Hail Mary

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You can’t outwit fate by trying to stand on the sidelines and place little side bets about the outcome.  Either you wade in and risk everything to play the game, or you don’t play at all.  And if you don’t play, you can’t win. -Judith McNaught

Football season is in full swing around the Midwest.  I have spent many weekends recently on the sidelines watching the team my husband volunteers to coach.  Because I did not grow up watching football, and my high school did not have its own team, this has all been a learning experience.  I am slowly growing to appreciate the game. Notably, I am now critically evaluating how I believe the game could be better played and what penalties I would like to see enforced.  (I am frequently annoyed by the time outs at the end of the game! Illegal time out, anyone?) The play I now love to see incorporated in a game is better known as the “Hail Mary.”  Football is not really my thing, so I never gathered the true meaning of the term until a physician used it to describe the treatment plan for Mrs. C.*

 I had just received a call about her minutes before – “need you in the ER for a code.” When I walked into the room, the physician said, “she’s only 45, so I’m not going to call it, yet. What else can we do?”  I quickly went through my arsenal of ideas, slowly eliminating each one from my mental checklist of options, except for one.  “We could try this treatment,” I said.  “I’m thinking it will have a low probability of a good outcome, but based on what you are telling me, it makes sense to use it in this case.” The physician said, “it sounds like a Hail Mary, but we have to try.”  

 The physician was correct.  It was a Hail Mary play in the truest sense. A desperate measure to resolve a serious problem at the very last minute.  It was unlikely to be successful.  Truly, divine intervention would be needed for the treatment to succeed.  Therefore, I prepared the drug and hoped that against all odds it would work.  We had no other choice.  The treatment did not seem so risky when all other options were exhausted.

 When the nurse gave the medication, I prayed.  With every pulse check and every blip on the cardiac monitor, I prayed harder.  I kept my hand diligently on the femoral artery, anticipating that at any moment I would feel something other than my own pounding heartbeat. I prayed harder.

 As we left the room that day, the physician said, “Well, we did everything we could.”  He was right; we did it all, and then some.  It is at that exact moment when I realized that many times in our lives we are all faced with a decision of whether or not to take a risk. Not all of these risks are matters of life and death. Sometimes it is taking a new job, moving positions within the same organization, starting a new business, or just doing something outside your comfort zone.   Greatness requires risk.  Whether or not you are successful, the risk will stretch you and give you confidence in yourself and the faith to try again the next time.  

 I now understand why the “Hail Mary” pass is so important.  Whether or not the risk was worth it in the end does not matter.  What matters is leaving it all on the field.  You cannot expect to win if you give up.  Never leave the room thinking you could have given more.  

 

How will you identify the daily “Hail Mary” opportunities in your life?

 

 © 2019 Inspired Pharmacist

*Name and some details changed to protect the privacy of others.

 

Play Me Another One

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Life is like a piano. What you get out of it depends on how you play it. – Tom Lehrer

My earliest and fondest memories of my grandmother, Eileen, revolve around sitting beside her on the piano bench.  Her nimble fingers would glide across the shiny black and white keys and I would wish to play like her.  I had just started piano lessons, and my one handed do-re-mi paled in comparison to the old gospel hymns she could easily recall.  She would guide my little hands across the keys until I would get frustrated and say “Meemaw, play me another one.”  “Someday,” she would tell me, “you’ll play just because of the way it makes you feel.”

What frustrated me the MOST about learning the piano were the songs written in a key that contained those darn sharps and flats.  My grandmother would diligently highlight and circle the notes for me and we practiced looking ahead for awareness of what was coming.  In the depths of my discouragement with the whole thing, I asked her why we even needed the “stupid black keys.”  In her wisdom, she told me that music would be a lot less interesting without the black ones. “When you hit one, if you make a mistake, just keep right on going.”

I did learn, eventually, and just as she said, playing the piano became a contemplative practice.  It somehow became simple enough that my mind and heart are free to be with God more freely.  Playing the piano, for me, is an exceptional medicine.  It connects me to my past, my family and everything familiar.  In particularly trying times, you will most likely find me planted on the bench of my $50, untuned, yard sale piano.  I am still not as good as my grandmother, but thanks to her wisdom, I have learned to navigate the sharps and flats, both on the piano and in life.  

Life is certainly a lot like playing the piano.  The white keys represent the smooth happy times.  The black ones reveal the difficult and sometimes sad ones. However, as our journey of life progresses, we should keep in mind that black and white keys together create more meaningful music. Persisting in times of trials and tribulations adds to the enchantment of our individual stories. Now, if I make a mistake or face a challenge in my personal or professional life, I try to keep in mind my grandmother’s wisdom and just keep going.

