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When disaster strikes, it can change our perspectives and priorities in life. In this episode, we speak with Linda Munroe, a nurse practitioner who shares her experiences and insights on the challenges and rewards of being a health care worker. She discusses the impact of natural disasters on her community and the lessons she has learned from them. She also talks about the importance of faith, hope, and love in overcoming adversity and supporting others. Tune in to learn more about the resilience of the human spirit and the power of compassion in times of crisis.

Linda Munroe is a nurse practitioner.

She shares her story and discusses her KevinMD article, “Say ‘I love you’ often and mean it.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show we have Linda Munroe. She’s a nurse practitioner. Her KevinMD article is titled “Say ‘I love you’ often and mean it.” Linda, welcome to the show.

Linda Munroe: Thank you so much.

Kevin Pho: I appreciate you being here. We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Linda Munroe: So I have been a nurse practitioner for about 12 years now, and I’ve been a hospitalist cardiology nurse practitioner as well as urgent care. I’ve been a nurse for 33 years total, and if anybody asks, I was two when I graduated. That’s my story, and I’m sticking to it. I worked in Canada for two years before I came to Southwest Florida, so I’ve been here for about 31 years now. I am also an 11-year breast cancer survivor and a five-time major hurricane survivor, so that’s how the two ended up being together down here.

Kevin Pho: So I understand, as we talked offline, that you are a nocturnist currently. Tell me about your role in the hospital.

Linda Munroe: So as a nocturnist, I work night shift. We do 8 p.m. to 8 a.m., seven nights in a row, and then we’re off for seven. I am over a five-bed observation unit at a freestanding ER with an observation unit, and then I also cover the floor patients for Gulf Coast Medical Center, so usually around 350 patients at night. There are four to five nocturnist positions to actually work in that hospital, and I’m just trying to relieve some of the pressure on them, because they’re busy admitting all the new patients coming in from the ER. So I take care of all those floor patients as much as I can for them.

Kevin Pho: So what’s it like during an overnight shift? What kind of calls do you typically get? What kind of cases do you typically see overnight in the hospital?

Linda Munroe: I can get anything from “Hey, can I get a Tylenol for this patient?” to “Hey, this patient’s blood pressure is 70. Help me fix this patient,” and everything in between. So sometimes it’s just routine medication calls; sometimes it’s something far more serious. Definitely during the Delta part of the COVID pandemic, I might have five patients who were crashing all at the same time, and everybody was trying to have me pull a rabbit out of my hat: “OK, do something. How do we fix this one?” And it’s like, I’m running out of rabbits here.

But that’s my remote life. My actual on-site life is whenever a patient needs to come in for observation, so typically 24 to 36 hours of care for chest pain rule-out kind of things, TIAs, syncope, dehydration, that kind of simple stuff that we think we can get out in a relatively short amount of time. I will see those patients, do their orders, do their history and physical, and take care of all those patients while they’re there.

Kevin Pho: All right. And we have a lot of clinicians who may be listening to this podcast who may consider some type of overnight role, a nocturnist role. What kind of questions should they ask themselves to see whether they’re the right fit for some type of overnight clinical role?

Linda Munroe: So the most important thing is that you have to be very confident in your own skill set, because there is not a lot of help around. Unlike a day shift, where you might have 14 or 15 other people and X number of ancillary specialties and everything, you’re not going to have that. So if you are a little bit more of a lone wolf, say, you have to really know everything.

Night shift is definitely not for everybody. I’ve worked nights for 27 of my 33 years. I tried day shift for five years, and it was just awful, but I’m a natural-born night person. So for anybody who is not a natural-born night person, it’s probably going to be very difficult, because it is a complete flip from your normal sleep schedule and everything like that. So that’s a big thing.

I will say that people who work nights, we are very close. The doctors that I work with are just amazing. I love working with them, and we’re very good friends offline as well as when we’re in the hospital. So it’s just wonderful working with them. But yeah, it’s not an easy thing if you’re not kind of biologically suited to it.

Kevin Pho: All right, let’s talk about your KevinMD article. It’s titled “Say ‘I love you’ often and mean it.” Now, how did this article come together?

Linda Munroe: So at the end of September, I was at Gulf Coast Medical Center, and I spent 48 hours there because we were hit by Hurricane Ian. It was an almost Category 5 storm that came through all of Southwest Florida. It hit Collier County, where I live, and then Lee County, where I work, which is the next county north of that, then Charlotte County, and it made its way through Central Florida until it went out into the Atlantic. This is my fifth major hurricane, and I’ve spent four of them in the hospital, but this one was different. We’ve been lucky on a lot of these other ones, where we haven’t had as much damage as we had on this one, but this one was really bad.

So the crazy thing about a hurricane, and I’ve tried to explain it to people, is it’s like being shot in slow motion. You’re standing there, and you know the bullet’s heading toward you, ultra slow, and you can’t move, so you can’t get out of the way. So you don’t know until the bullet gets there whether it’s going to miss you, graze you, hurt you a little bit, or kill you.

