I choose fried chicken.

I rarely cry on the job. I try not to out of pure professionalism, but can certainly count the number of times I’ve cried on one hand. This past week, I cried the most I’ve cried since being a nurse.

She’s a young cancer patient with a slow-growing tumor. Nonetheless, it stopped responding to treatment. Her nausea persisted and grew worse to the point where she required TPN (total parenteral nutrition, nutrition you receive intravenously). Nothing controlled the nausea, and then came the pain. Luckily she was admitted to the hospital and her medical team found ways to control her pain. But here she was in clinic again, nauseous beyond belief, wondering if there was anything out there that could possibly alleviate that awful sensation of not being able to stomach even a sip of Gatorade. Pair that with anxiety of the unknown, and you have the perfect recipe for malnutrition, restlessness, and stress.

The second she met with her provider, she needed to know the truth: “I need to know if I’m dying or not.”

“Well, honey, what do you think?”

“I think I am.”

“. . Yes. I’m afraid so.”

“I’m afraid to die. Will it hurt?” she asked, her voice faltering.

Words don’t do this moment justice. While she was relaying her fears, a small group of supporters surrounded her and held her hand, gave moments of silence, spoke in soft voices, and allowed time for her to cry and digest what little she could possibly digest in that moment. What will never leave my mind, for as long as I live, and assuming I don’t develop dementia, are two phrases:

Her practitioner asked, “What do you want to do that would be fun for you right now?”

“I want to take a trip.”

And

“I’m glad I ate that fried chicken when I could. It was so good.”

I nearly broke out into tears (up until this point is was just a balance of keeping the film of water against my eyeballs and not blinking so they wouldn’t fall down my cheek) and had to leave the room.

Wow.

Being a young adult is ruff. Let me tell you. When I was young, I wanted nothing more than to grow up. I wanted my own apartment; I wanted to pay my own bills; I wanted to be independent mentally, financially, physically. I remember working a four hour shift at Hollister folding the same shirt over and over thinking “How am I ever going to handle a real job if I can’t even stand folding a shirt for minimum wage?” Fast forward years later. I have a job. I’m paying off my loans. I live in a cute one bedroom apartment with a man I love, in a city I love (mostly, minus the traffic and parking tickets). I buy my own clothes, and spend a hell of a lot more money on good food and fun travel. But it isn’t easy. People think I travel a lot when the reality is, I don’t. I work extra and try to pocket some money aside until my funds are good enough to allow for a carefully planned trip. Balancing my finances has easily been the biggest challenge of my young adult life, and rightfully so. Between paying for school loans, having to take out more for graduate school, and still trying to do the things I love on top of taking care of the essentials, it never feels like I am doing enough. It never feels good enough.

Which is why this moment validated all of my thoughts and beliefs on the idea of a successful life. A happy life.

While it might work for some people to deprive themselves of the “finer” things to pay off their loans and enjoy life later, which, honestly might be the smartest thing to do, this method does not work for me. I repeat, this method does not work for me.

I’ve taken care of people my age and younger, and know by now that tomorrow is never promised. You could die today, or tomorrow, or the next day, and you don’t need cancer to tell you that. I think the difference between a person with cancer and a person without cancer is that a person living with cancer is more conscientious of their time spent because some sense of a deadline constantly hovers in their subconscious. I could be wrong, because I don’t have cancer. I can’t sympathize with that. But this is what I’ve observed.

So if I were to die tomorrow, what would allow me to die the happiest? Would it be paying off my loans and becoming financially stable? Or would it be taking risks, throwing myself into the unknown, and meanwhile enjoying the time I have with the people who mean most to me, even if means I’m a little bit more broke? Or, rather, a lot more broke? It’s a delicate balance, and one I don’t have down yet. But I choose the latter.

I choose the trip and the fried chicken.

I’m reading a great book called Designing Your Life by Bill Burnett and Dave Evans, two professors at Stanford University. In the book, they delineate a successful life versus a happy life. I now realize the two may not be the same. Everyone has a different path. Whenever I beat myself up about not feeling “successful” enough, I pause and remember that if weren’t me, who would be me? Who would carve this path out to show others? I guess what I’m saying is . . it might not be the right way. But it’s the right way for you. So do what makes you . . happy.

Being part of this powerful moment made me understand that there are greater things in life than money, and doing what you think is the best or right thing to do. The best and right thing to do is whatworks for you.

Thank you to the person who helped me put all of this into perspective. I wish for the best for you, and you will never understand how much your honesty, fearlessness, and vulnerability helped someone struggling to find their way in this crazy maze of being in her twenties.

At least.

Lately I feel like life has been beating me up, so I took a few minutes to meditate this morning. I realized I hadn’t meditated for a week or so and really thought I could use it. Work has been annoying solely because of personalities. Driving back and forth every weekend to visit my family is draining, even though I love it. I also hate that there is so much life to live, yet so little time. An opportunity recently came up for me to learn a new art form, a hobby, a little more seriously. But the more I think about it, the more I realize I don’t actually have the time to commit to something so seriously with work and my project implementation coming up. These are minor injuries, but bruises build up over time. I guess I needed to release today.

