Nursing

COVID Storms & Human Sandcastles

/ J / Leave a comment

“Therefore everyone who hears these words of Mine and acts on them, may be compared to a wise man who built his house on the rock. And the rain fell, and the floods came, and the winds blew and slammed against that house; and yet it did not fall, for it had been founded on the rock. Everyone who hears these words of Mine and does not act on them, will be like a foolish man who built his house on the sand. The rain fell, and the floods came, and the winds blew and slammed against that house; and it fell—and great was its fall.” ~Matthew 7:24-27

I am struck by how eerie our town’s main street has become. I still anticipate cars cruising past and the aroma of fine food and coffee, even though shops have been shuttered for weeks. I miss stopping at the local bookstore and seeing people smiling over meals. The bustling life is now confined to individual homes, where anxiety is stifling and loneliness rampant. Emotions flux with the reported cases, the new deaths; possible hopes of new medications or plasma of recovered patients; but followed by the lack of ventilators and other supplies. The media strives to highlight chaos and concern, to provide the greatest shock, to draw the most attention, to sell their product of daily novelty.

In his book, Disruptive Witness, Alan Noble writes:

“…death comes for us all, and all around us we see its work in decay, violence, evil, sickness, and suffering. The weight of this cross pressure is too much for most of us to bear, so we have outsourced the burden of death to specialists: doctors, nurses, paramedics, law enforcement, fire departments, soldiers, and the like. We obsessively fight death, we push the sick and elderly to the margins of society, we quarantine the dying, we turn our fear of death into a quasicosmic war against global suffering.”

Not only is our distracted busyness failing to deny the reality of death, but healthcare workers – no stranger to death – confront the fact they are not impervious to illness themselves. And for many, we have no place to outsource the burden. 

In contradiction to expectations for modern medicine, local and national leaders are foregoing current policies and creating new ones – not out of proven outcomes but to ration of a lack of supplies. It takes me back to my experiences in clinics set up in third-world countries. All supplies are donated, resources limited and creativity – to address needs with available supplies – a necessity. 

Caring for patients with infectious, life-threatening conditions is not a new requirement for healthcare workers. We enter rooms without a second thought because evidence has shown that following the correct personal protective equipment (PPE) will protect us from contracting a disease. But now the reality is that our allowance of PPE is inadequate. These changes make bedside staff vulnerable to patient’s wounds of resistant bacteria, flu, and the plethora of other respiratory viruses. 

These changes also add concern for other patients who do not require contact precautions. There is a weight wondering if bedside staff are now a vector for infection to the immunocompromised. Suddenly a sneeze or a slight post nasal drip is a symptom of grave concern. Is this allergies or a seasonal cold? Or am I a carrier of a virus that might threaten the life I am assigned to steward? 

The work of task forces and clinical engineering is continuous; the questions are weighty and the lack of knowledge looms; the disruption to routine has triggered fear, anxiety, frustration, and sadness. But these throbbing emotions have opened my eyes to an unquestionable realization – these feelings are a result of misplaced hope. 

This virus has simply unveiled hopes that are vulnerable to storms.  

COVID-19 has exposed the hope I have put in my country. In our response, we face a man-made problem of little PPE due to hoarders, budget choices, and a reliance on global trade. Even the most developed and progressive nations cannot provide us with the security and protection we desire. This hope is a sandcastle. 

COVID-19 has exposed the hope I put in knowledge. Hospitals are, by nature, chaotic, but controlled by evidence-based practice and set protocols to ensure the best outcomes. But with the introduction of something unexpected, the threat of limited equipment and too little staff, we see how control was a mere delusion. Our knowledge is not omniscient and our plans are not infallible – hope in these alone is a sandcastle. 

We see the stark limitations of human intellect and infrastructure; we see its failure. But friends, Christ has not failed us. The world spins in its chaos, but – in all of his love and power – God sees us. He sees the corruption, suffering and sickness and he does not leave us alone. 

