Lions and Tigers and cardboard boxes, oh my!

http://youtu.be/J11uu8L8FTY

Enjoy!

AGV

Pre-conference and concurrent session presentations – see agenda at www.anpd.org

July 16-20, 2013

Sheraton Dallas Hotel, Dallas, Texas

(Private event – email under the contact tab to request this event at your organization)

May 14, 2013

Wake Medical Center, Raleigh, NC

April 29, 2013

Sheraton Imperial Hotel, Durham, NC

When my turn came, I took her at her word.  “When I grow up,” I said with the confidence that only a six-year old can muster when discussing such a subject, “I want to be a mermaid.”

“You can’t be a mermaid,” she said.  “Mermaids aren’t real.  Pick something else.”

I thought hard for moment.  “Okay.  I want to be Daphne from Scooby Doo.”

She shook her head and let out a loud sigh.  “Amy, you can’t be Daphne.  That’s not real either.  She’s just a silly cartoon.”

I stuck out my lower lip, resisting the urge to cry.  My first two career choices had just been shot down. I took it very personally, but tried my best to come up with a third option that was neither silly nor unreal.  It had to be something glamorous.  Something impressive.  Like the little boy next to me who wanted to be an astronaut, and the girl sitting in front of me who wanted to be the first female President of the U.S.

“Okay,” I finally said, “I want to be a dancer on Solid Gold.”

She asked me to sit down.

I didn’t know what I wanted to be when I grew up.  Most days, I still don’t.

I envy nurses a bit, in that when someone asks them what they do, they can say three words – I’m a nurse – and that’s it.  Everyone gets that.  No additional explanation needed.  When people ask me what I do now, I smile and say, “it’s complicated.”

There’s a long story that goes with it, and it begins in junior high school with my favorite teacher, Ethel Smith. She was in her sixties, always threatening to retire, but never making good on it.  She smelled like coffee and cigarettes and rode a Harley Davidson to school.  She would keep us all laughing when she blurted out curse words every now and then in class, after which she would make the sign of the cross and ask the Lord to forgive her.  Sometimes in English, but more often not. She was fluent in Spanish and taught it well.

While everyone else in junior high hated foreign language class, I fell in love with the Spanish language because our wild, entertaining teacher made it so much darned fun to spend an hour with her every day.  At the end of the year, I told her so.  I shared with her how much she had meant to me throughout that year, and thanked her for making it not just painless, but a joy to learn a second language.  As her eyes teared up, she hugged me goodbye and told me to keep learning Spanish so I could come back one day and teach it.  It was only then that she could retire, she said.

And I felt something happen inside me.  I was suddenly aware that just like an automobile, I had a built-in turn signal.  Something about her words tapped it.

Go this way, they seemed to be telling me.

I decided then that I wanted to become a Spanish teacher.  I continued taking classes throughout junior high, then high school, during which I had a brief study-abroad experience in Spain that got me even more excited about continuing to learn Spanish.  I entered college as a Spanish major.

As my sophomore year was ending, a flyer made its way into my mailbox, announcing internships in a medical setting for bilingual students.  Although I didn’t have any interest in healthcare at the time, it sounded like it would be a valuable way to pass the summer.  I applied for an internship and was assigned to work with the health education and community outreach department at a small migrant health center in rural North Carolina.

When I started, they assigned me to shadow Catherine, a native Spanish-speaker of Tex-Mex heritage in the maternity care department.  Catherine’s title was “Madre Ayudante” (helper mother),  and her role was mainly to transport women to and from prenatal appointments, stand in as labor coach when needed, and interpret for her Spanish-speaking patients in all of their exchanges with the healthcare world.  In spite of our different backgrounds, Catherine and I were close in age and had similar personalities.  We bonded and became fast friends.  And toward the end of that summer, another young woman who came into the picture would change the course of both of our lives.

