when i started this blog thing, i thought it would be for my own eyes only - an easy, modern kind of journal-thing that i could access from work. i've written off and on in tangible journals most of my life. it's a form of catharsis for me. but i've always just expected that these "journals" would be private (although i used to secretly hope that someone would find them after i died a tragic death and i would become famous posthumously like anne frank). eventually, i decided to share this link with a few special people - people i would likely share these stories with and feelings to anyway. i guess i thought it would be a good way to have my friends and family get to know me better - to allow some folks into my heart - to see why it is that it aches so much. but now i'm wondering if i am brave enough (slash stupid enough) to let people see how very sad and lonely i can be.
today was a hard day at work. and when i realized that i was headed home, to my empty condo, to a tv dinner or raw veggies with hummus, i wanted to cry (well, i didn't just "want" to cry, i did). i wanted someone to talk to, someone to hug me when i walked in the door, someone to walk around the block with, maybe get some ice cream... i just didn't want to be ALONE.
C died today. a 20 year old boy died today - may 14th, 2010. his parents lost their son. his older brother and sister lost their baby sibling. five nieces and nephews lost their uncle. dozens of twenty year olds lost their friend. and my friends and i at work, we lost our patient.
if C was brave enough to walk his journey, then i guess i am brave enough to admit that i am sad and sometimes lonely. tonight i am both.
i suppose it almost feels good to feel these things. to be alive with emotion. to be alive at all.
Friday, May 14, 2010
Wednesday, May 12, 2010
part 2: family
i can't seem to get C out of my mind. there are some patients that, despite our every attempt to leave them at work, follow us home in our head and hearts. not surprisingly, i am not the only nurse who has allowed C's situation to sadden me. i know this because i have spent a fair amount of time (both at work and outside of work) talking to my colleagues about the heartache we feel for C and his family.
on monday night, my dear friend who had cared for C the three days after my one day with him, texted me to let me know that C had finally been discharged from the hospital. hooray! success! i was thrilled that C and his family were finally able to spend some quality time together - outside the confines of a sterile hospital. as a huge proponent of hospice, i hoped that C would feel at peace in his familiar surroundings, that his pain would be controlled with his patient controlled analgesic pump, and that he would slowly and beautifully slip into unconsciousness and eventually, perpetual sleep.
but on tuesday morning, before my shift had even begun, i heard rumors that C was coming back. his return to home was not successful; the admission to hospice was not smooth; the home delivery of his medications did not happen; and his mother had to "play" nurse all night long, administering intravenous morphine into her sons veinous system (may i add, NO mother should ever have to do that!). when i heard that C was coming back, i felt this inner struggle. one part of me said, "you should take care of him. you care and could do a good job." and the other part of me said, "don't offer to admit him. this is too sad. preserve yourself, protect your heart and stay away!"
sure enough, the charge nurse asked if i would admit C. and i was not about to refuse. it had been 4 days since i last saw C and both he and his mother looked worse. C was a new shade of yellow; his eyes were glazed. and T, his mom, although primped and showered, looked more tired and more sad. the ambulance drivers reported some vital signs and assisted C to bed. and i reluctantly "welcomed" him back.
obviously, i could go on and on about this. like i said, it's effecting me in a different way that most of my patients (thank god, i couldn't feel this sad about all the patients on my unit that have poor outcomes). but i won't continue - i won't bore myself or my mom (the only person who religiously reads this blog!). but i do want to say just a few more things...
it seems that as one approaches death, very few things become important. while C was home for less than 24 hours, he played with his dog and watched a movie with his brother, sister, and sister's boyfriend. in the wee hours the following morning, his parents woke up to C crawling into their bed, like a scared little boy seeking comfort and safety.