Our God today was king during the bubonic plague, Spanish influenza, and ebola outbreak. He sees the AIDs problem and Zika epidemic. He sees persons plagued by failing organs and festering wounds. His heart is broken by the earth’s state and he actively intervenes. Jesus came to satisfy justice – to pay the penalty for sin. 

“For God so loved the world, that he gave his only Son, that whoever believes in him should not perish but have eternal life. For God did not send his Son into the world to condemn the world, but in order that the world might be saved through him.”

John 3:16-17

He asks that we believe, trust, and follow him, that we love him above our comfort and our plans, that we cast our anxieties on him and know that he is sovereign. We are to trust God, whose character is perfect, who is unchanging and who is good. He does not mean for us to carry the weight of this world or outsource it to someone else. We are called to rest in his arms, to cast our anxieties on him, and to press on with his strength. 

The sufferings we are experiencing are momentary. God promises that he will restore creation to his perfect design and includes us in the process of redemption. We are not meant to simply survive or endure life. He gives our suffering meaning and our work lasting value. 

The world is put on hold, but this should never prevent but rather propel us to what God calls us to – share the good news of his salvation.  Our lives can be a witness of the assurance we have in both life and in death because of Jesus. 

“By this we know love, that he laid down his life for us, and we ought to lay down our lives for the brothers. But if anyone has the world’s goods and sees his brother in need, yet closes his heart against him, how does God’s love abide in him? Little children, let us not love in word or talk but in deed and in truth.”

1 John 3:16-18

We demonstrate his peace by how we care for our neighbors, love our children, and serve others in our workplaces. We are called to act on his certain promises. 

God does not promise me my health; he promises me something greater. And I must go where he calls. I can enter a COVID-19 room with inadequate PPE and be the hands and feet of Christ to a loved creation of God. I can touch and comfort patients when their family members cannot. I can trust my life to God on this momentary blip because he has promised me forever. 

God does not promise me my health; he promises me something greater.

In a time where coworkers and neighbors are uneasy, I can work in such a way that holds nothing back because God has held nothing back from me. 

God is giving me peace as I press into his word. He is blessing me with friends who remind me to pray as I enter each patient’s room and perform each task. My nerves are calmed because I know that I am not in control and never was; someone who is much wiser, more powerful, and exponentially more loving is reigning today and will tomorrow. 

Friends, we entrust the reality of death and illness to a God who has already had victory over it. I pray that we will press on to how he is calling each of us with his strength. We do not have the answers, and we don’t need to if our faith is not in sandcastles but rather on the rock Himself. 

all things new

/ J / Leave a comment

“The more things change, the more they stay the same.” – Sidney Greidanus

The paradox of this line reverberates a truth I see too much as a nurse. The more patients we admit, treat, and discharge, the more I realize that we are in a perpetual cycle. More CHF, more pneumonia, more re-admissions. With new evidence and research, we get better at treatment and identifying problems sooner, but – without fail – hospital census remains high, our beds full.

Healthcare workers are perhaps privileged to see an up-close example of the unchanged human condition and the reality of our world.

Even as our world becomes more connected and progressive, we still have the problems seen throughout history: genocides, abandonment, hunger, and sickness. In our modern world, we address problems different from our history. We have the Geneva Convention and specific laws for international warfare. We have both Child and Adult Protective Services. We have vaccinations and modern medicine. In a way, this is incredible progress. But these interventions are necessary because the fact remains: life on our planet has not really changed. Those with power will abuse it and oppress others for gain. People are prone to prejudice and capable of neglecting those in need. And sickness – no matter how advanced our technology – still causes suffering and death. And with our advances, we have also added equal ethical dilemmas. New life-saving medications are only accessed through significant financial means or the right insurance coverage. Cars come with accidents. International air travel could be a means of terrorist plots. The foster system, designed to care for abandoned children, can also be a place of more abuse and neglect. As we address problems, there is an interwoven complexity of new potential problems.

Ecclesiastes 1:2-11 opens with a poem that expresses the sediment I feel today.

