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What My Patients Have Taught Me

Page history last edited by Jerry Carley 11 years, 7 months ago

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In December, 2005 I received the honor and burden of being asked, by the graduating nursing class at Del Mar College, Corpus Christi, Texas, to provide a graduation address to those fine students, and friends.  I had taught most of these students, but had recently moved on to greener pastures at Blinn College, located in Bryan-College Station, Texas. I taught them in class, and yet they were requesting more.    They had in effect, been to the circus, and had seen the clowns, but now they were asking for more  I have been to many 'cappings and pinnings' in the past, and frankly found that most of the speeches I had heard on those occasions had been less than memorable. I recall thinking: "Do I really have anything worthwhile to say to those new nurses?..anything that might impart the true meaning of nursing? Do I really even know what that is? Might I say something that will touch them, motivate them, possibly even take their minds off of the impending graduation parties, even for a few moments?"

 

Over a career that has somehow lasted for many years, I have encountered many patients who are very memorable, and who have affected my lfe in some way. Perhaps they materialized and impacted me at some crucial time in my life--making them memorable--or for some other, indiscernible reason.  At this point, there are many thousands of them (patients) --some who haunt me, because I could, or should, have done better-- and others who are a triumph of the human spirit, and have revitalized me and my personal and professional esteem.

 

And sometimes, they arrived just in the nick-of-time, for me and for them.

 

 

And students!--Each an irreplaceable resource to be treasured and cultivated--I can see their eager, trusting faces--old and young--and recall thinking on so many occasions: "What can I do to provide them with some inspiration or motivation, what can I possibly do for them?" 

 

But on that particular night, there was ONE special student there amongst that graduating group  who had truly saved my teaching career. I had already decided to quit--had taken a new, much more lucrative position outside the teaching domain, when her story and personal odyssey --her triumph through ordeal--occurred.

 

Her example caused me to reflect on the truly glowing examples, the people who influenced me and molded me, little-by-little. Their story--and hers-- is told below, in an essay that I delivered on that night.

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What I have learned about nursing and teaching, mostly--I have learned from my patients, and from my students.

 

MY TOP FIVE PATIENTS (OR STUDENTS), AND WHAT THEY TAUGHT ME (So Far...).

Presented in Reverse Order:

 

Patient # 5:

 

“ESPERANZA:” a 60 year old woman, recently widowed, from South Texas, admitted to my floor with Coronary Artery Disease, in for “testing.” If you’ve ever been in the hospital you know that “testing” is an ominous word which can entail a broad range of activities, all the way from getting some good news--to getting some bad news-- up to having major surgery very soon after the tests.

 

I have always liked the name "Esperanza" because that is the Spanish word for "hope,"  and Spanish is a particularly beautiful language. Esperanza was very anxious, and I went out of my way to try to calm her down and reassure her.  The nurse within me saw the need that she has, an I did my best to meet her need for safety.   She had her procedure—a heart catheterization and angioplasty—they cleared out her coronary arteries—and I hovered over her throughout  the night, watching for any complications—any bleeding or heart irregularities.

 

 

Everything went well, and the last thing Esperanza said to me, looking directly into my eyes—so earnestly--, as I left after report that morning was:  “Jerry, I feel that God has sent you --this night-- to care for me.” I pray that she was right, and I believe that she was.

 

 

This emphasized to me something that I already knew, having at that time been a nurse for about 30 years… Although we do need enough money to live on, and most of us could use some more— and most of us want some more--Esperanza reminded me—ONCE AGAIN-- THAT I DO NOT DO THIS JOB FOR THE MONEY.   One very simple, caring relationship--well-connected-- with a patient can keep me going for years.

 

 

Post Script: Esperanza is alive and well, living in Weslaco, Texas.

 

 

Patient #4:

 

VERNON: I took care of Verne in the VA Hospital. He had Multiple Sclerosis and had been bed bound, and on that particular floor, in that particular room, for several years. He required total care. Each morning when I went in to greet Verne, he had a smile, a new joke, or some light hearted quip for me. He seemed always happy and cheerful—despite being bed bound and totally dependent. After a time, I found myself seeking out reasons to go to Verne’s room. He cheered ME up. And I saw the other nurses, going to his room, even when he wasn’t their patient. He cheered THEM up. He supplied us all with a service, and in return, he received the care and attention of everyone on the ward.

 

One of our favorite routines, played out day after day, was my usual question, used to greet him each day:

 

 

"Morning, Verne. How's it going today?"

