Sometimes you need a second handful of chocolate

You do. You just do.

This afternoon is one of those times. It has been an extraordinary day thus far. Started off with legs that showed up for the day, always a nice beginning, and continued with me braving the drive to and from yoga. That was a tricky thing, driving home after yoga. Those ninety minutes in the hot room, working so hard I saw stars twinkling about my head more than a few times, don’t leave much in the way of stamina for the walk back to the car, let alone the ability to drive it.

But I did, I did drive it today, because I could.

That’s new.

I like new these days.

So this afternoon, sitting in bed reading through some emails and getting a few things done I decided chocolate should be in order. We’ve got some really good, dairy free, dark chocolate baking chunks in the cabinet and a handful seemed just the trick.

Not even close.

Some days are hard and some days are frustrating. Some days the legs show up for work and some days they don’t. Some days the dark threatens to creep out of its murky place and steal away the drive to recover. And then some days… some days rock because it all comes together in a way you weren’t sure would ever happen.

Those days are good days. Those days are chocolate days. And today? Today was one of those days, so I made it a double.

Fifth time around the sun broken

Five years since I broke.

No balloons. No confetti. Nothing.

I didn’t even mention it to my husband or friends. The day that marked the beginning of this saga came and went with nothing in the way of commemoration. My husband was travelling for work and I threw together a meatloaf and some sweet potato fries for me and the kids in the evening. A very regular day, two days ago.

I have mixed feelings about that “anniversary”. On the one hand, it has now officially been more than half a decade of living in a disabled body. That’s a long time to be Sisyphus. But on the other, who wants to commemorate a horrific injury? That’s just morbid.

So what has five years of this brought me? Everything. An amazing child who slays me daily with his quick wit and charming smile, a better relationship with my husband than I could have ever accomplished living a “normal” life, an older child who has learned amazing lessons living through something like this, lots of scars, too many surgeries and a few less people in my life because, really, who has time for pettiness or meanness even on a day without chronic pain?

The dramatic alcoholic who blames everyone else for her mistakes is gone. The mentally unstable person who refuses to get help is gone.

I can’t fix someone else’s junk. I’m too busy trying to get through physical therapy. Plus, you can’t help someone who won’t help themself. You just can’t. And that’s a sad reality to have to face any time, let alone in the middle of navigating the shitstorm I’ve been dealing with for half a decade. A couple of people I thought were friends really weren’t. There’s nothing like having a tornado land on you but part of what it brings, oddly enough, is clarity. Mostly because you’re too damn tired to put up with bullshit. Ever.

So I’ve walked away. One far later than I should have and the other rather quickly once it became obvious the alcohol had taken control. And those are the right choices.

A good friend who also happens to be one of the smartest healthcare providers I know and a very candid, wise and unbelievably tough human being with a giant heart told me two years ago, “…unfriend, and do it often. You only get so much life.” He’s right. We only get so many laps around the sun so why spend any of it with a person who is acting like a jerk?

At some point there will actually be a day to celebrate. It will happen. I am so very lucky to still have a ton of wonderful friends who will be there to celebrate it with me, but it won’t be an anniversary of something sad. It will be a truly great day. Maybe it will be the day I return to work or the day I do something really physically challenging with some measure of success. Or maybe it will just be a regular day when I wake up and realize I can’t remember the last time I had to deal with all of the stuff this injury has saddled me with.

Now that will be a day worth balloons and confetti. Maybe even fireworks.

This is why I’m not working

Hard week. This one is a hard week. I had a few strong weeks with a slow, steady improvement in the ability to do things like cook a meal or drive every day or even go out on a date with my husband. Weeks resembling something like a normal life.

But not this week.

This week sucks.

For whatever reason I’ve hit another road block in PT and it is a really nasty one. My right leg, the one with all the nerve damage from back when my pelvis dislocated almost five years ago, is a mess. Every night this week the muscle spasms wake me up but two nights ago it went from bad to horrific. The muscle spasmed again, very much like a Charlie horse except mine is on the front side of my lower leg. I woke up in a panic trying to grab my foot and straighten it out, releasing the cramp. But that time it wouldn’t budge. My entire foot was stuck, hard over, in a massive leg cramp.

From the base of my big toe all the way up to my knee was a giant, raised rope of muscle and tendon tissue that looked like some sort of huge snake popping out from underneath my shin. Hurt like hell and didn’t let go for over half an hour. One thousand and eight hundred seconds of screaming. That’s how long it took for the muscle relaxer medication to kick in. I couldn’t let go of my foot the entire time for fear that the spasm would actually dislocate my ankle. And then, four hours later when the Valium wore off, it happened all over again. Another one thousand and eight hundred seconds of unimaginable pain. It was so bad I wondered if people die from spasms like that, especially when my lower back spasmed for those last few minutes, like joining in on some sort of sick, demonic party.

