I'm so upset about it. Seriously. I feel sick. I'm very emotional over this, and I don't like either "door." This sucks. It sucks! I... Man. I don't even... I'm upset. My hands are even shaking. Great. Heartbroken. Really. :'(

I've given myself, and my kids, as normal a morning as possible. But now it's crunch time again. I'm drinking my first cup of cinnamon latte (gosh, I love this machine!) and hoping it will help me through the day. I've never had more than one cup, ever, and I wonder if I'll be resorting to multiples today. My to-do list is 11 entries long right now and I'm not even sure I can finish what's there.

So, cheers, coffee. Please, just for one day, live up to your reputation. This girl needs help.

When we were growing up, we fantasized about which Disney Princess we were most like. I was one of five daughters, the middle child. It was a group designation, which Princess we were. And once it was decided, it was final. A lot of thought went into it, too.

It was chosen that I was Ariel. I always wondered why my sisters chose what they did (I suspected it was because I was the singer of the sisters and defiant of authority) but in retrospect, I think it fit in some ways we couldn't have anticipated. Because the pattern of my life has always been breaking away for new adventures on my own. Never fitting the mold of what anyone expects - and not for the sake of rebellion or autonomy, but because authenticity is flat out a necessity for me.

It's funny that I grew up and married a man of the sea.

The water has always had a strong spiritual connection for me. It has a settling presence. I miss the ocean. It will be good for me to remember peace in the upcoming weeks. I hope that when we move (this and next week), I will again find my water.

Today, 4 years ago, a little boy was introduced to the world (and his sister) for the first time. Happy Birthday, Isaiah. My little man, who tells me every day, "you so beautiful" and I don't know why.

... When brother and sister first met.

In preparation for moving, one always takes stock of their belongings. Part of that necessitates some trimming of the fat and a few trips to the Salvation Army donation center. I am trying to bring myself to begin this process, even though Josh isn't home to help me with it, and I'm not sure that it's a good idea because of the contents and what it means to me.

I'm not a hoarder, not at all. Keeping extra things around feels "heavy" to me, and has never been something I was prone to (unlike my oldest sister who collects both things and people and has a hard time letting go even if they were never hers - for example, she has my ex-boyfriends on her FB. Excuse me, but why? It isn't like they were pals. KWIM? She's a collector). That said, the things I have that it's time to trim away are the baby items.

Because we can't have any more children due to my medical need for a Category D medication (absolutely poisonous for a potential baby). It's time for me to go through the closets and pull out the baby clothes I saved because they were still perfect for another baby or because they held precious memories for me. To get rid of our baby crib and baby toys. The baby swing, the bassinet. It all makes me start to choke down another sob. We wanted more children. We didn't plan for this, but we accept it. We love our family the way it is. We are satisfied with our son and our daughter.

But this process, man it just puts it right in my face. It's not just knowing that it's over. It's deleting the stuff.

I already know. The onesies will be the hardest.

I have to stop myself, I was just looking for an example picture of my kids when they were babies in their onesies. And it reminded me of how precious the baby robes were after bath time, and the socks, and just all of it. I'm not sure if I should go through these things when Josh is gone or not....

*Yes, it occurred to me to donate these things while there are trucks collecting locally for tornado relief (we live in Texas, and proximity to Oklahoma facilitates this process readily). It's kind of why I'm trying to push myself, although I'm not sure they would accept my crib (Salvation Army doesn't accept used baby "furniture").

This one is hard for me to write. I cannot clean this up, it is a ramble, and sometimes there is mature language. You can join this train of thought and feeling or not. I will simply plow my way through.