 

He'd reply: "Well Jerry, I feel like I did 20 years ago !"

 

My required response: "Well, that's great, Verne !"

 

Then he'd retort: "No it's not--I felt like crap then, too !"

 

Then we'd both laugh.

 

 

VERNE EMPHASIZED TO ME HOW IMPORTANT IT IS TO HAVE A PLEASANT, UPBEAT WORK ENVIRONMENT. AS NURSES, I ENCOURAGE YOU TO SEEK THESE PLACES OUT—THEY ARE VERY IMPORTANT. VERN ALSO REMINDED ME HOW VERY MUCH WE, AS NURSES, DEPEND ON THE FEEDBACK FROM OUR PATIENTS. HE, AFTER ALL, WAS CARING FOR ALL OF US—I LIKE TO THINK THAT HE SAW THE DISTRESS IN HIS CARETAKERS AND WANTED TO MAKE IT BETTER. HE WAS MY PATIENT, BUT HE WAS ALSO MY NURSE.

 

 

 

Post Script: Verne, a highly decorated combat veteran of World War II, died in 1976, and was buried with full military honors at the Oregon Trail Veteran’s Cemetery outside of Casper, Wyoming, with a beautiful view of the mountains. I was honored to be one of his pall bearers. Only VA nurses, physicians, attendants, and patients attended the funeral.

 

We were his family.

 

 

Patient #3:

 

CLARENCE & YPER.  I was, for most of my career, an Emergency Room nurse, but the position was filled when I got to Naval Hospital Guam, in 1979.  I was placed in charge of a pediatrics unit, and i set out to become the best pediatrics nurse who ever lived.  Sometimes life presents us with opportunities that we did not plan for, or count on.  What's that old saying?:  "Your life is not so much defined by WHAT happens to you, but by HOW you respond to those things that happen in your life."  So, I became a Pediatrics nurse for a few years.  It made me a better E.R. nurse, when I got back to more familiar surroundings.  Anyway--I always think of Clarence and Yper s together—they were pediatric patients who I took care of at Naval Hospital, Guam, Mariana Islands back in the 1970’s. Both were 5 year olds. Clarence was from the island of Saipan, and Yper was from the Truk Lagoon region.

 

 

Both of these little boys had suffered massive head trauma and had had very invasive neurosurgery. (Clarence had been hit by a speeding motorcycle and Yper had been assaulted—hit on the head with a lead pipe—by another kid his age.) Yper’s nickname—which his father gave him—was “The second toughest kid on Truk.” Of course the toughest kid was his best friend,  the one who’d hit him on the head. Yper’s father had a great sense of humor, a great sense of humanity, which I personally saw tested—but never compromised—over a period of several months while I cared for his son. Abraham (Yper’s father) demonstrated many things to me: strength, compassion, caring, humor, and honor. He was a great example of a "manly man" who is also a "gentle-man."  He taught me much about honor and compassion, and I frankly wanted to be as good as was he.  He taught me, this man who never so much as attended high school--he motivated me, in his grief--to seek to become a better man.   Wisdom is, as wisdom does. 

 

This is a reminder that we affect. and are affected by, the families of our patients--they are also our patients. And, additionally, there is much that we can learn from individuals who grew up in a culture vastly different from our own.

 

 

Anyway, neither Yper nor Clarence did very well for several weeks after their surgeries. They just lay motionless in their hospital beds, side-by-side, moaning-- and they pretty much vegetated in their beds when we were not torturing them with range of motion exercises or physical therapy or bathing or other such indignities. They were fed a foul green, ostensibly nutritious concoction known as Vivonex through nasogastric tubes and—frankly--did not much resemble human beings. Their subdued mothers and fathers came in each day for short periods, but I could tell that the visits really disturbed them. The beings that they saw in the beds only slightly resembled their beloved sons.  None of us nurses gave either one of the boys much hope for recovery.

 

 

Then one day a local Islander group set up a fiesta --for the feast of that particular village’s patron saint—outside the pediatrics ward where Yper and Clarence were wasting away. As the smells of the smoke from the Tangan-Tangan barbecue came wafting onto the ward, and as the boys overheard  the happy voices, laughter, and busy sounds of those preparing the feast, both of them were gradually but steadily stirring and pushing themselves up in their beds— trying to see out the windows. After this day, I believed in miracles, or whatever you want to call them.

 

 

These were the first overt signs of consciousness or purposeful movement either boy had shown since they received their injuries.