Fridays are all about the little treasures. I’ve been getting into a routine of waking up to exercise, going to work with a (semi) positive attitude, hanging out with my closest friends at night, and getting a good night’s sleep.

My five minutes of meditation were such a salvation this morning. I walked away feeling lighter by reinforcing the following:

  • At least you can wake up.
  • At least you have the energy and muscle power to roll out of bed over your boyfriend in the morning.
  • At least you can walk to a boxing class.
  • At least you can take that boxing class that you can pay for.
  • At least you have the freedom to sit outside and think whatever you want to think and breathe in fresh air, listening to the water of the garden fountain trickle beside you.
  • At least you can work and earn money.
  • At least you can use that money to vacation with your best friends this summer.
  • At least it’s Friday.
  • At least you can do this all again tomorrow, and the day after, and the week after.
  • At least you can even be mad. Remember that one day, you might kill to be in this shitty mood.

At least you are alive at all.

Time for work.

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Baby Steps

I achieved one of my short-term goals yesterday and passed the OCN (Oncology Certified Nurse) exam. I’d been meaning to take the test since last January when I started my job on bone marrow transplant and had been studying on and off but always got lazy and unmotivated. I’m glad it’s finally over. This means new short-term goals which include the following:

  1. Professional: Complete the final steps of my integrative nursing grant by the end of this month. Apply for scholarships this month in preparation to go back to school in September for my Doctorate.
  2. Mind-body: Continue to go boxing four times a week for the next month. I’ve been doing a solid 4-5 sessions weekly so far so hopefully this doesn’t become a problem.
  3. Family: Help my aunt explore alternative options for her career. Hopefully sway her to get a plan in place to make things happen.
  4. Friendship: Solidify summer plans to Costa Rica in August.
  5. Self-splurge: Start saving again for more travels after Costa Rica, 0:).

Hopefully will bring you good news in a month, :).

 

Nurses Week 2017

When I started my first job as a registered nurse at Brigham and Women’s Hospital, I’d walk into work and wait for the elevators to the fourteenth floor. There was a poster close by featuring the nurse who had won the Excellence in Nursing Award. I’d smile inside each time because what a treat it must have felt like for the woman who got it. I want one of those, I thought to myself. But it was my first year as a registered nurse, and I knew that I was asking for a lot.

Fast forward six months later, I still didn’t receive the award. But I did receive a really nice email from a palliative care doctor thanking me for the care I provided to one of our dying patients. I continued to receive thanks for this care from a few other doctors, and even the daughter of the patient who passed over the next few days. I hadn’t won any award, but it certainly felt like it to be recognized by a handful of people for the efforts you put into making someone’s transition into the dying process as comfortable and painless as possible. It was a daunting task for me as a new nurse – I hadn’t started many PCA’s (patient-controlled analgesia) before that. But I worked through my shift, and it earned me some gratitude that I never expected.

Fast forward a year from then, I got a new job. I transitioned from an intermediate medicine to a bone marrow transplant floor. In the two years and the two new jobs that I had, I could name every single nurse I worked with and one quality they had that I admired (with the exception of a few, but hey, that’s life). I quickly realized that while awards were nice, there simply weren’t enough of them. I could name so many nurses who deserved an award but never got one. And that was totally okay with them. I settled with the idea that if I never got recognized for something, it would be okay. Because there were so many hard-working, deserving, smart, compassionate, selfless nurses out there doing their job not simply because they had to, but because they wanted to. And they were good at it, too. I aspired to be just like them. They were my role models.

Then today, I woke up to an message from one of my old patients congratulating me on my nomination. What nomination?, I thought. I know I said it didn’t matter anymore, but I couldn’t help but to feel super excited at hearing that I might have gotten nominated for something.

Every year, the Boston Globe prints a special for Nurses Week – a tribute to nurses recognized by ordinary people. My patient’s husband nominated me. Again, totally unexpected.

It isn’t an award, but knowing it comes directly from the source makes me feel as if I’m doing something right. We always talk about patient-centered care being the focus of our work, but in a hospital where time constraints and the bottom dollar really rule the playing field, this doesn’t always get to happen. So seeing it manifest was something real sweet. I wasn’t sure how I was fitting into my new role at Dana-Farber, but seeing something like this absolutely justifies all the difficulties I’ve encountered so far from feeling pulled in a million directions at one time, to helping patients confront the reality of death, to checking in on the caregivers who care for their loved ones at home. It can be exhausting, but I try do what I do with a relentless love and determination to give meaningful care to real people who go home to real families and real friends and real jobs with real life dilemmas. This makes me full. This is always worth it.

