On Being a Nurse

Journal Entry: “Spin”
October 3, 2021
It’s been almost two years since COVID-19 enveloped the world and
permanently altered my sense of reality. Daily, I try to connect the dots
of data that flood my senses about this pandemic so I can form a
cohesive and comprehensive picture. However, there are too many
moving dots. They turn and twist like a tornado demolishing everything
in its wake. Information, misinformation, and disinformation lock me
into a perpetual “spin” where nothing is recognizable. The only thing
left standing and unchanged is my faith and hope for a better world.

Journal Entry: “On Being A Nurse”
October 4, 2021
I've had a busy day at the UCSF Clinical Research Center,
implementing various protocols. One study of note is the BOOST study:
Building Optimal AntibOdies STudy. Although my role is to draw
blood, I am keenly aware that each tube illuminates a potential bridge
between the well-being and sleep patterns of patients and the longevity
of antibodies in their blood after a Covid-19 vaccination. Knowing that a
Nobel laureate, prominent scientists, and psychologists are weighing in
on this study inspires me. How vital we look beyond the isolated task to
the bigger picture! Sometimes we need to trudge through the mundane to
reach the treasure. Although my relationship with nursing is
complicated, it's these elevated moments that catapult me beyond the
grip of burnout.
I wrote a poem to reflect this sentiment:
On Being A Nurse
Today is like any other day
in a world caught in the clutches
of Covid 19.
Clad in mask and scrubs,
I climb the garage stairs
to the hospital where hope
and hands grope,
searching for treatments
for those adrift
in the murky sea of morbidity.
My heart and breath
acclimates
from floor to floor
as the stark blue walls clash
with the grim grey cement
beneath my feet.
My mind swims through
twenty years of images
of those who waded in this space
beyond our current reach.
I made it to the top floor
once more ready to work.
As I open the glass door
to the Clinical Research Center
A timeless proverb surfaces
from my memory to greet me:
A true nurse can be
"A true friend...
born for times of distress."
So I squeeze on
those gloves worn
of care and comfort
like many in my profession
have done before
and will continue to do so
the next time tomorrow.

Journal Entry: “A Widened Heart”
October 5, 2021
Yesterday, I was stripped of a long-cherished wish. I nurtured an
illusion like a lonely child who created an imaginary friend to fill an
emotional void. For two years, I lived in expectation. Our last words to
each other were, “I love you.” Agapé. This kind of love is based on
principle and is rooted in the unbreakable belief in its Originator. If it
burns in our hearts, we can conquer the world. I want to widen the
circumference of my heart-come what may.

Journal Entry: “The Battlefield”
October 7, 2021
This morning, I worked with two patients I am fond of because they
are kind and grateful for each day of life. One had a kidney transplant,
and the other was medically prepping to receive one. Maybe it’s their
being dehydrated, which can “flatten” their veins, making them difficult
to find, or it’s me having a bad day, but both patients had to endure
multiple attempts at intravenous access. When this happens, it tears me
up inside. I feel so helpless. Yes, we are medical professionals, but we
are also human.
I observe through my eye shield how both patients cope with the
limits of the care they are receiving today. One man groans and grimaces
and the other falls silent with downcast eyes. I fight the rising feeling of
frustration and ineptitude as I see small hills of escaped blood and saline
rise and then disappear, marking where we missed the vessel. At this
point, I want to give up, but I keep trying with the other nurses who have
closed rank to help. Finally, we get access, and I start and finish their
potentially life-changing treatments.
At discharge, both men thanked the nurses before leaving the
research clinic. Their jokes and smiles return. Patient and nurse alike
will sweep those unsuccessful attempts to the back of our minds because
we both have to show up to combat our mutual enemy again tomorrow.
Sometimes to conquer, but usually to fight back the relentless advance
of disease across the battlefield of our patients’ lives.

