Tall Tales from Kansas

people are still getting sick and dying

Just in time for the 4th of July, the numbers of individuals with COVID is on the rise in our part of the country. In particular, in the Springfield Missouri area, the hospitals are having to divert patients because of the numbers of people hospitalized with COVID. All of this is being attributed to low vaccination rates and the Delta variant. A majority of those affected are under 30 years of age. 

This week I took care of a young person in their early 20's. Previously very healthy. He is on a ventilator with lungs so badly damaged by COVID that he is also on ECMO - tubes the size of garden hoses taking the blood out of his body, re-oxygenating it, and returning it to his body, all with the hope that his body will recover to the point where he is able to once again exchange oxygen normally in his lungs. The hard fact is that 40-50% of people who go on ECMO recover. That means the other 50-60% die. I don't know which category he will ultimately end up in. What I do know is his parents were heartbroken at the site of their son, seen on an iPad screen, so critically ill, unable to communicate with them at all, tubes coming out of every part of his body. The hope that the days of doing those visits  for families were over, was premature. 

All of this is to say that if you are NOT vaccinated, you should still be operating as you did at the height of the pandemic. Wearing a mask indoors as well as outdoors when you are in a crowd, maintaining social distancing, washing your hands all the time, cleaning and disinfecting surfaces. 

What do you do about family members who are not vaccinated? Tell them it's not too late to get a vaccine. This is hard stuff and we are not out of the woods yet. My intent is not to threaten, bully, or scare people into getting vaccines, just to talk about what I am seeing - which is that people are still getting sick and dying. 

to let the day go while laughing

Today during "Feedback Friday" session, Margaret and Shauna and I did a blind contour round robin. To mix things up we drew "post-it note" sized drawings with a thick line (sharpie marker). I have decided that an individual's response when faced with the suggestion of doing something like this is very telling about how well we will work together. 

Today as we sat around before we wrapped up the day, we talked about how impossible it would be to talk to anyone else about the things we saw this week. Who would believe it? How could we say it in a way that would capture such difficult moments in a life? So, instead we talked amongst ourselves, appreciating that we work in a "team" where we visit patients and families together, each calling upon our individual expertise to get the best outcome for each visit. One of the things that helps us stay strong as a team is to be able to give open, honest, timely, feedback about what went well and what could have gone better.

So while drawing on post-it's might seem a bit strange, it uses an entirely different part of the brain than we use all day long in tough conversations. To be able to let the day go while laughing at ourselves, appreciating our masterpieces is a gift beyond measure. 

holding hands with you across the oceans and mountains and deserts

Tonight it's a hodgepodge of jumbled thoughts. Take what applies, ignore the rest.

Today, after my second full shift of working from home, Chris and I went out for a walk as soon as I closed up shop in my virtual workspace upstairs. When I saw this, I wanted to do a ZOOM sing-a-long with my siblings.  Oh give me a home, where the buffalo roam, where the deer and the antelope play..... I am going to open a meeting room with them tomorrow am and if they participate I will video us all singing together and post it tomorrow.  Do definitely hold your breath waiting for this.  Brother and Sisters - I will send you the lyrics tonight so you will be ready in the am. This is going to be fun. Take my word for it!

Have any of you considered what you will do if someone in your family is ill and tests positive for COVID-19 and you are caring for them at home? In case you were wondering about things, maybe this video below will be helpful?

In Kansas our governor (who is a rockstar by the way!) has extended our mandatory stay at home order through May 3rd.  It was disheartening to learn that Kansas is the 3rd lowest state in the US in terms of numbers of coronavirus tests done.  All the more reason for us to be staying at home.  

I wish you all flowering fruit trees and blue skies with white puffy clouds. No matter where in the world you are social distancing, I want to extend my thanks to those who have reached out to me here recently, I am holding hands with you across the oceans and mountains and deserts.

keeping our loved ones close in new ways

As a new week begins, let me give you a glimpse into how things stood at the end of last week at my hospital in Kansas City.  We continue to have an average of 25-30 COVID-19 positive patients in the hospital and roughly half of those are in the ICU - mostly intubated. There also continues to be 25-30 patients who have been tested and are referred to as PUI - persons under investigation.  We have had deaths and have also had people who have been able to be liberated from the ventilator and discharged.

