the christmas scrooge in me woke up this morning and said,
"bah humbug..."
it's currently 5:38 PM on christmas day. i've been awake for 12 hours, almost 11 hours of which have been spent at work. sometimes being a nurse is not so fun. it means holidays spent in the hospital taking care of sick patients. it also means missing out on family traditions, the exchange of gifts, and the afternoon lull/nap once the festivities are over.
the little santa elf in me is singing a little jig of
"ho, ho, ho and a merry, merry, merry christmas..."
working on christmas can also be fun - depends on your attitude. it can mean spending time with friends/colleagues, potlucks, and christmas cookies galore. it means brightening sick people's holiday with loving care and christmas cheer. the time and half is a nice addition to my paycheck (i must admit). oh, and having my mom and auntie joanie deliver personalized starbucks drinks to the entire unit this afternoon is an extra special perk of working on the holiday - caffeine makes everything better! my patients and their families show extra appreciation too; i even got a treat of almond roca from one patient spouse to thank me for my presence.
i just feel merry because i am healthy and happy, my family is home, ready and waiting to greet me. it's the people that make christmas special - whether i am at home or at work. merry christmas to all!
Saturday, December 25, 2010
Friday, December 24, 2010
"my" favorite patient
in my last post, i mentioned one of "my" very favorite patients - my dad. like i said, he's not really a patient of mine. i mean, i do boss him around. i tell him when and how to take his meds. i lecture him on his diet and salt intake. but thankfully, he's not really a patient of mine. his doctor is a brilliant cardiologist we met almost 12 years ago when my dad's heart started to fail him. and his nurse is named kelly; she puts up with my dad and his harem of women who worry about him (meaning me, my mom, and my sister).
anyway...
december 23rd started just like any other day on my unit. i was assigned three patients; the day would be busy. but my dad had a doctor's appointment at 11:00 and i was determined to attend. so, i begged a friend of mine to watch my patients while i escaped from the unit. and boy am i glad i did.
turns out, my dad's heart was acting up! more so than usual. instead of beating regularly, it was beating irregularly - in a rhythm called atrial flutter. the heart is supposed to act like a well oiled machine; it has a certain way of behaving that is the most efficient and the most effective. and let's just say, atrial flutter is neither. when kelly heard the irregularity, she immediately called for confirmation. within minutes, we had an EKG to verify the rhythm and both my dad's cardiologist and electrophysiologist convened to determine a plan of action. my dad would soon be admitted. he needed a trans-esophageal echocardiogram and a cardioversion. translation - they needed to put a tube down my dad's esophagus to look through the back side of the heart for blood clots. if indeed, there were no clots (potentially formed by the lazy and quivering atria), then they could use paddles (ie. a defibrillator) to shock his heart back into normal rhythm.
ugh. sometimes being a nurse is irritating. i know too much. i knew to worry. i know that shocking someone can be potentially dangerous. it certainly sounds terrifying. and it's much scarrier when it's someone you know and love - when it's your dad.
by 12:15, i ran back up to my unit and quit. not forever. just for the day. and instead of being a nurse to my three patients, i became a nurse to my dad! once again, not really. other nurses took care of him. but i waited all day with him in the hospital. i called the troops (my mom and sister). and when needed, i explained and re-explained the procedure to any and all worriers.
thankfully, my patient behaved. and so did his heart. there were no blood clots. and the electric shock converted my dad's heart rate from his naughty rhythm to the proper one.
but i think i prefer being a nurse to strangers.
anyway...
december 23rd started just like any other day on my unit. i was assigned three patients; the day would be busy. but my dad had a doctor's appointment at 11:00 and i was determined to attend. so, i begged a friend of mine to watch my patients while i escaped from the unit. and boy am i glad i did.
turns out, my dad's heart was acting up! more so than usual. instead of beating regularly, it was beating irregularly - in a rhythm called atrial flutter. the heart is supposed to act like a well oiled machine; it has a certain way of behaving that is the most efficient and the most effective. and let's just say, atrial flutter is neither. when kelly heard the irregularity, she immediately called for confirmation. within minutes, we had an EKG to verify the rhythm and both my dad's cardiologist and electrophysiologist convened to determine a plan of action. my dad would soon be admitted. he needed a trans-esophageal echocardiogram and a cardioversion. translation - they needed to put a tube down my dad's esophagus to look through the back side of the heart for blood clots. if indeed, there were no clots (potentially formed by the lazy and quivering atria), then they could use paddles (ie. a defibrillator) to shock his heart back into normal rhythm.
ugh. sometimes being a nurse is irritating. i know too much. i knew to worry. i know that shocking someone can be potentially dangerous. it certainly sounds terrifying. and it's much scarrier when it's someone you know and love - when it's your dad.
by 12:15, i ran back up to my unit and quit. not forever. just for the day. and instead of being a nurse to my three patients, i became a nurse to my dad! once again, not really. other nurses took care of him. but i waited all day with him in the hospital. i called the troops (my mom and sister). and when needed, i explained and re-explained the procedure to any and all worriers.
thankfully, my patient behaved. and so did his heart. there were no blood clots. and the electric shock converted my dad's heart rate from his naughty rhythm to the proper one.
but i think i prefer being a nurse to strangers.
