Darkness

I feel the darkness descending on me. It's been away for a long, long, time, but now I think I'll allow it to visit for a bit. I'm in need of a bit of introspection. It fuels my creative energies. Like Hemingway. Not to say that I'm really like Hemingway. Just dark right now like he was. I've been shelving my negative thoughts at the advice of the positive minded gurus I listen to on the radio. Sometimes you just have to let the sadness in. This is a sad world and I've witnessed more than my share of sadness. Not in my personal life per se, but in the lives of others that have touched me.

Since I started working for hospice 16 years ago, I've kept a journal of all the patients I've cared for. I finally stopped adding to the journal, there were just too many deaths, but last night I looked through it. All those faces came back to me in an instant. They haven't been put as far away as I thought. All that pain and suffering.

THE NIGHT I'LL NEVER FORGET

In the early 1980’s, I spent many nights working in the intensive care units of hospitals in Orange County. My children were small and I’d found a way to work and still be home with them during the day when they needed me. My husband would come home and care for them in the evening on the nights I worked. My shifts were twelve hours long, from seven in the evening to seven in the morning, and I was able to make the same amount of money two days a week that I made in a forty hour work week at my prior job. I worked for a nursing registry that sent me to different hospitals each night, and this particular night I was working in Garden Grove.


Each hospital had their own distinct way of handling the registry nurses. Some of the charge nurses would assign the registry nurse the easier patients to care for and give the more complex patients to their own staff. Other charge nurses would give the registry nurses the most difficult assignments and let the regular staff take it easy.

The charge nurse in the Garden Grove Hospital assigned the most critically ill patient to herself, which was a tremendous relief to me. The patient was a twelve year old boy who had been hit by a car earlier that day and suffered a horrendous head injury. His head was swathed in a huge white turban of gauze and his eyelids were bruised purple and swollen shut. Drainage tubes emerged from the gauze and were connected to a glass bottle which was filling with pinkish liquid indicating it was cerebral spinal fluid mixed with blood.

A tube was inserted through his mouth and into his lungs, and connected to a respirator that did all the breathing for him. Intravenous lines ran into both his arms and a foley catheter kept his bladder empty as the clear yellow urine slowly drained into a bag hanging on the side of the bed.

The boy didn’t move a muscle, and the charge nurse rarely left his side. The ICU was a tiny one with only four beds, so we were all in close proximity to the critical situation and were there to help when the need arose. She would call one of us over to stand guard when she absolutely had to take a bathroom break, but the rest of the time she was the one right there with him.

His parents and older sister wandered in and out all night long. They’d stand by his side and stroke his hand, speaking softly to him, crying and hugging one another.

Around three in the morning, the boy’s heart monitor and blood pressure readings changed significantly, letting us know that he was dying. We rushed to the waiting room and called for his family to come in. They stood at the bedside as he died, weeping uncontrollably. His sister cried out, “Do something! He can’t die. He’s the only brother I’ve got.”

Oh, how I wish we could have done something. All we could do was watch and weep ourselves. It was out of our hands. I can’t think about that little boy or his family without tears coming to my eyes still.

I walked out of the hospital at the end of my shift and thought I would never set foot in one again. Be still, my soul.

APPALACHIA IN ORANGE COUNTY

In my part-time work as a hospice nurse I’m often sent to see patients I know little about. I view it as an adventure and also as an opportunity to put the pieces of a puzzle together. One day in early summer, I was sent to see an elderly lady in Orange County, California, who was dying of end stage dementia. The only information I was given was her name, address, and telephone number. I looked it up on my street map since it was in the days prior to GPS, and made my way there. I turned into an ordinary working class neighborhood of one story ranch style California homes, located the street and found the house number on the mail box at the curb.


This particular house sat at the end of a long driveway and was obscured from view by many fruit trees and tall weeds in the front yard. I retrieved my medical bag and notebook and started down the drive. Lined along one side were several junk cars that seemed to be slowly rusting into the ground. The house came into view and seated in a rocking chair on the front porch was a very fat, old, toothless man smoking a pipe. He smiled at me as I walked up and told me to “just go right on in the house”.

