My career as a nurse began in 1985, after graduating with an associate degree in nursing from Santa Rosa Junior College. Finally, I could sign "RN" after my name after years of school, with small children, and a husband who commuted 3 hours a day to work on construction jobs in San Francisco.

During those challenging times, my weekday alarm shrieked at 0415. I would stumble around, waiting for the coffee pot to fill as I made everyone's breakfast and lunch. Then, once my husband left, I would grab another mug and study until it was time to get the kids up, dressed, fed, and dropped off at grandma's or school so that I could get to an 0800 class or an earlier clinical rotation.

But when I graduated, hospitals were not hiring new grads. My first job was on the evening shift in the subacute unit of a local skilled nursing facility, where I received my first paycheck, earning $10 an hour! The following spring, I accepted a night-shift, on-call position in a hospital on a medical/surgical orthopedic unit, doubling my hourly wage. Four years later, I transferred to a new hospital closer to home, where I happily worked for the next 30 years. I picked break room locker 35 to remember how old I was when the hospital opened. Then it dawned on me: I have to work thirty more years!

As much as I loved being a nurse, it broke my heart over and over. Not only through providing physical, emotional, and spiritual care for patients and their families as they struggled with pain, illness, fear, sorrow, and death but also through the continued challenges of the changing hospital environment.

In the early 2000s, computers and technology ushered in the end of physical charts, hand-written orders, and nurse's notes. Even though we were told this new technology would allow more time at the bedside, it did not. We struggled to balance time for patient needs with attending to the computer: documentation and data entry, continual logging on or rebooting, and physically moving computer carts from room to room. It was not easy holding a patient's hand when our hands were always busy pecking at the keyboard, trying to fill out the electronic health record. Later, as healthcare became more of a business, the difficulty in giving care increased because greater demands were placed on nurses to do more with less. Budgets tightened, and the hospital units never seemed to have enough nurses or ancillary staff. Many days, there was more work than could be physically done in a shift, allowing only for hurried, essential care.

More changes came as hospitalized patients became sicker, and less critical patients were managed in the expanded ED or outpatient settings. Hospital stays became shorter and shorter, and a continuous stream of discharges marked our daily assignments, followed quickly by new admissions with higher acuity levels. By the time I retired, a patient admitted for a total hip arthroplasty had gone from an average hospital stay of 5 days to going home the same day as their outpatient surgery.

With the rapid patient turnover, higher patient acuity, and increased workloads, the medical/surgical units were noisy, crazy pressure cookers of stress. Instead of the occasional difficult shift, those days became the norm, leading to greater emotional and physical exhaustion for the nursing staff.

Even so, I enjoyed using my expertise to care for patients in some of the most challenging times of their lives while being the senior nurse and supporting my colleagues. I brought my particular interest in holistic care for patients and staff as a certified Reiki Master, Vision Quest Guide, visual artist, and poet. I created an "Art at the Bedside" project, which shared techniques on collage-making for stress relief and journaling as a healing and self-reflective practice. Nearly every hospitalized patient has stress and a story to tell. I found great satisfaction in helping patients find the story and meaning behind their experience and providing tools they could take home to find greater healing and happiness in their lives.

One patient, a young man, was admitted with skin abscesses from injection drug use. I taught him flow-of-consciousness journaling, where he could access some deep feelings and ideas for his recovery. Then, I invited him to read them aloud to me. It was a beautiful, healing moment, and both of us cried. I was on shift a year later, and he came into the hospital to visit a family member. When he saw me, he hugged me and said thank you. He had continued his journaling practice and had been able to maintain his sobriety, which he credited, in part, to his writing.

I also became an approved continuing-education provider for RN licensure, focusing on wellness and self-care classes. In addition, I was part of a research project in our hospital, called Preparing for Successful Surgery, which used guided imagery to assist patients preparing for surgery. After the project's success, guided imagery was implemented for surgical patients across our Northern California hospital system.

And at the same time, however, there was a cost to pay. On many 12-hour shifts, my pedometer logged 10 miles. Some days, I felt so burdened and drained that I could barely be present for my family. So when I started writing poetry in 1999, I quickly found a way to balance work stress. Poetry writing became a place to sort out and work through all the sorrows and joys I witnessed in life and on the job.

I discovered the work of James Pennebaker,1 a research psychologist, and his work on expressive writing. His studies showed that expressing deep emotions when writing for as little as 15 minutes a day could elevate mood, decrease stress, improve sleep and work efficiency, and positively impact the body's immune system.

When I was brave enough to share my work, I saw how it moved people by creating a window into the world of hospitals and nursing. Several people said that my depictions of the love and care given by the hands of a nurse offered hope if they or a loved one might need to be hospitalized. My poetry showed them that, despite the stress, constant press of time, and other difficulties of the profession, nurses will always fight to find moments to be present, hold a hand, and form a healing bond.

And now, 2 years into retirement, I have mostly healed from the stresses I carried for so long. I am no longer waking up panicked in the middle of the night from a nightmare in which I am late for my shift; wearing my uniform inside out with mismatched duty shoes; wandering around trying to find my patients; unable to log on to the computer; all my meds are overdue; call lights are blazing; and every patient yells, "Nurse! Nurse!" as I run down the hall.

While the freedom of retirement is grand, I still miss many things, including being part of a team of amazing people and the satisfying soul connection of the nurse-patient relationship. I can honestly say that I am so glad to have answered the call to become a nurse and to have been part of this incredible and challenging profession. I would do it all again in a heartbeat.

In Their Fire

8 am rounds, stethoscope in hand.

The endless rooms of patients

broken boned and cancer filled-

their fear and pain a bloody river

I can never staunch.

To be a nurse

is to be in their fire:

the diseased, incised, dying.

I didn't know

what I was signing up for

thirty years ago,

the shift after shift

familiar scent of sorrow,

theirs and mine.

I didn't know

how willingly

I'd share the burden-

how willingly

I'd burn.

Good Medicine

Today, dashing room to room on our busy medical unit, I fell in love again with the calling of caregiving, and with each patient receiving our good medicine-remedies to cool the fires of sepsis, to make the dragon of pain lie still, to conscript the red and white blood cells to swell the fighting ranks. I fell in love again with the phenomenon of the physical body, finite and frail, and how illness and breakings can ignite a path to transformation.

Today, I held the hand of a patient as she cried, fearfully awaiting cancer surgery. I sat on the edge of her bed, said "Let's take five breaths together." We inhaled and exhaled the heavy air, held each other's gaze-deeply, one human being to another. I watched the light shift in her eyes, as peace descended like gentle rain.

In these moments, medication isn't the medicine. The solution that heals our invisible lesions is the good medicine of love.

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