For over eighteen years, I have had the privilege of being a member of the nursing profession. My role at times has been that of a nurturer, motivator, cheerleader and source of comfort and support for patients who have allowed me entrance into their lives. Nursing has been a career that shaped and defined me as a person.

Going to school as an adult and taking care of a family was not an easy task requiring perseverance. After completing a diploma program in 1983, my next step involved working as a RN and attending classes part time while studying for a BSN and finally a master’s degree. Completion of these degrees spanned the time from 1985 to 1998. Still not satisfied and seeing myself as a lifelong learner a second master’s degree was undertaken and new personal and career goals were set.

In January of 2000 my role as a nurse changed to that of nurse administrator and I was charged with the responsibility of program development as Director of Behavioral Health at a large academic medical center in Baltimore. At the time, I felt my career path was on target. This was my dream job, it combined management, mentoring and clinical expertise into one position located in a leading academic medical center. My dream job would only last a few months.

March 2,2000 began like any other day, starting at 5:30 am by trying to wake up and get myself moving and off to work. My attendance was required at an early morning finance meeting the CEO scheduled to discuss budgets for the new unit. My mind was already churning as I got in the shower, thinking about the agenda and how I needed to approach my senior management team concerning the allocated monies for salaries of nurses. I was preoccupied and oblivious to what was happening inside my body as I mentally planned my day. Little did I know how life was going to change on that morning for me. All that I knew and held dear to me was going to be wrenched away from me and would disappear. My well-planned life was to slip through my fingers as quickly as sifting sand. I would not be attending the finance meeting that morning or any others ever again. As my colleagues sat around the conference table awaiting my appearance little would they know that at that very moment I would be lying on the floor of my home fighting to survive.

As I completed my morning shower I began to feel somewhat strange and later when asked could only describe the sensation as my brain suddenly felt hollow. My routine continued and while getting dressed, I noticed that I could not grasp anything in my left hand and suddenly I fell to the floor. As I lay there, trying to get up the entire left side of my body was immobile and no matter how hard I tried my body simply did not respond to the commands. I could not get up off the floor. My limbs felt heavy, awkward and like they were not attached to my body. The practical and analytic side of me began to take over and tried to assess the situation as I had been taught to perform years ago in nursing school in assessing and evaluating patients. My instincts told me something was terribly wrong and I needed help. The reality of the situation was so overwhelming though my denial was almost immediate and served as a means of self-protection. I found myself saying, “This can’t be happening to me, people at 46 don’t have strokes, just too young for a stroke, just my imagination that something is wrong, I’ll be OK in a few minutes. These kinds of things happen to other people, not to me. ” As I look back, the denial prevented me from panicking and becoming immobilized with fear and just laying there.

Living alone sure posed its problems that morning There was no one in the home to help me and the nearest neighbor lived half an acre away. All of the doors were locked. No one would be able to hear my cries for help. The phone was out of reach, clear on the other side of the room, and blocked by the bed. Lying there on the floor, I began to realize that no one would even know that anything had happened to me till late in the afternoon when it would be time for my friend to come let the dog out. If I continued to lie there I knew death would be imminent without the appropriate medical interventions. For the next hour and a half, I crawled along the baseboards of the wall pulling over furniture trying desperately to get to the phone to summon help. My brain continued to think and plan that by pulling the phone off the dresser by the cord and onto the floor, I could use the speaker mechanism to get the operator to send an ambulance. Finally reaching my destination, I hit the button marked O for operator on the phone. Nothing came out of my mouth but moans.

What felt like hours was surely only minutes as I lay there on the floor fading in and out of consciousness as my dog stood guard over me. By the time the rescue squad arrived and they broke the door down to get me my ability to speak was completely gone and the only sounds emitting from my mouth sounded like an animal wailing rather than anything that resembled words. Despite being unable to tell them what was happening to me, the paramedics kept trying to get me to sit up and talk. Instead, I just kept falling over on to the floor. My worst fears happened that day; my life was never going to be as I knew it. I was about to embark on a unknown and uncertain journey that would present me with the challenge of a lifetime. This would be the hardest job I would ever have, fighting for my life. Suddenly I was thrust into the role of patient and out of my comfort zone of being in charge and planning how my life and all the things around me were supposed to work. At that moment in time, I became totally dependent upon others for even my most basic needs and would remain in that position for many months to come. This was not a position of comfort for someone like me who was always so strong and independent and never seeming to need help from anyone.