These experiences were ... well they were, mostly, moments that everything seems to come crashing to a stop. The world ceased to spin. Every breath felt like an effort. Life was in the moment. There was nothing else but the moment. Sometimes it was all-encompassing and felt overwhelming. Other times, when I left work that day I knew for a fact, without any uncertainty, why I was there that day. Who I was there for. And that I'd had a powerful impact on someone's life and their experience. These are the things I miss about my job. The human interaction, the times that I knew I stood watch and connected with a person in a crucial life and death, profound way. Times even when life was lost, when a breath was their last, when a family member needed someone who had not become so calloused to the experience. Someone who could look, heartbroken, into their eyes and recognize the depth of the profound sorrow in that moment. That surreal moment, it never feels real. It never does. It is never something you grasp finality of, even if you cognitively know it.

I remember the loss of my own father, when I was 20. It wasn't exactly a heart attack, but kind of. I'd gotten home from my clinicals (I was in college at the time), and I waved hello to him when I pulled in the driveway. He was mowing the front lawn. Like I always did, I went inside and first things first, I took a shower to wash the hospital grime away. When I got out, I quickly got dressed, but still with a towel on my head, I heard a knock at the door. I answered. It was a stranger. He was scared to death. He could barely speak. The terror in his eyes was clue enough. He barely said, "there's a man lying in your yard."

I ran outside. My mother and one of my older sisters were close behind. Yes, it was my Dad. He was face-down. Not moving. Flat. We turned him over. Nothing. We began CPR as another sister called 911. Rescue took him to the hospital where I did my training. They all knew me. No one would look at me. He was gone. Why couldn't anyone in that moment *see* me? How was it better that they pretend I didn't exist, that they didn't know me? I tell this story because it impacted the way I decided to handle grief and death when it came along for me professionally. You cannot ignore the family. You MUST acknowledge them, it is THEIR moment, THEIR loss. To ignore them is hurtful, and how dare you hurt someone who is already going through the most desperate, deplorable time of their life?

All of my patient stories will not be of sadness or death, there is personal victory and triumph as well. But these are the stories and the patients who changed my life.

* The 17 year old boy also belongs here, but I already told his story here (he was #2).

________

5. Empathy can't be taught by any book or lecture, no matter how eloquent. To understand a man, you must sometimes wade through the anger, the dirty, the raw emotion that you naturally want to run away from. This man taught me how to face it. He was a war vet, a fucking hard-ass. He was in a wheelchair, now having suffered a stroke which left him without control of his left side. He did not want assistance, even though he needed it. All we needed to do was get him from the wheelchair onto the CT table, something we routinely helped people with - but he saw it as a weakness he could not tolerate. He screamed and cursed at us like we were the enemy when we asked if we could assist him to the table. For a few terrible minutes he tried to do it for himself, he simply couldn't though. He got angrier and angrier at himself. He began punching his paralyzed arm and leg. He shouted terrible things at himself about how worthless he was. He abused himself, physically, mentally, emotionally. And he could not, simply could not accept help. Why? Because he didn't feel he deserved it.

There are people all around us who need help. They are too afraid to ask or accept it because they don't want to be a burden. To be a burden on someone is one of the worst fears most of us have as humans. You cannot overcome this by just forcing your help on someone who cannot accept it. You must wait, wade through the ugly, and simply be. They know you are with them, on their side, when they can't scare you away like he tried to do with us. How did we get done what we needed? I sat in the room with him. When he was ready for help, he indicated it. Patience. Empathy. Not sympathy - no one wants pity. Give people the time they deserve. Even if it is extra time.

4. When I was a child, I had a rare blood disorder that required a TON of blood draws. I developed a serious case of needle phobia. During the entrance interview for my Radiology program, my opening statement was, "Does this program involve needles? If it does, do me a favor and don't select me." Great attitude, right? They selected me anyway, venipuncture was not a requirement for the program. But the reality is that in Radiology we inject contrast media, usually iodine. For the first half of my career, I was fine, it didn't really come up. But when I moved to Florida and they offered to cross-train me in CT, this fear simply had to be overcome. My co-workers trod through this with me for months, one step at a time, it was a true fear. But when I was finally ready (and had practiced a few times on my mentor), the time came for me to do it for real, on a patient. My heart racing, we selected from our to-do patient list a male in his young twenties (they usually have good veins). When my co-worker Ian brought him back into the CT room where I was, I swear my heart stopped. This guy was a dreamboat. REALLY??!! My first time had to be with the sexiest patient ever. He was a freaking honest-to-God rugby player from South Africa. Accent and all. Holy hell. (I'm giggling at the memory.) Ian told him I had been training for starting IVs, and asked him if it would be OK if I stuck him for his contrast injection. My dreamboat rugby player looked me in the eyes and said, and I'll never forget it, "I'd love to be your first." Die a thousand (pleasurable) deaths...