Friday, December 17, 2010
take care of me. please.
sometimes, as a nurse, i get sick of taking care of people. i don't just care for people at work, i care for people in all aspects of my life. caring is in my genes. it just happens - almost naturally, compulsively, intuitively (even when i try to care less or stop caring at all). but then, every now and then, when i've cared too much, i crack; and then, i need someone to take care of me. please.
these last three days at work have been hard. to be brief.
on wednesday, i cared for a 46 year old nigerian man. throughout my 12 hour shift, he lost his ability to speak in english. he lost his mobility and could no longer transfer from his chair to the bed. he had unmanaged pain. and was nearing death.
today (friday), i wrapped his body in plastic and zipped him up in a body bag. his three brothers watched us perform our last "caring" techniques (which feels more like lack of caring - plastic? body bags? ugh - inhumane). the brothers (and i) cried.
my other two patients are 24 and 34 years old. the 24 year old is pre-transplant. he is hopeful and anxious. he's getting sicker before we make him better. the 34 year old has had two transplants; the first one his body did not accept and sadly, he's relapsed after the second. his leg is gangrenous and he needs a walker. he has two kids and a wife at home.
my other patient is not my patient at all. he's family; he's my dad. my dad has congestive heart failure and is seen in the out-patient cardiology clinic in my hospital. the days he has appointments while i am at work, i usually con my charge nurse to allow me to leave the floor to escort my dad. he's lived in the US for more than 30 years (from switzerland originally), but he still needs an interpreter. not literally. but he does need an advocate and someone to force him to report accurately. so, we went together today to see why he's been more fatigued and why he is retaining fluid despite the diuretics. bottom line. it's hard to care for a parent. to watch them age and get sicker.
anyway, sometimes i care too much. if you catch my drift. i worry about my "patients." i feel sad when they have aches and pains. i want for them to get better instead of sicker. i want my caring to be curing. and it's often not.
when this realization comes, that i cannot care for everyone and that i certainly cannot cure anyone, i get overwhelmed. sometimes i cry. sometimes i eat chocolate. today, i just need someone to take care of me for a change. please.
these last three days at work have been hard. to be brief.
on wednesday, i cared for a 46 year old nigerian man. throughout my 12 hour shift, he lost his ability to speak in english. he lost his mobility and could no longer transfer from his chair to the bed. he had unmanaged pain. and was nearing death.
today (friday), i wrapped his body in plastic and zipped him up in a body bag. his three brothers watched us perform our last "caring" techniques (which feels more like lack of caring - plastic? body bags? ugh - inhumane). the brothers (and i) cried.
my other two patients are 24 and 34 years old. the 24 year old is pre-transplant. he is hopeful and anxious. he's getting sicker before we make him better. the 34 year old has had two transplants; the first one his body did not accept and sadly, he's relapsed after the second. his leg is gangrenous and he needs a walker. he has two kids and a wife at home.
my other patient is not my patient at all. he's family; he's my dad. my dad has congestive heart failure and is seen in the out-patient cardiology clinic in my hospital. the days he has appointments while i am at work, i usually con my charge nurse to allow me to leave the floor to escort my dad. he's lived in the US for more than 30 years (from switzerland originally), but he still needs an interpreter. not literally. but he does need an advocate and someone to force him to report accurately. so, we went together today to see why he's been more fatigued and why he is retaining fluid despite the diuretics. bottom line. it's hard to care for a parent. to watch them age and get sicker.
anyway, sometimes i care too much. if you catch my drift. i worry about my "patients." i feel sad when they have aches and pains. i want for them to get better instead of sicker. i want my caring to be curing. and it's often not.
when this realization comes, that i cannot care for everyone and that i certainly cannot cure anyone, i get overwhelmed. sometimes i cry. sometimes i eat chocolate. today, i just need someone to take care of me for a change. please.
Tuesday, November 30, 2010
my job is so weird...
a patient died last night.
i watched a techn from lifecenter northwest cut his corneas out right at the bedside.
they will be donated to someone to restore sight.
an amazing gift!
but, eyes give me the willies.
especially eyes with no corneas.
now i know.
i watched a techn from lifecenter northwest cut his corneas out right at the bedside.
they will be donated to someone to restore sight.
an amazing gift!
but, eyes give me the willies.
especially eyes with no corneas.
now i know.
Thursday, November 25, 2010
rejuvenated
i took a six week vacation. and it might have been the best thing i have done for my career. ever. i came back (not wanting to go back to work, but) feeling rejuvenated and ready for the challenges that a nursing career presents. and since i have been back in the country for 2 weeks and back at work for six shifts, i have had a more positive attitude and many positive - dare i say 'special' - moments.
my first week back, i took care of an older bulgarian gentleman who had had a transplant 2 weeks prior. unfortunately, he did not speak english. and hence, caring for him was difficult. so much of assessing our patients come from conversation. an interpreter appeared every morning at 10 am - which was great and helpful. but inevitably, at 10:31, after the interpreter left, i would discover one more thing i needed help translating. can you imagine not fully understanding what was happening to you in a hospital? transplant is one of the most complicated medical phenomenons and this poor gentleman couldn't ask questions whenever he pleased, simply because of a language barrier. anyway, my joy came when, on my second day of caring for this man, i used a phone interpreter for the first time. within 1 or 2 minutes and the touch of a few buttons, i was able to get a bulgarian interpreter on speaker phone. my patient and i could talk whenever we wanted now. we could talk about intractible nausea and persistent diarrhea or we could talk about the weather. the ease and freedom that this phone brought to my patient and his wife was indescribable. after having a long translated conversation, i hung up and was cheered and celebrated as if i was a celebrity. my patient held my hand in the air, like a boxing champ. his wife said, "nurse christa good." we all had tears in our eyes. it was a strangely special moment - to give someone a voice. after three weeks in the hospital, i think my patient finally felt heard.