Journal Entry: “Flight”
October 8, 2021
Today, all UCSF employees are invited to join an extraordinary zoom
meeting with UCSF professor David Julius. Dr. Julius and fellow
neuroscientist Ardem Patapoutian recently won the 2021 Nobel Prize for
their joint work on molecular mechanisms of pain sensation, heat, and
temperature. Frankly, I don’t understand all the science behind their
discoveries. Still, it’s evident to me that their work shines a light on the
marvelous way in which we adapt to various stimuli and how that
change is crucial for our survival. Transformative medicine in pain
treatment is no doubt forthcoming because of its dedication. As a nurse,
I have seen many patients who desperately need something to mitigate
their chronic pain without addictive properties. I have a few more
minutes to focus on this interview and the Q&A that follows before I
close the research clinic. I am struck not just by Professor Julius’
brilliance but his honesty and humility. In other interviews, he mentions
his “long valleys” when looking for “peaks.” And that “most of what we
do is failure...only a small part of it is a success.” His sentiments
resonate with me. Will I walk through those “valleys of deep shadows”
in life to continue to pursue my calling?
On my way home, I see the Blue Angels tear through the San
Francisco sky. The rumbling roar of one jet engine ricochets off my car
window, and I feel as if something very powerful just passed me by.
Fleet week always draws crowds full of awe, and some with fear as their
eyes and cell phones turn upwards trying to capture this manufactured
might in flight. The traffic is heavy, but I finally cross the Golden Gate
Bridge to the other side into the city of Novato. I notice two large black
birds hovering above me, silent in the sky.

Journal Entry: “One For All, All For One!”
October 9, 2021
I waited for my Covid test results, which turned out to be negative
before I met up for dinner at a local restaurant with two friends who
were also fully vaccinated. The opportunity to “break bread” with loved
ones I used to think was “a little thing.” Now, I see it for what it is- a
“life-sustaining” activity. It nourishes our souls.
At the end of the meal, we ordered a huge chocolate dessert with
vanilla ice cream that we decided to share with separate spoons. Like the
three musketeers who brought their swords together in unity and
shouted, “One for all, All for one!” Our three spoons became “One” in
affection while we savored each bite!

Journal Entry: “Friendship And The Power Of Listening.”
October 10, 2021
This morning I met a friend for breakfast at a local diner, and she
talked about her experiences in a school that encouraged spiritual growth
and volunteer work. I shared some poems between bites of delicious
apple sausages, eggs, toast, and hot coffee. After a good meal and
encouraging conversation, I wrote and called my neighbors to share a
positive message.
A day like this reminds me of when I was redeployed to the CATCH
team, which stands for (Covid, Assessment, Treatment, Coordination,
Hub). When the pandemic first erupted, many people were afraid to go
to the hospital despite serious health concerns. One patient had chest
pain but refused to call 911 or go to the emergency room because she
was frightened of being infected with Covid. The charge nurse took over
the call, and thankfully, he was able to persuade her that she needed
immediate intervention. He remained on the phone with her until an
ambulance arrived at her home to rush her to the hospital.
I also remember calling a patient to arrange a pre-procedure Covid
test, but she couldn’t stop sobbing. While she unburdened her heart, I
realized she had a history of depressive episodes. The isolation she felt
due to the pandemic and her concerns about transportation because of
not “living in a good neighborhood” compounded her preexisting
suffering. I was worried that she had suicidal ideation, so I continued to
listen to her until she felt a measure of relief. I then gave her resources
and contacted her physician to follow up. This situation underscored the
power of listening and that it can be like a curative balm to a heavy
heart. A moment of our undivided attention to another person can be just
what they need to brave another day.
Later in the afternoon, I went to a graduation party held in a
backyard. It’s a difficult time for everyone but especially for today’s
youth. It was important to celebrate my young friend’s accomplishment
and her dreams: A future beyond this pandemic.

Journal Entry: “Blue Suede Shoes And Versed.”
October 11, 2021
It’s my turn to assist in a bronchoscopy. The patient today looked like
an actor, and after speaking with him, it turned out he used to work as
one! I comment on his beautiful blue suede shoes as he takes them off
his feet and carefully places them at the edge of the gurney. As I place
his IV and draw his blood for various research tests, we chat about his
favorite plays.
His vital signs remain stable, and he finally relaxes after the doctor
instructs me to administer versed and fentanyl. I monitor his comfort
levels pre, during, and post-procedure. He confides later that he has had
difficulty swallowing even before the procedure. I was surprised that he
volunteered to participate in the bronchoscopy in light of this
information. He questions the doctor about the possible causes of this
problem and then mentions the recent death of both his father and a
brother who was addicted to methamphetamine. My patient is surprised
that he has opened up so much. The doctor kindly listens to him and says
that sometimes the medications can result in people losing their
inhibitions. The patient then turns to me and says, “You are an
extraordinary nurse.” I smiled and joked, “It must be the versed,” and we
all laughed.

