A Letter to My Nursing Class…

Dear Classmates,

Well…that was harder than expected.

I think we can all agree on that. The past two and a half years have been one big long grind to the finish line. Late nights, long hours, difficult tests, lack of sleep, loved ones who miss us, dishes that never got washed, laundry that was never folded (never), phone calls that were never returned, hours of studying just to squeak by with a passing grade, hours of studying that did not translate into a passing grade, leaving classmates behind that did not advance with us to our final walk across the stage at graduation.

You name it we’ve been through it.

From the beginning we were a special group but I believe we will all never forget the “med/surg massacre of 2015” when almost 25% of our class did not advance with us. The tears, the agony, and that feeling that our administration perhaps did not have the same faith in us that we had in ourselves. From then on we were a rag tag group of rebels, 75 strong, graduating quietly in December while an imperial march of 150 students in royal blue scrubs were clamoring behind us into auditoriums, filling up the study lounge, eating all the free pizza during dead week and demolishing bake sales like locusts. This group will graduate in May with confetti, fireworks and a tinker tape parade no doubt.

But as I said our class doesn’t need the fanfare. We’re non-traditional like that. We’ve got second degrees who have walked away from other careers to go back to school, mothers and fathers with families at home that they have had to balance along with full time class and clinical time, single mothers who did all of it alone, fiances trying to plan weddings on shoe string budgets in between studying and going to lab, partners trying to keep long distance relationships alive, out-of-towners who relocated their entire lives to be able to chase their dreams of becoming nurses, for some, English is a second language making the massive amounts of information we have to learn that much harder to absorb, one of our own even battled breast cancer (and won) while squeezing chemo and radiation in between rotations at the hospital.

Most, if not all, of us worked as nursing care techs to pay bills. Chugging coffee on night shift while studying pharmacology flash cards in between call lights. Sometimes getting off night shift and then going straight to class to sit through hours of new information or jogging across the hospital to a clinical placement to provide yet more patient care. No unicorns, rainbows, and cupcakes in the lounge for us folks. For us it was a struggle.

And I wouldn’t have had it any other way.

Because the great thing about struggle is that it binds people.

I’ll never forget the first time a friend helped me give a bed bath to a nonverbal preschooler with LLS. She knew I was intimidated and that pediatrics was not my strong suit so she did me a solid and grabbed the wash basin and hibiclens before I even had time to think.

During my OB rotation I was the WORST at finding fetal heart tones on the monitor so another student who became a fast friend came with me into rooms as a “backup” in case I needed help.

I remember putting my hands on a friend’s shoulders and telling her to take a deep breath, I took off her badge for her and reassured her “push hard and push fast.” It was her first code and she was about to rotate in to compress a man’s chest.

I remember spending hours in the NICU with another friend, born addicted infants in our arms, rocking them back and forth to try and soothe them while quietly discussing our plans for the future, the type of nurses we wanted to be, and our fervent hopes that we were strong enough to be them.

After a patient’s family requested that no students take care of their loved one and leaving the room feeling like I had utterly failed both them and the patient I was reassured by a preceptor that their decision had nothing to do with the care I had provided and everything to do with their need to take some kind of control over what was happening to their son…who was actively dying…and being reminded that other patients still needed me so I should wipe my tears now and get back into those rooms.

As I prepare to begin my first job as a nurse I know that the things I have learned which will make me a great one (at least I hope) are not the things I learned from text books or in simulation labs or lecture halls, it’s the real life experiences that I have had with my classmates as we all figured out a way to “muddle through” an extremely demanding degree.

And I guess I just wanted to tell all 75 of you one thing in response to that.

Be proud.

Because it takes strength and courage to put both of your hands on someone’s chest and become solely responsible for pumping their heart. It takes dignity to help bathe an adult who for one reason or another can no longer do this for himself. It takes grace to allow a distraught family member to take their frustrations at their loved one’s illness out on you. To understand that it’s not you it’s the cruelness of cancer that they are screaming at. It takes fortitude to continue to do your best every day even though you may rarely receive praise or gratitude.

Because nursing is not for the meek, it’s for the bold.

And I learned it all from you guys.

So be proud.

and thank you.

Sincerely,
Stephanie Fahs RN, BSN
Author (and survivor) of The Chronicles of Mayo

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Like Fine China…

Three years ago, I was being wheeled back to an OR suite with a tumor the size of the Easter Eggs we all just painted pressed up against my brain. I wasn’t sure what would happen or how it would all turn out.