Vanity of vanities, says the Preacher,

vanity of vanities! All is vanity.

What does man gain by all the toil

at which he toils under the sun?

A generation goes, and a generation comes,

but the earth remains forever.

The sun rises, and the sun goes down,

and hastens to the place where it rises.

The wind blows to the south

and goes around to the north;

around and around goes the wind,

and on its circuits the wind returns.

All streams run to the sea,

but the sea is not full;

to the place where the streams flow,

there they flow again.

All things are full of weariness;

a man cannot utter it;

the eye is not satisfied with seeing,

nor the ear filled with hearing.

What has been is what will be,

and what has been done is what will be done,

and there is nothing new under the sun.

Is there a thing of which it is said,

“See, this is new”?

It has been already

in the ages before us.

There is no remembrance of former things,

nor will there be any remembrance

of later things yet to be

among those who come after.

The author of this book – from the ancient world – pours out his heart and his wrestling to which speak to us in the 21st century. The more life changes, the more it stays the same. Life in 2019 is drastically changed from the ancient world, but we as people, our problems, our worries, and our search for a purpose are fundamentally the same.

But if we stop here in Ecclesiastes, we miss the point and beauty of this book. This book teases out the blessings of life, and how without God, they are simply toil and meaningless.

This means that that pattern we observe is not all that there is. History is not merely a cycle of changing, it is the story of God’s redemptive plan.

We are not left on earth to simply pursue what pleasure we can and dodge suffering, we were meant to share the biggest event, the most radical change in all human history. God sent Jesus into our actual historical timeline to answer for suffering and to redeem every square inch of creation.

Sidney Greidanus writes, “As the redemptive history progresses, therefore, there are new events, new realities, and new hopes that God will make all things new. Although people gain nothing from all their toil apart from God, through Jesus Christ there is much to be gained from our toil.”

I stated earlier that healthcare workers are privileged to see an up-close example of the unchanged human condition. We must confront more quickly how depressing and cyclical this life can be on its own. We see the same sufferings and literally the same patients over and over who are dying a slow death from their afflicted chronic illnesses. Often these patients come to us for a patch-up job, just enough to go to a skilled nursing inpatient facility until the next hospital re-admission. They continue with every medical option available because they are tormented by the thought of death.

As Christians, we were meant to share the biggest historical event. We are meant to share that Jesus paid the price for our sin, the precursor to our suffering. We are meant to share that this life is not meaningless, but that we are called to live God’s love for people. We are meant to share the good news that this suffering we see was not God’s intention for creation, but that God uses our suffering to draw us to himself. We are meant to share that one day, all things will be new.

“He will wipe away every tear from their eyes, and death shall be no more, neither shall there be mourning, nor crying, nor pain anymore, for the former things have passed away” (Revelation 21:4).

Let our co-workers and patients see that we do not cope through jaded cynicism or compartmentalization. Let them see how deep we mourn the sufferings of this world. And let them see how our sufferings cause us to turn to Jesus who gives meaning and hope that transcends our circumstances.

“You will be sorrowful, but your sorrow will turn into joy. When a woman is giving birth, she has sorrow because her hour has come, but when she has delivered the baby, she no longer remembers the anguish, for joy that a human being has been born into the world. So also you have sorrow now, but I will see you again, and your hearts will rejoice, and no one will take your joy from you. “

John 16: 20-22

coping with hearts; remembering personhood

/ J / Leave a comment

There is a tangible toll on those who are daily immersed in the suffering of others.

Hospitalization is rarely a result of planned procedures. Trauma and sickness are never convenient. Nurses arrive to work with the opportunity to walk with patients and families as they face uncertainty and emotional turmoil. Nurses bear the anxiety that proliferates with every poorly trending lab value or vital sign; they mediate family dynamics and pain that present themselves in crisis; they fight for the wellbeing of the lives in their care.

Some patients and families are grateful. Others are not.