FAMILY. family is what is important. it's what is important to C and what is important to me. if work can teach me something/anything, it is this: we are both so lucky to be surrounded by family - the mothers, fathers, sisters, brothers, friends, and pets (even though i don't have any pets and don't like animals, i recognize their importance for some people) that support us in our times of need.
on monday night, my dear friend who had cared for C the three days after my one day with him, texted me to let me know that C had finally been discharged from the hospital. hooray! success! i was thrilled that C and his family were finally able to spend some quality time together - outside the confines of a sterile hospital. as a huge proponent of hospice, i hoped that C would feel at peace in his familiar surroundings, that his pain would be controlled with his patient controlled analgesic pump, and that he would slowly and beautifully slip into unconsciousness and eventually, perpetual sleep.
but on tuesday morning, before my shift had even begun, i heard rumors that C was coming back. his return to home was not successful; the admission to hospice was not smooth; the home delivery of his medications did not happen; and his mother had to "play" nurse all night long, administering intravenous morphine into her sons veinous system (may i add, NO mother should ever have to do that!). when i heard that C was coming back, i felt this inner struggle. one part of me said, "you should take care of him. you care and could do a good job." and the other part of me said, "don't offer to admit him. this is too sad. preserve yourself, protect your heart and stay away!"
sure enough, the charge nurse asked if i would admit C. and i was not about to refuse. it had been 4 days since i last saw C and both he and his mother looked worse. C was a new shade of yellow; his eyes were glazed. and T, his mom, although primped and showered, looked more tired and more sad. the ambulance drivers reported some vital signs and assisted C to bed. and i reluctantly "welcomed" him back.
obviously, i could go on and on about this. like i said, it's effecting me in a different way that most of my patients (thank god, i couldn't feel this sad about all the patients on my unit that have poor outcomes). but i won't continue - i won't bore myself or my mom (the only person who religiously reads this blog!). but i do want to say just a few more things...
it seems that as one approaches death, very few things become important. while C was home for less than 24 hours, he played with his dog and watched a movie with his brother, sister, and sister's boyfriend. in the wee hours the following morning, his parents woke up to C crawling into their bed, like a scared little boy seeking comfort and safety.
FAMILY. family is what is important. it's what is important to C and what is important to me. if work can teach me something/anything, it is this: we are both so lucky to be surrounded by family - the mothers, fathers, sisters, brothers, friends, and pets (even though i don't have any pets and don't like animals, i recognize their importance for some people) that support us in our times of need.
Saturday, May 8, 2010
part 1: damn tumors
while at work on thursday evening, i agreed to change my patient assignment for friday. typically we take care of the same two to three people on our consecutive days of work for continuity of care. but on thursday, another nurse asked me if i would take care of her patient the following day, because she wouldn't be there and because she thought i would do a good job working with him and his mother. i agreed, flattered by her compliment. but when she told me "the story," i realized i had signed up for a challenging day. and sure enough, friday was hard...
my patient on friday was C, a 20 year old boy. i say "boy" because he has been sick for a long time and has hardly had the opportunity to grow up. C's mother attends to his every need and serves as his voice, making most of the hard decisions for him - i think in an attempt to fight his battle. anyway, C is at a critical time in his short life. he is 50 days post transplant and unfortunately, the transplanted cells are attacking his skin, gut, and liver. his small body is frail; his organs are failing. as if graft versus host disease wasn't life threatening enough, C has already relapsed too - he has tumors in his entire abdominal cavity and they are causing significant pain. sadly, we have run out of tools, treatments, and tricks to save him. C is dying.
i had the opportunity to facilitate a transition for C. he and his family had decided that it would be good to go home, at least for 24 hours. C has been in the hospital for over 2 months; he has been unable to leave our unit, unable to breathe fresh air for 65 days. and although C felt more comfortable and safer in the hospital, with doctors, nurses, pain management, and emergency treatment available, he did want to go home, one last time. so, with the work of many people (social work, transition nurses, pharmacists, palliative care attendings, pain management specialists, hospice nurses, home infusion companies, etc.), we made the plan for his 24 hour release to be executed on saturday.
