miracle of the year

i had the privilege of witnessing a miracle at work yesterday.

in case you haven't noticed, i'm sort of pessimistic. as an oncology nurse, i have acquired a dark sense of humor. you've maybe heard me say, "everyone dies." cuz i feel that way sometimes. i call myself "negative nelly."

but yesterday, i was proven wrong. i witnessed a miracle. and then and only then, i LOVE being wrong.

mr. m left my unit after more than 6 months of hospital stay. in fact, i admitted him. i don't even remember when it was. but some horrible tragedy had befallen his family. his wife had been attacked and because she was his caregiver, while she was in the hospital recovering, mr. m stopped caring for himself and stopped taking his transplant medications. because of this, he developed a VERY serious case of graft versus host disease. which prompted high doses of steroids. which made him susceptible to all sorts of infections. and infections he got. by the dozen. he must have been intubated 2 or 3 times. he had surgery on his leg because it was thought that he had necrotizing fasciaitis (an often lethal infection). he ended up getting FIVE pressure ulcers on his coccyx. he lost almost all of his independence. the only thing he could really do for himself was keep fighting. through months and months of rehab and recovery.

i must have thought, over and over, "he's a goner." in fact, i know i said it. we all did on my unit. NOBODY can overcome ALL OF THAT.

but he did. as mr. m wheeled himself out of our unit last night, i ran behind him to say a final goodbye. i got all choked up and had tears in my eyes. the other nurses i was working with yesterday were ALL new. they had been on 8NE less time than the patient. so, by myself, i stood at the elevator and clapped. i told mr. m that he deserved a standing ovation and a round of applause. never before have i been so impressed with somebody's will and determination, with his stamina and strength.

mr. m gets the miracle of the year award. here's to hoping that 2012 has a miracle or two as well!

poop

last week was shitty - literally. i got poop on my bare arm. only one time that i know of. but i might as well have bathed in shit. one day, in less than 20 minutes, i cleaned up the same patient three times. i worked four days out of five days last week and each day, i had the poopy patient. by the fourth day, i wanted to shoot myself. or her. not once did she thank me...

this week was quite the opposite. neither of my patients pooped (yeah for constipation)! and i was thanked a thousand times for cleaning bathrooms (just emptying urine), delivering buckets of ice, giving shots, and teaching side effects of chemo. when i left last night and said goodbye to my patient, she said, "you've been such a peach!"

i like constipated, kind patients. please let only these folks get cancer...

what are you thankful for?

*** i started this on thanksgiving and just now finished it. a month later, i'm still thankful for all these things. ***

because of nursing, i face some of life's ugly realities on a daily basis. and thanks to nursing, i sometimes have ah-ha moments when i stop, smell the roses, and remember to be thankful for the simple things in life. recently, i've seen some top 100 lists of people, places, things, and feelings for which people are thankful. and it has inspired me to do the same. here is my top 100 in no particular order.

1. family.
2. living in seattle - one of the most beautiful cities in the world.
3. traveling to reykjavik, paris, amsterdam, and prague in 2011.
4. tall 3 pump sugar-free vanilla non-fat extra-hot lattes (ridiculous, i know).
5. my laptop.
6. pho on a cold, wet, windy day.
7. short runs to clear my head.
8. dvr.
9. chemotherapy.
10. ativan (my patients' favorite drug).
11. clean water and hot showers.
12. living near molly moon's, bluebird, and cupcake royale.
13. walks around greenlake with friends.
14. my aunt joanie.
15. corduroy pants - my new wardrobe staple.
16. christmas! and having it off of work this year.
17. crisp new sheets on the bed.
18. pajama pants and fleece socks.
19. danskos (all five pairs).
20. the smell of banana bread.
21. the summit of rainier.
22. the colors of fall leaves.
23. my niece and nephew - emerson and cohen.
24. painted toenails.
25. my microwave.
26. having a zaw pizza in my building.
27. pinterest - keeps me entertained many a evening.
28. santa pictures on christmas eve.
29. 3 for 30 month.
30. bright colored tank tops.
31. friends that show up when you need them.
32. flip-flops.
33. my new camera.
34. diverging viewpoints that make me question my own thinking.
35. my dad's team of doctors.
36. memories of my granny.
37. family traditions.
38. nursing.
39. hot soup with pretzel rolls from alpenland.
40. adventure.
41. york peppermint patties.
42. my education.
43. my glasses.
44. a good night's sleep.
45. my planner.
46. mechanical pencils.
47. overtime shifts.
48. argyle socks.
49. croissants in paris.
50. scarves to bundle up in the cold.
51. curly bacon.
52. our gingerbread house tradition and ginormous bowls of candy.
53. mid-day naps.
54. morning star sausage patties - quickest breakfast ever.
55. bright colors.
56. having the privilege to get to know family members of my patients.
57. my lucky 13 necklace, given to my grandma from my grandpa the day after they met.
58. hot yoga.
59. camp parkview on vashon island.
60. honeycrisp apples.
61. good hiking boots.
62. having a friend who is good at fixing computers and teaches me new tricks on my laptop.
63. rei.
64. having amazing colleagues at work that have turned into friends.
65. felt christmas ornaments.
66. coupons (i'm a bargain shopper).
67. newborn babies, their smell, and the smiles they cause on everyone's faces and in everyone's hearts.
68. goretex.
69. having the insight to recognize my privilege.
70. flushing toilets and toilet paper (not always available when hiking and traveling).
71. homemade trailmix.
72. the smell of rain.
73. chaotic family dinners.
74. therapy.
75. the twinkle of christmas lights.
76. fresh sticky and drippy washington peaches by the crate-full.
77. stolen hospital scrubs.
78. massages.
79. listening to music while working out and feeling totally free.
80. baking dozens of christmas cookies.
81. tears - a good cry is very cathartic.
82. my ancient car that relatively reliably gets me where i need to go.
83. finding a good deal.
84. that my dad buys me a christmas tree every year.
85. the sound of laughter in our break room at work.
86. the magic of snow.
87. health insurance.
88. writing in a journal while away on vacation.
89. having crazy parents only miles away.
90. blog reading/stalking.
91. freedom.
92. seeing the sun rise over the cascades and set behind the olympics.
93. make believe people - ie. the toothfairy, the easter bunny, and santa.
94. peace and quiet.
95. INDIA.
96. farmers' markets with fresh produce and delicious treats.
97. my passport.
98. holiday cheer.
99. peanut butter.
100. my health!

as part of our thanksgiving day preparations, i asked my dear aunt joanie (who is developmentally disabled) what she is thankful for. her top three were: 1. christa (ME), 2. santa, and 3. jesus. when i asked my two year old niece for what she is thankful, she said "i'm thankful for the mall." here's to hoping that when she is my age, she recognizes some of life's more beautiful things and remembers to be thankful!

"i like you"

you know you're weird when you read obituaries like they're entertainment! my mom called me to read me this obituary (she's been reading obituaries since i can remember - i guess i get my weirdness from her). anyhoo, as she read it to me, i couldn't help but cry. wouldn't the world be a better place if we all acted a bit more like jeremy? what if you told someone that you liked them because you truly did or brought your neighbors' garbage cans in every week just because. maybe instead of listening to our ipods in silence, we should all sing outloud as we ride bikes and go on runs!