Overall, in the metro area, the number of patients admitted to the hospital who are COVID-19 postive continues to slowly increase.  It's too early to know where we are on the curve. There is no evidence that it has flattened. In our facility we are prepared for a "mild to moderate" surge. We are ok on amount of PPE but continue to be very judicious with use.  An area of greater concern is the potential for/likely shortage of medications required to keep patients sedated and comfortable while on breathing machines.  

There are still no FDA approved medications for COVID-19 though we continue to use hydrochoroquine and azithromycin following specific protocols. The use of convalescent serum is also being investigated.  

There remains much that is unknown about this illness. Patients are staying on ventilators for weeks instead of days. Generally when someone is on a ventilator for longer than 10-14 days a tracheostomy is done to prevent further damage to the vocal chords and allow for longer term weaning from the vent. We are not doing tracheostomy's right now because surgery on a COVID-19 patient poses significant risk for transmission of disease.  In addition, once a patient gets a trach they have significant ongoing aerosolization of secretions, and this creates a constant high risk for transmission of the virus.  We have seen patients who seem to be getting better precipitously take a turn for the worse, and some patients we thought would not survive, suddenly improve.

We are treading water, trying to be realistic and prepare families for potential deaths, while also understanding their need to hold on to the potential for a miracle. 

What we do know is that it still makes the most sense to continue our current state of social distancing, being vigilant to avoid transmission, washing hands, working from home if we can, reaching out to others virtually, keeping our loved ones close in new ways. 

forget what you think you know about team building activities

On a Tuesday afternoon in Kansas City all my brave work colleagues and I gathered at Hook Gallery in Westport and let our inner artists come out.  

Our extremely smart social worker came up with this brilliant idea as a "self-care" activity.  

It was FUN!  I loved watching all the different approaches to the daisy.  

At the end of an hour an a half we had 11 individual masterpieces (and a new appreciation of our collective creativity).

Forget what you think you know about team building activities and get your work group to a painting party in your neighborhood.   I do not go for "forced activities in the name of workplace productivity"... but a painting party?  Who knew it would be such a frolicking good time? 

This daisy now lives at Tall Tales Headquarters. 

armed at last with an accurate description

Yesterday, on the Writers Almanac, there was a poem that describes to a T what happens to me at meetings.  Armed at last with an accurate description, I will continue to look for a cure (though I believe in my heart the only remedy is to skip them).   In the meantime I post it here in case you missed it.

At the Very Lengthy Meeting

 

by Kevin McCaffrey

 

At the very lengthy meeting
I actually felt my soul leave my body
and rush toward the ceiling—
and fly around the walls and flare
toward daylight, toward the windows—
to throw silently its impetuous emptiness
against the glass in vain.
It could not go anywhere, the clear moth.

Then it lay on the rug, not exhausted
but bored and so inert that it almost—
though nothing—
took on a hue, stained with all the breaths
and words and thoughts that filled the room:
the yellow-green color of old teeth.

 

P.S.  the photo above has nothing to do with the poem, it's of one of the old stone walls on N1700 road in Douglas county.  Sometimes in a meeting I pretend I am walking on that road rebuilding the walls.  I do that so things won't come out of my mouth that I am likely to regret later. 

 

 

to florene girton, wherever you are

I do not remember the last time I made myself a rum and coke.  I think it might have been sometime in 1982 when I was working the the 3-11 shift on 3 West at St. John's Hospital in Salina Kansas.  After work we would all head over so someone's house and make velveeta cheese dip,  break open a bag of tortilla chips, shuffle the cards and have us some serious Pitch games.   Rum and coke was the drink of choice.   No special glass and no slice of lime to garnish.  Back then it was all about the cards.  And we took it seriously.  

I made myself a rum and coke tonight after work.  Just because it sounded good.  There were no cards involved, but boy did it bring back some good memories.  As I sipped, I raised my glass in tribute to all my old co-workers, but especially to Florene Girton who at the age of 65 taught all us young whipper snappers how to start IV's, deal with troublesome physicians, respond to a code-blue, and take care of each other as we made our way through those first tender years as nurses. 

 

a great opportunity to rejuvanate my inner artist

 In three and a half very short days I will be headed to Palm Springs for The Second Annual Art Retreat.  I have my hat and striped poolside cover up ready to put in the suitcase and the toenails have been polished with a lovely shade called pink flamenco.  

Last year this was a great opportunity to rejuvanate my inner artist.   We all have one.  Some of us don't let them out in public much; worried that our masterpieces aren't that good.   I have enjoyed reading what Loretta  has to say on this topic lately. 