So this man, this adorable man, was put in my path at just the right moment to help me overcome one of the greatest fears of my life. He was kind. He was patient. He was knowledgeable; he actually had cancer and was going through chemo at the time, so he showed me which vein was usually his best. He told me when I didn't put the elastic tourniquet on tight enough. He smiled at me. He didn't act like I was hurting him. He was distracting as hell to be around. And I overcame my first time, physically holding onto the muscular arm of my dreamboat rugby player.

This time, a patient was put there for me. Not the other way around.

3. The ER physician, attending staff, and crash cart came barreling into the CT room we'd cleared for a truly emergent exam, exactly what we were going to do was unclear. The patient was a middle-aged man and his blood pressure was bottoming out and they didn't know why, and they just knew they needed to see "inside" him now, like now. His monitor flatlined. They initiated CPR. The Dr said, "get him on your table." We did, they continued CPR on the CT table. One of the nurses was standing 5 feet in the air to be on top of him enough to compress his chest. This was a physical situation that we all knew was ending badly. The Dr still did not tell us what to scan. I assumed he would want some kind of angiographic study of his heart/aorta to see if he had a ruptured aneurysm and was bleeding out (explaining the blood pressure crash). They continued CPR. I stood at the ready. Probably being a pain in the ass to the Dr who couldn't decide what to do, I suggested, "Angio Chest Abdomen Pelvis?" He sort of nodded. I asked, "can I attach him to the contrast injector?" Yes. So I did. The problem was, to get the study, CPR would have to cease.

How do you know what you're treating though, were compressions simply making it worse? It was a no-win situation. I only knew how to be ready on my end for the order, so I readied anything I could. The man's family came in the room at the Dr's request. It was damn crowded now. They continued CPR on my CT table. The family huddled in the back corner of the room. I stood back with them. I looked at them, acknowledging them and everything they were witnessing. I waited for my cue to scan. The cue that never came.

After about 20 minutes of CPR and everything associated, the Dr called it. The flurry of activity stopped. The screaming alarms were silenced. A pin drop could be heard. I heard the breathing of the family as the ER staff and I gently put him back onto his stretcher and unhooked the monitors. I walked toward them, they weren't looking at me, but it didn't matter. I still said a quiet, "I'm so sorry," as I gave an unopened tissue box to one of them, just in case they wanted it at some point. They numbly followed the ER staff as they took their loved one back to the ER. My CT room was a disaster. It didn't matter. Whether anyone else in their experience acknowledged them in their loss and in their moment, I did. I'd gone through it myself.

2. There once was a woman, an inpatient who had end stage metastatic cancer. She was originally from Hawaii. She was in her 50's. There was no family around in this, the end of her journey. I was pregnant with Ava (very obviously so). She was my patient on more than one occasion, and we always spoke and laughed with one another. One day, she came for one of her routine scans, but this time it was different. She didn't look well, although she still smiled she looked tired. Before she left my room, she stopped me. I knelt in front of her wheelchair, I knew she wanted to say something she felt was important. She said, "I don't want to leave this earth without someone remembering me. You have been a joy for me in the end of my walk. I want you to have this, I've kept this bracelet with me since I left Hawaii. It's made out of magnetite from a volcano near my village back home. Never forget me. I won't ever forget you."

I haven't. I still have this bracelet, even though it is too big for me. This is one of my most treasured possessions. She passed away later that night.

