The Big Picture

She was the kind of crazy that made me feel boring.

“I did climb Mt. Evereset during chemotherapy.”  She confirms while pulling up pictures on her Iphone.

Mt. Everest under the chemotherapy influence, I think to myself, growing scared to view what has already happened.

“I got diagnosed with cervical cancer a couple months prior to the trip,” she continues while handing me her photos.

“My friend called me and said, ‘I’m climbing Mt. Everest- come.’  He had the trip all set up.”  She smiles.   “I hemmed and hawed for a couple days and then said to myself, It’s all set up for me! If not now, when?” She looks up smiling.

Somewhere in her 40’s, she carried a youthful look with her Birkenstocks and head of perfectly messy curls.  She stood tall and athletic, sporting a Budhha t-shirt and a flowery ankle length dress.  She was quirky, with a touch of spunk.

I know very little about her cancer history, her treatment plan, how long she was given or when it all began.  Her visit with me today was simply to draw blood work, which I finished minutes ago.

“That’s admirable,” I finally respond, looking up from the beautiful Everest landscapes.

“I had just gotten the kiss of death- I didn’t know how long I had…and still, I deliberated.”

“Yeah, well you were going through something very big.”  I offer.

“Which offered me the bigger picture.”  She retorts.

I nod, without response.

“I likely would not have gone without cancer,” she adds, almost crediting the cancer for her accomplishment.

It’s amazing what it takes to give us the big picture, I think to myself while spoting a beautiful sunrise on her Iphone.

“I would have waited for that ‘perfect’ time in the far off future, you know?” She adds.

I do.

“So I spoke with my Dr. and she approved it. I pushed my next treatment back a week and it all just fell into place.  So, I did it.”

She becomes less crazy the more I hear.

“I was definitely more fatigued than the rest of the group.  But we hired a top notch guide who carried my bags for me.  I needed to take regular breaks.  But I am so glad I went.”

I am overflowing with questions I don’t ask.

“If not now, when, right?” She smiles while handing me a postcard-like invite entitled Himalaya Adventures.  It is for a  yoga retreat in India.  We covered our shared love for yoga upon meeting.  The invite looked worn in, almost as if it had been passed along before.

“Come,” she demands as I immediately think of all the reasons why I cannot.

“Oh wow, thanks.” I accept, clearly noncommittal.

She notices.

“I finally decided I am going. I mean, again, here I am, stage 4 Ovarian cancer,” she pauses, “and I still deliberate.”

Fears can cripple us.  But fears can also be warranted, almost as a directional compass.  I suppose the balance lies in recognizing the difference.

“You like that picture?”  I am still holding her photo of the sunrise.

“Love it.”  I respond, eager for its’ story.

“That is the peak.”  She pauses, “they told us we would get up at 3 am to start that climb, but if it was raining, we would go back to bed and instead start the climb down, at our leisure.”  She chuckles.

“I secretly hoped for rain.  But there was no rain.  And Im glad because it was the trip highlight.”  She pauses, smiling at the days’ memory.

“We climbed, and climbed, and climbed some more.  I got dizzy at parts, the higher we climbed.  We arrived a bit before 5.  When we got to the peak it was cloudy and foggy.  We waited a couple of minutes and my friend and I both gave an, ‘oh well, enough waiting, lets head back down’- you know, typical Americans, in a rush to nowhere”.

I laugh, knowing that act all too well.

“The guide looked at us and said ‘Patience.’  So we waited, and waited, and waited some more.  And then suddenly, the clouds opened up to an amazing sunrise.  He knew.”  She smiles.

“He looked at us and said, ‘Some things are worth the wait.’  And this was.  The view was breathtaking.”  Her smile expands as she loses herself in the memory.

She finally looks up. “It sure as hell beat my living room view.”

I chuckle and offer an ‘I bet.”

For my patient it took her cancer to see the big picture; to take her from the bubble of familiarity and routine to tread oceans to somewhere new.