I was driving home in a thunderstorm one night to the student intern house, when I came upon an accident that had just happened. A van was overturned in the road, with a person penned underneath it.  I stopped to see if I needed to call 911. Not everyone had a cell phone back then, but my parents had armed me with an old bag phone for the long drives to and from home while in college.  Lugging the dinosaur-model cell phone to the scene of the accident, I had my finger on the keypad and was ready to make the call if needed.

A crowd gathered at the scene informed me that an ambulance was already on the way and they didn’t need a phone.  What they did need, however, was someone who could speak Spanish.  The person penned under the van was a Mexican girl who didn’t speak a word of English and couldn’t understand their attempts to communicate that help was on the way.

I knelt down next to the overturned van and reached for the girl’s hand.  In Spanish, I told her my name.  I asked for hers – Juana.  I promised her that help was on the way.

A fire truck arrived with extrication equipment and lifted the van off of her.  When I saw the extent of her injuries, I was almost certain that the girl wouldn’t live through the night.  The paramedics arrived a short while later and asked me to ride along to interpret as they barreled down the highway to meet a helicopter on a high school football field.

During the ride, I sat at Juana’s head, my hand on her shoulder.  I fed her questions in Spanish from the medics, and returned her replies in English.  She was fifteen, an undocumented immigrant from Mexico, and had only been in the U.S. for a short while.  The friend who had been driving the van when it wrecked had left the scene, and she had no other family or friends nearby to call.  She was alone and terrified.

She begged me not to leave her.  She didn’t want to die alone, without a friend, she said.  I told her to have faith that she was going to be okay, and said goodbye as they loaded her onto the helicopter for transport to a major trauma center.  I promised I would find her again.

The following day, I called the hospital where she’d been transported.  The pre-HIPAA days allowed me the opportunity to ask some questions and find my way to her within just a couple of phone transfers.  The nurse I spoke to informed me that Juana was in the ICU, and had just awakened from having been in surgery all night long.  Then the nurse asked who I was.  When I explained my relationship to the girl, a pause followed.  I could almost hear the nurse smiling.

“It’s you,” she said.  “You’re the angel.”

I asked what she meant.

“When Juana woke up from surgery, we had a Spanish-speaking priest waiting at her bedside to speak to her.  She grabbed his arm and demanded to know where her angel was.”

“Did she describe the angel?” I asked.

“Yes.  She said that the angel was a white lady.  With red hair and blue eyes, and she spoke Spanish with a really bad southern accent.”

I teared up.  “Yeah, that’s me.”

She transferred the call to Juana’s room.  Groggily, Juana told me that she was in a lot of pain, and very sleepy, but that she remembered me and wanted to see me.  I promised to come visit her soon.

When I returned to campus to start my junior year, as fate would have it, the hospital where Juana was recovering was a 15-minute drive from my school.  I visited her on a regular basis and we would sit for hours, drawing pictures, watching TV, and listening to Spanish language music I would bring her on tape.  I would accompany her to her therapy appointments and sit beside her while her nurses were changing dressings.  As soon as her caregivers heard Juana and I conversing in Spanish, they’d go running to grab a pen and notepad.

“While you’re here, can you tell us how to say a few things?” they’d ask, and we’d huddle together for Spanish class on the fly.  They’d immediately practice their newly acquired Spanish on Juana, and smile proudly when she’d respond with a nod or a smile, and sometimes a laugh with gentle correction of their pronunciation.  “She understands me!” One of the nurses said to me one day, as she assaulted me with an enthusiastic hug.  “This is amazing!  I’m speaking Spanish!”

And I felt it again – a tiny little tap on that turn signal inside me.

One day when I arrived for a visit, the mood was heavy in Juana’s room.  A social worker was there to greet me and asked if we could speak privately outside of Juana’s door.  She wanted to know my relationship with Juana, as I was the only visitor who was checking in with her on a regular basis.  No parents or guardians had come forward to claim her, and it was nearing time for her to be discharged.  The social worker wasn’t sure what they were going to do with her.  Without U.S. citizenship, a placement into foster care would be difficult.  Juana had quickly picked up English and could understand our conversation.  She was crying when I went in to see her.  I wept too, as I explained the reasons why she couldn’t come live with me when she asked.  I was a college student, with no home or income of my own, and just a few years older than her. I was a friend, I tried to explain, and she needed a parent.  Preferably a mother.