1. This is not a story of my own patient. It is a story of my experience. I have told one of you this story. It is not a happy one. But it was profound. Nobody walked away from this one unchanged. Nobody. (This involves a child, please don't continue if you cannot.)

There was a 3 year old boy. He'd been brought in by rescue. He'd drowned in his own backyard pool when no one knew he'd gotten outside. This is my experience with the situation, what I witnessed.

He was on the stretcher, the doctors were trying desperately to bring him back, to get some indication of life back. His mother and father were in the room, too. They were in the trauma room next to the exit for life flight, who was waiting, with the helicopter running and aircrew antsy to get him in the air (we were not a Level 1 trauma hospital, nor were we a children's hospital). Everyone was willing this child, this boy, to live. It was palpable.

(crying)

But they had to stop, he was not coming back. Before they officially "called his death," the ER doctor asked the child's father to come to his child. To talk to him. To ask him to come back.

Oh my God.

This father.

He tried so hard to be a hero for his child. His mother sobbed in the corner with the nurses. And the father began talking. Which turned into yelling. He shouted to his son, "COME BACK TO US!!!" Over and over and over. The whole Emergency Room listened. No one could help it. Time stopped. "I LOVE YOU!!! MOMMY LOVES YOU!! DON'T LEAVE US!!" At the top of his lungs, he shouted. Pleading that his child come back. But he would not.

That was the first and only time I had to leave work. It was selfish of me, it was not my story. But having witnessed what I'd witnessed and heard what I'd heard, I could not function. I was also pregnant with Isaiah. My supervisor sent me home. I couldn't get control of my crying, my grief for this family who'd just experienced the worst nightmare they never could have imagined.

________

Our experiences make us who we are. The purpose in telling these stories is not to be a downer. It is to show you a part of who I am. It's a part of me that I usually keep hidden in my heart, but it's part of what made me, Me.

Some of you know this about me, some don't. Before I decided to stay at home with my two children, I worked in healthcare. I carry initials after my name and I maintain them (even though I'm not currently working in the field) through course work and requirements (12 credit hours a year).

For giggles, my signed professional name is Sarah ****** R.T.(R)(CT)

I worked in radiology, first in trauma X-Ray and later in emergency and cardiovascular CT. I worked in the field for about 10 years. I started my professional career (after college) in Boston. I worked the overnight shift at Boston Medical Center. My primary job was as part of the trauma team, X-Rays are an essential part of the initial assessment and treatment of every trauma patient. The trauma series includes a chest, pelvis, and lateral c-spine X-Ray. Usually that's what was performed, but occasionally there wasn't enough time for all that and we moved straight to vitals, the chest and c-spine for life support (the neck because patients were likely either already or about to be intubated).

Some of this might be too much to read for some of you. Here are the 5 most gruesome cases I was personally a part of. (I will have another post where I write about the 5 patients whose stories touched me the most, whether positively or negatively.) Most of them are from my work in Boston, but some are from my work in Florida.

*WARNING: GRAPHIC

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5. I knew it was strange when I was called to the trauma bay for only a chest X-Ray, not a full series. It was stranger still when I got there and before going behind the curtain, the trauma team advised me to put on contact precautions gear because of excessive blood. I quickly got ready and walked through the curtain not knowing what to expect, and certainly not expecting to see an awake, alert woman sitting up on a stretcher looking normal, but tucking her chin WAY down. But then, she answered a question from the Dr, and her neck moved a little. Suddenly I understood. Blood came pouring out of her neck. She had been sliced from ear to ear, a victim of attempted murder. So long as she kept her chin tucked to her chest, the bleeding was mostly controlled. But as soon as it moved, it was like a fountain, all the way across the front of her neck. It was pretty tricky getting her chest X-Ray, but with minimal bleeding we accomplished it, and soon after, she was taken to surgery for repair. No simple stitches would do. She survived. This one always bothered me, and I still tuck my chin when I remember her, in fact as I write this, it's tucked to my chest in memory.

