The Social Worker’s Story

On Tuesday, the social worker is late to work and has to park on the top level of the garage. Instead of the elevator, she takes the stairs down to the bridge which crosses into the hospital and regrets it. She’s feeling fat and old, neither of which are true, but her knees and ankles are already telling her that the heels are a mistake. She has flats in her office, but before she even goes down there, she has to see a few people. The tearful drug addict who needs rehab. The man with no family who needs help at home (that should really be a case management issue). And Manuel.. She’s not thinking about Manuel, not until she has to see him. She has to talk to Manuel’s wife, Alicia. She hasn’t been in yet. Does she even know?

Two hours later, she needs a cigarette and a few excedrin. And a nap. She needs to go boxing. In addition to everything else, she’s had to council two patients trying to leave against medical advice and one of them threatened to hit her. Again sir, she said, I’m just doing my job. I’m required to talk to you, just to make sure you understand the ramifications of leaving.

I’ll give you ramifications, the man yelled, and the social worker left the room. Ostensibly she’s not paid to be abused, but some days, really, she is. And she’s not paid enough, either.

“Am I a terrible person if I hate him for that?” she asks one of the nurses. “Don’t answer that.” She’s still got to see Manuel, but she calls Fiona and they walk across the street to get coffee.

She leans against a warm brick wall in the sunshine. She doesn’t smoke, not offically, but every once in a blue moon, a patient twists her kindness into shrapnel and cuts her and she needs a drag. She thinks about Manuel.

“Jesus, Fiona,” she says. “Some people have all the luck. I mean, this kid left his country, fought in Libya, and he came home alive. Fine. He got married, he’s going to school and now he’s got cancer.”

Fiona drops her cigarette and looks at her watch. In their line of work, exceptional tragedies are everyday realities. “What kind of cancer?” she says.

“I don’t know. I don’t think the docs know,” the social worker says. “The nurses say he screamed when he found out. I mean here is this kid, so tough and so composed and he’s screaming.”

“Why isn’t he on the oncology floor?”

“I don’t know. I’m going to try to move him there today.” She looks up at the sky. “Time to go.”

But when she gets to Manuel’s floor, he’s not there. The bad news is that he’s been moved to the ICU. The even worse news is that it’s her ICU. Somebody hates me, she thinks. Somebody really hates me.

She goes in to meet Alicia.

The social worker is good at what she does. She’s not afraid of verbal abuse, of tense family meetings, of emotional catharsis. She’s probably too good, because she carries these things with her wherever she goes. She once went hiking (that was a bad date) to a place where the ground was all smooth rock, but filled with thin, deep, fissures, and it seemed to her, if one was strong enough, canny enough, one could wrench open those fissure and the earth’s secrets would spill out. People are like that to her. She can find their fissures, open them up. She knows denial, anticipatory grieving, dysfunctional coping, and when she opens a person, like a book, like a crack in the earth, she can help them. She helps them more than they’ll admit and more than she knows. But she can’t crack Alicia.

Manuel’s wife is standing at his bedside, staring down impassively. Manuel himself is beyond caring. A ventilator regulates his breathing and a sedative drips into his veins. Metastatic carcinoma of unknown origin. It’s not testicular and probably not from the colon. An exposure in the military? Or something he’s been keeping, like a dirty secret, a remnant of his impoverished childhood in the slums of San Salvador. Radon-rich groundwater or contaminated air breathed in 15 years ago, manifesting itself today as an orphan maker.

In the stroller, the baby kicks and smiles at the social worker. The social worker cannot help herself. She is delighted. She smiles back. She introduces herself to the baby, whose name by all rights, should be Sunny. She talks to Alicia.

She does all the right things. Introduction, open ended questions, non-judgmental attitude. Leading statements. Alicia answers only yes or no and sometimes she does not answer at all. She’s a well dressed, good looking young woman and she keeps staring at the social worker, as if she’s wondering why the profession exists. As if she’s saying, this is my tragedy. What right to do you have to lay claim to it? Finally, Jessica picks up the baby and turns her back. The interview is over.

 

Alicia watches the social worker close the door and then rub alcohol gel on her hands. What the hell does she know about Manuel? She allows herself to scowl at the woman’s back. That perfectly thin woman with her life together and her good job, coming to work every day to dissect human agony. Probably eats sorrow for dinner and grief for dessert. When she’s done, crumbs of hopelessness remain on her plate.