Journal Entry: “The Homeless Man And The Baby Shoe.”
October 12, 2021
Due to two sick staff calls, I arrived at the clinic earlier than usual to
open its doors and settle patients who had early morning appointments.
Today, I cared for a patient with cirrhosis waiting for a liver transplant.
Halfway through his treatment, my charge nurse took over his care so I
could go to lunch. I decided to take a walk. The fresh air, sunshine, and
the hustle and bustle of the city are a welcome distraction from the
stresses of the workday.
After I walked just three city blocks, I saw a homeless man in a deep
slumber, most likely induced by some addictive substance. His white T-
shirt was pulled halfway up his chest, and I noticed a black circle made
by a permanent marker on the side of his lower back. He must have been
in the hospital, and one of the doctors or nurses noticed a rash, so they
circled the area to monitor for possible shingles.
I feel like I am walking by a crime scene like the two “religious
people” who passed the man who was robbed and left to die at the edge
of the road in Jesus’ parable about the “Good Samaritan.” I comfort
myself that this is an impossible situation, and really what can I do? I
checked that he was breathing before I continued down the street. Guilt
weighed heavy upon my shoulders as I turned the corner and came upon
a little blue knit baby shoe on the ground. It must have fallen off while
the baby was being pushed in a stroller or carried.
A man waiting at a bus stop glances at my navy blue scrubs and says
through his mask, “Thank you for your service.” I glance up to meet
strikingly clear blue eyes and thank him for his sentiments. He continues
to say, “We don’t say thanks enough to you people... and firemen too.” I
thank him again and wish him a good day. His kind words are still fresh
in my mind as I return to work, but I can’t help but feel like a bit of an
imposter and that his words don’t belong to me. I think of how I stepped
around that man whose body lay helplessly sprawled sideways on the
cement. I wonder what circumstances and experiences led him to such a
solitary and desperate place. I also think of two mothers: one who lost a
shoe and the other who lost her son.

Journal Entry: “One Small Step For Man, One Giant Leap For
Mankind.”
October 13, 2021
This morning, a brain surgery patient arrived early to get vital signs
and labs drawn. The clinical trial he is part of investigates the efficacy of
two drugs that may repress tumor cell survival and growth. It’s
incredible how gene therapy has opened the floodgates for scientists,
pharmaceuticals, and medical professionals to explore and claim their
discoveries inside the human body.
These discoveries can span over decades of painstaking work,
unswerving persistence, and resilience in the face of many unsuccessful
launches. I imagine when one of the biomarkers for this study was
discovered that the researchers and scientists claimed it in the same
manner that Neil Armstrong from the Apollo 11 flight placed the
American flag on the moon and famously said, “One small step for man,
One giant leap for mankind.” Researchers are in a new type of space
exploration: the universe of the Human Genome.

Journal Entry: “The Great Resignation.”
October 14, 2021
I have heard that during this pandemic, many people are resigning
from their jobs to such an extent that they are naming this period “The
Great Resignation.” Some of my fellow employees are also moving on
to the next chapter in their lives, whether it involves relocating to
another state to be nearer to family, returning to school, or changing
employment.
I notice more tears, sick calls, and emotional outbursts due to
burnout. I have had difficult moments too, but I think my faith, friends,
and writing have been life jackets that have kept me afloat during the
storm that has deluged the world. I feel limited in what I can do, but I
will try to focus on “widening out in my affections.”

Journal Entry: “Fighting To Breathe”
October 15, 2021
My friend, recently diagnosed with lung cancer, called to ask me to
give her a ride to the hospital. I have been fully vaccinated, and she has
had the Booster. However, I took precautions and encouraged her to sit
in the back of my car and wear masks because of the increasing number
of “breakthrough” infections. From the backseat, my friend confided in
me that she will need her right mid lobe and right lower lobe removed.
She questioned me about her ability to breathe after the surgery. Will she
have to fight to inhale and exhale? I answer her questions honestly but in
measured doses. I am well aware of the journey she will embark upon
because I have worked as a nurse on the lung and heart floors. I am
careful to adjust my pace with hers and not run too far ahead by
bombarding her with information. The weight of all that is involved in
her recovery will be placed on her shoulders with each passing day, and
her faith and friends will be there to help along the way.
My nursing brain wants to compartmentalize her situation, but my
heart resists. As I hear her voice behind me, I crack the windows on both
sides of the car so that the fresh air can circulate. I imagine it forces all
things cancer out from the space that lies between us. We finally reach
the hospital’s parking lot, and I drive through the Covid testing area. She
pokes her head out of the window and drops her mask to get the nasal
swab. I then go in front of the entrance to get her flu shot. The whole
process takes less than an hour.
My friend loves to read, so after her appointment, we visited a used
bookstore downtown. Afterward, I order takeout at a local Mexican
restaurant while she sits alone in the car. While waiting for the food, my
boss phones and tells me that I have been exposed to Covid by someone
who was vaccinated. My heart sinks. Not so much for myself but for my
friend.
When I approach the car with her pork burrito and chips, I tell her the
bad news. I am beside myself with worry. To think that I could have
given my friend Covid who has lung cancer is too much for me to
process. We exchange words of comfort before I rush to the hospital to
get my nasal swab. She texts me later that evening, “I had a perfect day
with you today. I haven’t been in the bookstore for ages, and it’s the best
place for books! And thanks for lunch too. Don’t worry about Covid.
We were proactive. So, no worries!” Imagine. My friend is trying to
comfort me!

