Posts under ‘goodbyes’

As of today, I am no longer employed as a full-time worker. After eleven years of working 9 to 5 as a nurse, I am now a free agent, able to pick and choose when and where I work, on my own terms. With per diem status at four separate agencies, my weeks are mine to orchestrate and conduct. Of course, this means that I must now keep track of a much more complicated personal and professional schedule, and I must hope that I never show up at the wrong workplace on the wrong day. Still, the sense of freedom is incredible, and it will take some time to actually get my head around this new reality.

Of note, one of my greatest losses is the fact that my wife Mary and I will no longer be commuting together every day, and we will no longer be only 200 yards apart during our long workdays, meeting in the park for walks and sitting down for lunch in the midst of our harried days. As director of an inner city senior center just minutes from my former office, we have shared a place in this community for more than a year, and we both feel this palpable loss. I will be visiting weekly, able to actually be more present when I am indeed there, but there is still a loss incurred, and we are both processing its impact.

Yesterday, I was overwhelmed by my colleagues’ generosity as a surprise luncheon was held in my honor. According to my wishes, money was collected for a donation to Save Darfur, but my thoughtful colleagues still had to throw in a gift certificate to a local spa and a very personal photo album with a photo of each person accompanied by a personal message. It was a bittersweet day, and some tears were shed (by myself and others). I was, and am, deeply touched by such an outpouring of good will and camaraderie. I will miss my work family deeply. Even though I will help out at the office on a per diem basis from time to time, it will never be the same, and that is clearer and clearer to me even now.

As sad as it has been to say goodbye to so many patients, it is truly a great relief to know that my responsibility for the management of more than eighty individuals’ healthcare is over, and I can look forward to new types of therapeutic relationships with patients in varied clinical settings. Change is difficult and inevitable, and I embrace it willingly, even as moments of doubt and grief wash through me like waves.

For better or worse, I have shifts planned for both tomorrow and Monday at my new hospice job, short-circuiting any immediate sense of breathing room. However, there is plenty of time for breathing, and I plan to do a great deal of that each and every day.

For the moment, an inner sigh of relief, and a sense of peace that a chapter has been closed, a new one being written moment by moment, and day by day. I welcome the new, and will certainly cherish the old in a special place in my heart.

Well, it’s the eve of my final day of full-time work and I can’t sleep. Is there really any wonder why? Plus, my stomach has been acting up all week, my appetite is off, my back hurts more the last 48 hours, and my Restless Legs Syndrome is back with a vengeance, meds be damned.

Still, amidst it all, I am maintaining a relatively sunny outlook, and feel enormously good about my decision to leave.

Following a snow-day on Monday which elongated the weekend into a luxurious three days, I was hit straight on today by a wall of need which simply plowed down everything in its path. Like a fly waiting for a windshield on the freeway (a nod to Peter Gabriel for that imagery), I was like a sitting duck as the calls came pouring in throughout the day. Narcotic prescriptions, sick calls, complaints, missed appointments, more sick calls, prescriptions, transportation problems, more missed appointments, electrciity cut off for non-payment, even more narcotics—the day wore on uncomfortably, like wearing a suit that’s too tight.

Towards the end of the day, I realized that my days of being responsible for all of these patients and their care are coming to a close. With just three days of full-time employment remaining, this is essentially my “field goal” for the week (note the highly rare sports metaphor). I kept saying to myself: “This is my final Tuesday. This is my final Tuesday.” Waves of relief were juxtaposed with alternate (albeit smaller) waves of grief and/or loss.

One patient and I came to some semblance of closure on the phone this afternoon, although since she is the one person who I have actually given my phone number to, the closure had to do with our professional relationship rather than our new friendship. Our boundaries are clear, and I have no doubt that she would never abuse her personal access to me.

Conversely, other patients seem to be extending their needy tentacles towards me as I attempt to extricate myself, and I give non-committal answers when they ask me to “keep in touch”, and I generally respond by saying that I’ll hopefully see them around the clinic from time to time.

Sitting at the computer in the doctors’ area, I print out narcotic prescription after narcotic presciption, and I give thanks that these days will soon come to pass. This narcotic merry-go-round of which I have so recently written really seems to often put me over the proverbial edge. And with 5:00 pm Friday on the not-so-distant horizon, I feel excited at the prospect of so many odious and redundant tasks falling by the wayside.

Still, the human side of nursing is the sweetest, and the blessings and compassion which I receive from the majority of patients warms my heart and lightens my soul. When I choose to share with certain patients that I have been struggling with chronic stress-related illness and pain, the compassion that I feel reflected back to me means more than I can ever communicate in return. Shared humanity is truly the beautiful core of a healthy therapeutic relationship, and I am moved that that beauty is reflected in the eyes of many patients as I bid a heartfelt adieu.

Letting go is getting easier with each passing day. With only ten work days remaining (not that I’m counting!), the approaching new reality is quickly becoming less of a distant idea and more of a concrete certainty. Change seems to truly be the only constant in the universe in which we can have complete faith and trust.

Patients’ reactions are still varied. “But why?” is a common refrain, followed by worries about the future.

