Some things are stranger than you might imagine

5year old kid has surgery for an aortic stenosis. As often happens in this situation , he is hypertensive  post operatively. His left ventricle is accustomed to generating huge pressures to get blood out through the defective valve, and even post op, continues to be hyperfunctional.
In this case, however, we can't keep pressure down to a safe level, no matter what....nipride drip, lots of pain meds and sedation are only minimally effective.
Within a day or so it becomes clear that part of the problem is that the child is both constipated and in distress, which is increasing his blood pressure.
We give him the standard remedies: glycerin suppositories, some stool softeners.
His blood pressure gets higher.
We then give him some stronger guns...magnesium sulfate, then Miralax, then in desperation, golytlely, which is designed to clear out bowels before major imaging. He still doesn't  produce any stool, although xray tells us his bowels  are full and ready to evacuate. His blood pressure is still sky-high and he spends most of his time clenching his buttocks, his quadriceps, and moaning, clutching at his belly.
In desperation, I ask his grandmother (who is his legal guardian), "what is "boy's usual pattern? Does he often have constipation? Is there something you do for it?"
Her answer:
"We couldn't stress him with potty training because of his heart defect. He usually just goes behind the couch in the living room. "

death

conundrum

...a tiny, absolutely gorgeous girl...she looks like Judy Garland .
17, with a two year old baby.

She showed up here in heart. lung and kidney failure.It turns out that she has a big piece of yuk in her heart that has seeded itself to her lungs and her kidneys. She is a meth addict, and shoots the stuff; and she pulled out her own infected tooth a few weeks ago. Seemed like a good idea at the time, I guess.

So now she's sitting in our unit, pissed as hell because we took out close to a half liter of  infected fluid from around her heart,so she's now able to breathe again and awake...but the drain hurts. (Another 350 cc of drainage in 2 hours. Her heart is now working fairly well...no longer tamponaded, so she can breath, and her heart is working well. )

She really doesn't care that she is in danger of emboli to her brain; that her kidneys may be permanently damaged.

"Can I get something for my anxiety? I was supposed to see a psychiatrist to get started  on good  drugs."
"Can't she get some narcotics?" her mom pipes up.

"Here. Let's give you some IV Toradol..it's great. Works really well for pain."
(Toradol is an IV version of ibuprofen, and anti-inflammatory.)
Within seconds of the drug being put into the IV, she nods off, head drooping like a daffodil in the rain. Her mom sighs in relief.
Trust me..the pharmcodynamics of the drug don't work that way; it's all in her  head. She got "something" pushed into a vein, so it "works"

How do we fix this one?
She'll be asking for narcotics again in the morning, as will her mom...

Someone must be taking care of the baby.

A few days ago, I read a really nice blog post by another critical care nurse about how we carry our patients with us...
and it resonated.

http://www.huffingtonpost.com/sonja-mitrevskaschwartzbach-bsn-rn-ccrn/letter-to-patients_b_9034024.html

I've always thought of this relationship we have with our patients and families as something really profound; that our interactions change us, in ways we often could not have anticipated, but would never (or at least for me) would  avoid even when incredibly painful in the moment.

I've written  a lot over the years for myself in exploration and expiation:  poetry, short stories, short essays. I've written a plethora of policies and procedures to help others render care safely and according to specific standards of care. I have read and and been informed by extraordinarily erudite and lovely writers like Lewis Thomas, Richard Selzer, and most especially Oliver Sacks, who taught me just how much our experiences with patients require compassion and incisive thinking, both.

My metaphor is this....of course I carry you all with me..you've tattooed yourselves upon my soul.

Writing is something peculiar...sometimes we do it out of need to express an opinion, sometimes to change an experience into something other...something tolerable, something "useful".

For me, it's a way to take the many memories I have of patients and  families; great outcomes and horrendous ones. It's a way to explain the very weird world of critical care to people in my life who are not involved in health care, who have no knowledge of the very separate world of a hospital. It's equally important to me to validate the experiences I've had as a nurse, in critical care , for more than 30 years, during a time of great change...and to celebrate the colleagues I've been so fortunate to work with. 
I've found some other ways to work with the "bad" stuff over the years...working with a hospital ethics committee, for instance; and doing an enormous amount of reading.

And writing things for myself sometimes in journals.

I ended up in Taos, NM more than decade ago as a result of being part of a hospital ethics committee, just after a devastating divorce. My director of nursing was kind enough to pay for the vacation time and the costs of the workshop. At the time, I thought I was going to learn about how to write about ethical issues in health care.

