Brie Gowen

Savor the Essence of Life

COVID-19: An Inside Look

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Perhaps it’s because I’m a registered nurse working the bedside of this virus, but I feel like I’ve seen plenty of information about what it’s like for healthcare workers fighting this COVID-19 fight. I’ve seen stories about violence towards people in scrubs out there, but personally I’ve received nothing but support and encouragement. Most of my friends know about our struggles with personal protective equipment (PPE), be it the fears it will run out or the frustration with the ever-changing guidelines of safety by the CDC. People have seen the struggles nurses and others have wearing the same masks for twelves hours or more straight, and aside from them seeing the bruises and pressure sores on my face, I’ve told my family how the continuous wear causes me to feel fuzzy-headed and drowsy (not a good feeling for a critical care nurse).

We (as a healthcare team) mostly keep quiet about the inconveniences of no bathroom or water breaks. I mean, it’s just how it is. Another straw to add to the back of an already sagging camel. Yet, despite any struggles we face physically, or even the fears we attempt to overcome mentally, it’s been so helpful to have the praise and support of family and friends. I know they see me, and they try to sympathize with the war we’re waging against this tricky contagion. I guess, what I’m trying to say is, I feel like a lot of thoughts and prayers have been directed my way, but recently my heart has been breaking for the patients I serve.

If you could see inside my little world, behind smudged googles and hot breath, you would see how COVID is attacking more than our ability to go to the mall, or even beyond our inability to pay bills. You see, this pandemic is more than being forced to stay home, schooling your children, or even (sadly) being unable to gather with your church or extended family. I saw it went beyond missing my baby brother’s wedding, or not being able to find our favored toilet paper. Because beyond sinking stocks and failing businesses were people dying. Scared, alone, and confused.

If you could stand here beside me you would see the real effects of COVID-19. You’d see the frightened eyes of a patient when a crowd of strangers rush into the room, moving quickly, with a sense of urgency. You’d glimpse the fear the patient exuded over all the people surrounding them in hoods, masks, and billowing gowns. The worst part about a mask? They can’t see you smile.

If you stood in my shoes you would hold a patient’s hand with your own gloved one, attempting to offer comfort, wiping away a stray tear, patting their arm compassionately.

“You’re doing so good. It’s ok. Don’t be afraid.”

While foreign tubes are being inserted, with language barriers in place, you’d try to explain why rolling onto your belly in the hospital bed is needed to perhaps help getting a breath be less excruciating.

If you sat at my desk you’d try and calm a family member, over the phone only, since visitors aren’t allowed.

If you stood outside the glass fishbowl, like me, watching lifesaving procedures being performed in unprecedented ways, to keep staff contamination at bay, you’d feel your heart break while staff worked feverishly to sedate the anxious patient, just prior to passing down a endotracheal breathing tube. If you could read the patients frantic thoughts at that moment just prior to sweet sleep, you would be certain he wondered worriedly, “what if I never wake up?”

Because people aren’t waking up.

Y’all, I can’t understand all this. It’s not like anything we’ve ever known, and I’m sure you’re getting that Sci-Fi movie vibe too. As if we’re walking through a dream we can’t wake from, we all feel that surreal mood. It’s hard for everyone, and we all feel the sting, but we have to remember to feel more than just how this is affecting us personally. We gotta try to imagine how it’s impacting the world at large, how we’re all hurting in one way or another. Because, you see, it’s our ability to empathize with another than binds us, and if we can stand together (even as we’re physically apart), we will stand stronger when the dust settles. Eventually it will.

Thank a Nurse, Today

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We all stood in a rough circle, listening to another briefing about safety policies and fluid plans going forward. I looked around at the nodding faces of my coworkers, asking important questions as needed, or giving suggestions to improve overall outcome. No one griped, guffawed, or rolled their eyes. We listened to conversations of personal protective equipment running low, and straightforward statements that a nursing shortage was on the horizon. Stoic, we stood tall, and not one person said, “that’s it. I’m outta here!”

That’s not what nurses did. When the going got tough, we got tougher. I was reminded of my time in the military. Serving during 9/11, I was active duty when the war in Iraq first began. I watched my spouse and 90% of my coworkers leave the hospital to deploy overseas. In their absence I worked 12 hours shifts, seven days a week, for thirty days straight until reservists arrived to help. And although I held honor, courage, and commitment at my core, let’s be honest; I didn’t have a choice. I belonged to the U.S. Government, and I worked in hard conditions because, “that’s what you told me to do, Lieutenant Dan.” But seriously, I did my duty without question. Civilian Nurses, they’re a little different.

I want you to understand something very important. All the things you’re feeling, you are not alone. Feeling scared? Overwhelmed? Worried for your family? Despite the frequent assumption otherwise, nurses are indeed human, with emotions and needs. We don’t want to become sick with COVID-19 anymore than the next person, and we don’t get jazzed about possibly taking it home to our young children, elderly parents, or immune comprised spouse. We get tired when we work extra, and we need to go grocery shopping too. Today, after my twelve hour shift, I stopped and picked through the scraps left at my local grocery store.

Your bedside nurse isn’t immune to deadly viruses, but they go to work each and every shift, fearless. We utilize our training and knowledge to stand on the frontline despite the fact that we have all the concerns you may be feeling right this very moment. Any nurse could call out sick, walk away, or refuse that request to work overtime, but we don’t. We face the music, no matter how screechy the melody, and we dance a graceful waltz through uncharted waters.

I guess it sounds like I’m tooting our own horn, or uninvitedly skywriting “Nurses Rock,” but doggone it, I can’t help it. I’m proud to be a nurse, and I’m proud to stand firm alongside some amazing men and women. They come in each shift, already, with sick children at home, a chronically ill, aging parent in their thoughts, or a relationship on the rocks thanks to long hours and less weekends off. Never mind showing up with a smile when a pandemic is on the rise.

Today was a crazy day at the hospital bedside. I saw more movement than we wanted, and I saw a team pick up the reigns. I heard a stray, “I’m tired,” or as 7pm neared a weary, “I’m ready to go home,” but I never heard a real complaint. I never saw a bad attitude today, and there was more than a few things that could make a person flip. I saw what I see most, every day. I saw nurses caring for their patients with compassion and skill. I saw my peers intervening to save lives, and advocating for the people in their care. In this regard, it wasn’t much different than any other day, other than all the masks, gowns, and protective eye wear. We still washed our hands, like we always do, and we used required precautions to prevent the spread of contagious disease. Again, like we always do.