I opened the door and stepped inside. I’d only taken a couple of steps when I had to stop, not sure whether what I was seeing was real or a hallucination. The house was dark, dirty, and dreary. What were formerly drapes now hung at the windows in shreds that resembled ropes. To block out the light, someone had taped big pieces of cardboard to the windows, and old sofas lined the walls of the living room. Once my eyes adjusted to the dim light, I realized there were bodies covered with blankets lying on the sofas. Various bodily noises were frequently being emitted from these lumps under the covers, the odor in the house attested to the origin of the noises.

Trash, newspapers, and junk were piled everywhere. I wondered where I would find my patient in all of this, then finally located her lying in a hospital bed in what would have been the dining room of the home. She was clean and her clothing and bed linens were clean as well, much to my surprise and relief. I took a disposable plastic barrier from my bag and placed it on top of a stack of newspapers so I had a sanitary place to put my bag and notebook. I was getting ready to examine the patient when I heard footsteps coming down the hall. Expecting to greet the patient’s son, I was dismayed to find myself face to face with a man wearing only a towel. He’d apparently just come from the shower. When I inquired if he was the son, he said no, and shouted out the son’s name.

Soon, Billy appeared. He was a younger version of the elderly man on the porch. Billy wore overalls that were filthy, and he didn’t have a shirt, so I was treated to the sight of major chest hair and pretty foul body odor.

Billy greeted me with great enthusiasm and said he was just about to get his mom up to the commode by her bed and then I could do my exam. He lifted the lid of the commode, and I was again dismayed to see it was filled almost to the brim with bodily waste. Apparently it was the real source of the odor in the house. Billy explained without apology that the toilet wasn’t working so he couldn’t empty the contents of the commode. I didn’t bother to ask what the rest of the residents of the house did when they needed to use the toilet.

I finished my exam, checked the patient’s medications, and gave him some more supplies to help him care for his mother. I stood up to write my nursing notes as I balanced them on the patient’s chart, as there wasn’t a clean place to sit. I exited the house as soon as I could.

Billy met me outside with a paper bag. He thanked me for the visit and told me there were homegrown tomatoes in the bag. I thanked him for the gift and said homegrown tomatoes were one of my very favorite things, and I took them to my car. Once home I scrubbed them with soap and water and laid them on paper towels in the kitchen to dry. That’s where they stayed until my husband decided to eat them, telling me I was being silly not wanting to touch them. I couldn’t bring myself to take even one bite, and still wonder what kind of fertilizer grew such beautiful tomatoes.

NO WINING...Nurse Story

THE LIONESS HAS NOTHING TO DO WITH THE STORY, BUT SHE SURE IS BEAUTIFUL EVEN AFTER HAVING JUST EATEN A WART HOG. I TOOK THE PICTURE!

Millie was ninety-five years old and on Hospice for end stage cardiac disease. She and her daughter, Dena, lived together in Millie’s home. Millie was weak and fatigued, but didn’t require a lot of care when she first came on service. She was mentally very alert and I enjoyed my visits with her immensely.

We’d discussed her smoking when she’d first been admitted to the hospice program. She’d tried to quit over the years and she and her doctor had agreed that there wasn’t much point in quitting now when she was at the end of her life. My opinion was the same, and I let her know that. Dena didn’t want her to smoke in the house, so she’d made a little area in the garage for Millie to go to when she wanted to smoke. Millie went out a few times in the day and evening to have a cigarette.

One day, shortly after I’d arrived for the visit, Dena walked in from the garage carrying a wine glass. She said, “Mother, how many times do I have to ask you to bring your wine glasses back into the house?”

At this, Millie’s head whipped around and she looked guiltily at me. “I like to have a glass or two of wine in the evening, is that all right?” she asked.

I smiled and patted her hand. “I like a glass of wine in the evening, too. If it’s okay with your doctor, it’s okay with me.”