Sunny giggles at one of her toys, and chews thoughtfully on her hands. Jessica touches Manuel’s arm. It’s already not the arm, not the body of the man she married. He feels unstable and unanchored, like a strong wind could whisk him off to heaven any moment now. This is what she’ll do. See him as a different person. As the twin he never had.

She won’t see him as the veteran who cried about the children in Soyapango, or the shy boy who proposed to her by whispering in her ear during a late night, half-drunk slow dance when they’d only been dating for two months. She won’t think of him as a frustrated student, struggling with some of the English words, and laughing at himself when he said (his words, not hers) that he sounded like an immigrant.

This man laying in bed, this sick and bloated remnant of a person is not her husband. He’s a brother. She’s looking in on him while Manuel is visiting his mother.

 

Manuel is 26. He’s getting chemo, but he’s already critically ill. He’s going to die and Alicia is going to lose her husband and the father of her beautiful baby. She sets her face like a flint. She is not going to crack.

Over the next few days, Manuel gets worse. The social worker has a lot of other patients to see, but she always checks in with Alicia. She’s persistent, if not effective. I’m here for you, she says. Alicia smiles that tight little smile. Sunny smiles with her whole body, kicking her legs and laughing.

“My god,” she tells Fiona. “That boy is going to die. He’s going to die and the baby isn’t going to have a father and is Alicia even going to cry? This woman is like made of steel or something. I can’t imagine. I just don’t get it.”

But she does imagine. She imagines Sunny without a father and she feels tears prick the corners of her eyes. It isn’t fair. She gives up smoking again, and goes to boxing. She punches cancer in the face, again and again, but cancer won’t die. Cancer won’t be defeated. It roars back.

 

In the waiting room, Sunny charms. Other families smile at her and talk to her. They use her as a buffer for their own sorrow, looking into her eyes forgetting for a moment that the world has teeth and it can bite. Alicia doesn’t mind. She’s glad to share. Glad for the distraction. It means she can avoid the pity.

It’s more than the social worker. She’s seeing pity in the eyes of the nurses, the oncologists and she swears the parking garage guy is in the know. All these people wanting to reach out and comfort, so they can forget their own snarled lives and smelly entanglements. She’s just a convenience for them; her tragedy is the gristle of their dinnertime conversation and the meat of their self-avoidance. They can feel bad for her, reach out to her, but she’s not going to help them.

Down the hall, Manuel has taken a turn for the worse. The nurses have asked her to leave for a little bit. There’s blood coming out of his lungs. Alicia stands in the warmth of a sunny window and pushes the stroller back and forth. She needs to find a baby-sitter.

 

Two weeks after he has been admitted to the ICU and five weeks after he has been diagnosed with cancer, after 25 blood product transfusions, four thousand dollars worth of chemo and several hundred hours of nursing care, Manuel dies. The social worker watches the doctor talk to Alicia and hears the words between them, even though she’s not close enough. She sees Alicia nod, sees her eyes close for a minute and sees the grief etched on her face. For a moment, Alicia cracks.

At the bedside, in a room full of machines and beeps, the nurse sets down a syringe of morphine. This is to help him, she tells Alicia. He’s going to feel like he can’t breathe, and the morphine will help.

Alicia stands in the corner. She knows there’s nothing more they can do, she’s known it for a few days now and she’s not ready for this, but what’s the point in waiting. She’s trying to stay out of the way, but really, she’s scared out of her mind. She tries to put the fear in a box, push it away as the respiratory therapist removes the breathing tube and the nurse turns off the IV pumps and gives the morphine. They seem to certain. How can you be so sure, Alicia screams inside her head. She’s on thin ice, barely intact over a dark and chilly river of doubt.  

Manuel jerks. He coughs and his face turns a horrible color. The nurse turns. She is crying.

“Come hold his hand,” she says. “Come be with him.”

Alicia does. She does not think, does not feel. She takes her mind away to a cold gray place where no smiles or tears exist. She stands biting her lips so hard they bleed while the life slips out of her husband. Manuel coughs and then his breathing slows. There are no last words, no final gaze. This is not how it is on TV.

The social worker sees the nurse come out of the room and close the door. They stand at the desk and watch the monitor as Manuel’s heart slows and stops. She has never seen this nurse cry before, but they are both thinking about Sunny. Who will teach her to ride a bike or walk her down the aisle?

“Why do we do this?” the social worker asks. She does not expect an answer.

The nurse wipes her eyes and blows her nose. “Who else should?” she says. “We did everything. I mean, we couldn’t have done more.”