Thank you, Blair, for this thoughtful nomination! I can’t tell you how honored I feel to be able to meet such beautiful people like you and your family. This is what life is all about.

https://www.boston.com/jobs/jobs-news/2017/05/06/salute-to-nurses-2017-letters-c-g

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Tender

Intimacy is one of the pearls of my job. From the first day of clinical where I was given the opportunity to give a patient a bed bath with one of my peers, to yesterday, two years into my nursing career hearing my patient tell stories of her grandchildren, my job never ceases to give and give.

She’s an international patient who had to leave her family behind to live alone in a new country for cancer treatment. Imagine getting thrown into an entirely novel situation where your foundation is thousands of miles away, familiarity is lost, and you have no friends. You can’t work because treatment throws you into nausea, discomfort, aches and pains, and an unmanageable amount of fatigue. Yet, you’re expected to come in for daily radiation, manage your side effects alone, and support those back at home while there’s no one around to support you.

She’s literally an angel. Has the sweetest voice, is the most pleasant patient, and always greets me with an exciting “Hi, Cindy!” as if she hasn’t seen me in years. I get excited every time I see her name on my schedule. We’ve gotten close over the past few months because she started treatment with me when I was still a new nurse on orientation. I’ve watched her wax and wane over these past few months, and although she received news that her disease progressed on her birthday, she still mustered a smile.

She told me she received good and bad news on her birthday; on one hand, her treatment wasn’t working. But on the flip side, that meant she’d be trying a new regimen, which would allow her to fly home to see her family more often. Here was the irony in it all; this was the happiest I’d seen her in months!

In this moment, I suddenly realized the importance of what all medical care aims to be – patient focused. As nurses, we are often trained to see a side of patients that other personnel might overlook. While a doctor might be preoccupied with your disease, we are preoccupied with you. Sure, she wanted to be cancer free. But after months of living alone, not seeing her grandkids, and missing them like hell, you can imagine that maybe her priorities shifted a little bit. Yes, she wished to be cancer free. But more immediately, she needed to see her family. So the news of being able to see them again trumped any bad news that could have been thrown her way that day.

She grew so reminiscent of them that she felt comfortable enough to tell me the story of how she lost her grandson, how much it affected her granddaughter, and how much she believed her grandson would have survived had there been more trauma centers in her country. She also told me a dream she had where God came to her and told her that she could not find her grandson in her dream, because he was with her the whole time. She woke up that night with a face full of tears tears.

The moment was so tender and sensitive, I couldn’t help but feel honored to be able to care for someone so beautiful.

 

Goodbyes

Reading about palliative and end-of-life care brings me back to the time my grandpa was dying from colon cancer. We’re Vietnamese, so naturally, the entire family was involved. We bought my grandpa a hospital bed, one where the head of the bed is easily adjusted up and down. He had his oxygen tank. My aunt was in charge of his medications, and now knew everything a caregiver needed to know about Ativan like the back of her hand. We dragged our mattresses out to the living room to be with him, always. Every moment was so tense. The air in the room felt heavy with dread, anticipating his imminent death, guessing which breath would be the last, or which day his death would fall on. Praying that my uncle would “get here” on time from Delaware to see his father for the last time, my family was literally in shambles. No one slept. To get by, we played board games late into the night with the kids. All the meals were cooked on the first floor of our three-story apartment building where my grandpa rested. We cracked jokes when appropriate, because that’s just the nature of my goofy uncles. It was hard, but we made it through.

And here I am, revisiting this moment again skimming the pages of my textbook. Every symptom read aloud with a vision in my head, a video played on repeat like a boomerang, textures and temperatures felt at the tips of my fingers as if I was actually touching blankets and cold hands, and not batting away at these keys right now. Every problem more prominent, now that I’m older and can recognize them more easily as they play in my brain.

 

Coldness. Cardiopulmonary dysfunction. Multi-organ system failure. Decreased peripheral tissue perfusion, and what felt like a slab of ice when I touched your feet the night you passed away. They say that your core body temperature doesn’t drop, and that adding more blankets only exacerbates the effort to breathe, but we didn’t know any better. We just wanted you to stay warm.

Shortness of Breath. Periods of apnea. Holding onto every breath like it was the last one. Gurgles. Wet breathing, rattling, wondering if you were having trouble breathing. They say this “rattling” sound actually doesn’t produce any discomfort for you, but it’s hard to believe each time you take a breath.

Agitation. The worst of them all, but also the best since it gave us a good laugh. Being the independent, proud man you are, you were reluctant to receive help from your daughters when bathing. You insisted you do it yourself, and as she reached out to help only to do the job improperly, you tried with all your might to give her a good smack in the face! Sounds painful and devastating, but to us, was actually so funny, we still think of it to this day. To think you were dying yet still had the energy to do things your way . . well, that was just your spirit. You had your moments of shaking your head, coming to, and losing focus. But I’m thankful you were never truly agitated, and that when you passed you weren’t struggling or uncomfortable or in pain.

Grandpa, so many moments come back to you.

I hope the heavens are treating you right.