Not Always What It Seems

As nurses we are taught and learn many, many skills.  From dressing changes and heart sounds, to compassion and bedside manor.  Our assessment skills are endless.  We are trained to know signs, symptoms, and manifestations.  We are continuously on the lookout, watching your behavior, vital signs and health status.

We pay attention to the teensiest, tiniest, smallest of details, literally down to how many breaths you take per minute.  We learn your body and we monitor its every change.  We noticed your skin color when your blood pressure is elevated.  We check your blood sugar when you orientation is a little off.  Nurses know what labs to order when your urine output decreases and how to read your EKG when your heart races.  Most of us can tell if you have a bacterial disruption in your intestinal tract based off the smell of your poo 😜

For 12 hours we we watch, we listen, we look, we inspect, monitor, document, observe, and we adjust your medications, treatment and care based off our assessment.  We provide the best we can based on these details.  Most of the time we know what the doctor will order for you before we even call to ask.  Nurses pay attention. Nurses are THE number one most trusted professional in the United States.

But.

But sometimes we miss things.  Sometimes we are wrong.  Sometimes clinical manifestations present as one thing on the outside but are something completely different on the inside.

Sometimes the drug addict, who looks deathly, checks out with a near perfect bill of health (minus the positive UA)  and sometimes the yoga instructor is diagnosed with cancer having no signs or symptoms or family history.  Even though we spend our every waking moment assessing all the outward signs, sometimes it's just not what it seems.

Which brings me to my point: Not everything you see, not everything you hear about a person is true.  Your assessments are open to error.

Just because someone's social media portrays "happy" doesn't mean they don't suffer from depression.  Just because someone has a dog, a house, 4 children, and a spouse of 25 years doesn't always mean they fulfilled their dreams.

Just because a heartbeat is labeled "irregular" doesn't mean it's atrial flutter. And just because someone appears happy in their smile and in their laugh doesn't mean they're not somehow struggling in ways you cannot see.  

Sometimes our assessments about people are wrong. Sometimes our judgements are inaccurate.  Sometimes we jump to conclusions because we have seen the same manifestations so many times that it's easy to make cookie cutter labels.  Sometimes we get comfortable and rule out the truth because it's not "textbook."

This is dangerous...in nursing most definitely, and absolutely in life.  Our assessments, no matter how practiced, are not fool proof.  We all make mistakes....and we are ALL guilty of assessing each others lives and drawing up our own conclusions.

As nurses we are fair to our patients and we never count out possibilities. We should do the same with our family, friends and loved ones.  We should remember that people change.  We should be reminded that things aren't always as they seem.  And we should approach each other in the same way we do before our initial daily assessment....with an open mind and a new, fresh start.

The Rest Will Folllow

It's been quite some time since I've shared a blog post.  It's not that I haven't had meaningful  connections or stories to share, I've just been processing life and trying to make sense of it all.

I've sifted through some of my experiences the last few months and decided to share a story about a patient who had the most simple advice.

She was an elderly lady, in her late 80s and she was faced with a decision: Hospice.

She still had several living family members, most of who would visit her at bedside.  She was still in her right mind, able to make medical decisions herself.  She was loved in her community, with a history of giving back as much as possible.  The sweetest, most vibrant and cheerful patient I've had in a very long time.  She cracked jokes, kept a positive outlook and always, always smiled at me when I walked in the room.

Now some people think I'm crazy, but nursing is a give and receive profession.  As nurses, we give ourselves...we give our care, compassion, sympathy, our time.  But like I've always said, I receive just as much from my patients as I give to them.

Whenever I'm caring for someone at the end of life, I always muster up the courage to ask the tough questions.  What do you regret? What can you teach me? What is your best and single most important piece of life advice? Surprisingly, my patients are always happy to answer these questions and I feel it creates a bond.  A human bond. Something that reminds us both that outside of our age, outside of our life experiences, we are all the same.

So as the story goes, I asked her, " If you could give me one piece of advice for me to carry with me forever, what would it be?"

She smiled.  She thought.  She said,

"Sweetie.  Don't just DO things.  Do things because you want to, because they make you happy. All the rest will follow. Oh, and keep that smile."

I smiled back at her.  Simple enough.  After a few more words, I left the room, headed into the next.

Now, there's something to be said about advice.  People can give it all day long, but if you don't see them following their own beliefs,  the advice itself becomes less meaningful.  It doesn't carry as much weight.

Fast forward, she was my patient the next day.  I walked into the room, and she was her bright eyed self.  However, her family had a different demeanor.  The room seemed sad.  Quiet.  Stiff.  And then a family member spoke out..."But if you continue with treatment, you could get better and get out of here."

My patient spoke instantly and without hesitation.  "That's what you want.  That's not what I want."  And then she winked at me. The conversation ended right there.  There was no argument, no fighting, no explanation.

It seemed so easy for her...to make decisions, literally life decisions, without being influenced by the pressures of society or what other people thought was best for her life. I've never felt so happy about someone deciding on hospice. However, she had demonstrated the advice she had given me the day before and I just knew she meant what she said and I just knew she was happy with the decision she had made...and that's all that mattered to me at that point.

"Don't just do things, do things because you want to and because they make you happy."

She left the hospital the next day to go on hospice but she never made it home before she passed.  I went to her memorial a few days later and the room was so full of life.  I couldn't help but think that maybe it's because she lived so open and truthful and because she truly tried to make decisions for 80 years that made her happy.

They say happy is contagious.  That was made quite obvious at her memorial...and while I was sad the world lost such a kind and honest spirit, I was happy to have known her for even just a moment.