Counting Down

At the forefront of my mind has been an upcoming anniversary day. Anyone who knows me, probably is aware of my penchant for marking birthdays and anniversaries. This upcoming anniversary date, for me, is February 16th. One year since I worked my last nursing shift. I really didn’t know what to expect for that day. How would I respond when I admitted patients or discharged patients? Some I had cared for several times over the years were especially poignant. Learning the person buried behind the addiction really does make a difference. I do hope my sadness, as I silently said good-bye to my patients, was not visible. My many colleagues throughout have added such texture to my career and professional life. Most recently, those who were my companions and co-workers while working at VIHA have their own special place in my heart. I think of all of these people, places and things off and on as I go about my days in retirement.

The before picture of retirement was one of an alien, vast, and very dark, landscape. I have watched others slip into this phase easily. For others it was not so easy or comfortable when illness or misfortune shattered plans for these so-called ‘golden years’. I am grateful for activities established over previous years. A walking group, book group and of course my writing practice at home became trusty flashlights, helping me crack open this new book. Even so, empty spaces on my calendar, like vast tracts of space, greeted me each day. Every so often, a ‘work dream’ in my early morning hours remind me of this past that I held so tightly.

The after picture of retirement has been much like a dawning spring, gradually opening my heart. Each day different, but slowly filled with the familiar, with new life, and only a bit of turmoil. Cheers to my colleagues who saw me off with such love and respect. Cheers to my families, far and near, who have welcomed me home and into their homes. Cheers to my circles of friends, also far and near, who have patiently listened to my retirement journey. This ‘land’ I thought that would be so dark, has been filled with frivolous fun, gentle guidance and steady light from everyone.

“The afternoon knows what the morning never suspected.”

~ Robert Frost

An Old Story of Nurses

Let me tell you

a story

of the resiliency of nurses:

We care for the sick even

when the sick is a colleague 

with no other to fill their shift.

Young or old we jump into the fray

in all the many years of nurses ~

for the young, a trial by the fire of need.

It’s a story as old as nursing ~

we care for each other while

we care for sick patients all the same.

“Fortitude is the guard and support of the other virtues.”

~ John Locke

Moving Forward ~1

Archaeology is a such big word. 

Finding twenty and thirty year old official papers - a big job. 

Fearsome potholes have been encountered!

Packages of photographs (and a tiny note from a very tiny niece, Daisy)

Letters from patients

Notes from colleagues from my Texas days

Reams and reams of writing about addictions nursing

Didn’t poke through any of it despite itchy fingers

From it all I’ve found two…

only two…..pieces of officialdom with possibility

I am grateful though as the dates are close!

More searching tomorrow

Something with dates more accurate.

“For there is nothing lost, that may be found, if sought.”

~ Edmund Spenser, The Faerie Queene

A Memory Unearthed

It was an old memory

Unearthed in my search

For government documents

A bit faded but not tattered

 ~ a greeting card

from a patient long ago

He was a young scrappy guy

temporarily wheelchair bound

with a smile and laugh for us all

I am grateful to this young fellow

and the gratitude I’ve had from patients

across many miles and many years.

Addiction is a terrible disease

that breaks the spirits of far too many in this world.

Gratitude breaks through that darkness.

“Gratitude is the fairest blossom which springs from the soul.”

~ Henry Ward Beecher

Reunion Reflections

The Registration table was ready. Spring flowers in a stein-shaped mug from our 10th reunion in 1978 centred an ivory coloured cloth on our table. Our beautiful name tags with our individual graduation pictures were sorted in alphabetical order in small groups of five. One or two of our classmates had arrived, but there were other guests coming through to the elevator from their rooms or from the pool area. A young 40-something woman and her husband stopped and asked if we were having a convention. When I told her that we were celebrating our Fiftieth Nursing Class reunion, she congratulated us and said - ‘Thank you for your service! My sister is a nurse.’ Not long after, another young man, coming from another direction and on his own, asked about us and admired our name tags. He also said ‘Thank you for your service’.

I had heard those words before but always related to the military in the United States. It may also be that Canadians say the same words to our military. I had, however, never heard it said to a nursing group. It felt good to be recognized in such a way. I have, over the decades, heard many similar words but often with a ‘you have a hard job’, which is many times true. Or called ‘angels of mercy’, which sometimes seems tinged with a wee bit of pity. I do know, and appreciate, that in many cases both of these are said with a great depth of meaning. Coming from random members of the public, outside of a health care environment was both surprising and very much appreciated. The words ‘for your service’ seem to speak, not of the difficulties of a nursing career alone, and not of the caring or patient advocacy that is a core value of a nurse’s career, but to the nurse, her or his dedication in all of this amazing career and the work that we do.

So to all the nurses out there: Thank you for your service.

“When I think about all the patients and their loved ones I have worked with 

over the years, I know most of them don’t remember me, nor I them. But I do know that I gave a little piece of myself to each of them, and they to me, and 

those threads make up the tapestry that is my career in nursing.”

