THE ARRIVAL...

WE'VE ALL BEEN THERE WHEN THE SIMPLE THINGS JUST PLAIN REFUSE TO GO THE EASY WAY. TOO MANY YELLOW TRAFFIC LIGHTS, TAKING A NAP AND FORGETTING TO TURN OFF THE PHONE, AND GETTING JUST PAST THE HALF WAY MARK ON MY WAY TO WORK WHEN THE FRONT TIRE BLOWS ON MY BIKE...WHAT WAS I SUPPOSED TO DO? RIDE THE SHORTER DISTANCE TO THE HOSPITAL AND DEAL WITH IT IN THE MORNING AFTER A LONG NIGHT SHIFT? OR RIDE THE LONGER DISTANCE HOME, RISK COMPLETELY DESTROYING MY TIRE, RAPIDLY CHANGE CLOTHES, DRIVE LIKE HELL BACK TO THE HOSPITAL HOPEFULLY MAKING IT ON TIME? I CHOSE THE LATTER. ONLY TO FIND ON MY ARRIVAL TO THE UNIT, BREATHLESS, SWEATY AND PITTED OUT, THAT FOR THE FIRST TIME, A NEW 70% BURN WAS ON ITS WAY UP FROM THE E.D. AND HE WAS GOING TO BE MINE THROUGH THE NIGHT...

ON MY FIRST DAY OF NURSING SCHOOL THE DEAN LEFT US WITH THIS MESSAGE:
OUR LIVES CONTAIN PERIODIC "RED LETTER DAYS" THAT SIGNIFY MEMORABLE MARKERS. THIS SIGNIFIES ONE STEP IN THE FULFILLMENT OF YOUR DREAM TO BECOME A NURSE, AND I CELEBRATE THAT WITH YOU. I CONGRATULATE YOU ON THE HARD WORK AND ACCOMPLISHMENTS THAT GOT YOU HERE; WELCOME ABOARD!

AS THE TAIL LIGHTS FADE ON MY FIRST YEAR AS A PROFESSIONAL ICU NURSE I HAVE FOUND MYSELF REFLECTING ON THE VARIOUS RED LETTER MOMENTS THAT HAVE BEEN ETCHED IN THE VERY STEEP LEARNING CURVE, THAT THROUGH 148 TWELVE HOUR SHIFTS, HAVE COME TO DEFINE THE BURN NURSE THAT I AM:

THE FIRST BURN DRESSING, LOOKING INTO "MR'S" EYES OF PAIN, WITNESSING HIS GHOSTLY AND SILENT SCREAMS...FEELING HIS ROUGH UNEVEN GRAFTED SKIN.

WATCHING AN UNSUSPECTING FAMILY COME TO THE DECISION THEY THOUGHT THEY WOULD NOT BE MAKING THE DAY THAT IT WAS REQUIRED OF THEM TO MAKE IT; WITHDRAWING LIFE SUPPORT ON A FATHER AND HUSBAND, AND THROUGH THEIR TEARS, WATCH HIS LAST BREATHS.

FEELING ETHICALLY STRAINED AS EXTENDED MEASURES AND CARE WERE LAID DOWN UPON PATIENTS WHOSE VOICES WERE MUFFLED BY THE NOISE OF RELIGIOUS RESTRAINT AND FAMILIAL INDECISION.

THOSE IN MY FOXHOLE, TRUSTED MENTORS AND LEADERS, THE ICU CREW, THE "TOP 3", & B.F.F

THE SMELLS.

THE DISFIGUREMENT.

THE POWER OF DEPRESSION, GRIEF AND UNHAPPINESS LEADING SOMEONE TO FEEL THAT THE ONLY WAY OUT IS TO LIGHT THEMSELVES ON FIRE AND BURN AWAY THEIR PAIN...AND LIFE.

HEARING THE LAST TENDER SWEET WHISPERINGS BETWEEN HUSBAND AND WIFE AS THE VESTIGE OF MORTALITY CLAIMS IT'S FINAL VICTORY.

THESE EXPERIENCES AND MANY MORE HAVE LEAD ME A STEP CLOSER TO BECOMING THE QUINTESSENTIAL PROFESSIONAL I ENVISIONED IN THOSE FIRST HOURS ON THE BURN/TRAUMA ICU.

