positions and in all kinds of exotic locations. Most of these romances were about nurses in peril or thrust with a dilemma, only to be rescued by handsome doctors. Then there were interesting titles such as “Hootenanny Nurse”, “Dental Nurse at Dentley’s”, “Dr. Brad’s Nurse”, “Headline Nurse”, “Ice Venture Nurse”, “Run Nurse Run”, “One with the Wind”, and yes, ”The Satanic Nurses”. Some of these nurse romances were cringe-worthy because of the "weak feminine and subservient" stereotypes. Light-hearted fluff which, in my opinion, is better than the vampire/zombie stories that cater to young Adult readers. On the other hand, we have seen the antitheses of these characters with the crazy Miss Ratched and the nurse from Misery (shudder).

And now, a great find. Mary Roberts Rinehart, a nurse herself, was a well-regarded and prolific author often called the American Agatha Christie. Ms. Rinehart was the queen of mystery thrillers who wrote “The Circular Staircase”. The phrase “The butler did it” was credited to Ms. Rinehart. The book “Miss Pinkerton” was written by Miss Rinehart in 1914 about a nurse Hilda Adams who was affectionately called Miss Pinkerton because of her penchant for solving mysteries. Because of my research for this article, I discovered Miss Pinkerton. Thank you, thank you, Miss Rinehart. I am now a fan.

In contemporary nurse literature (within the 21st century), here are my favorite books:

Of course, I would be remiss if I don’t include my absolute favorite book. Readers, please indulge me. This is a fulfillment of a lifelong dream. My bucket-list item was checked off.

When Nurses Cry

The viral picture of a doctor grieving after a patient died resonated with me. The loss was palpable; the helplessness was disturbing. It has struck a chord in every other person who works in the medical field. A poignant image that happens all the time, it is replicated in the privacy of the staff lounges, in the restrooms, in the offices, and anywhere nurses and doctors are able to escape for a few moments to grieve.

I have cried many times in my nursing career. For those we have lost and those we cannot help.

I spent my first four years in the US in a chronic care hospital on Roosevelt Island in New York. My first patient death experience was an end-stage renal disease patient who suffered a cardiac arrest. The other nurses who helped me do the post-mortem care were as distraught as me. Our tears mingled with the bath water as we washed the patient’s uremic skin and combed her gray matted hair.

There were more patients in that unit who died after her. 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 mourned their passing because the families had long abandoned the patients.

When I started to work in the emergency department, I taught myself to be stoic. It was my shield against the pain of tragic loss, my armor to protect my heart from shredding whenever a patient died. I could not afford to be burned out. The compassion and empathy remained, but breaking down in tears is something I avoided.

Death is a constant in the emergency room. Some of those deaths were hard and brutal, unexpected and difficult to accept. However, there were some deaths that were almost a welcome event, especially for those chronically-ill patients who lived through extreme pain. For them, death released them from hell on earth.

Every so often, something pierced through the thick armor I built around my emotions.

I cried for one young man who came in traumatic arrest after a motorcycle crash.

I cried with a wife and her son when the patient died after they signed the Do Not Resuscitate papers.

I cried when the cardiac ultrasound revealed no cardiac activity. The patient was one of our own nurses who came in cardiac arrest after collapsing on her way to work.

I cried with the elderly husband who grieved for his wife of fifty years.

I cried when a six-month-old baby drowned in bath water.

I cried with the nursing staff when one of our favorite “regular’ drunks died from hypothermia.

I cried when the seventy-year-old woman who swallowed cocaine bags to earn money for her daughter’s cancer treatment died on the way to the OR.

I cried when a young pregnant mother succumbed to her injuries after she was struck down by a forklift. I cried for her baby who survived but had brain damage.

After I cried, I went back to work. Such is the life of those who work in the medical field. There is always someone who needs our help, someone who needs his Dilaudid. Breathe in, breathe out. There was not enough time to lament the loss of life because there are so many more who need our attention.

But there are also times when I cried for joy.

Many years ago, a boy was hit in the middle of his chest with a baseball. He went into cardiac arrest, in commotio cordis, and was rushed to the OR. Three weeks later, the boy returned to the ED with his mom to thank the ED and surgical staff for their heroic efforts of saving him. The boy named Pedro beamed as he was surrounded by weeping nurses.

There are many moments of happiness in the midst of the darkness in the medical world. We have saved many patients, eased the sufferings of those we cannot save, and touched many lives along the way. Caring for someone does have many rewards.

