Prayer for Our Veterans

Nurse Case Manager

I dialed the phone and on the third ring, an elderly man answered in a deep gravelly voice. “Hello?”

“Hi, Mr. G, I am your nurse case manager from the veterans’ clinic and work with your doctor. Your veterans’ clinic home care  nurse said that you came back to your assisted living apartment from the nursing home today, so Welcome Home!”

Mr. G. sadly replied, “I wish I was still in the nursing home. They were so nice to me there. I won’t take any pills until my nurse, Jane, comes here and puts them in my pill box!”

“Mr. G, I’m afraid the nurse from Medicare has to see you for a few weeks first until you are stable, and then Jane will be back.”

“But I don’t like the Medicare nurse! I love Jane. She’s wonderful! I fought in World War II for this country and gave this country the best years of my life. If it weren’t for guys like me, you would be speaking German or Japanese right now! I should be given the nurse I want! Why are you dumping me now???” he shouted into the phone.

I took a deep breath and prayed silently, “Dear Lord, give me the right words for this dear veteran. Help me to explain the rules to him.” “Mr. G, Jane is not allowed to see you twice a week like you need right now. She is only permitted to see you once or twice a month after you are stable for health maintenance visits. Please let the other nurse come to visit you for a few weeks, and then Jane will come back. If you don’t like the Medicare nurse, call me and I will ask the agency to send a different nurse.”

“Well, OK. If that’s how it has to be. I’m so lonely ever since my wife died and went to heaven to be with the Lord. I’ll be glad when I see the Lord Jesus Christ and her again. Thank you for your help, Pam. You’re OK! Could I tell you one more thing? God loves you, and so do I!”

My eyes filled with tears. “I love you too, Mr G.” I slowly hung up the phone and prayed,

Dear Father, Thank you for all our veterans who served our country. Thank You for the freedom I have in the USA. Bless and strengthen and protect our troops right now around the world. I pray that each one would look to you and receive Jesus Christ as their personal Savior. Amen.

Thank You, Lord, for our Veterans!

Thank You, Lord, for our Veterans!

Reflection

Mr G. died the next year at the age of 93. I thank the Lord for him and our other veterans that I might enjoy the freedom I have here in the USA. As a nurse case manager working for the federal government, it was sometimes very challenging to explain the complex rules and insurance regulations of the various programs available to veterans. As we honor our veterans here in the USA on November 11, I pray God would bless and strengthen them.

I hope you watch the following video about a dear World War 2 veteran, Harry Walmer, who gave much for his country. I have had the pleasure of meeting him and thanking him for his service. Despite his 100% disability from the war, he continues to rejoice in the Lord Jesus Christ and looks forward to that day when he will go to heaven to be with his Savior.

Harry Walmer story

I also pray that we would all be good soldiers of the cross for the Lord Jesus Christ as we are in a spiritual warfare daily. May we be able to echo with the Apostle Paul, “I have fought a good fight, I have finished my course, I have kept the faith; Henceforth there is laid up for me a crown of righteousness, which the Lord, the righteous judge, shall give me at that day; and not to me only, but unto all them also that love His appearing.” 2 Timothy 4:7-8

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Will God Provide?

October, 2001

Dr. T., my manager, called me into his office. “Pam, I’m afraid I have some bad news for all of us. The parent hospital has decided to close this campus in the next few months because they are losing so much money at this facility. Next month, they will decrease our hours to 20 hours per week. They have offered us positions at the parent hospital on the psychiatric unit, but we will need to be on call at night and weekends. Let me know what you decide to do. I think I’ll be looking for another job closer to my home.”

This news took me by surprise. I knew the hospital was struggling, but I didn’t know it was this dire. Three years ago, I built my dream house because Dr. T. told me my job was totally secure. I so enjoy living here because it is close to church and work and I host guests frequently. But I will not be able to pay my monthly bills on half my salary. I think this is a good time to leave psychiatry since I don’t want to work weekends and night shift again.

When I arrived home, I opened my Bible and asked God to show me the next step and to provide for me. Certainly God, who created the universe, can supply my every need. This is my time to trust Him and see His provision.

