role reversal

i've spent the last four months training to climb mount rainier. in fact, i've even blogged about it in an entry or two. it's been my main focus this summer. and likely one of a few reasons i haven't blogged much at work about work. i've been determined, excited, and unbeatable... until last week.

this last week, i got beat. and i got beaten badly!

let me describe the days prior to my hospital admission. on friday and saturday (almost two weeks ago), i did a trial run of an altitude sickness medication called diomox. the reason for the trial was that i am allergic to a cousin of the drug and wanted to assure that if i had a reaction, i was in seattle, at sea level, and near a hospital. so, i took my first two doses while working a 12 hour shift. and i was fine. perhaps a little dizzy (but it's a mild diuretic, so it made sense). the next day was a long training hike - a 14 mile loop with a 35 pound backpack. and i took two more doses. i was tired, but the training hike went well on the medication.

sunday was a day off from exercise. and monday i was at work. tuesday, i developed a respiratory infection that i feared would hinder my climb. so, i went to the doctor in search of antibiotics. instead, i was told i likely had a viral infection and would have to wait it out. blah!!! the exercise continued, as last week was supposed to be my most intense week of training. despite a fever, weakness, and general malaise, i went to hot yoga on tuesday evening and crossfit the rest of the week (not to mention 52 minutes on an escalator-like machine at a fast pace). two of the three days at crossfit were upperbody exercises. and although i have relatively buff arms (if i may say so myself), i did TOO much. advice: never do 100 pull-ups followed by 100 push ups the day after you've done push presses at your maximum weight.

friday evening, after crossfit, i literally could not lift my own water bottle to my lips. i had dinner with a friend and had to excuse my poor table manners and clutsiness. saturday i hiked, figuring i did not need my arms for a 9 mile hike with a 40+ pound pack on my back. but i certainly was sore beyond belief, unable to flex or extend my arms. i iced things and took ibuprofen to hasten my recovery. but it was to no avail.

on monday morning, i woke up still sore and feeling "fat." really, my muscles were just inflamed and incredibly angry at me. however, my right arm was larger than the left. and being a nurse, i worried that i may have developed a blood clot. because i had to work that day, i iced and medicated while working for 12.5 hours. but my worry grew throughout the day as others noticed and commented on the size of my arm and the possible diagnoses. blood clots, a torn bicep, cancer, elephantiasis - it could have been anything!!! by evening, i had a physician's assistant look at it and he told me to get it checked out immediately. so began my hospital stay...

i became a patient at swedish medical center, first in the emergency room and then on a medical unit in room 906. and for the first time in my life, i was a patient and not a nurse. the role reversal was strange and the experience was incredibly humbling.

essentially, the combination of my intense exercise, possible dehydration, and overuse of my arms had caused rhabdomyelisis - a severe breakdown of muscle tissue which results in the build up of waste products and toxins that damage your kidneys. i was admitted to prevent acute renal failure and put on a sodium bicarbonate drip. within minutes of my ultrasound to rule out clots in my arms and assessment of my lab results, i was given an IV in the lesser of swollen of arms and pumped full of cold intravenous fluids.

as a nurse, i was on high alert. the ER nurse never offered me a warm blanket. i had no nurse call light to ask for help. there was no bathroom in my curtained room. when a transporter came to wheel me up to my new room, i was on a gurney, looking up at the ceiling, getting nauseated from the bumps in the floor and the sharp turns; oh my goodness, how do my permamently nauseated oncology patients tolerate being wheeled to chest x-rays and procedures? my first night "sleep" was interrupted at least 4 times between midnight and 6 AM - doctors visiting, an admission history to complete, vital sign checks, blood draw in the wee hours of the day. with incredibly swollen arms, my veins were hiding deep below the surface and i had to get poked at least three times, just the first day! i grew increasingly impatient with my lack of control and the great unknown. nobody could tell me i would be okay; nobody knew my lab results for hours (even though i knew they were completed and in the computer); nobody could make the doctors appear when i wanted to talk to them. i was stuck, confined, totally at the mercy of others. my only role was to WAIT - to wait patiently for others to tell me news.

for a complete and total control freak, it was a challenge - to say the least- to be in the hospital. because i was so weak and my arms so damaged, i couldn't shower myself or put on my own clothes. hence, it was a good lessen in humility to have to ask for help and such a great reminder of how lucky i am to have family and amazing friends. my dear friend emma saved me from having to ask my nurse, a total stranger, to help me wash my hair. she kindly helped me to get undressed, wash, and get redressed without feeling the least bit embarrassed. the next day, my mom even shaved my armpits! all this may sound silly, but being clean was important to my happiness... and since i couldn't do it on my own, i felt blessed to have support. aside from tuesday, wednesday, and thursday nights, i was never alone in the hospital for more than 1 hour. people brought me flowers, meals, magazines, chocolate peanut butter malted milk balls - the supply of kindness was endless.