another funny experience... i had the opportunity to care for a sweet, sweet 29 year old female on our floor. she wasn't the warm and fuzzy kind of sweet. she was the rough and tough, shaved her chemo hair into a mohawk, kind of sweet. her cousins sat at her bedside playing wi-bowling, eating chips and salsa. it was almost a party in her room. but one day, she was alone and sullen. we talked, girl to girl, 29 to 30 year old, heart to heart. i acknowledged how unfair it is for someone our age to be sick, with CANCER. i asked some questions - how long has she had the C word, how was she diagnosed. and she relayed the story. she had gone to her gynecologist with what she thought was herpes. after many tests, all of which came back negative for for HSV, she discovered she had AML (leukemia) instead. her joke was, "i think i'm glad i have leukemia - at least there's a cure." true enough. transplant is a possible cure; herpes has none. let's hope her cure works!
the same gal, after i had cared for her for three days in a row, requested that i be her nurse every time that i worked. what an honor and compliment!
my first week back, i took care of an older bulgarian gentleman who had had a transplant 2 weeks prior. unfortunately, he did not speak english. and hence, caring for him was difficult. so much of assessing our patients come from conversation. an interpreter appeared every morning at 10 am - which was great and helpful. but inevitably, at 10:31, after the interpreter left, i would discover one more thing i needed help translating. can you imagine not fully understanding what was happening to you in a hospital? transplant is one of the most complicated medical phenomenons and this poor gentleman couldn't ask questions whenever he pleased, simply because of a language barrier. anyway, my joy came when, on my second day of caring for this man, i used a phone interpreter for the first time. within 1 or 2 minutes and the touch of a few buttons, i was able to get a bulgarian interpreter on speaker phone. my patient and i could talk whenever we wanted now. we could talk about intractible nausea and persistent diarrhea or we could talk about the weather. the ease and freedom that this phone brought to my patient and his wife was indescribable. after having a long translated conversation, i hung up and was cheered and celebrated as if i was a celebrity. my patient held my hand in the air, like a boxing champ. his wife said, "nurse christa good." we all had tears in our eyes. it was a strangely special moment - to give someone a voice. after three weeks in the hospital, i think my patient finally felt heard.
another funny experience... i had the opportunity to care for a sweet, sweet 29 year old female on our floor. she wasn't the warm and fuzzy kind of sweet. she was the rough and tough, shaved her chemo hair into a mohawk, kind of sweet. her cousins sat at her bedside playing wi-bowling, eating chips and salsa. it was almost a party in her room. but one day, she was alone and sullen. we talked, girl to girl, 29 to 30 year old, heart to heart. i acknowledged how unfair it is for someone our age to be sick, with CANCER. i asked some questions - how long has she had the C word, how was she diagnosed. and she relayed the story. she had gone to her gynecologist with what she thought was herpes. after many tests, all of which came back negative for for HSV, she discovered she had AML (leukemia) instead. her joke was, "i think i'm glad i have leukemia - at least there's a cure." true enough. transplant is a possible cure; herpes has none. let's hope her cure works!
the same gal, after i had cared for her for three days in a row, requested that i be her nurse every time that i worked. what an honor and compliment!
Thursday, September 16, 2010
final breaths
that patient that i mentioned a few days ago, the one with the fungal infection in his brain... well, i've been keeping tabs on him lately. i've not been his nurse, but i've visited, spoken with his wife, and caught up on his condition with his nurses. he seemed to be in the clear. he was doing remarkably well for how sick he had been and for having just had massively invasive brain surgery. his team of neurosurgeons and oncologists were optimistic for a full recovery.
today, i got to work and looked at the six intensive care beds on our unit. someone had been admitted overnight. his name was W - the same name as the above mentioned patient with whom i feel so connected. and there was a butterfly by his name - gasp! the butterfly is the symbol we use on a patient's door to signify that we have put them on comfort care (translation - that we have finally acknowledged the imminence of death, and instead of fighting it with all of our artillery, are welcoming it with open arms). what had happened?
W had become unresponsive last night. a ct scan of his brain showed an enormous head bleed. death was inevitable. with grace and bravery, his family accepted the news and continues to wait at his bedside.
this job is so hard. i so badly wanted to go into W's room, to console his family, to say goodbye and make peace within my own heart. but at the same time, i didn't want to walk in their at all. what do you say to a wife who is losing her husband? to children, close to my age, who are losing their dad? i almost had to force myself into the room... but i am so glad that i visited. when i went in to offer my support, W's wife, son, and daughter were all laying their heads in W's bed; they were holding his hands, loving him, and nurturing him as he takes his final breaths. it is a beautiful scene. one family. together. for one final time.
i say it is beautiful only because it is not mine. i am so sad for W.
today, i got to work and looked at the six intensive care beds on our unit. someone had been admitted overnight. his name was W - the same name as the above mentioned patient with whom i feel so connected. and there was a butterfly by his name - gasp! the butterfly is the symbol we use on a patient's door to signify that we have put them on comfort care (translation - that we have finally acknowledged the imminence of death, and instead of fighting it with all of our artillery, are welcoming it with open arms). what had happened?