4. The winter I worked in Boston, we had a crazy Christmas blizzard. I ended up working for almost 3 days and nights straight because of it (I napped on a stretcher in an unused Ultrasound room when I could). Eventually, the snow plows were allowed to start clearing the roads. The snow was thick, and conditions were still not the best, but even emergency vehicles could not pass. And so, they began their dangerous trek. Visibility was very low. There was a man in the road, God only knows why. He must have heard the snow plow at the last minute, at least there's that. He tried to jump off to the side, but didn't completely make it. His legs were destroyed. When he came in (via Life Flight, because those heroic SOBs will do anything in any condition to save any one of us), one of his legs was already gone, lost mid thigh. The other was a mangled, barely distinguishable mess that was hanging on by ripped flesh. He was not awake (I wouldn't want to be either). I took a pelvis x-ray to see if his pelvis was fractured too, as well as any obvious internal bleeding, and x-rayed his remaining "leg." The "bones" were just chips. Hundreds of fragments, nothing that could be saved. He was then taken to the OR, and his remaining "leg" was amputated, if you want to call it that. But his life was preserved.

3. I touched on this story in my 16 facts survey. A homeless man was brought in, unresponsive, by rescue. They had been administering advanced cardiovascular life support (CPR, defibrillator, etc) for quite some time, and Drs and staff continued their efforts once in the trauma bay. The special circumstance: He had frozen to death, and that was presumed to be the reason for his unresponsiveness. They set up heating lamps all around him, they put warming blankets on him, all as they continued their efforts to revive him. I was called for a chest X-Ray (yes another strange one, I knew it before I got there because it wasn't the "protocol"). Again, before walking in the room, I was warned about contact precautions and given full gear. They did not, however, warn me about the smell. Dear God In Heaven. Death plus heating lamps would be bad enough. But there was another factor. You see, since he had died from hypothermia, and God knows how long he'd been dead before someone saw him and called rescue, he was internally "frozen." That includes his bowel contents. So as he was warmed up, and they called his death while I was in there, but still wanted the X-Ray anyway (bastards), his bowel contents began to warm and thin, and then melt out of his deceased body. It was the worst fricking X-Ray I ever took. But they didn't have the heart to tell me to do it again. Hooray for small favors.

2. I was on-call for CT one night in Florida. My pager went off, I rushed to the hospital. I was told I had to get a head CT for a "drunk combative kid." That was as defined by the nursing staff who were evaluating him at the time. I went to his ER room and he was laying, still strapped to the orange ambulance board, on a stretcher. He was 17. His quick blood toxicology showed evidence of some alcohol, but it wasn't a crazy amount. I walked over to him. He was mumbling. I greeted him softly by his first name, I told him my name. I stood where he could see me, his head was turned to the side. He smiled, and said hello. I told him I was going to take him to get a "CAT scan" of his brain to make sure everything was OK, since he'd bumped his head. He mumbled something that didn't make sense. He smelled strange. Not like normal drunk patients. I saw some kind of bodily function up by his head, but didn't look into it, his nurse told me he'd vomited. I took him in the stretcher to CT. Since he was still on the hard orange board, it was easy for me to slide him over onto my table by myself. I pulled him into the scanner, he would go in head first, and then got behind him to get him into the right position. That's when I saw it. It was not "puke." The nurse was being an obnoxious, negligent bitch. He had an open skull fracture and there was a handful of brain matter mixed with pink blood on the sheets and on his head. It was the first time I'd seen traumatic brain matter. My heart began racing. As I quickly did the scan, I was on the phone with the ER physician informing him. He ran over to watch the images as I took them.

I'm shaking. (Breathe)

It was very bad.

His brain was filled with blood. The ventricles inside his brain were displaced. The images also showed that yes, his brains had been "mushed out." The physician used my phone and called the nearest Neurosurgeon and initiated life flight which he knew was useless. He looked at me and said, "His family isn't even here yet, they probably won't get to say goodbye."

