Poetic Juxtaposition in a Small Town

Working in a small town provides a glimpse at some truly beautiful, near-poetic things. There are the smiles and friendly waves of townspeople as you walk around downtown in your uniform. There’s the warm food, donated by generous local restaurants that volunteered to open in the middle of cold, brutal nights; provided to the victims and responders of a local tragedy. There are the “Thank you” cards that are proudly and thoughtfully tacked to the station cork boards. There’s that pristine hour after clearing an end-of-shift call, where new morning sun filters through the mist, and reflects softly off still ponds. There’s the privilege of being allowed inside of those small, sleepy townhouses and cabins; the same ones that seep curly plumes of sweet woodsmoke into crisp morning air. There’s the sanctity of caring for the people we see every day; those we grew up with and know well, and those who are familiar strangers.

That familiarity–that close-knit bond unique to those who work and live in a small town–can provide for the most inspiring, speechless joy; and unfortunately brilliant sorrow. Sometimes, you are called into those small, sleepy townhouses and cabins, and you witness and participate in the recovery of not just an illness, but a life that weaves frequently into yours within this little town. Other times, you are called around the stoves’ hearths that seep those curly plumes of sweet woodsmoke, and you are asked, demanded, begged to fix something that cannot be fixed; cure something that cannot be cured. Then, that particular thread of life is missing from the usual, comfortable tapestry of every day.

It’s hard to tell a family, “I’m sorry, but she’s passed away.” It’s hard to stop pushing on the chest of someone you’d known, either close or from afar. It’s hard when a family member cries into your uniform as you try to console them with a hug. It’s hard when they watch you pick up the trash, pack up the equipment; and leave them with their sorrow, the whirlwind of funeral directors and arrangements, and the shell of their loved one. What’s harder is when you can’t put the call to the back of your mind, filed away somewhere along with the other codes and unfortunate calls you’d been a part of–when you are forced to face the aftermath of what you couldn’t help. When you are required to attend this person’s funeral.

I was uncomfortable as we waited for the services to start. I kept my head down, chin tucked against the lump in my throat. Part of me hoped I wouldn’t be recognized by the survived who were there on that day my partner and I were called to try. I prayed I wouldn’t be asked once again by a distraught family member, “Why didn’t you save her?” Because it was too late. Because the odds were astronomical. Because it was her time. Because I couldn’t. I would never say those out loud. They wouldn’t alleviate the pain. What’s more, it doesn’t answer question they really want answered: Why did she have to go now?

I focused so intently on trying to find comfort in this awkward, sad situation; trying to be both present and invisible. I was focused so intently, I almost didn’t recognize the man who had taken the seat beside me. He turned and chatted with a friend and coworker of mine. Then, my shoulder was tapped.

“Do you remember that code a while back?” My friend started. I squinted my eyes and thought as he described the house, the room, the circumstances. It all flooded back to me, back from the corner of my mind where the code that resulted in this funeral should be. I nodded. “This is him. This was your patient.”

I looked into those bright, sea-glass green eyes. The last time I looked into them, I was breathing for him. He was cool, gray, limp. Now, his handshake was strong and warm. There was such a life about him. Every blink, every smile, every word out of his mouth seemed so completely miraculous and wonderful. I wanted to talk to him all day, if for no other reason that to truly be in awe of life and every little thing we take for granted.

We sat next to each other during the ceremony. I sat beside a man whose life I helped save, whose thread I helped preserve; while mourning the loss of a life I couldn’t save, the newest uneasy void in our local community’s tapestry. The juxtaposition was beautifully, inspiringly, sadly, uniquely poetic; leaving me with a deeper, greater appreciation for my life and work in this small town.

Pinning

It all began with a plain piece of 8.5 x 11 paper. A little more than two years ago, a lump sat decidedly in my throat as I nervously opened an envelope from a school. My eyes searched that simple sheet of paper, finding the only words that mattered: “Congratulations! We are pleased to inform you that you have been accepted into our nursing program.” That summer seemed to crawl by as I anxiously awaited the beginning of my nursing career.

On a late spring evening in 2014, I sported a traditional white scrub dress and goofy-looking cap, as my mother pinned the hard-earned nursing school pin to my chest. I stood before my family, my closest friends, and my classmates as I lit my candle and recited the Nightingale Pledge. I promised to be the best nurse I could be, and to serve my patients above all.

The two years in between were the most difficult I’ve ever endured, and were fraught with more challenges than I’d ever imagined. There were unfair, condescending professors. There was the one instructor who looked me dead in the eye and said, “EMS is for people who aren’t smart enough to get through nursing school.” There were cut-throat classmates. There were absurd policies, forcing students to choose between missing a family member’s funeral or paying $850 to make up their schoolwork privately. There was the ever-looming threat of failure, made all too real by the steady loss of 62% of my classmates. Some friendships drifted apart–some probably irreparably so. There were brutal shifts on the ambulance. There were calls and incidents that shook me to my core and made me question things I was so ignorantly secure in. There was the loss of my only living grandparent–a loss that was unexpected, and occurred with a simultaneously shocking speed and a heartbreaking slowness. There was my father’s diagnosis of cancer. There were plenty of all-nighters, tears, and swearing I could not take another day in this program.

