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08/24/2015

“One Shoe Can Change Your Life”*

by Jeanie Sauerland, BS, BSN, RN

I hate shopping for shoes – always have. Footwear was not the reason I chose nursing – but it sure made it nice, to be able to wear comfortable walking shoes without looking like you wore orthopedic shoes made for someone 90 years old. The world of white caps and starched uniforms disappeared long before I became a nurse. Even so, the shoes are still designed more for function than fashion: These are meant to be work shoes. I put them on at the beginning of the day to provide support as I move from patient to patient. At the end of the day, I take can take them off and leave them and the worries of the day behind. Most days.

There have always been those cases that no matter how many times the scrubs went through the wash or the shoes were polished, the memories lingered. Those were the times when nothing matched – the reality of the patient condition, the wishes of the family, or the “goals of care.” No matter how supportive the shoes were, being in them was not comfortable. There were answers I didn’t have. There were role conflicts. The family, the patient, and the healthcare providers needed much more than my robust pair of shoes to get them through these days.

At the end of those days, I would notice scuff marks on these shoes. They matched the scarring I felt on my professional persona – experiences that would mark me for a long time. I don’t believe it’s possible to live without earning scars. How could I take the scars, seen and unseen, and turn these into something positive and worthwhile. Could it be as simple as changing shoes?

I spent a long time wrestling with this question. You see, I love nursing and the sacred moments I have shared with patients, families, and co-workers.   My identity was reflected by my closet, filled with scrubs and nursing shoes. That is who I am – a nurse. As a nurse, I was trained to assess situations, plan and evaluate the care I was giving, and seek help when it was appropriate to do so. I was a member of a team, with a sacred role as the bedside vanguard, the advocate. Like most of the nurses I know, over time, you develop a sixth sense that something is wrong, even if the vital signs are not reflecting that concern.   The most haunting concerns went well beyond the physical body lying in a hospital bed. There were providers who viewed death as a failure, even when it was the most merciful of all possible outcomes. I knew families who were so guilt ridden that they couldn’t let go – Daddy had to wake up; I need to tell him why I haven’t called in ten years. And there were the cases on the other extreme, typically less common, when the patient or family surrendered before completing the good fight.

Looking back, I’m not sure I appreciated how variable views on quality of life could be. It would be arrogant to suppose that I knew the innermost thoughts of my patients.

On such days, the scuffs on my shoes didn’t match. One shoe seemed to take the brunt of the struggles for the day. It would appear that the shoes reflected not only the emotional scars I tried to hide, they also my biases. How could I be truly neutral when equally passionate voices ask unfettered support in proclaiming a right to life and allowing “death with dignity? It was much easier to take off my shoes than to emotionally disengage at the end of such conflicts. Some patients leave a mark on your soul that is much deeper than the scuffs on the shoes.

I questioned why on many occasions. I had the nursing skills and I had the compassion. I didn’t have answers or even how to phrase the questions. I wanted to find structure, logic, and some kind of reason to provide with the emotional support that came so naturally. Thus, I began to study ethics and the more I learned, the more I wanted to use this knowledge to help others. I wanted to give more support than my best pair of nursing shoes offered.

Eventually, I earned my certificate in clinical ethics and have recently been accepted to a graduate program in Bioethics. I accepted a position in the clinical ethics department. After the joy of realizing that my dreams were coming true, I realized I had a problem. I didn’t have the right shoes for the job.

That may sound crazy – but it was a big concern. I had spent two weeks during a practicum wearing fashionable shoes and discovered I could not walk at the end of the day. My feet hurt more than they ever had. While at the bedside, I was witness to ethical challenges and sought answers. Now I was the person that other professionals would be turning to for answers. Although my training had been excellent, it is not as easy to take off my shoes at the end of the day and leave work behind. Those haunting cases are now called consults. I look at my old shoes but there is no turning back.   Those wonderful, supportive shoes served their purpose well. If anything, those shoes walked into a new journey.

I honor the scrubs and clogs. My uniform has changed with my job title. Memories of swollen ankles and sleepless nights trying to find the perfect answers still linger.   I’ve read about the imposter syndrome, aka “fake it till you make it.” I needed more of a selection in my closet. Replacing the scrubs was not so much of a problem. The shoes were another story. I needed shoes that fit and could be worn with an entire dress wardrobe and could still allow me to walk long distances in the hospital. I need something that something that could somehow combine function and fashion. I’m a firm believer in combinations. My clinical background certainly blends in with my studies of bioethics. Who knew finding the right shoes would be such a challenge.

Did I mention I hate shopping for shoes?

I knew that I would find the right pair. It would be a search but they had to be out there, right? I mean, how could my nursing shoes be leading me in this direction for so many years, only to let me down? I had to seek the out the right fit for the current situation, something I would be doing as an ethicist. Whether by fortune or fate, my wedding anniversary and Mother’s Day arrived in the midst of my transitioning roles. This year I knew what I wanted. My husband was searching for a romantic gift. He was a bit caught off guard by my request and he even went shopping with me. It’s important to have that kind of emotional support at home, as much as it is to have supportive shoes. It would be too hard to get through the day without it. And with his help, we found the perfect pair: brown loafers. They cost more than my nursing shoes. The design is simple but fashionable. They don’t have high heels that announce, “I’m here” before I’ve entered a room.   They aren’t flashy.   Somehow that understated look fits me as well as the shoes.

As much as I hate shopping for shoes, I enjoy wearing shoes once I find them. We were headed to a family event and I was going to have the chance to show them off. I told everyone about my new job and my new shoes. My brother, a classic movie fan, in his best wicked witch of the west voice crooned, “you’ll need those shoes to run to all the plugs you will be pulling.” My older sister shook her head – she’s a nurse and she understands. I looked down at my feet and shook my head. Is that how the public would see me from this day on? Do they have any idea of how many sleepless nights there could be because the cases on which we are consulted are not the cases with obvious answers? Do they know—as I am still learning—that sometimes there is not a “right” answer? Do they know that even if the shoes fit, there will still be days that are not comfortable?

I don’t pull plugs. I am not a member of a death panel. I do not take pleasure in watching someone die. I wrestle to find what would be the kindest recommendations when all choices cause pain. I pray for wisdom. And if any of these things brings someone a sense of peace, a sense of acceptance, than I am at peace too.

I have retired my nursing shoes, putting them on a shelf in the closet. When I look at my brown shoes, I think of the many miles we have yet to walk and lessons ahead.


 

* Title is a quote from Cinderella.

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