I stood on the frontline today with a team that superbly carried out their duty, and despite the odds stacked against us, carried it out well. So, while a lot of things are uncertain and ever-changing in our world right now, one thing is the same. One thing is steady despite the storm, firmly rooted despite the slipping sand. It’s your bedside nurse. They are doing what they have always done. Excellent patient care with a smile. Your local Walmart may be out of toilet paper, and your child’s school may be closed, but your hospitals are still open, with all the amazing healthcare staff present and doing what they do best. In uncertain times, you can still count on that.

So, thank a nurse today! Thank the doctors, techs, therapists, and many other frontline staff. Show your gratitude to your police officers, and all the other people who go about their work just like any other day, with just a bit more stress in the mix. Wink, wink. I’m proud to stand in the ranks with so many who help keep this world going, even when life wants to shut it down.

What to Say When You See a Nurse Sitting Down

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I think part of the problem is you’re not used to seeing it. A nurse sitting down, I mean. There’s a reason I put a step counter app on my phone. It helps me feel justified when I’m scarfing down a couple of donuts at 4pm because I’m starving from a skipped lunch. Point being, the miles I walk on any given day at the patient bedside would trump just about any exercise routine I might try to begin. Between back and forth trips to a room or quick dashes to the pharmacy, I definitely burn my fair share of calories. What I don’t do a lot of, in comparison, is sit. And even if I am sitting, I’m usually charting. Yet that’s not the moment a passerby will catch me.

If you’ve been a nurse any length of time then you know that nursing has its own cruel version of Murphy’s Law. This happenstance will mean that uttering the word “quiet” makes crazy things happen, or that saying you’re all caught up will make the stool hit the fan. It’s that peculiar nuisance that makes your face itch like crazy when you’re fully donned in PPE, or your patient’s blood pressure plummet right after you lose your one working IV. You know what else it is? It’s the fact that the moment you sit down to take a break two things will happen. Either a call light will go off, or someone who isn’t working the bedside will walk by.

Ahhhh. You see the nurse, phone in hand, leg propped up. My, they almost look like they’re on vacation. I totally get it. First thoughts might be, “wow, guess nobody works here,” or perhaps “they need something to do!” It does look that way. But I wonder what might happen if we all put ourselves in the shoes of another before making snap judgments in haste?

I think you’d find out some things you might not know about your nurse. The propped leg? Maybe that’s to rest and alleviate pain in their bad knee that aches something awful after 13 hours on their feet. I find as a middle-aged woman that my body no longer agrees with how young I desire to be, but instead reacts like someone much older, especially after lifting the weight of others for three days straight.

Did you consider the phone use is a quick text home, checking on a sick child or a parent who’s fallen? It’s easy to forget in a population that spends the majority of its time caring for others, but nurses have families with needs of their own. As your nurse is giving 100% to the sick people under their care, their hearts still cry internally for whatever is going on at home. But you know what? Even if that nurse was checking their social media, it’s the first time they’ve relaxed all day, what, with keeping that post-op patient who’s been circling the drain from buying a one way ticket to heaven.

I think we forget the emotional stress and physical strain nurses go through on any given shift. It’s easy to forget the weighty stress of keeping someone alive. We miss the fact that the bedside nurse can spend hours at one person’s side, forgoing their own needs, to alleviate whatever ails the one under their care. But those are the unseen things. Those are the hidden gems a nurse performs each shift. They just see it as part of the job, and they certainly won’t brag. You’ll never know how they made that suicidal woman feel special for the first time in her life, or how they intervened for the safety of their patient, preventing what could have been a deadly event. You won’t see those secret steps a nurse makes each day, but you will see them sitting at the desk, apparently with nothing to do.

Maybe next time we see that nurse in that brief moment of respite and much needed rest we can think something like, “good for them. They need that moment of stillness to recharge for the difficulties ahead.” Because, you see, nurses are like a vessel, pouring out so much of themselves, but as everyone knows, any container eventually runs dry. So perhaps the next time you see a nurse sitting you should just know that they’re there for a refill before the next round of serving begins.

How I Fell in Love With Nursing. Again.

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First love is easy, isn’t it? With stars in your eyes and a naive nature, you swing headfirst and heart-strong into the relationship. You have dreams for the future, the butterflies for excitement to spur you forward, and even a bit of healthy hesitancy to keep you honest. But somewhere between that first date (or shift in the case of nursing) and eventual broken expectations, you end up feeling betrayed. It’s nothing like you hoped it could be. You end up disappointed, likely broken-hearted, and sadly, if your experience was especially harsh, guarded and skeptical for any silver lining that might exist up ahead. Sound familiar?

A profession you can truly love isn’t that different from a romantic relationship. It’s something that gives your life a new purpose, a reason to hope, excitement, and the ability to get better at it as you go along. It’s the chance to think of someone other than yourself, but like any relationship, the one with your career can become strained. I’ve been in the medical field for 20 years now, and I think I’ve experienced every stage of the process. I mean, if Nursing was Dante’s Inferno, I probably transversed through every circle. Y’all, I fell out of love with it, and it took purposeful determination to make my way back into my partner’s good graces. At one point, I think I hated it. Just being brutally honest here.

That first year was something, am I right? Fear, panic, but somehow an exciting adrenaline rush, a pride that I’ve discovered you can’t let slip away. I was proud to be a nurse. I was proud of my vocation, and I was proud of the hard work it took to get me there. I was proud of that R, and of that N, and for a while no one could take that from me. But then came the bad apples. Damn, if they don’t ruin the barrel.

Somewhere between holding an elderly woman’s hand and double charting for the billionth time, my heart started to harden. Do you know the difference between a good nurse and a great nurse? I was always a good nurse. I took care of my patients, and I got the job done. I was honest (for the most part), and I did no harm (that I’m aware of). I smiled at my patients’ faces, and I even meant about 80% of what I said. This will sound so harsh to the layman, but my fellow nurses will understand. It’s not easy giving all of yourself with little to nothing in return. I mean, yeah, you get the paycheck, but that even seems paltry in the face of preventing death or giving up Christmas with your family. So, it becomes a job. A thing you do, day in and day out. I can even recall telling my husband I felt stuck. Lord, help me, I did. I could think of no other “job” where I could work 24 hours, yet get paid for forty hours, while maintaining the best benefits offered in our little city.

