Ev’ry Time We Say Goodbye

My father died when I was less than 3 months into my new position as a Home Health Hospice Nurse. Barely off orientation. Much as I cherish my new job – a job I specifically went to nursing school to train for back in 2003 – a job I spent over a decade of preparing for via my many roles as an Oncology Nurse – a job that suddenly I felt trapped in, when I needed time to heal from my own loss.

While as a Quaker, I sincerely view the profession of nursing as a role of service, I also work for my, and my family’s, health insurance benefits.
I am a pre-existing condition. A walking, talking, pre-existing condition.
Born with a deformed kidney, I was extremely ill for the first 2 years of my life. Some kind and talented doctors at UCSF removed the offending organ, and I became a poster child for Healthy Living with a Solitary Kidney.
At the age of 37, just after I graduated from nursing school, I was diagnosed with Crohn’s disease. Crohn’s is a shit-ton of fun. Shits, giggles, scar tissue all over my small intestine.

But anyway. I always cringe when people say that Hospice Nurses are saints. Or angels. I am neither. Not by a long shot. I love the work; I feel tremendous gratitude for my job. That said, I also do it for paycheck. Let’s be real.

I need my fücking health insurance.

So, Bob King dies when I am so new to the Hospice organization towards which I spent 15 years of volunteering, studying, and working, to join, that I have no PTO. I was generously granted 3 paid days of Bereavement Leave (for which I am grateful), but then the greatest irony of my life unfolds: The Hospice Nurse can’t take a leave of absence to mourn her own father’s death.

Working my Hospice shifts while grieving has been tricky. How does one feel absolutely nothing, and then almost simultaneously, absolutely everything, as my son used to say when he was young, at the whole same time?!

When a person wants to work for Hospice, or even volunteer for Hospice, they are asked to wait at least 6 months, preferably a year, before they enter into the field.

If Bob had died in February, rather than May, I would likely not have been hired for my current position. They would have kindly and respectfully suggested I take some time to mourn & heal first.

Things have developed precariously since May 1st, the day my father died. There was a lapse in communication with my employer, and I was even scheduled to work the afternoon of my father’s interment at Willamette National Cemetery. Whoops! Fücking Whoops!
(We got it straightened out.)

However, as my manager and I have discussed, it is quite possible that there are no coincidences. Some of the home visits I have made in recent weeks, have been incredibly healing; I have felt that I was indeed In The Right Place At The Right Time.

Last night, I was asked to visit a home in a small town about an hour outside of Portland. A 90+ year old had just died, and I was there to support the bereaved spouse, and the patient’s daughter. Way too close to home, I thought initially.

The purpose of my visit was to support the family in any way needed: preparation of the deceased’s body for the journey to the crematorium, disposal of unused medications, anything and everything that the family might possibly need or want. Mostly, just presence. Holding Space with them, for them. Just being human, and understanding, and present in that sacred place and time.

The spouse told me that they had been married for 72 years. “Almost 73.”
I asked how they had met one another. The reply, “We were neighbors. We grew up together.” They had slept side by side together for over 72 years, always holding hands throughout the nights.

This was not the first time I had dreaded reporting for work. Often times, I’ll think of my father, and how I would either visit or call him on my way to work. My gut will clench, then drop, as I forget that he is gone, for just the briefest moment, and then…

But this was also not the first time that I drove away from a home at the end of the visit, feeling mystified by it all. In The Right Place At The Right Time. I’m doing exactly what I am meant to be doing, difficult as it may feel at times.

Sometimes, a certain song will come on the car radio when I’m driving alone; I feel my father’s presence, and my heart opens wide. Last night as I was driving away from this family’s home, a Natalie Cole version of Cole Porter’s 1944 song, Ev’ry Time We Say Goodbye, came on the radio. I’m not sure whose spirit was visiting me in my car at that moment, but someone’s sure was.