Here is what I do know.   I have a day job already.  I like it pretty well.  I don't ever intend for my artistic explorations to take me anywhere other than where I am right now.  But I do believe that being able to hang out with creative types and have the chance to dabble alongside them makes me better at my real job.   Don't ask me to explain the science behind this, I just know it's true.   

 

 

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important friday night tasks

It's Friday evening.  6:43 pm.  I had a most lovely day at work.  I met a 92 year old man who was entrusted with carrying a secret document across enemy lines in Italy during WWII.  He told me the story of how a young boy helped him pass safely across a beach filled with land mines so he could make it back to his ship.  You may be able to imagine something nicer than sitting by a bed listening to stories like this.  But I can't.  He also told me I had nice teeth. 

Tonight I am giddy with delight at the thought of a 3 day weekend.  Chris is downstairs fixing dinner.  It smells divine.  I tried to take a picture of his famous garlic bread but the light is bad.   Another time. 

Instead here is what I am doing.

Messing around.  Drinking wine.  Important friday night tasks.  Thinking about how I am going to try and duplicate the sesame covered, honey coated, almonds I tasted from Trader Joe's this week.  Yes I know I could just go and buy some, but what fun would that be?  It will be plenty fun if my idea doesn't work out.  But only then. 

I plan to figure out how to turn on the new fangled steam machine that Chris bought for cleaning so I can use it to block this afghan that I finished on Sunday night. 

After I finish that I am going to work on this. 

And when I get done with all that I'll probably start writing a novel .    On a Friday night with a 3 day weekend looming ANYTHING is possible. 

a new perspective on snow

Last week I took care of a woman who was going home with hospice.  As I entered her room the day she was leaving I heard her talking to her daughter on the phone.  She was giving last minute instructions for the people who were going to deliver and set up her hospital bed at home.  She said "honey, have them put that bed parallel to my big picture window in the living room, I want to be able to see the first snow flakes if I live that long".   

I'm not sure Helen will be around to see the first snow.  But you never know.  She's pretty tough and has lived through some hard times.  Either way, I will be thinking of her this year when I see those flakes, with a whole new perspective on snow.  

everytime I see my buttons I smile

Did you know that you can't use tacks or push pins on the walls of cubicles?  I didn't until I moved into one a year or so ago at work.  I didn't let a little thing like that stop me from decorating though. 

Buttons make the perfect hanger-uppers on a fabric covered wall that you can't stick things deeply into.   Aren't these the best?  I love them.  Everytime I see my buttons I smile.   Pam made them and sent them to me to try on for size.  I am so happy they fit!

a tale of two neighbors

Raise your hand if you have ever watched a movie about someone who was dying, in the hospital, on a ventilator, and the patients husband was conflicted about whether to take her off life support.   Keep your hand up if you yelled at the screen "pull the plug you dummy, no one wants to live like that",  OR  "don't give up,  keep trying, she might make it".  

I recently cared for 2 patients right next door to each other in the hospital who had both had extensive strokes.   Betty is 75 and lives with her daughter.  She has been pretty independent  prior to admission although declining somewhat over the last 6 months.  The stroke affected her ability to speak and eat, she is now pretty much confined to bed, and is not interacting with family.   Her doctors are telling her daughter it is unlikely that she will recover to her previous state of health.  They want to know if she would want a feeding tube.   

Bill is 62 and had been pretty healthy until he had a sudden stroke and is now completely unresponsive, his kidneys are failing and dialysis has been started.   He has a tracheostomy tube  as well as a feeding tube.  His wife tells us he would not want to live like this but his kids refuse to give up on him and she does not want to go against his kids.   She is now faced with having to make a decision to transfer him to a facility that can take care of a patient with a trach, a feeding tube, and also be able to do dialysis or get hospice involved and stop dialysis and the tube feedings.                                            

There are no right and wrong answers in these scenarios.  What IS important is that your family knows what you would want.  Don't tell them to "pull the plug".  It's rarely that simple a decision.  Don't tell them "you will know what is the right thing to do for me",  they often do not.   You can make a very hard time easier by having "the talk" ahead of time.  Identify what is an acceptable quality of life to you and what sorts of things you don't want done.   