W had become unresponsive last night. a ct scan of his brain showed an enormous head bleed. death was inevitable. with grace and bravery, his family accepted the news and continues to wait at his bedside.
this job is so hard. i so badly wanted to go into W's room, to console his family, to say goodbye and make peace within my own heart. but at the same time, i didn't want to walk in their at all. what do you say to a wife who is losing her husband? to children, close to my age, who are losing their dad? i almost had to force myself into the room... but i am so glad that i visited. when i went in to offer my support, W's wife, son, and daughter were all laying their heads in W's bed; they were holding his hands, loving him, and nurturing him as he takes his final breaths. it is a beautiful scene. one family. together. for one final time.
i say it is beautiful only because it is not mine. i am so sad for W.
Tuesday, September 14, 2010
FYI
both my patients are 27 today. that's too young to be in the hospital, too young to be sick, and definitely too young to have cancer.
Saturday, September 11, 2010
hope vs no hope
yesterday there was a glimmer of hope in my day. a patient that i had taken care of a month or so ago had been re-admitted with a horrible fungal infection located deep within his brain. he needed a massively invasive surgery to remove the infection and pieces of decayed brain matter. this is not the good news. the bright side came when i walked into the patient's room and met his 20 year old son. he was kind and talkative; he introduced himself to me and thanked our hospital and staff for taking such good care of his dad and for supporting his mom. then, he proceeded to place smiley face stickers all over his dad's gauzy bandaged head.
sadly, today there was no hope. on a telemetry monitor located above the computer at which i was charting, i watched a 36 year old man's heart rate go from a very sick and rapid rate of 150 to zero. and i listened to his laotian wife wail ghastly cries in the hallway. as comfortable as i feel with death, it never feels normal to watch someone slip away... or to hear someone's shrieking anguish and pain.
sadly, today there was no hope. on a telemetry monitor located above the computer at which i was charting, i watched a 36 year old man's heart rate go from a very sick and rapid rate of 150 to zero. and i listened to his laotian wife wail ghastly cries in the hallway. as comfortable as i feel with death, it never feels normal to watch someone slip away... or to hear someone's shrieking anguish and pain.
Friday, September 3, 2010
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!
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!
Sunday, July 25, 2010
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.
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.
Tuesday, July 20, 2010
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..." ***
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..." ***
Tuesday, June 29, 2010
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.
Monday, June 21, 2010
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).
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).
Friday, June 11, 2010
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.
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.
Monday, June 7, 2010
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!
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!
Sunday, May 30, 2010
stairs
at 6:45 AM, when i typically get to work, i have to FORCE myself to take the stairs from the 3rd floor to the 8th floor. honestly, the elevator takes longer. but the stairs are such an effort that early in the morning (and i typically arrive on my unit hot and out of breath). the elevator is pure convenience and utter laziness.
this morning though, i took the stairs - no problem. you should know, i am already sore beyond belief. i have been working out with a local crossfit gym in preparation for my mount rainier climb. but i decided, if i am about to summit a 14,411 foot mountain, a few sets of stairs really shouldn't scare me. so, despite the lactic acid in my muscles, i did EXTRA sets of stairs throughout the day.
from the 1st floor to the 8th floor - what we will call a complete set - is 140 steps. the stairwell is small, narrow, cement, and ugly; there are no windows and no respite from the stale hospital air circulating on the rest of the unit. but today, during my 12.5 hour shift, i did 7 full sets... that's 980 stairs (not including the semi-set (from 3rd to 8th) i completed at 6:45 to get myself up here. and not including the last full set i should go do right now).
see, sometimes nursing isn't really nursing at all. today was a nice, easy holiday weekend day. i'm making extra money AND training to summit a mountain (the mountain that i could not see from the 8th floor "penthouse" because of horribly cloudy, icky, seattle weather).
this morning though, i took the stairs - no problem. you should know, i am already sore beyond belief. i have been working out with a local crossfit gym in preparation for my mount rainier climb. but i decided, if i am about to summit a 14,411 foot mountain, a few sets of stairs really shouldn't scare me. so, despite the lactic acid in my muscles, i did EXTRA sets of stairs throughout the day.
from the 1st floor to the 8th floor - what we will call a complete set - is 140 steps. the stairwell is small, narrow, cement, and ugly; there are no windows and no respite from the stale hospital air circulating on the rest of the unit. but today, during my 12.5 hour shift, i did 7 full sets... that's 980 stairs (not including the semi-set (from 3rd to 8th) i completed at 6:45 to get myself up here. and not including the last full set i should go do right now).
see, sometimes nursing isn't really nursing at all. today was a nice, easy holiday weekend day. i'm making extra money AND training to summit a mountain (the mountain that i could not see from the 8th floor "penthouse" because of horribly cloudy, icky, seattle weather).
Wednesday, May 19, 2010
professional opinion
sometimes the hardest part of my day is not nursing related! today i had quite the funny predicament. it might be one of those incidences that only seems funny to the people involved. but i laughed pretty hard.
my patient asked me to heat up his microwaveable chicken pot pie. i asked, "are there any special instructions? or is it pretty self-explanatory?" the patient's wife, also an ICU nurse, replied with "if yesterday's nurse figured it out, you should have NO problem!" i implied that as both a criticism of yesterday's nurse and a compliment to my mad skills!
so, i grabbed the pot pie - marie calendars - and read the instructions. not as easy as the regular TV dinner, which unfortunately i am pretty adept at preparing! you have to cook the pot pie in the box with this special pad on top to crisp up the crust. cook on high for 6 minutes, rotate one quarter, and cook on medium for 7-8 minutes more!?! really, 13 minutes for a TV dinner? i got confused. was i reading the directions correctly? after the patient's wife's comment, i really didn't want to screw this up!
in nursing, we are always taught to ask questions, to ask for help. so, i asked a colleague of mine for his "professional opinion." i chose to ask this specific RN because his lunch typically consists of pot pies, corn dogs, and taquitos. in fact, i think today is the first time i saw him eat an apple! my friend offered me a seat, ready to discuss some serious nursing dilemma. and instead, i asked for assistance with the pot pie! his response - a punch in my arm! but what followed was quite a crack up. i got three nurses to surround the microwave, poking and prodding, guesstimating how many more minutes, seriously discussing the nuking instructions of a pot pie. it made me laugh. most of the time, we gather to discuss sad scenarios, to debate whether someone should be a do not resuscitate or what nausea medication would work best for projectile chemotherapy induced vomiting. today, we huddled over a chicken pot pie!