Jeremy John GILROY Jeremy John Gilroy, 37, died December 11, 2011, in Seattle. Jeremy lived loudly. The fiery redhead was born in Oswego,N.Y., to Jack and Helene Gilroy. He was joined two years later by sister Kristen. Jeremy spent most of his life in the Seattle area. He grew up in Issaquah, surrounded by loving friends and a nurturing community. He rode his bike for hours and hours every day, singing at the top of his lungs. He paid daily visits to many of his neighbors, and followed the garbage truck around Squak Mountain so he could put away the trash cans of everyone who lived in a 3-mile radius. He loved dogs and little kids, Matchbox cars, stickers and sidewalk chalk, and annual trips to Ocean Shores. Everyone who knew Jer well remembers his infectious laugh and has a great story about him. Jeremy was a graduate of Issaquah High School. He had several jobs, most recently at Auburn Volkswagen. He liked going to work and was never shy about making friends and saying whatever was on his mind (often it was "I like you"). He helped us live more compassionately and joyfully. Jeremy's family would like to thank those who helped him through his last year of life. In his memory, please consider a donation to Special Olympics (www.specialolympicswashington.org) or the Sibling Support Project (www.siblingsupport.org) at 6512 23rd Ave NW, Seattle, WA 98117. We'll gather to remember his life at 11 a.m. Jan. 7, St. Madeleine Sophie Church, 4000 130th Place S.E., Bellevue.

christmas lights

i bought a christmas tree yesterday with my dad. not because i really wanted a tree, but because i worry that one of these years it might be our last father-daughter christmas tree shopping adventure. and it's become our tradition. my dad pretends to be a scrooge. he pretends to hate christmas. but in reality, he puts up too many christmas lights on the house and buys me any tree i want. and we have fun. he makes a raucous in the lot and complains about the price; i act embarrassed and hide amidst rows of douglas firs - but in reality, i'm proud that my dad is mine and his craziness makes me laugh.

tonight i started to decorate my tree. i'm particular. sparkly white lights must be twirled around each branch. no segment may be left unlit. things were going artfully well when all of a sudden, i started to cry. i imagined my patient's wife decorating a christmas tree ALONE.

my 31 year old patient, one whom i have grown particularly fond of, passed away this morning at 3 AM. his family was at his bedside holding vigil - his wife, his parents, and several aunts and uncles were there. and supposedly it was peaceful and pain-free. but when i came in to work this morning, dale's body was gone. his hospital room was empty. his family had left the building. and i will never see him or them again. this might be one of the weirdest things about my job (and i do some pretty strange stuff) - to become an important part of someones life leading up to their death, to get to know an entire family unit, and all of sudden, just because one member stops breathing, my entire relationship with the family ends right then and there. i will never be a nurse to dale, nor will i ever have the opportunity to support his family who i have grown to love.

i will think of dale often; he was a memorable character. and because we are the exact same age, i can't help but feel a certain guilt and an extra sadness. but tonight, i thought of dale's sweet wife as i decorated my christmas tree with iridescent twinkle lights. tara had to leave the hospital this morning without her husband (her partner of more than 16 years) and tell her 4 year old son and her 6 year old daughter that their daddy is not coming home - that he got too sick and no band-aid could fix his boo-boo. dale's family will soon return on a flight to their hometown. and of course, it's christmas. so tara will have to put a smile on her face, maybe even decorate a christmas tree, and continue living life - for her kids. they need to celebrate christmas. they deserve the twinkle of christmas lights. and stockings full of treats. they need to believe. in something. and i hope they can.

fired

a nurse got fired form my unit yesterday... it's still hush, hush. i don't know all of the details. but it's crazy. we've had several errors lately with our pyxis machine (the locked machine that holds all of our medications and tracks who logs in and out via fingerprint) that have lead to an investigation. it's not like just one tablet was missing here and there (which is bad enough). the other day, there were four 20 mg tablets of oxycontin and eight 5mg tablets of oxycodone missing. good street drugs, in high demand, worth a pretty penny! but who is stupid enough to think they can get away with stealing SO many drugs? i guess someone who has a horrible addiction and loses sight of reality. desperate enough not to care if they get caught. i feel sad for this nurse. she is amazing at what she does. she's super involved in our unit, a skilled professional, and patient advocate. what a big loss.

ice cream cures

i had one of the worst shifts i have ever had on friday. there's almost too much to explain and i feel like i couldn't make it sound bad enough. but imagine this. at one point, it got so bad, my charge nurse put his arm around me, said he was sorry my day was sucking, and that i won the award for worst day. because of his small act of kindness, i broke into hysteric sobs at the nurses station and said something like, "i hate working here. everyone dies!"

my dear friend marian stood beside me, kind of unsure how to proceed. the charge nurse, a 6 foot 2 grizzly bear of a man, also asked what he could do to lighten my load. and i decided i needed three minutes to myself in the bathroom, to cry harder and/or compose myself. as i ran off the unit, i could hear the charge RN say to marian, "follow her." so, marian and i convened in the bathroom where i proceeded to cry a bit more (and chuckled about our pow-wow in the handicapped bathroom stall). and then i peed with marian standing nearby. i've cried at work before, but i've never peed in front of a colleague. work has hit an all time low.

on my drive home, i cried some more. i cried because my 31 year old patient was told he has two weeks to live. and i cried because this 31 year old was going home, ALONE, with no one to hug her or support her and tell her that she and the world were going to be okay.

by some strange twist of fate, my friend called me on my drive home. and when i answered, he immediately could tell i was distraught. he's heard me sob before; but i think i surprised him mid-misery, instead of forewarning him with some comment like, "i had a shitty day." instead, i snotted and sniffled into the cellphone. we talked for 30 minutes or so and when our conversation was coming to a close, i decided to invite him over. he too had had a bad day at work; he has deadlines and projects galore. and for someone who is almost never phased, he seemed stressed also - i thought ice cream might cure both our ails. and to my surprise and utter delight, he thanked me for the invite and said he was looking for parking in my neighborhood. what a dear friend! he knew exactly what i needed and jumped in the car even before my invitation. i needed to not be alone. i needed a split scoop of cinnamon and maple walnut ice cream. and i needed to watch an hour of bad tv with someone by my side.

i woke up on saturday AM with swollen and puffy eyes. but the ice cream and company had "cured" a small piece of my heart the night before. and i was able to get out of bed and carry on.

bathing

one of the reasons i love nursing is because i get to be a part of some of the most loving and intimate moments in peoples' lives. it's truly an honor to witness and, in some sense, be invited to participate in loving rituals and devastating goodbyes.

last week, i was called in to the ICU to help a fellow nurse clean up a patient. most folks think of nursing work as "dirty work," and it can be. but really, sometimes the "dirty" stuff leads to the most beautiful moments. the 32 year old patient, whom i had cared for weeks prior when she was very ill but not yet required ventilator assistance to breathe, needed a small bath and turn. her non-english speaking mother helped us with the bathing. in all honesty, she "dictated" what be done and how without uttering a single word. she cleaned her daughter's body as if it was the most important job in the world - every nook and cranny was washed, rinsed, and lotioned. i stood there, with two other nurses, in awe of this mother's love for her "baby."

another young woman was in the room. she sat in the corner and cried. i asked her if she was a friend of the patient and she said "no, i have never met the patient or the mother. but i am from the same country and from the same church." she came simply to show her support and in turn, ended up serving as a translator. and with me, had the opportunity to witness a very special bath - one of my patient's last. i told her to tell the patient's mother something for me - "should i ever get sick, i would like for olga to care for me." it was my way of giving her a compliment, my way of saying to olga that she was doing her best, that her love was enough (not to cure her daughter, but to envelop her daughter with love and compassion as she lay dying).

the patient died yesterday morning. and although i was not there, i know the patient was embraced by her mother's love. and for having been just a tiny part of their last moments together, i am thankful.