God calmed my heart as I read Matthew 6:25-34, “Therefore, I say unto you, Be NOT anxious for your life, what ye shall eat, or what ye shall drink; nor yet for your body, what ye shall put on. Is not the life more than food and the body than raiment?…For your heavenly Father knows that ye have need of all these things. But seek ye FIRST the kingdom of God and His righteousness, and all these things shall be added unto you. Be, therefore, NOT anxious about tomorrow; for tomorrow will be anxious for the things of itself. “

“Be anxious for nothing, but in everything, by prayer and supplication with thanksgiving, let your requests be made known unto God. And the PEACE of God, which passes all understanding, shall keep your hearts and minds through Christ Jesus…. But my God shall supply all your need according to His riches in glory by Christ Jesus.” Philippians 4:6-7, 19

God encouraged me with Philippians 4:19

Dear Lord, You know all about this situation and my finances. Show me the next step. I’m trusting You to provide my every need. Use me for Your glory and honor. In Christ’s Name, Amen.

December, 2001

I have had a desire to teach nurses again in some way, so I applied to teach at a Christian college 1000 miles away. I visited the campus for ten days  to observe the classes, speak with the nursing professors, meet with the Dean, attend several different churches, and look at a few houses to buy. The Dean said they would love to have me join the faculty.

I returned home and asked God to show me His will. If I joined the faculty, I would not have time to keep working as a Nurse Practitioner and would eventually lose my NP license. Because it took me so many years to become a Nurse Practitioner, the Lord did not give me peace about giving it up. So I wrote the Dean and declined their offer.

I applied to a home care agency and was hired as a RN to do psychiatric home visits after I finish my four hours daily at the psychiatric hospital. I drive to the worst parts of the city, enter smoke filled apartments with blaring TV, assess the patient, and fill his locked med box for the week. Some of the patients are quite unstable mentally, so I ask God for protection as I quickly work. The agency said I can leave a patient’s home at any time if I do not feel safe. I always keep myself between the patient and the door and keep my cell phone in my pocket. How I thank the Lord daily for His protection! I continue to look for a full-time job as I know this is not the right job for me long term, but I thank God for His provision in the interim.

May, 2002

I interviewed for a job as a Nurse Practitioner to run the employee clinic of a large insurance company. The manager grilled me on how I would handle emergency situations. She said I answered all the emergency questions correctly and offered me the job. The pay is more than I made at the psychiatric hospital, but I’m a little hesitant about the 45 minute commute. I will need to leave my house daily at 6:30 a.m. to arrive in time. But since this is the only NP position God has opened, I accepted the offer.

August, 2002

I was trained at the downtown office by an experienced NP, and then was sent to the suburbs to run a busy clinic alone for 4000 employees.  I have a receptionist, but no medical assistant to help me with vital signs or electrocardiograms (ECGs). The supervising MD comes to the office once a week to review my notes. He is also available by phone whenever I have an emergency.

I am amazed at all I am expected to do. For every new employee, I do an ergonomic assessment of their desk, chair, phone, and computer to make sure it is in proper alignment for them to prevent carpal tunnel syndrome and other repetitive use injuries. The majority of the employees work in a cubicle and are on the computer and phone eight hours daily. We also hold health fairs for the employees periodically where we check their blood pressure, cholesterol, and glucose.

And then there are the daily clinics. Sometimes I have a line of 15 employees out the door waiting to see me. They come to work so sick because they don’t want to use any of their sick time or waste time going to their own doctor. If a Vice President comes in, they get to go to the front of the line. In the four months that I have been here, I have had to call the ambulance about a dozen times for emergencies ranging from chest pain and asthma attacks to hemorrhaging.

I also draw routine labs for patients who bring a prescription from their regular doctor, give vaccinations, and run and interpret ECGs. Since I did not need to read ECGs in my other job, sometimes I need to fax them to my supervising MD to have him confirm the interpretation. But if I don’t have time and it is an emergency, I just call the ambulance. “When in doubt, send them out” is what my boss told me.

Every morning I ask the Lord for wisdom in every decision and a quiet heart in the midst of whatever emergency situation walks through the door. I don’t enjoy the stress of this job. I have never worked in the emergency department or intensive care unit. Some days, this feels a little too much like that.

Reflection

How I thank God for carrying me through that challenging period of job changes and providing so wonderfully for me. Little did I know that an even more difficult trial lay ahead of me where I learned to trust Him in the midst of utter weakness.

Prayer for Our Veterans

Nurse Case Manager

I dialed the phone and on the third ring, an elderly man answered in a deep gravelly voice. “Hello?”

“Hi, Mr. G, I am your nurse case manager from the veterans’ clinic and work with your doctor. Your veterans’ clinic home care  nurse said that you came back to your assisted living apartment from the nursing home today, so Welcome Home!”

Mr. G. sadly replied, “I wish I was still in the nursing home. They were so nice to me there. I won’t take any pills until my nurse, Jane, comes here and puts them in my pill box!”