The social worker nods. She’s going to take this one home; they both will. But they’ve done everything they can. There’s nothing more.

“We all failed,” the social worker says. She thinks of all the failures, and Alicia, standing, cold and remote at her husband’s bedside.  

The nurse wants to tell the social worker that she didn’t fail, helping Alicia get childcare and locating Manuel’s long lost mother. But the nurse’s voice is full of tears and she says nothing.

Alicia leaves. She pulls out of the parking garage and gets on the highway. She makes it to the first exit before the first spasm wrack her body. By the time she reaches an empty parking lot, she barely has control of the car. She jams it into park and curls up in a ball of anguish. She wails. It’s like being possessed by a hurricane. There isn’t enough space in her body for the volume of grief trying to fill it, and yet it grows and grows, this loss this desolation, this utter agony. How can the human heart hold so much pain and go on beating? This is why the Sioux women cut themselves, to bleed out the pain. She wants to slip into a hole and never be seen again. She wants to drive  for hours until she reaches the ocean and drive in. She wants to be alone forever. She grips the steering wheel, beats it, rests her head on it, and grieves.

Sometimes there are no good answers. There aren’t any lights at the end of the tunnel, or happy endings to smile at. Fate is capricious and tragedy is real and cruel and I can testify to this. I was that nurse who stopped the drips and pushed the morphine and told Alicia to hold his hand. I sat in the back room afterward and cried. In telling Alicia’s story, I want a moral to it, something good to hang onto, but there is nothing. This is what happened. It was not an everyday tragedy; it was extraordinary, and yet Alicia, the social worker and I, we bear no scars. Maybe I am feeding off her grief, thanking God that it is not my own. The social worker and the doctors and I see so many cases where illness and tragedy could have been forestalled if a person had been more careful or come to follow up appointments, but here, nothing could have been changed. It happened and its ending was foretold as soon as it began.

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The homeless alcoholic with withdrawal seizures

You don’t know what they can do to you. You don’t know until you’ve been on the outs, in the cold weary weather where even the other bums turn the shoulder and the salvation army bed starts reeking of piss and self-righteousness so bad you think you’re gonna get religion if you stay there. The religious ones are the worst, I mean the absolute shits. The crazy crazy bums who got religion and who moon around talking about God and the stars and the prophecies they come to fulfill, and then the religious helpers. They do it all in Jesus’ name. Ask in My Name, He said, well then then why the hell didn’t I get a beer when I asked? And a nice house and a hot wife? Or even a spot under the bridge out of the rain? And they show up on Thanksgiving and Christmas, these meek fat white people, ladling out soup and pity, well they smell so goddam good because they got showers in their houses and if I didn’t have to wear everything just to stay warm, I’d wash my clothes every once in awhile too.

Then there’s that other thing he said. Jesus. The poor you will have with you always. Ain’t that the truth. As long as there’s shitheels, there’s gotta be people to be the turds. And won’t nobody turn their head and look twice if you’re cold and hungry or need smoke, but they get you in the hospital and its all you can do to get away. We have to make sure you’re stable, they say. I ain’t been stable for 14 years, and you’re gonna fix that with IVs and a heart monitor? Like hell.

You don’t even know what they can do. They can tie you down and shoot you up and not even read your Miranda. You say one thing about leaving the goddam hospital and that little nurse so tiny you could break her in half says, well, I’ll call the cops. She will too. Cops’ll hold you down and it’s all good with the law. I don’t even think they make laws about the hospital.

Three times I woke up with a tube in my mouth and almost choked to death. That 19 year old doctor told me I had seizures. Bullshit. I never had no seizures. Not me, not never. They just wanted to clear me offa the street and when I said no, I’m good on the street they beat me up. Got the scars to prove it. Course it’s my word against theirs, those blue shirts. Those tough guys with their big bellies and their scissors, ruining all my clothes, shooting me up and putting me to sleep. Then I wake up and they tell me I had seizures.

It’s a warm place to sleep, though. There’s food. But they don’t give you no choice, that’s what gets me. And when I’m done sitting inside, laying in bed like a lazy bones, I gotta be out on my own terms. Back to my turf. Back to my place. Cuz you don’t know the things they can do to you.