The darkness of human nature is quickly revealed in times of fear and loss of control. Patients are at the expense of medical intervention and their time to the flow of hospital procedures. Too often entitled and inappropriate behavior dominate the day. Entering a room may open the door to objectifying language and reaching hands; to screams of obscenities over something of no consequence; to family members whose actions may uncover motives that are beyond ethically gray.

One patient will trigger the weight of countless hard experiences. Upon discharge, a homeless woman will need insulin, a high-risk medication if administered incorrectly. She is encouraged to use some of her 2,000 dollars, collected every month from social security and disability, to buy a prepaid cell phone that could be used for emergencies. This advice is ridiculous in the eyes of the woman; she demands the hospital pays for her cell phone. A married man – as soon as his wife exits the room – continually tells the bedside nurse that he should come home with her and take her husband’s place. A young patient with an infection in his heart is found crushing narcotic pills and secretly flushing them through his intravenous catheter, undoubtedly making his infection worse. This young patient, having left the hospital against medical advice the week before, leaves again – likely to continue his known drug habit and return to the hospital in worse condition. An old woman lay in the hospital bed, her breathing apneic; she could die between any breath. The old woman’s daughter refuses to put her on hospice and be made comfortable, stating: “I just need her to live until next month so I can get her social security check. When I was a child, she never had compassion for me when I was in pain. Now she knows what that feels like.”

These memories wear on hearts and minds. It is much easier to remember appalling situations than those that are considered polite and acceptable. These memories grow like wild blackberry shoots which are difficult to eradicate or even suppress. Its brambles begin to choke out good and beautiful memories. It becomes easier to treat the illness and not the person. It also becomes easier for caregivers to avoid their own heart.  

The confrontation with human depravity is not just seen in the hearts of others, but can be reflected in the heart of the caregiver. The simplest way to cope is for front-line staff to become numb to the suffering they engage. Patients can become tasks; the temptation is to check off isolated cares and treat diagnoses without having to think and feel the weight of how it is affecting each individual person’s life.

The greatest toll on those that are daily immersed in others’ suffering is to see the weakness and complacency her own heart. It creeps up unexpectedly and deconstructs the idealistic framework that believes – with the right ethical principles – humans can engage perfectly every single time. While this realization is exhausting, it is perhaps the most beautiful. Service should never be out of self-mustered strength. It is not out of labels of being the “wisest” or “most compassionate.” It is because of Christ and His work in broken hearts: “And I am sure of this, that he who began a good work in you will bring it to completion at the day of Jesus Christ.” (Philippians 1:6).

Christian scholar, Nancy Pearcey writes:

“The problem is that many people treat morality as a list of rules. But in reality, every moral system rests on a worldview. In every decision we make, we are not just deciding what we want to do. We are expressing our view of the purpose of human life.”

For followers of Christ, patient care must be informed by a Christian worldview if there is any hope of escaping either burn-out or cynicism.  

The Gospel shows how cherished human life is. Each person has intrinsic dignity and worth because they are made in the image of God. Jesus’ example of deep love, service, and sacrifice prompts those same actions to others.

When confronted with the reality of human hearts, the only answer is to cling to Christ. Only He can permeate broken hearts to fully engage this world. Often it is easy for beliefs to remain strong intellectually but not lived out in the day-to-day mess.

His work is the balm to burnout. He gives life to love well; to not just see the diagnosis and lists of tasks, but to see the person, who – regardless of voiced thank yous or screamed obscenities – was created by the God who made all life and offers salvation to all life through His own sacrifice.

For those that feel tension and toll between heart and mind, it should be an encouragement. It demonstrates that coping is not through sheer numbness.

Cling to truth and through Christ’s strength do each task remembering the personhood of each patient. With Him, there will be fruit amidst thistles.

“‘My grace is sufficient for you, for my power is made perfect in weakness.’ Therefore I will boast all the more gladly of my weakness, so that the power of Christ may rest upon me. For the sake of Christ, then, I am content with my weakness, insults, hardships, persecutions, and calamities. For when I am weak, then I am strong” (2 Corinthians 12:9-10).