13 minutes later, i returned to the patient's room, chicken pot pie in hand. and i had to laugh! yesterday's nurse is smarter than she appeared, if she made the chicken pot pie without difficulty!
my patient asked me to heat up his microwaveable chicken pot pie. i asked, "are there any special instructions? or is it pretty self-explanatory?" the patient's wife, also an ICU nurse, replied with "if yesterday's nurse figured it out, you should have NO problem!" i implied that as both a criticism of yesterday's nurse and a compliment to my mad skills!
so, i grabbed the pot pie - marie calendars - and read the instructions. not as easy as the regular TV dinner, which unfortunately i am pretty adept at preparing! you have to cook the pot pie in the box with this special pad on top to crisp up the crust. cook on high for 6 minutes, rotate one quarter, and cook on medium for 7-8 minutes more!?! really, 13 minutes for a TV dinner? i got confused. was i reading the directions correctly? after the patient's wife's comment, i really didn't want to screw this up!
in nursing, we are always taught to ask questions, to ask for help. so, i asked a colleague of mine for his "professional opinion." i chose to ask this specific RN because his lunch typically consists of pot pies, corn dogs, and taquitos. in fact, i think today is the first time i saw him eat an apple! my friend offered me a seat, ready to discuss some serious nursing dilemma. and instead, i asked for assistance with the pot pie! his response - a punch in my arm! but what followed was quite a crack up. i got three nurses to surround the microwave, poking and prodding, guesstimating how many more minutes, seriously discussing the nuking instructions of a pot pie. it made me laugh. most of the time, we gather to discuss sad scenarios, to debate whether someone should be a do not resuscitate or what nausea medication would work best for projectile chemotherapy induced vomiting. today, we huddled over a chicken pot pie!
13 minutes later, i returned to the patient's room, chicken pot pie in hand. and i had to laugh! yesterday's nurse is smarter than she appeared, if she made the chicken pot pie without difficulty!
Saturday, May 15, 2010
part 4: refreshing day!
i woke up with swollen, puffy eyes today. i wonder if lasix (often known as the water pill) would have reduced the swelling? anyway, i had to force myself to go to work today. it was one of those days, the kind you really want to call in sick. but i went. and the best part... it was only an eight hour shift! here's what the day entailed:
- i infused more hope today! i gave a woman her second day of stem cells. three bags yesterday, three bags today (and she'll get two more tomorrow).
- my friends and i were able to take time to enjoy one anothers' company at work. we reminisced a bit about C, found his photos of facebook (from when he was healthy), and laughed together instead of cried.
- i left work at 3:30!
- i sat at starbucks and planned which seattle international film festival movies i can attend in the coming weeks. i wrote in my tangible journal. and i texted a few friends.
- i went on a 6+ mile run in the warm, late afternoon. it was a new route for me, all the way from my house to eastlake and back. got back and felt good!
- my mom and i went shopping to get a gift or two for my niece, emerson's, first birthday party tomorrow!
- i watched gray's anatomy! gotta keep up with the fake hospital drama. i deal with the real drama enough! wish there was a mcdreamy/steamy to drool over at my workplace.
i LOVE eight hour shifts. i feel human at the end of the day because there was more to my wakefulness than simply work.
- i infused more hope today! i gave a woman her second day of stem cells. three bags yesterday, three bags today (and she'll get two more tomorrow).
- my friends and i were able to take time to enjoy one anothers' company at work. we reminisced a bit about C, found his photos of facebook (from when he was healthy), and laughed together instead of cried.
- i left work at 3:30!
- i sat at starbucks and planned which seattle international film festival movies i can attend in the coming weeks. i wrote in my tangible journal. and i texted a few friends.
- i went on a 6+ mile run in the warm, late afternoon. it was a new route for me, all the way from my house to eastlake and back. got back and felt good!
- my mom and i went shopping to get a gift or two for my niece, emerson's, first birthday party tomorrow!
- i watched gray's anatomy! gotta keep up with the fake hospital drama. i deal with the real drama enough! wish there was a mcdreamy/steamy to drool over at my workplace.
i LOVE eight hour shifts. i feel human at the end of the day because there was more to my wakefulness than simply work.
Friday, May 14, 2010
part 3: sad and lonely
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.
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.
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!
Monday, March 8, 2010
so tired...
nursing can be exhausting! then again, the hours are a bit ridiculous! i was scheduled to work 3 12 hour shifts in a row - saturday, sunday, and monday (which is ENOUGH). however, because we were short staffed on sunday evening, i stayed for 16.5 hours. i got home at 11:35 PM and returned to work this morning at 6:45 AM! ugh. the money is nice; i can't complain. but keeping my eyelids open right now is a real challenge. the best thing about my day... i got a compliment from my patient. after a long bronchoscopy, several conversations with pulmonologists about fungal infections and poor prognosis, coughing up blood and requiring oxygen, my patient said, "you are a very dedicated professional - thank you." i'll take that - and on only 5 hours of sleep! not bad.