"i'm leaving. i don't care what you say. i hate it here."

i took care of that 22 year old gal yesterday, the one i mentioned last week, with a premie in the NICU in spokane. poor thing. i think she was a bit immature to start with, but then this series of disasters has seemed to set her back a bit. taking care of her is a lot like trying to rationalize with a 5 year old. it's impossible!

she is on the mend; her body has responded to the transplant in the way we hoped. her immune system has started to come back. BUT... she is still extremely vulnerable to infection. she is still on IV antibiotics, not to mention IV sugars, fats, and narcotics. she requires IV anti-nausea medication to prevent her from throwing up, and even still, she gets sick on occasion. and for some reason, she thought it was a good idea to refuse all nursing and medical care and pack up her belongings and try to leave the hospital - ALONE (since her mother was unsupportive of the idea and wouldn't pick her up).

it was an interesting experience. one that involved a lot of patience. i had to involve her primary care provider (a nice visiting doctor from somewhere with a great accent!), the attending, social work, and ME. i spent ALL morning in her room, trying to convince her to stay. having to outline ALL the risks of leaving early, against medical advice. we had to be honest - and tell her that an infection cause cause life-threatening results. and then, i had to pull the baby card, which just felt mean and horrible. but was true. "your baby is sick and needs you to be your best, healthiest self. that means you need to stay here until you are better. do you want your baby to be without a mommy?"

poor little girl. she cried. and demanded to leave anyways. and then, about 15 minutes later, called me into her room, told me she was staying, and asked me to help her get into the shower.

compliment?

i think i got a compliment today. my patient needed a dressing change; when i asked if it could be done, he said, "are you gonna do it? or are you gonna send in one of those crackheads you work with?" i shouldn't have asked, but the question flew right out of my mouth before i could stop myself. "who do you think is a crackhead?" he proceeded to tell me the name of a nurse i work with and i had to chuckle. the nurse he mentioned is more than a bit scatterbrained, but he is kind and intelligent and more than competent enough to do a dressing change. but my patient preferred me and suggested i tell the other nurses on my unit how to scrub the hubs on his central line and how to administer his IV pain medications - fast and in large doses.

i must add, while we were having this comical conversation, my 31 year old patient lay with his eyes closed, nauseated, holding his 4 year old son's hand. after discussing the "crackheads," my patient shook his son's hand firmly and proceeded to teach him how to be a man. it was sweet. they practiced a time or two and then my patient, in a slight drug fog, tenderly touched his son's cheek. it was loving. and genuine. and oh so sad. i couldn't help but think - these lessons, on how to be a gentleman, are the only lessons this little boy will get from his daddy. my patient, the one who thinks my colleagues are crackheads, is not long for this world.

blah

it's been one of those weeks at work... where everything seems to go wrong. our computer charting system went down on both sunday and monday. for hours. and although i HATE charting and not being able to may sound like a good thing, it's actually really bad, more than annoying, and totally unsafe. thankfully, nothing went disasterously wrong. well, nothing that i know of. but it was a rough few days. for one of many reasons.

one of my patients is 22 years old. that's unfair enough; right? listen to the rest of her story (i don't know all of it in detail, because i couldn't get into her chart long enough to find out her entire history). but, what i do know is that this very immature 22 year old is on my unit, suffering from non-hodgkin's lymphoma. she is in the middle of her transplant, waiting for her immune system to come back after the very high doses of chemotherapy and radiation she received. but the real kicker is - she is 12 weeks post-partum. that means, 12 weeks ago, she had a baby. her baby was born at 26 weeks - barely viable - 40 weeks is term. and while she is here in seattle fighting for her life, her premie son is fighting for his in spokane.

i'm not a mother, so i can't quite imagine how traumatizing this situation must feel. but i am empathetic. and loving. and kind. and i feel devastated for this family. my 22 year old patient has no significant other; there is no boyfriend, no husband, no father to her tiny son. thankfully, she has parents. and they are supportive. but imagine their predicament - new grandparents, watching their daughter fight to survive, with the possibility of losing her and gaining an infant "son." my god the world seems unfair sometimes, huh?

the rocking chair

there was this patient on our unit for about two months. it's the kind of patient all nurses talk about - for both good and bad reasons. i would come in to work in the morning and secretly wish i could care for her, but would then breathe a sigh of relief when she wasn't my assignment for the day. she was a challenging person to care for, but she was so darling and her parents were so kind. her situation tugged at your heart strings and questioned your faith in medicine and fairness and all that is good in the world (if you even dared to believe in any of those things to begin with).

little lisa was 23 years old. i speak of her as though she was a child because in some sense she was. lisa had down's syndrome and strutted around our unit with attitude and sass when she was well enough. most of the time though she laid in her bed, snuggling her favorite stuffed bunny or shooting nerf hoops from the reclined position. her chemotherapy was mountain dew and the blood pressure cuff was an arm hug. she made nurses be creative and patient and appreciative.

but of course, like the rest of my patients, she got sick. super sick. and ended up being intubated and ventilated. eventually her kidneys shut down and she required dialysis. and just a few days ago, she developed a bleed in her head and a possible stroke and/or heart attack. her prognosis was dismal with intubation; hence, with the additions of numerous complications, her care became futile. her brave and kind parents decided to withdraw and allow lisa to die, with dignity and comfort.

i wasn't at work yesterday when she passed. but i heard the story. and i've cried several times since. people like lisa are often born to special people; or perhaps special people are created by folks like lisa. anyway, her father asked if he could rock lisa to sleep in a rocking chair, like he did when she was small. a fantastic nurse and good friend on my unit, nancy, made his wish possible. she went to the NICU and borrowed a rocking chair. and with the help of the respiratory therapist (who was needed to skillfully assist lisa and her many tubes into her father's lap), she transferred lisa from a giant, impersonal hospital bed to the lap of someone who loved her more than i bet he could ever have guessed. within just a few seconds of being disconnected from the ventilator, lisa slipped away. she stopped struggling to breathe (in a world that was likely challenging for her in many ways). and her parents embraced her goodbye.

heaven or hell and why health care is stupid!

