Mountain climbs, Sunshines and Sweet Victories

So I had learned to stand in the face of perceived danger, and now I had learned to walk fearlessly in the face of real danger. Where did that leave me? It left me in a place where I could now enjoy the precious wins of the ER. Finally mentally present, I started to actually meet my patients and hear their stories. I had the opportunity to see new worlds. It was like when you learn to hold your breath underwater. You finally see the fish that had been missed in your fixation on not drowning. Or when you finally creep over the side of the mountain trail that brings you from shadows to sunlight.

I remember one patient, though older, he was completely uncorrable. Even though I explained the purpose of a heart monitor several times, he perpetually took the stickers off, wandered down the hallways; impatient with the process, and far too curious about what might be happening in other patient rooms. As soon as the stickers came off, the monitor would beep - a fair warning that my patient's heart may have just stopped. Before, I would have been annoyed, fearful of what I would miss in an inappropriately monitored patient. But now I realized a man healthy enough to be wondering what was going on in the world around him, probably wasn't on the brink of death. I found myself enjoying the excuse to walk into the room to make sure he still had a pulse, finding him sitting at the edge of the bed, wires all misconstrued, yearning to leave. His sweet wife's chiding was to no avail. It was only her requests to get his "chest pain looked at" that had prompted him to the ER in the first place. They cackled back and forth at each other with tender endearment, told me of first dates, the power of small and meaningful romances, and the secret to lasting love. Once his blood work came back perfectly healthy, and he berated her for their "wasted experiment in American healthcare", they were out the door, arm and arm. It wasn't until I went back to clean the room that I noticed the blankets were draped over the lone chair in the room, the visitor's chair, and not the stretcher. The thin patient gown, which never completely closes in the back and had barely reached this man's knees, lay on the empty stretcher. Even in his hour of pain and sickness, he had tended to his dear wife's comfort by giving all that he had, one coarse white hospital blanket. Their love rekindled hope for what I dreamed of.

Another patient that I remember so fondly was a sweet little woman. She was in her 60s-70s, and she had had a stroke. Her stroke, a blood clot in a large vessel, had resulted in a loss of oxygen to massive parts of her brain. She was what we call, "caught inside the window". People who come to the ER with stroke symptoms (loss of speech, loss of movement/sensation in one arm or limb, drooping smile) that occur in the first 3-6 hours can be given a really strong blood thinner. And if given in time, it is possible that the lack of oxygen could be reversed. Maybe their symptoms wouldn't be permanent. She had arrived just before my shift had started, and the nurse before me had just administered the clot-busting medicine. My job would now be vigilant watching and waiting. The problem with a strong drug is bigger complications. If the medicine worked, it would thin the clot. If it worked too well, there could be bleeding in the brain, often worse than the stroke itself.

As I took over the patient, the nurse and I did a team assessment so I would know exactly what changes to look for. She laid perfectly still in the bed, both her hands lay limp like soggy noodles by her side. She turned her head towards us as we moved around the bed from her right to the left, but never looked back to the right. No words slipped from her tongue. Her eyes stayed forced to the left, unable to see straight. We call this neglect - the inability to receive information from half of her world. She didn't even know we existed when we stood on the right side of her bed. This was the worst stroke I had really ever seen. My heart broke for her because even though she lay in silence, I could see in her eyes that she was still there, really present. Her eyes were not empty, and when I moved into her vision, her questions lingered unspoken. I performed my repeat exams every 15 minutes, then every 30 minutes... praying for any change, any improvement for her.

Finally, her ICU bed was ready. Due to the danger of her bleeding, I would move this patient myself. I went to the room and put her on a transport monitor. As I worked, one of the other nurses stood at the door making game plans for what would happen when I returned. While looking at her, I suddenly felt movement in the lower layers of my hair, brushing just past my neck. Immediately, I thought it must be a spider, and a large one at that. I jumped back and screamed, which elicited a giggle. Startled again, because I certainly wasn't laughing, I looked down at this petite lady in front of me. Could she be giggling!? I leaned down to find her head turned to her right! Her eyes looked straight back at me, clearly amused. The edges of her lips turned up. And then she lifted that once lifeless right hand up one more time to my neck and grabbed the curl closest to my ear. She pulled it slightly, then twirled it around a finger, and giggled again. My jaw dropped. Not only could she move her hands again, she had coordination and humor! She knew exactly what she was doing, and in the face of what had to be a terrifying experience, she was finding a small joy.

And the wins started to continue.

A heart once stopped, restarted. A small catch in a lab resulted in a better diagnosis, a better treatment. A quick snatch pulled a baby out of a toilet from the surprised mother, who didn't know she was pregnant. And these wins were the rewards that reinforced my passion. Learning how to stand in the storms had now positioned me to witness incredible miracles and play a part in other people's sweet moments.

So dear friend, if the journey you've set out on turned out to be a little less than your idealized version, more bumps and hurdles than imagined, and the learning curve has felt steep, keep pushing. Sometimes it's rollercoasters, sometimes hurricanes, but real journeys are mountain climbs: exhausting, at times overwhelming, and most certainly costly. But the view at each peak is sweet. If you want to see something unusual, you will have to step out into the uncertainty. Leave your couch behind and dare to do the difficult. Don't give up in the seasons that feel futile, when all is dark and heavy. You may just be in the shadow of the side mountain. In these seasons, doubt will creep in - there is no end to the grind, to the pain, to the darkness. But let others' sweet victories rekindle your hope. The mountain tops are just beyond your darkest night. The sunshine is still golden. Joy is still real.