Betty's daughter was pretty sure her mom had lived a good life and was "ready to go".  She did not get a feeding tube.  She went to an inpatient hospice facility and died surrounded by her family 7 days after she left the hospital.    Bill was transferred to a facility that could care for   him.  It is not real close to his wife.  She visits when she can.  His kids are still hopeful that he will get better.                                                                                                                                                                    

she helped herself feel better by talking about things she was really good at

Way in the back of my front garden, where I sit to watch the annual Alium show unfold, there lives a lovely selection of Columbine.

You might look at these and think "good fill in flower, low maintenancy, hardy, comes back every year" and so forth and so on.   When I look at them I think about Charlene.  She was one of those very graceful, refined, women I had the pleasure of taking care of in the hospital about 7 years ago.  During her stay she had some rough days when she felt terrible.   One of the ways she helped herself feel better was by talking about things she was really good at.  She taught me about the lovely Columbine and when she died her daughter sent me a package of  these seeds from her garden. 

I remember Char much more for our talks about gardening and knitting than I do for whatever kind of cancer she had.   I paid close attention when she told me about where to plant these and how not to give up because it might take a few years for them to get really established.   She sure was right. 

Charlene also taught me that people who are sick and dying have stuff they need to pass on, if I just stop, sit down, and listen.  That is powerful medicine. 

a super hero trying to pass himself off as a palliative medicine doc

I just got back from 4 days in Denver, Colorado.  Unfortunately this is as close as I got to the mountains.

Fortunately, I did see lots of other things.

I was at a Palliative Care conference.   More about that later.   I need to tell you 2 important things. 

I saw a super hero trying to pass himself off as a palliative medicine doc.   I wanted to tell him he forgot to take off his lightning bolt enblazoned body suit before he put on his regular clothes, but I just couldn't bring myself to.

AND - I learned how to use a mobile boarding pass.    I feel so technologically accomplished. 

sadly caught up in the moment

If you are going to boldly go where you have not gone before it's a good idea to go with someone fun AND reliable.   Someone who says what they think, expects you to do the same, and doesn't get their bowels all in an uproar when things don't go just exactly right.   

A person like Nancy.  You've met her before.  She's one of the quails.  BUT what you don't know is that we have journeyed together into the world of nursing research.  Our subject?  Bullying in nursing.   What we learned from our research and from hundreds of conversations with nurses about this topic has lit a fire under us.   Enough of a fire to make us engage in some scholarly writing that has just been published. 

I had Nancy sign this so when I pull it down off the shelf when I am 90 I will remember we both liked to write with colored pens.   I don't know exactly where this whole research thing will take us.  I do know that as 30 year veterans of the profession we are committed to doing our part to break that cycle of nurses "eating their young". 

Here is a link if you want to read the article:  Sadly Caught Up

two brothers coming to see about their dad

This past week I met some real Kansas men.  They were not cowboys.  They were not farmers.  Just 2 brothers coming to see about their dad.  Coming to find out what needed to be done.  I was in their dad's room at the hospital when they arrived, the one in camouflage coveralls had worked the night shift, so the other in his John Deere hat did the driving. 

We talked about how their dad was dying, and wanted to get home and see his dogs.  Not a word did they say about their lack of training.   It was just understood that what their dad wanted they would do.   We talked about getting hospice set up for services and support.  I asked if they had questions.  The older brother took out his wallet and said  "my Aunt wants to know this".   He handed me a small piece of paper with these questions in neat cursive writing.

1.  How much time does he have?
2.  How can we make him comfortable?
3.  What is the best way to get him home?

We talked about every one of the things on the list.   I did not hem or haw, just gave them straight answers.   No notes were taken.  He tucked the list back in his wallet.   Then they gathered themselves up and headed down the hall.  Side by side.   Two Kansas men.   Going home to get things ready for dad. 

exactly 117 times

Each day at work, on the walk from my office to get a cup of coffee, I pass under this.  

I have now walked under it exactly 117 times.    I like to examine it from all angles.

I haven't found a bad perspective yet. 

my comrades in nursing

Thanks Dianne for sending me a message about this video yesterday.  This short film, We All Came Home:  Army and Navy Nurse POW's in WWII,  was made by the department of defense.  In it a group of nurses who were held prisoner  by the Japanese in WWII tell of some of their experiences.   It's about 28 minutes long and worth a look.  I am not sure what year it was filmed - based on the style of spectacles I would say perhaps in the 1980's?  What a gift to get to hear bits and pieces of their stories from them! 

My WWII nurse comrades, I salute you.

