nurse AND girlfriend

last week i had the pleasure of going to kauai with the new man in my life.  it was a rather spontaneous trip.  i don't typically do spontaneous well, but this man helped me to relax and enjoy.

while i worked as a nurse at a camp for developmentally disabled adults for one week, surfer boy (one of his many nicknames) made ALL of our plans.  our tickets were purchased, cars were rented, resort stays scheduled, and everything one could think of for camping was prepared (down to the ever crucial rolls of toilet paper).  C did a fantastic job. and despite my return from camp at 5PM on a friday night and our departure at 9:45 AM on saturday morning, i barely felt crazy.   just a bit!

all in all, kauai was a delightful trip.  surfer boy and i got to know one another better.  in fact, we got to know one another on a very intimate level.  one that is safe to discuss on a public blog that my mother reads.  in fact, it's more than appropriate for a nursing related blog because it has to do with yet another ER visit and hospital stay!  i am proud to say, i remained healthy in kauai - even after our strenuous hike and more bug bites than i can count!

tuesday and wednesday, C and hiked the napali coast.  it's an infamous hike, on the top 10 most dangerous hiking list (which also includes mount rainier).  we trekked 11 miles along the coast line, switchback after switchback, up and down cliff sides in crazy hot, very humid weather.  one misstep could have wound us stranded hundreds of feet below, dead, or in shark-infested tumultuous waters. the 7 hour journey was grueling.  and sleeping in a tent that night was equally as challenging - we were SO hot, there was NO breeze, and any idea of romance i had created in my mind vanished!

wednesday morning, we decided to pack up and hike out.  neither C nor I is very good at relaxing and although the beach on the coast was beautiful, we couldn't imagine an ENTIRE day with nothing to do (it's not recommended to swim there because of the currents).  so, at about 11AM, we began the hike back to our car.   the return trek might have been harder than the approach; we knew what we were in for...

but thursday, friday, and saturday brought about the most challenging part of our trip.  thursday AM, C woke up with right lower quadrant pain.  as a nurse and with C in school to become a physician's assistant, we both worried about his appendix.  did he have rebound tenderness?  was he nauseated?  did he have a fever?

C is an amazing man for numerous reasons.  not only is he very intelligent (which makes his sexy), but also, he is very fit.  both mentally and physically, C is one tough man.  he waited out thursday, coping with periods of nausea and sharp pains.  we discussed getting checked out, but with our "expertise," C felt comfortable waiting to see if things got worse.  which, of course, they did.  on friday at 3 in the morning!  C was smart enough to check which hospitals in kauai have CT scanners.  and so, we headed to wilcox memorial hospital.  should your appendix ever misbehave while in kauai, go there!

this could be a very long story.  it already is.  i'm a blabbermouth.   but suffice it to say, C did indeed have a potential appendicitis.   his CT scan showed an enlarged appendix.   but chronic gastrointestinal issues complicated diagnosis and treatment.  C ended up being admitted for surveillance.  the surgeon wanted to keep an eye on him.  our departure flights were cancelled.  and we set up shop in room #300.  C did his best to be a decent patient.   and i did my best to keep him in line!

C has never been a patient in a hospital.  and i have never been a nurse to a significant other.  it was a new experience.  a new kind of relationship.  and although we both survived the experience and are doing well, back at home in seattle, i think we would both choose to remain healthy in our futures.  it feels weird to be a nurse AND a girlfriend. just as i imagine it would feel weird for C to be a physician's assistant AND a boyfriend.

comfort care

i've mentioned this before, but did you know?  nursing is a strange profession!

on wednesday, i arrived at work.  my patient assignment included a 43 year old, heavily tattooed man whom i had admitted on monday.  and a 69 year old woman on comfort care, dying of pancreatic cancer.

to top it off, i also had a nursing student assigned to work with me; she is sweet and religious and competent, but in a shy, nervous way.  she lost her dad in 2006 to cancer at my hospital (which likely prompted her interest in nursing).  and wednesday was her last day on my unit, her last day of clinicals while in nursing school; in fact, she graduates TODAY!  it would have been nice to help her end her nursing student career in a FUN, HAPPY, POSITIVE way.  but instead, i anticipated and warned her that we would likely see a woman die on our shift, that we would complete post-mortem care, and zip a once-living-loving woman in a body bag...

i haven't cared for someone on comfort care in a LONG while.  which, in some way, is too bad considering i think i'd still like to be a hospice nurse some day (and could use the experience).  and considering how many people die on my unit, you'd think more people would be on comfort care.  but sadly, people die suddenly on our unit, with codes, and CPR, and everything but peace and quiet.

anyhoo, i was not surprised to hear that my patient was on a morphine drip; but i was surprised to hear that she was on 40mg an hour.  that is a HUGE dose.  enough to sedate, if not kill, a large elephant.  not surprisingly, when i assessed her in the AM, her respiratory rate was 4 breaths per minute.  my nursing judgement told me from that and from her cool, mottled skin that she was nearing death.

