Tuesday, September 04, 2007

Poetry from nurses and doctors -- Part II

Here are some pieces of prose and some more poems written by doctors and nurses here that were presented at one of our Schwartz Center Rounds several weeks ago. Warning: Some of these will hurt to read.

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A Job
By Grace Campbell-Dupont

A job is a job, but it is what you bring to it which makes the difference
your job should bring out the best in you, no matter the situation or circumstance.

Experience comes in many ways and comes in handy when applied to every day situations. It does not matter what you do, as long as it is done with pride deriving satisfaction at the end of the day.

High values and great expectations come with the job sometimes
that expectation fall short when there is no connection between self and job.

To listen is to learn and to learn is to give your very best, to observe is to be diligent
To see and to do without being asked, Give your best as is expected.
Never short change your giving because you will compromise what you believe in. There is Satisfaction to be gained in knowing that you give not only of what is expected, but of your very best.

My work is very important to the smooth running of the UNIT
I may not have all the answers to many question asked but there is resource
just a phone call away, and just knowing that you have tried makes a difference. Smile while you can, no matter the outcome let your eyes brings hope, your voice sooth the caller, the one who is grieving and hope to those who need to see that the person at the desk gives respect and understand their anxiety.

Finding a job that you like is not easy or one that brings satisfaction
but when you do, it brings out the best in you, even though it is not about you
but what you can do and how well you can do it.
Working in the UNIT gives a clear and sober understanding of how important
and precious life is. Each day brings new experience and new appreciation for the smallest things in life, nothing is taken for granted as it can be taken away in just one breath...

Behind each drawn curtain excellent care is given to which I may not be a part but when that curtain is drawn with urgency and there is no time to waste it is time For action you must ready.

With humility I take my chair and give the best of my self performing
Just like the day before. As you look and see, listen and learn a whole new world unfolds of endurance, strength and dedication of those on whose shoulders rest the responsibility of making health and Safety their priority and the true spirit of TEAM coming together for the purpose of caring.

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Ownership
By Matthew Hitron, MD

During my third year of medical school one of my patients died. It was a medical error that killed her, and I have been told to feel that the responsibility for it is shared, as a system and as a team. I didn’t feel that way then, and I don’t feel that way now. She died not only because of a screw up, but because no one really cared. I live with the fact that I could have stopped it. She needed someone to care, and I failed her in that. She was an elderly woman with many problems and a dementia that made her difficult to interview and examine. She was uncooperative and at times combative. She had no family, with a court appointed legal guardian and HCP. She arrived from her nursing home with mucus stains on her face and two necrotic toes. She swore at you, and even spat at you when you tried to speak with her. There are ways to break down the story into its components, and analyze the systems that failed; the cracks that she fell through. But it is smoke clouding the picture of a patient who was going to challenge all her care givers by requiring of them a true and exhausting commitment to her humanity; a humanity that was easily forgotten after a few seconds in the room. She was passed off from person to person, service to service, consult to consult; and I was complicit in this.

It was two weeks into my third year medicine clerkship. At times it felt like a show and I was painfully aware of the need to impress. I was not about to back down from any task, and was constantly negotiating the third year paradox of needing to learn everything while hiding the fact that you know nothing. My resident warned me she would be tough, but I had to prove I was good. She was admitted that night uneventfully, numerous consults were called, and the day was over.

The next day she was the last patient on rounds, kept NPO and on maintenance fluids while she sat in her room like that was the curative measure. Nothing happened. The team would wait for the consults to do something and the consults would wait for the team to tell them what to do. The removal of her dead toes was at least some sort of plan, but her strangely elevated INR, her ominous acidosis, and her altered mental status were just glossed over before lunch, with vitamin K, bicarb, and olanzapine given to make everybody feel better.

I came in the next morning, and as I flubbed my way through the note jotting down a K+ value of 2.0, it never occurred to me to be sure someone else knew about it. I remember thinking “wow; that sure is low…” if it were a test question I would have gotten it right. With all the nurses, consultants, and residents milling around her, someone must have seen it too and acted with purpose. No one did that morning. Instead of taking ownership, I was just another in a long line who passed the responsibility off, with no one left after me to pick it up.

Late that afternoon potassium was finally hung on her IV. The patient was alive, and I had dodged a bullet. I walked to the stairwell, stopped on a landing and leaned against the wall, “Take ownership” I said to myself, “you may be the only one left.” I remember feeling like I learned a huge lesson without a patient having to pay with her life.

I also remember moments later, and will never forget; the panic, the disbelief, and the grim realization that a patient had fallen through the cracks to her death, while I ran up the stairs to the sounds of the code alarm.

