life and death

i'm so glad i didn't have to go to work today. i don't think i could have done it. my heart broke a little more yesterday (i say "more" because it breaks at work frequently)... and i needed today to nurture my soul. aside from a dentist appointment at 8 o'clock (i HATE the dentist, especially at 8 o'clock), i've been really good to myself. coffee in my glass mug while surfing the internet and eating a croissant from my favorite bakery - bakery nouveau. some organizing in my kitchen. taking out the garbage, recycling, and compost (while these chores are not fun, they do leave my space smelling and looking better). i think i might go rock climbing this afternoon to sweat out some of my demons (or ya yas as my friend cassie would say). and tonight, i have a massage at 7:30. i'm hoping to relax, to get to that dream la-la-land state, and let the tension in my muscles and brain leave my body.

yesterday, i stood in the room of my 31 year old patient, with her mom, stepdad, sister, and friends. there were four nurses, one social worker, and a priest. and we watched, as a respiratory therapist disconnected a sweet, spunky soul from the ventilator. sometimes the human body has an incredible reserve. and sometimes, it is only medicine keeping a body alive. abigail took her last assisted breath as tears filled the room. the monitor screeched. her ekg flat-lined. what moments before looked like a pink, glowing soul, turned mottled, blue, and waxy right before my eyes. (cole and i spoke about life last night. when is it that the soul leaves the body? does it leave right away? or does it linger, trying to figure out where to go next and what just happened). i'd like to think that a little bit of abby's soul seeped into each of us in that room. that each of is better, stronger, and braver because we knew her and because we were there, holding her hands and touching her body during her final moments.

i was right, a few weeks ago, when i helped my patient escape from the hospital to feel normal, just for a few hours. it would be her last hours outside. the last time sunlight kissed her face. the last time oxygen made from trees would fill her lungs.

i feel honored to have been a part of both of those days - both abby's living and her dying. her life. and her death.

may her soul live on.

a wedding at work

yesterday was supposed to be an ordinary day. i had a four hour class in the morning for work. nothing special, just learning our new method of medication administration using a scanning "gun" to prevent medication errors. it was lame. but after class, i went up to my unit to see two of my colleagues who were having their very last days on 8NE. my co-workers are dropping like flies, leaving the in-patient nursing world for lives in the out-patient world - all because what we do on 8ne is heavy. challenging. heart-breaking. overwhelming. and sometimes, AMAZING. like so amazing, that it's hard to deal with. hard to hear. and hard to be a part of.

anyway, when discovering that my unit was short a secretary, i decided to stay on for over-time only if guaranteed to NOT work with patients. isn't that horrible? i had it in me to answer phones, but not to do patient care. so, i stayed for 4 hours in my flip-flops. and it turned out to be one of my most jaw-dropping, heart-warming days at work i've had in 8 years.

are you ready for this story. get the kleenex.

there is a 25 year old woman in our ICU. last week she went to the ER with abdominal pain only to find that she has a terminal, metastatic cancer and has days to weeks to live. crazy, right? to be healthy one week and dying the next. at 25. at about 2:50, my charge nurse said to me, "christa, i need your help. we're planning a wedding. the 25 year old patient wants to marry her boyfriend before she dies in the next 24 hours."

what transpired in the next 2-3 hours is unbelievable. it's the perfect example of teamwork. how one person's vision and efforts can make a difference in a BIG way. and how 20 people, working together, can make a life-changing things happen.

one nurse started making flowers petals out of red construction paper to throw during the "ceremony."

another called a bridal store to donate a veil and gloves (the bride was too sick to stand and/or wear a wedding dress),

the nurse practitioner in charge of the patient's care called friends and colleagues who donated their money and time. i saw her at the edge of the bed, whispering to the patient, "how have you envisioned this day? what can we do to make it special?"

a pulmonary attending brought her photographer husband to the hospital to take wedding photos. on the way, they stopped at a store and bought a wedding cake.

i called a local florist, explained the situation, and within 2 hours the owner of the store personally delivered a bouquet, a boutineer, and lavender rose petals.