...12 HOURS LATER, WITH GREASY MATTED HAIR AND SEVERAL FLUID POUNDS LIGHTER, WEARING A GRIN. I STOOD IN THE SHOWER WASHING AWAY THE SWEAT AND STINK, FEELING THE "RED LETTER" ACCOMPLISHMENT OF HAVING MADE IT THROUGH MY FIRST MAJOR BURN ADMISSION. AS MY HEAD HIT THE PILLOW IN PREPARATION FOR THE TWELVE MORE HOURS AHEAD, A FLEETING THOUGHT AND BURGEONING CONFIDENCE PASSED THROUGH MY MIND WRAPPED IN THE FEELING THAT I HAD ARRIVED...

#1

ON ANY GIVEN DAY, WE WAKE WITH A CERTAIN CONFIDENCE AND APPRECIATION FOR THE MUNDANE REQUIREMENTS AND TASKS THAT LIE SAFELY AHEAD. A SORT OF NEVER ENDING LIST OF "TO-DO'S" THAT WE ATTACK AND MINIMIZE DAILY. WE HAVE OUR JOBS, OUR KIDS, OUR WORRIES AND CONCERNS. WE DRIVE THE SAME ROUTES, WE FREQUENT THE SAME STORES, AND CONTINUALLY ANALYZE OUR LIVES SEARCHING FOR THAT SOMETHING TO MAKE US FEEL MORE ALIVE AND BUMP OUR ROUTINE OUT OF THE RUT OF NORMALCY. THOUGH IT IS CERTAINLY ACKNOWLEDGED THAT ANY NUMBER OF EVENTS MIGHT TAKE CONTROL AND SHAKE OUR DAILY "TO-DO'S", SURELY CHANGING THE COURSE OF OUR LIFE, WE STUBBORNLY INSIST THAT THOSE EVENTS ARE SOMEWHERE UP THE ROAD, AND THAT "TODAY" WILL JUST BE ANOTHER REGULAR DAY.

#1'S HEALTH HAD BEEN AILING IN THE PAST MONTHS, AND A UNFORTUNATE OVERUSE OF AN ANALGESIC HEAT RUB (BENGAY) CAUSED A CHEMICAL BURN AND BROUGHT HIM TO OUR FLOOR. #1 BEGAN TO LOOSE CIRCULATION TO HIS EXTREMITIES LEADING TO FULL BLOWN SEPSIS AND A NEED TO AMPUTATE. DAYS PASSED, AND MACHINES WERE ADDED. I WATCHED A CONFLICTED WIFE BEING PULLED BETWEEN HER OWN HOPE AND HIS WISHES. THOUGH A DECISION TO GIVE TREATMENT THROUGH THE WEEKEND WAS REACHED WITH THE BURN TEAM, THIS YIELDED NO FREEDOM TO HER QUIET STRUGGLE. 12 HOURS LATER AND 72 SHORT OF THE AGREED PLAN, HER ANGUISH FOR HIS SUFFERING SURPASSED HER OWN HOPE. SHE KNEW BETTER THAN ANYONE THAT THE MAN SHE WOKE UP TO EACH MORNING FOR 63 YEARS WOULD NOT HAVE ANY OF THIS, AND THEREFORE THE DECISION WAS ALREADY MADE...IT WAS TIME. THE MACHINES WERE REMOVED, PAIN WAS TREATED, AND PRIVACY GRANTED. AS I WATCHED #1'S FAMILY CIRCLE HIS BED TO SHARE HIS LAST MOMENTS I COULDN'T HELP BUT THINK THAT THIS DAY WOULD FOREVER MARK A CHANGE IN ALL OF THEIR LIVES, EACH DAY AFTER WOULD BE DIFFERENT FOR TODAY WAS GOING TO BE THE DAY THAT THEIR FATHER AND HUSBAND WOULD DIE.

LATER, AS I PULLED THE TUBES AND IVS FROM HIS BODY, TAGGED HIS TOE AND ZIPPED UP HIS BODY BAG, I REFLECTED ON HOW ORDINARILY MY DAY HAD BEGUN, LIKE MANY OTHERS...WITH THE DREAD OF AN EARLY ALARM WAKING ME TO THE REDUNDANCY OF LIFE...OR SO I WOULD THINK...

...RIP #1...