By the time the paramedics got me to the hospital emergency room, the symptoms had progressed and the news was as bad as it gets. Nurses and doctors rushed me into an exam room and within seconds whisked me into radiology for a CT scan of my brain. Lying there on that hard table awaiting my fate, the technicians could be heard talking and saying “There’s something right here ”. I wanted to ask them if they were referring to my CT scan and what did they see, but I had no power of speech, only audible moans. The diagnosis was a massive ischemic stroke involving the mid cerebral artery and my prognosis was poor. Unable to move my body I was only able to look upwards. Just imagine how relieved I was when seeing the face of my friend and colleague standing over me. He was the medical director of the ER, a big tough guy, in green scrubs standing over six feet in height, and trained in emergency medicine. No one could ever accuse this guy of having anything close to a gentle demeanor. This was a man who was used to being in charge and giving rapid fire orders to others. I was confused and could not figure out why there were streams of tears running down his cheeks. Watching closely, I saw him hold up the CT scan of my brain and heard him say to me” Oh honey, it’s real bad.” He informed me my status was critical. I had had a very dense and massive stroke and it was unlikely I would survive any transport to a designated stroke facility an hour away.

This community hospital ER did not have protocols for TPA administration. They would have to call the designated stroke center and find out just how to treat me and get two additional physicians in and agree to risk administration of TPA. The administration of TPA would give me the best chance I had at survival. If I survived, the road ahead of me was going to be long, laborious and uncertain. Even with TPA, it was not known what or how much function I would recover; without TPA, survival was questionable.

I was admitted to ICU in critical condition and would be listed that way for the next three days. As I progressed from ICU to PCU, my therapy began and the difficult journey of rehabilitation was before me. I would cry due to the frustration I now experienced in expelling efforts to try to move only my thumb on my left hand, or the embarrassment I endured having to eat pureed foods and having them drool down and out the side of my mouth or soiling myself due to incontinence. Tears would start without any provocation and I had no ability to control them. Tears were so foreign to me I could only dredge up a memory of crying from childhood years. Never had others been allowed to see me cry and yet here I was unable to stop the flow. Periods of tearfulness even three years later have continued because of the location of the clot in my brain.

The colligate dictionary defines rehabilitation as “to restore to former capacity, to bring to a condition of health or useful and constructive activity” The rehab therapy staff spent three hours daily with me over a period of 6 months re-teaching me the activities of daily living we all take for granted. I needed to learn to walk again first using a 4-prong cane until progression to independent mobility. Learning to speak ,bathe, dress myself without the use of my left hand and feed myself became challenges that would take me almost 2 years to complete. Tying my shoes took 30 minutes each morning and getting dressed took so long and was so exhausting that I had to lay down and nap afterwards.

During this time, resolve unwavering, my goal remained returning to work, returning to nursing and my life. Each day when asked by the therapists working with me what my goal was for the day the reply was always the same “getting my life back”. True to the definition of rehabilitation, I wanted to be restored and to return to useful activity. Stubbornness and tenacity became my mantra. Friends helped me set up situations in which I would /could succeed. They were there on the sidelines in physical therapy watching and cheering me on as I took my first step 3 weeks post stroke on the parallel bars with a great deal of assistance. (Many friends remain as my cheerleaders today encouraging me as I continue making strides). Goals would now be measured in baby steps and would often take months to accomplish. The focus of my life was no longer budgets and staffing needs or making plans for my weekends, but simple things like how to go to the bathroom independently.

At the end of my first year of recovery, I was introduced to the world of the disabled and found much to my horror the discrimination that blatantly occurred. No longer could I purchase life insurance, long-term care or even health care coverage. At the age of 47, I was uninsurable. No longer was refinancing my home to lower my mortgage rate an option, as I didn’t have a definable or documented income or an employer. What made this role transition so difficult for me was I did not see my self as disabled. I still saw myself as being able to take on the world and run it quite effectively. I was adapting to my limitations or challenges by doing tasks differently. For example, since I couldn’t seem to work snaps and buttons on my clothes I simply purchased clothes that that didn’t have snaps, buttons, hooks or zippers and could be managed independently.

Nursing theorist built conceptual models on the science and philosophy of nursing that have served to create very foundations and practice of nursing, as we know it today. As nurses, our job has been to help restore the patient to his or her highest level of well-being and function physically, mentally and spiritually. These conceptual models now became the basis of care as a team of friends and professionals helped me adapt to this new way of life and reach my highest level of functioning.

These conceptual models were applied in my daily life as I faced challenges each day that required me to perform tasks differently. Most often times assistance from others was needed. The assistance came in many forms and not just in meeting my physical needs but also in helping me attain self-actualization as my life was being transformed. It became apparent to me that one source of assistance I needed to reach a state of complete rehabilitation could only come from the professional community of nursing in the form of re-entry to work in the health care arena.

At the end of one and1/2 half years of recovery, my goal of returning to work seemed stronger than ever and I wanted to feel useful again. The nation was in the midst of a shortage of nurses and there were jobs available that I saw myself being able to effectively perform based on my education, skills, experience and limitations. Nursing administration and director level positions were out of the question but another career path where I could still use my skills seemed to be the answer and would provide an avenue for re-enter into the profession of nursing.