Everytime we say goodbye, I die a little
Everytime we say goodbye, I wonder why a little
Why the Gods above me, who must be in the know
Think so little of me, they allow you to go
When you’re near, there’s such an air of spring about it
I can hear a lark somewhere, begin to sing about it
There’s no love song finer, but how strange the change from major to
Minor
Everytime we say goodbye

When you’re near, there’s such an air of spring about it
I can hear a lark somewhere, begin to sing about it
There’s no love song finer, but how strange the change from major to
Minor
Everytime we say goodbye
(Lyrics and music by Cole Porter, published by Chappell & Company.)

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(Photo cred: my personal stash. Bob King: October 1962)

 

 

Bob King Diaries; o4.27.2o18 @ 00:27

Bob presents as a charming mix: equal parts Pleasantly Confused Gentleman, and Wiseacre
Neurologist:   Mr. King, are you right, or left, handed?
Bob:    (pause)… Yes.

This takes place during  an assessment following a most uncharacteristic afternoon and evening for Bob. With the only forewarning being a mild complaint of “the sniffles” for a few days, Bob curled up on his bed after lunch, and remained there for several hours. Slowly becoming febrile, then skipping his supper, he became pretty ill in a short period of time, catching everyone (himself included, I suppose) quite off guard.
In fact ~ we realized later that he had become incontinent of urine (a first), and vomited on himself without ever letting anyone know.

IMG_8618Bob’s fever, weakness, immobility, and confusion, ended up buying him a fancy ride to visit The Sisters of Providence.

Settling in for a night of observation.
Spending the night, as Bob does not do well in unfamiliar surroundings.
The only solid info confirmed: +Human Metapneumovirus (a close viral cousin of Avian pneumovirus).
For extra fun, some elevated troponin labs are detected, and a few other things pointing to Congestive Heart Failure.
Bob has asked hospital staff to call him “Robert,” which is totally his prerogative, yet baffling. He has always preferred “Bob,” no matter the setting.

Meanwhile, there was a Potluck dinner back at Chez Blapplegate… heard it was excellent food, delightful company, and apparently HH performed a Sneaky Preview of his upcoming piano recital piece. Something involving Billy Joel.
Was sorry to have missed it, but sometimes the Kristin & Bob King Show needs to take precedence.
(Random side note: I later learn that there had been some Penis P
asta, flown in fresh from Italy. Really? This I miss?)

I was finally able to get some po intake for myself, after the hospital cafeteria re-opened for the Midnight – 03:30 supper crowd. And I must say, it was surprising how quickly the old NOC Shift Nurse in me was revived. I was back in my old element. I still had it in me.

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#fortheloveofbob

 

Bob King Diaries; o3.31.2o18

Apparently, Bob snuck into the shower at an odd hour yesterday. He slipped and fell.
He was completely out of it when I went to see him later.
He appeared to be confused when I told him it was time to walk down the hallway in the Adult Foster Home where he lives to get his supper.
I had to take his hand and lead the way.
I don’t even know what a person does with that. My dad. Sitting on the edge of his bed, not understanding my words.

Bob King Diaries; o3.o4.2o18

Bob King Diaries; o3.o4.2o18
Bob had “too many” visitors last week.
Home Health PT, OT, RN.

Sunday morning call:
Bob: Hello, Apple’s cell!
Me: Heya, Pops! How’s the morning?
Bob: Oh, the usual. Time keeps passing.
Me: Are you accepting visitors today?
Bob: No.
Me: Not even me?
Bob: Oh, you’re not a visitor.
You’re an… intruder.
Me: Oh, I see.
Well, I have some chocolate for you that I got on sale at Safeway. I was going to bring it by.
Bob: Well, that’s another matter!

Upon my arrival, Bob was sitting in his recliner. One of our favorite old movies, Born Yesterday (1950), was on the tele.
I filled his candy dish with Hershey’s Kisses, and plopped down on his bed to watch.
And all was right in our world.

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One nurse’s thoughts about guns…

The time for polite silence is over.