Well, yes, and no.

As it turned out, first of all, we were forced to do many sorts of writing exercises, ranging from short paragraphs to essays. I had always thought that I was pretty darned good at writing the typical term paper or technical exposition (many years of policy writing, plus a degree in technical writing had assured me that I was "ok" at those things.) As it turned out...I actually had a whole lot more to say, and was encouraged to write more personal reminiscences. I  was critiqued in ways that told me that I actually had a real voice, and value. That was extraordinary.
I met in this workshop, and was incredibly fortunate to work with the late Ellen Meloy, who took the whole genre of science writing/personal memoir to a level I had never imagined, full of humor and quirkiness and intellectual rigor.
At the same time I also joined an online community of people who originally had joined a "dating site' which very quickly evolved into a remarkable writing community. Shared blogs, daily haikus, weekly short pieces on one word...the inspiration and feedback was incredible fun and highly creative. There are still a hundred+ of us who have met in person, and connect online, although it's changed in texture.

Two years later,after that writing workshop,  I found myself in the Middle Rio Grande area of New Mexico, making a new life in the high desert very, very far away from the lovely, verdant, sometime cold and dark northeast. In retrospect, that was very probably the bravest thing I've done in a lifetime...to just pack up the Subaru with the dogs and the the coffee grinder and some clothes and just  head out to an unknown job/place/life. At the time, it seemed simply the thing I needed to do.

I've been here for almost 10 years now, and I still think that there is a "reason" I've been drawn to the Southwest, this barren, water starved pace so full of history and myth,  and a "reason" I've spent the last 10 years working in pediatric critical care, and a "reason" it's time to get back to writing.

More later about my inspirations and aspirations. It's hard to know where to start in this recreation of this blog, although I'd welcome  you to "follow' me and see where it goes.

I would leave you with this quote from Ursula LeGuin, and extraordinary writer of 'speculative fiction.

A story is, after all, and before everything else, dynamic: it starts Here, because it’s going There. Its life principle is the same as a river: to keep moving. Fast or slow, straight or erratic, headlong or meandering, but going, till it gets There. The ideas it expresses, the research it embodies, the timeless inspirations it may offer, are all subordinate to and part of that onward movement. The end itself may not be very important; it is the journey that counts. I don’t know much about “flow” states, but I know that the onward flow of a story is what carries a writer from the start to the end of it, along with the whole boatload of characters and ideas and knowledge and meaning — and carries the reader in the same boat.

renaissance

I have  left this blog alone and lonely  for way too long!

The closer I get to possible retirement from my main gig in PICU, the more I realize that:
a) I am addicted to critical care ..the intellectual challenge of working with sick kids, the fun of working with people who are at the top of their games, the emotional rewards of helping others in extremis...I still love it.

and b) DAMN!I've been doing this for decades now, and I actually don't like working twelve hour shifts.I'd rather go home in daylight, do a little gardening, play with the dogs..

and c)what the heck else can I do with my life that gives me so much satisfaction?

and d) can I actually afford to retire at 62 anyway?

Well to work from the bottom up:
d) The answer is no, not really , unless I end up writing something that makes me a best seller. Not so likely.

c) Can't imagine,still, else I'd have done it already. Critical care nursing is pretty amazing.

b) Well..at least I work days, now :)

a) I have thought for years that I will end up like the wonderful jazz singer Alberta Hunter, working as a nurse into her early 80's before she was rediscovered . (Of course I'll have to simply be discovered, rather than rediscovered.) I will simply get shorter and shorter, more and more pithy.

All joking aside, I think there is a place for nurses to write meaningful, intellectually rigorous things about our experiences.It's a genre that has been largely ignored and/or sensitionalized.

a dart to the heart no 1

A dart to the heart

Is learning that our newborn will die without surgery on her heart, the size of a walnut

NOW

And might die anyway

After the surgery that opens up her chest and her heart to the dry air

She stretches out her fingers and folds them around our fingers
falls asleep under the warming light,

Festooned not with ribbons and lovely dresses, but with

Wires and tubings erect from her belly button.

She has one hand huge with a dressing over an iv into an invisible vein

She moves, and suckles briefly on the green pacifier, and smiles.

