Wednesday, April 13, 2016

dialysis headstands

i feel like i've been working a lot lately. and i think i've mentioned, i've taken on some new responsibilities. being in charge is one of them. i think nurses jobs are underestimated always. tv shows show doctors doing our jobs (seriously, what doctor even knows how to use a blood pressure cuff these days or walks a patient in the hallway). and they show nurses with bedpans. but they don't show us administering 39 different medications in a 12 hour shift. or hanging units of blood, chemotherapy, nutrition, antibiotics, hydration, and morphine all at the same time. even nurses underestimate their jobs sometimes - not realizing how important of a role we play and how much responsibility we have. but who even knows what a charge nurse does? or why s/he is important? let's just say, i didn't understand and i've been a nurse for almost 10 years.

so, this new role. it's hard. in a 12 hour shift, i have NO patients that i am directly responsible for. i don't administer medications or hang blood products. i am indirectly responsible for 21 patients AND my staff of 10 nurses. and i am the liaison for the attending, physicians, physicians assistants, nurse practitioners, nursing assistants, dietitians, pharmacists, the secretary. i sit at the front desk and help field phone calls and family members. i answer questions all day long and get interrupted during every task that i try to complete. when patients decompensate, i am the second set of hands. when new nurses have questions about how to safely care for patients, i have or find the answers. i direct nurses and physicians to our policies and procedures. i call other units to double check protocols. and i attend flow meetings throughout the day to help determine where patients in the hospital land. for instance, which oncology unit does a patient with breast cancer go to? not mine. solid organ cancers go to 7SE. if they're full, then maybe they go to 8SA. when they're full, perhaps they come to my unit. but not if i have a need for transplant patients to come and go. it's a juggling act. and i feel like i have to barter with other charge nurses and the flow supervisor not to give me every patient who is sitting in the ER. a hospital bed is a precious commodity, who knew!

but, one of the most important roles as charge is to assist in emergent situations. to respond to code lights. so when i heard the frantic code bell at shift change on monday night, my heart started racing. i knew the patient was getting dialysis - which means he was hooked up to a machine that filters his blood. two lines connect the patient - one taking all of the "dirty" blood out of his body, and the other returning the cleansed blood back. being disconnected from these lines accidentally is a potentially fatal disaster. and is just one of the risks of needing dialysis. hence, imagine my shock when i found the patient on his head with his feet in the air... almost like a yogi headstand. it will go down as one of the weirdest things i have ever seen. the dialysis nurse was crazed, trying to protect her lines from being disconnected and exsanguinating our patient. and within a minute or two, we had at least 20 people and 40 hands trying to assist us. the patient had felt chest pressure during his dialysis run and as he sat up to cough, he must have passed out and coughed himself onto the floor. somehow, his 6 foot 5 inch body twirled, ever so gracefully i am sure, onto the floor landing on his head with his feet in the air, almost resting on the bed.

thankfully what initially seemed like a disaster turned into just a good story. the patient was fine. his head scans showed no bleeding. he was disconnected from his dialysis machine with ease and without losing any blood. and his nurse survived to tell the tale. but let's just say, being in charge, i had no idea that this is how i might end my shifts - with patients attempting headstands.

namaste!

Sunday, March 13, 2016

mine

this was a long week. i lived at UW. not just because of work, but because my dad was in the hospital.

ugh.

his health is so complicated. it's so volatile. like he lives on a teeter totter, and only if perfectly balanced, does he feel ok. never great, but okay.

so, after 16 hours of work on sunday, and what was supposed to be a 12 hour shift on monday, my work day got cut short so i could meet my parents in the ER at 4:30 PM. dad had had some shortness of breath on his typical morning walk and neck pain that i didn't like the sound of. so, after a mini mental breakdown in my manager's office, i left my unit in a heartbeat (something that is intrinsic and so easy for me, and yet requires medications, effort, and that fine balance for my dad) and spent the rest of my day in the company of my family.

i could write pages and pages about my dad's health. about the dumb residents who suck at their job and ask questions like, "if you died right now would you want us to pound on your chest?" (these were her words, seriously!?! they don't teach hard conversations well in med school, apparently). or about the doctors that don't like to believe a patient's daughter, especially when she is in hospital scrubs, even though i was right about his heart rhythm without even seeing the EKG that they struggled to read. i won't talk about the anxiety and the fear we all have that one day this won't end well.

instead, i want to talk about how special my family is. how much i love their company. even in the hospital. actually, especially in the hospital. as crazy as it sounds, it's the only time the four gadola's hang out - just my mom, dad, corina, and i. typically, we have a cohen or emerson in the mix, or my goofy brother-in-law, and sometimes, to really spice things up, joanie joins us on family gatherings. but it's rarely just US. and WE are good. my mom thinks that corina and i don't get along. she worries that one day we won't support each other in times of need. but we prove her wrong every time we do this UW cardiology thing. every hospital stay, we unite. we eat grilled cheese sandwiches in the cafeteria. we sit by dad's hospital bed and make all of the white coats laugh during rounds. we put bobby pins in each other hair and pick blackheads (this is true love).

we gadola's we're pretty special.

my dad got out of the hospital on wednesday night (i worked thursday and friday). after his "tune up," he feels a little better. and i am so thankful. but i'm also thankful for time to be with the ones we love. for family. for mine.