But Mt Everest was more than just a feather in her cap.   It was finding that adventurer inside, that strength when she was weak, that dose of crazy.

We all have that adventurer inside.  Yet, sometimes, wait for life to come get us, or our friends to join or for romance to enter and accompany us.  Sure, there are finances, and logistics and the unknown, but a little tinge of fear is what keeps things exciting.

We part ways as I hand her back the yoga invite.

“No, keep it.  Maybe you’ll make it,” She offers a smile that says, “Someday.”

I smile knowing.

Knowing that, for each of us, it takes something different to get us outside of our living rooms, to a sunrise atop Mt. Everest, to a yoga retreat in India, to the big picture.

And some things are just worth the wait.

 

 

 

 

 

A Laugh A Day

“Laughter is believed to have originated as a primal way of communicating relief from danger: that something potentially dangerous turned out to be o.k.

Thus we laugh with surprise and delight.”

- Psychology Today ‘Laughter’

His smile alone made me laugh. It held itself a bit too long, almost knowing something humorous was on its way.

“What is your preferred name?” I ask, reading off the admission questions.

“’Tiny.’  He offers a hearty belly laugh, clearly loving his own joke.

Built like a football player, with broad shoulders and a husky frame the only ‘tiny’ related to him is his hospital bed.

“You liked that one?” He asks laughing some more. It is the kind of laugh that spreads laughter well beyond the joke itself.

“Very much so.” I attest.

“Good.” He gloats as he sits up a bit taller.

I chuckle and finish his admission questions.

I leave his room feeling better about my long stretch of 12 hour shifts. I am on day 1 of 6 and was a bit daunted about the stretch.

I re-enter his room no more than an hour later and am greeted with a ‘What-took-you-so-long?”

I do not recognize the seriousness.

“Did we have something set?”  I am confused.

“No, I need some water,” he responds curtly.

“Oh,” I pause, still waiting for the punch line. He is not bedridden. He can take a walk or reach for the call bell.

“Well you can reach me with the call bell, you know?”  I motion towards the bell attached to his bed.

He looks at me straightfaced, “I know.”

I am totally perplexed, “Oh.” I pause hoping he will elaborate.

He doesn’t.

“Why didn’t you?”

The silence builds as I stare at him, confused.

“Lazy.” He breaks the awkwardness with a belly laugh.

I join in.

He is a family man, with young kids and, I imagine, a busy, full house. My guess is its too quiet here in the hospital. It may be more loneliness than laziness right now.

I give his morning medications. We chitchat. When I leave he stops me.

“I thought of something for these stupid call bells.” The call bell is now at fault. I chuckle. “What’s that?”

“Make them voice activated because finding these is a guaranteed effort. I mean really, my call bell fell and I was SOL.”

I laugh but give him the you-can-walk look.

But he is right. The call bells love to burrow into the dark beds crevice and never return.

When I come back in I awake him from a nap. He complains of a backache and chest pain. Any chest pain raises concerns of cardiac issues. I notify the doctors and he is ordered for some tests, all of which he needs to depart the floor for a stretch of time.

“The Dr. ordered some tests for that pain so you are going to leave the floor for a bit. Transportation will be here shortly.”

His face reddens.

“What-I have to go somewhere?” He is growing annoyed.

“You do.” I respond matter-of-factly.

He throws up his arms.

“Oh forget it. Tell them nevermind. I’m actually fine.” He is annoyed he has to move.

He looks at me with an eye roll, “I’m not telling you people anything anymore.”

“We just need to make sure everything is alright.” I offer.

He looks up at the TV and sighs.

“Well I need to watch the Jersey Shore.” His face lightens as he mocks my Jersey heritage.

“Come on, its fist pumping time.” The belly laugh breaks out again, as I watch his fists dance in the air.

I laugh out loud with him.