Photo from yorkblog.com

Ruth McClain, WWII Navy Nurse Corp at veterans parade in 2008. 
Photo from http://tnwwiireenactors.homestead.com/mission.html

the main character should write the last chapter

Have you seen Stephen Kings' book, "On Writing"?  It's been awhile since I read it,  but the thing that stuck with me was his notion that each of us is the main character in our own story.  I think about that a lot.  Everyone's life is a book.  Each person the hero of their book. 

I was reminded of this last week when I met a woman at work who wanted to get the heck out of the hospital.  She told me me she needed to get home so she could take care of her plants and work on writing her obituary.  It's not often you meet someone who has thought about their death enough to know they might want to do that.   In a real way.  She told me she wanted to say goodbye to some people and thank them for what they had meant to her.  And I thought of Stephen King because of course the main character of the book should be the one who writes the last chapter don't you think? 

I read a great obituary about 10 years ago.  In it the woman reported that she had been the "May Queen" of her home town back in 1956.  It's these little details that people want to tell that someone else might overlook in the writing of accomplishments.   I'll be looking for your obituary Jerline.  I want to read the things you thought were consequential about your life. 

Make new friends, but remember to keep the old....

The best thing about leaving friends from an old job?

 
Making plans to meet up with them outside of work!    

 
One can really not have too many after work coffee dates.  Those girl scouts (or was it Brownies?) knew what they were talking about. 

A sense of optimism prevails

I snapped a photo this morning as I crossed the threshold to my new job. 

 
Compositionally this picture has many flaws but it will trigger memories in years to come of the drive in this morning, of walking up to from the parking lot and staring at the sky, and the sense of optimism that prevailed.    It was a great first day... and I found out where the coffee aficianados get their morning cup of joe on campus.   I predict tomorrow will be even better.   

A good measure of unease barking on the periphery

I have had a case of the "weepies" off and on over the last week as people find out I'm leaving my job.   That little catch in the throat.   The quaver in the voice.  The sure knowledge that at any moment the tears are going to spill and your nose is going to drip, even though your brain is sending the "cease and desist" message to the crying center.  

     
These are some of the people I work with now.   Friends I have made over the last 26 years.  People I could always count on no matter what the day might bring.  I am going to miss these smiles. 

I can still recall the day in August of 1985 when I clocked in and started my new job as an oncology nurse in the big city.  I made that choice based on a gut feeling that it was the right thing for me.  I'm trusting that gut feeling again.   Right now I am feeling optimistic, but I won't lie to you.  There is a good measure of unease barking on the periphery just to keep me on my toes.  

I think that's the way it's supposed to be. 

Item #3 on the list has been crossed off

This is a Kansas sunrise.  Everytime I see a pretty one I say to myself - That's it.  The prettiest one ever.  I better get a shot of that.  I have lots and lots of photos that look kind of like this.   Captured quickly, while driving and through a dirty windshield,  it's not perfect, but it captures the essence of my mornings. 

 
The moon however is a totally different animal to photograph.  Getting a good shot of the moon has eluded me thus far.   I remain undaunted.  So determined am I that I have put it on the "52 by 53" list.  Item # 39 reads like this "learn to take a decent photo of the moon."  Speaking of the list,  I had a phone call this week, and look what came in the mail today.

 
Did you notice the color of the sticker?  Did I tell you that the recruiter I had my first interview of the day with was wearing my new shoes?  Item #3 on the list - "get a new job"-  has been crossed off. 

Are these the shoes that will seal the deal?

When I was 26 years old I started working at the place where I remain gainfully employed.  I have now worked there for almost exactly 26 years.  One half of my life at the same place.  Does anyone work at the same place for that long anymore? 

As kids growing up, we moved around a lot.  I went to a total of 10 different schools from 1st through 12th grade.  It's what we did.  We didn't think about it much except for those first few days in a new class when I know I got a little nauseated, sweaty, and nervous about being the new kid again.  It always passed.  We adjusted.   I think maybe that did something to me.  Made me need to change things up, start over,  see if I can jump in feet first and adapt to whatever situation I find myself in. 

So all this preamble is to say I got a new pair of shoes this week.  A new pair of shoes for a job interview.  If you saw me walking in your office in these shoes would you hire me?  All other things being equal I mean.

 

Ok well how about if I told you that I pulled off on a street I don't live on when I was driving home from buying them and sat on the curb and took a photo of my feet in them because I thought the background of the old cobblestone streets would be cool?  Would that much information and eye for detail convince you or scare you off?