Saturday, March 5, 2016

Dear Jakie

today i was sorting through old paperwork and files of cards that i keep, mostly from my mom and friends (you'd think emma and i were lovers. i save all of her cards because they are the best, kindest, most encouraging sentiments). and i came across an entire file of lovely reminders of the people i have cared for in my lifetime. some from even before i became a nurse.

a picture of one of my favorite campers (carol, the most special of women with downs syndrome) whose kiss would brighten anyone's day.

helen lahey's obituary - my church grandma, who befriended me when i was a kid. she sat in the pew in front of us and loved me as if i were her own.

a photo of dick brunell from room 21. he's flipping off the camera. he was one of my favorite's at Bailey Boushay. He pretended to dislike everyone. But he liked me. I was so young then I hardly recognize myself.

but the little scrap of paper that made me cry the most, that touches me every time i find it... a note to jakie. i don't remember jakie. he must have died while i was a nursing assistant. even then, it was my job to do post mortem care. to clean dead bodies and prepare them for the morgue. this note was left by his side (and i couldn't bare to throw it away). i share it only because i know you will honor it and cherish the words as much as i do.

dated march 19th, 2004

Dear Jakie,
What can I say? Jakie, I don't want you to die! Already, I feel as if an arm or a leg has been cut from my body. After being married for 55 years, it is hard to imagine continuing life without you by my side - but I will try to muddle on.
Oh Jakie, I am going to miss you so much!
All my love forever and ever.
Dear Sweet

Wednesday, February 24, 2016

a list of things

there is always so much to say about my job. and if i was better at this blog thing, i would say one thing each day that i work. one thing that exasperated me. one thing that made me cry. one thing that i found particularly interesting. or one thing that i learned. but instead, i let time go by. and the impact of these things that feel really BIG when they happen, lessen just a little bit. so instead of one powerful story, here's a list of some things about my job.

- i've been in charge now just three times. and each day, every patient on my floor survived. and only a few nurses hated me because of my assignment! i'm excited about this new role. it makes me feel important. my manager always says that being in charge is an extension of management. and in a way, i get it now. i make decisions on an hourly basis that effect our unit's budget. whether i send a nurse home or call one in on overtime, i not only impact the unit's budget, but also, the staffing, safety, and patient and staff satisfaction.

- i took care of one patient MANY shifts in a row. and on the day of his transplant, of course his cells arrived 5 minutes before shift change. instead of being annoyed that it would take extra time on my part to receive the cells and quadruple check them, i felt excited to deliver this gift to someone whom i had grown to really enjoy. i gathered a bunch of other nurses, who also had just worked 12 hours and wanted to go home, and we sang happy birthday to him (since transplant is a birthday of sorts - another chance at life thanks to a kind donor!). as soon as the first words came out of our mouths, my male patient lost it. he sobbed like a baby in his hospital bed, curled up to next to his adorable wife. and i cried too. i couldn't help it. it was a lovely way to end my day.

- i had the first of my teaching sessions last week. and i'd like to say, it was a BIG success. my two new nurses who had already spent a few weeks on the floor totally appreciated my welcome and the chance to go over material more in-depth without having to complete patient care at the same time. we have another session next week. what's really nice is i've received feedback from management and they are impressed too! thanks goes a long way at work. it's really motivating to hear you're doing a good job.

that's it for now.

oh. one more thing. i'm working on my non-resolutions. i have a cleaning lady coming on saturday (overtime money put to good use).