Friday, February 19, 2010
mistakes happen
nobody is perfect; everyone makes mistakes. but obviously, some mistakes are more serious than others.
a secretary dials a wrong phone number - no big deal. a bus driver takes a wrong turn - oops, some people are a few minutes late. a barista uses whole milk instead of non-fat - oh well, a customer gets a rich treat!
but when an airline pilot falls asleep - hundreds of people are in danger. when a surgeon mistakes her left from her right - a person ends up losing the wrong limb.
unfortunately, nurses are always the last check when administering medications. it's a huge responsibility. a doctor prescribes a drug. a technician enters it into a computer system. a pharmacist mixes the med. there's room for all sorts of error. but in the end, it's the nurse who delivers the medication and is responsible for the famous five rights:
right patient
right medication
right dose
right time
right route
last night, i caught an error. it could have been hugely serious. a dose of immunoglobulin was ordered for a patient: 60 grams of IVIG diluted in 2 liters of normal saline. the doctor prescribed the right medication and the correct dose. the tech entered the information into the computer. the pharmacist mixed the right medication with some normal saline and filled a 2L bag. and finally, a sticker was printed with all of the correct info.
as the nurse, i received the medication, did my checks, and began infusing it into my sweet patient's central line. it's a serious medication, prescribed for a very serious illness. the medication costs several thousand dollars and is known to cause severe reactions. extra monitoring is required. the medication is started VERY slow and increased cautiously.
after 1 hour and only 62 of the 2000 mL were infused, i noticed something strange. the infusion pump notified me that 1938mL remained; but when i scanned the bag for verification, i noticed the bag did not contain 2L of fluid. i double checked the pump. had i infused the drug too fast? was there a leak? no, no. so, i called pharmacy. they insisted that there was a triple check; they could not have made a mistake. so i asked another RN to assess the bag. perhaps i was crazy and just missing something; perhaps the error was mine.
but then my phone rang; the pharmacist fessed up - there had been a mistake. instead of diluting the medication in 2L, they diluted the medication in 1L and placed it in a 2L bag. my patient had been receiving twice the concentration of the medication. and although the error was made by pharmacy, technically, the error is my fault. i should have noticed the volume; i should have called pharmacy before starting the medication. should my patient have had a serious reaction, it would have been my fault.
when nurses make mistakes, patients can die.
mistakes happen. thankfully this one ended okay.
my patient is safe...
for the time being.
a secretary dials a wrong phone number - no big deal. a bus driver takes a wrong turn - oops, some people are a few minutes late. a barista uses whole milk instead of non-fat - oh well, a customer gets a rich treat!
but when an airline pilot falls asleep - hundreds of people are in danger. when a surgeon mistakes her left from her right - a person ends up losing the wrong limb.
unfortunately, nurses are always the last check when administering medications. it's a huge responsibility. a doctor prescribes a drug. a technician enters it into a computer system. a pharmacist mixes the med. there's room for all sorts of error. but in the end, it's the nurse who delivers the medication and is responsible for the famous five rights:
right patient
right medication
right dose
right time
right route
last night, i caught an error. it could have been hugely serious. a dose of immunoglobulin was ordered for a patient: 60 grams of IVIG diluted in 2 liters of normal saline. the doctor prescribed the right medication and the correct dose. the tech entered the information into the computer. the pharmacist mixed the right medication with some normal saline and filled a 2L bag. and finally, a sticker was printed with all of the correct info.
as the nurse, i received the medication, did my checks, and began infusing it into my sweet patient's central line. it's a serious medication, prescribed for a very serious illness. the medication costs several thousand dollars and is known to cause severe reactions. extra monitoring is required. the medication is started VERY slow and increased cautiously.
after 1 hour and only 62 of the 2000 mL were infused, i noticed something strange. the infusion pump notified me that 1938mL remained; but when i scanned the bag for verification, i noticed the bag did not contain 2L of fluid. i double checked the pump. had i infused the drug too fast? was there a leak? no, no. so, i called pharmacy. they insisted that there was a triple check; they could not have made a mistake. so i asked another RN to assess the bag. perhaps i was crazy and just missing something; perhaps the error was mine.
but then my phone rang; the pharmacist fessed up - there had been a mistake. instead of diluting the medication in 2L, they diluted the medication in 1L and placed it in a 2L bag. my patient had been receiving twice the concentration of the medication. and although the error was made by pharmacy, technically, the error is my fault. i should have noticed the volume; i should have called pharmacy before starting the medication. should my patient have had a serious reaction, it would have been my fault.
when nurses make mistakes, patients can die.
mistakes happen. thankfully this one ended okay.
my patient is safe...
for the time being.