I ask again, do you know the difference between a good nurse and a great nurse? A good nurse gets the job done, but a great nurse loves the job they get to do. I guess I had to move from one to get to the other.

All I know is, I entered the field like a young, star-crossed lover, but about a decade into it, I wanted to breakup. I had become disillusioned, and it wasn’t what I thought it could be. Maybe I entered the career thinking I could make so many differences, but I wasn’t open to what could change in me. I became a woman focused on the obstacles before me, and blinded to any blessings scattered throughout. I wasn’t heartless, mind you; I still felt contentment when a patient told me how much my care had meant to them. But those Hallmark moments couldn’t outweigh the injustices I felt. I focused on every single hardship in my field, and I took personally each offense. I allowed the Negative Nancy’s to feed the fire of bitterness inside me, and I assumed every demanding patient canceled out the kind ones. There’s certainly that need for self-care, but I think I came to a place where it was almost always about me.

“Why is this so hard,” I asked, never contemplating for very long how it must be on the other side of the bed.

“What do they expect of me,” I would question angrily, without asking myself what I might give.

I saw my field only as a difficult endeavor, and seldom as a privilege. I carried the weight of a thousand martyrs, except I had forgotten the cause for which I gave myself. I was a good nurse, who did my job, but not a great nurse who loved the opportunity to do it. And I suppose that’s many of us. It’s not that we don’t enjoy what we do; it’s just that sometimes we hate it just as much. That sounds so terrible, when I type it out like that, but if you’ve never held a position where you don’t cry while cleaning the dead body of someone you just hugged that morning, then you may not understand. If you haven’t been punched, kicked, or called the worst of all swear words by someone you’re trying to help, then you won’t get it. If you haven’t cringed over calling someone in a position above you, knowing they will scream at you merely for doing your job, then this may seem like harsh words. If you haven’t felt the anxiety of trying to do the work of two people, while not making a mistake that could cost someone else’s life and your career, then you just won’t have a clue. It’s not easy to carry the weight of so much on tired shoulders, and for many who do, they end up angry and perhaps even resentful for a profession they once loved so much.

Back to the relationship bit, it’s as if the marriage is falling apart, and you don’t want a divorce, but you can’t look at his socks balled up on the floor another day or you might snap. I guess sometimes, when you realize you don’t love them like you used to, you have to take it back to the beginning. You have to remember the first time you saw them, that first date, or first, tender kiss. The spark is still there. You just gotta know how to stoke it.

I recall sitting in a computer class taking a critical care course, and I was digging it. Us Critical Care folks, we love all that medical stuff! Sitting there, I knew I loved the knowledge. I loved the dynamics. I loved the process. I loved the people. I loved making a difference in people’s lives. I loved nursing. I did. It was time to act like it.

Back when my husband and I were just dating, I remember we had been off again, on again, at one point. I had found out some stuff, and each of us had been idiots. We loved each other, we knew that, but we were kinda just coasting along, existing as a couple. Like, maybe involved, but not committed entirely to the future of it. Well, anyway, I remember standing in the card aisle on Valentine’s and I had found the perfect, mushy card for him, when suddenly God smacked me upside the head.

It was like, God said, “Brie, if you’re going to give that to him, you need to mean it.”

And I was like, dang, you’re right. I love him. I really do. We can work through this.

And we did. Every day since our relationship got better, and even now, each day is better than the last. I guess, I had to come to a place in my nursing career that was similar. I loved it, but I had to start acting like it. I had to do more than just show up. I had to get invested. I couldn’t focus on my husband’s faults, any more than I could deny my own. And I couldn’t selfishly fixate on what nursing took out of me. I had to start giving of myself more. I had to see through clear eyes. If you focus on a stain, that’s all you see. What you should look at is the fact that the fabric is still good. It can be washed. Nursing was still good. I think my vision of it had just become tainted.

My career truly began to change when I focused on the opportunity to provide care, the privilege of meeting people at their darkest hour, and leading them back into the light. I threw off sympathy and instead embraced empathy. I put myself in my patient’s shoes. Heck, even the administrators’ shoes. I saw my occupation as the ministry it was, my chance to care for the hurting, and to help those in need. I didn’t face the relationship with what I could gain, but what I could give. I didn’t focus on what wrong was being done to me, but rather what good I could sow into it. Y’all, I fell in love all over again, and it wasn’t because the object of my affection was perfect, but because it gave me purpose, passion, and a sense of fulfillment. Was it still hard, at times? Yes! But beyond that it was good. In fact, it was great. And then I realized, I was great too.

A Word of Advice for the New Nurse

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I was walking down the hall this morning with a new nurse, and she asked, “so, were you an IV nurse before this?”

She said it with genuine respect as I followed her down the hall to the room of her “hard stick.”

“Nah,” I replied. “I’ve just been putting em in for twenty years.”

“That’ll do it,” she replied in awe.

I wasn’t even working on that floor. It was one I sometimes floated to, and I had run quickly there from my Intensive Care Unit to grab a stowed jacket. When this new nurse had seen me her eyes lit up, and she eagerly let me know she needed me. It seems I had quickly garnered the reputation on that floor of being very skilled at inserting IV’s. As I walked with her to her room (confident that whatever veins awaited me I’d nail it first try) I realized just how odd this was.

I had become the nurse you asked to help you get an IV started in a patient with “bad veins.”

It was crazy, but I was the one you came to when you had a question, needed a second opinion, or encountered something you had never seen before.

Even more crazy, it had occurred to me over the past year that I had become that older nurse with decades of experience that I used to look up to. Now I was the more seasoned RN on the floor.

I bet you’re wondering when the advice is going to come in. Well, here’s the thing. Most of the time it seems like only yesterday that I was the one with shaking hands when I started my first IV (or two, or three), or that I was the one going insane questioning every single move I made. I was the anxious young woman with a nervous stomach. I was the one afraid to call and wake up the doctor. I was the nurse scared to death of making a mistake, running my butt off to try and get things done on time, but leaving an hour late regardless. That was me. But now, it’s not.