Today I still don’t.

Recently my best friend from college got the fantastic news that her husband, after his second battle with Lymphoma was cancer free. I sent her an email welcoming her to “the new normal” where life is that much sweeter because we had to fight so hard to get here. We had earned this “thankful for every breath” new paradise. It was ours.

Sweet Elysium.

But the truth is the “new normal” is still hard.

Days are no longer run on adrenaline and the choices that were once so easy because they boiled down to fight or quit now become more complex. The longer your life is “normal” the more time you have to rebuild that which was broken. Suddenly a bump in the road becomes a much bigger deal because now you have something to lose. You financially rebuild, you emotionally rebuild, and slowly your life starts to look more and more like what life was like “before.”

The problem with this is that now you live your life like grandmother’s china. Staying locked safely inside the hutch until a really special occasion because you don’t want to risk cracks or heaven forbid actually dropping one of those dainty Wedgewood teacups on the floor and shattering it. And when a special occasion does force you to pull the gravy boat from its secure location on top of the luncheon plates (which you can hardly distinguish from the salad plates or the dessert plates) you handle it with baited breath until it is delicately hand washed and placed back in the safety of the hutch.

That’s the hard part about the “new normal.” You’ve survived the earthquake. The doors to the hutch were thrown off their hinges and maybe a few things broke, but you still have enough dishes to eat off Grandma’s china every night for the rest of your life.

And at first you do.

You pull out the crystal, use the fancy napkins, and drink the wine you were saving for a special occasion.

Because you’re alive.

That special occasion is now.

And during the day you sweep up the broken pieces, put the doors back on their hinges, replace the shelves and the glass, and then, maybe without even noticing it, you start putting the china back on the shelf.

And you begin to realize that three years ago during the earthquake, little things like a stress fracture refusing to heal, or the fact that you cannot go anywhere without five prescription bottles in your purse, would not have mattered. But now that life’s been pulled back together, they do.

Like chips in a teacup.

The thing about “new normal” is that you are still thankful for every day. The memory of struggle does not fade. You know how truly lucky you are. But it is for that reason that you don’t want to lose any more than you have already lost. It’s the reason you begin to gently place those dishes back on the shelf.

But the more times that you neatly stack those exquisite gold chargers behind those glass doors and marvel at the beauty trapped within, the harder it becomes to swing those doors open again to let that beauty out.

So it’s fine to clean up after the crisis. You have to if you want to move on with your life.

But don’t forget who you were when life called on you to be brave.

The earthquake may have broken much of who you were then, but when the dust settled you were still standing. Those Wedgewood teacups are delicate and fragile but you are made of stronger stuff.

Do not be afraid to open the door.

And hey, remember, if you drop one of those teacups there are 11 more in the hutch. When was the last time you had 12 people ask you for tea? When was the last time you entertained 12 people?

And if the gravy boat breaks? Put it in one of those other odd shaped bowls that you have no idea what they are for and call it a day.

Gravy is delicious, no one cares if you sail it across the table in a boat or if it shows up in a life raft.

Bibbidi Bobbidi Boo

This past weekend I did something crazy.  I woke up on a Sunday morning at 3:30 am, had breakfast, put on a bathing suit, and went down to the banks of the Ohio River and jumped in.  No I am not suicidal I am just one of those ridiculous people who signed up for Ironman Louisville.  For any of us who do not know what an Ironman is it is a triathlon that consists of 2.4 miles of swimming, 112 miles of cycling, and 26.2 miles of running.  8 months ago my boyfriend Sean, my friend Tyler and I all had paid the unbelievably expensive entry fee for the privilege of putting our bodies through 140.6 miles of blood, sweat, and chicken broth (you cringe, but it is the best tasting thing ever after 13 plus hours of being out on the course in the heat.)

I realize I have not posted a blog post in a LONG time so I’ll catch you up on what’s been happening with me. Was able to cycle off my beta blockers and began training during the winter like a maniac after signing up for ironman.  Was in fantastic shape and looking forward to race season as spring rolled around but then, of course life happened.  In April I developed a stress fracture in my leg and had to give up running for the year.  I also lost both my grandfather and my aunt that month within two weeks of each other.  In July I was diagnosed with skull base tumor number 4 and began another cycle of beta blocker therapy.  This made training for Ironman even more difficult.  So let’s just say as I stood in line on race morning that I was less than confident in  my ability to finish in the 17 hour cut off time. Sean had reassured me that after the swim which I would most likely finish ahead of the boys he would find me out on the course and that we would finish together.  I had my doubts that he would stick to this promise because I would need to walk the marathon. Yes walk. All 26.2 miles of it.  Sean is a runner.  I knew he had the best of intentions but that would be like asking me to dog paddle the swim.  I was not sure if he would feel so committed to walking next to me after being out on the course in the Kentucky August heat for more than 13 hours.

