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.
Thursday, September 16, 2010
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!
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