One of my classes this semester is Nursing Care for the Older Adult. With all the pandemic stuff going around, we are unable to go to a clinical site for that portion of the class. We are making it work with having a clinical group online. For the past 3 Saturdays, I have spent 8 hours a day with 10 others learning about different ways to be mindful of working with the older adult population. I first got my nursing license in 2004 and spent just short of five years in various facets of long-term care. I worked in transitional care units, memory care units, long-term residential units, in an adult day center, and lastly, in a hospice unit. The hospice unit was my last direct nursing care job before I started with transplant in 2009. 

Our topic today was palliative and end-of-life care. I have a very concrete view of this area of care. Before I got sober, there were very few things about which I felt strongly. I had lost a lot of my identity in those years and just talked out both sides of my mouth. With hospice and palliative care, however, I knew and know where I stand. Those views were formed when my dad was ill for the last several months of his life, battling cancer. In those last months, it was nothing but an amazing honor to have been with him and there for him in a meaningful way. He died at home, surrounded by love and his family. This time of my life was very hard, of course, with losing a parent and being an early teen. However, the nurses I got to know when he was hospitalized were terrific. The family and friends that surrounded us for the months leading up to his death and afterward showed me how gracious the world can be in a time of sadness. What stands out most is that I was part of his care team and had these intimate moments of caring that not everyone gets to experience.

I shared a different story with the clinical group today. It's a story that I only share with select people. It's a patient that has stuck with me for over 12 years. I get emotional when I talk about her because the situation was so sad. I was working at Redeemer Health & Rehab, and I was on the hospice wing there. We had several patients pass during the eight months I was there. It's part of the job. It's challenging, but when I think of end-of-life care, I think of the incredible honor it is to care for someone and allow for a peaceful, comfortable transition to the next life. It was the first time in my nursing career (only really 3 years old at that point) when I felt like I was providing the kind of care that I wanted to provide as a nurse. It was incredibly difficult and incredibly rewarding. 

Our patient, D, was young. She came to our facility in her late forties with stage 4 breast cancer. She was visiting her family in MN (home was out of state) when she started feeling poorly and went to the ED at one of the local hospitals. She was immediately admitted and aggressively treated. She became so quickly deconditioned, she came to the rehab floor to get back on her feet. She was an incredibly neat lady. She was very anxious and terrified. She didn't like being with all these old people. She was a thousand miles away from home and wondered how her life ended up here. She was back and forth to the hospital for treatments and complications. One evening, I received a call from the nurse on the floor where she was at. "She is going on hospice care; her body has failed." I immediately advocated that she needed "to come home to us." The plan was to transfer her to a hospice floor at the hospital. Nothing against them, but she knew us. She should come home to us.

When she transferred back to us, her son came with her. He thought she was going back to rehab and was going to be OK. No one had the conversation with him that she was actively dying and only had less than a week to live. I finished my shift at 11:00pm that night and pulled him out of her room. I talked with him for nearly 2 hours about what was really happening. We were keeping her sedated because she would be in immense pain if we didn't. We were keeping her comfortable. He cried and wanted her to wake up to say goodbye. I had to rely on my experience with a parent's death and talk with him about things I had come to believe. "She can hear you. She knows you are there. I asked my dad to stay with us until I was done with something important to us both. He waited. I knew he heard me." 

D passed only a few days later. The aunt and the son decided to have her wake and funeral at our little chapel. "She received more love and care from you guys in the last 2 months of her life than she probably received in her whole life. We wanted for you guys to say goodbye." Many nurses attended the service. I said a prayer to her thanking her for having a significant impact on my life. I thanked God that she was free of pain now. I prayed for her son and family, who lost someone so quickly and so young. I walked back to the floor and started to care for my other hospice patients. I lost another patient that night who I had also come to enjoy. D has stuck with me for a couple of reasons. I advocated for something I truly believed in - something that rarely happened in those drunken years. She made me the nurse I wanted to be. She allowed us to take care of her at her most vulnerable time. She helped me to understand compassion. She was not always pleasant to us. She had a sharp tongue. However, I believe that our request to have her come home to us made a difference in the end. She passed comfortably in her sleep with love and her family. Her family allowed us to honor her and say our goodbyes.