We watched the sun come up over the river (which looked almost clean and not filled with sewage in the morning light). Both the National Anthem and My Old Kentucky Home were sung and then the trumpet signaled the call to the post.  The canon fired and it was time to jump off the dock into the murkiness of the Ohio.

I took the plunge first with the boys right behind me and once I jumped there was no turning back.  The water was total chaos.  Filled with swimmers who were not comfortable with open water, thrashing arms, people clinging to kayaks like survivors of the titanic.  As soon as I came up for air I got kicked in the face, knocking my goggles off. Only to have them knocked off again a few moments later by a stray arm that was fighting the water trying to get the swimmer to the next buoy.  I headed for the inside of the pack closest to the island which was in the center of the river and made kind of a swimming lane that corralled all the swimmers and tried not to think about the fact that most fish, snakes, and any other critters were probably hanging out over there away from the throng of people in the middle of the lane. I lengthened out my stroke and tried to conserve energy while dodging in, out, and over top of other swimmers.  When I got out past the island I did a few strokes with my head up to try and see the turn around buoy.  The sun was in my eyes so I was having trouble siting the straightest line to get there.  From behind me I heard, “the buoy’s over there babe” and wouldn’t you know it there was Sean looking fresh as a daisy! That little guppy had drafted my feet and used me as a lineman to take him through the swim lane.  Drafting is legal and it was a smart thing to do but I won’t lie I was a little jealous. I was tired! I’d catch my breath soon though because once we turned the buoy we were in the current.  You could float and the river would carry you in as long as you pointed yourself in the right direction.  I flew like Michael Phelps for the last 2/3’s of the swim! I emerged from that nasty water singing Jethro Tull’s “AquaLung” in my head, waved hi to my parents who were on the sidelines and checked the clock.  2.4 in under an hour, I was ahead of schedule! Sean was right behind me so I trotted down to the transition area, grabbed my bag and headed in to the tent to change into my bike clothes. It took me awhile to get changed and then I took a restroom break so I figured Sean was already out there. I grabbed my bike and was off to pedal 112 through horse country.  There was not a moment to lose, Ironman has a cutoff time of 17 hours which starts at 7am and ends at 12.  I was like Cinderella at the ball. At the stroke of midnight the spell would be broken.

The thing about Ironman is that while you are racing the clock, trying to get in before midnight you find yourself out on the course with quite a bit of time on your hands.  Lots of pedaling which for me turned in to lots of thinking.  As the miles, and the hills, rolled by I found myself thinking about 2012.  About biopsies and angiograms and skull base tumors and surgeries.  About doctors and nurses and bosses and insurance agents. About stress, and sadness, and heartbreak and fear. I thought about all that I had been through and all that I had lost.  When I really took the time to think about all the things that had changed in my life in just two years I became almost overwhelmed.  The life that I live today is a totally different life than the one I was a part of two years earlier.  I reflected on the fact that change was possible.  But that change had not come without loss.  In order to grow into the person that I am now I had had to let go of the person that I once was.  That had been hard, just like the miles I was pedaling now.

Around mile 60 there was Sean in his American flag kit!  He had finally caught up to me and we finished the bike together.  As the bike turned into the run the day turned into night.  Sean and I walked the marathon because I was still recovering from a stress fracture and as a result we were out on the course with many other Cinderellas who were simply trying to get in by midnight.  I saw so many people around me struggling with the heat,  fatigue, and some their own inner demons.  All of us were fighting for the will to keep moving forward. All of us were hurting.  But all of us were still in it.  Many of us with smiles on our faces and still others offering words of encouragement to others on the course.  The people out on the course at night do their best to make the most of it.  You have to be positive or the pavement and the heat will force you to the ground. It was out there in the dark that I realized that it’s not the load that will break you down, it’s how you choose to carry it. You can stand tall, grin and bear it, or you can slouch over and groan and complain. Neither gets you there any faster but it’s a choice.  One pill makes you taller, the other makes you smaller.  My friend Mary dubs the people who are out on the Ironman course after the sun goes down “Survivors” and I realized that this was where I belonged.  I was not someone who coasted through life with minimal resistance arriving at the finish line early and with my hair done, clothes clean and pressed, I was someone who slid in vicariously, knees scraped up, and clothes all muddy.