As I exit his room, I forget about the long stretch of shifts ahead of me. I forget about the long road of chemotherapy ahead of my patient. Instead I embrace some silver lining.

I laugh some more.

It is a great feeling, an expansive, all-encompassing emptiness.  The good kind of emptiness, the kind which leaves nothing but the humor itself to think about.

Life throws its challenges. For me, it was the stresses of my profession; for my patient it was a battle against cancer. Although vastly different, for both of us, humor helped us rise above our stresses and escape our realitites.  Humor offered that escape to feeling relieved, good, temporarily free from dis-ease.  I guess, in a way, we all rely on humor to get us through our own life dramas. Humor offers that necessary distance to view our suffering, a different perspective, hope during despair.

So, as we hope and fight and rush and run, or whatever it is we are doing, let’s pause.

Let’s pause and savor a laugh.

Because there is a greater connectivity with the world at large if we can laugh our way through it.

Life Between Chemo Cycles

He speaks with an intensity and conviction that makes me want to listen.

“No one knows I have cancer.”
“Really?” I am surprised.
“I will go to work tomorrow at 9 am,”  he pauses, “And I no longer have hair, so maybe they wonder, but no one but my family knows I have cancer.”

I nod. Usually patients find blogs or mass emails to update their latest progress or setbacks.  They feel it simplifies responding to the concerned masses.  I guess support can be as overwhelming as it is comforting.

“Why do you withhold it?”  I inquire.

He looks at me sternly.

“If I tell people they will feel bad for me, sympathesize, treat me differently. I do not want to feel like I have cancer.  I do not want to believe I am sick. I want to go on with my life, doing what I love.”

This is a nice change of pace for me, working in an environment where my patients can go home after treatment, or back to work the next day.  They can live a life between chemo cycles.

“I see,” I mutter as I think about the psychology factor at play here.

He does not want cancer to define him.

“So, as long as I have no fevers, I can still work.”

I nod.

Fevers are an emergency in the oncology world. Fevers likely indicate a foreign attacker invading the patients body. With a weakened immune system, due to the cancer and chemotherapy, the fight against a foreign attacker is much weaker. This could lead to a massive attack, spreading throughout the body, and at its worst to the organs.  If intravenous antibiotics are not initiated immediately, fevers, for an oncology patient, could be life threatening.

“I hope for no fever this round.”  He states as I hang his chemotherapy.

“I hope not either.” I respond, meekly.   He is older, at an age where studies are inconclusive on whether the geriatric body can tolerate the compromising effects of chemotherapy.

I remind myself of this man’s spunk.  He carries an unrelenting passion for his work.  A passion that is not folding in the face of cancer.

In time I come to learn from my peers he is a master of his speciality. As much so as a Hall of Famer, a well renowned surgeon, or a Noble prize writer is a master in theirs.  Our subject matter shifts from his cancer to his career.  I think I like hearing about him as much as he likes telling me.  But he is humble in his conveyance,  honing in on his history of setbacks and powerful teachers.

Cancer can not define him, I think to myself.

When his treatment finishes, he invites me to his upcoming performance in town.  I am excited for the new opportunity, I’ve never experienced this type of show before, but am most eager to witness him performing.  It is something new, experiencing a patient detached from an IV pole and engaged in a life between chemo cycles.

We exchange goodbye’s as he gathers his belongings and exits eagerly.  His passion awaits him.

**************************************************************************

As I sit, eagerly awaiting his performance.  I hear my patients name in an annoucement.  He is taken ill by a fever. He will not be able to perform.  I am in the small population that knows it is his cancer.

The show proceeds with his backup as I oscillate between the melody and sadness.  Thoughts of fevers and relapses monopolize my mind.  Eventually the melody works its way through my meloncholy.  Eventually the music captures and moves me beyond thought.  Eventually I am lost in a beautiful performance that just makes me want to listen.

