On end-of-life care.

Sunday, May 20, 2018

This veers far from topics I normally choose to write about. I'm writing it because it's something I encounter so often at work and yet few people outside the hospital discuss it. I'm writing because there seems to be a wealth of misinformation. I'm writing because I think it's something we should all think about, especially those caring for aging family members. I'm closing comments on this one, but if you have questions/comments, please feel free to email me.

I see it nearly every time I go to work as a nurse.

A little old lady is admitted to the hospital. She suffers from congestive heart failure, needs diuretics, and is weak and fragile. She may weight 100 lbs. but at least 10 of that is extra fluid. She's 89 years old, has lived a long and full life, and is now spending her final days in a skilled nursing facility. She knows her name, but can't tell me she's at the hospital or what year it is.

And there, in capital letters at the top of her chart: FULL CODE.

Often, her family has made it known that if this little lady's heart stops at any point, they want her to be revived. Whatever it takes, someone must save her.

And so as her medical team, we do. Or at least we try.

Time after time, I've been involved in code situations where a patient just like this one has stopped breathing or her heart has stopped beating. Because of her code status, she is not allowed to go peacefully. Instead, a "code blue" is called. Code team nurses from all around the hospital race to the bedside, joining nurses on the floor who are already doing CPR. There are probably cracked ribs under the pressure of chest compressions. There is often vomiting. There are sometimes holes drilled into bones to get epinephrine in as quickly as possible. There can be blood in the mouth from a tube forced down the patient's throat. It is not a pretty or peaceful way to die. In fact, it's quite the opposite. And in most cases, the patient still dies. And if they don't, would they want this traumatic intervention to return to a poor quality of life?

A few months ago, I had the privilege of caring for a younger man who was terminally ill and whose death was imminent. His code status? DNR/DNI (Do Not Resuscitate/Do Not Intubate). His breathing had become quick and shallow, his blood pressure had dropped, and the signs were there: the end was very near. He had been estranged from his family, so no one was around for his final moments. Near the end of my shift, just before midnight, I stepped into the room, sat down by his bedside, and held his hand. Softly, I sang the words to Amazing Grace. At the end of the song, he stopped breathing.

As a culture, we fear death. We do everything in our power to stave it off. We simply do not accept it. Even just writing this blog post is uncomfortable for me, but if it helps just one person understand this situation for yourself or your ill family member, it's worth it to me. Or if you're interested in learning more about end-of-life care, I've had this book recommended to me by several trustworthy physicians. Have a conversation with your loved ones: your parents, grandparents, spouse. What are their wishes? Have the conversation before you're having to make the decision on your own. Then honor them in death as you honor them in life.

Happy Mother's Day.

Saturday, May 12, 2018

Lanie, at three, has a few sweet phrases that I wish would stay locked in her vocabulary forever. Upon entering a room, she begins almost every sentence with, "I jesh..."

"I jesh want you to hold me."
"I jesh fell down and hurt myself," as she limps in the room with her thumb hanging out of her mouth.
And my all-time favorite... "I jesh need my momma." This one comes at a wide variety of times, whether she's just scraped her knee, she's stalling before bedtime, or she comes upstairs from playing and hasn't seen me for a few minutes. My heart swells at her "jesh" needing me, and frankly, I get it. I just need my momma too sometimes. Maybe now more than ever.

When I was 16 years old, I was involved in a serious car accident in Texas and miraculously walked away with only minor injuries. A few months later, I found out I was being sued by the other driver. I had briefly blacked out during the accident, so I couldn't even remember the whole sequence of events and was terrified to go to court. Mom and I flew to Dallas for a deposition, and what I remember most was not how frightening it was to record my testimony or be cross examined by a ruthless lawyer, but how Mom helped me to cling to the Word. This verse still sticks in my mind from Psalm 37: "Commit your way to the Lord, trust in Him and He will do this: He will make your righteousness shine like the dawn and the justice of your cause like the noonday sun." We memorized it together and repeated it endlessly because we had to trust that He would act.

At age 26, in labor with Liam, I called Mom in the middle of the night to let her know, "This is it." I was in active labor and knew our boy was coming within a few hours. By early morning, Shawn had fallen asleep in the chair after being awake all night, and I tried to rest with an oxygen mask on as Liam's heart rate had dipped a bit during labor. Mom came and sat next to me in my hospital bed in the early morning hours, just oozing excitement for her first grandson to arrive. When I started to push, she waited outside the door (much to the chagrin of hospital staff), waiting to hear that very first cry. A few minutes later, she did.

When we decided to move to Raleigh, we'd been living with my parents for a couple months and the night before we moved, it hit me like a ton of bricks. 'I may never live under the same roof as my parents again,' I realized. Of course it was natural... I'd been married for almost 5 years and had a son. But the little girl in me still needed her momma.

Last June, I called my mom to tell her my water was leaking and our third baby would be born that very day, two weeks early. It was surreal as I wasn't having any contractions. But before he was even born, Mom bought a plane ticket and made it in time to meet Brooks on his birthday.

As a mom myself, I realize more and more each year how I just need my Mom. I need her to share in my joys, my pain, my mundane. I need her friendship, her wisdom, her insights from the Word, and her reminder that "This is truly just a season."