my friend c called her husband and said "i need you to bring the pink champagne from our fridge to the hospital ASAP. we have a patient getting married; she's going to die soon." within minutes, c's husband was standing on our unit, champagne and glasses in hand.

the patient's pastor from her church arrived to carry out the ceremony. our hospital chaplain attended and brought candles and bibles and more flowers.

the patient's nurse washed her hair, de-hospitalized the room, and not only turned up machines to help her breathe and turned down machines to stop beeping and squeezing and chirping, but also, helped to make everything look special and appear calm.

there were numerous family members and friends. hospital staff. parents of the bride. parents of the groom.

words can't describe what it felt like on our unit. in some ways, it felt frantic - what takes most brides months to pull off happened in a few hours. and in other ways, it felt magical. there were tears. there was shock. our new manager assisted and turned her eye to the real flowers (that are not allowed on our unit), the real candles, and the champagne. we wrote thank you notes. and patted each other on the back for jobs well done.

this 25 year old will never live to see 26. she will not get to fulfill her dream of becoming a nurse. she will never get to be a parent. she won't grow old with her husband. but she will die knowing that she is united with the love of her life. that people she doesn't even know worked hard to make one of her dreams come true. that sometimes miracles happen - in different ways than you hope - and they are beautiful!

my patient "escaped"

i helped to plan an escape for a patient of mine this week. perhaps it's because i too once escaped from the hospital while i was a patient and still attached to my IV pole or maybe it's just because this gal is cool (and so am i?!?) that i relate so well. she's 31. younger than me. and she's been dating a man for maybe two years total (just like cole and me). they're unmarried. and in love. or once in love. and i can't help but to put myself in her shoes (TOMS) and wonder what it would be like. how would i feel. what would happen to my relationship. and my future (if i made it to the future).

this gal has had a rough go. or as one of my other super young patients put it, she's won the "anti-lottery." like the shittiest prize ever. not only cancer - lymphoma. but lymphoma with brain tumors. debilitating brain tumors. WTF? why should a 31 year girl get that? when she's in school. and hoping to do something amazing with her life. and feeling excited about love and marriage and family.

(side note: my heart broke for her for the like 27th time as she was telling her mom about the different kinds of chemotherapy she's going to get. while describing one she said, "this is the one that destroys my ovaries." her mom cringed and not to be mean, reminded her daughter that she's already in menopause, from the other chemo she has received in the last 10 months. her mom, who also experiences hot flashes and the un-sexy-ness of dry vaginas, said to her sweet daughter, "we'll get you a baby somehow. don't you worry.")

UGH.

anyhoo. my patient will likely be in the hospital for the next month or more. and of course, i want for her to do well. but my experience tells me that she won't. that the nice ones always do poorly. and that with her disease, her prognosis is VERY BAD. like, she won't get out of the hospital E-V-E-R, bad. so, when her doctors said that it would be okay to sneak out of the hospital for a little shopping and lunch adventure, i was in full support. insurance companies don't allow patients to come and go. and of course, if something bad happened to her while she was out, her insurance would flip out, likely not cover her hospital stay, and WE would be at fault and shit up a creek. so the "escape" had to go well.

i felt like an accomplice to a crime. or like her mother. although her real mom was in on the crime also, i was the nurse. the responsible one. i had to think of everything. the wheelchair she had to steal - to prevent falls. the hat - to protect her bald, radiated head. the pain medication i had to tuck into her pocket - in case her persistent headache became too unbearable. the timing of her other medications to keep her safe.

what was supposed to be a two hour pass turned into four plus hours. and although i started to worry, i was elated when she returned. my patient was happy. she ate lunch in the sunshine. she bought make-up to fancify her face. and jewelry to adorn her cancer ridden body. she gabbed with her sister about clothes and shoes and retail. and even though she didn't say it, i think she felt normal. for a second.

instead of dying in a hospital bed while the rest of the world passes her by, she got to participate. for four short hours. and i'm so happy that i could help.

self care

i don't have a lot to say today. but i felt like writing. i'm home. sick. sitting on the couch. recuperating from four twelve hour shifts in a row. and mentally preparing for the three more that start on saturday. ugh.

