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).

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!

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.

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.

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.

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.

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...