Millie breathed a sigh of relief. “Oh, I’m so glad you don’t think badly of me. What kind of wine do you like?”

“Oh, my favorite is chardonnay.”

“That’s my favorite, too!” she said, beaming. “Would you like a glass?”

I chuckled at this and said, “Not right now, Millie. I’m working and can’t drink on the job. Thank you for offering, though.”

She smiled, too, and said, “Oh good, because I would have been really worried if you’d said yes.”

Be Still My Soul

We come into this world with a huge imperfection...an enormous hole in our soul. It is our job to learn how to fill this hole. Some try to fill it with alcohol, drugs, sex, food. Others with mysticism, psychic encounters, meditation, AA, shopping, or self punishment. This book is filled with stories of the people I have encountered in my life’s journey, and how they have helped to fill the hole in my soul.









THE MAKING OF A NURSE



Grandma Grace died on August 4, 1954. I was six years old and stood outside her bedroom with my nose pressed against the window pane watching my Grandpa cry, his face in his hands.

I walked around the side of the house to the porch and found my dad holding Mom in his arms while she cried on his shoulder.

“Your grandma just passed away,” Dad said to me.

“I already know,” I replied,

Dad gave me a puzzled look, turned back to comfort my Mom.

I understood a lot despite my young age, having spent most of that summer in 1954 at my grandparent’s home while my mom and my Uncle Richard helped care for Grandma during her final days battling leukemia. I’d watched my family give Grandma pain medication, bathe her, turn her over, change her clothes, and empty the colostomy bag she’d worn for many years.

I liked that she was in her own bed in her own home. I also liked that my brother and I could go in and climb up on the bed and visit with her on the days when she felt well enough. On the days that she didn’t, I’d stand outside her window and wave. She called me her little butterfly at the window.

As sad as it was for me to lose my beloved grandmother, the way she died seemed so peaceful and natural that I’ve carried the memory of it with me my entire nursing career.

North From Alaska

I'm writing a book of stories based on my nursing career. I've decided to share them on my blog. Here's the first:

June, a 67 year old woman on our hospice program for lung cancer that had metastasized to her bones, was in tremendous pain, both physical and spiritual. The physical pain was due to the cancer, the spiritual pain due to the hole in her soul. She’d had several failed marriages and her three children hadn’t grown to be the successful individuals she’d hoped for. Her oldest daughter, Julie, wasn’t allowed inside her home because she would steal anything she could, including money and the drugs we prescribed for her mother. June had custody of Julie’s three year old son due to Julie being confined in prison for drug abuse and grand theft. Now she was out but apparently hadn't been rehabilitated.


June’s second daughter, Betty, lived with her, along with Betty’s two young sons. Betty also had a criminal record and was on house arrest for one month during the year I was seeing June. Her arrest was for forging checks. The Judge decided on house arrest so she could supervise her two sons and care for her mom. Betty was a pleasant though ineffective caregiver. She probably had attention deficit disorder and didn’t understand the instructions I gave her on how to care for her mom. When Betty’s charming and handsome husband, Eric, was released from prison after his most recent stay, he also moved into the house. Betty’s attention then turned to keeping Eric happy, and she did little to care for her mom.

After much prodding from me and the hospice social worker, the family contacted their brother, Mark, who lived in Alaska. Mark arrived along with his girlfriend, Debbie, and moved into the house with all the rest of the family.

I arranged a meeting with Mark for the day after his arrival. When the door opened, I was greeted by a bear of a man with the most beautiful blue eyes I’d ever seen. They didn’t look like they belonged on this man, but if the eyes are the windows to the soul; I was soon to learn this man’s soul was as beautiful as his eyes. His gray hair was long and stringy, rather thin on top, and a huge gray beard that hung halfway down his chest. It stopped at his enormous belly that looked as if he had a full term baby inside. He was fond of going without a shirt and the sight of his huge stomach and tattooed arms took a bit of getting used to.