this week, i met a 43 year old woman who was diagnosed with cancer in 1993. she had osteosarcoma (cancer of the bone) and survived after receiving chemo, radiation, and having a new femur bone constructed with titanium plates and rods (of course, not without complication - she had an infection and needed screws replaced and on and on). it's now 2011, years later, and she is back in seattle (from her native north pole, alaska) with recurrence of her disease and metastises to her lungs and trachea. despite chemo and radiation, she is dying. and she is scared. and angry. and a patient on my unit.

i'll spare you the many details on how poor her admission was carried out by my night time colleagues. wait, no i won't. i can't help but mention just one of the tiny mishaps because it is SO scary and ridiculous. when i was getting report from the night nurse who admitted the patient, i asked if the patient had a tracheostomy because i saw mention of it in a physician's note. now, a tracheostomy is a hole strategically cut in the trachea or windpipe to ease with breathing (in SUPER laymens terms). i didn't ask the nurse if the patient indeed had a wart on her left pinky toe - there are just some things you don't look at or assess, especially on a night shift. but come on, you should look at your patient's HEAD. you should notice if the patient is breathing through a hole in her neck or through her mouth! but the nurse couldn't answer the question. "oh my god, did you look at your patient?"

anyway, back to why healthcare is so stupid! the patient (i will call her M) uses 2L of oxygen delivered through little straws in her nose. we have all seen little older folks carrying their tanks to help them breathe. well, M uses this too, to help alleviate some of the terrifying feelings of suffocating. as tumors fill her lungs and surround her windpipe, she constantly feels as though she is gasping for air. without oxygen, her oxygen saturation is about 92%. this is not a bad oxygen sat; it's low, but not dangerous. in the hospital, at 92%, we put people on oxygen. but, for some assinine reason, medical insurance requires that people saturate at 88% to have their home supply of oxygen covered. what that means is, M does not qualify for home oxygen (even though wearing just 2L provides her some relief). M's husband is kind, devoted, and doting. he would do anything for M. and so, he has been stealing oxygen tanks from the hospital. kind of funny, kind of sad. if your loved one felt as though they were drowning, would you steal oxygen tanks? probably!

after some sleuthing and M's husband finally revealing the source of their illegal oxygen supply, i asked if i could help them set up home oxygen legitimately. that's when M tearfully admitted that without oxygen her saturation is not low enough to qualify. my response kind of surprised M and her husband. "i don't care if you qualify legally or not. gasping for breath sounds pretty miserable. i think you deserve to have a little oxygen wherever you are if it provides you just the tiniest bit of comfort." they looked at me curiously. i was happy to document that the patient desaturated down to 88% without her oxygen; it's the least i could do. after some white-lie computer charting and a call to social work, i had a portable oxygen tank delivered to the hospital, delivered to their hotel, and set up in their home town in alaska.

does it make ANY sense that we provide futile medical treatment covered by insurance to thousands of people? on a daily basis, there are folks in the ICU on my unit that we all know will not survive. and yet, they are receiving MRIs, CT scans, dialysis, and thousands of dollars worth of nursing and medical care. BUT... we won't provide oxygen (a natural gas) to a woman who wants to die more comfortably, without gasping for air?

M and her husband thanked me profusely, as if i had performed some miracle. no nurse before me had done them this favor. as i left the hospital that night, i wondered to myself... am i going to nursing hell or nursing heaven?

"easing" back into work

there's no such thing as easing back into work after vacation. unlike most people's jobs, i do not return to hundreds of emails and telephone messages. thank god! there are no stacks of papers on my desk; hell, i don't have a desk! thankfully, there are no deadlines i am behind on. but there are sick patients lying in hospital beds - and some are the same sick folks i cared for three weeks ago!

sunday, my first day back to work (still struggling from jet-lag), i did not "ease" back into work; i dove in, head first. two of my three patients are my age - 31 and sick with cancer! the female is dying; her transplant has failed her and her weakened body is being overtaken with stupid infections, like yeast. the 31 year old man, husband and father of two, was just informed yesterday (while i was in the room with he and his entire family) that there is nothing more medicine can do for him, that perhaps he should pack his bags, return to alabama, and wait to die.

how's that for a reality check?!? life is not just about eating croissants in paris and roaming the canals of amsterdam and discovering hidden truths about your family heritage in prague. life is not always simple and amazing and full of discovery. sometimes life is unfair, painful, and plain old shitty! makes me appreciate the patisseries, van gogh's self-portraits, and the statues on the charles bridge that much more...

enjoying a chocolate crepe in place du tertre, on the way to sacre couer in paris!


some of the thousands of bicycles i could not ride in amsterdam (perhaps i should learn)


sitting on the charles bridge in prague over 70 years after my grandparents were there together...

work to live

do you work to live or live to work?

this week, the answer is simple. i am working to live. in fact, i am working A LOT so that i can live HARD! i'm working too many days and hours of overtime so that i can take off two weeks from work and see the world.

when people ask me if i like my job, i often have mixed emotions. my gut instinct is always to say, "i love nursing." i do. i love caring for people during their most vulnerable times. and i feel honored to be with people during cancer. but other times, i feel disenchanted with my job. we're often understaffed. sometimes i don't have the time to spend quality time with my patients. and sometimes i just get sick of caring for needy people.

but, one thing i ALWAYS love about my job is the schedule and the flexibility it allows in my life. i am blessed with opportunities to take weeks and months off of work to galavant the globe. last year it was iceland and nepal. the year before that, mozambique, south africa, and turkey. next week, i am off to paris, amsterdam, and prague. what a treat! what a rejuvenating adventure. i cannot wait to eat croissants in paris, to see anne frank's house in amsterdam, and to walk the charles bridge in prague (i will imagine my grandparents standing there decades before for their wedding photos).

four lives please...

if you think you're having a bad day, think about my sweet, brave, amazing patient...

at age 14, she had hodgkin's lymphoma.  her radiation treatment lead to...

breast cancer at the age of 38.  her chemotherapy for her breast cancer has now caused...

leukemia at age 49.

she's getting a transplant.  and she's stuck in the hospital this weekend as her son gets married in montana.

let's hope she has 4 lives...

goodbye chris

i climbed mount adams this weekend.  it's the second tallest mountain in washington.  i have now climbed washington's top three peaks - if you don't count mount tahoma, an off-shoot of mount rainier (most lists don't include it).  i suppose it was a good way to conclude my summer - to cross off one more mountain from the list, to spend time outdoors with a dear friend, and to recognize how fortunate i am to be healthy, to feel alive in the outdoors, challenging my body and mind, exerting every last muscle.

after getting home VERY late on sunday night/monday morning, i worked labor day.  typically weekends and holidays are low-key on my unit - less management, less scheduled admissions, and less stress.  but monday turned out to be a sad day...

the patient that i had been writing about - the hoarse gentleman who stole the motorized wheelchair and gave me the best compliment ever - lay intubated in the ICU monday morning when i arrived with three different medications infusing to attempt to keep a life-sustaining blood pressure circulating.  being curious, surprised, sad, and thoughtful, i asked his nurse what had happened.  and to everyone's surprise, chris coded sunday night after struggling to breathe all day.  it was sudden.  he had been doing fantastically, like i mentioned, zipping around, listening to metallica, beating the odds with a positive attitude and amazing outlook on life.

