A date with death

I have a date with death: April 3, 2017.  It’s not as ominous as it sounds, though – in fact I think it’s going to be a wonderful day.  This will be my first day as a hospice nurse.

Early into my maternity clinical rotation at NYU, I decided I should be a Labor and Delivery RN.  Having assisted in a few uncomplicated deliveries with epidurals on board, clueless as to what the agony of labor felt like, it seemed a fantastic career plan. L+D nursing, at first glance, appeared to be mostly cheerleading with some IV fluids thrown in for good measure.  Several weeks later, I realized I had been terribly wrong when the board in the staff room read: IUFD.  After learning what those letters meant, I left the floor with sore feet and a broken heart – which were nothing compared to what the patient was suffering.

During the year that followed, I continued to identify potential areas of specialty, only to be humbled again and again in one way or another.  Orthopedics and sports medicine intrigued me, until I had to set up an operating room for one of the surgeons.  In addition to the usual scalpels, suture kits, and sterile gauze packages, the OR checklist also listed several kinds of drills, multiple clamps, and two power saws.  Until that day, I had not realized that orthopedic surgery was equal parts medicine and Home Depot.  I *hate* Home Depot.

Next up was Neurology, the first course where I was truly able to transfer classroom knowledge into patient care – so much that my clinical instructor took a liking to me.  Our professional romance soured, however, the day she led me first to the sinks and then excitedly towards an operating suite, promising a once in a lifetime learning experience with a world-renowned neurosurgeon. Upon entering the OR, I looked over just in time to see Dr. WorldFamous peeling scalp neatly away from the patient’s brain. I turned back around and bolted, barely making it outside of the OR bay doors before vomiting into a clean laundry bin.  Barfing on freshly-laundered surgical scrubs after fleeing a famous surgeon’s operating room was, advised my irate instructor, “puke icing on a shit cake.”

By the time I graduated from nursing school, I had discovered that unlike pretty much everything I thought I’d like, nonprofit-based nursing really was right up my alley. This led to a decade of work with the underserved (often confused with un-deserved), particularly in the areas of women’s and community health.  At-risk populations have been my favorite challenge, appealing to me for the same reason many would rather not get involved: the likelihood of a poor – both literal and figurative – outcome.

Which leads me back to hospice.  Over the years, I’ve witnessed the evolution of my own definition of a “bad” outcome.  Dr. Paul Kalanithi said: “My highest ideal was not saving lives – everyone dies eventually – but guiding a patient or family to an understanding of death or illness.”  Sometimes a good outcome doesn’t mean a cure, it might mean finding a way to make one hour of a patient or family’s day less agonizing.  Which includes more than just clinical skills, often creativity and kindness come into play as well.  Bringing a dog to distract an anxious pediatric patient, for example. Staying a few extra minutes to answer questions, or just sitting quietly with a grieving spouse. My goal as a palliative care nurse is to provide physical pain relief whenever possible, and offer a measure of comfort to suffering patients and families.  I may not be able to extend anyone’s life story, but I’m hoping to brighten some final chapters.

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