However, Mark was a natural caregiver. He cooked for his mom, fed her when she couldn’t eat, took her to the bathroom, bathed and kept her in clean clothing and bed linens. He monitored her medications carefully and kept them under lock and key. Though he had spent time in prison on drug charges and was currently on parole, there were never any drugs missing once Mark took over his mom’s care.

Many times I would arrive to find Mark grieving over the impending loss of his mom and the many regrets over the choices he’d made in life. On those days, tears would fill his blue eyes and pour down his cheeks once they’d dropped off his long, curly black eyelashes. All I saw when I looked at him were his eyes and what lay behind them. I knew the rest of the world would probably never get to know what a tender, loving man he really was.

One day I arrived for my visit and Mark answered the door wearing sunglasses. After a few minutes, he asked me to take a look at his eye, saying it was bothering him. When he took the glasses off, I gasped at the sight of his formerly blue left eye that was now completely black. On closer inspection, I found that his pupil was completely dilated. He denied injuring it and when I pressed, he finally confessed he’d put his mother’s “eye drops” in his eye since it was irritating him. Puzzled, I asked him to show me the eye drops. He came back with the bottle of Atropine eye drops, clearly labeled with his mother’s name and the directions for her to take the drops orally for congestion, which is standard practice for hospice patients. Atropine is normally used to dilate the eye for eye exams, but we use it to dry up excessive secretions when people are dying. Knowing that there wouldn’t be any permanent damage to Mark’s eye, I burst out laughing before I gave him the lecture about never using someone else’s medications. I then went on to explain that his pupil would eventually go back to the normal size but it would probably take several days and he’d need to wear the sunglasses until then. Relieved, he finally smiled a sheepish grin. When I visited the next week, his pupil had indeed returned to normal size.

Several times during the months Mark cared for his mom, I wrote letters to the Judge in Alaska to whom he was supposed to report during his parole, telling him about what a good job Mark was doing and how much he was needed in California. I never heard back from the Judge, but he didn’t order Mark back to Alaska, so apparently my letters worked. I wonder now where Mark is and how his life is going. He was truly a special person hidden behind a burly, and pretty intimidating façade. This big grizzly bear man was really a teddy bear underneath.

Grief: I Cried Today

My dad passed away on February 28, 2007. I'll miss him always but the tears come less frequently now. Today I put a Jamey Johnson CD in my car player and was fine until his song, You Should Have Seen it in Color played. The tears started at the line, That's me and Uncle Joe just tryin' to survive... You see, I had an Uncle Joe. He and my dad were orphaned as young boys and they did have to try and survive together. The next line that did me in was, That's me and Grandma in the summer sun...that rose was red and her eyes were blue... Yes, my mom and dad got married in June. She wore a red rose and her eyes were blue.

The tears were pouring down my cheeks now as I tried to navigate around the trucks on Southern California's 605 freeway on my way to make visits to hospice patients.

My dad had a hard life. He was a lonely boy when he joined the Navy and sailed off to WWII. He did have a good life with my mom, and had his own family that was with him when he died, but I still mourn for that little boy that lost his parents so young and always had a big hole in his heart. He grew up in the generation that didn't whine and complain, and he never did, but it still makes me sad to think about how many tough times he had to indure in his life. I wonder if he ever knew that I aspired to be like him in a lot of ways. Probably not. I didn't ever share that with him.

Posting an entire book on a blog

I'm wondering about posting an entire book on a blog, chapter by chapter. Has it been done? I have a completed manuscript and am thinking about going for it.

I'm working through my block. My muse hasn't found me yet--probably on a prolonged vacation in Tahiti which is one place I would like to be. I'd love to be lounging on the sand, drinking tropical drinks one by one, and bobbing in the water when I get too warm. Maybe some sun-drenched god-like creature would come by every now and then and rub sunscreen into my already roasted skin. Perhaps someone could fan me every now and then, too.