sudden deaths and disasters are not common on our unit.  we are most accustomed to slow, painful demises.  so this one took me by surprise.  but i was thankful that i had a chance to see chris, to hold his hand and tell him how amazing i think he is, to share with him that his spirit moved me and will be remembered.  i was not in the room when chris passed, but i did participate in his post mortem care.  i was able to clean his body with respect and kindness.

chris will never climb mount adams.  he had muscular dystrophy and likely never could have.  but his presence in my life and his wild spirit reminds me to be thankful that i have opportunities and successes, that i see mountains and get to climb them.  

best compliment ever

i'm at work taking care of the patient who stole the motorized wheelchair. he continues to make me smile and enlighten me with deep thoughts (of course, in his hoarse, barking voice). just now, he grabbed my hand and said, "christa, thank you for being a kick-ass nurse!"

the mysterious motorized wheelchair

last week, i wrote about a patient with the "missing" voice. this week, C continues to amuse me. his voice has returned, somewhat. now instead of a whisper, he has a mean bark - especially when calling food service to swear about his meals being delivered cold and with the wrong condiments.

his most recent and best antic so far has to do with a mysterious motorized wheelchair. on sunday, C was zipping down the halls, rocking out to heavy metal. we teased him about fining him for speeding. but eventually, all of us nurses wondered where this fancy wheelchair came from. when the physical therapist showed up, we asked her if physical therapy indeed gave him the chair. when she said NO, there was sleuthing to be done.

turns out, just asking C point blank got us the answer. C stole the wheelchair from the complete other end of the hospital, near the rehabilitation unit (our hospital is HUGE - he travelled a long way to get this prized possessions). he had seen the chair in the halls near rehab the previous day when PT brought him there to workout. he even asked if he could use the motorized wheelchair - but PT said NO. the patient has muscular dystrophy; he can walk - albeit slowly and with a strange gait. but apparently, he wanted to zip around. so in the middle of the night on saturday, he wheeled himself in a regular wheelchair to rehab to confiscate the cadillac of wheelchairs - the motorized wheels!

PT forced C to hand over the chair. poor C with his little bark seemed deflated. but the heavy metal continues. C adds a little spice to our oncology unit. and i enjoy his spirit!

august update

i've been slacking off on my blog lately. i wonder why that is? sometimes i think it's because work is not challenging me. or perhaps, work continues to challenge me in the same ways as always, but life outside of work challenges me more. then, i simply don't have the time or motivation to write about nursing. anywhoo...

my week of camp nursing was great! this was my fifth year of being a camp nurse at a camp for developmentally disabled adults and my 16th year of volunteering. it all started when i was a wee 15 year old; i convinced my sweet friend, amelia, to attend camp with me and my special aunt joanie (joanie is developmentally disabled and looks forward to camp ALL YEAR LONG!). we had the time of our lives. but we were challenged beyond our wildest imaginings. the two of us sweet, little innocent gals ended being responsible for one 21 year old boy. he had down's syndrome and was non-verbal. he required both of our attention for the entire week, and still, we couldn't get him to sleep. and sadly neither of us were sure he had "fun" or benefitted from the experience. but we tried our damndest. the two of us, on the other hand, had monumental, life-changing experiences. despite the sleep deprivation and the changing of adult male diapers, we were hooked. amelia now lives in LA and has a wee-one of her own to care for.

but this year, i had the special privilege of bringing a new friend to camp. marian, a colleague and dear friend of mine from work, braved the world of camp nursing with me. she and i, with the part-time help of two other very experienced nurses, were in charge of doling out hundreds of pills each day - breakfast, lunch, dinner, and bedtime pills. and it was fun to watch her ease into the world of differing abilities and specialness. each day, each med pass, became easier. campers warmed to her bright spirit. and the week was better for me having her there...

"real" nursing returned on monday morning after an emotion-filled and wacky weekend with the beginnings of a cold. blah! and sadly, the sweet 25 year old guy i had taken care of the week prior, the one whose father didn't want me to be off for so many days, had been intubated and placed into one of our intensive care beds. double blah! i knew he was sick; i worried he would not fair well. and although i LOVE being right most of the time, i do not love being right about sad outcomes on my unit.

monday and tuesday i cared for a very unusual patient. somehow, he "lost" his voice. he has cancer. and he's been intubated recently. but every test we did, shoving cameras down his throat, assessing his vocal cords, checking his swallow and gag reflexes, showed nothing abnormal. my patient has an extensive history of drug use and certainly seems to have some mental illness, but this voice business, his quiet whisper slash bark seemed comical to me. he wrote me notes all day and attempted sign language. i made business phone calls for him to strangers in alaska. and we laughed together trying to figure each other out. all in all, it was a fun two days.

but my cold worsened. my nose started to drip while in patients' rooms. i had to sniffle and wipe my face on my sleeve like a four year old child. and i realized, if i truly care for my patients, if i really want to be a good nurse, i must care for myself first. i had to call in sick on wednesday so as not to pass on my cold that for me is benign but for my patients could be deadly. it was a good day off. a nice day to rest, relax, and re-cooperate from camp, life, and work!

long week done, long week ahead

in the last week, i have worked five 12 hour shifts. that's more than 60 hours. and although they weren't that challenging of days, it still feels like too much.

i do a very poor job of leaving my home life and dilemmas at home, so often times, i use work as a processing plant. i work with supportive friends and colleagues. and it just so happens that sometimes, work is my therapy. our 60 year old male secretary doesn't hesitate to give me boy advice. and my girlfriends and i spent the last several days hiding in the hallways, avoiding patient rooms and actual nursing work, to whisper about naughty things and funny experiences. dare i say that work (or therapy - whatever you choose to call it) this week was almost fun! and it's cheaper than my real sessions; in fact, i actually get paid to work on myself and spend time with friends!

i did do some real nursing this week. in fact, for the last two days, i cared for a young gentleman who is VERY sick. he is 25 years old. of course, he has cancer. and he is surrounded by loved ones - a super attentive girlfriend, two loving parents, and aunts and uncles, nephews and nieces. unfortunately, he's only at the very beginning of transplant and is already suffering pretty intensely. i only mention this guy because i actually enjoyed caring for him. is that bad? i don't always enjoy caring for my patients. this guy though, he's motivated. he listens well. he wants to work hard to get better, despite feeling like you-know-what. and at the end of the day, he asked if i would be caring for him every time that i worked. sometimes, when people say that, for a split second, i fear they are going to say, "because i don't want you to be my nurse again, not tomorrow when you're back, not ever." but this little guy (i say "little" because 25 year old men are so vulnerable and needy), he said, "you do a really good job!" and his dad chimed in and said, "i don't think you should be allowed to have the next 9 days off. we like you too much!"

that is a nice way to end a 60 hour work week.

tomorrow begins another tough week - a 120 hour work week. i head to camp parkview on vashon island. once again, for the 5th year in a row, i will be one of the camp nurses at a camp for 60 developmentally disabled adults. it's actually my 16 year (i did miss a year or two during college summers and travels) volunteering. and as fun as camp is, it is work. with it's own challenges and drama...

here's to camp nursing!