As I walk towards my car, I think about my evening.  It was not the glimpse of a life between chemo cycles I envisioned, but it was still something special.  It was a new experience, a dose of greatness.

For me, greatness is more than a list of accolades.  Greatness is in our path of setbacks.  Greatness is in our passions shining through those we have touched, even in our absence.

Greatness is in our teammates, our teachers, our inspirations. Greatness is in doing something with real fervor, even if the outcome is a loss, an unacclaimed title, a fever.

Tonight, I experienced a performance that just made me want to listen.  Perhaps because it was a glimpse into life between chemo cycles afterall.

Happy Hours

It is Christmas Day and I have the 11 am to 11 pm shift.

“Doesn’t get much worse than that,” says a good friend on the phone as I walk to work.

“I know.” I retort, suddenly envious of her day spent beside family.

But, actually, it does get worse.

She was young, by today’s standard, but cancer does not discriminate. She was admitted to the hospital late last night with a sudden inability to move her legs. She could no longer walk. The cancer has spread.

Her smile envelopes the room as she introduces her ‘pack': many adult children, in-laws, nieces, nephews, sisters and a husband whose love is immediately apparent. They embrace me with warm smiles, extending a hand or a wave and wishing me a Merry Christmas.

“Thank you,” I respond, in awe of the energy. “Same to you all,” I wave as my body does an awkward 360-step around the room. We laugh. They are an invigorating bunch, despite the grim circumstance.

“Welcome to the pack, Tara,” my patient offers me a warm smile. “We look forward to sharing our Christmas with you,” she hands me an ornament, “go ahead and place that on our Charlie Brown tree for me.” I spot the tree in the back corner, impressed by their spirit. I nod and make my way past the crowd. I fill an empty space on a fake branch and notice, for the first time, the handwriting on the ornament.

The words scroll across the ball, “Happiness, not in another place but this place; not in another hour but this hour.” I notice the room is now silent.

I look towards my patient, “Did you write that?”

She nods, “I did, but I cannot take credit, it is a Walt Whitman quote.”

I nod offering an appreciative smile, “It is great, thank you.”

Throughout her assessment she remains positive, inspiring, insightful. There is no evidence of pity or anger. It’s revealing, reacting with such an appreciation for simplicity. But her disposition; the soft eyes, embracive smile, her keen perception; all make me wonder whether it has anything to do with her bleak prognosis. It may just be the way she lives her everyday.

I think about the way I live my everyday as I contemplate why I was the chosen one to deliver the ornament. Was my desire to be somewhere else today THAT apparent.

I sigh.

Through the course of my 12 hour shift I frequent their room, engaging in some storytelling, dinner preparation, even a quick round of charades. They invite our entire staff in, from other nurses to custodians, for their home-prepared Christmas dinner. When my shift ends I thank the remaining ‘pack’ for a very nice Christmas. As they depart for the night I make my way towards my patient’s bedside. She extends both arms as I welcome the hug.

“Thank you for everything.” Her eyes are teary.

“My pleasure,” I respond awkwardly as I notice tears streaming down her face.

For the first time today, I notice the room is empty.

“What can I do to help?” I ask, recognizing sadness setting in.

She motions towards her legs as her husband re-enters the room.

Together, we reposition each leg but neither of us can find those perfect words.

I’m learning that sometimes there are none.

My patient starts giggling, “That tickles!” She screams as her husband’s fingers run down her foot’s sole. He continues to tickle torture her feet, knowing she cannot move them away.

She is belly laughing now, the contagious kind that catches like a forest fire.

A pillow fight unfolds as I make my exit.

My legs ache beneath me as I stand in the elevator, digesting my unordinary Christmas. Today I gained a Christmas with a family who, under ‘normal’ circumstances, I would not have shared the holiday with. A family who helped me look past the where I’d rather be, who I’d rather see, what I’d rather do, and enjoy the day. A family, who, despite bleak circumstances, found happiness behind a cancer centers’ doors.