And then I remembered Catherine – the helper mother. I called her, shared Juana’s story with her, then asked her to visit Juana with me.  As I expected, the two quickly bonded.  Before I even thought to suggest it, Catherine was on the phone with a lawyer investigating options for pursuing guardianship of Juana.

A short while later, I returned for what would be my last visit with Juana in the hospital.  She was getting discharged and going home to Catherine, who was in the process of adopting her.  I brought a cake, as it was her 16^th birthday. It seemed fitting with the new beginnings that were unfolding for her.  We had a party in the hospital cafeteria, and her nurses and therapists joined in the celebration.

Juana stood up on crutches and walked across the room for a group photo with all of her caregivers.  As Catherine and I took pictures, she leaned in toward me. “You know all of this would have gone down a lot differently for this girl, had it not been for you,” she whispered.

And there it was again – the turn signal, blinking like crazy, telling me that this was the way I was supposed to go. Right there in the hospital cafeteria, surrounded by people who take care of people, I knew that this was where I belonged.  My heart had found a home in healthcare, so I changed my major and stayed in college an extra semester so I could squeeze all of my courses in and graduate with a degree in health education.

In addition, I got my Emergency Medical Technician certification – Basic at first, then Intermediate, and volunteered with a rescue squad in my spare time.  And during that entire time, I taught Spanish to medics and nurses and therapists.  And I shared stories.  Then I began to write stories down, and nurses began to read them.  Then I authored the Nursing Novellas series.

And over time, I went on to finish graduate school, and my employers and job titles have changed a bit, and even if you asked me now, “what do you do?” I’m not sure I could tell you with a phrase as simple as “I’m a nurse” (which I’m not).

What we do defines us profoundly, which makes it so difficult for me to try to convey with accuracy who I am.  But if you asked me, and insisted on an answer, I would tell you that sometimes I’m an educator.  And sometimes a rescuer.  And sometimes a Spanish teacher. And sometimes a writer and a storyteller.

And sometimes, in the eyes of those whose lives I get to touch, an angel.

More than two decades ago, a 15-year old girl woke up from surgery, grabbed the closest person she could find, and told them her story.  It changed my life.

And now I tell you my story because in doing so – in opening up and sharing what I do, and who I am, with the rest of the world – it will continue to change my life.  It keeps moving me down the path I’m on until the turn signal tells me to change directions again, at which point I go, ready for the next adventure.

I still don’t know what I want to be when I grow up.  And should Solid Gold ever make it back on TV, I might just abandon my current calling and go stand in line to audition for a spot on the dance floor!

Not really.

But that’s my story.

It’s a bit complicated, but well worth sharing.

And so is yours.

My friend Devon is a counselor and has three horses that she uses to do equine-assisted therapy.  The first time I visited her farm, she took me out into the pasture to meet the horses.  They’re beautiful, friendly, intelligent creatures, and each one brings something special and unique to the therapy that she provides. 

But there is one who is just special.  Cain is a big, black horse with an interesting life story.  In a nutshell, he’s overcome a difficult past and is a survivor – like many of her clients.  Now he’s an amazing therapy horse.  “He’s like a big puppy,” says Devon, when describing him to those who haven’t met him.  “He’s the horse who will change your soul.”

When my eyes fixed on Cain, I was in awe.  In love! Every bit of stress and frustration that I’d accumulated throughout the day and carried into the pasture with me was suddenly gone. I wanted nothing more than to meet this majestic horse and become his friend.  Apparently, it was mutual.  Cain walked right up to me, sniffed my face, and rested his head onto my shoulder. 

“Ah,” said Devon, “he likes you.  He’s giving you a hug.”