I know it’s cold outside. I know the places where the rain falls sideways and the snow’ll be your blanket when you wake up in the morning, if you wake up, and I know the reek of desperation. It’s inhospitable. Ain’t that a two dollar word. But at least it’s not hospital. The hospital’s warm and dry and the meals come regular but when I gets to feeling restless, start to missing the love of my life and my constant mistress, the bottle of Grants I left in the pile of gravel at the corner of State Street, I can’t get out. It ain’t a hospital, it’s a goddam prison. I can’t help it that I said f- you to the nurse and I dumped everything offa the table onto the floor and it made such a noise, I needed out, and then the guards came and yelled at me, and I heard the little nurse bitching about next time he has a seizure, he should make sure he has it where no one will find him. You’re welcome for saving your life! Well the problem is I didn’t have no goddam seizure, I got beat up by the cops what didn’t want me on the street. Cleaning up for some operation, something they didn’t want no witness to.

I’m back outside now. Frozen and free. I gotta hot date with a lady who warms me up like no other. Left her hidden on the corner of State Street.

Shirley

(This is a true story. Details that would reveal patient identity have been changed,  to protect patients and to comply with HIPPAA.)

Inside the hospital walls,we still have the lights off, as night pales to gray dawn. In the outside world, alarms clocks go off and normal people start their morning. The day shift will be leaving their houses, and soon I can go home. Salvation is at hand. It’s been a busy night, but not a memorable one in the medical ICU. Not one of those nights that it occurs to you at 3 am that you haven’t peed in more than eight hours and you probably can’t slow down and go now. But it’s been busy enough and we’re ready to go home in an hour. Until there’s a rapid response down the hall and the swat nurse asks if he can just bring the patient right now because she looks really bad. Ok, I say, bring her up.

I log into the computer to see what’s coming our way. “Oh no. Avery, Mrs. Rivers is coming back.”

Avery looks puzzled for a moment and then his face opens up. “Shirley!” he says. “Oh God, what’s wrong with Shirley this time?”

I shrug. Mrs. Rivers’ name is not Shirley, but Avery has a particular way of getting close to patients, close enough that he can do things like call them by the wrong name, and they think it’s funny. He helped me out with Shirley last week when her frail heart was racing and her blood pressure was dropping. “She’s back for more of the same,” I say. “Her blood pressure is 50/20, o2 sats are low and they want to try bipap.”

“She’s a DNI,” I tell Teresa, the nurse who’ll be taking Shirley. “She did it herself. Said no vent, but want compressions. She said she’s had them before and they work.”

Teresa rolls her eyes. She’s hanging IV tubing in the patient’s room. “Well, we won’t be doing compressions. We got 1 hour til day shift gets here.”

When Shirley comes, she’s lost in white blankets in the bed. She’s frail, she weighs all of 90 pounds. We put her on our monitor, put her on bipap. Her blood pressure reads 45 over nothing, and she’s completely unresponsive.  Teresa touches her neck. “Do you feel a pulse? I don’t feel a pulse.” A few others reach down, touch the tiny old woman’s neck, wrist, groin. Heads shake. We look at each other.

Shirley, before she was unresponsive, made two things very clear. She never wanted to be on a ventilator, and, if her heart stopped, she wanted chest compressions to restart it. Unfortunately, the doctor who signed this paper work with her did not explain that it is extraordinarily difficult, sometimes impossible to bring back a stopped heart without the presence of an artificial airway and mechanical ventilation. If Shirley had wanted neither, we would have held her hand and let her die in peace. If she had wanted both, we would have called anesthesia, put in an airway, and done everything to stabilize her. But as it was, as we stood there looking at each other, and  in that moment of silence, we knew we were going to break her ribs and we knew she was going to die.

“Start compressions,” the doctor says. One of the nurses goes for the code cart. I delegate; you’re going to push meds, you’re going to draw them up, you’re going to record. In the middle of it all, Teresa is pushing on Shirley’s emaciated thorax, tears running down her face. I know with every compression she can feel the ribs pop as they break and then the chest feels all wobbly because the rib cage is falling apart. “This is criminal,” she says. But she keeps going.

After a few rounds of epinephrine, we get a pulse back. But there’s no question of bringing Shirley back. She’s too far gone. The resident, for some asinine reason, orders fluid boluses, blood cultures, a stat echo-cardiogram and an chest xray on a woman who is virtually dead. Poor Shirley. None of it will help her. Of her six children, none of them has a working phone number. Her husband must have passed years ago and she has no friends or siblings that we’ve been able to reach. In the clear light of day, two attending physicians make the case for futility (this almost never happens) and do not escalate care. Shirley dies.