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Sharing My Body
By Janet Greene, RN

Before I knew it,
I was sharing my body with a stranger.
No love binds us, but my whispers go unheard.
I cannot get away.

A cancer has crept in.
Motionless, I dance with this intruder.
My feet are numb.
I struggle for balance.

I am sharing my flesh with a partner
Who touches private parts in me
And leaves me nothing.

---

A Smile
By Sally Dennett RN

Why do we do what we do?
Long days, tired legs,
Families stressed,
100 things in our heads,
Trying to mend,
Trying to heal,
Mind, body and spirit thrown into one day,
Hoping our efforts pay,
Sometimes feeling helpless,
What else can we do?

A beautiful young woman in her prime,
Came to us just hanging to life,
Mother distraught wanting answers and hope,
Time would tell, is all we could say,
Head injuries have their own game play.

A daughter lying dormant in a hospital bed,
Mom and family while they are there,
Helping paint nails and wash hair,
Small gestures make strong bonds grow,
In a situation where nobody knows,
Will she wake up?
Talk again?
Walk again?
Be my beautiful daughter again?

Three months pass,
A phone call received,
You’ll ever guess the voice said,
She jogged today,
Speechless, Wow, what could I say?

Weeks pass and a visitor arrives,
The beautiful young woman, is before my eyes,
Walking and talking, incredible to see.
Mom has a grin that could light up the sky,
Her beautiful daughter looking strangely at me,
My eyes filling with tears of delight,
Why is she crying Mom?
Who is she?


I was your nurse,
Seemed all I could say,
Still in awe of what I saw,
Hours and hours of multiple tasks,
Hoping to make it all good at last,
Rollercoaster emotions for all concerned.
Then months of not knowing just what happened,
(often the norm in hospital land)

The emotion I felt at the sight that I saw,
Makes every long day mean so much more.
Every day struggles are put into place,
And all I see is a smiling face.
So, why do we do what we do?
Long days, tired legs?
Families stressed,
100 things in our heads?????????????????

Life is special………………


---

JM’s God.
By Glenn Bubley, MD

Entering JM’s room I find him where I always do,
Pouring over his large print Bible as if its all brand new.
Before I can ask him how is today,
He looks me in the eye and asks if I’m ok. I marvel at how important my answer is to him
As he lies on his hospital bed, tubes in every limb.
If there is an ultimate justice of genuine worth,
Surely JM and his kind will inherit the earth.

In JM’s time he was a victim of segregation,
With no chance to rise above his station.
He working loading boxes with his back and hands,
Acceding for years to his bosses demands.
And now even with cancer he’s neither bitter nor angry,
His struggle comported with the utmost dignity.
This man of sorrow, acquainted with grief,
Only by his release will he find ultimate relief.

Although there may be a balm in Gilead,
On this ward, IV morphine is the best we have.
Although the pain of cancer gnaws at his bones
He’s apt to laugh more often than groan.
His smiles leave lines etched on his old black face
Reflecting an inner peace that cancer can’t erase.
His strength seems to be emanate from a glimpse of God,
A glance that may be as close as men are ever allowed.
Now hobbling through the valley of the shadow without moorings,
Will he soon “mount up on the wings of eagles” up soaring?

As for me, I have much more than my daily bread.
So I wonder what it is about the future I dread.
If I could embrace the mystery of his faith might I break free,
If I could quash my doubts could JM’s God touch me?
If I could genuinely consider the lilies of the field,
Might I find a faith that feels strong and real?
Then would vain-glory and self promotion,
Fall away in favor of more genuine emotions?
Would everything change if I could begin to ponder
If it really possible that He walked on water?
Did Moses really hear the Lord from the bush?
Does JM’s bible verses contain seeds of truth? Can a book learning cynic be taught by an unschooled man,
That some things are controlled by an unseen hand?

I had thought that JM’s God was only a useful superstition,
But his life bears witness that the Holy Ghost’s not just an apparition.
If he’s found a lasting faith and true hope that abides,
Then nothing else matters on this mortal side.
His pain and the cancer is just a brief bother,
Before he finally stands before his Father.
And on that last journey that we all take alone,
Will a redeemed JM stand before the throne?
And will he hear these words now that his race is run,
“My good and faithful servant, well done, well done.
Walk up right into this new Jerusalem, it’s not a dream
Here justice pours down like water, righteous a never-failing stream”