Journal Entry: “Waiting”
October 16, 2021
With such a heavy heart and troubled mind, I wait to hear my Covid
results.

Journal Entry: “BCV And ACV”
October 17, 2021
I receive a text from the Color Lab, and it states that my Covid test is
negative. My relief is beyond words! I text my friend right away with
the results. She sends me a clapping hand emoji and texts, “Hooray for
both of us!... I love you too!” I cancel all my social engagements until I
get the Booster.
After a zoom meeting, I walk to CVS. I see a friend in the store, and
we both talk through our masks about her daughter, who is having some
mild congestion and malaise, so she came to purchase a Covid self-test
kit. To think that two years ago, we would have taken these same
symptoms in stride, chalk it up to allergies or the common cold! I
imagine someday all the history books and calendars will have
abbreviations such as “BCV” for Before Coronavirus and “ACV” After
Coronavirus!

Journal Entry: “The Armor We Wear.”
October 18, 2021
I noticed a blood-stained mask left at the crosswalk while walking
down the city street during my lunch break. My nursing brain
automatically thinks tuberculosis, but it's probably just the result of
someone’s bloody nose. A father and a little girl, maybe a few years old,
were walking further up the block. She had to use the bathroom because
her father proceeded to take out of his bag a small portable potty for her
to use right in the middle of the street. I was impressed with his
preparedness but saddened because it reminded me of the lack of clean
public restrooms.
Before the pandemic, I witnessed an increase in the homeless and
human waste on the streets. A few days ago, the news reported an
orchestrated looting of businesses and cars in broad daylight. As my
thoughts spiraled downward into images of busted glass and shattered
dreams, an older woman with a small dog walked in front of me. I
comment on how adorable the little red sweater looks on her dog. Her
face lights up, and she tells me her dog’s name is “Izzy” and that “she is
friendly!” The bright sweater on that happy dog cheers me up. It makes
me think of Bill Cunningham, the talented fashion photographer, and
what he said about clothes. He said clothing is the “armor” we wear to
face the world.

Journal Entry: “Covid Tests In Vending Machines.”
October 19, 2021
I relish my days off. Today, I received a timely text from the Color
Lab that my Covid test is negative again. This is my fifth test, and
thankfully they all have been negative. What a world we live in when
the hospital cafeteria has one vending machine with Covid self-tests next
to another one that sells snacks and drinks! Earlier last week, I emailed
an infectious disease doctor on an independent news station. She
mentioned something quite intriguing about memory B cells and sent me
a link to her work.

Journal Entry: “Fight Or Flight”
October 20, 2021
After volunteering to write letters of encouragement to the public, I
dropped lunch off for my friend who has lung cancer. I wore an
n95mask over a surgical mask when delivering the food, and we waved
at each other from a distance.
Today, I have a zoom meeting with my therapist. She has been
essential in helping me function as a nurse during the pandemic. My lack
of sleep coupled with the increased demands on my mental, spiritual
and emotional reserves sent me into a perpetual “fight or flight mode.”
Even before I heard anything about Covid19, there was a period
when my hands couldn’t stop shaking. Even though I appeared calm, my
hands told the truth: I had some form of PTSD. During this time, I
reassured my patients that another nurse would insert their intravenous
access. My therapist shared visualization and cognitive behavior
techniques to help me make it through my workday. My hands are now
steady, and although I wouldn’t say I am a “vein whisperer” like my
boss, I can now hold my own again. Perhaps my body has habituated to
this “new normal?” Whatever the case, I am grateful it has been
resolved.
During my session, I talk about a friend of forty years who has helped
me improve my writing. She has an eye like an eagle and can see the
slightest grammatical mistake in my work. She will not hesitate to
swoop down with her magic marker and land on my helpless misplaced
word. My therapist and I conclude by discussing how the pandemic has
impacted her profession. Many counselors and therapists have left their
careers due to the stresses caused by the pandemic prematurely forcing
new graduates out into the field.
My therapist is holding fast. Although the conditions in each client's
life vary, her support is steady despite the climate. I admire that. We talk
about what Abigail Adams said during revolutionary times, “Great
necessities call out great virtues. When a mind is raised and animated by
scenes that engage the heart, then those qualities which would otherwise
lay dormant, wake into life.”