But Shirley does not die alone. There is a nurse there. We were with her to change her name and make her laugh, to tempt her with food when she wouldn’t eat, to help her out of bed. We were there to try to save her life and we were there when it ended. This then, is nursing. It is science, paperwork, and heavy lifting but as Peggy Anderson wrote in 1978, it is about caring for other humans. This is the place where I never thought I’d be, never wanted to be, but now I can’t imagine being anywhere else.  Nursing is not glamorous. It is messy and sad and awful, and it is uplifting and renewing and amazing. It is the science of disease management and prevention and the art of intervening in the human response to suffering. It is being able to give the right medications at the right time and knowing their purpose and side effects, but it is also how to approach the patient getting the meds, and how to teach him what he doesn’t know and how to make him smile. The profession is difficult to define; nurses write volumes trying. No other discipline so skillfully blends compassion and science, or mixes so well rigid policies with creativity. On the job, we hold lives in our hands and at the end of the day, we clock out like everyone else. We work with high stakes and drama, with monotone reality and with the heartbreaking agony of everyday pain and sorrow. I never thought I’d be here and today I can’t imagine myself anywhere else.

The Hero

David is 38 years old. He has been a nurse long enough that almost nothing makes him gag anymore, but not long enough that he is annoyed if he misses lunch because of a cardiac arrest. In his mind, full of logic and order and straight lines, this is a not very precise measurement, but he understands that if he reaches the point where he’s doing CPR and wishing the patient could have waited until after he ate, then he’s been a nurse for a very long time.

On an average day doing charge on A6, David  answers 32 phone calls, starts seven IVs and corrects four mistakes made by new nurses. He hangs eight new bags of IV fluid, questions fifteen new md orders, discharges four patients and admits five new ones. He helps eight people to the bathroom, cleans up six dirty beds and helps other nurses and tech to lift or reposition a total of one ton of human flesh. He clocks between three and seven miles on his fitbit. When he gets home at night, he lays on the couch and stares at the ceiling. Some days A6 is more work than the Air Force.

He likes it, though. Likes that he knows the answers, he can assist and correct, likes the way illness and disability don’t faze him anymore, because there’s something he can do. And he likes the way he moves. In a place where walking down the hall is a feat and so many are hampered by stiff knees, disease and extra weight, he walks easily, for hours, his body still lean and strong from years in the service, a lodestone of order and sanity in his cluttered and chaotic environment.

On Tuesday morning, after switching the assignment twice (the pregnant nurse can’t take the chemo patient and the patient in 20 door is suddenly refusing male RNs) David illegally eats a cliff bar in the med room.

Three call lights are going off. One will be 20 door, asking to page the doctor about her change in morphine dose. 16 door is probably ready to come off the bedpan and other, well, it could be anybody. He swallows his cliff bar and thinks he’ll make a break for his water bottle in the break room but as soon as he steps out of the med room, he is confronted by middle-aged man in a Vietnam hat.

“You know what’s going on with my wife?” he says.

“Who is your wife, sir?” His mouth is dry. 15 steps and he can grab his water.

“I’m Howie. My wife is Beatrice.” The man gestures towards 18. “She’s been here for a week and can’t nobody tell me what’s wrong. You doctors just sit around with your thumbs up your ass all day or something?”

David is thinking about Beatrice. He’s been hearing her rattling cough and raspy voice much longer than a week, and he’s pretty sure she’s dying. Then he realizes the man’s mistake. “Howie, I’m not a doctor, but I can page one for you.”

Howie peers at David’s name tag. “Oh,” he says. “What’d you become a male nurse for?” He looks David up and down. “You a homo?”

At the desk, the phone is ringing. There is no secretary today. The nursing tech hurries by, laden with linens. David bites back three ridiculous answers. “I’m not a homo.”

“Hmph,” says Howie. He looks at David’s ringless fingers. “You ever been married?”

David is puzzled now. “I was.”

“Ha! Wish I could say was. Damn woman is a pain in the ass.” He scratches his head beneath his hat. “Nevva mind callin a doc for me. They’re just gonna tell me the same stuff.” He glances towards his wife’s room. “I just thought you was a doctor and maybe…” His sentence hangs, fractured.

David lays a quick hand on the man’s shoulder goes for the phone. It is his manager, reminding him that the staff have mandatory empathy training over the next two days.  Ok, he says, while scrolling through Beatrice’s chart. Chronic diastolic heart failure, non-resectable lung tumor, unstaged, history of smoking, DNR. He was willing to bet Howie knew all that stuff, and Beatrice did too. Sometimes people want a different answer.