i am thankful to be out of the hospital. of course, i am crushed that my dream of climbing mount rainier is shattered... at the very least, postponed til next season. but, when i return to work this friday, i will return with a greater understanding of my job and the role of patient. i've always known that being patient as a patient must be challenging, but i have a new appreciation of the vulnerability that my patients feel. may i be a better nurse from here on out!

over and over

did you ever see that movie "50 first dates?" i think i saw it; i don't remember much about it - perhaps my memory is fading too. but it's about a girl with NO short term memory. she keeps asking her partner the same questions over and over; she doesn't remember who he is or that they were ever together - that she ever loved him.

today, i am taking care of this very sick 71 year old lady who is near death. her husband won't acknowledge it, and she doesn't remember us telling her. but for some reason, she too has short term memory loss. and it's actually been quite pleasant - for me.

i've been in her room at least a dozen times today and she re-introduces herself each time - calls me darling, asks how i am doing. she tells me when i tell her how brave she is and how amazing it is that she is so kind, appreciative, and positive despite her pain and sickly state that "i am 71 years old and have no choice but to be happy and positive."

working with M has been so beautiful! i have had the pleasure of hearing hers and her husband's love story over and over. on august 4th, they will have been married for 54 years - since she was 17 and he was 21. for her husband, i bet her loss of memory is painful. how do 54 years disappear? how do you forget details about the love of your life?

tomorrow, at 2 pm, i will be transferring this dear woman from UW hospital to a hospital closer to her home. she will be taken away in an ambulance with husband at her side. and hopefully, if she is lucky, she will forget all the pain seattle, seattle cancer center, UW, and transplant have brought her.

just want sun

i was NOT at work today. but being a nurse often translates to life outside of the hospital. i frequently get into situations where my nursing skills come in handy. sometimes it's my loving, yet forceful nudge to get my dad to go to the doctor. "no dad, your cut on your finger shouldn't bleed for 8 hours - you need stitches!" but every now and then, it's a bit more serious. and with total strangers.

today i was hanging out with my dear friend, emma. we seem to get into trouble together often - emma was ditching work, i was avoiding working out/rainier training. we were enjoying one another's company, when all of a sudden...

as we were driving on rainier avenue north, we passed a woman, completely toppled over, lying on her back, STIFF as a cadaveur, with her right hand bolt-upright holding a half smoked cigarette. she was at a bus stop and nobody was helping her. it looked as if she had died while smoking one last puff.

going 35 mph, we passed. then looked at one another. and decided to stop. are we good samaritans? or just stupid? neither of us would have felt okay the rest of the day had we not offered our services and so, after discussing CPR (30 chest compressions and 2 breaths), we headed over.

the lady looked horrible. her skin was ashen and weathered. she was wearing a burgundy, polyester coat. her dentures were dirty. and she had nail fungus on her left hand. it took a minute or two to get her to respond, but eventually, we discovered - she was not dead, just incredibly intoxicated.

i couldn't believe nobody else had stopped. she REALLY looked dead. rainier and dearborn is a highly trafficked intersection, so numerous cars sat and starred, probably laughing at us nice, young women offering help to a dirty, disadvantaged human. the world is strange. emma pointed out that if i had keeled over - a young woman, dressed in nice clothes, with a clean appearance - someone would have probably stopped. but sadly, no one seemed to give a damn about this woman.

i asked if i could help her up, if she needed anything. did she want medical attention? did she need an ambulance? was she okay? all she wanted was her case worker. when i explained her situation, that she was looking half dead on the sidewalk of a busy intersection and that her case worker was unavailable, she then replied with, "i just wanted some sun..."

so we left her, lying in yoga's dead body pose, on the concrete, baking in her polyester coat, worshipping the sun.

*** imagine the irony. a very similar situation happened to emma and i once before, maybe 2 or 3 years ago. i'll spare you all the details. but the final response we got from a nearly comatose, also inebbriated man was, "just catching a buzz..." ***

the best gift

i had the pleasure of delivering potentially life-saving stem cells to a patient today. he was alone in his room when i barged in with 2 other nurses and a secretary to sing happy birthday. it's a tradition that some of us nurses carry on. and although none of us has a particularly good singing voice, it's a nice way to celebrate a new birth of sorts. my patient was very thankful and excited, disappointed that his wife missed the commotion, but excited nonetheless. thankfully, his wife and sister arrived within a few minutes - before i began to transfuse the cells into his body. we took the obligatory photos! my patient's sister is the donor; she donated her cells yesterday and was able to hold her bag of cells and actually hand them to her brother. as she did this and we documented it on film, i said, "i bet that's the best gift you ever gave!" there were huge hugs and giant tears from all. and i left feeling thankful that some days my job is full of happiness and hope, wishes and dreams.