Time passes quick at the bedside. It may not feel like it when you’re trying to make it through a crazy, twelve hour shift, but trust me. One day you will look up and realize a year has gone by, then two, five, and beyond if you decide to stay. On a side note, the patients hope you will. There are far too few of us seasoned (but not salty) bedside RN’s left.

So, here’s what I want you to do. I want you to enjoy yourself. I know that’s not always easy when you’re trying not to bang your head against the wall in frustration, but bear with me. You see, right now is a wonderful opportunity for you. You have the chance to be a sponge, to ask a thousand dumb inquisitive questions, and to take every instance you can to learn.

I remember as a young nurse feeling like I should know more, and often times I neglected to ask for confirmation on a situation because I didn’t want to appear like an idiot. Don’t get me wrong. I never did anything to put my patient at risk, but I did lose many opportunities to increase my knowledge in favor of saving face.

I can also recall not taking chances, not grabbing at situations where I could grow my knowledge base and skill level. Rather than missing an IV that looked hard, I might just ask someone else to do it for me. When faced with the chance to take care of a really critical patient, I would be more than willing to pass it along. This only hurt me. My fear of messing up held me back. Don’t do that.

Being a new nurse is hard. Even though you went to school there’s still so much to learn! I get it. But don’t let this keep you from grabbing those extra certifications and educational opportunities. These things will only add to your knowledge, making you a better nurse in the long run.

So, if you’re just barely keeping your head above water as a new grad, hang in there. Know you’re not the first to feel that way. But just make sure you don’t end up floating along content on still waters. Stir it up. Realize that while being a new nurse is hard, what can be really difficult is being an older nurse who everyone comes to. Because one day you will look up to ask a question, and you’ll realize you’re the most experienced person there. You will be the one people come to. You’ll be the one teaching others, mentoring new nurses, and offering your venipuncture skills to the masses. It happens before you know it. So enjoy your season to learn and grow. Your future patients will thank you.

The Curse of Healthcare

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We’ve gotten really good at what we do. Have you noticed that? Hey, I’m all for it, for the most part, and if you or your family have come through my doors, you probably are too. The technological advances are amazing, and the things we can do are such a blessing to so many! I mean, diabetes used to kill little kids, but now modern medicine gives us the ability to live longer despite chronic illness. Widow Makers no longer make widows as much anymore, and the number of people who survive things like a ruptured aortic aneurysm has increased. Teens are surviving that deadly car wreck that no human should have survived, neonatal medicine saves babies that would have been doomed, and cancer no longer automatically spells death sentence. It’s wonderful! Except when it’s not.

It’s been going on a while, but I’m starting to see it more and more. I can glimpse pieces of the unraveling fabric that is good medicine. I can see where healthcare fails by being so damn good. I watch us become our own worst enemy, playing God a little too sufficiently, and we’re left with nothing but the hope that He can get us out of the mess we ourselves created.

Let’s say an elderly woman walks into the grocery store and falls face first into the frozen food shelving. Her heart has stopped. The blood is no longer pumping to her vital organs, and without that precious blood she lacks one other important ingredient for life. Oxygen.

A bystander who remembers enough from the community CPR course they took last summer arrives to the scene and initiates first response. 9-1-1 is called, EMS arrives quickly, the woman is zoomed to the nearest ER (which is really close because we’re building more and more satellite ERs everyday). Everything goes seamlessly, y’all. The CPR was high quality, the paramedics fast-acting, and the ER physician on-point, but despite the stellar work of the healthcare team a delay in the previously mentioned oxygen happens. You can’t die and not suffer some sort of repercussion of that, but what’s changed is how easily we can go forward from there.

Is your heart too weak to pump on its own? No problem. We have a machine for that.

If you don’t have a blood pressure high enough to pump blood throughout your body, no worries, we have medicine for that. A good handful, actually, and we’ll give you the maximum dosage of every single one!

Can’t breathe? You guessed it. We’ll breathe for you! You just rest a few days and we’ll handle the tough stuff.

And while all these advances are amazing and much needed, the problem is that sometimes they aren’t. Or perhaps they shouldn’t be. The problem with getting so good at playing God is dealing with the consequences of our actions.

So, remember our 86 year old grandma who passed out by the frozen ice cream? Well, ice cream is part of her problem. According to lab results and an ultrasound of her kidneys, she hasn’t been controlling her diabetes. Her kidneys are shot, her body is in shock, the waste isn’t exiting her body like it should, and all those life-sustaining medicines we’re pumping in aren’t really being dumped out on their own.

No problem, though. We can be her kidneys. We got this.

She’s swollen to the point of her skin busting, and her nurses are changing pads underneath her constantly from the fluid that is literally oozing out of her pores. We have medicines for this too. We call it a balancing act, you see, maintaining a blood pressure compatible with life while pulling off excessive fluid. As of now, it’s building up, backing up from her already damaged heart into her already supported lungs.

Kidney failure, heart failure, respiratory failure, these are nothing new to your critical care team. We see it all the time, and we’re pretty frigging good at keeping you alive despite all the failing organs, infection, and unexpected complications. What I’m trying to say is maybe sometimes we’re too good.

See, we’re great at fixing what’s broken, but some things we cannot fix. We can’t fix things like our precious aforementioned grammy not getting enough oxygen flow to her brain before her heart was restarted. We can’t make an EEG show brain activity when none is there. We can’t cure chronic conditions; we can only extend the life of them. And even then, when is enough enough?

I don’t want to sound heartless or cruel, because that’s not what this is. It’s the opposite, in fact. It’s the voice of a caring bedside nurse who sees the pain in a daughter’s eyes when her mom’s poor prognosis is explained and she’s asked if she wishes to withdraw care.

The blessing of healthcare is we’re so good at what we do.

The curse of healthcare is we’re so good at what we do.

We can artificially feed an individual who has no awareness of the world around them. We can do this forever.

We can bring back and sustain a life that probably should have moved on to Heaven. We can create prolonged suffering. It’s not the intention, but it happens. Without our high-functioning intervention a son would have had to suffer through the unexpected, quick death of his dad. But, he wouldn’t have had to watch his father waste away, a shell of himself, skin turning purple, skin breaking down. I don’t say these things to downplay the travesty, but rather to highlight it, to bring awareness to the devastation that can occur when a body lives on, when perhaps it should not have.