 

At 3pm, staffing changes. He’s down a nurse and the supervisor is sympathetic, but sympathetic doesn’t help do discharge paperwork and turn total care patients. She sends him an LPN and he feels obligated to thank her even though that means he’ll have to look out for the LPN’s patients. At 330, the girl in 20 door has screaming meltdown because she’s in horrible pain and the pills aren’t cutting it. 16 window was all set to go home and then his discharge got cancelled because his insurance wouldn’t pay for a critical medication. A new patient arrives in 8 in from ED and when she arrives, her blood pressure is 65/40, confirmed, thank you and and it takes an hour to get her transferred to the ICU.

At 530, he finally checks on his patients. The LPN (who would think about lunch while doing CPR) gives him an update, he thanks her, and says hi to all of them. This is a little hazardous because there’s a pretty high chance that one of them will want something that will either be impossible or take a half an hour. But the LPN is good, she knows her stuff, and his patients are well cared for. He checks on Beatrice last.

As soon as he opens the door, he knows his mistake. There’s no rattling cough or raspy voice, and the room feels empty. He steps around the curtain. She lays alone in a quiet room. The light above her head is like a halo. He gets that queer dizzy feeling like the world is shaking a little beneath him. He knows what he will find, but he touches her anyway. There is no pulse at her wrist, her skin is waxy and cooling and the DNR bracelet confirms that his work with her is finished. If I checked on her earlier, he thinks, this might be different. But would it have? Was there anything else he could have done?

He hears a shuffle step behind him. Shit. He turns, and imagines how he must look to Howie. The male nurse, the potential homo, holding Howie’s wife’s dead hand, confirming her non-existence.

The man sits down heavily in a chair at the foot of the bed.

“Howie,” David says.

Howie grunts. His knuckles are tight, squeezing and releasing his legs. Men of that generation do not  cry, nor do they show emotion. David slowly places the dead woman’s hand on her chest and walks to Howie. He squats next to the chair and touches Howie. The man stiffens and then grips the nurse’s hand tightly. They both look at Beatrice, beatific beneath the lone fluorescent light. Howie shudders and his head drops to his chest.

In a few moments, David will step out of this sacred moment and into the bright chaos. He will call the supervisor to let her know 18 window has passed. He will help bag the body and send her to the morgue. He will answer more phone calls and call lights, manage the assignment for the night shift. But right now, there is nothing more he can do. He is thinking about Howie, and that both of them will, tonight, be home alone. He is thinking about how, because he is a nurse, it is ok for him to hold hands with a complete stranger, and share sorrow.  He is thinking about how it is not that he is a nurse and Howie a client, but that they are two human beings, grieving together for the beautiful temporary blink that is human existence.

An RN, unintentionally

“You take your material where you can find it, which is in your life, at the intersection of past and present. The memory traffic feeds into a rotary up on your head where is goes in circles for a while, then pretty soon imagination flows in and the traffic merges and shoots off in down a thousand different streets. As a writer, all you can do is pick a street and go for the ride, putting down things as they come at you. That’s the real obsession. All those stories.”

-Tim O’Brien, The Things They Carried

What I have found in nursing, is that there are stories everywhere and I can’t not write them down. Medicine is drama unscripted and I, at the bedside in the hospital, am the unprepared audience or an unrehearsed player. I never know when a normal day, a normal situation can spiral towards disaster or evolve into a miracle. I often feel like a voyeur, knowing the intimate details of my patients’ bodies and maladies, their family secrets and tragedies, and also the function and dysfunction the world’s most expensive health care system. Miracles, tragedies, extraordinary people, extraordinary odds, even the mundanities. Each time I’m certain I’ve seen it all, something new happens. I’ll never have seen it all.

I don’t understand why more nurses don’t write. The professions lends itself to the telling of tales but it usually stops with gossip in the back room, or those stories that start with “This one time…”. For myself, I can’t comprehend how the extremes we undergo become normal to us. That’s really what I’m trying to work through. It doesn’t matter how my times we try to resuscitate a man who will die despite our trying, I rage against the trying. Each time I take away life support or roll a patient to the morgue, I’m struck by the brazenness of I’m doing.  How can I counsel and comfort an anguished husband who is going to stop treatment on his wife? Since when am I, a human being, qualified to prolong a life or aid in a peaceful death? When I help a family navigate a difficult situation, I think, this is my job, and this is their life. How can I walk into this drama, partake, and go home? The moment that will scar this patient forever is merely what I’m getting paid to do.