We always have the news on, because with all these storms coming, the meteorologists are on there 24/7 trying to tell us what’s going to happen. You just keep watching this. And there are remote cameras around, like the weather net stations kind of thing, where “Oh, at this hotel, the temperature’s this,” or whatever. So you can see these cameras, and some of them are on, like, Fort Myers Beach, which is one of the barrier islands. So we could actually see this horrible storm surge coming in. But it’s slow, and so it was 24 hours plus before we really started seeing the damage.

So when I finally left on Thursday evening, I walked outside, and it’s so crazy, because after the storm comes through, the weather’s beautiful. The sky was this pretty kind of pinky-gray color. It was not really hot; it was really pleasant out. And I looked up at the palm trees that line our hospital walkway, and these poor things just looked like they had been through a war. The palm fronds are mostly gone, and it’s just unbelievable. I was driving home, and I’m driving home quite a ways inland, so there’s not as much visible damage. But once you start seeing these pictures of homes that are under 10 feet of water and stuff like that, it’s just crazy. So when I got home, I went to sleep, because it was the end of my seven in a row, so I slept.

And then as the weeks go on, you get Facebook posts from people, and they’re telling you, “We don’t have power back on yet.” I was very lucky. We had power. We had water. We didn’t have any damage to our house. I think my kids lost internet for a couple of hours; talk about first-world problems. But I was very lucky, and I was one of the few. And then you have friends who are just waiting for the power to come back, and it’s always the power. Everybody wants the power back on, because when the power comes back on, the air conditioning comes back on, which is so crucial in Southwest Florida. It is unbelievably hot and humid and awful down here if you don’t have air in the summer. The water comes back on, they can have a hot shower, you can do laundry, and all the things that we just kind of take for granted as part of our normal everyday lives. All of a sudden, we don’t have those.

And so people come together, and it’s amazing. I told people, “Come down to my house. I have air conditioning. Come sleep at my house, because you have to work tonight.” How do you sleep during the day when it’s 95 degrees outside? It’s so hot. How are you going to get any rest? I told my daughter and son-in-law’s friends, “Come down here and get a hot meal,” because their house was badly damaged. They had no power. They hadn’t had a hot meal in four days, and I was like, “Come down here and get some dinner.” Other people were taking laundry in for people so that they could have clean scrubs for work. Other people were going and helping clean out people’s houses that had a foot of mud in them. It was amazing how the community comes together.

But everybody wants it to go back to normal, and normal, by that definition, is the way it was before the storm. Except the problem is that it doesn’t ever go back to normal. It’ll go back. It’ll get better, and it’ll get closer to the way it was, but nothing is ever going to be the same as it was before the storm. Because even if your house was completely destroyed and we could completely rebuild it exactly the same way as it was, and you lost all of your possessions and somehow we could replace every single one of them, which is impossible, because everybody has irreplaceable keepsakes, wedding albums, baby blankets, and family art, but just pretend you can, the one thing that you can’t get back to the way it was before is you. Because you have been changed personally by the storm, and you’re never going to approach another hurricane the same way.

So I was thinking about that, and then I realized that it was October now, and it’s Breast Cancer Awareness Month. Normally, we breast cancer survivors put up our survivor pictures and our pink ribbons and wear pink in our hair or whatever, and we do charity walks like the Susan G. Komen Foundation’s. And I heard on the radio that one of our walks was canceled because of the storm. That’s when I started thinking about the connection between a life-changing diagnosis and a life-changing storm, how these things are so similar, and maybe how somebody who has survived the storm of breast cancer can help those people who have survived the storm.

I want people to know that even though it’s not going to be exactly the same, anytime that you come out of a life-threatening situation on the right side, which is the alive side, you won. Because the one rule is, as long as you’re alive, everything else you can make work. You can get over it, you can recover, and you can rebuild. And once you realize that you came out on the right side, you have this tremendous strength that you didn’t know you had. And that’s an amazing thing: “Wow, I came out of this, and I’m still alive. I’m still here.” And you start to realize the things that are really important, and it’s not the material things. It’s the love of people. It’s the love of friends and family and those people who come to support you when you’re getting chemo.

My best friend, it was so crazy, because she was our secretary in the ER. She worked seven-to-seven nights, changed her uniform into her nursing student uniform, and then went and did clinicals from eight till two or three or whatever. And instead of going home and sleeping for a couple of hours like she should have, she would go to Dairy Queen and bring me a hot fudge sundae while I was getting chemo. That meant all the world to me, just her coming in there and sitting with me. You wouldn’t think that anybody would want to eat a hot fudge sundae when you’re getting chemo, but you’d be surprised. It’s a very long process. It takes hours and hours, and you get really hungry.

She would come in and sit with me, and we would watch these crazy, crazy British comedies, and we’d be laughing our heads off. We’re in this big room with people getting chemo, where it’s very solemn and hushed, kind of like being in church, and we’re sitting in the corner cackling like two hyenas over there, eating hot fudge sundaes. That just meant the world to me. It really did mean the world to me. It meant everything to me. It means more to me than anything else. And so that was when I started to really understand the love of people.