 

I do not do this job for the money.

 

I hesitate to tell you—because I have a tendency to become very emotional about this, each and every time I think about it or speak about it—but I will tell you.  I will attempt to get through it, because it is so important.

 

 

The entire experience was an epiphany for me, as a young man who really thought he had 'been around and had seen some things.'.

 

“Epiphany” is defined as a sudden, intuitive perception of--or insight into-- the reality or essential meaning of something, usually initiated by some simple, homely, or commonplace occurrence or experience.

 

 

One cherished golden memory, etched  into my consciousness, forever, --forever-- is the sight of Clarence’s Mother, Amelia, walking onto the peds floor that afternoon. That one sight--alone and individually-- has 'paid' me  for my entire career as a nurse.  This one occurrence alone has made all of it more than worthwhile.  I have  been enriched.  Amelia had been shopping and was carrying several packages. All of the shopping bags (5) she carried said "Gibsons."  When Clarence slowly turned his head and with great effort said “Mama,” she dropped her packages, fell to her knees, crying uncontrollably--so very, very happy-- so very, very relieved that her boy was once again able to communicate with her—that he was going to be all right.  "Milagro."  Miracle.  God is good.

 

 

Clarence was going to get well.

 

 

All of her worries, accrued and piled-on as an ever-increasing burden over an ordeal lasting several months --were removed, as suddenly removed as the packages which fell from her arms.

 

Later that same day, I put these former semi-lifeless lumps of human protoplasm into wheelchairs and took them outside, to the fiesta. (And, yes I got in trouble for doing it, since they were both on “bed rest”…not to mention, NPO...). Their eyes were following the movement of the dancers; they were gesturing and trying to communicate. They wanted some fiesta food, and they wanted to be a part of the celebration. All of a sudden they had been placed into a familiar, happy context—fiesta time —and they were once again human beings.

 

 

CLARENCE AND YPER TAUGHT ME TO NEVER WRITE ANYONE OFF—NEVER THINK YOU KNOW THE FINAL OUTCOME IN ADVANCE… TO NEVER GIVE UP ON ANYONE…AND TO REMEMBER THE ROLE OF CULTURE AND FAMILY AND HOPE ("ESPERANZA")  IN HEALTH AND HEALING…

 

 

 

Post Script:  In the early 1990's I went to the Truk Lagoon area, looking for my former patient.  Sadly, Yper died while fishing—lost at sea, many years later, as a young man. Accompanying him, and also lost at sea was his childhood nemesis, “The Toughest Kid on Truk.” They were lifetime best friends. They died together, doing what they loved best—fishing-- according to Abraham, Yper’s father.  Abraham and I cried and laughed together, honoring and remembering his beloved lost son.  God is good.

 

 

In the early 1990’s I had the occasion to pay a return visit to Saipan, and—as a matter of course (you’d know what I meant if you’ve ever been to Saipan, or similar places in Micronesia)—attended a fiesta given in my honor by Clarence’s family.

 

 

 

It was really the greatest honor I have ever received.

 

 

It was only for the immediate family, so of course hundreds of people were there! I was thrilled to see Clarence as a happy, well-adjusted young man—with a family of his own. That sight alone, to me, justified my entire career as a nurse.  I feel so blessed to see the tangible result of something good that I had done--it is an infrequent thing for nurses to receive that kind of positive reinforcement for all of the many great things that we do. 

 

Anyway--He (Clarence) did not remember me, but his mother and father did...This may sound odd here on the mainland, but the ultimate form of respect in the Marianas Islands area, dating back to their Catholic heritage, is to show honor and respect by kissing the ring of 'the elder.'   On the occasion of this fiesta, my ring was kissed by scores of this young man's family members, much to my amazement, embarassment, and great honor.  When I talked privately to Clarence's father, he—always the joker—confided privately that Clarence “was not the sharpest tool in the shed” and had had some troubles growing up, but that he could participate in family life and contribute constructively to society—which was most important.

 

Needless to say, I had to delay my flight out of Saipan the next morning, owing to the fact that I was suffering from what I was sure was a terminal hang over.  Wonderful time, well remembered.

 

 

Patient #2:

 

NINFA was one of my students, a bit older than the other students, very serious--and she was an outstanding student, scholastically—she paid attention to detail and worked hard to master the material. She wanted to be a nurse, and the attitude that she displayed was that nothing was going to stop her from achieving her goal.