I put my arms around his neck, and he turned his head, nudging me closer to him. His nose grazed my face.

“And a kiss, too!”  She said.

If you’ve been around horses, or even if you’ve just seen any horse movies lately, you know – they’re highly sensitive creatures.  They’re SUPERsensitive to electricity.  You should see the distance they keep from the electric fence.  They don’t even need to be zapped to learn; they can sense it just as they approach it.  Human beings are “bioelectric” and we’re constantly discharging energy.  We put off vibes – literally – and horses can feel them and read them.  They are amazingly intuitive about what kind of “baggage” we’re carrying when we enter their space.  Approach them with confidence, grace, and humility, and they’ll allow you into their space.  And if they sense negativity or malcontent, they’ll retreat and won’t allow you near them. 

Meeting Cain and the other horses made me think about how we interact with people in the healthcare world.  While our fellow homo sapiens may not be quite as intuitive as horses are, I think we can still sense and feel what kind of vibes we put off when we approach one another.  Maybe a patient can sense our vibes, for instance, when we come to give them meds.  Maybe there is a big difference between these two scenarios:

“Here are your meds.”  Please hurry up and take them so I can chart this and go home.  I’m tired and ready to get the heck out of here.

Or…

“Here are your meds.”  Let me help you take these so they can get to work in your body.  Let me help you heal and feel better.

The same could be said of our interactions with our colleagues:

“Is there anything I can do to help you today?”  I’m asking to be polite, but I hope you say no.  I’ve got plenty of my own work to do.

 Or…

“Is there anything I can do to help you today?”  It would be a privilege for me to help you.  We are all part of a team, working to care for those who need us.  I want to give all that I can to make us a stronger, better team, so that our patients ultimately benefit.

There’s a lot that we can learn from horses.  When we see how clearly they can sense or feel human energy, it makes us recognize how important it is for us to approach them in the right spirit.  We have to put aside our “baggage” and come to them peacefully, honestly, and compassionately. We must offer them the very best of ourselves.

And we should do the very same for our patients and co-workers.  A hug and a kiss from a big black horse named Cain made me realize the power of our motivations and intent; how our interactions with others mean little if they do not come from a sincere and compassionate place inside of us.  We are every bit as accountable for our “vibes” as we are our words and actions. 

That said – we should all bring a little more horse sense to work with us each day. 

“Who’s there?”

“Control Freak.  Now you say, ‘control freak who?’”

It’s always been my favorite knock-knock joke, but I didn’t realize just how much of a control freak I truly was until today.  I downloaded the latest version of iTunes, which opened on my computer after the install, randomly playing songs on shuffle.

Shuffle!!! 

How I hate the shuffle feature.  I’m a creature of habit.  I like my routines.  I order the same entrée at my favorite restaurant that I frequent, read the same magazines each month, watch the same TV shows every evening, and when it comes to music, I have dozens of my own carefully prepared playlists.  I know what kind of music I like, and the order I want to hear the songs, and when I’m in the mood to hear them.  I also know what songs are not my favorites, and I’ve left them out of my playlists.  Why in the world would I need to have them resurrected and thrown haphazardly in with the songs I want to hear?

A song I didn’t recognize was playing on my computer and I didn’t like it, not one bit.  It frustrated me that I wasn’t able to drop what I was doing and run to the computer to turn off the shuffle feature.  I had to wait it out.

But the next song surprised me.  It was a song I didn’t have on any of my current playlists, and hadn’t heard in years.  It brought back memories from a wonderful, carefree time in my life.  It made me smile.

The next song, while not one of my favorites, was also a throwback to the past.  I hadn’t heard that one since my college days.  In my mind, I found myself back in my dorm room, smiling as the tune poured into my headphones from an old cassette in my Walkman – the caveman predecessor of the iPod.

Ah.  This was fun.

I spent this afternoon enjoying all kinds of songs that I would not have listened to, had I chosen for myself.  Shuffle chose them for me.  I’m so glad it did. The experience inspired my one and only New Years resolution for 2013: to lighten up and not be such a control freak.