a good night's sleep

a 12.5 hour day is always long. when it's a busy day, 12.5 hours of busy-ness is exhausting. and when it is slow, 12.5 hours of watching the clock tick is agonizing. a good night's sleep can make all the difference. so imagine, work on very little sleep can be quite miserable! last night, i got less than 5.5 hours of sleep. but when the reason for insomnia is fun and exciting, 12.5 hours isn't so bad. i had a date last night with a boy and without spilling any details (of which none are THAT juicy), it was a very nice evening.

today was unusual though... i must say. at times it was slow, but never too dull. i had two non-transplant patients. the first patient had prostate cancer and had been admitted for sepsis (a systemic blood infection); he was to be discharged with a foley catheter and required teaching. the second was a substance abuse user post liver resection and hernia repair with severe abdominal pain, distention, and constipation. despite my disinterest in either gentleman, somehow, i found my way into both men's nether regions. not my idea of fun at work.

let's suffice it to say i had to change a foley catheter (and for those of you that don't know what that is - imagine a tube in a man's most private of parts, used to drain urine, and stabilized by a balloon inflated in the bladder - ow!) and give a suppository (you do know what this is, right? a wax bullet shoved into the other most private of parts with plenty of lubricant).

my job is so strange! i never cease to be amused by nursing tasks... thankfully these two chores did not require much concentration, just professionalism and humility (which i can fake on 5.5 hours of sleep).

read at own risk: a few gross descriptions

i graduated from nursing school four years ago! and i can hardly believe it. i've been working on the stem cell transplant unit for 3 years and 8 months. i will admit, it took me a VERY long time to feel comfortable as a nurse. hell, i didn't feel safe for over a year. but it has finally begun to feel natural.

i can handle most situations that are thrown at me - related to transplant that is. i can treat the most severe cases of mucositis; i've seen people vomit the lining of their esophagus. i am not bothered by 4 liters of diarrhea on a 12 hour shift. and i can administer 8 blood products to three different patients before lunch time. but throw something new at me, something i don't see very often, if ever, and i regress.

this morning, in report, i learned that my patient had two holes of which i am unfamiliar. perhaps that's an inappropriate or strange description. but let me explain. my patient had both a PEG tube (a hole on the belly that leads directly to the stomach for feeding) and a tracheostomy (a hole in the neck that leads to the airway to allow for breathing). these are two "holes" that i have very little experience with and instantly, i noted my anxiety and blood pressure quickly increasing. in fact, i voiced my discomfort during report, in front of the entire staff, perhaps in an attempt to ask for help... but maybe, just maybe, to see if someone else was up for the challenge!

my 67 year old male patient has laryngeal (neck) cancer. he's had parts of his tongue removed, in addition to tumors in his neck and throat. he cannot speak. and now, he breathes through a hole in his neck that is kept open by a plastic device. all of that works fine and good when he is "healthy." but add some pneumonia to an already sick man and that airway fills up with gunk fast. i'll spare you ALL of the details, but imagine the most vile and putrid smelling substance. it was hard to even be in the same room as the man because of the stench, let alone up close, in his face, performing tasks i do not feel comfortable with to help him breathe. oh, what an interesting day.

i learned how to suction a patient. it's not that hard. it's just new. and at first, new things are scary to me. but i was reminded, once again, how vulnerable my patients are. this man, who is dying of cancer, cannot speak. he has no words to voice his thoughts, feelings, and emotions. yes, he can write with pen and paper, but imagine how exhausting, challenging, and unsatisfying that would be. i so often get caught up in my own feelings, my own fears and concerns, that i forget how brave my patients are.

elevator

so, my last post was about the stairs. i bragged about how many "sets" i had completed in a 12 hour shift, just for fun! well, today... today was not a stair day. i don't think i took the stairs once. i was TIRED. the elevator was calling me. it called in the morning on my way to work, when i went downstairs with a friend to get a 10 cent peppermint patty, and in the evening, on my way down and out of the hospital! big mistake!

i had waited for some of my fellow nurses to finish report so that we could walk to the garage together; it's always more fun to walk with company. so at 7:45, later than i like to stay at work, six of us got on the elevator to descend from the 8th floor to the 3rd. why we didn't all traipse down the steps, i cannot say. but, as we waited for the slow elevators to ding and pick us up, we talked about how one of our colleagues had recently gotten stuck for 15 minutes. just then, we piled in the elevator, and it began to plummet; the elevator shuttered to a stop and started to vibrate. it was crazy! we all looked at one another as if the hospital was haunted. how could that happen, especially just right after we had talked about it. thankfully, none of us panicked... and thankfully, there were two bright and strong gentleman nurses who pried the doors open. or perhaps i would still be there!