I walk home reflecting on this great message.  Happiness itself is the way to live life. It is not something that we are going to get in the far off places of our tomorrows. Happiness is not a destination. Happiness is conjured; it’s created. It is actually in the walk to work.  It is in a Christmas morning conversation with a good friend, a game of charades, a tear turned tickle fight. And, believe it or not, happiness is in Christmas Day at work.

Describing the Indescribable

“How was work?” I am asked, yet again.
“Fine,” I pause thinking of how I could possibly elaborate on my day and be understood.  The thought exhausts me.   Instead I yawn and muster an, ‘I’m exhausted.”
But I do wish I could give a more descript answer and be understood.
And, maybe, I could.
If I did, I would start off with how many times a patient made me smile, cry, laugh.
I would talk about the insights I gained and the judgments I lost.
I might describe the number of times my heart rushed, opened, broke.
I could talk about the families I learned about, reassured and consoled.
I would describe the family that tried my patience, the family that pushed me away and the family that thanked me, endlessly.
If I could really talk about how my day was I would talk about the chemotherapy I questioned or the times I thought enough is enough. Or the times I thought that everything will never be enough.  I would describe the patients that left against medical practice because they had enough. 
I could talk about how I hoped a patient chose a different treatment option.
I would talk about the patient who fought for more treatment options despite having none.
I would talk about the patients I fought for and the ones that fought for me.
I could talk about the family whose loved one spoke a coherent sentence for the first time in days and how they took this small victory as a sign of hope.
I could describe how this family taught me about hope.
I might talk about the students I taught or the nurses I learned from.
I might talk about the patient that was fine and then suddenly…..wasn’t.
I would describe the rush of fear, split second decisions, priorities set.
I would talk about the teamwork in saving a life or life that just couldn’t be save.
I might talk about how many times I sighed and thought, ‘This isn’t easy.’
I would have an easy time describing the remissions, their eager exits home or visits back with proud life updates.
I might not want to talk about the relapses.
I might talk about how many times I felt annoyed, frustrated, sick to my stomach.  I might talk about the foul smells or gruesome images that I wish I could forget.
I might recite a patients’ word of insight I wish to never forget.
I would describe the family who shaved their heads, mustaches, beards in support of their loved one struggling with losing her hair.
I might talk about a moment of happiness, shared with a family, a patient, a colleague.
I would talk about a colleague that made me laugh till I cried.
I could talk about a colleague who cried and couldn’t really explain why.
I might explain how I played ‘rock, paper, scissors’ with a patient’s children.  I might talk about the pictures they drew, the questions they asked, the choice words I used. I might talk about how I fumbled for those words or how there really were no perfect words.
I could talk about the steps I walked; the hands I held; the ears I lent.
I might talk about echoes of ringing call bells, beeping monitors, screaming IV pumps lingering in my head.
I would struggle to talk about the postmortem care.  I would have a harder time talking about the goodbyes.  I would have the hardest time describing the unexpected losses.
Sometimes, when asked about my day, it is easier to answer with brevity.  Sometimes a ‘Good,” with a sigh; “I’m beat,” with a yawn, is all I can muster.
Because, at the end of the day, oncology nursing is as difficult as it is rewarding.  It is one of the hardest things I’ve ever chosen to do. It challenges me.  It exhausts me.  It inspires me. It empowers me.  
But perhaps the next time I am asked about my day, I will fight the need to be understood, gather the strength of my patients and answer instead with “It was indescribable.”

The Climb

We share the same age but much different stories.

“Since my diagnosis its been an uphill battle. There were small victories along the way but, overall, the treatments failed to suppress my cancer,” she pauses, “I did every option possible.” She sits up a bit taller. “But we can’t always win.”

There is a sense of calm in her poise, her delivery, her story. There is no quiver in her voice, no tears in her eyes, no uncertainty her words.