Friday, January 15, 2016

2016 non-resolutions

well, it's 2016...

i've never been one to make resolutions. especially because it's mid january, and if i was to make resolutions, i feel like i'm behind. and that i've already failed. in fact, that's why i don't make resolutions. i don't like to look back on a year and feel like i did something wrong. like i didn't succeed, complete, or perfect my goals.

but this year, i'm making a list. of suggestions (NOT resolutions). just ideas. far out dreams. plans. wishes. hopes. i'm putting them out into the universe (thanks to emma) to see what happens.

here's a few things:

- take on new challenges at work
- explore new things, near and far
- continue going to yoga
(turns out, the whole breathing thing is really good for me)
- read more books (start AND finish them)
- find a husband
- win the lotto
- organize my bills, papers, and documents
- decorate more of my white walls
- look into adoption
- inquire about school
- write in a journal, at least once per month
(it's good to set attainable goals)
- hire a cleaning lady every now and then
(let's face it, i'm a bad housewife even to myself)
- be less self conscious and more confident
- cook more
- be amazing

what do you think? attainable? certainly a list of things i can work on. daily.

my work life looks interesting this year. i'm already working on goal number one! i'm gonna be a charge nurse soon. should be interesting, taking on this leadership role. and, i've asked to teach more too. we need to hire 18 new nurses on my unit (it's complicated, but we're losing 23 nurses as our ICU beds move to another unit). and although i already precept A LOT, our orientation process for new nurses is less than perfect. i feel like some preceptors struggle with teaching. so, i've offered to teach two four hour classes to every new hire during their six week orientation. i've yet to develop a curriculum, but i'm excited. i'm passionate about teaching. and about helping a new nurse feel confident and prepared to be independent. i'm excited to impart some of my expertise and some of my wisdom, not just on how to care safely for patients, but also, on how to care for yourself as a new nurse. it such a hard job! one that i continue to love (for the most part).


Tuesday, July 28, 2015

a pat on the back

a letter sent to my manager...


I hope this note finds you well.

I’m writing today to share a comment from one of our transplant donor coordinators, Leah. This week, two of your nurses worked with us on a potential cornea donation and they made an impression on her.

Leah writes, “RN Christa and RN Lauren were both very proactive and pro-donation. (They) Wanted to support the family the best they could. They were great, despite their patient being a MRO d/t lymphoma”.

The decedent’s family was very interested in transplant donation but due to the patients illness, it was not possible. Christa and Lauren did everything they could to make donation happen.

It’s interactions with champions like Christa and Lauren that keep us excited about donation and happy to be working so closely with hospital staff, like yours. We can’t do it without you.

Please feel free to share this note of gratitude as widely as appropriate. They both deserve a pat on the back.


this was a nice thank you for just some of the hard work i put in last week.

Monday, July 27, 2015

he sails on

it's been a long time dear blog...

i could make excuses. but in reality, i've been avoiding this space on purpose. i haven't wanted to process work life or real life (and now more than ever, the two feel very connected). it feels too hard. so i've just been letting things mull over in my mind, wreck havoc on my soul. some days i show up at work, just because i have to. and some days, i do my best. my very best.

the last week i had more amazing moments that i can count. more than i could ever share in writing. how lucky am i? when i contemplate job changes and career goals, i feel blessed to have been a part of amazing nursing moments. life moments. that remind me why i do what i do. why i was meant to be a nurse.

on wednesday of last week, after a fantastic birthday celebration that included 30 miles of backpacking in two days, i arrived at work to find one of my favorite patients on comfort care. strangely enough, i cared for david for the first time exactly one year prior.

comfort care is a blessing and a curse. i love taking care of people on comfort care. for some reason, i feel at ease with people when they are dying. i enjoy participating in families biggest, hardest, sometimes most beautiful moments. but of course, comfort care is sad. there are usually tears. shared memories and the best of stories. there is noisy breathing. and morphine. endless questions with difficult answers. often of which i do not have the answer to. but i'm good at saying i don't know. i'm good at answering the questions i can. and my calmest and kindest self appears. and it feels nice (especially when lately i've been a grouch).

i spent much of my 12 hour day in david's room. his wife, daughter, and son-in-law were present. there were visits from social workers, palliative care physicians, and friends. and there were snuggles (i love when loved one snuggle with their family members as they are dying; it's the most beautiful intimate moment to witness). there were stories - boy were there stories. david had spent many a year on a sailboat. in fact, he and his wife raised their daughter on a sailboat i believe. they were adventurers. kind and giving people. the kind i would like to be when i grow up. seriously. i'd be ecstatic if i could impart just a little bit of david and a whole lot of barbara in my life.

david's wife is the epitome of an angel. i can't imagine a better wife. she lived and breathed for david. his every pain was hers, and his every success was celebrated (i will never forget one time i was caring for david and he successfully pooped in a bedpain; barb celebrated as if he had won a gold medal in the olympics. and david, in his most cynical, dry voice said, "barbara, anyone can take a shit?!? but to her, it was noteworthy. celebratory. if she had had balloons, they would have been blown up. if there was cake, she would have lit a candle). barbara told me that over the course of the last year, david had been in the hospital 173 days. and while he was out-patient, there had been 150 clinic appointments. she was there for every one. every day. she never left his side.

david died peacefully in his sleep the evening after i cared for him. he and his family have touched me. deeply. if they are able to carry on with such grace, so too must i.