To be more adventuresome.  To find more to enjoy out of life than just a narrow list of what I deem my favorites.

To take risks. To be surprised.

And to face uncertainty with the same hopefulness of finding something wonderful on the other side – like an old familiar song.

Last November, I started a new job as an educator in a home care agency. The field of home care was a whole new world for me, and I’ve spent the past twelve months learning all about it at warp speed.  I love my new role, and see the impact of the work that I do daily.

But more than that, I love the people that I work with.

This Thanksgiving day finds me at home, reflecting on the things that I’m thankful for.  At the forefront of my mind is the wonderful group of people that I spend 40+ hours with each week, but won’t be seeing today, because our office is closed.  They’re my other family.

My work family.

Last year, about this time, I wandered into my first staff meeting at my new job, feeling thoroughly dazed and confused as the newcomer.  I remember looking around the room at the sea of new faces, engaged in happy chatter about patients who were improving, the upcoming holiday banquet at work, and their plans for time off to spend with their own families.  I felt like an outsider looking in.  I wasn’t part of the family yet.  I didn’t belong.

But how quickly that changed.

How quickly they took me in, and made me one of their own.

And I just want to thank them.  All of them.  And a few individuals in particular:

Alex – in such a short time, you have become one of my dearest and most trusted friends.  What a wonderful thing to know that you’ve got my back – on or off the clock.  I don’t know what I’d do without you.

Patty, Connie and Karen – you are some of the finest leaders and mentors that I’ve ever had the privilege of working with.  I’m proud to be a part of your team, and thankful for all that I’ve learned – and continue to learn – from each of you.

Lorraine and Donna  – both of you make me laugh every day.  If ever I’m feeling down, five minutes of talking with you lifts my spirits and I’m ready to take on the world again.

Bill – I admire you more than you’ll ever know.  You’re my favorite clinician to ride out into the field with!  The way you care for your patients and their families is the gold standard for what every home care professional should strive toward.  And this is why we use the heck out of you as a preceptor for new staff – because you’re simply the best.  I appreciate you so much!

Annette – your smiling face is usually the first thing I see in the morning when I arrive, and it sets the tone for my whole day.  I am glad to work with you!

Brittany – You’re a joy to work with.  It was a privilege to be with you every step of the way throughout your pregnancy – to be among the first to hear the news that you were expecting; to watch your little fellow move around in your belly after a spicy lunch at Theo’s, and to be among the first to get the news that he had finally arrived.  I’m honored to be one of his “aunties” and thankful that his mommy is part of my work family.

My work family.

I’m so thankful to call you mine, and I love you all.

Grace and peace to you this holiday season, and thank you all so much for taking me under your wings and making me a part of your team over the past year.

-AGV

What I do remember, is that at some point during those four hours while I was “out of it,” I could hear a voice speaking to me.  He called me by name and told me that all was well. 

I’m not the only one who has experienced such a thing.

Marcus Engel, who co-authored the short story “Open” with me, is a speaker who travels around the country, talking to audiences about his hospitalization after being hit – and nearly killed – by a drunk driver.  Blinded, severely injured, breathing with the help of a ventilator, and fighting for his life, there’s much that Marcus doesn’t remember about what happened in the hours and days following the accident.  What he does remember, however, is the voice of a volunteer named Jennifer.  She held his hand during those first critical hours after he was brought into the hospital, and would tell him repeatedly:

I’m here.

Recently, a nurse named Kim* told me the story of a stranger who greeted her in public one day with an enthusiastic embrace.  “Kim,” said the woman, “I know you don’t remember me, but you saved my life.  You were my nurse a while back.  You spoke to me every day.  I would recognize your voice anywhere!”  And Kim then remembered her – a different version of her, one she’d only seen lying in a hospital bed, unconscious and unresponsive. 

It was the first time Kim had been able to look into the eyes of a woman who had coded on her watch, and she’d resuscitated back to life. It was clear that throughout her time in Kim’s care, the patient had heard those words more than once:

I’m here.