I teared up a bit as I shared this story. If you talk to any nurse, some patients and situations just stay with us. I had the whole clinical group on the verge of tears too! I received all this beautiful feedback from the group via private messages. One of my classmates said, "What is your sign?" I am a full-fledged Aquarius. "Your Aquarian heart is going to change the world," she wrote. "Just don't forget to slow down and realize that you already have." Pretty wise advice from a person I have known for 18 hours of my life. I just stared at those words. Since getting sober, I have felt like I have something big to do. I don't know what it is. I feel like I can make this huge impact. Aquarians (or maybe it's just me) tend to think big. I want to make a huge impact. I want to be a motivational speaker that changes lives for the masses. I guess I can get sort of loss and pass over the differences I have made to people over the years. 

I still think my biggest accomplishment in my life was getting sober and staying sober. The empowerment I felt in changing my own life was so refreshing that I want the world to feel that way! I want to talk to people to let them know that they can do it too. I will never forget the darkness, and I will always remember who were the lights that help me find my way out. I suppose I could say I have a message that I want to share with the world. I am now working a job where recovery isn't an active subject, and there isn't a whole lot of reason to say anything about it at this point. I am in a school where substance use disorders are not the main topic (yet). It just made me realize that I have passions outside of recovery. It's not like I forgot about them; I have been just super focused on the recovery piece for the last six or so years. It is sorta nice to connect again with a few things outside of recovery that are important to me.

I tell people that I am not sure what I want to do when I grow up. That has to be pretty obvious as I am sitting here in school for the 4th time. Recovery is so important to me, so I keep thinking that a career related to recovery must be the place I need to go. What I fail to consider some days is that recovery is a part of everything I do. Today, I woke up in recovery so that I could go to school, get some errands done, and write this blog. Recovery has given me my passion for life back and a connection to the value system that is most important to me. So, should I become a mental health nurse or an ICU nurse, recovery plays a huge role. I have learned resiliency with recovery. After D's death, I went on a bender for a week or so. I didn't want to feel the emotions of her loss. Today, I shared the difference her passing made in my life. Being sober and resilient makes me a candidate for all sorts of options. Recovery is the foundation of it all. 

The last few weeks have been such a fun ride. I enjoy my work so far and engaging back in that technical nursing piece. I feel like all these experiences I have had in life (good, bad, or otherwise) have a new purpose through this clinical experience. I am actually enjoying that not everything is about recovery at the moment. Recovery will always be the most important thing for me because I will have nothing without it. I am starting to realize that maybe working full-time in recovery services is not quite the answer. One way or another, I will always remain connected to it, and it will always be a part of my perspective of things. There is no shortage of addiction issues in nursing in any specialty. I see it in transplant regularly. I see it in working with the older adult populations. I see it in mental health. I think I am coming closer to finding the balance.   

So, all in all, life is moving along. I am taking a moment to think of the people who have told me I made a difference in their lives. I am fortunate to have heard this more than once. These moments are changing the world just a little bit. A change of focus is never a bad thing. My Aquarian heart still has lots of love and compassion yet to share. Eventually, I will figure out the best place for it.

J

I think the last time I worked a straight night shift was 2013. Since 2013, I have been on the day shift and for the past 10 months on evenings. With daylight saving times, a full moon, change in the month, and getting used to sleeping during the day, life feels a little confusing. I got up yesterday at 10pm. I kept having to remind myself what day of the week it was. I bummed around the house, did a little cleaning, played some video games, and watched a movie. At 8am, I was out the door, did my grocery shopping, Christmas shopping, hit the Goodwill with donations, hit the bank to cash in some excess coins, and got some gas for the coming week. It dawned on me that 8am was such a big deal for getting up previously. Why such a big difference?

The night shift makes me happy. I can't explain why. I like sleeping through most of the day. I enjoy the quiet of the night. My mornings are productive, and I go to bed at 11am. I like not having traffic on either side of my commute. I am oddly energized by this schedule. Are some people just hardwired for nights? I really think I am. Honestly, I was a bit concerned that straight nights would be hard. Since starting my new job, I have been more productive at home than I have been all year! I can't help but think that I am on my ultimate schedule. 

When I was discharged from my first inpatient treatment, my aftercare plans provided by my counselor suggested that I not work nights, not work 12-hour shifts, go to sober living, attend aftercare, and sign up for the monitoring program (as I was obligated by law to do so). Well.....I attended 2 sessions of aftercare and got into a verbal altercation with another group member. I told the counselor it was her or me. They weren't going to ask her to leave, so I did. All those other things.....I did not do a single one. I continued to work overnights. I continued to work 12-24 hour days. I went home and managed to sneak by without reporting myself to the Board of Nursing. I stayed sober for 60 days.