In the meantime, we just returned from the Harbor Mexican Cafe where you can "sit anywhere you like my friends" and I had a couple of glasses of wine and a chicken tostado. I had a hard day with hospice. The 45 year old man is close to dying but still hasn't gone. I let my guard down today and shed some tears while I was visiting. I don't do that too often. I'm supposed to be strong for the family, but I couldn't help it. They're all so wonderful and loving and I feel so bad for them. My next three visits were okay. One of them, an 87 year old lady, I learned is an RN too, and worked for 50 years in a lot of the same hospitals I've worked in. Small world.

Now it's time for me to sign off so I can recoup for tomorrow whatever lies ahead. I'm formulating my next story while I'm driving around during the day.

Muse! Where are you?

Count your blessings.

I woke up at 5:45 AM, worked out with Al and the "girls", walked the dog, showered and dressed, and drove to the "mandatory meeting" at Kaiser. I'd been able to grab a cup of coffee, nuke some soy bacon, and read a bit of the paper before I drove to work, so I already knew Kaiser was laying off 1800 people in California. 1200 in Northern California, and 600 in Southern. I had a good idea that's what the meeting was about.

I was right. The administration staff announced that positions had to be eliminated due to the lack of growth in membership Kaiser has had since 2005. Three positions in the hospice department were being eliminated. None of them clinical staff. All administrative and support staff. What does this mean to us? The clinical staff will now be working even harder to absorb the duties previously performed by those individuals. And you know what? We're all happy to do it if it means we're still working. We'd already lost about 20 clinical staff earlier in the year. We know the drill. Smile and keep on keeping on.

But what about the 1800 people that are now without jobs? I and those around me left the meeting with a heavy heart knowing there were others that are now with out a job. I hope they all have some sort of a backup plan. I hope their significant others are employed. I hope, I hope, things turn around soon for all of us.

Reality Check

Today I put my hospice nurse hat on and went to work. There's nothing like it for putting your life in perspective. I'm going to stop sniveling now and move on.

My first visit was to a palliative care patient that isn't dying any time soon. I love to visit him. I fill his pill boxes, check his vital signs, talk with the caregiver at the facility, then he and I sit and visit. Today he really wanted to go out for some Jack Daniels even though he hasn't had anything to drink in 9 years and he's 92 years old. We laughed a lot and then he kissed my hand when I had to leave.

My second visit was also to a palliative care patient to change a dressing on her leg wound. It was also a nice visit. She's a pleasant lady with a bit of dementia which gives her a bit of a childlike innocent quality.

Then I made my third visit to a 45 year old man dying of a brain tumor. He's married to a wife who loves him a lot. He has a teenage son and a preteen son who are having problems accepting that Dad is going to die. He's one of 8 kids, and all his brothers and sisters are around the house, too. And his uncle is there. Thank God for the uncle. He's a retired hospice Dr. and he's the glue that is holding the whole family together. He looked really tired today when I was there. I hope he doesn't have to do this much longer. I left that home with a heavy heart and drove back to my own home.

Enough introspection and wallowing in my self pity for having lost my muse. He'll either come back or he won't. I have bigger things to do.

Searching for my muse

I ran across this logo from Night Owl Romance. They reviewed my ebook, LET THEM EAT CAKE, and chose it as a top pick. My muse was around then.

During my writing hiatus, I've decided to work full time at my other job as a hospice RN. When I began writing, my plan was to replace nursing with writing. I thought I'd be there by now. Maybe I'm not supposed to replace nursing with anything. Maybe I'm supposed to continue my work as a hospice nurse. I did have a good week last week despite the man that chose to misplace his anger at his wife's illness and take it out on me. Boy did he bend my ear! Oh well, the rest of the folks I saw benefitted from my visits. 1 bad one out of 20 isn't so bad.

Back to finding my muse...my thoughts are turning to historical California. I recently finished a book, CALIFORNIA WOMAN by Donald Knapp, and it was full of history about California. It was such fun to read because I've been to all the places he wrote about. I'm especially drawn to Northern California where my mom lives, near Chico. I guess I'll do some more research and see if my muse finds me.

Enough thoughts for today. I'm going out to float on the pool and meditate.