My grandmother is now 88.  There is a special sort of magic in this number, which also reflects the number of keys on a standard piano. Perhaps this is why, on her birthday, her church also honored her for 70+ years of playing the organ and piano at services.  While she would certainly be justified in calling it quits, my grandmother, to me, has never been anything but steadfast.  She told the local newspaper reporter that she would play until her hands give out.  A long life full of black and white, creating the most beautiful music.    

Comment below: What are the hobbies or things that center you? Who helped cultivate your love for that activity?

Brushing Up on Dignity

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I long to accomplish a great and noble task; but it is my chief duty to accomplish small tasks as if they were great and noble. -Helen Keller

A few weekends ago, my husband and I were driving home from a wedding late at night.  It was late enough that we probably should have stayed in a hotel and made the two-hour drive in the morning.  Instead, and he will probably give me some grief for saying this, we listened to and belted out show tunes nearly the entire way home.  I had control of the music, but he was a willing participant.  I digress, though.  Usually when the song “Will I” from the musical Rent comes on, I change it.  It’s a little too slow for staying awake.  For some reason, my husband stopped me this time.  “I like that song,” he said. As I listened to the words, I could not help but think of Mr. B.*

He was mid-forties, tan with an athletic build and sparkling white smile. He appeared to be the type who would not leave the house without perfectly starched and pressed clothing; his dark hair was expertly coiffed.  When I met him, however, he was wearing superman pajama pants.  His mom had given them to him before he was admitted.  She was sick too, he said, unable to be there for support – so he needed to be strong for both of them; he had no other family.  He was newly diagnosed with leukemia and preparing to receive his first round of chemotherapy.  We entered the room to discuss his plan and provide information on the medications he would be receiving.  When he invited us to sit on the couch with him, I knew I was in for the long haul.

It is not that I did not want to take the time to make him feel comfortable, it is just that I was an overwhelmed, impatient, first year resident, merely observing.  I could not really answer any of his questions, as this was one of my first days on rotation.  As the interaction moved forward, one question stood out to me, because he interrupted my colleague many times to ask it. “Can I still brush my teeth?”  The second-year resident curtly answered “yes,” each time.  As we left the room, I briefly contemplated why  brushing his teeth was so important, aside from the obvious consequences of poor dental hygiene.  For some reason, the desire to know the answer to that particular question seemed more vital to him than the wealth of other important information provided to him that afternoon.

I really did not think about it much more until the next day, when again, while we were on rounds, he asked “Can I still brush my teeth?”  Instead of just moving on, my preceptor paused and said, “Yes, Mr. B, but tell me a little more about why you ask that question.”  He answered, “you said when my blood counts drop, I might bleed more easily and gave the example that my gums might bleed when I brushed my teeth.  So, I just want to know if I can still brush them.  It will not feel normal if I can’t.”

Listening for the answer and not listening to respond allowed him to open up and connect with us.  It also enabled us to reassure him.  On the surface, it seemed like such a meaningless question. To the patient, the answer meant independence. By acknowledging his concern and answering the question honestly and with a shared understanding, he felt seen, heard, listened to – cared for.

George Elliott once said, “What do we live for, if it is not to make life less difficult for one another.”  While I do not believe you can take someone’s dignity away, I do believe during trying seasons, one may start to question his or her value. I learned through this interaction that in medicine, and our daily lives, it is important to recognize and give permission to others to discuss insecurities.  Doing so, may provide them with comfort and ease their worry. As for Mr. B, he could rest easy knowing he would not lose the small measure of dignity brushing his teeth provided.  I like to think it gave him a little boost of confidence, just like those superman pajamas.

 

Let’s talk more about it: What does it mean to honor someone’s dignity?

© 2019 Inspired Pharmacist

*Name and some details changed to protect the privacy of others.

 

Piecing Shattered Dreams Into A Beautiful Story

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“If your heart is broken, make art with the pieces.” – Shane Koyczan

The low-pitched, gut-wrenching, tortured wail of grief sounds the same in every language. A sound that gives you chills to your core.  The sound of unbridled pain.  Sometimes, after especially brutal shifts, I can still hear those horrifying screams ringing in my ears.

The first time I heard it, I was a student; the patient was eight.  He had been admitted the entire time I was on my pediatric rotation with complications from leukemia, but was slowly improving. In fact, the medical team was talking about transferring him out of the ICU.  He unexpectedly coded one day while we were rounding; his mom was in the shower.  She heard the alarms and came running, arriving to the room barely dressed and soaking wet.  Because I was a student, I smashed myself against the wall to observe.  He did not make it.