---

INSENSITIVITY
By Christina Ho

As a medical interpreter in the hospital, the target group I encounter daily is mainly Chinese. They are mostly from China, Southeast Asia or even other parts of the world. Their education and cultural backgrounds are so diverse that I sometimes have difficulties to interpret the way to make them understand thoroughly. Moreover, there are even some miscommunications or misinterpretations in between that I am

totally unaware of due to my insensitivity until they speak up to let me know. One day, I was told by a doctor to call a patient at home for an immediate blood work which was very important for the adjustment of the dosage of the medication that he had been taking. At the time I called, I got the patient's mother (an elderly) on the phone. She told me that his son was at work and wouldn't be home until midnight and she didn't have his work phone number. The best way that I could think of to contact him was to leave my phone number for him to call me back. So, I tried to have her to take down my phone number. Without hesitation, she refused. No matter how hard I explained and stressed on the importance of getting this message across, she refused. It sounded weird to me. I got so frustrated and talked to myself, “That’s your son! What is the reason that you are not willing to help at all? How difficult is it for you to take down numbers?"

As I calmed down a little bit, I asked," What is your difficulties? Is there anything that I can help you with? She hesitated and stuttered, “To be honest, I am totally illiterate. I couldn't write, not even numbers." I was awakened and apologized, “I’m sorry for being insensitive. How do you usually do if you want to write numbers?" She answered, “Using strokes.” ”Great! What a good idea! Let us try." I then gave out my number slowly. During the process, we had a lot of fun though. When she finally got the number and repeated to me, I was so happy that she got it all right.

Before I hanged up, I praised her for doing a great job and thank her for the help. She was so happy for what she did and promised me that she would definitely pass the message to her son.

In my job, I learn something new everyday. Not just I can be sharpened on the skill of the language but the sensitivity to people which is the most rewarding part. The more I asked myself this question -- How often do I put my feet in someone's shoes to try to understand them better? -- the more I understand Jesus's love for being a mankind on earth.

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What it Means to Care (Vol IV/2007)
By P.T.S.

It can make an impression
not so many years after you are born
the calming influence
in the midst of a storm
Your first one more often
is a mom or a dad
as they share the good
along with the dad
It might be a mom
a cousin or a friend
who inspires you also
to follow the trend
It may be a noun
It can be a verb
There can be negatives
well deserved
It can be one who is there
during your years in school
a friend and a teacher
who helps you with the tools
It might be something
better than any other
because the person cares
and helps another
It is something that
will probably never be given its due
but in its ideal is an example
for more than just a few
It should command respect not only from others but from those who perform its tasks as it recipients often
do not have the words to ask
It can have horizons that know no bounds It may stumble
and have its ups and downs
It may cause all of us to pause and remember what makes a job a profession with rewards that can't be measured. It is not always about the money or the red that is often seen
that can make it held
with well deserved esteem
It might be an extra moment
to listen to one's concern
or studying a little harder
to help and to learn
by anticipating a need
or giving a med'
or just by helping one
to get out of bed
It may be speaking up
when no one else will
I am worried
This person is ill
It is the giving of one's time
a most valuble gift
which makes it so unique
with each continuous shift
It may be actions performed today
that are remembered long after tomorrow
which help others overcome
their fear, their pain, their sorrow
This is Nursing
if you don't know by now
a job, a profession? that asks
the why, the when, the how
This is Nursing
if you want to know more
knowledge, organization, respect
enthusiam and more
This is Nursing
as observed through the years
or a synonym
for what it means to care

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The Destruction of Urban-Day Market
Dagan Coppock, MD

The market was open, the market of sand,
Of dust blowing down with harmattan wind
Over pulp of a mango, pulp of a hand.

Fingers of smoke and ashes had fanned
Over bodies of people, burnt and pinned
By the market when opened, the market of sand.

Two tribes of Yoruba, claiming the same land
Of dry season fruit, desiccated and thinned.
The pulp of a mango. The pulp of a hand.

The soldiers had guarded, the Ife had manned
The gates of Urban-Day, its corrugated tin,
And opened the market, the market of sand.

Armed Modakekes with a list of demands
Entered the tension, an explosion of limbs,
The pulp of a mango, the pulp of a hand.

It must have been stirring, it must have been damned,
That obsession with volume, the splitting of skin
As markets when opened and salted with sand,
The pulp of a mango, the pulp of a hand.

---

Remembering Walter
By Janet Fantasia

I approach your portal, weathered wood of snakeskin amber and brown.
Through the film of gray lace, a shaft of light and you emerged,
a short, hunched figure scuffing towards me down the hall, your
withered hands, one melded to the other, straining to heave
open the door so I could give you the weekly shot to oil your joints.

I trailed behind, the nurse’s bag digging in my shoulder.
“How are you doing?” I asked.
“SOS” you said and smiled that mischievous smirk unless you were worried about your health or money
which I could tell by your downturned mouth and monotone.