I started working straight nights in 2009. Before that, I worked evenings, then days, then back to evenings and then nights. I tried a Monday-Friday office job and was laid off in mid-2009. When I was offered the transplant position, I trained on days for a month or two and then went to nights. I had managed over the years to have friends who worked similar schedules and never had a significant problem connecting with other people. We night people are a strange lot....we are also a lot of fun, in my humble opinion. I was so happy to get back to nights. In terms of my drinking, the problem is that working 12-hour shifts made it hard for my drinking. I simply didn't have enough time to get home, get drunk, and then recover before needing to go back in. The kicker for me was the 24-hour shift that I worked once a week. It became impossible for me not to drink for 24 hours. My withdrawals were too bad. That was the downward spiral that ultimately landed me in detox and treatment. 

After I finally got some sober time under my belt, I was happy working nights. I had a great co-worker, too, which made the nights go by quickly. I did a sober "no-no" by playing around a lot with my sleep schedule on my time off. I would do a little sleep deprivation to get back onto a "normal" schedule so I could do things on my time off. I have generally happy memories of being with my family a lot and having ample time for friends. When I think of 2012, I was the most satisfied in my sober life during that year. Oddly, working nights as part of happiness. Somehow, my job doesn't feel like it gets in the way of the family and social things I like to do. 

Part of my reason to switch to nights had nothing to do with liking the schedule. I was more fixated on making school work. I don't get a lot of notice of scheduling changes, and now I am in clinical rotations. All the class times and clinicals seem to plop right in the middle of either day or evening shift. While I had a lot of flexibility with my schedule, it just seemed like too much to change every other week to meet my own needs. Nights just seemed like the best option to keep work outside of the schooling needs. A couple of weeks in, I am happy as a clam. The job itself is not overly stressful. There is just enough steadiness, so I can be active. The patients are complex. Let me tell you, it feels good to be nurse-y again. G-tubes, vents, trachs, suction, dressing changes, medication administration, and catheters....there is something that makes me feel proud about being competent to provide this kind of care. The added bonus is that clinical rotations are generally online or through simulation right now. I can get my hands-on skills through the job for the time being. 

I think back over the past seven years about the struggles to be a day shift person. I don't know why I cannot get out of bed at 7:30am. Yet, I am ready to hit the door running at 8am as long as I have been up all night. I knew when I left counseling that I would go to a later shift. Evenings were OK for a while. Nights are feeling much better. I work 10-hour shifts now, which I also like better. Fewer days, still enough hours. As long as I am already there, no problem putting in a couple of extra hours. I don't work more than 2 days in a row, and my weekend off is a 4 day weekend. I am on an eternal grid, so I know my schedule until the end of time. Am I working on July 22nd, 2023? I could actually figure that out and tell you. Consistency goes a long way for me,

Each year of sobriety has brought happiness, challenges, disappointments, achievement, support, new friends, tough times, and times of celebration. I have been chasing the overall satisfaction of 2012. That year was great for work, great for social needs, great for motivation to do something new, challenging to keep sobriety going, and so much time with my family. Of course, there were challenges in that year; however, the future's excitement was well and alive. I had things I was looking forward to. I was also learning a new way to live. I was surprised and delighted when I could actually be sober and like it. Let me tell you, I spend an extra 3 years intoxicated because the fear of being sober was so terrifying. Today I wonder how I managed to live like that for so long.

At the beginning of 2020, I felt that things were going to change for the better. I was happy and sad to leave counseling. I knew that was for the benefit of my sobriety and sanity. I took a giant leap and started school again. I settled into a job which, for many months, was incredible. Despite COVID, quarantines, and a whole lot of unknown, 2020 is turning out to be an OK year for me, all things considered. I valued the time more than ever with my family when we could be together. I ended up working outside of the home, which is very important for me. Had I been working from home, I would not do well. I had a lot of socialization with my work family and clients. I needed these things to survive in 2020. 

2020 has been a year of significant changes. I have a hard time with change; however, I experience a really positive change every once and a while. While I did not like leaving my most recent work family, I know I did the right thing. I followed my mom's advice to really look into jobs and feel good about the position I was taking and not just jump at the first offer. It was a significant change for me not to do that!! I am most happily surprised that the night shift is working out very well for my needs right now. I am working just the right amount of hours to still make school work. I am also feeling productive again. I missed this part of myself, and it's been a bay for a long time. I miss running around and getting things done. I miss not being on top of my home cleaning. I miss not working on the painting around the home. I lost the motivation for all of that. I let things slide more than I would be proud of if you walked into my house. I am finally digging out and feeling organized again. I guess not all change is bad, after all. 

More to come!
Julie