So, where do we draw the line? I wish I knew. As of now, we have advanced directives, and unless those say otherwise, we, as the healthcare team, will fight tooth and nail to ward off demise. We will throw a patient everything we have, which with today’s technology, is almost literally the kitchen sink. And I am so proud to be a part of these crusaders against death. Sometimes, though, in retrospect, you see the suffering all around you and you wish you hadn’t.

When keeping a body alive hurts, and there’s no known or likely chance of recovery, you wish you weren’t so good at what you do. When the lights are on, but no one is home, you wish nature could have taken its course. When suffering is prolonged, healthcare almost seems like hurt-care.

The number of nurses are declining, but the number of patients are increasing. People live longer (which is a good thing), but sadly a large number of the bedside nurses who see on a daily basis the suffering of patients, they’re leaving that same bedside. They’re going to further their education or into administrative positions where they don’t have to explain to another family that their loved one has zero chance of recovering after they were revived.

Quality of life is sacrificed just for life, often times a shell of one, and it’s not up to nursing to decide what is considered quality and what is not. They just watch from the sidelines where that conversation is concerned. It’s emotionally exhausting, and I think where a lot of burnout derives. Many times the healthcare team is the only one that sees the reality/downfall of sustained life that should be let go. The families don’t come. They call frequently, make demands, but they don’t come to witness the hard stuff. I get it; it just doesn’t make it any easier in the end. I can’t tell you how many hands I held when they needed it most.

But I guess that’s what we’re here for, right? We’re here to save them, and to rejoice when they improve. But we’re also there to suffer with them as they slowly die. It’s hard for everyone involved. I suppose we take the good with the bad. We give a man with a 100% blockage to his heart muscle a second chance, where he holds his grandkids, and sits on the front porch swing with his wife. But we also break ribs. We put surgical holes in people, place lifelong tubes there, and whisper a desperate prayer as we try and do no harm.

I try to focus on the successes. I try to listen to God’s voice really hard. I pray. I pray a lot. But mostly I just love on folks. Every single one. The ones we save, the ones we don’t, the ones we shouldn’t have, the ones where we didn’t know. Because in the end, many times, love may be all we can give.

Have the Conversation!

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Have the conversation.

Even if you think you’re too young.

Believe me, you’re not.

I’ve seen muscled, young men, college bound, who haven’t met the right girl just yet. I’ve seen them laying there, those same muscles wasting away, and the truth hanging in the air that they will never meet the right girl.

I’ve watched Mommas fall flat on their face in a torrent of hot tears, torn over what decision to make.

“Maybe he’d want us to keep fighting for him!!”

Trust me, he wouldn’t. He’s gone.

Have the conversation.

Even if you’re not sick.

I’ve seen thirty year old men who run marathons have a widow maker. I’ve seen the most fit fall to a heart attack that not only steals the oxygen from their heart, but also takes the blood supply from their brain far too long. A young wife with a toddler on their hip shouldn’t be forced to decide whether it’s time to tell their daddy goodbye. She should have the peace that letting go was what he would have wanted. Now she feels like she’s literally pulling the plug as a five year old, wobbly waif of a child pleads, “when’s Poppa coming home?”

Have the conversation.

Even if you think your although aging, but robust and spry parent will be offended by the topic.

“I’m not sure what Dad wanted. I always thought we had more time.”

“Maw was too proud to talk about dying. Now I don’t know what to do!”

“Why did she put this on me?!”

I’ve seen siblings fight over what they think Mom wanted. I’ve seen ugly spats and downright barroom brawls, except they’re fought right over a hospital bed. No parent wants that. I’ve seen no one want to make the call. I’ve seen everyone think they know best. Why guess?

“My brother is the oldest. It’s his job to decide.”

“You haven’t been around in ten years! What qualifies you to know what she would want to do?!”

Have the conversation.

Even if you’re facing a hard battle ahead.

Making your wishes known doesn’t equal defeat. You can say, “I want to fight this,” while also saying, “when the battle is over, I want to surrender in dignity.” Talking about the what if’s doesn’t mean “I give up.” It just makes it easier for your family to let go if and when you do.

Have the conversation.

Even if you’ve gotten better.

I’ve seen doctors break the news to a patient’s family that were all just celebrating remission that the cancer is back.

“It’s everywhere. There’s nothing we can do.”

Have the conversation.

Even if you’re healthy as a horse.

“Mom has always been so healthy. She doesn’t even take any medicine!”

I’ve watched children cry over the bed of their previously healthy parent. In the shock of terrible news, in the wake of unthinkable odds, no one should be expected to make life and death decisions, but they have to.

I’ve seen a husband flabbergasted that his wife he kissed that morning before his shower is now hanging by a thread after a car wreck.

“We never talked about it. We meant to; we just didn’t.”

Have the conversation.

Even if you think you have all the time in the world.

You don’t. Tomorrow isn’t promised. Don’t wait.

We buy life insurance. It’s considered prudent. If something happens to you, you want your family taken care of financially. But what about their emotional well-being? Do you really want to place upon your spouse and children the hard decision of how you want to leave this world?

Do you want to let nature take its course? Do you want to fight until there’s no fight left? What about when the fight is lost? Can they let you go then?

Have the conversation.

I’ve seen shells of a former person laying in the bed. A machine does all the breathing. Rows of intravenous medications keep the blood pressure and heart rate compatible with life. Fingers and toes cold and purple. The nurses turn the patient every two hours because they can’t even shift their own weight to prevent their skin from eating away to the bone. Tubes in every open hole, food through the one sticking out of their nose. It’s hard to see, hard to talk about. No one wants to imagine.

I’ve seen family stay away because it’s too painful to watch. We’re left to hold the limp hand of the dying, the last face they see. No one wants to talk about it.

Medicine is good. I praise God for the knowledge and skill to bring people back from the brink of death! But there’s also only so much we can do. That’s why you have to have the conversation. You have to help us know when you would want to stop.

I’m all in favor of giving it everything we’ve got! I’ve seen so many miracles, I could write a book! I’ve seen physicians say, “it doesn’t look good,” and then my God pick up the pieces and show out. I’ve been wrong. I’ve been certain a patient wouldn’t make it, wouldn’t get better, but then they have. So, I’m not asking you to wave the white flag before it’s time. But when there’s nothing left to do, know what they would want you to do. Tell your family what you would want. If it’s not your time, don’t worry, despite our clasped hands, you’ll bounce back just fine. I’ve seen it so many times. Sadly, I’ve also seen when it’s time, but family won’t let us let them go.