In the spare room stood columns of boxes, a stockpile of saline, gauze pads, sterile gloves and ointment.
“Walter, this medicine is expired.
You cannot use it to treat your wound,” I cautioned.

Worn oilcloth covered the large kitchen table hidden by medication inserts, papers, coins, novelties
a coffee mug, napkin holder and an outdated Pill Bible.
I sat in the dinette chair, but yours was the office swivel with a cushion of five inch yellowed foam.

You filled tiny paper cups with your daily pills. Using both hands
to lift the Princess phone,
a recorder attached for fading memory,
you called the pharmacy and doctors’ offices.

Clever contraptions you devised made it easier to get through the day-from the window-shade puller-upper to
the angled piece of tin on the air-conditioner to deliver the coolest blast on a scorching day.

The stove and fridge were on borrowed time.A dented saucepan sat tilted on the burner, steam escaping from the crinkled tin foil cover.
Boiling water crackled for instant coffee to have with your soft-boiled egg, hemorrhaging yellow on the plate.

I examined you and peered at your feet,
two squishy water balloons, dusky and cool, your toes, gnarled and overlapping, then a foray into your ancient icebox for the Tin Man’s injection.

Sometimes, I asked you to lie in your bed for a dressing.. In slow motion, you removed the tattered blue terry robe.
Hiking up each hip, knobby fists with shriveled claws
pressing downward into the mattress, you reached the precipice and I vaulted your legs to supine.

We commiserated about your latest doctor’s visit, the news or something on your mind like the time your coronary artery was blocked and the doctor said “That was almost it.”
“He shouldn’t have said that. I was scared.”

A hard binder on the shelf bulged with files kept of so many admissions, dubbing you a “frequent flier.”
Grinning, you showed me an image of your coronary arteries before and after the stent. On the left, a hazy cluster of
branches and the right, a blossoming tree of blood flow.

You trusted me with your life, my pager screeching when your heart pounded double-time and for the pain in your neck, a cervical fracture.

You returned home, an erector set from the shoulders up and handed me a
camera to capture a miniature astronaut.

You had my number on Caller ID and called the night your bag broke and you were alone and frightened.
My phone rang at 3 a.m. I heard the anxiety and embarrassment in your voice. Dressing quickly,
I splashed cold water on my face for the long drive.

I gave you the “bad” news I was
promoted and moving to another office.
Later, I learned you had died
in the hospital where the nurses knew you by name. I took this hard, having been your nurse so long.

Since you left, I slow my car while passing your home half expecting to see your oversized Buick tipped
into the tiny driveway. There is a BMW there now. I wonder how much has changed inside and how much of you remains.

5 comments:

Mother Jones RN said...

Very powerful. Thanks for putting these works up on your blog.

MJ

n, md said...

To Dr. Hitron,
The lesson you learned in your third year about taking ownership was a valuable one.
I couldn't help thinking, though, as I read your essay, that some day when I am an elderly demented woman with multiple medical problems and no one around who cares about me, a hypokalemic arrest would be a very nice way to go. (Without the code, of course.)
Take the lesson for the benefit of your future patients, but not the regret. God works in mysterious ways, and perhaps He sent this lady to you specifically because He knew it was time for her suffering to end, also knowing it would be unintended on the part of the team taking care of her. He sent you the patient, and the lesson.

Anonymous said...

Hello - Can you talk about how the current credit issue on Wall Street will impact non-profit hospitals like yours, has it already?

Thanks,

VG

bev M.D. said...

Wow, most of those reminded me forcefully why I idealistically went into medicine those years ago. So different now. But all is not yet lost.

YogiBear_ said...

Very Touching & Profound expressions...
Here is the view from the otherside,... in a lighter-vein

LAUGH A LITTLE EVERY DAY....


SPECIAL POEM FOR SENIOR CITIZENS!!
A row of bottles on my shelf
Caused me to analyze myself.
One yellow pill I have to pop
Goes to my heart so it won't stop.
A little white one that I take
Goes to my hands so they won't shake.
The blue ones that I use a lot
Tell me I'm happy when I'm not.
The purple pill goes to my brain
And tells me that I have no pain.
The capsules tell me not to wheeze
Or cough or choke or even sneeze.
The red ones, smallest of them all
Go to my blood so I won't fall.
The orange ones, very big and bright
Prevent my leg cramps in the night.
Such an array of brilliant pills
Helping to cure all kinds of ills.
But what I'd really like to know...........
Is what tells each one where to go!

There's always a lot to be thankful for if
You take time to look for it. For example
I am sitting here thinking how nice it is
That wrinkles don't hurt...