“Mr. G, I’m afraid the nurse from Medicare has to see you for a few weeks first until you are stable, and then Jane will be back.”

“But I don’t like the Medicare nurse! I love Jane. She’s wonderful! I fought in World War II for this country and gave this country the best years of my life. If it weren’t for guys like me, you would be speaking German or Japanese right now! I should be given the nurse I want! Why are you dumping me now???” he shouted into the phone.

I took a deep breath and prayed silently, “Dear Lord, give me the right words for this dear veteran. Help me to explain the rules to him.” “Mr. G, Jane is not allowed to see you twice a week like you need right now. She is only permitted to see you once or twice a month after you are stable for health maintenance visits. Please let the other nurse come to visit you for a few weeks, and then Jane will come back. If you don’t like the Medicare nurse, call me and I will ask the agency to send a different nurse.”

“Well, OK. If that’s how it has to be. I’m so lonely ever since my wife died and went to heaven to be with the Lord. I’ll be glad when I see the Lord Jesus Christ and her again. Thank you for your help, Pam. You’re OK! Could I tell you one more thing? God loves you, and so do I!”

My eyes filled with tears. “I love you too, Mr G.” I slowly hung up the phone and prayed,

Dear Father, Thank you for all our veterans who served our country. Thank You for the freedom I have in the USA. Bless and strengthen and protect our troops right now around the world. I pray that each one would look to you and receive Jesus Christ as their personal Savior. Amen.

Thank You, Lord, for our Veterans!

Thank You, Lord, for our Veterans!

Reflection

Mr G. died the next year at the age of 93. I thank the Lord for him and our other veterans that I might enjoy the freedom I have here in the USA. As a nurse case manager working for the federal government, it was sometimes very challenging to explain the complex rules and insurance regulations of the various programs available to veterans. As we honor our veterans here in the USA on November 11, I pray God would bless and strengthen them.

I also pray that we would all be good soldiers of the cross for the Lord Jesus Christ as we are in a spiritual warfare daily. May we be able to echo with the Apostle Paul, “I have fought a good fight, I have finished my course, I have kept the faith; Henceforth there is laid up for me a crown of righteousness, which the Lord, the righteous judge, shall give me at that day; and not to me only, but unto all them also that love His appearing.” 2 Timothy 4:7-8

Transcultural Nursing Course in Dominican Republic – Part 2

January, 1995 – San Juan, Dominican Republic

After awakening, I began reading my English-Spanish Bible in my Pan Dia village home, when Maria, a ten year old girl came in and shyly started reading over my shoulder. I gave her a Spanish gospel tract to read, and she was thrilled.  Before we said goodbye, the cute children gathered around us for a final photo.

The village children loved chatting with us!

The village children loved chatting with us!

After we returned to the clinic, we compared our clinic stays. It sounds like Debbie and Julie stayed in a much wealthier community and even had an indoor bathroom, but I think Paula and I had a truer picture on Dominican life for the majority of people. We all watched Paula analyze the water samples she had collected from the boiled water they had given us, the town pump, and the clinic. Paula is doing an extra project on water quality since her first degree is in biology.

The next day, Paula discovered the water that we drank in Pan Dia was unboiled and the filtered water here at the clinic is almost as bad. The tap water here came out clear of bacteria. She will repeat all the tests to confirm her results.  Thankfully, neither Paula nor I became sick from the unboiled water. Perhaps I’m building up a little immunity since this is my fourth trip to the Caribbean region. But it does make me realize how much I take for granted clean water in the USA. (We later learned that the clinic’s board of directors took steps to improve their water filtration system as the result of Paula’s work.)

Watching Paula analyze village water samples.

Watching Paula analyze village water samples.

The next day, Dr Elaine had me work in the city hospital in the Intensive Care Unit (ICU). There was no running water or electricity that day, so no one was on an EKG monitor, and it was very hot since they could not run fans or air conditioning. The only way I could wash my hands was with wet wipes that I brought with me. The nurse pulled out their only stethoscope which had five foot long tubing on it and no diaphragm on the bell, so she grabbed a piece of paper and placed it over the bell. After she checked a 46 year old woman’s blood pressure who had a blood clot in her lung, I rechecked it with my stethoscope. I was shocked that it was very high at  180/120 and that they only checked her blood pressure every 12 hours. She then gave the woman Procardia under her tongue and pushed Ranitidine intravenously quickly through her IV line. I checked the patient’s blood pressure twice after that and it came down to 150/88. There was a can of pear nectar on the woman’s bedside table, so Dr Elaine and I helped her sit up and she drank it thirstily. There was no water pitcher beside her bed. I pitied her because it was so hot in the ICU.