They told us that babies don’t smile,

But she did, we saw it and photographed it, shared it

Instead of coming home pictures

And every time we speak to her, her lips curve into something sweet

She smiles under the warm yellow  light,

We touch her gently, unable to pick her up, close to our hearts

Wires and tubings trailing.

Nursing...the intellectual dissonance?

The tradition of physicians as writers and poets is a very long one, and revered, as it ought well be. From Avicenna to Michael Crichton, physicians have often made their mark in history, memoir, poetry, writing about the human condition.
I "grew up" in healthcare reading  Lewis Thomas and Samuel Shem, Richard Selzer, Oliver Sachs, William Carlos Williams...writers who took my personal experiences in critical care and made sense of them in terms of philosophy and history; they taught me about neurology,surgery, biology, and poetry and compassion.
I've watched, and loved television...from St Elsewhere to Private Practice that has depicted deeply moving human experiences, but has almost universally focussed on doctors as the prime movers, indeed only practitioners of healthcare. The very few television/movie renditions of nurses are formulaic and stereotyped.

What has always felt lacking to me is the dearth of really good, highly intellectual writing about being a nurse.

I don't believe for a minute that this has anything to do with lack of intellectual capacity or understanding of universal meaning, nor do I think that being a nurse, in a primarily female profession, means that we don't think about the big picture. I've been gifted with working with extraordinarily talented, intelligent and thoughtful practitioners...people who have deliberately chosen the hands on profession of nursing  rather medicine. I know I'm not the only person who deliberately chose  nursing above medical school, and it certainly wasn't because I was and  am not intellectually capable.

It's curious to me that having made that choice, we also choose not to write about our experiences, even though they are as important, as universal, arguably more proximate to actual death and dying, suffering  and healing. I don't like to admit it, but I think it's because we nurses have for so long been predominantly women, and more, we've been inured to the subordinate.

I'd like to change this dynamic, to write about my experiences with my peers, my patients, and the things I've learned as a human being interacting with other human beings in the most extraordinary times of their lives and deaths.

embodiment of a metaphor

it sucks to embody a metaphor

“Too bad”, they told you,
“We were able to rebuild
the worst of the visible damage.
But these are inoperable.
You’ll learn to accept them.
And you look pretty functional after all.
We did a great job resurrecting you”


Purple hearts
Silver arrows
Sharp-edged shards of destruction
Lodged here
And here and
Here
Encapsulated in
Nightmare, lymph, muscle

They will lie dormant
For the decades
Until some swell of memory
Awakens them, and moving
Like blind fish from the caverns of flesh
Seek light again.
The splinters emerge
Gritting skin with old blood,
Poisons long brewed
Skirting an artery
drivng through flesh
Against tight-wound nerves

Does the metaphor
Comfort?
That decades later you
Manifest in sharp
Edges
Long slow healing
Or is it bitter?
Spines emerging

Where’s the prize
In having held dormant
The pain,
Transcended the immediate?

Purple hearts
Silver arrows

intimations of mortality---a draft

Poet and visionary, Lord Byron was infamous for (among other things) transforming a skull found in his back garden into a drinking cup, burnished and set with chased silver, inscribed with a poem. In Tibetan Bhuddist practice, a katana, a vessel made from a skull, serves as a container for offerings made to any unfriendly deity; a tangible reminder of the transitory nature of life.

During the medieval Christian craze for annexing bits and pieces of saints and other venerated folks, skulls, too, were confiscated, altered, and used to counteract evil influences. The reverent hoped that drinking wine or medicine from a saintly skull would counteract poison, ensure truth telling, keep at bay the forces of darkness. Saints Theodulf and Sebastion, both parted out to sanctuaries, monasteries, churches in Northern Europe, ended as brainpan chalices.

We humans tend to collect oddments to represent things larger than ourselves; stones and twigs, bits of eggshell, a fallen leaf, a clipping of hair, bits of bones, collages of what we see, remember, dream. We know, have known since the beginning , that the universe is larger than ourselves, needs must be made tangible in paint, song, metal, stone.

I imagine that my ancestors, Celt, Goth, and Viking, mongrels all, took the heads of vanquished enemies, carried away jouncing at saddle bow and fashioned into jeweled cups. I see the truncated mementos shelved in rows, grinning. Looking a former adversary in the face, so to speak, must engender a sense of both triumph and relief. There’s a compelling immediacy to the bones of the skull, a sense of things contained, the remnants of tributaries of thought.