Question:
Nurse Apple, why did you leave your last ‘New’ job?
Answer:
One flippant remark made by the Medical Director of that company about *How Gun Safety Issues in private homes were communicated to Home Health Clinical staff*

That was the tipping point, anyway.
I was still within my 3 month training period with a primarily amazing Home Health organization.
I was giddy with excitement when I was first hired by this innovative, forward-thinking, community-oriented Health Care organization.

99% of the employees were dedicated, passionate, reasonable people. The goals of the company were in direct alignment with my personal and professional goals as a nurse who cares deeply about homebound people with chronic illnesses or disabilities.

People who know me, know various combinations of things about me. But for the sake of a concise answer to the question at hand, I will summarize a few relevant points.

1) I was raised by my grandfather, a WWII army veteran.
He took me along when he taught gun safety courses in a rural community he lived in during his retirement years.

2) My husband grew up with a father and an uncle who were cattle ranchers in the rural SE areas of Georgia and Northern Florida.

3) I *LOVE* my veterans. Most people know this about me.
I *LOVE* serving veterans through my volunteer and nursing work.

4) I *LOVE* to eat animal flesh. I value and appreciate every morsel of beef, lamb, elk, that I am privileged enough to have honorably hunted and killed for my selfish dining pleasure.

5) I do not shy away from “delicate” or “sensitive” social issues. I feel that if we do not discuss and share our fears/concerns/thoughts about issues such as mental illness and gun safety, we cannot move forward and function as a healthy society.

6) I dig seat belts.
I appreciate Ralph Nader.
(Random, I know, but please hear me out…)

7) I have a 17 year old son who has attended public schools in Portland, Oregon since 2005.
He is my only child, he is my world.

8) I vote.

9) I pay taxes. Nurses are well-paid. I pay *lots* of money in taxes. #Happily

10) My son will be a freshman at MSU in Bozeman, Montana in the fall.
The dorms at MSU have gun lockers available for students living on campus who want to have guns available for sporting and/or hunting use.

11) This one might be less well known:
I enjoy archery, and gun target practice.
But both my son and I have been struggling with some depression over the last couple of years, so my husband and I have *DECIDED TO NOT HAVE GUNS IN OUR HOME AT THIS TIME*

Now, back to the pivotal moment that cemented my decision to leave a new-to-me nursing job that I loved:

The setting was a meeting about how, and if, to proceed with the Home Health care of an individual who was known to be struggling with both debilitating physical, and mental illness.

A Nurse Practitioner (also a newer employee with the company), had called an emergency Ethics Committee meeting to develop a strategy for how we, as a Home Healthcare Team, were going to approach this individual’s care.
It came up *as a side-note* that it had previously been noted that there “might” be guns in the home, and that “perhaps” we should have a Two-Caregiver Buddy System protocol set up for visits to this particular home.

A bit of context:
The general approach to Home Health Teamwork, is that visits are made by individual solo members of the team (Nurse, Social Worker, Physician or Nurse Practitioner, Chaplain) in order to maximize the time and attention that each patient/family receives from the Home Health Team.

I learned, approximately 2 hours before I was scheduled to go meet this patient in their home for the first time, about this “possibility” of guns on the premises.

I requested that we backtrack the conversation a bit, as I was new to the situation, and this issue had not come up yet in my orientation or training.

I wanted more information about what I was heading into, and wanted to discuss the company’s policy for sending employees into homes with guns.

I was silenced.

Apple,” the Medical Director said, “we have the Second Amendment in this country. We have no way of really knowing which private homes we serve may have guns.”

We cannot sterilize every home we go into.”

Stunned, I managed to reply that I had grown up with guns, and that that was not my concern.

What I wanted to know was how my new employer addressed the issue of gun safety for their employees.

Another person in the meeting, a member of the administrative staff, not part of the clinical team, picked up my line of questioning:

What is our policy for disseminating this type of information to clinical staff?” she asked.