i have one friend in the hospital at 26 weeks pregnant (who is being brave and calm and amazing). and cole's dad with sudden vision loss due to unknown causes. another friend has her TWO in-laws in the hospital due to two different issues that occurred at the same time. her mother-in-law had a stroke at home, did nothing about it, and then started having seizures. and a father-in-law who suffered a heart attack at the very same time. excuse my french, but WTF?

suffering is hard to witness sometimes. there is so much of it. and only so little space in your heart to carry it all. how do you support your friends and loved ones who are hurting? or feel stressed? what can you do as a nurse and as a friend? when are you over-stepping boundaries or simply going above and beyond? is there a difference?

i'm gonna vegetate today. and maybe buy vegetables at the grocery store. i need to eat better. and drink juice with vitamin C. i need to take good care of myself so that i can continue to take good care of others.

(over the last four days, i cared for a 23 year old gal. she's beautiful. and quiet. she's in pain. and getting REALLY sick from her chemotherapy. i gave her her stem cell transplant over the last two days (3 bags on tuesday and 2 bags yesterday). and i'm REALLY hoping it works. she wants to go to school to become a pharmacy tech. and one of my other 23 year old patients who i re-admitted on monday is one year post transplant and wants to be a doctor when he's finally healthy enough to go to school. how cool is that?).

some lessons i learned

i attended a palliative care class last friday and monday. for 16+ hours, i heard lectures on death and dying, pain management, how to communicate difficult news to mourning families, the stages of grief, etc. we shared devastating stories, some beautiful experiences with good deaths. and we even walked the journey of our own passing - imagining the losses experienced along the way: the loss of control, the inability to complete favorite tasks/hobbies/activities, the changes in our relationships, the weakening of our muscles and perhaps our spirit. and although i've heard these lectures before and completed these activities, although i constantly think of illness and dying, i learned NEW things. i appreciated the time to reflect on my job. and my life. to acknowledge the difficult work that i do. and the toll it takes on my heart.

here are a few things i learned.

first of all, i find it amazing that as a nurse, i have the opportunity to attend classes about death and dying. there are hours and hours of lessons to be learned. we just glossed over some subjects and we spent SIXTEEN hours learning. and in med school (or PA school, since i have "shared" cole's experience as a student), they spend maybe ONE hour learning these same subjects. no wonder some doctors have a difficult time with this process...

we discussed the importance of breath. scientifically, i get that we need to breathe. that there is oxygen exchange in our lungs. that every muscle in our body needs 02 to function. but what i never really think about or practice is the importance of deep breathing as a nurse, when i get anxious or have to do difficult things. one lecturer asked us what things makes us nervous as nurses. being sterile and placing foley catheters? placing IVs? walking into the room of a dying patient and talking to crying family members? when is it that we find our hearts racing, our minds whirring with fear and anxiety? when do we run on auto-pilot instead of acting as humans with caring and compassionate hearts? and what if we took intentional deep breaths during those moments to slow down our own heart rates and to allow our brain to receive the oxygen it needs to use our frontal lobe and actually THINK and ACT.

i was also reminded about attitude. they say "attitude is everything." and i actually believe that. but still, i start most of my days grumpy. not wanting to be at work. annoyed that i have a certain assignment with difficult patients, ones that call too much or are rude to staff. what if instead of starting out with a negative attitude, i spent just 60 seconds recalling why it is that i became a nurse? what if i remembered that my goal has always been to take care of vulnerable (sometimes grumpy) people and make a difference in their life? to help people along challenging illnesses that sometimes end in death and to make that road easier, to listen and share in intimate experiences? might my day be better? YES.

i'm gonna put these lessons into action!

birthday twin

yesterday, as i was preparing for my day, writing out lists of medications and times for blood draws, i noticed that my patient and i were the very same age and had the very same birthday. kind of creepy, huh? someone my age with my birthday has been battling cancer for years and now is 16 days post a transplant. am i lucky or what?!?

one flew over the cuckoo's nest

my patient called me nurse ratchet today.

i think that's an insult.