assholes

for the last two days, i've taken care of a very kind gentleman. he is sick and weak. and he is a dentist.

being the judgmental person i am, i assumed he would be smart, inquisitive regarding his health, and perhaps a bit arrogant. i don't know why. but sadly, that's my perception of physicians. i don't like caring for medical professionals. we make bad patients!

but he was none of the above. he thanked me for every last task, despite being in pain and feeling miserable. he called me sweetheart (which i actually hate and think is disrespectful of my age and professionalism - but that's another story), i think in a kind tone. and my day with him was pleasant.

his wife however. she was a different story. a total nightmare. seriously, i wanted to shoot her. thankfully, she only arrived at 5:00 pm - so i had just 2.5 hours with her. but honestly, she may have been the most annoying person i've cared for.

her husband returned from a procedure quite sedated. he needed to be transferred from a stretcher to the bed. and she sat and watched us, commenting every 2 seconds, accusing us of almost dropping him (which we didn't), reminding us to be careful of his leg (duh, i've spent the last two days with him helping him out of bed and transferring him. i know he's in pain. and i'm not going to be careless and intentionally hurt him), and asking why i needed to do certain things i was doing (like log-roll him over soiled sheets to protect his skin from laying in shit). i can't make this lady sound annoying enough. i cannot describe the tension in the room. the other nurse i had in there with me to help just kept looking at me with this look, like "really, is she being so inappropriate?"

the worst comment...

eventually i helped the dentist to the commode. when he was finished, i helped him stand and proceeded to clean his backside. she said, "i would offer to do that, but you got training for this, right? i mean, you get paid to do this after all!" i could hardly contain myself. "really, you think i went to nursing school to learn how to wipe butts?"

i don't get paid enough. i don't mind wiping behinds. if i ever need help cleaning myself, i'll be thankful to have a nurse that does so gently and with respect. it's not the ass-wiping that makes nursing challenging, it's the assholes i sometimes deal with! (excuse my language).

lessons from a patient,

the patient was ME.

yesterday, i was a patient AGAIN. and can i just say, what a strange experience! that role reversal feels so weird.

without going into graphic details, let's just say, i had some polyps removed from a private place. and it required general anesthetic. i'm fine. all is well. "a forest of polyps" was removed and i should be good as new.

but wow! how weird to be in a gown, with my hiney sticking out. with an IV in my arm. with drugs fogging my brain and blurry vision taking over the room. an hour or two of my life went by without my awareness. people poked and prodded me. a machine breathed for me. and i woke up to a quivering jaw and chattering teeth.

being inquisitive and curious, i asked all sorts of questions, even in my drugged stupor. how did i respond to the sedation? am i a light-weight, as i expected? did i have any irregular heart rhythms while i was being monitored? did that annoying beeping mean that my oxygen saturation was low? "no, please don't give me demerol for my extreme shakes. i will be fine, eventually." "did someone let my mom and friend know that i am okay?' i'm such a chatterbox, even when sleepy and drugged.

but i learned, AGAIN, that i don't like being a patient. medicine and procedures, nurses and doctors, gowns and needles make people feel extremely vulnerable. the nurse didn't really soothe my anxiety; she did not explain everything that was going on. everything felt a bit rushed. before i knew it, before i could ask all my questions, i was OUT, three sheets to the wind.

on a regular basis, i walk into a patients room expecting that my patients KNOW what i am doing... certainly they've had chemotherapy before. of course they've had a blood transfusion. this far along in their treatment, they must be familiar with blood draws and IV antibiotics. right? WRONG!

my patients deserve more from me. they deserve more thorough explanation. they deserve to have ALL their questions answered. they deserve to feel safe and confident in their care. they deserve my best, each and every day, each and every time i walk in their door. here's to better nursing in my future....

timing is everything

once again, this is not nursing related...

it's mountain related.

but i just felt the need to share a little snippet of news regarding mount rainier. the bushwhacker class i took offered two mount rainier trips. somehow, despite wanting to be on the second trip (with a teacher i preferred and dates that suited my work schedule better), i ended up on the first one - the holiday weekend. as aforementioned, we summitted! all 8 of us pushed our bodies to the limit. and it felt incredible. and, hopefully without sounding cocky, can i just say - i still just can't believe i did it! i had the opportunity to fly OVER mount rainier this last weekend when returning from boise and it's just SO massive.

but...

i just heard from a friend who was on the second trip. and sadly, they did not summit. they started their climb with amazing weather. things were going fine. the snow was in good condition, they were making good time. and then, at 12,700 feet, one of the climbers got AMS - acute mountain sickness. nausea, vomiting, headaches, weakness - not good symptoms to have on a 45 degree slope with crampons your feet! the entire team had to turn around.

of course, as a nurse and just plain old caring person, i would have been concerned about the climber's health. i would have offered water. food. any medications i had in my emergency kit (advil, tums, and immodium!). but also, i would have been incredibly disappointed. sad. angry even. it would have been my second failed attempt. and although i knew it was a possibility and i would have dealt with it, i am SO, SO, SO thankful that i did not have to experience that turn-around, that "failure," that non-summiting experience.

timing is everything. someone or something greater than myself made my summit possible. the stars were aligned. i was with the right group of people. the conditions were great. my body worked that day, when it might have not on a different one. and i summited rainier. sometimes luck plays such a big role in life - i feel so lucky!

mount rainier

i've tried to keep this blog thing to mainly work-related, nursing things. then, my dad got sicker in the last year and i broadened my topics to all health-related issues, even if they were personal. but i have something to report that is not related to nursing and is only loosely related to health (if you call carrying a 50 pound backpack, sweating like crazy, pooping in a stinky outhouse, and achieving a personal goal 'health').

drum roll please.....

after a very long and round-about journey, i summited mount rainier this last weekend. on july 2nd, at about 10:15AM, i stood on top of a mountain that i have looked at my entire life.

i am not sure when this goal came about. i've always loved staring at mount rainier as i cross i-90. one of my favorite things about traveling to far away destinations is coming home to seattle to be welcomed by the green surroundings, lake washington, the puget sound, and the many mountains that make up my state. but rainier, really? why did i have to choose to summit the tallest mountain in washington? is it because i am crazy? determined? or truly passionate about climbing mountains?

in the last several years, i have become more adventurous, outdoorsy even. i have dated a few boys that challenged me to do new things. three summers ago, i camped for the very first time. i sort of liked it. i think that summer i spent 3 nights in a tent – they were the only 3 nights i’ve spent outdoors ever, in my whole life, until this summer. a few months after that boy, i held my first ice ax with a different boy. we tried to look cool, but neither of us really knew what we were doing or how to use an ice ax safely. i did however stand on some cool peaks (mailbox, granite, mount barring, and naveho de toluca in mexico) - which, i guess you could say, "piqued" (get it?!?) my interest in hiking. dare i say climbing!

but this rainier thing came about two years ago. after some serious soul-searching, i made a bucket list. it included some random life goals (learn to ride a bicycle, shave my head, and run a half marathon). but i also created a plan for the year 2010 – the year i would turn 30. i jokingly dubbed the year "the year of christa” and it turned into just that – a year to celebrate myself! i spent time and money on healing and growing, and challenging myself to prove that i am strong, capable, and independent.