This 17 year old kid had a drink or two. But then he fell on a slippery concrete stair. I had spoken with him, and smiled with him. I'm glad his bitch nurse wasn't the last person to talk with him, I was. He was unconscious when he left my CT room. He never woke up again.

1. This is one for the books. You might not even believe what I tell you. I'll take that chance; it's true, and it's possible. The patient: a man with severe facial trauma after being hit in the face with a metal pipe. I was supposed to get a Facial Bone CT to see the extent of his fractures, because he was REALLY swollen and it was hard to tell what exactly was under the swelling, he was pretty deformed looking. My co-worker and I got him in the room, and he suddenly said he felt sick. We hurried and got him an emesis pan, and he proceeded to vomit. But WTF was in that vomit!!! Me and my co-worker looked at each other like, holy s***. It looked like ground meat. Pink and white, mottled, and kind of solid. Similar to raw hamburger meat. But not exactly. We called the ED staff, it just wasn't freaking normal. You'll never guess what it ended up being. Are you ready for this?

The trauma, the impact to his face was so great, particularly to his eye socket and maxillary sinus (the sinus where your cheek is, right under your eye), that it not only fractured his orbit and his sinus cavity, but it also ruptured his eyeball. His eyeball was then basically squeezed down through the broken orbital floor, through to the sinus cavity, and then drained like mucus would, until he swallowed it. Which is when he vomited. He vomited his own ruptured eyeball and surrounding tissues.

Yummy.
 

So, those are my top 5 most gruesome (or horrifying to me) patients. But really, these stories are a part of who I am because I've experienced them and they have profoundly impacted me. 

When I saw this story online, I knew I had to share it. Here's the link to the original.

Jaime Moore is a photographer, and when her daughter turned 5, she needed new inspiration for her birthday celebratory pictures. Nothing against Disney Princesses (or Barbie), but it was just so cliche, and frankly, they weren't tales of real women. So instead of dressing her up as a favorite Princess, they chose 5 notable females to emulate. Real women with real stories. Because anything is possible, and these women proved it. These are the pictures they recreated.

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"Forget conventionalisms; forget what the world thinks of you for stepping out of your place; think your best thoughts, speak your best words, work your best works, looking to your own conscience for approval. * I had rather...make history than write it. * Failure is impossible."  - Susan B. Anthony

"In order to be irreplaceable one must always be different. * Life isn't about finding yourself, it's about creating yourself. * A girl should be two things: Who and What she wants."  - Coco Chanel

"Now and then women should do for themselves what men have already done - occasionally what men have not done - thereby establishing themselves as persons, and perhaps encouraging other women toward greater independence of thought and action. Some such consideration was a contributing reason for my wanting to do what I so much wanted to do."  - Amelia Earhart

"Be of good cheer. Do not think of today's failures, but of the success that may come tomorrow. You have set yourself a difficult task, but you will succeed if you persevere; and you will find a joy in overcoming obstacles. Remember, no effort that we make to attain something beautiful is ever lost. * What I am looking for is not out there. It is in me."  - Helen Keller

"My family has very strong women. My mother never laughed at my dream of Africa, even though everyone else did because we didn't have any money, because Africa was the 'Dark Continent,' and because I was a girl. * What you do makes a difference, and you have to decide what kind of difference you want to make."  - Jane Goodall

Set aside the Barbie dolls and the Disney Princesses for just a moment, and let's show our girls the real women they can be.

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I, too, have nothing against Barbies and Disney Princesses. But I love this because there are also real women for our daughters to know about and look up to. Beautiful women. With beautiful dreams. Who succeeded and had failures, but who persevered and made a real difference. I'm definitely going to make sure my daughter knows about the real inspirations out there. Whether they were extraordinary in traditional roles or not.

When I was in 9th grade, I wrote a paper on Marie Curie. I would add her to my list. Julia Child, too (I find her work during World War II particularly interesting). Who would you add to yours?