As they called time of death, and the alarms that initially alerted us to his deteriorated condition were silenced, I remember looking around the room trying to find something familiar, because everything in that moment seemed so foreign.  It was not right; he was too young to die.  Hanging around the room were hundreds of letters and cards from his classmates, wishing he would be well again.  All of them telling the story of his vibrant life, a stark contrast to what I now saw.  His mother was crumpled laying on the floor in a heap near my feet, understandably weeping.  The faces of the seasoned medical professionals appeared so emotionless, mechanical, and cold.  I wondered how they could be so unfeeling.  I wanted to lay on the floor with his mother, but I pulled myself together, fearing I would appear weak.  I did not cry until I got into my car that night.  In my grief over his life cut short, I made a vow to myself that I would never be so detached.

Walking in the room that day, I thought I would learn about the role of a pharmacist in a pediatric code, and I did, but it also deeply and completely changed me.  The idea that I could grow through this experience still seems objectionable.  However, death and loss teach us something about ourselves and challenge our assumptions.  We have no choice about death.  We have no choice but to grieve.  What we can choose is how we will respond…will we grow better, or will we grow bitter?

It was in that moment that I chose to grow better.  I reassessed my life and how I functioned within it.  My priorities changed. Now, every day, I make a choice to be optimistic and kind to those I encounter.  I am determined to truly listen to those around me.  I dive deep into my spirituality, because what good is all this without the love of God beside me.  I have realized that I am stronger than I ever thought or knew I was.  Most of all, I am grateful for my life.  His death taught me about living; it also changed a job into my vocation.  I wish I could tell his mom how much he touched my life and changed my attitude.

When I made the promise that I would never grow jaded, I also vowed that if there ever came a day when I, too, was emotionless, mechanical, and cold, I would hang it up. Yet, how do I remain optimistic despite the heartbreaking things I regularly see?  The truth: there is no simple answer.  Thus, Inspired Pharmacist was created to document this journey, my journey.  A journey of gratitude, hope, love, and resilience – the good drugs of life.

*Names and some details changed to protect the privacy of others
Copr 2019 Inspired Pharmacist

Learning the art of surrender

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“How beautifully you are learning the art of surrender.  The courage to let go in the wild of your unknowns.” – Morgan Harper Nichols

 

My dear colleagues,

 

Today, I officially leave the Emergency Department and transition to the Intensive Care Unit.  While I firmly believe this was the correct decision for me, it is difficult to leave an area in which I have grown to love and one where the patients and my colleagues have taught me so much. An area where we treat everything from dandruff to the most severe traumas all in one day.  The shut of the ER doors locking behind me today felt so final; but also, it felt surprisingly okay, because the ED taught me how to embrace change.

 

In the marginally controlled chaos of the ED, you my dear colleagues and friends are, well, everything. Hilarious, dedicated, unrelenting in your advocacy, compassionate; all while simultaneously carrying the life, love, and hardships of your patients within your hearts when you leave.  I see you.  I am proud of you; I will never stop being proud of you.  You do the most amazing things every day.  

 

When I say my colleagues taught me many things, I mean a LOT of things. Some things are medically important; others were how to navigate life, and how to approach tricky ethical dilemmas.  I could fill pages here and bore you with everything you taught me, but I will keep the list to myself, and instead relay the most important one.  The lesson of surrender. 

 

When I first started working here, I would get hung up on outcomes, and become so easily overwhelmed.   I (hopefully, without letting on too much) resisted everything that felt uncomfortable and new.  In the beginning, a lot of it did – never before had I practiced in an area with such high stakes while knowing so little about the patient.  Letting go of any semblance of control felt like I was compromising care.  

 

That is until one of you told me that part of the art and the beauty of the ED was not knowing everything about the patient and being able to “fly a little blind.”  While there are difficult times and difficult decisions to be made, we do not define ourselves by these challenges.  The greater purpose and goal is and always has been to provide the best care for the patient.  As long as we keep that in mind, the result will be commendable.  You helped me realize that surrender does not mean calling it quits or compromising, it means that even in times of great risk and uncertainty, you put yourself in a position to trust. 

 

Therefore, I took a calculated risk to trust you, to learn from you, and work beside you.  It has come with such a great and immeasurable reward.  Without you, I would have never had the confidence to embrace this change and pursue this new opportunity. Further, I will never take your trust in me for granted.  Standing shoulder to shoulder with you on the front lines of medicine has been one of the greatest honors of my lifetime.  

 

With gratitude,

 

IP

 

Copr 2019 Inspired Pharmacist