Today? I’m in yesterday’s pajamas that I am fully confident will become tomorrow’s ensemble. I tried to read but my eyes can’t clear the lines and my ears are ringing too loudly to focus. I’m doing all the things I can to try and fix this: ionized magnesium supplements, water, potassium, prescription medications and rest but other muscles have been threatening to do the same thing for most of today and I’m scared. I’m becoming afraid to move at all.

Cancelled plans today too. It wasn’t much, just that little help for my friend on the computer while both my kids are in preschool/science camp. It was that thing I wrote about before that looked an awful lot like work. Something I thought I could do for a few hours to be useful. But instead of a little victory and a step towards rejoining the workforce, my day included making a phone call and saying, out loud, how much I still reside in a broken body. I had to tell my friend I am still unreliable, still unavailable, still disabled.

I know I have come a long way and I know my path is one of recovery and I am well aware of how lucky that makes me in the long haul. I just wish this wasn’t such a long damn haul.

Last week one of my doctors asked me when I planned to return to work. First of all, no offense, but I didn’t plan any of this so I sure as shit can’t just plan my way out of it. Secondly, when I go at least six months without being bitch-slapped back into submission and left whimpering in pain and exhaustion and stuck in bed for days, maybe that would be a good time to consider working. Until then I’m going to have to try to figure out how to continue physical therapy without screaming. I’m going to have to figure out the logistics of taking more of that medication I abhor that leaves me fuzzy headed and unable to drive.

And I’m going to have to figure out how not to cry.

Stop wasting my time

Over the last month I’ve made some remarkable gains. The pool has become a part of my life again and I’m slowly gaining stamina, starting to make those laps turn into real distance. It is incredibly hard, working through the middle of my atrophied body, combining upper and lower body movement in a rhythmic swim stroke that is a coordinated enough effort not to drown. It isn’t pretty to watch me try to swim but even with the flailing, I am again reminded to be thankful that I was an athlete before this injury happened so as to reduce this mountain of recovery, just a little.

I’ll take my victories wherever I can find them.

And a friend asked me for help on a project, something that looks remarkably like work. We talked about it for a bit and it is actually something I can help with. Just a few hours is all he needs in an arena it turns out I’m good at with no deadlines or pressure. I was delighted at the possibility of trying to work just a little. I want to go back to work. I need to work. I’m just not ready to work because I can’t possibly do things like be reliable, have enough stamina to finish a day or even show up on time because the chiropractor might need me first to fix my neck and return feeling to my hands. It is terribly frustrating that I can’t work yet and that I am still firmly fixed in the “disabled” box, even with all my recent gains.

But… I can deliver on a few hours of help to be completed “whenever” for a friend so I said I would do it.

And then life got in the way a little, as it always does. The first few times we were supposed to meet something got in the way or delays set in. That last time I got frustrated, sitting and waiting for the meeting to begin before it hit me – I was unhappy about someone wasting my time. That’s something that happens to normal people. Which meant…

I’ve got time.

When did that happen? I still get so wiped out from physical therapy and the basics of living that my husband is often the one tucking the kids in at night because my legs just can’t take another trip up and down the stairs. I still have to take naps or lie down in the middle of the day just to make it through the second half but still… There I was… With time to spare that I didn’t want someone else to waste.

That’s new.

That’s fantastic. I’m going to help my friend if we ever meet up and I’m going to relish that I’ve got the time to do a little more. But I won’t be waiting around. I’ve lost too much time already and what remains is far too precious to waste. Like I said before, I want my time, all of it.

The night I killed a dying man

“You’re not a good healthcare provider until you’ve made a medical mistake. You’re not a great one until you’ve killed someone”

That’s what they told us in nursing school. That’s what they repeated in nurse practitioner school. The ER doctor I spent months working with during clinical rounds even had a chart graphing out what happens before, during, after and then down the road when it happens. It always happens.

In most other professions, when someone makes a mistake it can be expensive, frustrating, career ending even, but is it not often fatal. Yes there are high-risk professions like mining and roughnecking where mistakes can be catastrophic but that isn’t the same as a person coming in to be saved but being killed instead. If I make a mistake caring for an emergent patient, there won’t be time to fix it. A person in a true emergency is actively on the brink of death. We have to get it just right to even have a chance at saving them.