My grandmother died over a long period … or perhaps it is more accurate to say that she slowly sublimated. Like so many extremely elderly women, after a hundred years she just began to disappear. Each day she grew visibly smaller, her interactions more limited. The overwhelming need she had manifested for a century to talk, to connect, to interact, to socialize, all melted away into ever longer naps and periods of immobility.

I remember sitting at Priscilla’s bedside after a month of seeming coma, her once well-upholstered limbs draped in swathes of thin skin, batiked in bruises. She was quite literally turning into a shadow of her former self. I thought perhaps this was the week I’d be calling family, making use of the prearranged funeral contract.

Suddenly her eyes opened, great bright blue cataract-hazed pools set deep in bony orbits. She glared at me, suspicious, and gripped my arm with her claws. I extricated one hand, made sure her hearing aid was firmly seated in the ear nearest me.

“Grandmother, you know it’s ok to go now”, I said. “What are you waiting for?”

Silence. Her eyes closed. No contact today, any more than days previous. Suddenly, I heard what sounded incongruously like a giggle, eyes wide open and full of joy.

“I might miss something.”

She closed her eyes again, loosened her hold on my wrist, and drifted off into the depths. I never heard another coherent sentence from her again.

Each day after, as I sat by her bed, the bones of her body came clearer and clearer, like a skeleton in an archeological dig, one stroke at a time brushing away the sand of flesh, sand of time. At the end, the shape of her skull was clear, only the thin veil of skin and shreds of fine downy hair clinging to the beautiful bones.

I found myself plotting how to liberate that gorgeous skull before the last journey to the funeral home and crematorium. Surely the mortician could be satisfied with the rest of her, ample material to manufacture the “cremains”. Perhaps I could set her on the granite mantel piece in the living room that she’d sat in for 50 years. She’d return home, and I’d lay claim to her century’s memories .

I imagined holding her skull, cradling it in my hands.

Last summer I held the skull of a remote ancestor at the Tomb of Eagles. There, above the North Sea, I gazed into the cranium of a woman dead for possibly two millennia and traced the markings of blood vessels etched into the underside of the bone, like the meanders of the river in the Kilmartin Valley. They made perfect Celtic swirls and knots, mirroring the carved knots on the standing stones a few miles away.

Did my ancestors, too, peer into the opened skulls of their dead? Did they try to capture the traceries of thought and memory in their boney carved standing stones, skeletal counterparts of the now inscrutable blue tattoos once inked deep into living skin?




Skulls
Masks
Tomb of the Eagles
Autopsy
Seed pod
Skara Brae
Trepanning
Head injuries…saving bone chunks
Medieval reliquaries.
Cave paintings
Celtic knots
Baba Yaga

Moonlight Madness

Here at road’s end
Hunched behind the stonewall crumbling
Nothing but rags and bits
Shredded illusions,
Sharp bone shards
Not much to eat

Sunset, moonrise, stars falling

Gather up those shards,
Dead white, memory of love songs
Tatters of anger
Disappointments , victories covered in mold
I remember your eyes, pleading
And words of betrayal

Sunset, moonrise, stars stilled

Grind the bones one by one,
Filled with marrow of loves, hates,
Marriages, jobs, wasted days and brilliant sunrises
Add garlic, a carrot or two, some rosemary for remembrance,
Sage for wisdom,
Salt with teardrops

Cook down until thick enough to coat the spoon,
A recommended minimum of
Forty days and nights
Then sieve out the bits, let cool the bouillion
To demi-glace, glue for the job at hand
Add compassion and promise and wry acceptance


Sunrise, moonset, stars dimming

Comb out the rags and marabou feathers of that last bright affair,
The tinsel and nail parings, the bits of hair
Spin loose and lumpy
Weave on a loom warped with joy
To lay the table
Here, before the east-facing window

Will you share my meal?
I promise moonlight, candles and bright stars
Lighting the table
And a complex stew,
This soup,
Just the start of the feast.


Sunset, moonrise, stars singing

copyright Judith Jenness 2007

storm wræc

wræc driven by the sea

seawrack,
heaped above the tideline

sun steams
open stormflung
treasure,
bursting iodine bladders

small crab
scuttles
from beneath
dulsedriftwoodplasticringsdeadurchins
sparkle-scoured glass chips

unshelled
the air is clear
water calm

pace slowly
along wave edge
pick open the gifts
wave-driven to your very feet

one perfect star
tinselled in seagrass


copyright Judith Jenness 2007