THE PLAN: C was supposed to get his blood work drawn early in the morning. should he need blood products or electrolyte replacements, they would be infused early. his other IV meds would be given, back to back before his discharge. his mom would pick up his oral medications in the discharge pharmacy. a hospital bed, commode, wheelchair, and walker were being delivered to his home. the infusion nurse was coming to hook C up to a new pump to make the delivery of IV narcotics available with a simple button push. an ambulance was coming to take C home over an hour car ride away. if everything went smoothly, C would be home by 1:00 PM.
so today, at 1:30, while eating my lunch of PB and homemade jelly on a hiking trail, i thought of C. i hoped he had made it home and was sitting in his favorite recliner. i hoped their were balloons and friends at his side. i imagined a celebration of sorts, albeit a relatively sad and unfair homecoming.
but much to my dismay, when i returned from my hike and checked my email this afternoon, i got news from a nurse friend of mine (the one i had handpicked to care for C today since i would not be there) that the plan had failed. it's not that we hadn't thought of everything. it's that C started to have unmanageable pain. they couldn't control it in the hospital and therefore, it would likely be worse and scarier at home. all of our hard work and preparation, all of our hope - dashed by tumors pressing on his intestines. damn them!
i can't help but feel that life is unfair. this boy is 20 years old. he's confronting death and he's angry. he's scared. and he has very little time left. i wonder if C has been in love. if he's seen a shooting star or watched the sunrise. i wonder if he has unfinished business with any of his friends, if he's been brave enough and strong enough to tell the people in his life that he loves them.
oh my heart aches for this young boy. i so wish there was something i could say or do to make him better. last night, when saying goodbye to C, i apologized for not having been able to fix him, for his transplant failing. he hadn't spoken to me all day really... and when i said this, he looked up at me, rolled his eyes, and said, "yeah, thanks!" there's nothing i could say or do to make him better. and that is just about one of the worst feelings.
my patient on friday was C, a 20 year old boy. i say "boy" because he has been sick for a long time and has hardly had the opportunity to grow up. C's mother attends to his every need and serves as his voice, making most of the hard decisions for him - i think in an attempt to fight his battle. anyway, C is at a critical time in his short life. he is 50 days post transplant and unfortunately, the transplanted cells are attacking his skin, gut, and liver. his small body is frail; his organs are failing. as if graft versus host disease wasn't life threatening enough, C has already relapsed too - he has tumors in his entire abdominal cavity and they are causing significant pain. sadly, we have run out of tools, treatments, and tricks to save him. C is dying.
i had the opportunity to facilitate a transition for C. he and his family had decided that it would be good to go home, at least for 24 hours. C has been in the hospital for over 2 months; he has been unable to leave our unit, unable to breathe fresh air for 65 days. and although C felt more comfortable and safer in the hospital, with doctors, nurses, pain management, and emergency treatment available, he did want to go home, one last time. so, with the work of many people (social work, transition nurses, pharmacists, palliative care attendings, pain management specialists, hospice nurses, home infusion companies, etc.), we made the plan for his 24 hour release to be executed on saturday.
THE PLAN: C was supposed to get his blood work drawn early in the morning. should he need blood products or electrolyte replacements, they would be infused early. his other IV meds would be given, back to back before his discharge. his mom would pick up his oral medications in the discharge pharmacy. a hospital bed, commode, wheelchair, and walker were being delivered to his home. the infusion nurse was coming to hook C up to a new pump to make the delivery of IV narcotics available with a simple button push. an ambulance was coming to take C home over an hour car ride away. if everything went smoothly, C would be home by 1:00 PM.
so today, at 1:30, while eating my lunch of PB and homemade jelly on a hiking trail, i thought of C. i hoped he had made it home and was sitting in his favorite recliner. i hoped their were balloons and friends at his side. i imagined a celebration of sorts, albeit a relatively sad and unfair homecoming.
but much to my dismay, when i returned from my hike and checked my email this afternoon, i got news from a nurse friend of mine (the one i had handpicked to care for C today since i would not be there) that the plan had failed. it's not that we hadn't thought of everything. it's that C started to have unmanageable pain. they couldn't control it in the hospital and therefore, it would likely be worse and scarier at home. all of our hard work and preparation, all of our hope - dashed by tumors pressing on his intestines. damn them!