The doctor then came in and changed the abdominal dressing of a man who had a ruptured appendix using Betadine and sterile gloves. The nurse then had me give him a gentamicin antibiotic injection in his arm. Normally I would have given it by IV drip slowly or given it in his thigh. Then she mixed up 1 gram of ampicillin in 5 ml. of normal saline and gave it rapid IV push through his line. She asked me to give it, but I refused and told her I was used to dripping it slowly through the IV over 30 minutes. She then gave him 100 ml. of Gatorade with brown sugar added for lunch. There was a quart of it, but she said he couldn’t have any more. Then she offered Dr Elaine and me a glass of Gatorade as she drank one, but we politely declined.

The third patient in ICU was a woman who had been stabbed by her husband. She had a tube in her stomach with the drainage bag lying on the floor under her bed. She also had a tube in her bladder, with that bag also lying on the floor. She had on no gown and was exposed from the waist up. She was behind a curtain so no nurse could observe her, and her IV ran dry. When the nurse discovered it, she hung a new IV bag and ran a tube full of air into the patient. Since there was no running water, none of the patients were bathed and the nurses never washed their hands. All the patients appeared dehydrated from lack of fluids in the heat.

The medicine cabinet had 3 more bags of IV fluids, and medicines in bottles with labels. Another nurse came to the door and asked for a pill, so the ICU nurse took one from the bottle and handed it to her. Each patient had a chart with doctor’s orders, operating room record, and nurse’s notes. The nurse’s note was divided into four sections: date, hour, medicine, and observation. Dr Elaine pointed out that the nurse’s note didn’t have much room, but at least they had a chart.

On our way to lunch, we stopped by to see Julie in the pediatric ward.  There was a baby in severe respiratory distress. She watched the nurses try 20 times to start an IV in a baby with the same butterfly needle. One male nurse accidentally stuck himself with the needle, and then continued to stick the baby with it.

Since the operating room was closed for the holidays, we went with Cora, NP,  as she made home visits to families who have infants on her nutritional program. This very poor village is a number of shacks beside a bean field and the river. We watched them wash their clothes in the river and cook their food over a charcoal fire. One home had two babies because one baby’s mother had died in childbirth. The remaining mother was trying to breastfeed her own baby and the orphan, who appeared to weigh only about three pounds.

Cora spoke with an  18 year old woman about family planning who already has four children. Many women have their first baby before they have their first period. The poor people don’t marry, but just change from one man to another. It is estimated that 25% of the population is HIV positive.

After walking down dirt roads and fording several streams, we arrived at the local midwife’s home. She delivers 100 babies yearly and charges no fee. She was a dear friendly 40 year old grandma who got down on the ground and demonstrated how she delivered her own twins alone! Until last year, when she spent three days training at a local hospital, she had never received any formal instruction. At the end of our visit, she handed us each a chicken egg as a gift. It was difficult for us to accept this gift as we knew we were taking most of her food for the entire week, but Cora said we would have offended her greatly if we would have refused. In turn, we gave her a gift of several boxes of gloves for her home deliveries since she could no longer obtain them. She hugged us all as we left.

Local midwife tells us the amazing story of how she delivered her own twins!

Local midwife tells us the amazing story of how she delivered her own twins!

Reflection

Those days in the city hospital with hardly any supplies and in the homes of people who had very little material goods, once again brought home to me how I have grown up in such relative material wealth in the USA. The poorest people in the USA are wealthy compared to many people in the world. One missionary in Ecuador told me that the people there think that all Americans sleep on mattresses stuffed with money! She offered to let them look at her mattress to prove that there was no money in it:)

I was blessed as I read through some of the many verses in the Bible about poverty and wealth. The only kind of wealth that lasts for all eternity is our relationship with Jesus Christ. The person who has received Christ as Savior is the richest person in the world and the only one who can truly be happy.

“For ye know the grace of our Lord Jesus Christ, that, though He was rich, yet for your sakes He became poor, that ye through His poverty might be rich.” II Corinthians 8:9

“Lay not up for yourselves treasures upon earth, where moth and rust doth corrupt, and where thieves break through and steal, But lay up for yourselves treasures in heaven, where neither moth nor rust doth corrupt, and where thieves do not break through nor steal; For where your treasure is, there will your heart be also.” Matthew 6:19-21

 

From Dialysis to Home Care

November, 1991

I have now worked in the new dialysis center in the suburbs for about three months. It is going fairly well, although the 13 hour shifts three times weekly are so long and exhausting. I’m having trouble recovering on my days off and am feeling about as badly as when I used to work night shift. I started looking for a job with daytime hours. I was able to find a good home for my dog, Sandy, with a single man at church who has his own business and takes Sandy with him in his van. My condo seems rather empty without Sandy, but I enjoy visiting him some weekends at his new home in the country. He just about wags his tail off when I visit, but he seems to enjoy his new owner.