THE NIGHT-WATCH

BY PHYSIOLOGIC DESIGN OUR BRAINS ARE WIRED WITH A CIRCADIAN CLOCK OR SLEEP AND TIME TASKMASTER. THIS INTERNAL TIMETABLE IS IN CAHOOTS WITH A NUEROTRANSMITTER CALLED ADENOSINE, WORKING TO INHIBIT MANY OF OUR NATURAL PROCESSES DECREASING WAKEFULNESS. IN ADDITION, EACH HUMAN BEING'S CHRONOTYPE, OR RATHER THEIR INTRINSIC FAVOR TOWARDS BEING A "MORNING LARK" OR "NIGHT OWL" DICTATES THE TIME OF DAY EACH OF US IS MORE ALERT. HOWEVER, REGARDLESS OF ANY ONE CHRONOTYPE OR CIRCADIAN TASKMASTER, ON ANY GIVEN NIGHT ACROSS THE COUNTRY, THERE ARE THOUSANDS AND EVEN MILLIONS OF PEOPLE WHO ARE CONSCIOUSLY AT WAR AGAINST THE PROPENSITY TO SLEEP. TAKING PERSONAL RISK, IT IS THESE MEN AND WOMEN THAT TAKE UP POSTS AND STAND GUARD WHILE THE REST ARE SLEEPING AND MOST VULNERABLE. NIGHTS ARE MORE SOUND AND REJUVENATING DUE TO THE COMFORT BROUGHT BY THE KNOWLEDGE THAT OUT THERE IN THE NIGHT SOMEONE HAS OUR BACK. THESE POLICE AND FIREMEN, NURSES AND DOCTORS MAKE UP THE NIGHT-WATCH. I FEEL EMPOWERED WITH A DUTY AND RESPONSIBILITY AS I DRIVE IN THE OPPOSITE DIRECTION OF THE RUSH HOUR MASSES TO TAKE A POST AND JOIN THE NIGHT-WATCH.

WHEN THE FAMILY OF "POST-OP" SUCCUMBED TO A LONG DAY OF TRAVEL AND THE BIOLOGICAL FRAILTIES REQUIRING REST...I ASSURED THEM I WOULD BE HERE FOR THEIR LOVED ONE THROUGH THE NIGHT. LATER I ENTERED THE ROOM TO CHECK ON "POST-OP" FINDING HER FEELING ANXIOUS, ALONE AND UNCERTAIN WITH TEARS RUNNING DOWN HER FACE...I TOOK HER HAND AND REASSURED HER THAT FAMILY HAD BEEN HERE EARLIER AND THAT I NOW WOULD BE HERE FOR HER THROUGH THE NIGHT UNTIL THEY RETURNED, AND SHE SLIPPED BACK TO SLEEP.

SOME MIGHT SAY THAT THE NIGHT SHIFT IS ABOUT BETTER MONEY, LOWERED STRESS AND CHAOS. FOR ME...THERE IS A CALM AND TRANQUIL GRACE THAT COMES FROM TAKING A POST AND WATCHING THE BACKS OF OTHERS WHILE THE REST OF THE WORLD IS SLEEPING...

SWEET SIX16TEEN

WHEN WE STAND BEFORE A MIRROR EACH MORNING, THE REFLECTION CAST IS MORE COMPLICATED THAN THE COLLECTION OF FINITE CHEMICAL REACTIONS TO WHICH WE SURVEY AND CRITIQUE. IF WE LISTEN CLOSELY AS WE STARE BACK, TIME STANDS STILL AND OUR THOUGHTS PASS INWARD. IN THIS MOMENT A PRIVATE MONOLOGUE AND COMMUNION BEGINS AT THAT PLACE BETWEEN BIOLOGICAL ORGANIZATION AND SPIRITUAL AWARENESS. FOR THE IMAGE CAPTURED EACH MORNING AT THE MIRROR IS NOTHING LESS THAN WHAT PHYSICALLY REPRESENTS EVERY SINGLE DETAIL OF WHAT WE HAVE EVER THOUGHT AND FELT. OUR FACE MERELY ENCAPSULATES AND IDENTIFIES WHO WE ARE TO OURSELVES, GIVING FORM TO OUR EMOTIONS AND EXPERIENCES...WHAT IS TO BECOME OF THE SOUL THAT HAS LOST ITS CONSORT?