BUT...  the plan of the day shifted when her team of physicians approached me and asked in a rather gruff, concerned way, "how did we get to 40mg of morphine per hour from the 2mg we started on just yesterday afternoon?"  let me explain.  nurses have the authority, based on an algorithm, to titrate drip rates to patients' comfort.  if a patient is in pain, nurses can give a bolus and increase the drip rate at increments.  but there had been NO documentation of the patient's pain; in fact the previous nurse charted that the patient was calm and comfortable.  it seemed that the nurse prior to me increased the drip rate rather willy-nilly, perhaps expediting the patient's death - which is ILLEGAL.

so, for the first time (and hopefully the last) in my nursing career, i was asked to decrease the rate of the morphine drip.  in essence, to reverse the comfort care orders.  to possibly wake a woman peacefully dying and perhaps cause her pain.

i hated the idea.  and told the team this.  i agreed that perhaps the way in which her morphine drip was handled the day before was inappropriate.  but the fact of the matter is, it hadn't killed her.  and now, she was comfortable.  and i didn't want to play any part in changing that.

after much discussion with one of my managers, and further discussion with her provider, i turned the drip down.  i monitored my patient more closely, with peace of mind, knowing full well that if my patient showed the slightest bit of discomfort, i had the authority, based on MD orders, to bolus the patient with morphine and increase her continuous pain medication.  thankfully, the patient remained calm. comatose. obtunded.  and to my surprise, almost horror, the patient survived my entire 12 hour shift.

and yesterday's.

it's strange to want a person to die.  to hope that the two breaths i counted in one minute were someone's very last two breaths.  but at the same time, it's hard to see a woman, barely clinging to life, hang on.

divorced

mount rainier and i have a love/hate relationship.  i've decided, we're getting divorced!

as stated in my last post, i climbed mount rainier last week - for a second time.  and for the second time, i wound up in the ER.

reminder:  almost two summers ago, i had signed up to climb mount rainier with a guide company.  in preparation, i joined crossfit and got into crazy shape!  however, 100 push-ups, 100 pull-ups, and 100 squats sent me to the ER with severe muscle breakdown in my arms leading to rhabdomyelisis.  i could have permanently damaged my kidneys.  but thankfully, after 5 days in the hospital, and a month or so of recovery, i was fine.  i am fine.  but i did not get to climb rainier.

last summer, the mountain and i got along, fairly well.  it must have been the therapy i attended between summers to mend our broken relationship!  i summited mount rainier last summer.  we seemed to respect one another on my climb.  and although i felt extremely proud of my accomplishment,  i vowed to only visit the mountain's lower-lands in the future.

rewind to last week.  as previously mentioned, for some crazy reason, i decided to test our tumultuous relationship.  i went on a 3 day date with rainier.  and have since decided, we're broken up.  forever.  i descended the mountain on friday morning.  it was fast, sliding thousands of feet on my poor little behind.  i hate glissading.  but i made it safely, in one piece, to the parking lot.  with only a few itchy bug bites and incredibly sore quadricep muscles.

fast forward.  to friday night.  a bug bite on my hand began to swell.  it was itchy.  most bug bites are, right?  but by night time, i started to worry.  i was losing definition of my hand.  my skin grew taut and uncomfortable.  my handsome boyfriend, a PA student, decided i should probably go to the ER.  not wanting to make a big deal of nothing, i decided to sleep on it.  if it was worse in the AM, sure, i would go!  4:30 in the morning came quickly.  and with that, came the realization that something was seriously wrong.  my hand had doubled in size.  i had an infection of some sort.  and since i've seen too many cases of flesh eating bacteria (necrotizing fasciatis) leading to amputations, i decided not to mess around.  my eager to learn boyfriend and i went to the ER at my place of employment.  i was treated quickly and efficiently (maybe because it was serious, maybe because i'm an employee).  i got an IV dose of serious antibiotics and was started on four times daily oral antibiotics.

cellulitis.  of course, i got cellulitis on my hand from a bug bite on mount rainier!  cellulitis is a skin infection.  but i felt like it's an STD from my sketchy date with mount rainier!  we're over.  i'm getting a restraining order.

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(this picture doesn't quite do the swelling justice.  not to mention, it got bigger throughout the day on saturday.  currently, i think i am cured.)

mount rainier

i accidentally climbed mount rainier this week.  

and to my surprise, i summited a second time.  the photo above is on august 2nd, 2012.  the photo below is july 2nd, 2011 - just 13 months earlier.  i've since acquired better climbing clothes!

anyhoo, this climb was not planned.  in fact, last year, i had promised myself that i would NEVER climb mount rainier again.  it was the HARDEST physical thing i have ever done, without a doubt.  and i felt that i never needed the challenge again.  

but on monday, when the invitation was sent by some friends in my mountaineers course, i almost couldn't pass up the opportunity.  in order to pass my basic climbing course, i have to complete one glacier climb this summer.  there are numerous climbs i could have done - easier climbs, less intense, less risky (on mountains in washington people have never heard of).  but every attempt i made previously this summer had been cancelled due to weather.  so, i felt like this was my only chance to pass my class AND to do so with people i trust and enjoy.

in what may be the MOST spontaneous thing i have ever done, i signed up on monday at 9AM while at work and within 48 hours, i began the grueling ascent of the mountain i have come to respect and admire.

