By Betsy Rosenblatt Rosso
Not every nurse has treated spider and tick bites along with wounds inflicted by coyotes and wild horses. But NMCRS Visiting Nurse Susan Zebedies has. “Nursing in the desert is different than in other communities,” she explained about her first decade working for the Society. Zebedies was based out of NMCRS China Lake in the western Mojave Desert of California. In addition to encounters with insects and animals, local desert residents face high levels of arsenic in the air and water resulting from a dry lakebed, which causes thyroid disorders and extreme asthma and other respiratory illness.
From 2001 to 2010 Zebedies was a traditional visiting nurse, working primarily with the family members of active duty service members as well as retirees and widows. Besides treating desert-specific injuries and ailments, Zebedies also assisted new moms and their babies, patients who needed follow-up care after surgery, and older clients who needed assistance monitoring chronic conditions or maintaining their medication schedules.
Previous work in rehabilitation and psychiatric nursing prepared Zebedies well for serving NMCRS clients. “I worked with orthopedic surgery and brain-injured patients from many different walks of life and many different cultures,” Zebedies recalled. “I helped them with physical rehabilitation as well as mental health issues. Although they weren’t military, their injuries were similar to those which the combat-wounded and injured clients I see now.”
When Zebedies and her husband moved to Patuxent River, Maryland for her husband’s job as a civil servant, Zebedies hoped to continue her nursing work with the Society. NMCRS’ Combat Casualty Assistance (CCA) Visiting Nurse program had grown and the Society asked her to take on CCA as well as traditional clients. Zebedies was eager to take on the new challenge. “I learned more about psychological issues, addiction, wound care, PTSD, and traumatic brain injury,” she said. “I’m always doing continuing education to learn new things and maintain my licenses in five different states.” Zebedies works with clients in Michigan, Pennsylvania, Maryland, Delaware, and New Jersey.
The number of clients in her caseload and the numerous details about their conditions, medications, and family members are manageable for Zebedies – thanks to her nature and her experience in mechanical engineering. “I worked for 18 years in engineering before changing careers.” When the company she worked for went out of business, Zebedies decided to go to nursing school. “Nursing was a higher purpose and it suited me better. Instead of dealing with mechanical objects, I could work with people. My family history is nursing—my sister is a nurse—and my grandmother became a nurse at age 55, so when I went to nursing school at the age of 35 I didn’t feel too old. Becoming a nurse was the best life choice I’ve ever made. It’s a tough job but very gratifying.”
The greatest challenges of being a CCA visiting nurse typically stem from the less visible injuries that clients have. “You have to develop a rapport with them. They have to trust you before they will open up to you. When I first walk in, they don’t know if they can trust me. The longer I sit there, they realize I’m not there to hurt them, report them, or change them. For 15 minutes or so, I make small talk to make things less stressful. Then, some will say, ‘the truth is…’ I have to spend time and let the process work. If I go in thinking it will be a 15-minute evaluation, I’m not going to get to the heart of what’s going on. The joy of this job is I can go in and take as much time as I need.”
Struggles with insomnia, anxiety, and drug interaction often overlay CCA clients’ other medical issues. “Most clients are surprised to learn that they’re heavily medicated,” Zebedies explained. “They don’t realize that each medication is playing off the other and making them feel terrible. For example, if you mix sleep and anxiety medications, you could be risking your life. I talk to them about everything that could interact, including vitamins and herbs, and whether they need a different type or dosage of anything. I encourage them to talk to their doctors. If the doctor has questions, I will talk with the doctor, but I want them to advocate for themselves. Sometimes they’re not taking medications as prescribed. Often they think if they can’t tell if something is working, they don’t need it. Or, if this helps their anxiety, instead of taking one they’ll take five. I talk to them about overdoing it, or mixing prescription medicines with alcohol, or frequently changing their doctor. I discuss alternatives that will make them feel better – physically, such as yoga, electrical stimulation, or chiropractic care. Some people appreciate alternative treatments and love it when they do it. Other people think it’s stupid because they just want to take a pill. Taking such strong drugs makes your muscles weaker and messes up your digestive system. It may help one thing but messes up five others. I try to give them new information every time I see them, even if they’re having the same problem, hoping if I say it in a different way they’ll get it.”
Zebedies values the opportunity to involve the client’s family in her interactions. Sometimes, family members need as much help as the client – or more, she explained. “One of my patients from Pennsylvania had a stroke at the age of 40. It was devastating to his wife and five children. Over the past five years I’ve assisted all of them. The wife is the patient’s caregiver and her life is centered on his needs. He has made great improvements over the years but is still impaired. In the meantime, his wife’s health suffered and their children have had many issues that I‘ve helped with. Every time I see the family we address all the issues that have come up since my last visit. I sit at their dining room table for two to three hours talking about all their problems. The kids come in and we all talk. Every family member has been in counseling. The father’s improved, after a lot of rehab. He can talk again, but he probably won’t be able to work again.”
“Another patient I saw 13 years ago in China Lake, California just transferred to Patuxent River, Maryland. When she realized I was here she was excited to tell me how much my resources and support helped her and her newborn all those years ago. Her infant was diagnosed with failure-to-thrive and needed special formula because she wasn’t growing. I was able to get her some of the formula but it was so expensive and hard to find. The formula company representative finally gave me the recipe so the mom could make it herself for a fraction of the $40 per can that it cost.”
“She now credits me for saving her sanity and helping her maneuver through the medical establishment to bring her child to normal growth,” Zebedies said. “Her daughter is doing well in school and has no signs of problems related to when she was an infant.”
“I feel like I’m making a difference. One of the best things about this work is taking someone who’s absolutely miserable—at the end of their rope—and giving them hope. Visiting them a few months later and seeing how they can function—not just because of me, but because I got them in contact with the right people who could help them and encourage them.”
Congratulations, Susan, on 15 years of service to the Society!