This person, also, was silenced.

We were informed that this was not the purpose of the meeting we were having at that time. There was apparently “another committee” that was working on formalizing the organization’s policy on safety issues.

I should clarify that there were other concerns I had about the organization I had been newly hired into.
But all of those concerns were related to a pattern I was beginning to see of serious problems with communication.

That one dismissive comment, in that one specific meeting, was the tipping point for me. I was offered another position the next day, and I jumped on it.

I basically fled that job like my hair was on fire.
Not because I am uncomfortable with Veterans, or people with mental illness, or the possibility that I, as a Home Health Nurse, might be entering into homes with guns.

It was the refusal of a person in power, to pause and communicate about people’s concerns. My concerns.

I was fortunate. This is not lost on me.
I’m an experienced nurse. I can work anywhere.

I felt unsafe, and unheard, and unprotected.
I left.
And my heart aches for people who are not given that choice.

Thank you for reading this.
With love, Nurse Apple

Bob King Diaries; o1.31.2o18.

Like clockwork.
Nurse Apple books a trip to remote Idaho to see her best gal from Nursing School.
There are 2 precious weeks left b4 Crabby CrabApple starts her (next) new job.
She hasn’t seen Nurse Angie, aka Malheur County Public Health Goddess, for… for far too long.
They book rooms at Frozen Dog Digs Bed & Breakfast in Emmett, Idaho.
Like clockwork, Apple’s phone rings.
Bob has had another dizzy spell. Nay, lost consciousness, taken a wee fall.
Bob knows. Bob does not like it when his daughter leaves town.
Bob always knows.

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Preaching To The Choir

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I find myself reminded of why I had to pull out of the fray of Social Media after the election last year.
Without too much replay, but to provide context… I was witness to people I care about, along with complete strangers, tear one another apart over the topic of:
Vegan vs Non-Vegan.
Everything from the ethics of eating eggs from your own backyard hens, to wolves in National Parks, to breastfeeding, to Economy-Ecology-Ethics.
I stepped out for a half day to think, and then in a moment of insomnia, came back with my final reply:

Woah.
I need to Peace Out on this one.
Fucking take some breaths, people.
My departing advice, as a passionate RN, who has learned some hard lessons about Prioritizing and Politics, Policy, and Procedure…
1) Look at what HAS to happen vs what you would PREFER to have happen.
2) Prioritize. (*This is often much harder than it seems)
3) Think about what you can change, and what you simply cannot change.
4) Focus your energy where you think it will have the most impact.
5) Ask yourself if you think action “X” will really lead to desired change “Y.”
6) Before you jump to action, think first: “Will this really change the long-term outcome?
7) Who am I arguing with? Am I turning away someone who is basically in, or near, my camp? Am I effectively searching for common ground?
(Grammar Police, help me; ‘Am I being effective in my search for common ground?‘)
8) If I want to achieve some long term change, how can I learn how to get people with opposing views to engage with me, and actually consider where my thoughts are coming from?
9) Am I at risk of letting my passion cloud my message?
10) Is my behavior respectful to, and of, the people I am trying to engage with?
And lastly, it is a cliché, but nonetheless, a Solid Gold Cliché:
PICK YOUR BATTLES CAREFULLY.

Some other day, I will write more about my own experiences as a vegetarian (never a vegan), the people I managed to piss off rather than impress when I was a 17 year old vegetarian-living-on-a-farm-who-had-all-the-answers, When/Why/How I started eating animal proteins again later in life, and other meaty nuggets of conversation. (Meaty, get it? Meaty Nuggets. Which reminds me that my childhood BF Chrissy used to call McDonald’s Chicken McNuggets Pinchin’ McKNuckles)

For now, at the hour of 0200 Portland, Oregon, time, and in the interest of being neither a constipated Meat Eater, nor a Constipated Writer, I shall end this run-on sentence and hit that Publish button. Cheers!

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