I spent almost five years working in the ER. My patients often came in the sickest but my positive outcomes far exceeded standards of care and my door to floor (for ICU patients), door to cath lab (for someone having a heart attack), and my patient satisfaction scores, by every measure really, were at the top in the department.

Except for that one night.

It was a long, long time ago, one of my first nights working in the ER, fresh out of nursing school and before I even started on my nurse practitioner program. I was new to everything, still trying to find supplies and get the electronic charting down in addition to taking care of my patients. The other nurses were good about helping me when things got crazy but it was night shift, a skeleton crew, so there were only a few of us on the floor to begin with. I found it hard to be a thinker in those early days with so much task management piled on top of me in a busy, short-staffed department and I relied heavily on “just getting it done” which turned out to be a lethal coping mechanism that night. The night my patient died by my hands.

He was the victim of a random mugging. Some guy had jumped him out of nowhere, hit him in the back of the head with a heavy object and stabbed him in the back before making off with his wallet. Someone brought him in by car, dumped him off at the door before taking off leaving him to present at the triage window bleeding and screaming.

The triage nurse brought him back to my trauma room, trying to get an understanding of what happened. He was speaking English at the main door, switched to his native language half way down the hall and was only uttering gibberish by the time he got to the room. It was going south really fast and we knew he was in bad shape.

We had called a trauma alert even before he hit the room so we did what we always do very well and quickly: c-collar on his neck, IV inserted by the tech, on the monitor by a nurse and clothes cut off to see how/where he was injured, etc. We saw the giant stab wound on his right flank and the night doc called for a catheter to check for blood in the urine. We had the catheter inserted in a flash and my fellow night nurse yelled, “positive for blood!” which meant the stab wound went all the way into the kidney. We were in the middle of the rest of the trauma protocols when he started projectile vomiting.

“Drop a NG tube,” the doctor barked at me before walking out to the desk to make sure cat scan was ready for us. (NG is short for a tube that goes up the nose and back down into the stomach to prevent any stomach contents from backing up into the lungs) With the rapid deterioration and head injury we needed to see how bad things were via cat scan imaging. With his vomiting we had to protect his airway while he was lying flat on his back on the cat scan table and decompress any stomach contents prior to surgery so it was the natural call but something wasn’t right. I stopped for a second and paused. “But, wait,” I said to the room, trying to think through all the noise and tasks and stress to get to that something flickering in the back of my brain trying to tell me not to drop the NG tube. Wasn’t there something about…

“DROP THE DAMN TUBE!” screamed into my ear making my whole body jump as the doctor re entered the room. The tech had already prepped the tube, connected it to suction and was handing it to me to insert. I had it in my right hand and stopped again, begging, in my mind, for just a second, one second to think about head injuries and NG tubes and…

“NOW, GODDAMNIT!” the doctor screamed again so I introduced the tube into my patient’s nose. I didn’t know his name. We never knew his name. All of his paperwork was “John Doe” but with the Eastern European language he was speaking in the hallway before going downhill, his name probably wasn’t John. This man I didn’t know who was actively dying, someone’s son, friend, maybe even father who showed up terrified and begging for help before being placed in my trauma room was lying in front of me. My patient. My responsibility.

The tube started up his nose. There is a sweet spot where, if you give the tube a little twist, it helps round the corner and progress down the back of the throat to the stomach. I got to the depth where the tube was ready to make the turn. I gave just a little twist and advanced and…

The tube didn’t turn.

It didn’t meet any resistance.

That fat, stiff NG tube designed to withstand the acidic environment of the stomach…

Proceeded, uninhibited, right into his brain.

I could feel the soft folds of his brain at the far end of the tube give way and turn to mush. “Oh my God!” I screamed inside my head. My heart stopped, my breathing stopped, my jaw dropped and everything went odd and terrifying, like after an explosion, and I knew. I knew what I had done. And then I remembered what it was my mind was trying to tell me: you can’t drop a NG tube on a patient who has a posterior head injury because the force of such an injury can cause the bones in the back of the nose to break. I had just lobotomized my patient.

I withdrew the tube gently but it didn’t matter. His pupils instantly reduced to pinpoints in eyes that fixed hard over to the right as he started seizing. It was over, he was over and nothing we did next could possibly fix my mistake. The rest of his time in our hospital went by the book: the NG tube dropped from his mouth instead of from his nose into his stomach, cat scan completed and on the helicopter to the neurosurgery center hospital all within twenty minutes of his showing up at our front door. He made it to the neurosurgery hospital but not alive. His heart stopped beating in the helicopter en route. They worked on him for a long time both in the helicopter and upon landing but there was no saving him.