i can't help but feel that life is unfair. this boy is 20 years old. he's confronting death and he's angry. he's scared. and he has very little time left. i wonder if C has been in love. if he's seen a shooting star or watched the sunrise. i wonder if he has unfinished business with any of his friends, if he's been brave enough and strong enough to tell the people in his life that he loves them.
oh my heart aches for this young boy. i so wish there was something i could say or do to make him better. last night, when saying goodbye to C, i apologized for not having been able to fix him, for his transplant failing. he hadn't spoken to me all day really... and when i said this, he looked up at me, rolled his eyes, and said, "yeah, thanks!" there's nothing i could say or do to make him better. and that is just about one of the worst feelings.
Saturday, May 1, 2010
i infuse hope for a living, what do you do?
today was my patient's birthday! not her real BIRTH day, but her transplant birthday - her day 0.
let me explain:
the days leading up to transplant are minus days (for example, day -1); they are full of icky things, like chemotherapy and total body irradiation. the days after tranplant are plus days (ie. day +1) and include waiting for engraftment (when the cells burrow into the patient's bone marrow, make themselves a home, and start working to produce red and white blood cells - in essence, a new immune system).
as a nurse, in the morning, when i see that i'm giving someone stem cells, i roll my eyes. it's extra work. i'll likely have to be in my patient's room for over an hour; i'll have to do extra sets of vital signs all day; and my patient just might have an anaphylactic reaction (which, let's just say, is not fun and certainly complicates the day). it doesn't happen often, but we must always be prepared (with emergency meds at the bedside, extra monitoring, and adrenaline at the ready).
my patient's partner helped to remind me that transplant day is not all bad; it's not all nuissance. it's not just extra work for me. it's why i became i nurse (and i guess i forget that sometimes) - to make people's lives better. i didn't become a nurse to "cure" people, like some doctors (and thankfully that wasn't my motive, because transplants don't always work). i became a nurse to assist people when making hard choices and to support them, physically and emotionally, in their greatest time of need.
as my patient lay in her bed, sedated from high doses of benadryl, her partner of 21 years talked. and it was not just small talk. it was BIG talk. he said to me, "that woman right there, she is everything to me." he then proceeded to tell me that he hoped i don't take my job for granted. he asked, "do you realize the importance of what you do? do you know you are infusing hope into my darling?"
as a red kool-aid like substance dripped into my patient's veins, i thought about it. i don't always realize what i do. i don't always remember the significance of my job. the stem cells that i gave my patient today came from two separate umbilical cord donations - two separate, small miracles that were born into the world and given the chance to save another life. what a miraculous scientific invention? what an amazing gift! and i get to participate?!? i will forever be the nurse that administered geraldine's stem cells. i had the honor of celebrating her new birthday. and whether or not her transplant is successful, i have the privelege of knowing that i infused hope, in an attempt to let geraldine's partner share more time with his "everything."
who else gets to say they "infuse hope" for a living? i'm going to put that on my resume some day...
let me explain:
the days leading up to transplant are minus days (for example, day -1); they are full of icky things, like chemotherapy and total body irradiation. the days after tranplant are plus days (ie. day +1) and include waiting for engraftment (when the cells burrow into the patient's bone marrow, make themselves a home, and start working to produce red and white blood cells - in essence, a new immune system).
as a nurse, in the morning, when i see that i'm giving someone stem cells, i roll my eyes. it's extra work. i'll likely have to be in my patient's room for over an hour; i'll have to do extra sets of vital signs all day; and my patient just might have an anaphylactic reaction (which, let's just say, is not fun and certainly complicates the day). it doesn't happen often, but we must always be prepared (with emergency meds at the bedside, extra monitoring, and adrenaline at the ready).
my patient's partner helped to remind me that transplant day is not all bad; it's not all nuissance. it's not just extra work for me. it's why i became i nurse (and i guess i forget that sometimes) - to make people's lives better. i didn't become a nurse to "cure" people, like some doctors (and thankfully that wasn't my motive, because transplants don't always work). i became a nurse to assist people when making hard choices and to support them, physically and emotionally, in their greatest time of need.