Have the conversation.

Have it when you’re young, when you’re older, when you’re well, and especially when you’re not. Have it now, while you still can, so your weeping family doesn’t have to have it then. Don’t do that to them, don’t do it to us, don’t do it to yourself.

I’ve felt arthritic bones crack under my compressing hands, and I’ve heard an elderly woman scream “it hurts” as the joules of electricity racked her body. When an organ is done, there’s not much we can do except prolong the agony. I got into the field of nursing to bring healing, not pain. When healing is no longer possible, only hurting remains. It’s not fair.

Have the conversation.

Trust me. Ask your family now what they want done if there’s nothing left for the healthcare team to do.

Tell your family now what you would want in the case that you’re unable to speak for yourself.

Did you never want a machine keeping you alive?

Let them know.

Do you want the whole kitchen sink thrown at you as long as there’s a chance, but then the drain pulled when there’s nothing left to be done?

Tell them. Get it in writing.

What if your brain is gone, but your body lives on? What if you’ll be unable to speak, eat, move, or recognize loved ones? Do you want to be kept alive with liquid food through a tube? Don’t leave the weight of these decisions on the people you love. Because sometimes they can’t make them. Then they count on us to have the hard conversations. We’re the ones holding your family as they weep, and we don’t mind it, but wouldn’t you have rather saved them the pain?

Don’t wait. Have the conversation.

I Cried About a Patient Today

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The day was over. A long shift had finally ended and I gathered together my belongings for the brief trip back home to sleep before returning tomorrow. I smiled at thoughts of my children. My six year old daughter had learned to ride her bicycle without training wheels, and though I had missed the momentous event in person, my spouse had been good enough to capture video evidence for me. I looked forward to dinner together, even though I knew I’d be exhausted and ready for bed. The idea of a hot supper and quick sitcom before snoozing made me smile again, but then I didn’t. Because I thought about my day. I don’t guess I had really thought about it. I hadn’t allowed such a thing. You couldn’t.

As I stood behind closed doors, the bathroom door and break room between me and the patient care world, tears began to well in my eyes.

The horror of it.

I swallowed hard trying to dislodge the lump of emotion that had taken up residence in my throat, but that exercise was as futile as trying to will the tears not to flow down my cheeks. The emotional heaviness of such a horrible happening for my patient had left me deflated. I hadn’t realized it before. I couldn’t.

And as the empathetic emotions reared their ugly head, the raw tears streaked my face in frustration. I couldn’t change my patient’s circumstances anymore than I could have prevented the befalling of such tragedy, for the patient and their family. I wiped a stray tear away. It had snuck up on me, this emotional outpouring. I hadn’t felt it all day while I was in the thick of the awful. I hadn’t. I couldn’t. That’s not how it worked.

Nurses see a lot of pain, their beyond, fair share of heartache, but also occurrences so terrible that words can’t even begin to describe. You wouldn’t know it by their face, though. In death, work continues. In patients’ and families’ grief, condolences and support are given, but efficiently. To some it might even appear aloof. It’s not that.

We feel pain. We know pain. We know it so intimately that we wish we didn’t. We have held hands, heard prayers, and passed out Kleenex more than you can imagine. We’ve held shaking daughters who never got to tell mom goodbye, and we’ve picked up inconsolable mothers off the floor when their only son passes suddenly. We know pain.

We’ve stood there silently, back against the wall, hands wringing behind us, silently praying while the physician delivers the news no parent of a toddler wants to hear. Cancer. We’ve made the long walk down the hall to the waiting room. The one where the family all look up at the sound of the door, like a group of deer caught in the headlights. We hope our face doesn’t betray the sentence the surgeon is going to have to say.

Your dad didn’t make it out of surgery.

We watch your pain, we see your tears, we hold you up so you don’t hit the floor. But our tears seldom fall. They don’t. They can’t.

Not yet.

As I stood in the private bathroom I allowed my tears to fall, tears that had been there for thirteen hours, tears that I had hidden so well, they were hidden even from myself. I let them fall, I felt the pain of the horrible things my patient had experienced, and my heart broke for my patient. I suppose it had been breaking all day; I had just been to busy to allow it to surface.

It wasn’t that we didn’t feel. It wasn’t that we didn’t care. I think, in my own personal experience, it’s that we care so much. We care so much that we keep our own emotions in check. We do this so that our patient can have all of our effectiveness and thorough care. Yes, we empathize. And yes, we support their turmoil. Our turmoil, though, it stays below the surface. The thing is, we’ve seen so much pain, year after year, that if we let in the fullness of the whole lot, we’d crumble. It’s not just understaffing or overworking that leads to burnout. Sometimes you can only hold so much pain before you must step aside. With this in mind, we have a bit of a fence in place.

We joke, some often times inappropriately. We laugh, we sing, maybe we seem distracted or detached. But maybe that’s just how we cope. It’s how we cope with the pain, the grief, the patients who cause their own demise. It’s how we hold all the awful within without toppling over. Although, sometimes we spill over. We spill over the hot tears behind closed doors. You can only hold so much behind a fence, even if it’s built for your own protection.

I cried about a patient today. I know I will cry again. Maybe not tomorrow, the next day, or even the following week. But I will. I’ll cry, and I’ll probably do it when they can’t see me. You see, when they’re looking at me, I’m too busy looking at them, ready to help with their tears. That’s just how it is, and how it has to be.

How to Find Peace in Patient Care

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Not long ago I encountered a new nurse with multiple questions, and while I adored the fact she sought answers to the things she did not know, I also sensed a self doubt within her. I totally got it. I saw myself in her wide, startled eyes, and even fifteen years later I could easily recall the hesitancy prevalent in being a new nurse. I remembered well the fear, worry, and realistic concern that I might do something wrong. I mean, it’s true. Hastily made mistakes could kill people. But I also could remember the irrational fear I had held, the anxiety that I would mess up even the things I knew how to do. For years that irrational worry had made nursing far more difficult than it needed to be for me. And though a whopping, healthy dose of attention to detail and awareness could save your license, as well as a person’s life, one step over the line into performance anxiety and bedside-care doubt could tire you quickly. No one could survive the burnout of that particular feeling. I saw that fear in this new nurse’s eyes.

