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.

Shapeshifters

One of my favorite, and most challenging, aspects of my job is my ability to shape the patient experience. Getting diagnosed with cancer can be petrifying in itself, but going through the process itself is also unfamiliar and at times, unnerving. Some patients have to quit their job. Some patients have to reconnect with family members they never wanted to reconnect with again. Some patients grow incredibly anxious at the idea of receiving chemotherapy, only to have an allergic response to it and become more anxious in the process. Others find out they can’t even receive their treatment that day because of low blood counts, toxicities, or disease progression. Add all of this onto Boston traffic, waiting in the waiting room for what feels like hours, and then feeling like shit for weeks to months afterwards, only to possibly do it again in the next few months or coming years. It can really feel like it is consuming your life.

That’s why every moment matters. Nurses are at the forefront of your entire experience, in congruence with your doctors, receptionists, pharmacists, lab technicians, and environmental cleaning people. When you have to take on a whole new lifestyle, you really have to learn how to make the best of it with the new faces presented to you. That’s why I take such pride in being a nurse – every encounter I have with you is an opportunity to shape your experience living with this new disease.

One patient I can think of in particular is Kathleen (posting with permission). Kathleen came in anxious about receiving chemotherapy. It took some time to help her settle in, but we found ourselves bonding over our mutual understanding of being from the Woo, life at BC (her son went there), and our love for family. I had the honor of getting to meet someone new from her family every week, and every Friday I knew that I would be able to see her and see how she was doing. I watched her at her most emotional moments, but also got to watch how much she grew over the past four months.

I like to think that because I was able to understand her so well, I was able to curate an infusion experience that was helpful and particular to her. I knew her antics, could predict her response to certain things, and got a sense of how to deliver information to her that could help her get through treatment. This is, by no means, a way for me to brag. But rather, I just want to highlight the beauty of the nursing care experience and the magic at the interface of where this happens. Trying to help Kathleen cope with this new experience was not easy. But is in these moments of hardship and feeling like you don’t know what to say or what to do when you have the potential to make the most impact for your patients. You say what you can and offer as many hugs as you can. You do what you can. You might not think it’s enough, but it’s the intention and genuineness that matter. Sometimes, you don’t need words.

Kathleen finished her last round of treatment and will be back soon to see how she responded. Her cancer is tough, but her mentality is tougher. I can’t be more grateful to have met someone with so much tenacity. Thank you for letting me be part of your journey.

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.

Why This Week Rocked

Work has been pretty busy. I think I came in hot during the holiday season. It was Thanksgiving, then Christmas, then New Years. Apparently holiday season in the clinic is a hectic time because we’re trying to squeeze necessary treatments in for patients. This bullrush, in congruence with completing orientation and finally being on my own, brought a lot of new challenges but also gave me some room to breathe and rediscover my nursing voice in the clinic setting. This week made me realize how precious my job can be, and the amazing relationships you can develop with people from just a few visits sitting in infusion.

One patient who comes to mind (I’ll call her Ivana because Trump now, boo) is literally the sweetest patient that can be. She comes in with her husband and they always greet me with the kindest hellos and goodbyes. Every time I ask her how she feels, she exclaims that she’s feeling “great,” and you could never tell she’s fighting cancer. She has this cute little laugh and I can tell how her husband fell for her so long ago. Just has this genuine sweetness about her that makes you want to be around her even more.

Another little lady who I treat is one of the funniest patients. She doesn’t crack jokes, and in fact, I’ve never really seen her smile. She’s a little grumpy and always sounds like she’s cutting you off, but I really don’t think she means to. She never seems pleased, is always asking “How much longer?” her treatment is while her husband sits by reading the newspaper. But at the end of our visit they both thank me a million times with “Thanks, Cindy,” and “See you next week,” and I can tell they appreciated me. Even if she seemed pissed off the whole visit.

Another patient I have comes from abroad to get treated. She was super nervous at first to get treated, and understandably so. New country, new home, new transportation, new building, new sickness to deal with. And I don’t mean the cancer – I mean the treatment itself. Her chemotherapy regimen is one of the most emetogenic treatments out there, so she became incredibly nauseated and miserable. Still though, she remained so upbeat, jolly, and optimistic during her infusion visits with her boyfriend by her side. She even offered me a tour of her hometown if I ever visit her overseas someday. I look forward to seeing her just because I know she’ll put a smile on my face every time I see her.

The last patient to come to mind was a Vietnamese speaking patient I had this week. This patient stood out to me mostly because it makes me so frustrated when I can’t connect with a patient due to some technical difficulties. I can’t speak Spanish fluently despite taking it for five years in school, but when I pull out those simple phrases asking about pain (¿Tienes dolor?), or simply, “What’s your name?” (¿Cómo te llamas?), and their favorite “I know a little bit of Spanish” (Yo sé un poco de español), their eyes light up. The barrier has been breached; I reach through to them a bit. At this point, they usually assume I know more than I let on and start speaking in full sentences that are too fast for me to comprehend.. but the point is that the trust is there now. Bit by bit, people can tell you’re trying and they appreciate that. It’s made me realize how language is so important anywhere you go. Which is why in this particular case, I was so grateful to be able to connect with this patient. Also, I learned the Vietnamese word for “kidney,” too.

It was just nice to see pockets of kindness and appreciation this week. Being given the chance to care for such kind-hearted people during such tormenting treatments reminds me how special this job can be.

Hugs

One of my patients finally finished up his first round of chemotherapy yesterday. It was an important day because I was his primary infusion nurse, which gave me the opportunity to track his progress from week to week. It’s amazing how courses of treatment can vary from patient to patient; people who you think will breeze through end up needing extra support early on, and people who you think won’t do so well end up proving you wrong.

Yesterday ended up being pretty special. You know how tough guys aren’t supposed to cry? Well, for weeks, my patient had tried to be that tough guy. He received his last infusion yesterday and gave me a hug afterwards and thanked me for helping him get through his treatment. I’m really going to miss looking forward to come in every morning just to see how he was doing. It was a nice weekly gift.

Seems insignificant, but I’m still only two months into my new job! It’s the small victories (the hugs) that count.