as my patient lay in her bed, sedated from high doses of benadryl, her partner of 21 years talked. and it was not just small talk. it was BIG talk. he said to me, "that woman right there, she is everything to me." he then proceeded to tell me that he hoped i don't take my job for granted. he asked, "do you realize the importance of what you do? do you know you are infusing hope into my darling?"
as a red kool-aid like substance dripped into my patient's veins, i thought about it. i don't always realize what i do. i don't always remember the significance of my job. the stem cells that i gave my patient today came from two separate umbilical cord donations - two separate, small miracles that were born into the world and given the chance to save another life. what a miraculous scientific invention? what an amazing gift! and i get to participate?!? i will forever be the nurse that administered geraldine's stem cells. i had the honor of celebrating her new birthday. and whether or not her transplant is successful, i have the privelege of knowing that i infused hope, in an attempt to let geraldine's partner share more time with his "everything."
who else gets to say they "infuse hope" for a living? i'm going to put that on my resume some day...
Wednesday, April 28, 2010
i scream, you scream, we all scream for...
ICE CREAM!
i'm having a good day today for a silly reason. nurses are part chef, part waitress. and so, on occassion, i get to whip up a milkshake with carnation instant breakfast, 2 small cartons of vanilla ice cream, and a splash of milk - the ratio is crucial! and don't knock the strange ingredients until you try it! the best part of making this concoction is not the joy on the face of the patient, but the critical taste test that i allow myself! and today, i've made not one, but two strawberry shakes. and hence, had not one, but two sample spoonfuls. i prefer the vanilla and the chocolate flavors, but i won't complain. i do enough of that and who complains about ice cream anyway?!?
i'm having a good day today for a silly reason. nurses are part chef, part waitress. and so, on occassion, i get to whip up a milkshake with carnation instant breakfast, 2 small cartons of vanilla ice cream, and a splash of milk - the ratio is crucial! and don't knock the strange ingredients until you try it! the best part of making this concoction is not the joy on the face of the patient, but the critical taste test that i allow myself! and today, i've made not one, but two strawberry shakes. and hence, had not one, but two sample spoonfuls. i prefer the vanilla and the chocolate flavors, but i won't complain. i do enough of that and who complains about ice cream anyway?!?
Friday, April 23, 2010
to go or not to go!
today was a rough day. and i go back tomorrow.
sometimes, it is so challenging to motivate myself to return to a place full of stress, illness, diarrhea, chaos, blood, nausea, crying, pain... the list is endless.
i precepted a brand new nurse today; it was her first shift on our unit. and i warned her, there are just some days that are plain ol' hard... some days your best isn't good enough. some days you never want to return. some days you wish you worked behind a computer. and some days you stay late, more than the 12.5 hours you're scheduled for.
by 7:40, i was done charting, done giving report, done with patient care; in short, i was done, done, done! but i stayed an extra ten minutes to walk out with nursing friends - to share our days' stories, to unwind, and to motivate one another to come back tomorrow. i'm planning on showing up. i wonder who else will join me?
sometimes, it is so challenging to motivate myself to return to a place full of stress, illness, diarrhea, chaos, blood, nausea, crying, pain... the list is endless.
i precepted a brand new nurse today; it was her first shift on our unit. and i warned her, there are just some days that are plain ol' hard... some days your best isn't good enough. some days you never want to return. some days you wish you worked behind a computer. and some days you stay late, more than the 12.5 hours you're scheduled for.
by 7:40, i was done charting, done giving report, done with patient care; in short, i was done, done, done! but i stayed an extra ten minutes to walk out with nursing friends - to share our days' stories, to unwind, and to motivate one another to come back tomorrow. i'm planning on showing up. i wonder who else will join me?