As a newer nurse you have a choice to learn from your mistakes and press on, or you can crumble under defeat. You have the choice to build on your knowledge and gain much-needed confidence. I’ve seen the other side of the spectrum, mind you, as I’m sure most of us have. It’s that overly confident, cocky new grad who thinks they know everything. They don’t ask questions, and it’s usually the patient who suffers. They teach their incorrect knowledge to the new hires that follow, and safe technique goes out the window. So, I’m all for the pursuit of knowledge, asking questions, and taking an extra pair of eyes along. Heck, after twenty years in healthcare I still ask questions and seek new answers daily. That’s not what I’m talking about. I’m talking about doubting the knowledge you do have or anxiety over skills you hold under your belt.

This problem of bedside anxiety won’t go for everyone, and if it doesn’t pertain to you then I say, that’s awesome. Truly. Because it sucks. I think it’s the introverted, overthinkers who encounter this problem the most, and it will surefire make you resent your career. I used to be that nervous nurse, but no longer. I found my peace in patient care.

So, here’s what I said to this new nurse when she spoke anxiously about the continued stress of making a mistake in nursing.

You have no control over out of control things.

And that’s the truth of it, my friends. I used to be one of those people who desired control over all the things! I think most critical care nurses have that desire within them. I wanted everything just so-so, my ducks in a row, and my plans laid out. Basically, I desired a Mary Poppins kinda day, everything practically perfect, and anyone who’s nursed for like five minutes knows that ain’t happening. But it wasn’t just that. I also put too much pressure on the control I had over a patient’s outcome. And, yeah, while my performance could positively or negatively affect my patient, my ability to do well couldn’t stop someone from checking out to the great beyond. Somewhere around my tenth code, where the patient didn’t make it, I realized this.

I don’t care if you knock out your compressions like an ACLS guru, if a patient’s heart is tired of pumping, they will probably die.

I don’t care if you give every medicine correctly, checking allergy lists and the five rights, if a patient is too far gone to respond to the treatment ordered, it won’t matter.

It doesn’t matter if you give the best Diabetic education and insulin administration teaching on the planet. If a patient wants to chug Mountain Dew like it’s the air they breathe, they’ll be back next month in DKA.

It doesn’t matter if you provide the most encouraging and uplifting advice to the addict, you may find out they’re dead next week. I’ve had this happen.

It doesn’t matter if you provide the best care in the whole hospital, certain families will still complain.

I don’t care if you do everything right, catch every mistake before it happens, and think three steps ahead for your patient’s best outcome. If it’s their time, then it’s their time.

It’s not you. It’s not me. You can’t control an uncontrollable situation.

For me, I had to realize that I can only do what I can only do. I can’t get everything done. I won’t check all the boxes administration wants me to check. I can’t place myself in two rooms at once, no matter how much my charge nurse may wish it was so. I can’t control what a patient’s family does when I leave the room, and I can’t change what a person does when they wheel off my unit. I can’t save everyone. Sometimes because they don’t want saving, but most of the time it’s because healthcare is bigger than me. Life and death is bigger than me. Destiny, God’s will, or whatever you personally call it, is bigger than us all. We can only do what we can only do.

We come in and do the best we can. We work with what we’re given, which often times is less than we need. We do the absolute best we can, and to quote my favorite work-husband of all time (love you, Terry), we try and “leave em better than we found em.” But then we just gotta let go; let go of this idea that we hold life and death in our hands. I mean, yeah, how I titrate those three vasopressor drips can mean the difference between life and death for my patient! And giving the correct med or wrong one will have good versus bad outcomes. It’s my keen eye that catches a potential problem before it becomes a real problem, and that makes me feel very good. Yet I can’t keep bad from happening if it’s gonna happen. I can do my best, but that’s all I can do.

In nursing we hold much responsibility. As we’ve seen in the news, our mistakes can be costly, to more than just ourselves. That’s why we keep learning, keep asking questions, and keep trying hard. What we don’t do is fear. Fear, worry, and anxiety have no place at the bedside. Fear and anxiety will tell you that something bad might happen. Realistic thought will tell you that something bad will happen. Maybe not today or tomorrow, but one day it will. You can do everything flawlessly and it still will. You have to let go and just do what you know to do, realize that you’ll make mistakes, but you’ll learn from them. Sixteen years ago I failed a clinical exam because I didn’t give my patient up in the chair his call light before I left the room. Do you think I’ve ever forgotten to give a patient their call light since? I haven’t.

You’ll mess up, miss something, and forget plenty. Personally, each day before I work I pray in the shower. I ask God to “help me hear His voice and do no harm.” It has worked well for me thus far, but I also know I had trouble hearing that small, steady voice in my heart until I let go of the fear that I wouldn’t. I had to become confident in where God had placed me as a career, and each day I go to whatever floor and whatever assignment with that same peace. I’m going where I need to be, with the patients I need to have.

I can’t control everything that happens at the bedside, but I can control my own thoughts. After all, it’s my thoughts that drive me.

What You Can’t Anticipate About Nursing

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I enlisted in the military a year before 9/11, and after that day that I watched the second plane crash into the South WTC Tower things changed. It didn’t take long for our country to spring into action, and before I knew it my base was announcing a deployment to Iraq. I wasn’t naive, exactly. I knew when I joined the military that war could happen, but I suppose I just wasn’t ready for it when it came around. I mean, I was proud to serve my country, and I had every intention of doing whatever my service required, but I was scared.

I remember calling my mom and dad on the phone and crying, “I don’t want to die.”

Some things you’re just not ready for, I guess. You can train, prepare, psych yourself, get motivated, or whatever. You can listen to the stories of those who have gone before you, hear the concerns of well-meaning family and friends, and be certain that you are prepared for the worst that can be thrown your way, but then when your number gets called, you’re stunned. When the crap hits the fan, you’re shocked. When the hard job becomes trying and more difficult than you ever imagined, you’re thrown off balance.

After I had cried to my parents, I dried my cheeks. I puffed out my chest, and I stood tall. I was still afraid, but my pride for country, dedication to duty, and commitment to my job helped me tell my folks it would be alright. Then I hung up the phone to go about my day. What I’m saying is, I was thrown off balance bad, but I stood back up and kept walking. It’s no wonder I became a nurse.

My mother was a nurse, and I still remember her saying, “are you sure?”