She tells me about her young child, her significant other, their wedding planning placed on indefinite hold. She tells me about her upbringing, her past relationships, her favorite music.

She pauses between thoughts.

“What’s your favorite song?” she asks with sincerity.

My mind draws blank.

“Great question,” I pause without thought, “I need to think about that.”

She looks at me matter-of-factly, “Well I don’t have much time,” she smiles while immediately adding, “my favorite song is kind of corny.”

I chuckle, “I like corny.” I lie.

Her smile remains, “Its ‘The Climb’ by Miley Cyrus.”

I don’t tell her my friend and I backpacked Europe to this as our theme song.

“I love that song.” I say thinking about whether, in her short lifetime, she was able to travel some of Europe.

“Really?” She is surprised but eager to explain. “I love the lyrics. The steps, the changes, the struggles and small victories; they are the moments we remember most. What’s waiting on the other side is only important when we are there, but no sooner.”

She continues, “There’s always going to be another mountain, an uphill battle, some we win some we lose,’ she pauses, ‘but life is about that climb in between. This stuff.’ She gestures towards me, I assume in reference to our conversation.

I find her disposition admirable. Her days were limited, and perhaps because of that, she wanted to appreciate this one. I’d like to bottle a dose of that present mind for all us forward thinkers. For the times I find myself counting the days till a vacation, hours left on the job or tasks left to complete. Perhaps then I would not be feeling a sense of loss, this premature mourn.

“I want to thank you.” I am stopped from thinking forward. I am caught off guard, I am the grateful one here.

She continues, “for asking about my story.”

My eyes dampen.

“Well it was my pleasure,” I respond awkwardly, I hate following a thank you with a thank you, but I do anyway.

“I would like to thank you as well,” I fumble unsure of where precisely my gratitude lies, “for my borrowed answer to my new favorite song.” I hear myself say.

Her smile widens.

It was the easiest muster of gratitude amongst a pile of difficult emotions. Truth is, my gratitude lies well beyond a song and answer. It lies in that dose of present mind; in those moments of standing still, after the small victories and before a big loss, to hear a new story.

Living Fully

“Don’t work so hard,”  he states with a touch of rage. Even sick he is vivacious.

“Really, don’t,”  he shouts.  I nod.

“Enjoy life more.  Go on vacation.  Spend time with people you love.  Do more of what you love,” he pauses, “because look at me, this isn’t living.”  He gestures to his hospital bed.  “I worked hard all my life, now I’m here.  I may never leave.”

The hospital bed, when faced with death, is a revealing platform of emotion.  Some become closed off, curt, angry; others open up, share their hopes, regrets, stories.

In time his anger lessens as his fears subside.  We talk about the past and his future. He tells me about his family, his dream car, his dream vacation.  He circles back to work and his 7 day-a-week-job; the supplier of finances yet demander of time.  He admits not noticing the steady incline in stress levels or the decline in doing the things he loves.

Until his diagnosis.

I see him again, months later, back for a visit.  His smile is ear to ear as he opens his arms, “I’m allowed to hug you right?”

“Of course,”  I respond as I embrace him.  He looks vibrant, refreshed, alive.

“We went on vacation,” he blurts out before I can ask any questions, “I took the family on a trip.”

His excitement is overflowing.

“You did?!”  I am equally excited.

He tells me about their dream caribbean vacation.  He tells me about his wife’s child-like euphoria the days leading up to departure.  He tells me about the amazing restaurants, breath-taking sights, budding friendships.  His excitement carries through the pictures he flips.  When he finishes he looks at me with a newfound  contentment.  “I’m working less.”

I smile, “I can tell.”

As oncology nurses, we don’t always see the life after the chemo, feel the energy from a second chance, hear about a life now living fully.  As a society we can be more attuned to the losses then the gains.  The emotions are more powerful, hit harder, have the ability to knock us down.

Today, I met a man who got back up.  A man, who, when faced with death, learned how to live.