I love you dearly, Mom. Happy Mother's Day. 

The helpers.

Monday, April 30, 2018

Her husband was in the final stages of liver failure and I was his nurse. She called me in the late afternoon to say, "My favorite nail lady is coming by the hospital to give my husband a manicure and pedicure. If you'd like, I'd love for you to sit for a pedicure, too. Just put it on my tab!" The thought was a silly and impossible one - receiving a pedicure in my scrubs, at work, in a hospital room - but the idea was generous.

I watched the manicurist from Viet Nam lovingly crouch over a jaundiced, dying man to make him feel more human. She probably never pictured herself in a hospital room with a client who could barely respond. But as I watched her going about her work with great compassion, a Mister Rogers quote came to mind. When Fred Rogers was a young boy and would witness a catastrophe in the movies or on the news, his mother would remind him,

"Always look for the helpers. There will always be helpers... If you look for the helpers, you will know that there's hope."

I'd love to add this: so often, the helpers aren't wearing badges or stethoscopes or a uniform of any kind. They're teachers who spend many more hours than are required of them to teach kids to read. They're ladies enjoying retirement who pass their days knitting hats for NICU babies. They're nursery workers at church who allow moms to enjoy an uninterrupted hour to hear the Word. They're truck drivers who buy an extra lunch for the man who calls an underpass his home.

Always look for the helpers. They often go unnoticed, but if you look, you'll find them everywhere. In the saddest and loneliest and darkest places, they'll be there bearing the light.

For Brooks.

Sunday, April 22, 2018

Brooks Wilder,

After a 12-hour shift at the hospital, which becomes 14 hours by the time I've left home and returned, one of the hardest parts is giving you what's left. It's easy to feel guilty because what's left... isn't much.

But as I rocked you tonight and soaked in your warmth, I couldn't help but think, I want to give you every last bit. Even when it would be so much easier to hand Daddy a bottle for you and head to bed, I couldn't stand to miss those precious final moments of your day.

My eyes, bloodshot and weary from watching the saddest stories flicker by, will never be too tired to look into yours, bright with hope.
My legs, sore from running down hospital corridors, are never too exhausted to bounce you in rhythm until you drift to sleep.
My arms, which ache as they pull patients up in bed, ache now to hold you.
My hands, scrubbed clean after changing wound dressings, now touch your soft, warm head.

You will always have first place in my heart, Brooksie, even when I go away for the day to be with patients. And I hope that when the day comes when God asks you to be brave and leave home and serve others, perhaps you'll see your Daddy and me and remember that with God on your side, you can. And you should. We've tasted and seen that when you spend yourself on behalf of the needy, God will give you what you need. Someday, I hope I will have the faith to lovingly push you out the door when you need that extra courage. Be brave, little love. Be strong in the Lord and in His mighty power.

I love you,
Your Mama

Showing them Jesus.

Wednesday, February 28, 2018

A few times through the years, I've been asked to share what resources we use to help point our kids to Jesus. By no means is this an exhaustive list. It's simply a handful of books and music we've found helpful in helping us point our kids to the hope we have in Christ.

As much as these resources are helpful, they are simply resources. They don't replace daily conversations about Jesus that must happen for our kids to really understand our faith. In our house, we confess our sin to each other often and ask one another for forgiveness. We allow the kids to see us reading our Bibles and if they interrupt, we just read it aloud to them. We encourage them to join us in the worship service, if they're able to somewhat participate (mostly just Liam at this point). We sing worship songs in the car. Our faith in Jesus is personal, but not private. It's to be shared, and our greatest audience is our tiniest disciples.

If you have questions about something I've recommended, please leave it in the comments section and I'll be happy to go into more detail about it.

Kids' Bibles:
The Jesus Storybook Bible by Sally Lloyd-Jones
The Rhyme Bible Storybook by L. J. Sattgast
The Biggest Story: How the Snake Crusher Brings Us Back to the Garden by Kevin DeYoung
The Bible in Pictures for Little Eyes by Kenneth N. Taylor

Some Favorite Books:
The Garden, The Curtain, and the Cross by Carl Laverton
The Storm That Stopped by Alison Mitchell
Found: Psalm 23 by Sally Lloyd-Jones
Just Because You're Mine by Sally Lloyd-Jones
Song of the Stars by Sally Lloyd-Jones

Kids' Devotionals:
Thoughts to Make Your Heart Sing by Sally Lloyd-Jones
The Ology by Marty Machowski

For those who are unfamiliar with the purpose of a catechism or how you use it, these are simple questions and answers about God that we can teach our children that will form a framework for their theology. The questions and answers contain core doctrine for our faith. So when we read a Bible story, they might remember from the catechism, "Who is God?" "God is the creator of everyone and everything!" It has become an important part in our week - every Friday morning - to rehearse a new catechism question and answer with our kids. The New City Catechism has made this simple with a free app that includes the questions and answers as well as kid-friendly songs to help us all hide these truths in our hearts.

The New City Catechism by the Gospel Coalition
The New City Catechism Devotional by the Gospel Coalition

The Jesus Calling Bible Storybook Audio by Sarah Young
Hide 'Em In Your Heart by Steve Green
Hide the Word by Steve Green
Only Jesus by Austin Stone Worship: Kids
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