The fellowship with the believers at church has been very precious and refreshing. I feel like I’m growing in the Lord and being encouraged to know God better through the Bible messages. I thank God for a good job in a poor economy and trust in Him for strength to keep going.

God is my strength and power; and He maketh my way perfect. II Samuel 22:33

July, 1992

But my God shall supply ALL your need according to His riches in glory by Christ Jesus.  Philippians 4:19

The Lord has been marvelous to me and continues to teach me so much about how wonderful He is! In December, I became a member of the Bible church I am attending,  and joined the choir in January. It has been such a blessing to sing with a group again, and lift up my heart to praise God. I was also able to play my violin with an ensemble at a children’s program.

I was thrilled to go cross country skiing three times in the mountains of Vermont and New Hampshire! I also spent a long weekend in Washington DC with a couple ladies from church. In June, the Career Group from church had fun touring the quirky Gillette Castle overlooking the Connecticut River. Quite different from the castles in Europe!

Skiing in Vermont 1992

Skiing in Vermont 1992

Skied at the Balsams grand resort in New Hampshire 1992

Skied at the Balsams Grand Resort in New Hampshire – 1992

Toured the White House in DC with some ladies from church 1992

Toured the White House in DC with some ladies from church – 1992

Quirky Gillette Castle overlooks the Connecticut River

Quirky Gillette Castle overlooks the Connecticut River

The 1880 colonial home God let me buy in 1992.

The 1880 colonial home God let me buy in 1992.

The long hours in dialysis continued to be a trial. Praise God that He gave me a new job in home care last month! I took quite a pay cut, so I have a second job doing home care with a different agency two evenings a week. I love driving around the pretty green countryside and being able to eat my sack lunch at a different place daily. I discovered the town library and town hall have clean restrooms, as well as most fast food restaurants.

A favorite library, lake, and orchards in my district

A favorite library, lake, and orchards in my district for lunch stops.

Lake Beseck 3 Lymans view 3

I feel like I am using my brain again to autonomously solve the problems of my patients. I can understand why the agency requires every home care nurse to have at least one year of hospital experience. When I am all alone with the patient, I must be confident in my assessment skills, know when the patient can remain at home, and when I need to call the ambulance to send the person to the hospital. Most of my patients are elderly and very kind, so it is nice to have time to chat with them instead of rushing off like I did in the hospital. Many of my patients have wounds that I assess and then change the dressing. I do extensive teaching with each patient on how to manage his condition, and when he needs to call the doctor or the nurse after hours.

The most difficult part of the job is finding the patient’s house the first time. The admission nurse writes directions in the chart, and then I study my maps every morning before I leave the office to try and remember the route visually. I usually can locate the home, but I have trouble finding my way back to the main road. I also have trouble backing out of long driveways, so sometimes I just park at the end and walk to the house. Perhaps I have poor depth perception?

I write the name, address, and phone of each patient on an index card and then place the cards in order of my visits on my desk at work. If my supervisor needs to contact me, she calls each patient until she locates me. Occasionally, I have to make an urgent visit or see a patient a day earlier than I had planned. After I finish my visits, I return to my home to finish charting so I only go into the office in the morning, which is conveniently located one mile from my new home.

My car trunk is full of chart file boxes, extra supplies, and my large nursing bag. I write down my mileage every day and turn in my total mileage every two weeks to pay roll. They reimburse me 28 cents for each mile I put on my personal car to cover the gas and maintenance.

Reflection

With the invention of  GPS and cell phones, it is much easier for a home care nurse to find her patients and for her supervisor to find her in the field. Unfortunately, the volumes of charting in home care have increased over the years even though it is done electronically now on laptops. The pressure has increased to see more patients each day and bring more income to the agency since the reimbursement rates from Medicare and insurance companies have decreased. By the way, the 2016 Federal rate of reimbursement is 54 cents per mile!

It was great to be a home care nurse on days when the weather was gorgeous, but not so much during snow storms, freezing temperatures, or sweltering heat.  I enjoyed the daytime work schedule which allowed me to participate in evening activities at church. I only had to work one weekend a month and could sit in the balcony for a portion of the morning worship during my lunch break since the church was within my territory. There are pros and cons to every type of nursing!