If that dark picture entirely described my two years of nursing school, there’s no way I would have made it. The nursing cap and pins on my bookshelf would never be there. There were people who gave me strength to give it just one more day, to try just one more time. There were professors who pulled me aside and told me I was going to be a great nurse. There were classmates who would vent with me, give me incredible words of wisdom, and drive to Chipotle for dinner while blasting music at an unreasonable level. There were instructors who tried to fight unfair policies that put students in unreasonable positions.  There were new friendships that were forged under the hot stress of school, and older friendships that were strengthened. There were shifts at work that were filled with camaraderie and fun, and were absolutely vital to keeping my sanity. The calls and incidents that had caused me so much pain are sewn into the fiber of my being, making me stronger and wiser than before. And there were calls that reminded me why I love taking care of people so much. The loss of my grandmother brought my family even closer. My father’s illness is allowing me to reorganize my priorities, to think less selfishly. I’m learning to look for the things I can change and help with. And, I’m learning to accept that some things are out of my control. Above all, the love, support, and compassion I’ve received has absolutely astounded me. All I can do is say “Thank you,” although words could never adequately express what these selfless kindnesses have done for me, and what they continue to do.

My nursing pin is a celebration of all that has happened, all I have pushed through, and everyone who was there along the way. It is for the bad as much as it is for the good.

And now, for better and worse, on to the next…

Let Them Say Goodbye

“Huh, interesting,” I thought. I was being sent up to the ER to assist with a transfer to another, larger hospital. “Interesting, but not particularly rare or unusual.”

I’d seen this diagnosis numerous times. Hell, I’d seen this presentation for this diagnosis a couple times too. When asked if my assistance would be needed, the doctor sucked on the inside of his cheek thoughtfully, and finally said, “The patient will probably be alright. But, eh, it wouldn’t hurt to stack the deck.” And that’s how I became a second set of hands in the back of the truck. If you were superstitious, you might say I was sent with the intention of being more of a good luck charm than a second practitioner. If you weren’t, you might just say I was a poorly allocated resource.

Four-leaf clover or unnecessary weight in the back of the truck, I was happy to be going along on a transfer with a pretty sick patient. Even better, a pretty sick patient with an anticipated positive outcome. Sounded like I was going to go home that night content with the somewhat false knowledge that I helped a little bit today.

Our patient was a sweetheart. Polite, witty, intelligent, friendly, but definitely a bit nervous and frazzled. She had a dog that needed walking, a yoga class to get to, an upcoming vacation to pack for. This trip to the hospital was not planned in her tidy schedule. Her husband stood at the door, fidgeting with his jacket, occasionally taking a few paces forward and a few paces back.

We got her settled on our stretcher, and hooked her up to all of our equipment. Explanations were sprinkled with light jokes, which seemed to calm her somewhat. In short order, we were ready to load her into the ambulance and get on our merry way. I started for the door when I felt my partner pull back ever so lightly on the stretcher.

“Would you like to give her a kiss goodbye?” The paramedic offered gently and brightly. The husband sheepishly grinned, and shuffled over to his wife. He kissed her on the lips, then gently on the forehead. He smoothed back the stray, wavy locks that had sprung free from her braid.

“I’ll be over soon. I’m just going to go home, pack a few things, and call the boys. But I’ll be right there,” He promised.

“Take your time. Don’t worry. I won’t be going anywhere,” She dismissed with a smile and a squeeze of his hand.

It was a cute and tender exchange–one that softens my heart for a little whenever I see it. We whisked her away into the back of the ambulance and took off without much of another thought about it. After a few quiet minutes, her concern became evident.

“I never thought this could happen to me. I do everything right,” She said quietly, tears brimming in her eyes. The paramedic set down his paperwork, and fished around for the small box of cheap tissues. Our patient squeezed my hand lightly. I squeezed back.

I picked a line from my mental toolbox. I’d used it plenty of times before, and I meant it every single time.

“Hey. Look at me,” I started gently. When she lifted her eyes to meet mine, I offered a timid, crooked smile. I tried to let my eyes reflect the compassion and concern I had for this wonderful woman. “Do I look scared?” I ticked my head in the direction of the paramedic. “Does he look scared?”

“No.”

“Then it’s okay. We’re doing everything we can for you, and there is nothing about what’s going on right now that scares us, or is making us panic. You’re in great hands. We’re here to help.”

 

I will never use that line again.

 

She thought it over for a second, as a playful smile eased her worried brow. “So, when you guys start looking scared–then I should be scared?” She teased.

“Yes,” I laughed, “Then you can be scared.”

Her nervousness diminished some as she told us about her life. About how her childhood best friend grew up to be a nurse. About how she met her husband at the local lake one summer. About how she turned down his friend’s request for a date because she really wanted to date her future husband instead. About how she went on to be a teacher. About how she loves to make apple turnovers while singing, which she thought bothered her husband (although he never said anything). About how she loves going to yoga in the morning, and taking walks in the evenings. About her small house by the lake. About how the smell of daisies, pine, and pond water always seems to set things in perspective.