The first interview occurred in January 2002.My excitement over being given an interview for a nurse recruiter position was to be short lived however. After the interview, I found myself crying all the way home with such heart wrenching sobs that I could not see to drive the car. The nurse recruiter (who was charged with the task of hiring a complementary counter part to her position) politely informed me that I was too disabled to perform the duties of the job. As a way to prove her point, she briskly walked me around the entire hospital complex and showing me every unit of the 400-bed facility. I noted her careful watching and gauging of my impaired gait and slowness. She informed me that the hours were long and demanding but I responded in a positive tone that I had always been successful when presented with challenges and felt that I would rise to the occasion once again. The time spent with this nurse did not help restore any self-esteem in fact, by the end of my hour with her I felt very demeaned, demoralized and defeated by one of my own colleagues.

Each day I monitored hospital web pages, professional publications and sent out resumes and continued to apply for positions that included psychiatric liaison, case manager, research study coordinator and a host of other titles. All total sending out more than 200 resumes and never getting that second phone call post interview. At each interview, the tone of the recruiter would change when noticing my employment gap of almost 2 years and questioning my reason for leaving a director level position. Polite mention of my slowness was always made as I lagged slightly behind the recruiter conducting the hospital tour. Friends and colleagues advised skirting around the issue of my non-employment status for 2 years when it arose during the interview process. Colleagues reviewed my resume, helped me with mock interviews and made suggestions in an effort of helping me find a position where I could once again have success.

Well known nursing theorist Virginia Henderson states in her conceptual model for nursing that “nursing is about complementing the patient by supplying what he needs in knowledge, will or strength to perform activities of daily living on his own”. She further states that every nurse should “ get in the skin of the patient in order to know what he or she needs” and to assist individuals to gain independence in relation to the performance of activities contributing to health or its recovery”. Despite the years of training in conceptual frameworks, the nursing profession has not been successful in the application of these theories when viewing their own colleagues.

In 1982 the ANA took a bold step and published a position paper challenging nursing leaders nationwide to form rehabilitation programs for nurses who lives and careers have spun out of control because of drugs/alcohol abuse and psychological dysfunction. The ANA recognized the problem and spoke to necessity of saving nurses, placing value upon their worth to society and encouraged establishing programs that would enable the nurse to become “rehabilitated”. I support and applaud the ANA position, but a group was excluded and forgotten from this call for action. The referenced group are nurses who like myself have become ill or who have sustained work related injuries making it difficult for them to resume former roles but still possessing skills and could make positive contributions to nursing. These nurses would be provided with peer assistance , support and a mandate to healthcare employers to make reasonable accommodations to help them re-enter the profession of nursing.

I propose the following questions to my peers, colleagues and nursing leaders, what have we done as a professional group representing a work force of thousands to assist our peers in rehabilitation following an illness or injury? How can we help them return to the health care arena? Doesn’t every nurse have worth and value to the profession as well as society? Currently only one nursing board gathers statistics on a nurse’s leaving the profession because of an acquired disability.

When a nurse recruiter looks at me, she only sees my deficits, instead look past the obvious and see the assets of 18 years experience in nursing along with a wealth of knowledge and a valuable resource. When the recruiter sees my slowness, I challenge them to see it as taking time to think through and evaluate situations. When the hiring manager sees my inability to carry a full patient load, I say look deeper and see my ability to establish relationships with patients and family because of my own experience and a unique ability to display an empathy that can only come from some one who has walked that road of surviving a catastrophic health event. When the recruiter sees an open position needing to be filled from the already over taxed and dwindling pool of nursing candidates, look to me and see a person willing to re-enter health care and a make a positive contribution to nursing. When the recruiter notices only my impaired gait and lack of coordination, look past the obvious, look deep within me, and come away with a recognition that you have just met an individual who is a survivor.

As I leave each interview, I say a silent prayer for the recruiter that he or she never has to experience a catastrophic health event and suddenly become one of the disabled. For a few moments I reflect and wonder if he /she is able to apply Virginia Henderson’s conceptual model by being “able to get in my skin”.

I continue to recover and at my three year, mark may be considered by some in the field of rehabilitation to be a success story. I volunteer at an agency providing case management for individuals who have suffered a catastrophic health event just like me, some even worse. There, my disability is really the norm and I am viewed by the people I serve as “necessary, valuable and useful” I will consider myself rehabilitated when I can be gainfully employed once again in my profession of nursing and have thereby reclaimed my life.

Read Debra's essay on discrimination in the workplace.

A STROKE OF LUCK by Dr. Howard Rocket

"Howard wants the world to know his story so that others, and their families may avoid the pain, the physical agony, and the shattering of their dreams. And for those on the road to recovery from stroke, he offers this book as a beacon of hope, that rebirth of body and spirit is possible..."

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