Yesterday, I was traipsing through the health center waiting room, hoping not to be noticed by any patients lurking in the corners. Suddenly, I heard my name being called and I turned. There sat a patient whom I have not seen for some time, and as I informed her of my imminent departure, her face fell, although she quickly smiled and wished me the best. “You’ll continue to be in my prayers every day,” she said, reaching out to give me a hug and a kiss. A sweet goodbye.

So far, I have chosen to give my home telephone number to only one patient who I trust implicitly not to abuse that information. She is an educated and self-sufficient woman who understands that our therapeutic relationship is coming to an end and any subsequent contact will be solely as friends. Additionally, I have told a few of my favorite patients that I may call them from time to time, but not to have any specific expectations. For the majority, it is a final goodbye, with the caveat that I will be working per diem shifts in the clinic and they may run into me now and then.

There are still three patients I have not told for whom I fear my departure will be difficult at best. Taking my fears into account, I am attempting to arrange joint visits with their therapists or case managers so that the news can be broken in a safe and supportive environment with another trusted professional on hand. These are the most tender goodbyes that could actually have clinical repercussions.

Overall, this process is going smoothly, and I am somewhat impatient to begin my new work lifestyle. Still, there is much work to be done—a plethora of t’s to be crossed and i’s to be dotted—before I can truly close that door behind me. I am processing my guilt at leaving my colleagues in the lurch, and I am also processing the fact that my professional identity—of working with the poorest and sickest of the poor and the sick—will need to change in the coming weeks and months. This does not diminish my self-chosen position as an advocate for the disenfranchised and vulnerable, but it does underscore the fact that I will not be slogging away in the trenches forty hours a week after the 18th of January. Can one leave the trenches and still be a fierce advocate for those in need of advocacy? I believe so, and I plan to figure out how to do just that.

Now for a weekend of R & R, and psychic preparation for the continued process of letting go.

Today was one of those days where this line of work can give an earnest Nurse Care Manager a run for his money. (And I do certainly feel like I’m running for my money today.)

First, there’s the patient with acute psychosis who apparently went on an inhaled heroin binge this weekend to celebrate finishing a very important multiple-month medical treatment. She told me that a friend had suggested going out to a fancy dinner instead of blowing her money on heroin. “It was actually a pretty good idea,” she said with a laugh. After discussing the voices in her head and her non-compliance with taking her medications, she agreed to go by ambulance to the ER for an evaluation.

Another patient just seems to be having a hard time getting his life on track (a familiar complaint and observation here at “Train Wrecks ‘r’ Us“. I feel deep compassion for his suffering, but sometimes it seems we just have to sit and let them work it out themselves.

The next patient complains about my long leave-of-absence, and says over the phone, “You mean, you’ve been back since yesterday and you haven’t called me yet? I missed you so much!” How will I break the news to her that, in five weeks, I’ll be permanently gone from her life?

Still another patient hears the news of my imminent departure and says, “Oh no! Another doctor leaving me behind? What next?” (She always refers to me as her doctor.)

These and other reactions are enough to make me feel guilty for leaving, but then I simply remind myself of the reasons why I’m leaving, the multiple stressors, the fast pace, the overwhelming feeling that I am running a race with no end in sight. I’ve been running like this for seven years, and working full-time for eleven.

We all run for our money in many ways, and any line of work will generally keep one running. This particular line has simply worn out the treads of my old Nurse Care Manager tires. I’m just due for a tune-up, some new treads, and a new place to run. In old-fashioned terminology, I’m “plum worn out” and have opened myself up to a new way to make my living in the world. The hardest part of that process is saying goodbye, and that is without a doubt par for the course.

He left six months ago for his homeland of Puerto Rico, certain that he wanted to die there. Five years of a professional yet intimate relationship were behind us: AIDS, cancer, remission, diabetes, wasting, cancer relapse, colostomy, and a downhill slide from there on.

When hospice at home failed, and wet sheets, untaken meds, and benign neglect demonstrated that being alone in his own apartment was not working, his family whisked him away to Puerto Rico, where he could come to rest surrounded by the smells and sounds of his motherland. I was sad to see him go, but happy for his reception into the welcoming bosom of family, and honestly relieved that my years of urgent calls and emergencies were over.

I had considered going to Puerto Rico to say goodbye, to visit him in his native land, but our financial situation and my responsibilities here stayed my hand. I also was just not sure that my appearing at his bedside would be truly beneficial to him, or only painfully remind him of all that he left behind, perhaps giving rise to unnecessary remorse and regrets that would have otherwise have remained blessedly subterranean. If I had gone, it would surely have been for me, not him, and I just wasn’t convinced that it would be for the best. Instead, I erred on the side of caution, following the ages old adage, “Don’t just do something, sit there.”

We did have one telephone conversation about four weeks after his departure. I called the home where he was staying in Puerto Rico and we chatted for a while. I told him that I loved him, and that God would bless him and his family. He blessed me as well, and we hung up. Although I had planned to call again, the number on a sticky note by my desk, it just didn’t happen.

Another goodbye, another letting go, another opportunity to say “I did enough”. And I can say it truthfully. I did enough. No room for regrets. It’s simply goodbye.