16'S YOUNG LIFE HAS COMPRISED MORE HARDSHIP THAN MANY FACE IN A LIFE TIME. MUCH OF IT FROM POOR CHOICE AND CIRCUMSTANCE, SOME MORE FROM THE UNFORTUNATE COMPLICATIONS ARISING OUT OF ONE MISMATCHED PAIR OF MICROSCOPIC NUCLEOTIDES IN A STRAND OF DNA. 16'S STRUGGLE IN LIFE WOULD FIND NO RESPITE ON HER SIXTEENTH BIRTHDAY. ALONE IN A STEAM ROOM, 16 EXPERIENCED ANOTHER IN A HISTORY OF SEIZURES, THIS ONE INCAPACITATING HER TO THE GROUND. HER HEAD AND FACE FALLING INCHES FROM THE PIPES SUPPLYING THE STEAM; IT WOULD BE HOURS BEFORE SOMEONE NOTICED SHE WAS MISSING. BY THE TIME THAT HELP WAS CALLED, 16 HAD SUFFERED PARTIAL AND FULL THICKNESS BURNS TO MOST OF HER FACE AND SCALP. WHERE VERY LONG, THICK AND BEAUTIFUL HAIR ONCE THRIVED, NOW A DESOLATE SPACE LAY, WHERE SUCH GROWTH WILL NEVER BE KNOWN AGAIN.

EVERY TIME I LIFT OPEN 16'S EYELIDS TO APPLY MEDICATIONS, I CAN'T HELP BUT WONDER WHAT HER 17TH BIRTHDAY WILL BRING AS SHE WAKES TO STAND IN FRONT OF THE MORNING MIRROR, AND HER EYES CAPTURE THE REFLECTION OF AN IMPOSTOR. WILL HER SOUL EVER FIND PEACE AND HARMONY WITH THIS NEW COUNTERFEIT...AND WHEN THOSE PRIVATE MONOLOGUES RETURN, WHAT CONVERSATIONS WILL SHE HAVE WITHIN HER SOUL...?

325

MORTALITY IS A CONSTANT TO WHICH ALL HUMAN LIFE BOWS, IT IS NO RESPECTER OF SOCIAL STATUS, TEMPORAL ACQUISITION, OR BELIEF SYSTEM. MOST TRAVEL LIFE WITH THIS REALITY PLACED SAFELY BELOW THE SURFACE...SOMETHING WE KNOW, SOMETHING NOT ARGUED, AND SOMETHING TO THINK ABOUT LATER. IT EVADES OUR CONSCIOUS LIFE FOR NO OTHER REASON THAN SIMPLE SURVIVAL. PROPERLY CALCULATING MORTALITY INTO ALL OF LIFE'S EQUATIONS WOULD DEVOUR US...HOLD US CAPTIVE. CONSTANTLY EVALUATING THE ODDS WOULD HAVE BROUGHT MANKIND TO A HALT AS QUICKLY AS IT BEGAN.

THOUSANDS OF MILES FROM HOME ON VACATION WITH A LOVED ONE; BURDENED WITH A COMMON URINARY TRACT INFECTION, 20-YEAR-OLD 325 SOUGHT TEXTBOOK TREATMENT. WITHIN DAYS 325 BECAME ONE OF ONLY 300 DIAGNOSES PER YEAR IN THE U.S. - STEVEN-JOHNSON SYNDROME. DAYS AFTER BEGINNING THE TEXTBOOK ANTIBIOTIC SCHEDULE, 325 BEGAN HAVING FLU-LIKE SYMPTOMS. THIS WOULD ESCALATE INTO A WIDESPREAD RASH TURNING INTO BLISTERS CONCLUDING WITH THE TOP LAYER OF HER FLESH SEPARATING AND SLOUGHING AWAY.

SIX DAYS DOWN THE PATHOLOGY, VENTED AND SEDATED WITH CONTINUOUS HIGH DOSE I.V. DRIPS, I ENTERED THE ROOM. COVERED HEAD TO TOE WRAPPED LIKE A MUMMY IN THICK BANDAGES, 325 WAS UNIDENTIFIABLE. DRESSING CHANGES TAXED OUR TEAM OF FOUR FOR THREE HOURS IN A 99 DEGREE TUB ROOM. I FELT MY OWN SKIN BEING TORN AWAY FROM MY BODY AS I RIPPED AND PULLED BACK THE SKIN OF HER TOES TAKING OFF THE NAILS ALONG WITH IT. I COULDN'T IMAGINE WHAT WAS GOING ON IN HER SEDATED MIND AS WE WORKED OVER EVERY SQUARE INCH OF HER BODY. TWO DAYS BACK TO BACK WITH 325 AND I WAS HUMBLY EXHAUSTED. AS I EXITED HER ROOM FOR A THREE DAY WEEKEND A THOUGHT RESTED ON MY MIND:

THIS IS SOMEONES DAUGHTER AND SISTER, THE GIRLFRIEND TO ONE, AND BEST FRIEND TO ANOTHER...HER WHOLE LIFE IS AHEAD OF HER WHEN SHE CLIMBS OUT OF THIS UNFORTUNATE CIRCUMSTANCE. THIS RARE EXPERIENCE WILL NOT DEFINE HER...IT WILL HELP BUILD WHO SHE BECOMES...FUTURE WIFE, MOTHER AND GRANDMOTHER...