Come what may.

At mile 25 of the run you can begin to see the city and feel that the finish line is within reach.  It was during this last mile that I thought about recovery and strength, family and friends, starting a new career and leaving the negative things in my life behind, I thought about the man who had said he would walk beside me and kept his word, I thought about the future, I thought about how far I had come.

and I’m not talking about the 140.6 😉

As Sean and I ran the last two blocks together and crossed the finish line hand in hand I smiled wider than I believe I ever have.  I heard the announcer say those magic words,

“YOU ARE AN IRONMAN!”

the words that I had fantasized about since I was a teenager and watched coverage of  Kona on TV.

We stayed to watch the clock count down to midnight and watch the other Cinderellas sneak in before curfew.  But what was truly amazing about that night was not my new identity as an “Ironman” but the realization of who I am and will always be:

A survivor.

The 5 O’Clock Shadow

It had been six months.

SIX MONTHS!

(No not since I put up my last blog post but it feels like it no?)

When I got the reminder phone call from the Mayo clinic that it was time for me to come back to rescan my tumor my stomach dropped.  How could it be time for that so soon? Things were just getting back to normal.

I guess time flies when you’re not dying.

This time my mom would go with me (as always).  We booked our flights, made our hotel reservations, packed the pink suitcase and my bear, and we were off.  All of this felt mechanical.  It would be our fifth trip to Mayo and we were seasoned vets.  We knew the quickest car service, where the best restaurants were, and I could quite possibly find my way through those underground tunnels connecting the hotels to the hospital in the dark.

Something else that had become routine were the nerves.  Since my diagnosis in 2012 I no longer felt like I could trust my body.  It had proved unpredictable and defiant.  I still felt status quo and could guess that my films tomorrow would not show any new growth but who really knew? I had been given six months by my doctors but would my body feel like giving me six more?

The next morning we woke early, showered, braided my hair into my Katniss braid, and headed down the street to radiology to get my MRI.  As usual, check in, get your beeper, go back, change into your hospital gown, nope no metal in or on my body, get your IV, nope no metal in or on my body, wait for a few minutes, last chance, nope no metal, in the tube, nap time, out of the tube, contrast in, in the tube, out, change clothes, thanks! Have a great day!

We always did MRI in the early morning and then saw Dr. M in early afternoon so we went to our favorite diner and had brunch complete with apple pie and cinnamon ice cream. After that we poked around the many shops adjacent to the Mayo Clinic to kill time.  One of the stores was filled with funny cards and pictures with positive thoughts and quotes on them.  I remembered thinking that working there must have been a catch 22.  To be nestled in this cozy little store surrounded by knick knacks and cards that had such positive messages but to know that the reason you were there was because of all of the struggle that was being experienced in the glass tower 500 feet away.

We heard the church bells from the Presbyterian church around the corner strike 2. Four visits ago my mom and I had wandered in the ornately carved doors on a walk out of curiosity and boredom.  Back then we were in the waiting period between surgery and going home.  Like planes in a holding pattern we had to stay in Rochester to wait and see if anything went wrong before we could go back to KY. Niether one of us had been seeking sanctuary but it is funny how a quiet space used for worship (whether you believe in a higher power or not) can create a moment of calm. Almost like the marble and stained glass use the thoughts and prayers of others that have been deposited there to create a space that can feel safe. No one was there but us and we took five quiet moments in that space to be quiet…and breathe.

Funny how such a serene place then could instill such panic in my mind now with the gonging of its bells! It was time to walk over to the Gonda building, zip up the elevators to the 12th floor and see what surprises my body had in store for me this trip.

As usual, check in, get your beeper, sit for five, beeper goes off, meet the nice lady at door B, follow her back to the room, wait five minutes, in walks Eli, camera up the nose, take some pictures, and since they have an even fancier new endoscope today (someone’s been filling out their grant proposals Eli!)  some video. Eli asks how I’m feeling, I say fine. He smiles, ok I’ll go get the boss.

And then my hands get clammy.  My head starts hurting, is that a sign? Do I really feel fine? I’ve had my symptoms for so long can I really tell anymore? What if things have gotten worse? I grip the armrests as I normally do and focus on my breathing.  In, out, slow and controlled. I repeat to myself the phrase that I have said over and over again since March of 2012.