Thursday, April 15, 2010
back to work
it's been a LONG time since i've written. in fact, it's been a LONG time since i've worked! i took off three weeks of work to go to bali, indonesia! and it was AMAZING. the whole thing - the first week which was yoga, the second week which was adventure, and the remaining days pre and post travel to prepare and then to catch up. what was also fantastic was the time away from sick people, from death, and from sad situations.
now, i'm back. and it's the same. more cancer, more sadness, more death...
an update on things at work from while i was away:
there were SO many sad stories and situations before i left that only got more sad while i was traveling. one of my very favorite patients, a 50 year old filipino woman, got discharged home to die; she was going to fly to the philippines to be surrounded by her 11 brothers and sisters. another 50 year old gentlemen died in the intensive care, with tubes in every orifice, and his parents by his bedside, devastated that they couldn't take his place. the 62 year old woman who had been here since october or november finally passed away (to join the mom whose comfort she had been craving so much). and there are numerous others whose stories go undocumented.
today has been slightly comical for a change. i'm taking care of a patient who is confused; i'm not sure of her baseline mood and behavior, but i think she might be crazy to begin with! anyway, she's totally off the wall today and i got called a name while trying to help her. let's just say, it was not christa - it's something i've never been called before... "you're a smug little shit!" she said with glazed, devilish eyes. how does one respond to this name calling? "why thank you!" i said, a bit taken aback!
time off from work was so restorative. i thought a lot about my patients while away; they inspire me and teach me many things. and i love being a nurse, but mainly in retrospect... if that makes sense. i love the idea of nursing, when i'm not in the midst of a crazy 12 hour shift! but despite the vacation, i'm already looking forward to my next non-healthcare related adventures (of which, thankfully, there are plenty).
in august, i'll be camp nurse at camp parkview, a camp for developmentally disabled adults (my fourth year as nurse, my 12th plus year of involvement). in september, i'm climbing mt. rainier - wish me luck! and the following week, i'll be heading to upstate new york for one of my best friend's wedding and a short rendezvous with my mom in the big city. not long after that, the first week of october, it's off to nepal for 10 days of trekking and 2 weeks of building a home with habitat for humanity in pokhara!
wish me (and my patient) sanity for the remainder of the day and patience as i wait to embark on more trips and adventures!
now, i'm back. and it's the same. more cancer, more sadness, more death...
an update on things at work from while i was away:
there were SO many sad stories and situations before i left that only got more sad while i was traveling. one of my very favorite patients, a 50 year old filipino woman, got discharged home to die; she was going to fly to the philippines to be surrounded by her 11 brothers and sisters. another 50 year old gentlemen died in the intensive care, with tubes in every orifice, and his parents by his bedside, devastated that they couldn't take his place. the 62 year old woman who had been here since october or november finally passed away (to join the mom whose comfort she had been craving so much). and there are numerous others whose stories go undocumented.
today has been slightly comical for a change. i'm taking care of a patient who is confused; i'm not sure of her baseline mood and behavior, but i think she might be crazy to begin with! anyway, she's totally off the wall today and i got called a name while trying to help her. let's just say, it was not christa - it's something i've never been called before... "you're a smug little shit!" she said with glazed, devilish eyes. how does one respond to this name calling? "why thank you!" i said, a bit taken aback!
time off from work was so restorative. i thought a lot about my patients while away; they inspire me and teach me many things. and i love being a nurse, but mainly in retrospect... if that makes sense. i love the idea of nursing, when i'm not in the midst of a crazy 12 hour shift! but despite the vacation, i'm already looking forward to my next non-healthcare related adventures (of which, thankfully, there are plenty).
in august, i'll be camp nurse at camp parkview, a camp for developmentally disabled adults (my fourth year as nurse, my 12th plus year of involvement). in september, i'm climbing mt. rainier - wish me luck! and the following week, i'll be heading to upstate new york for one of my best friend's wedding and a short rendezvous with my mom in the big city. not long after that, the first week of october, it's off to nepal for 10 days of trekking and 2 weeks of building a home with habitat for humanity in pokhara!
wish me (and my patient) sanity for the remainder of the day and patience as i wait to embark on more trips and adventures!
Subscribe to:
Posts (Atom)