 

In that respect, she was not unlike many of the nursing students--at least the best ones--who I have encountered. Then, one night, Ninfa came in to take a test. She took the test, hung around looking kind of nervous and sad -- and then confided that she had received a potentially life-threatening diagnosis that day (ovarian cancer) and would be needing to have major surgery, followed by chemotherapy.

 

She was worried about completing the class.

 

 

Now, let me put this in context to some of the concerns or requests I have received as a teacher of nurses, and others.

 

“Professor Carley,  I am going to miss clinical and an exam because there is a Ricky Martin Concert tomorrow, and I’m going.”

 

“Mr. Carley, I broke up with my boyfriend of 2 months last night, and I’m not ready for the test. Can I take it tomorrow?”

 

“Prof Carley, I didn’t sleep well last night. Can I go home? Were you going to say anything important today?”

 

 

Sometimes, the everyday happenings cause us to place importance on items which, after all, are really not that important. They SEEM important--that is how they FEEL at the time.

 

And sometimes we get smacked right between the eyes with reality.

 

Now here was a student— placing all of those essentially lame requests and trivial matters into their proper perspective—

 

Ninfa was facing potential personal extinction—death-- but still concerned with fulfilling her commitments, doing the very best that she could do, doing the job.

 

For the first time, she was faced with the true meaning and impact of Shakespeare’s famous hackneyed line:

 

“TO BE, OR NOT TO BE.”

 

NINFA REMINDED ME HOW VERY IMPORTANT IT WAS, AND IS —FOR ME AS A TEACHER—TO DO EVERYTHING THAT I CAN  POSSIBLY DO TO ENSURE THAT MY STUDENTS SUCCEED.

 

THAT'S THE DEAL WE  MAKE, WHEN WE ACCEPT THE ROLE OF "TEACHER."

 

MY EFFORT AND COMMITMENT SHOULD MATCH --OR EXCEED--THAT OF MY STUDENTS.

 

ANYTHING LESS IS NOT ENOUGH.

 

AT LEAST, THAT IS MY OPINION, AND PHILOSOPHY.

 

NINFA EMPHASIZED TO ME THE MEANING OF COURAGE AND INTEGRITY.

 

THERE IS NO ONE,  ANYWHERE,  WHO I PERSONALLY ADMIRE OR RESPECT MORE THAN THIS WOMAN.

You may rest assured that if THIS nurse is taking care of you, she will expend 100% of her efforts to make you feel better.

 

I THANK HER FOR THE LESSON, AND EXAMPLE, AND INSPIRATION SHE HAS PROVIDED TO ME, HER TEACHER.

 

I GET THE MESSAGE.   I HAVE BEEN TAUGHT.

 

Post Script: Ninfa, —unknown to most of her peers—was a member of the graduating class at capping and pinning on the night when this speech was delivered. I used a different name on that night, because this humble woman would have been so embarrassed to be set apart in such a manner. She graduated a little late, but she attained her goal of becoming a nurse.

 

 

An even higher goal, which prompted her to seek medical care to begin with—she was trying to have a baby—has since been realized, as well. Nurse Ninfa is also Mother Ninfa—she delivered a healthy baby girl in October, 2006.

 

Triumph through ordeal.

 

Patient # 1:

My hospice patient, who I will call “The GENERAL”:  a 95 year old man.

He was famous, and very important.

 

If you were a history buff (and I am…) and if you studied World War II and the Korean War, you would see his name in print many, many times. The General at one time made life-and-death decisions and controlled the destinies of thousands of individuals. The fate of our nation literally hinged on decisions which this man was required to make. He is remembered today for his wisdom, compassion for his troops, and tactical genius.

 

So you might understand how incongruous it was for me—a great and ardent admirer of his career, a true fan -- to change his soiled  adult diapers and lift him out of his bed and place him into his wheelchair.  I suppose-if we are all fortunate enough--we might get to that station in life.  God hope that there is an honorable, respectful person like me to be there and help, at that time. I would apologize to him for the labors which I had to do—and he would apologize to me for my having to do them. We made a pact of understanding. Let me say now that caring for this great man in no way paled my love or respect for him--indeed, it was an honor and privilege to care for him.

Although his body had finally betrayed him, his mind was still sharp.

 

One long night, over a period of several hours-- he described to me–in detail—minute-by-minute--all of the events which he witnessed at Pearl Harbor on the morning of December 7, 1941. On another night he explained to me the absolute horrors which he saw and lived-through in 1944 on a tiny island named IWO JIMA.