Personal Educational Philosophy

I love my job as a nurse educator. My goal is to mentor nurses to achieve their highest potential. As a nurse educator, I am doing my share to influence nurses (future and current) to provide the best possible care to the patients under their care. As others have done for me, I want to pay forward the excellent mentoring that has guided me and inspired me to make a difference in my patients’ lives.

I believe in the enormous influence of education in changing lives. The great Nelson Mandela once said, “Education is the most powerful weapon which you can use to change the world” (Durando, 2013, para. 12). I believe that the student I teach will someday save someone’s life. My personal educational leadership policy has never wavered since the first day I was given a new nurse to precept. At that time, I just had finished my first year of work as an emergency nurse so I expressed my discomfort in being a preceptor to my head nurse. She looked me in the eye and said, “Your face lit up when you do patient teachings. I saw how your patient was so grateful to you for your clear and patient instructions. You are a born educator.”

I believe in the inviolable privilege of caring for a patient in need. As a nurse educator in a busy emergency department and as an adjunct clinical faculty, I always instill in my students and my nurses the love and respect for the profession. I encourage them to hold in their heart their passion for the job. I constantly remind them of Jean Watson’s saying “Caring is the essence of nursing and the most central and unifying focus for nursing practice" (Watson, 1985). Nurses need to embrace the profession and the unique opportunities it gives in service of others.

I believe that in today’s global society, we need to teach all healthcare personnel to respect cultural diversity. Having worked in an inner city hospital for twenty-one years, I appreciate the kaleidoscope of cultures that had enriched me as a nurse and as a person. The healthcare community is a microcosm of cultures that presents distinct and increased challenges to the delivery of safe and compassionate patient care. Leininger’s Theory of Culture Care Diversity and Universality provides a valuable framework for healthcare professionals to attend to the needs of their patients in a culturally congruent way (Leininger, 1995). Nurses are in an excellent position to foster cultural tolerance and respect for the similarities we all have.

I believe that interprofessional collaboration and team-building are crucial to ensuring patient safety. Medical errors and catastrophic injuries may be avoided with improved team dynamics and communication (O’Daniel & Rosenstein, 2008). The collaborative practice among the physicians, nurses, and other members of the healthcare team promotes shared mental models and efficient communication (IOM, 2010).

I believe in nurse empowerment. As the largest healthcare group, nurses should be vocal advocates for positive innovations in the workplace and the school community. Nurses need to recognize their collective power in producing ground-breaking solutions and demanding change in the healthcare community. I encourage the nurses to explore new frontiers in nursing excellence and to practice evidence-based practice. As recommended by the Institute of Medicine, nurses should prepare to practice to the full extent of their scope of practice (2010).

I believe in the concepts of emotional intelligence and transformational leadership. I will role-model presence and vision in leadership and will integrate the concepts of emotional intelligence in my professional relationships (Marshall, 2011). As Marshall wrote, “Change is a journey taken with those with whom you work” (2011, p. 90). As a change agent, I need to prepare myself fully for the challenge of leading the way in a complex healthcare landscape.

Looking back on that day when my head nurse started me on my way to a career in nursing education, I can only marvel at the sense of achievement it had given me. I reflect on the lessons learned and on the great memories along the way. Nursing had been good to me. I had given my all to this profession, but the rewards I received for my efforts are immeasurable.

As First Aid Instructor, Philippine National Red Cross





References:

Durando, J. (2013). 15 of Nelson Mandela’s best quotes. Retrieved from http://www.usatoday.com/story/news/nation-now/2013/12/05/nelson-mandela-quotes/3775255/
Institute of Medicine. (2010, October 5). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press; 2010. Retrieved from http://iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.
Leininger, M. (1991). Transcultural nursing: the study and practice field. Imprint, 38(2), 55-66.
Marshall, E. S. (2011). Transformational leadership in nursing: From expert clinician to influential leader. New York, NY: Springer Publishing Company
O’Daniel, M. & Rosenstein, H. (2008). Chapter 33. Professional communication and team collaboration. Retrieved from http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/ODanielM_TWC.pdf
Watson, J. (1985). Nursing: Human science and human care. CT: Appleton-Century-Crofts. 2nd printing 1988; 3rd printing 1999. NY: NLN (Jones and Bartlett).


Excerpt: ASU Educ Philosophy- JCS