Wednesday, February 3, 2010
broken heart
sometimes my patients break my heart.
because of my fantastic nursing care (!?!!), i have been requested by a patient's daughter to take care of her mom most of the days that i work. as great of an honor as that is, it can also be very challenging. you get to know your patient and their family well; the walls that you build up to prevent heart-ache and sadness start to crumble. and eventually, when the prognosis is bad and the patient miserable, you start to feel depressed and overwhelmed by the reality of your patient's life.
my 63 year old patient (the same one who had the seizure not too long ago and has been hospitalized for months) is having excruciating abdominal pain. i sent her down for a CT scan of her abdomen to assess her pain crisis and unfortunately, we created another one. the contrast that was injected into her IV extravasated (that's a big word for "leaked out of her veins"); she now has been visited by a plastic surgeon, as the contrast can cause serious damage to the surrounding tissue in her arm.
my patient just feels uncomfortable. she is sick of being in the hospital, sick of being in pain. as i watched her grimace and listened to her moans, she said to me, "i just want to cry." i replied with, "that would be okay marcia." then she said, "it's silly, but i just want my mom." marica is 63 years old. her mom is not here - not in the hospital, not on earth.
we always want what we can't have. and today, it's breaking my heart.
sometimes i want my mom and i am blessed to have her.
because of my fantastic nursing care (!?!!), i have been requested by a patient's daughter to take care of her mom most of the days that i work. as great of an honor as that is, it can also be very challenging. you get to know your patient and their family well; the walls that you build up to prevent heart-ache and sadness start to crumble. and eventually, when the prognosis is bad and the patient miserable, you start to feel depressed and overwhelmed by the reality of your patient's life.
my 63 year old patient (the same one who had the seizure not too long ago and has been hospitalized for months) is having excruciating abdominal pain. i sent her down for a CT scan of her abdomen to assess her pain crisis and unfortunately, we created another one. the contrast that was injected into her IV extravasated (that's a big word for "leaked out of her veins"); she now has been visited by a plastic surgeon, as the contrast can cause serious damage to the surrounding tissue in her arm.
my patient just feels uncomfortable. she is sick of being in the hospital, sick of being in pain. as i watched her grimace and listened to her moans, she said to me, "i just want to cry." i replied with, "that would be okay marcia." then she said, "it's silly, but i just want my mom." marica is 63 years old. her mom is not here - not in the hospital, not on earth.
we always want what we can't have. and today, it's breaking my heart.
sometimes i want my mom and i am blessed to have her.
Thursday, January 21, 2010
healthcare dilemmas
like the title of this blog states, nursing involves some of the strangest tasks and interesting predicaments. i just spent 90 minutes in a patient room with a gown, gloves, and mask on; i'm hot, sticky, and sick of smelling my own breath and recycling stale air. but that's not why i am writing. i am simply writing to say, health care is strange in general - not just nursing. are you familiar with HIPPA; it's a healthcare privacy act. so i'm probably breaking major rules. but we just admitted a prisoner to our unit for a stem cell transplant. interesting, huh? he has to wear his orange jumpsuit. and he has an armed guard with him at all times. honestly, i'm not sure how i feel about this... but just think to yourself, who is paying for this gentleman's care? our tax dollars are buying his chemotherapy, his stem cells, and a second chance at life (which typically results in a one million dollar bill). he may have simply gotten three speeding tickets (washington's three strikes and you're out law), but he could also have raped and/or killed people innocent people? hospitals are full of ethical dilemmas. what to do, what to do!
Saturday, January 16, 2010
nursing gods
the nursing gods were good to me today. it's rare, but when it happens - what a gift! i was out late last night (reason not to be shared!) and felt exhausted when i woke up at 5:33. but, like the good girl that i am, i dragged myself to work. and although i had one total care patient, my other patient was incredibly sweet and self-sufficient! i had the opportunity to chat with my favorite PSS (patient service something/secretary) and share recipes. i folded some cranes. and i just plain enjoyed the nurses with whom i work. the day got even better when at 13:00, i won the coin toss that allowed me to go home at 15:30. woo hoo!!!
twelve hour shifts are SO long. and often times, SO hard. i always realize that when i have the opportunity to work a short day and see all of the other things i accomplish. i visited a friend i hadn't seen in a while. i ran 4.5 miles. and i even ate a relaxing dinner. currently, i am doing laundry and texting folks on the phone. might not sound like an ideal night, but it sure felt great. like i said, the nursing gods were on my side today. lord help me tomorrow!
twelve hour shifts are SO long. and often times, SO hard. i always realize that when i have the opportunity to work a short day and see all of the other things i accomplish. i visited a friend i hadn't seen in a while. i ran 4.5 miles. and i even ate a relaxing dinner. currently, i am doing laundry and texting folks on the phone. might not sound like an ideal night, but it sure felt great. like i said, the nursing gods were on my side today. lord help me tomorrow!
Tuesday, January 12, 2010
little birds
i know today is not over, so anything is possible. but for now, i feel thankful for an easy day. the morning has been spent folding paper cranes! let me explain...
last year, i had a hard year personally and professionally. i was feeling extremely burnt out and disillusioned by cancer, chemotherapy, and stem cell transplants. so, to start out the new year right, and to encourage a more positive outlook on our unit, i decided to fold 1000 paper cranes while at work as a symbol of hope for our patients. ever read the children's books, "sadako and the thousand paper cranes?" well, it explains the significance of paper cranes and is a beautiful story about post-hiroshima japan and the aftermath of the atomic bomb.
anyway, i have inspired nurses and secretaries alike to use their free time (or to make free time) to fold little colorful birds. in less than two weeks, we have more than 300 of the little fellows. and soon, our unit will be more colorful and more hope-filled. it's strange, but there is something very cathartic about making things with your hands. and so, i find the activity a nice relief from nursing.
every now and then my manager walks by and stares at the group of us nurses who have collected to do artwork and i just smile. if i ever get fired for inspiring hope and unity on our unit, i'll just laugh and fly away with the birds!