i cannot say i enjoyed the entire experience.  climbing mount rainier is hard.  i did it in three days this time, instead of four.  and we took a different route, because last year's route was too melted and riddled with impassable crevasses.  the winthrop glacier, that we took instead, turned out to be more challenging than i ever expected.  at times we crawled on all fours, using our ice axes to slither across snow bridges and crevasses.  no joke - at one point, i had to JUMP over a crevasse so big i would have been swallowed up by ice had i not successfully crossed. 

my anxiety, my stamina, my determination - all were tested on this mountain.  i cannot say that i was positive the entire time.  i cannot promise that i didn't want to turn back.  i cannot tell you that i did not cry.  but i can say, i am crazy proud of my second summit.  i am amazed by my spontaneity.  and i am impressed by the changes i have made within myself in one year.  i am still the same height, but i think i may have stood a bit taller on top of rainier this year compared to last.   

slavery

i've never thought of nursing as slavery.  but in a way, depending on how patients treat us, it could be considered a form of it.

i cared for a psychologist the last two days.  at first, i thought he was nice.  we had a thing or two in common.  he's a hiker and climber, a member of the mountaineers.  but after spending just a short amount of time with him, i realized this man is a control freak.  i am too.  i appreciate straight lines and tidy hand-writing.  if given the choice, i prefer doing things MY way.  but i don't believe i mistreat people because i am particular.  i know i respect other folks who do things for me.  i say thank you in a genuine tone when someone makes me my coffee or bags my groceries.

that was not the case yesterday.

this man HAD been very sick.  he was admitted for acute renal and liver failure related to a new diagnosis of lymphoma.  he had nearly died just a few weeks ago, hooked up to machines, getting dialysis.  in the blink of an eye, he lost his independence.  but just as quickly, he began to improve.  by the time i met him on thursday, he was just using a walker to ambulate.  but otherwise, he had regained most of his strength.  i do not know what his baseline personality was like, but his current personality is royally F%&**$#d up.

just some examples:

he asked me to tie his shoes.  so i did.  then he proceeded to say, "you know, normally i tie the loops a little bit tighter."  i asked if the shoes were too loose, if he felt like he would trip.  he said, "no, i just tie the loops in a tighter knot, so they don't untie."  WTF?  i really wanted to say, "you know, i've been tying my own shoes since i was four; i think i've got this covered!"

when he asked me for assistance in the shower, i agreed to walk him to the shower bench and to take off his compression hose.  they are a challenge.  but i was not about to help an independent 60 year old man bathe.  sorry.  i draw the line.  i agreed to standby, in his room, tidying his linens, so that i could help him dry his feet off (a task he may actually not be able to do independently).  but when he called for me and i entered the bathroom, he was sitting naked, with a washcloth on his junk.  once again, WTF?  his hands work.  why the hell didn't he put on his own gown?  gross!!!

just another example, i'd get him all situated in bed, call light in reach, water bottle in hand.  then i'd ask if he needs anything else and he would say "no, you're such a good nurse.  i have everything i need."  within 7 minutes, he'd call again and say, in a gross, commanding, dominating voice, "could you increase the heat, just the slightest bit!"  i would do that.  and leave ASAP.  but without fail, he'd call again, in less than 15 minutes for another irritating chore.  i swear to god, he just wanted me in his room all day, waiting on him hand and foot.  i don't get paid enough for that!

i'm embarrassed to admit it.  but i am reading fifty shades of grey.  it's a horrible book, promoting the concept of women as submissive to men (and sadly, i can't put it down, despite being a staunch feminist).  i couldn't help but feel like my patient was attempting to dominate me, like he thought i was his slave, his submissive.  only, there was nothing sexy about it!  i was irritated and grossed out ALL day.

Source: en.wikipedia.org via Lesley on Pinterest

smell

our senses are amazing.  all five of them.  but every now and then, i'm taken aback by one of them.

on monday, i cared for a 74 year old man.  he looked a bit more frail than his 74 years, hunched over a walker, pale and disheveled in hospital pajamas.  but he smelled dignified.  and in an instant, i was reminded of my grandfather.  who died more than 12 years ago.

i feel bad admitting this, but i don't think of poo (his nickname) that often.  and if so, it's more of a fleeting thought than a realistic, tangible memory complete with longing and ache.

as i left my patient's room and passed by his sink, i saw a familiar green bottle adorned with a gold cap and the signature polo emblem.  my grandpa used to wear so much polo cologne it was almost as if he bathed in it.  the "collector" that he was, his bathroom always had numerous green bottles.  it was the obvious, standard father's day, birthday, and christmas gift.  and i realized why my head was flooded with thoughts, taken back a decade in time.

all because of my sense of smell.  

Source: sephora.com via Jeremy on Pinterest

ACLS

i passed my ACLS class on friday.  we had a mock-code that i led and my patient survived after numerous shocks and the administration of many, many medications.  but i must say, i would still prefer that my patients not code on my watch.  mainly because my instinct is to let someone die.  but also, because codes are chaotic and stressful.  here's to never needing to use my ACLS skills!