i went to bali with my friend kate. we spent one week doing yoga twice daily and eating the most glorious meals at a beautiful resort. i went to therapy more often than i’d like to admit. and i got massages. i exercised to clear my mind and to strengthen my body. and i started hiking to prepare myself for the biggest goal of all – to summit rainier. in january of 2010, i committed myself to mount rainier by signing up with alpine ascents for a guided late season, september climb. it would be a three day adventure unlike any before.

but for those of you that know me and have been following my blog, you know the year didn’t transpire as planned. my rainier goal was left unaccomplished when i over-trained and wound up hospitalized just one week prior to my climb. with severe muscle breakdown in both my arms and hugely elevated liver enzymes, it was impossible to attempt the climb. the doctors broke the news on the first of my five days in the hospital. i cried. and felt angry. but mostly, i wondered if i could have done it – if given the chance, my body would have carried me to the 14,410 foot summit.

september was disappointing to say the least. i went from being insanely active and healthy (and proud of myself to boot), to slug-like and almost embarrassed by my failure.

my nepal trip came quickly though and thoughts of rainier were put on hiatus. instead of summiting a 14,410 foot mountain, the himalayas brought upon a different challenge. a 10 day trek was a different kind of adventure - it would be walking, not climbing. my team consisted of mostly adults in their 50s and 60s. and instead of feeling like a huge challenge and lifelong personal goal, it felt doable and safe. we did hike to over 16,000 feet and after having not been able to attempt rainier, getting above rainier's elevation felt pretty damn exciting. but it was different. it was not rainier. i was not in washington. tserko ri was not the mountain i look at daily; it was not the summit i was shooting for.

so, when i returned to washington in november, i thought long and hard about attempting rainier a second time. did i really want to commit myself to the same goal? the previous year, truly every day involved some sort of training - whether it was physical or mental. and it was hard. i wasn't sure if i had had fun or if i was just hugely driven and worked really hard. my biggest fear and hesitation in trying again was whether or not i could handle another potential let down? another failed attempt? an unsummitted mountain... could i train smarter, less intensely, and more safely? could i have fun? and still be proud of myself if i didn't make it?

instead of signing up with a guide company, i decided, while in the midst of a very sad break-up and my dad's many hospitalizations, that i should take a glacier climbing class. a course would provide me with more knowledge of glacier climbing and provide me some opportunities to hike and climb with a new community of people interested in the same things. but i was NOT committing to THE MOUNTAIN. in the back of my mind, i knew the opportunity would present itself. but signing up for the bushwhacker climbing class was NOT as stressful and intimating as committing to climbing mount rainier. it felt safe.

the classes started in may. every tuesday i learned new knots and knew vocabulary words. i went on hikes with my backpack to "train." but i didn't take it to the extreme; i didn't train like it was my job. i felt that no matter how hard i trained, i had it in me to keep up with my team. and for once, i attempted to adopt the attitude - "if i didn't have it in me, and i couldn't do it, oh well!" i tried to be low-key and to keep my expectations realistic. but when the opportunity arose to join a team on rainier, i jumped! i signed up immediately. i still felt the NEED to climb rainier. i couldn't let that mountain beat me AGAIN; i couldn't let last year's attempt be my only attempt. i am NOT a quitter.

since this has quickly turned into an auto-biography, i will cut the rest of the story short. but suffice it to say, climbing mount rainier was by far, the hardest thing i have ever done. it was both a physical and a mental challenge. i carried a 50 pound backpack up 5000 feet to our base camp at camp schurman. i wore crampons and used an ice ax while roped to my team members. i spent three nights snow-camping, eating dehydrated foods, and going to the bathroom in a vile outhouse. i woke up at 1 in the morning on summit day, started climbing at 2:20 AM via headlamp, and climbed 5000 more feet to the summit of rainier by 10:15 AM. my own two little legs stepped one foot in front of the other when my mind told me it was impossible, that it was too steep, that it was not humanly possible to go on. and i cried when i got to the summit. i cried tears of joy, pride, and utter exhaustion. i cried not only because i made it to the summit, but because i achieved a personal goal. and there had been many obstacles. not just the crevasses i had to jump over...

i had thought "the year of christa" was done when 2011 started. but "the year of christa" continues. i summited mount rainier as a 30 year old gal. and although it did not happen in september of 2010, like i had anticipated, hoped, and worked towards, it happened in july - before i turn 31. and in the process, i have learned to be more flexible in my goals and expectations, more forgiving of my limitations and mistakes, and more proud of the things i achieve!

p.s. this seems like little news after rainier but, by the way, i summited mount baker on monday, june 20th. it was part of my training and the final climb in my glacier climbing class. had i only summited baker this summer, i would have still felt proud and accomplished. it was the hardest thing i had done prior to july 2nd! now i just feel extra bad-ass for summiting two BIG mountains in two weeks!

poop

i feel too grown up! i'm 30 years old and already, i'm taking care of my parents!

don't get me wrong. i love being there for them; it's a privilege really. after all the parenting and support they've given to me, it's certainly time for me to give back. but at the same time, sometimes i wish this wasn't happening until i was 50 and they were 80.

my poor little dad somehow developed a cyst on his knee. of course, it's on the leg that has no veins (because they used them for his 7 grafts during his bypass surgery 13 years ago); hence, he's extra swollen. and he's in excruciating pain. i found him hobbling around the house this morning and had to help him put his socks on his feet and his pants around his ankles. of course, he thinks he's "healthy" and "fit" enough to go to work today. so he's gonna hobble, hop, skip, and jump around the kitchen at his restaurant. what a crazy fool!

this morning is a bit different than the typical "escort" i provide. instead of bringing my dad to some cardiologist or wacky procedure, i'm with my mom. she's having a colonscopy. ugh. poor little thing. without need for description, we all know what that is and where they go. makes me cringe and clench just thinking about it. i'm her designated driver for after the procedure when she's all drugged up on fentanyl and versed. should be an entertaining morning!

just another day in the life of christa... nurses, doctors, waiting rooms, procedure suites, gowns, gernies, drugs, IVs, blood, gas, and a whole lot of poop!

a week of chaos

i didn't write last week because it was just too CRAZY!

now that the events have come and gone and i am more rested, i don't feel like "reflecting" on the chaos. i'm trying to get over it, not delve deeper. but i will share the "highlights."

monday of last week, i had to make that scary phone call to the mother of a 21 year old. it overwhelmed me in some way and i really didn't like being the bearer of bad news.

that afternoon, i also admitted a patient with low blood pressures - 80s/40s. She was unable to get in and out of bed on her own due to hypotension and new-onset bilateral lower extremity weakness. try safely getting a hefty woman with limp legs to the toilet after a failed attempt at a bedpan.

tuesday and wednesday i had off from work. and to be honest, i don't remember much of what transpired. but i know it involved a few tears, a visit to my therapist, and trying to get out of a date with a foreigner that reminded me of my father (poor english, balding, and black socks).

thursday of last week was the most intense. my dear, dear friend's uncle had had surgery prior in the week. and sadly, to our shock and dismay, he coded early that morning due to a swollen airway. cassie called me while i was at work to share the news. uncle john had been emergently intubated and placed in the ICU. but it didn't look good.