And there wasn’t going to be. His head injury was fatal. One look at the cat scan images of shattered pieces of bone splintered throughout the back of his massively hemorrhaging brain and we were all shocked that he was even conscious after taking such a hit, let alone able to speak for those first few minutes. We found out later that the attack occurred just blocks from the hospital. Any farther away and he would have died way before any attempt could have been made to save his life.

I killed a man. It happens in healthcare. It always happens. Medical mistakes are often fatal. Sometimes it is a system failure that leads to the mistake, sometimes it is a prescription error that leads to a fatal combination or concentration that causes death but, in my case, the death was caused by my own hands, by my right hand.

I remember him every day. I remember his dark, curly hair and his pale green eyes that were the color of a Caribbean lagoon. I remember the heavy collection of freckles that ran across the tops of his shoulders before giving way to clear, olive skin, broken by the angry puncture of a knife wound. I remember he was young and strong and had a beautiful face marred by the classic scars of a fighter’s life. And I remember exactly what it felt like to accidentally take that life when I shoved a tube deep into his brain.

After that night, things were different. I was different. I’ve never again silenced the voice inside of me. If I’m not sure, I don’t proceed, and every time it matters. Every time it makes a difference and I’ve been better than I should be throughout the years. It wasn’t the doctor’s fault I didn’t listen to it that fateful night, it was my fault I didn’t listen. It was a lesson I needed to learn, that most of us in healthcare are destined to learn.

I’ve often thanked God for giving me the gift of learning that lesson on a dying man. A man who had no business being alive in my trauma room with the extent of his injuries. A man who made me a much better nurse practitioner, even though the memory of him is a hard one to carry. Great gifts are often difficult and always come with great responsibility. I hope I can live up to this one.

Let it snow, let it snow, let it snow

We didn’t wake up to a white Christmas but we certainly finished with one. The storm system that came through dropped just over six inches of fluffy, white powder flakes in less than a day. We were covered in snow.

It was beautiful. It was magical. And it didn’t scare me.

That’s new.

For the last four winters, every snowflake was like a land mine falling from the sky. I couldn’t risk slipping or sliding on anything icy so every snowfall was a prison sentence to be carried out as long as it took for the sun and the shovels to clear the way. Back then it was still beautiful, but it was terribly frightening to watch.

Not this time.

The kids got giant sledding tubes for Christmas and were drooling at the opportunity to take them down the hill. My husband asked if I was coming along and, without hesitation, I said, “Yes!” So we headed up the stairs to the attic to get out all the snow gear. The circumstances of having to move my crutches aside to reach the box with my old ski pants was not lost on me, or my husband who was completely unsuccessful at hiding his glee at my progress.

And so, geared up and thankful that those pants of mine still zipped, we loaded into the car to head to the hill. There was singing, there was excitement and there was clapping, from the kids too. We were the first ones on that part of the park. First tracks in the deep snow. They went down the hill, spinning and squealing and laughing in those big tubes. It was really great.

And me? I tromped through the snow to the top of the hill. I did that! Through the unstable surface of new snow, over the unseen obstacles buried beneath it and even over an icy bit, I walked, unafraid.

And then? After watching the kids go down a bunch of times, I took a turn. I did. I got in a tube, got a push from my delighted daughter and laughed all the way down the hill, bouncing and turning with snow constantly kicking up into my face.

It was awesome.

The walk back up the hill took forever, stopping frequently go catch my breath and let the muscles rest, so that kind of exertion is still way outside of my regular skill set. But who cares? I got to go, I got to walk around and I got to ride!

With you

I want to slow dance with you
To this song
In a crowded club
Under the dark lights
Moving through the haze
Of one too many drinks

I want to feel your breath
On my skin
When our body press
Arms entangled
Swaying through the heat
Of too much sweat and perfume

I want to stay out late
Flirt dangerously
Taste the lightening when our lips meet
In the middle of it all
Making a scene
Of too much of your heart beating through mine

Too far away

The scissors for my shaking hands
Too weak to open the box alone
Something, anything to catch
Frustrated tears spilling onto the floor

The pencil and lists off in a drawer
To think, remember, do
Sometime later, all that
A normal person has already finished

The beep of the washer
On a floor I can’t reach
On legs that won’t respond
To the things that need tending

Strength, real strength, a fleeting memory
Can’t hold on to what it once felt like
To live in a body, unbroken
Able

The finish line
I can’t ever cross
Painfully distant, a cruel promise
In a place I can see but never know

So far, so far today
Each step, dragging myself along
Only to still be right here,
Too far away

And another week goes by

It does. No matter what. That’s the good and the bad of weeks spent chronically rehabilitating on the hamster wheel of a prolonged injury and recovery. Things get better, they get worse, time stands still then leapfrogs into some strange future where your kids aren’t little anymore and you lament that what was an incredibly special, albeit impossibly difficult, time has passed forever.