I could’ve listened to her forever. That might be my favorite thing about EMS–being granted the privilege to look through these snapshots of life with another person. But, soon enough, we arrived at our destination. We wove our stretcher through throngs of nurses, doctors, and families, we found our room assignment.

I turned to prepare our patient for the sheet transfer to the hospital bed. In a sickening, heart-dropping instant, everything had changed. That rare, potential complication that is listed when consent forms are signed…it was actually happening. It was no longer just words on paper. It was no longer something the doctors say to cover their ass. It was right there, and it was real. And there was nothing we could do about it.

The changes were subtle, but rapid. The next few minutes were a blur of gloved hands, quick assessments, urgent murmurs, and STAT tests. A frustrated doctor cursed in the hallway. Nurses were preparing to take our patient to other departments, other rooms; somehow heading simultaneously towards and away from hope. We all knew what the results were going to say, but we needed to see the physical, undeniable damage to permanently extinguish the ever-diminishing hope that maybe this won’t be so bad.

As we passed the stretcher to the staff, our patient grabbed my hand, nearly pulling me over from the momentum of the rolling gurney. Her glassy eyes searched my face. My eyes probably betrayed my fearful, worried interior that I tried to mask with a stoic, serious face.

Barely lucid, she mumbled, “I’m scared now.”

I squeezed her hand and swallowed hard. They took her away to care for her as best they could. Approximately ten minutes later, she was unconscious. She would never wake up again.

My crew and I cleaned the stretcher and ambulance, occasionally muttering something to reflect our disbelief. We stood in the ambulance bay, taking in the skyline of this foreign, distant place. On some street between here and home, is a husband driving over to check on his lovely wife of so many years. A bag is packed and sitting in the backseat. Maybe an apple turnover is sealed up in some Tupperware in there. Maybe a shirt from off the clothesline, saturated with the comforting scent of daisies, pine, and pond water. And as he sings softly along with the radio, he has no idea that he just kissed his wife goodbye for the last time.

We sighed. “I can’t believe…” We’d start. “It happened so fast…” We’d try. But in the end, we were left with nothing but the road noise and a quiet, sad shock.

“We can’t prevent everything. We can’t treat everything. Some things you just don’t see coming,” The paramedic said numbly. “But you can always let them say goodbye. You can always give them that minute. You just never know. It might be the last time.”

Words of Wisdom in the Back of a Truck

I’ve been told by many a good teacher that every interaction with a patient presents a learning opportunity. I really believe that’s true. Each individual allows you to refine your assessments, or practice interacting with people. But, I’m also learning that each patient has a chance to teach you something; give you something to think about.

I once had a very sick patient, going through some very challenging things physically, mentally, and socially. With everything going on and going wrong, one could only expect that he would throw his hands up and say, “Can I just have one thing go right? Can I just have one good day?” I’ve said that myself plenty of times over lesser events. I searched for words. I tried to verbalize my sympathy. I quietly noted aloud that all the gray, rainy days must be exhausting for him.

“But, you know,” He said calmly, looking away as if he were actually physically searching for words, “Even too much sunshine can get you burnt.”

The dull roar of road noise was the only thing that filled the silence as we absorbed his words. He sighed and nestled a little deeper into his pillow.

“Balance, dear. Life is about balance.”

Angels

It wasn’t until we were in the truck and moving that I really noticed it. Those eyes. They looked so, so much like my grandma’s. The same cool, celery green that turned that softly blued in low light. I was torn between wanting to stare at those eyes for the duration of this trip, and wanting to look anywhere else.

Those eyes remained closed, mostly. When they did open, they pulled at my heart, reminding me both of the happier memories and the harder good byes. Her gaze drifted around the truck, never really focusing on anything. I couldn’t help but wonder if my grandma did the same thing when she rested on that very same cot, taking this very same journey. I absentmindedly wriggled my hand into hers and lightly squeezed. She very gently squeezed back. We continued on in silence, lost in our own thoughts.

Her lips moved, forming words I couldn’t quite read or hear. Her gaze still hung around me, not at me. I leaned closer, struggling to hear over the road noise. I asked her to repeat herself. She spoke just a little louder, but not quite loud enough. I asked one more time. She squeezed my hand. Quietly, shakily, but certainly, she answered.

“I see angels.”

My heart thudded in my chest. I asked, “What?” more out of disbelief than not hearing her correctly. She repeated herself.

“I see angels.”

It was reassuring, and shaking. Comforting, and shocking. Instilling hope and unease. I’ve seen people die. I’ve heard a loving last testament, spoken with the hope it would be passed on to those who were held dear. But this, for some reason, came as more of a shock. I don’t know what I do or don’t believe in. Maybe that’s why I can’t figure out how this feels.

To this day, I don’t know what to make of it, or my feelings around it.