 

He told me about standing—unbelievingly-- on the deck of the U.S.S. Missouri and watching the Japanese diplomats sign their documents of surrender. After witnessing the carnage on Iwo Jima and Okinawa, he was sure that he and hundreds of thousands more Americans and probably millions of Japanese citizens would die in the impending Japanese mainland invasion. And now—suddenly-- the war had ended, and he was safe.

 

He related to me that he had always thought that Hell would be a hot place until he lived through the frozen retreat from Chosin Reservoir, Korea, in November and December of 1950. "We'd strap the dead Marines on tanks (the U.S. Marine Corps never leaves behind their honored dead) and then their frozen bodies, eyes open, looked at us accusingly for the entire duration of the retreat."

He was a major player and witness to some of the pivotal moments of the Twentieth Century.

 

One night as I was putting him to bed, I got him all settled down and sat down in the chair next to his bed. I asked him—“General, if you could change anything in your life, what would you change?”

 

Oh, I expected that he would reissue some battle order, reshuffle his troop commitments, or change the outcome of some historical event. What earth-shaking event would he replay?

As usual, his answer was well-considered—over a period of several minutes,-- to the point that I thought he had forgotten my question, or decided not to answer.—He sometimes did that when I asked stupid questions--

 

I noticed as he sat there— that his eyes were growing wet, and then the tears traced down his cheeks.  And he still remained silent, for a while more.

 

Finally he gave me his reply:

 

“I used to come home from work, after a long day of Marine Corps business.  I never did a good job of separating my personal life from my professional life.  To me, they were one and the same, --one the extension of the other.  After supper, my wife would be standing at the sink, washing the dishes. Night after night, I would stand in the kitchen doorway and go through my list of things that she had done wrong that day, what she had done to displease me.”

 

“She would stand at the sink, washing the dishes, tears falling from her face into the dishwater. I did this for years—after all, what officers do is to correct people and try to get them to do a good job, motivate them to do the best job that they can do”--

 

“Anyway, I am not exactly sure when it happened—the exact night—but it struck me like a jolt one night, as I was delivering my usual litany of complaints and corrections—that she was not crying.”

 

“She never cried again, after that.”

 

“Jerry”—The General said—“it is as if, each night that I talked to her like that---that I was putting tiny little scars on her heart—the scars built up—and in time she no longer cried, because she no longer loved me, or even liked me. And scar tissue cannot be repaired…”

 

“So what I would change” said The General, a figure in world history, the man who made momentous decisions which altered the destinies of perhaps millions of people:

“ I would go back to the last time that I made my wife cry, whatever night that was…”

“I have searched my mind over and over again, trying to remember when it was—“

 

The General locked eyes with me and said with great resolve:

 

“I would go back

and I would stop,

and I would make it better,

and I would never,,. do,,, it,,, again.”

 

And then he turned over and went to sleep.

 

 

Post Script: The General died a few weeks later. Sadly, I was off that night. I will always feel like I let him down--perhaps only a dedicated hospice nuse can understand that.  --but I hope that he knew how much I loved, honored, and respected him.  I truly feel like this is one of the times were I let someone down, sadly.  I will try to do better.. .All honors and respect to the General.  I loved him. 

 

The General is buried in an honored position in Arlington National Cemetery.

 

Epiphanies !

I would like to recite one of my favorite poems, from one of my favorite books. Perhaps you have heard it before, but please listen again, and place it into the context of your life.

 

1 Corinthians 13

If I speak in the tongues of mortals and of angels, but do not have love,

I am a noisy gong or a clanging cymbal.

When I was a child, I spoke like a child, I thought like a child, I reasoned like a child;

when I became an adult, I put an end to childish ways.

 

For now we see through a mirror, darkly,

but then we will see face to face.

Now I know only in part;

then I will know fully, even as I have been fully known.

And now faith, hope, and love abide, these three;

and the greatest of these is love.

 

Epiphany !

 

THE FAMOUS GENERAL –A MAN WHOM I GREW TO LOVE AND REVERE--TAUGHT ME THIS THING AND IT IS WHAT I BELIEVE.

THIS IS WHAT HE GAVE ME:

 

The only thing that is important is love for your family and friends.

The rest is JUST DETAILS.

 

Find your epiphanies.

They are out there for you to discover,

to guide you on your way.

 

Thank You, good night, good luck and may God Bless each of you very special, unforgettable people who have chosen the noblest and truest of all professions.

 

 

 

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