I spent the better part of last week trying not to vomit through the hang-over that withdrawing from the pain patch saddles me with for days on end. I’m spending the better part of today on the heated mattress pad trying to ride out this next cold front without medication. And my kids are growing up, like all kids do, far too quickly.

There are lots of ways to survive the terrible days that come: bad television, silly games that only serve to move the present into the past, and things like that. Distraction works wonders when you’re trying to get to “there”. The problem is that it doesn’t let you get to experience now. The now, the only now today will ever give you, matters. Time is something you never get back. It means everything.

But so does surviving.

It is a hard balance when an injury dominates half a decade. That’s what it will be for me shortly: five years come March that I’ve been trying to extract myself from quicksand. Trying to keep hope every time I was sucked back down to the bottom, trying to think about my future in terms of actually being alive without fear crippling that very idea, and trying to be present for my family when the act of settling into my own lived experience was an unimaginable horror.

But I’m a little better now that the hardware is gone. Well, most of it. It was indicative of the insanity of my lot when I recently said to a friend, “…the remaining two plates and six bolts weren’t safe to remove.” Remaining. Who has that much hardware as “leftovers”?!?!

So, in an effort to rely less on distraction and to attempt to live my days, I’m eliminating some of the crutches. Those silly games that got me through so many nights have been deleted off my telephone. Many of the mindless talent shows have been cancelled from the digital recording schedule and we are dumping cable once college football season is over this year.

A new year is coming and we are going for a technology detox. More time for family game night. More time for reading. More time for live conversations with a friend. More time for living.

I never wanted the pain medicine and I am praying not to need the distraction anymore. I want to be well, to heal, to breathe. I want my time, all of it.

I forgot about the barometer

To hell with the barometer. I mean it. Damn, damn, DAMN!

Everyone has been asking me lately if the surgery worked, if I’m feeling better and some are asking if I’m going back to work soon.

What?!?!

I would LOVE to go back to work. Even a little. Even just call. Anything to feel like a part of my chosen profession. I worked my ass off for years studying, memorizing, learning, seeking out challenging opportunities to get really, really good only to be sidelined with an injury so bad it is impossibly hard to read, study, memorize or work out much of anything challenging.

I’m still looking at years of rehabilitation to have the strength and stamina to work again.

So there I was last week, trying to steel myself against the onslaught of pressure wrapped in the guise of well wishes and letting hope back in that I might one day be able to consider working again with how good I was doing when the damn pressure dropped. And then dropped again.

Back to back winter storms complete with arctic freezes. Bastards.

I was doing so well before the storms I had stopped the pain medicine. I got through a few days of the moderate withdrawal that comes from washing out from a pain patch without too much misery. It was the same crummy chills, nausea and all the rest that happens every time but it seemed easier this go round with the hope of finally having a recovery. I even posted on social media how good I was doing off the patch and smiled at all the positive response. I let myself look ahead to the ability, once the withdrawal was over in another week or two, of sharing a nice glass of wine with family and friends over dinner. I was doing so well I let myself think about being better.

Then the storms hit and the pressure dropped. I was able to gut through the first one but the combination of a one-two weather punch was just too much.

The second storm front came through last night. I don’t know how much the pressure dropped but it was enough to hollow out the holes left behind where the hardware used to be and morph them from slightly sore healing sites into frozen icicles of pain. The hollows responding to the pressure felt like newly broken bone being pushed constantly from the inside out. I couldn’t breathe. I couldn’t move. I couldn’t speak.

I put a patch back on. Another fucking patch I don’t want to take. Another night spent waiting for the medicine to kick in. Another week or weeks of being medicated with something I don’t want. Another week having to recover enough to chew because of the horrid jaw clenching that kind of pain causes.

Today? Today I can breathe and talk a little. Moving is pretty tough. It will take some time for the pain medicine to win the war over the pain. That’s how it goes with a pain spike. That’s why folks in the hospital are such sticklers for pain control – once you get behind you’re basically out of options. For days.

Today sucks. I hate being in bed. I hate the pain patch. I hate that bitch of a barometer and I hate that the polite words just don’t cut it anymore.