Journal Entry: “Boosters And Banana Bread.”
October 22, 2021
It’s been raining for the last two days. I love how the air is so crisp
and fresh after it rains. I am enjoying a cup of coffee and will meet on
zoom with my friends. My work provided the Pfizer Booster, and it was
a pretty quick process with just a 15-minute wait and assessment post-
injection. The first Pfizer shot I received in December of last year was
quite a different experience. Each syringe was hand-delivered with care
as if it was on a “silver platter!” I was the first person in my clinic to get
the vaccine because my clinic was considered a “high risk” environment
due to our Covid research. I am happy that my sore arm doesn’t stop me
from making banana bread!

Journal Entry: “Building The Plane When It’s In The Air.”
October 23, 2021
I am sleeping in today. I got the Pfizer Booster and feel fine, just a
sore arm and some dizziness. I am so grateful to have this added
protection for myself and my patients. I know that the experts
are“building the plane while it’s in the air” because of the fluid nature of
Covid, but I am immensely grateful that I work at UCSF, where we are
informed of changing developments in “real-time.”.

Journal Entry: “Storms And Sirens”
October 24, 2021
We have a storm here in Northern California. It’s reported to be
a “bomb cyclone” and “a 100-year storm.” A giant redwood tree next
door to my apartment stands strong as I see smaller trees around it sway
and bend to the onslaught of rain and bursts of wind. My windows
shake, and I wonder if they will crack and break. I get a text from the
Marin Sheriff: “Continuing heavy rain, winds into the afternoon.
Flooding & down trees across Marin. Stay home, off roads.”
My parking area has flooded but nothing compared to what I
anticipated. The trees and animals are getting what they desperately need
because California has been in a drought. I hear more rain and wind
splash against my roof, and streams of water spill off the sides of the
house. Unbelievably, I still have electricity and can attend a zoom
meeting. The meeting was very encouraging to me—a spiritual gift. I
call one of my friends in her 80’s to make sure her phone still has a
signal. Her phone, a landline, tends to lose connection during high
winds. She says she is alright. I hear another siren. The sound of seven
sirens has rushed by my house so far...

Journal Entry: “Placebo”
October 25, 2021
Not much to say except one patient “crossed over,” which means that
it was clear that he had the placebo initially, but now he will get the
actual medication. These situations can be awkward.

Journal Entry: “Just Around The Corner.”
October 26, 2021
Every time I walk to the post office, two memorials arrest my
attention. One was for a son who died at a crosswalk, and the other was
for a lover who died at a street corner. The flowers, notes, and photos are
left on traffic signs poles by surviving family members beckoning
passersby to pause and remember that they are standing at the place
where their loved ones lost their lives.

Journal Entry: “Pushing Through Fear And Imperfection”
December 7, 2021
I woke up at 4:00 in the morning and was thrilled to hear David
Julius again on the Nobel Prize channel. It's such a stabilizing influence
to listen to such a stunning discovery amid this dark and divided time. I
am rereading the book “Courage is Calling” by Ryan Holliday. His
section about Florence Nightingale is meaningful to me. He stated, “ Her
experiences with fear helped her relate to and love the thousands
wounded, dying patients she would care for.”. Nightingale wrote,
“Remember he is face to face with his enemy all the time, internally
wrestling with him, having long imaginary conversations with him.”
I never want to forget Nightingale’s words, nor do I want to stop
pushing through my fears, self-absorption, and imperfection to speak up,
step up and reach out! One woman described the people who helped her,
“They tried to do the right thing in an imperfect way.” I can only hope
do the same.