What a difference they had made.

The human memory is self-protective.  We are hardwired to forget much of the pain, fear, and confusion that we face in a situation like a dire medical event or a hospitalization.  Being unconscious for a little while certainly helps.  Whether it’s in a coma, or a state of shock after a car accident, or even during a surgery; whether it happens naturally, or is medically induced, we should be thankful for those moments we’re allowed to slip out of consciousness and tune out the world around us.  We’re graciously given permission to forget some of the things that are better left unremembered.

And yet, we possess the amazing ability to weed out – and retain – parts of those experiences which are wondrous and hopeful. 

Like those voices that find their way to us the in darkness.  The ones which promise us that we are cared for; we are in good hands.  We are not alone.

I’m here.

Thank you to the Kims and the Jennifers of the world, who grasp the hands of their patients every day and speak those precious words of reassurance to those who cannot speak back.

And to Dr. K., thank you for those kind words you said to me last week. 

And the way you spoke those words – just as if I’d been awake, alert, and fully capable of understanding and remembering them.

Because I did.  Because I still do.

You’re doing great, Amy.  Just great.

I’m here.

Chime in below and leave a post about a time when you were a voice in the darkness for a patient or a loved one.  We’ll pick our favorite response and send an autographed copy of ‘Through Other Eyes’ your way.  Make sure you enter your email address (won’t be publicly visible) so we can contact you if your post is the one we choose!

**A short suggested reading list:  

Alsad J . & Ahmad M (2005) Communication with critically ill patients.

Journal of Advanced Nursing.  50(4), 356–362

***Engel, Marcus  (2010) “I’m Here:  Compassionate Communication in Patient Care.” 3^rd edition.  Ella Press.

Geraghty M (2005) Nursing the unconscious patient.  Nursing Standard.  20, 1 54 – 64. 

*Name changed to protect privacy 

**Thanks, Michael Wold, for the lit search!

***Check out Marcus Engel’s website when you get the chance – www.marcusengel.com. 

Every nurse I talk to in this day and age is in a continuous quest for information.  Many are on Magnet journeys and are involved in research or quality projects in their organizations.  Some are in nursing school and are working on the Bachelors or Masters degrees, and need help with finding resources for a paper or a project.

And many are simply hungry for knowledge and skills that will advance their practice.   Are you one of those nurses? If so – there’s a place for you to go.  Your local health sciences library!  I asked my librarian friend, Michael Wold, to do a guest blog about health sciences libraries.  So here goes – see what Michael has to say about what your library – and librarian – can do for you!

Guest blog by Michael Wold, MLS, OSF St. Mary Medical Center, Galesburg, IL

You have searched and searched. You have found thousands of hits on Google. You are looking for relevant, evidence-based information on your topic. You found a couple of article citations, but gaining full access to these articles would cost $40 each! You’ve spent hours searching for information, and you’re about to give up.

Don’t give up!

If you’ve ever been in this position, or you find yourself there now, don’t fret.  There’s any easy remedy!  Whether you’re searching for information on patient care, research, treatment guidelines, or evidence-based practices, go to your hospital library, where you will find a professional librarian who can help you with your search. With access to various databases, and the skills to navigate through them, you’ll find that there’s plenty of relevant and useful information available to support you in your practice.

Medical libraries in hospitals are a great resource for you and all the staff. Your library is up to date with the latest online technology and the best databases. You’ll have access to thousands of online journals and books. Anything that isn’t available to you on-site can likely be accessed online or through an interlibrary loan.  You’ll have searching tools to access the literature. You can do the searching yourself, or you can ask the medical librarian for help.

If you can’t make the trip in person, many medical libraries have a page on the hospital shared drive, with bibliographies and links to medical information.  Some are even on Facebook and Twitter!  

Don’t let your medical library remain your hospital’s best kept secret!  Stop by today for help with your information needs, and spread the word to your colleagues!