~ Donna Wilk Cardillo, RN

Failure to Recognize

Not a good way to begin the month of June.
Anger and huge frustration about addictions health care
And I do use those three words with great caution
The health care of patients and clients on the frontlines
The health of health care workers on the frontlines

I have devoted the last several decades to this work
I also became aware of the neurobiology of addiction
Always expecting that the bizarre behaviours of our clients
will be seen as a symptom,
that the approaches taken 
in nursing, in social work and in medicine 
and in health care systems will be developed;
that brain trauma of any kind changes an individual’s behaviour,
and such behaviour can be unpredictable and extremely dangerous  to any of us on the front lines charged with the individual's care.

Am I angry about the uncontrolled behaviour of a client with severe brain trauma?
Organic, substance affected, mental illness, in withdrawal or all of the above?
And did I mention anything else ~ oh say like poor nutrition, poverty, ……
Or angry about the systems that appear to continue utilizing ineffective models of care?
And did I mention under-funding and under-educating systems that are in place?

I think that’s enough venting for now.
I won’t stop working for and caring for these clients, these patients ~ my fellow human beings.

“Compassion is all inclusive. Compassion knows no boundaries. Compassion comes with awareness, and awareness breaks all narrow territories.”

~ Amit Ray, Nonviolence: The Transforming Power

Brave Souls That Have Passed

Many have passed this life in a short few weeks
I learned of another yesterday
Today I do not want to learn about anyone else.
Whether friends, family or patients
The grieving for each gets too intense.
It is easy to say
They are in a better place
The are free from the pain of their life.
The pain of my own life haunts me,
tied to all past pieces of grief
All bundled and tied
Put away in a memory cupboard.
Each time I open that cupboard door
Shuffling and wedging into ever tinier spaces
Finding an empty corner for the next sad bundle
Letting go of the heaviness of grief
Is part of the next step
But a piece of that grief - that memory -
Is mine to keep for a while
The memory of many loved ones
The memory of walking through many healing journies
And memories of the kindness and light in eyes
Even if just a flicker
The sign on the cupboard door reads 
Brave Souls That Have Passed
To know that my grief has not been in vain
That I will keep seeing goodness in the eyes of the living
Will sustain me through my sadness.

“In a dark time, the eye begins to see.”

~ Theodore Roethke

Final Day of Addictions Nurses Conference

A much shorter day of speakers today. I am writing this on the bus returning us from Biltmore Estate where we have spent the afternoon. (The bus has wifi so hopefully I'll get this posted before returning to the hotel).

The final two sessions were presented by the same speaker.

08:40am
The Opioid Problem
Stephen Wyatt, DO, Medical Director Behavioural Health Services, Carolinas HealthCare System

Much of this session was similar to previous sessions about the seriousness and the wide spread nature of the use and abuse of opioids. While much blame has been put on physicians for over prescribing, and while much of this is also an issue, the blame needs to be shared.  The other area of blame or fault is placed at the feet of those individuals who are drug addicted. This speaker, a physician of many years, who has worked long term in various areas of medicine and osteopathy, provided us with two main issues related to The Opioid Problem. One statistic is that 55% of overdoses have resulted from family and friends sharing medication that should have been discarded.  The other issue is the nature of pain and the vicious circle of uncontrolled pain:  pain - avoidance - decreased mobility - altered functional status - diminished self efficacy - social limitations - pain. This is enhanced if opioids are over used because pain has not been accurately and effectively assessed, provided with appropriate treatments or if patient's do not understand the nature of this drug.

10:40am
Integration of Addiction Medicine in Primary Care
Stephen Wyatt, DO, Medical Director Behavioural Health Services, Carolinas HealthCare System

After a short break, Dr. Wyatt spoke about a critical change in the primary and medical care community for addictions care. That being, alcoholism and drug addiction being treated as any other chronic disease is treated. It i in fact a chronic brain disease. This would include accurate assessment, recommended treatment of a multimodal nature by the physician that include followup review and discussion of the patient's progress. Much to my pleasure he used an analogy that many of in addictions nursing have used for years:  If a patient with diabetes doesn't follow the regimen prescribed, he or she is not punished and care withheld. There is followup to determine how to help this patient.

There was one other session and I believe it was between these two. Now understand, my brain is kind of on overload, so the exact time I'm not certain. However we had an opportunity to sit with different board members to discuss different areas of the organization. I sat at the table with Stephen Strobbe, our president elect, to discuss position papers. He outlined what they are and his ideas for the upcoming year.

Then it was off to the Biltmore Estate. An amazing piece of architecture and forward thinking of George W. Vanderbilt in Asheville, North Carolina. Furniture, immense wall tapestries, a winter garden indoors,  a heated swimming pool and gymnasium. A vast library. A billiard room and bachelors quarters. An entire floor for guests. Huge kitchens and walk in refrigeration. Separate and beautifully appointed bedrooms and quarters for Mrs Vanderbilt and for any female guests (Even separate change rooms in the pool area.) This all in the early 1900's.

"There is no real ending. There's just the place where you stop the story."

~ Frank Herber

Steady On!

Triaging patient care amid 
pills, stethoscopes, charts and telephones with expectations of providing needed care.

“….an uncanny yet well honed knack to see beyound the obvious 

and address, in some way, the deeper needs of the human soul.”

~ Donna Cardillo