“Whatever happens, it will be fine”

Dr. M enters the room and I immediately crack up.

No I have not lost my mind from dealing with the pressure (physcial and mental) of having a skull base tumor.  Dr. M’s appearance simply made me burst out laughing.

I have described him before as serious and to the point.  He does not use four words when two will do, there is no chit chat about personal lives or emotions.  When I meet with Dr. M it is to discuss findings and symptoms then to strategize about next steps.  His appearance reflects this straightforward approach.  He wears grey, black, and navy suits, with solid button downs and either bold or muted colored ties.  No crazy patterns, loud color combinations, or bow ties here folks.  This man is all business, clean shaven, sometimes I have seen him in square rimmed glasses but that’s about it for accessories.

Today was different.

Dr. M walked into that exam room in his normal uniform but his visage was partially hidden by a 5 o’clock shadow that was slowly transitioning into the beginnings of what appeared to be a beard! I hate to say it but my clean cut surgeon was looking down right scruffy this afternoon! Before I could stop myself I blurted out, “Whoa, late night last night?” and immediately turned a deep shade of crimson and gave myself an internal slap on the wrist.

You don’t joke with Dr. M Stephanie.  He’s your surgical robot.  Don’t scramble his circuits with laughter and emotion.

To my surprise this was one of the rare moments that Dr. M cracked a smile and even shared a personal detail about himself.

“I coach a high school lacrosse team and it’s tournament time.  All of my kids are shaving their hair into mohawks but I don’t think my wife or my patients would find that acceptable so  I told them as long as we keep winning I’ll grow out my beard.”

Huh. Lacrosse.  I pictured him on the field with a bunch of 16 year olds surgically dissecting plays on a hand held white board.

Scalpel, I mean Sharpie please.

Until then I had not ever thought of Dr. M as a person really outside of the hospital.  My surgical robot now seemed strangely human.

I had little time to reflect on this because as briefly as it had begun the small moment of reprieve from the medical world was over and Dr. M was running through the video Eli had taken as well as scrolling through my MRI. He turned away from the computer monitor to face me and I held my breath. 6 more months, that’s all I want, 6 more months, please god, I want more time.

Well Miss Fahs, everything here looks good.  Your tumor has continued to regress in size.  I think we should begin cycling you off your beta blockers.

I was jumping out of my chair in exultation only to be caught in mid air and slammed back into my seat. Cycle off my beta blockers? Why in the hell would we do that? They were my magic potion.  Taking them had saved me from an exploratory craniotomy.  We were winning! My tumor was even smaller today than six months ago.  We had the enemy on the run, why on earth would we put our weapons down now?

Dr. M could sense my hesitation, “We will cycle you off slowly, if you feel like your symptoms are returning you can simply contact me and we will cycle back on.  But I would suspect that these are making training difficult for you and from my standpoint, if you do not need to be on them then we should take you off.”

Don’t you hate logical thinking? I could not deny that being on the beta blockers, while saving my life was also diminishing its quality.  Lightheadedness was an everyday affair and it is very strange to push as hard as you can for an interval of time on your bike and not see your heart rate rise in accordance.  I agreed to cycle off in a manner equivalent to the armed forces draw down in Afghanistan.  I would reduce the dosage slowly but there was no set plan in the immediate future to go cold turkey.

As we walked out of the Gonda building my mom pulled me out of my over-analytic state and said something she hardly ever does.  Looking mischevious she pointed to a bar across the street and said “let’s go get a drink to celebrate”  In all of my worry about going off my medication I had missed the most important part of the doctor’s visit. My tumor was smaller. I had been given the one thing I had begged for when I was sitting there waiting for Dr. M.

Six more months.

How had I missed it? I should be feeling elated not worried.  I could not predict the future, but there was just as much of a chance of these next six months going well as going poorly.  My friend Mary would inform me later that this is something called “awfulizing.”  Getting caught up in all of the things that could go wrong in the future so that you can no longer enjoy the present moment.  It, in effect, kills the engine before you can even kick start it to get moving down the road.

Luckily my mom was there to steer me in the right direction.

Across the street to the bar.

That night we had not one but a shocking two rounds of drinks and both went back to the hotel feeling bubbly just like the champagne.

I could not predict or control what the future would bring but I learned that night that it’s no use straining to see the horizon through binoculars, the real beauty of life is here and now, it can be seen simply with the naked eye.

Be careful not to miss it.