And so my daughter, I didn’t know when she started doing this. I had to ask her. I said, “You started saying ‘I love you’ whenever I leave.” Whenever she leaves, or whoever leaves, she always says, “I love you. Be safe.” And I asked her, “When, or why, did you start doing that?” And she told me it was because she has a really bad anxiety disorder, and she always wanted to make sure that the last words that she said to anybody when they left were “I love you.”

A couple of times we’ve been fighting, like moms and daughters do, and I had to leave because I had to go to work or whatever, and she still said, “I love you.” I know one time I was getting ready to go, and she said, “Are you really going to walk out without saying ‘I love you’?” And it made me stop, and I went, “OK, I do love you.” It made me realize the silly things that you’re fighting about. It doesn’t mean that you hate the person. It doesn’t mean that; it’s just an issue you disagree on. But as long as you have that love, you can resolve it. And so every time we leave, we always say, “I love you.”

Unfortunately, last year she had a friend who was killed in a car accident, and she asked another friend of theirs, actually the girl that I invited down, she and her husband and son, for a hot meal, she said, “Did you get to tell him ‘I love you’ before he left and was killed?” And it makes you understand that this life that we have is so precious and it is so fragile, and we never know when it’s going to end. We’re all going to have a last birthday, and we never know when that’s going to be. How awful would it be to say, “I reached the age of 79, but next year is a big birthday, so we’re going to do something big next year,” and you don’t make it?

So that’s where I said, “You know what? I celebrate every single day like it’s my birthday,” because this life is that precious, and to just celebrate it one day out of the year is not good enough. Celebrate it every single day. Enjoy it every single day. And tell all those people around you how important they are to you, and make sure that they know that they are your number one priority in life.

Kevin Pho: Such a wonderful perspective. Of course, telling your story as a breast cancer survivor and telling your story of surviving multiple hurricanes in Florida, how do these experiences influence you as a clinician when you see patients every night?

Linda Munroe: So first of all, I will say I have no regrets about being diagnosed with breast cancer, because it has made me a much stronger person in my personal life. But I think it’s also made me a better clinician as well, because I have had to give people bad news. I have diagnosed people with end-stage cardiomyopathy and known that this was the end; they were coming to an end. And so it makes it easier for me, because I’ve been on that side of the bed, to be able to have that conversation with people.

I find a lot of times people don’t want to have the talk with people, like, “Things aren’t looking good. Things are coming to an end.” It doesn’t even have to be anything life-threatening. When you have a patient who comes in who’s 95 years old and they have a broken hip or something, you need to talk to them about their code status, because 95 is 95. I’ve told people many times, “I can’t cure 95.” And the fact of the matter is, an 18-year-old with no medical problems undergoing an appendectomy is going to be a lot lower risk than a 95-year-old with multiple medical problems undergoing a hip operation.

And I have had to call these family members at three o’clock in the morning. They had no idea who I was, because I’m a nocturnist, right? Nobody meets me. I’m the person who just pops in. And I’ve had to call family members in the middle of the night and say, “Hey, look, I know you don’t know who I am, but this is who I am, and this is what I do. Your family member’s not doing very well, and I need to know where you want me to go with this.”

And so I wish people would be more comfortable talking with patients about their wishes. When you have a diagnosis like end-stage cardiomyopathy, end-stage renal disease, COPD, whatever, at some point we’re all going to end up in that place where we are all going to be end-stage something or other. So it’s really important for us to be comfortable talking to people and saying, “Hey, what are your wishes?” Because it’s really awful to have to call somebody’s family member at three o’clock in the morning and try to figure out what their wishes were, especially if the family and the patient have never had that conversation. And that’s part of our job as clinicians: We need to initiate those conversations.

Now, I’ve had patients diagnosed with critical aortic stenosis who were 94, and this lady that I’m thinking of did not want to have surgery, and that’s fine. She was symptomatic, and I said, “OK, you know what? Then let’s talk about going forward. Let’s get you enrolled in hospice. Not that you’re going to die today, but your life expectancy is limited, probably six to 12 months. Let’s get the people in there to help you, so that whatever time you have left can be the best quality time that you possibly have.”

So I think that’s really made a big difference for me, being comfortable with that, and I hope I can encourage everybody else to learn to get comfortable with that. And if you’re not comfortable with it, find somebody that you work with who’s like me, who’s a survivor, and have that conversation and learn how to have it.

Kevin Pho: We’re talking to Linda Munroe. She’s a nurse practitioner. Her KevinMD article is titled “Say ‘I love you’ often and mean it.” Linda, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Linda Munroe: Remember, the most important thing in your life is not things. The most important things in your life are the people that you love. The friends and the family are the people who are going to rally around you in times of crisis, so keep them very close to you. Make sure that they know how close they are and how important they are. And then make sure that you have that ability to talk about what you want to have done, or what your patients want to have done. That’s the biggest thing to me: Life is precious. It’s short. It’s fragile. Celebrate it and make it the best one that you possibly can, because we only get one.

Kevin Pho: Linda, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Linda Munroe: Thank you so much for having me. I really appreciate it.