last year, i had a hard year personally and professionally. i was feeling extremely burnt out and disillusioned by cancer, chemotherapy, and stem cell transplants. so, to start out the new year right, and to encourage a more positive outlook on our unit, i decided to fold 1000 paper cranes while at work as a symbol of hope for our patients. ever read the children's books, "sadako and the thousand paper cranes?" well, it explains the significance of paper cranes and is a beautiful story about post-hiroshima japan and the aftermath of the atomic bomb.
anyway, i have inspired nurses and secretaries alike to use their free time (or to make free time) to fold little colorful birds. in less than two weeks, we have more than 300 of the little fellows. and soon, our unit will be more colorful and more hope-filled. it's strange, but there is something very cathartic about making things with your hands. and so, i find the activity a nice relief from nursing.
every now and then my manager walks by and stares at the group of us nurses who have collected to do artwork and i just smile. if i ever get fired for inspiring hope and unity on our unit, i'll just laugh and fly away with the birds!
Wednesday, January 6, 2010
CODE 199
why do they call it that? when "code blue, code 199" is frantically called on the overhead pager throughout the hospital, isn't it pretty obvious that someone is dying? silly numbers don't really sugar coat the message.
my patient had a seizure this morning at about 7:55. i hadn't even been in to see her yet. poor thing. i know her well. she has been in the hospital for at least two months. she got a stem cell transplant, but is now currently suffering from GVHD (graft versus host disease). the cells we transplanted into her body to cure her cancer are now attacking her GI tract (causing copious amounts of diarrhea and an inability to absorb medications and nutrients from food). she's miserable and grouchy and eager to get the hell out of here. and now she had a seizure... and we don't know why. sort of threw off my plans for the day. and hers.
i'm such a planner. i like organization and to follow a schedule. i make myself a list of all my tasks for the day and check them off as they are accomplished. i write down all of my medications for the entire day (often totally more than 30 meds in a shift). and something like a seizure really ruins the plan! there were blood gases drawn. stat portable chest xrays. a stat CT. incontinence of bowels and bladder. emergency platelets to hang. family members to keep calm. labs to be drawn. foley catheters to be inserted. none of these were on my list!
i'm nearing the end of my shift. my patient and i are tired. i get to go home. she doesn't.
my patient had a seizure this morning at about 7:55. i hadn't even been in to see her yet. poor thing. i know her well. she has been in the hospital for at least two months. she got a stem cell transplant, but is now currently suffering from GVHD (graft versus host disease). the cells we transplanted into her body to cure her cancer are now attacking her GI tract (causing copious amounts of diarrhea and an inability to absorb medications and nutrients from food). she's miserable and grouchy and eager to get the hell out of here. and now she had a seizure... and we don't know why. sort of threw off my plans for the day. and hers.
i'm such a planner. i like organization and to follow a schedule. i make myself a list of all my tasks for the day and check them off as they are accomplished. i write down all of my medications for the entire day (often totally more than 30 meds in a shift). and something like a seizure really ruins the plan! there were blood gases drawn. stat portable chest xrays. a stat CT. incontinence of bowels and bladder. emergency platelets to hang. family members to keep calm. labs to be drawn. foley catheters to be inserted. none of these were on my list!
i'm nearing the end of my shift. my patient and i are tired. i get to go home. she doesn't.
Sunday, January 3, 2010
death stinks
on new year's eve day, i got to work at 0645, like usual. at 0700, i sat through report, preparing for my day, barely listening to the ramblings of the night charge nurse recapping the previous 12 hours. but when i hear, "room 8232 expired at 0432," for some reason, i start to listen. as often as deaths occur on my unit, i continue to be saddened and the tiniest bit surprised. i often think to myself, "what a strange job. how many other folks can expect to witness and participate in death on a daily basis." well, i do. it's the reality of working as a nurse on an oncology unit. i am not assigned to room 8232; i do not know the woman who died. i never knew her and never will - or so i think.
my friend, courtney, is assigned to the woman's post-mortum care. and so, i become involved. hours after i've begun to care for my live patients, courtney asks for my assistance with her dead one; it's nearly lunch time. the family of the woman who has expired (what kind of word is that anyway) asked courtney to put in the 83 year old's dentures. so, we go in together. we kindly ask the family to leave the room. and then, we struggle to put stinky dentures into a dead, starting to stink mouth. death is not pretty. it does not smell good. rigor mortis has set in. the woman's jaw has drooped to the left. her tongue protrudes. how awkward. we have rubber gloves on. one of us is pulling down her jaw. the other is shoving uppers and lowers, trying to get them to click in place. i envision improper placement and teeth flying out as the family returns. after a tongue blade and some major force, we get them in. phew. job well done. time for lunch.
my friend, courtney, is assigned to the woman's post-mortum care. and so, i become involved. hours after i've begun to care for my live patients, courtney asks for my assistance with her dead one; it's nearly lunch time. the family of the woman who has expired (what kind of word is that anyway) asked courtney to put in the 83 year old's dentures. so, we go in together. we kindly ask the family to leave the room. and then, we struggle to put stinky dentures into a dead, starting to stink mouth. death is not pretty. it does not smell good. rigor mortis has set in. the woman's jaw has drooped to the left. her tongue protrudes. how awkward. we have rubber gloves on. one of us is pulling down her jaw. the other is shoving uppers and lowers, trying to get them to click in place. i envision improper placement and teeth flying out as the family returns. after a tongue blade and some major force, we get them in. phew. job well done. time for lunch.
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