...YOUNG 325 PASSED AWAY LAST NIGHT...AND TODAY MY THOUGHTS ARE ACUTELY AWARE OF THE ACTUALITY THAT OUR MORTALITY IS AS THIN AS THE AIR WE BREATH. THAT WE EACH WALK A FINE EDGE BETWEEN LIFE AND DEATH EVERYDAY. AND NO ONE KNOWS WHAT TOMORROW WILL BRING...

HC2H

DRUGS - CHECK
ALCOHOL - CHECK
COP FRIEND - CHECK
BLOCK PARTY - CHECK
LOUD MUSIC - CHECK
PUNCH BALLOON - CHECK
PUNCH BALLOON FILLED WITH ACETYLENE - CHECK
MATCHES - CHECK
EXPLOSION - CHECK

HAND BLOWN TO A CRISP...CHECK!



AS MY PRECEPTOR TELLS ME...MOST OF THE PATIENTS ON OUR UNIT WOULD NOT BE HERE IF THEY DIDN'T PLAY WITH MATCHES!

HEY MR.?

I HAVE OFTEN WONDERED IF THE CHOICES AND PATTERNS THAT WE SET IN LIFE TRULY COME FULL CIRCLE. IS THERE A CERTAIN AMOUNT OF KARMA AT PLAY IN THE TWILIGHT YEARS OF OUR LIFE?...DOES WHAT WE HAVE PUT OUT INTO THE WORLD INEVITABLY COME HOME? I HAVE TAKEN CARE OF "MR." FOR TWO DAYS NOW AND HAVE DESPERATELY WANTED TO KNOW WHAT THOUGHTS AND FEELINGS ARE TAKING PLACE BEHIND THOSE EYES. A LIFE OF STRUGGLE HAS REACHED ITS PINNACLE IN THE WINDING DOWN YEARS OF HIS STORY. HIS LIFE WAS SWINDLING PEOPLE AMID TIMES OF HOMELESSNESS. NOW NEARLY ALONE IN THE WORLD AND NOTHING TO HIS NAME I WONDER HOW HE VIEWS HIS PRESENT PREDICAMENT...

...40% FULL THICKNESS BURNS COVERING HIS ARMS AND LEGS...THE RESULT OF A WEE HOUR EXPLOSION IN HIS CAMPING TRAILER (AKA...HIS HOME). HE COLLAPSED AFTER SELF EXTRICATING FROM THE BLAZE, AND OVER A MONTH LATER HE FINDS HIMSELF STILL ON THE UNIT, AND IN THE CARE OF A ROOKIE BURN NURSE...WHATS LEFT OF HIS SKIN HAS BEEN USED TO GRAFT THE BURNS IN SEVERAL SURGERIES LEAVING HIS BODY COMPLETELY REMODELED. TODAY I PARTICIPATED IN CHANGING HIS DRESSINGS...A TAXING RESPONSIBILITY THAT TUGGED AT MY "NEW NURSE" BLEEDING HEART. DUE TO A TRACHEOTOMY (BREATHING TUBE IN HIS THROAT) THE HOUR AND HALF PROCESS LEFT HIM SPEECHLESS. MR. COULDN'T SPEAK...COULDN'T SCREAM... A TRUE CAPTIVE. THE CHARGE NURSE WHISPERED AND ANSWERED ME..."SCRUB HARD". AS I BEGAN TO WORK DOWN HIS ARMS HIS EYES MET MINE...THEY PIERCED DEEP INSIDE ME AS I MOVED BACK AND FORTH OVER HIS LEATHERY, SCARRED SKIN. I THOUGHT TO MYSELF..."MR. WHAT WOULD YOU SAY TO ME IF YOU COULD SPEAK? I LOOKED AWAY AND PUSHED SEVERAL MORE MEGS OF FENTANYL AND MIDAZOLAM HOPING TO ALLEVIATE PAIN THAT I CAN ONLY IMAGINE IN MY WORST NIGHTMARE...

...MR. UNABLE TO SPEAK AND VOICE MEDICAL DECISIONS AND TREATMENT, THE CHOICE HAS FALLEN ON ANOTHER...ONE WHO HAS ONLY SEEN MR. BANDAGED...ONE WHO WANTS EVERY LIFESAVING MEASURE PERFORMED...

...HEY MR. WHAT DO YOU WANT?...