She wanted to ensure a career in nursing was really something I wanted for my life. She knew the difficulties I would face. At the time, I thought she meant long hours or working holidays and weekends. I had grown up seeing her do those things. I had heard her complain to my dad about documentation and staffing shortages, but I figured I could handle that too. I still remember the strange look on her face after I told her I was going into nursing, and before she asked if that’s what I really wanted. Her eyes had shown a mixture of pride, amusement over my ignorant excitement, and a concern for her child thrown into the mix. I realize now that she knew. She knew I’d be thrown off balance, but she didn’t know how it would go after that.

I still remember my first Code Blue. I was a new graduate, mid-twenties, on orientation, and green as spring grass. I was on night shift when we ran quickly to the ER as part of our Code Response Team. I was excited, scared, adrenaline pumping, hands shaking. It was just like all the medical shows I had watched with my mom, but better. We were saving lives, man! It was awesome!

But then it wasn’t. I felt the tone of the room change. I watched in shock as the man’s slack skin jiggled back and forth while a nurse violently pushed up and down on his chest. His flaccid body jerked up and down on the cold, narrow gurney. He face looked contorted from the large tube coming out of his open, drooling mouth. It was terrible. It was nothing like TV. This man was dead.

“Push another Epi,” the ER doc commanded!

The drawer I had been pulling from was depleted. Someone pushed new medicine cartridges into my hand, and with frantic fingers I assembled the syringe.

I could feel it in the air, though. This round wasn’t going to work either. The look on everyone’s face told me it was so.

“Hs and T’s, guys,” the doctor asked. “Anyone have any ideas?”

It was that last ditch effort, a collaborative meeting of the minds to try and think of something we could reverse to magically restore this man to life. Everyone stared ahead, silent, searching the database of their knowledge, but coming up with nothing.

“If no one objects,” the MD announced flatly, “we’ll call it. Time of death, 2357.”

And just like that it was over. The floor lay littered like a battlefield, the trash, drops of spilt blood, and empty syringes a reminder of the fight we had lost. Our prisoner of war still lay on the hard stretcher, a victim to the iron grip of death, despite our valiant efforts. I stood slack-jawed, surprised that we had stopped, and that the patient was really gone. In the back of my mind, as if through a cheesecloth, I heard the doctor say something about going to speak with the wife. It wasn’t supposed to go this way at all.

“Come on,” my preceptor called cheerfully. “We got a lot of charting to catch up on!”

That was fifteen years ago, but still fresh in my mind. I think, though, the one that shook me the most was an unnumbered Code. It wasn’t my first, nor my second, and not even the third. I had gone through dozens of codes by the time this one occurred, and as I assembled a medication syringe from the crash cart, my fingers moved at lightening speed. Like a liquid team, my SICU coworkers and I ran the event. We followed the steps smoothly, we did everything right, yet it ended the same way as my first code. It wasn’t as if death was a new thing for me. In fact, I had even done a stint as a Hospice Nurse. Death was a part of life. It was what happened to everyone. Yes, it was never “good,” per se, but it was inevitable. It was out of my control, in the end. So, I did not feel guilt. I didn’t feel overly traumatized by the event. It felt like any other work day, and maybe that’s why what happened next happened. Maybe God was trying to shake me up, make sure I could still feel.

You see, in nursing, after seeing death day in and day out, you build up a certain barrier. It’s not that you don’t care. It’s kinda hard to explain to the layman, but it’s like you stop making tears about the sad stuff, because you know that if you ever started crying, you may never stop. That’s the part you don’t anticipate in nursing. How the loss will affect you, how it will rock you, shake your foundation, threaten your faith, or harden your heart. You don’t realize how all the pain, death and dying, grief, and overwhelming helplessness will affect you. You don’t understand the pain of a hopeless situation or the trauma of being unable to change the downward spiral. You don’t understand it until you live it, and even then it changes.

This day, the day of an ordinary, unsuccessful code, I broke. Y’all, I fell apart, and I didn’t even see it coming. After this old woman died we called the family back to the room. It had been so unexpected. They didn’t even realize we were coding her until after she was already gone.

I stood in the room, readying the body before calling back the son. And at that moment, as I looked at the woman’s face, I saw her son kissing her cheek. Less than half an hour ago he had swept his lips across her cheek, telling her bye before she wheeled away for a simple procedure.

“See you in a minute, Momma,” he had said.

And that’s what I thought of as I straightened the sheet across her chest. He had no idea that would be the last time he saw her alive, and the thought of it made me bawl like a baby. Right there at a stranger’s bedside. My mother had passed away in much the same manner, and I never knew that particular kiss of mine on her cheek and “see ya later” would be our last. I also never knew when I became a nurse that the pain of others could become like my own, that I would build stoic fences to keep me strong, but let them be torn down just as easily to keep me empathically tender. Nursing hurts. I think that’s what that particular look in my mother’s eyes some twenty years ago was trying to say.

Not long ago my husband and I were watching Grey’s Anatomy. One of the surgeons was tore up by the loss of their patient. They were really having a hard time, and I told my husband, “I totally get it.”

I explained to him how after my last code and patient death I had trouble getting it out of my head. I had three days off after it happened, and I needed every one of them. And even after that, it was still hard to return to work. You see, I questioned myself. I didn’t do anything wrong. There was nothing I could have done to prevent his death, nor anything I could have done differently that would have been better. I knew this to be true, but it didn’t change the fact that I still asked myself those questions. When you hold life and death so closely, it’s hard not to take it personally, to feel responsible, to feel the pain, to feel grief, to feel defeat in some sort of strange way. I couldn’t stop my feelings of responsibility anymore than I could stop breathing. It came just as naturally. I don’t think I ever anticipated it would be this way.

It’s like that, you know? You stand straight, firm, tall, proud. You laugh so you don’t cry. You feign indifference even. You break down, you piece it back together. You march on, battle after battle, a soldier for good, an angel of health, moving forward in the calling you wear so mightily. Broad shoulders, air of confidence, liquid efficiency, like a well-oiled machine. You fall, you get back up. You cry sad, salty tears. You dry your eyes, you smile again, you laugh. Sometimes you do all these things in a single afternoon. You keep going. The pride, courage, and commitment continue. It hurts, it makes you happy. It breaks your heart, it repairs your confidence in mankind. It is Nursing, and I never anticipated it would be this way.