just by chance, my mother also had a good friend in the ICU. i know her well - when i was little, she drove my carpool and her kids and i played together making gymnastic routines in the lawn and swimming in the lake. she had donated a kidney to her sister-in-law. so while visiting and supporting cassie, i decided to visit my mom's friend also - just to check in. she was doing satisfactorily. so imagine my disbelief when i heard a code blue called in her room just hours later. could i really know two people teetering on the brink of life or death in the same unit of the same hospital just rooms away? yup. as i was running down there to offer support to her family, i ran into my mom's friend's husband. he was clueless as to what was happening. so, of course, i had to take it upon myself to share the news and walk him into the scene. 15 doctors, code cart, chaos. to make a long story short, turns out, she's okay.

that same evening though, while still working my 12 hour shift , just to keep things exciting, my fourth patient of the day "decided" to fall at 6 PM. a STAT head CT and incident report ensued. and my day ended in a blur. if i were a drinker, i would have kicked back a few!

friday brought sadness. it was determined that cassie's uncle had no brain activity. so in the morning, his courageous family decided to withdraw care and allow him to pass. an adventurous, inspirational, and beloved man died that day. a family lost their father, brother, uncle, and friend - and the world will never be the same.

because someone/something had decided that i was superwoman and could handle more...

to end my work week, one of my three patients on friday evening began to suffer from chest pain. so instead of lazily charting, spacing out at a computer screen, and taking the time to say goodnight to each of my patients, i ran around the unit like a chicken with my head cut off. there were numerous emergency meds, STAT orders, tests, and blood draws. it's a strange thing to watch someone in pain, perhaps having a heart attack in front of your very eyes, and to be unable to stop it. and it's even weirder to go home before the conclusion, not knowing how the story ends.

saturday morning, i went hiking. ALONE. i spent 4 hours outside in misty rain and clouds. i had brought music to listen to, in case i needed "company." but truly, the noise was too stimulating. i needed silence. i needed to breathe in fresh air and blow out a week of chaos.

dreaded phone calls

i'm not a parent, but i know about every parent's worst nightmare - that something has happened to their child, that they are ill or in danger, or god forbid, dead. i know about dreaded phone calls because when i was 12, my mom got one. it was harborview (the best hospital for the worst cases - trauma) and they called to have my mom come and identify her daughter. it was a friday night. my mom and i had been watching the miss america pageant. my sister was headed to her high school's soccer game. sadly, she and her three friends never made it there. two teenagers died that night; thankfully, my sister survived (she was intubated at the scene of the accident and had brain swelling). and although it was over 18 years ago, i will never forget that phone call. and neither will my mom.

this week, i made that phone call. and it sure felt horrible.

a 21 year old patient on my unit was in the midst of his transplant. well actually, he had been transplanted 6 days prior. but he was in the midst of the worst part. the previous days of chemotherapy and radiation were catching up to him. without an immune system, his body could not heal any of the damaged and dying cells. the lining of his entire GI tract - from his mouth to his anus (that's how i always describe it to patients) - was raw with mucositis (inflammation, ulcerations, and pain that is difficult to treat). and for some unknown reason, he began to have difficulty breathing. it's likely that his airway was so swollen that he could not safely or easily pass oxygen. and within minutes, he was in a very dangerous situation.

i was not the boy's nurse (i say boy as if he is some little thing, but as a 30 year old, 21 now seems so young - too young for cancer). but i was helping his nurse - drawing STAT labs, finding doctors, getting emergency medications, and of course, making phone calls. with one glance at the patient, it was obvious that he was terrified. he was gasping for breath. he could not sit upright enough. he was restless and i swear the pathetic, terrified look on his face said, "i need my mom." i asked his nurse if his parents were somewhere in the hospital and she said no. so i asked if i should call them.

i didn't realize what i had offered until i left the room to go dial his parents' phone number. what would i say? what does one say to a parent as their son is on the brink of crashing, requiring intubation, and possible CPR? how do you tell a parent that their son is dying? and that he is alone? i didn't have much time to think. and likely a rehearsed conversation wouldn't sound any better than a non-rehearsed one. so i dialed and his mom picked up.

i don't remember exactly what i said. but it went something like this:

"are you Cs mom?"
yes

"hi, my name is christa. i am a nurse on the oncology unit where you son is a patient. i am not currently his nurse, so i have very limited information. and i am so sorry to be making this phone call. but i wanted you to know, that C is having difficulty breathing. we are moving him to the intensive care unit to be more closely monitored. he is surrounded by doctors and we are working very hard to keep him safe. i think you should be here. do you have someone who could drive you?"
i can drive myself; i'm on my way

it was a quick conversation - a minute, maybe two. but it was the most difficult phone call i've ever had to make. sometimes, i hate the phone.


*** for once, my story has a happy ending. well, at least it's happy so far. after many, many drugs and many, many interventions, the 21 year old boy ended up NOT getting intubated. his swollen and bleeding airway somehow managed to stay open. and he continued to breathe on his own. he is now 11 days post transplant and closer to healing, closer to recovering from transplant, and closer to remission! ***

patient updates

on may 15th, i wrote a post titled, "who will have passed away." it was about a 32 year old patient of mine; her name was erin (i am allowed to use her name because once someone has died, it's okay to talk about them by name. something about public death records. weird, huh?). anyway, erin died the sunday i wrote that blogpost.

thankfully, i wasn't at work that day. i was not her nurse. i did not have to watch agonal breaths and gasps for air. i did not have to see the final in and out. there was no stethoscope check for a heart beat. no need for me to tell her husband, parents, friends, and family that indeed, erin had passed. that was someone else's job that day.

but i thought i should update the blog. i've been avoiding writing the conclusion to that story. but here it is. lots of my stories have sad endings.

check out her obituary - it's heartbreaking.

Spanier, Erin (nee Gaffney) It is with great sadness that the family of Erin Victoria Spanier announces her passing. Erin was born in Regina, SK on March 27, 1979 and passed away with family by her side in Seattle, WA on Sunday, May 15, 2011 at the age of 32 years. Erins greatest love was her family and nothing brought her more joy than spending time with her three boys husband Ryan and sons Liam and Ethan. Erins life will be forever celebrated by her parents, Brian and Beth Gaffney, her sister Tricia (Jason Scott), brother David (Teresa Ciccone), and her niece and nephews Hannah, Carter, Luca and Dante. She will be lovingly remembered by Ryans parents, Garry and Arlene Spanier, his brother Mike (Donna), their children Tony and Dylan, and grandmothers Bregita Spanier and Bernice Giesz. She also leaves several aunts, uncles, cousins and a long list of friends who will miss her dearly. Erin lived her life with humour, pride, determination and loyalty. She shared her love for others in her own quiet ways and we are forever grateful for the time we had with her. We will honour her life through the stories and memories we will continue to share with her sons. Her boys will always know how special she was and how much their Mommy loved them. A celebration of Erins life will be held at a later date. A trust fund for Erins sons, Liam and Ethan has been set up at the Royal Bank (3816 Albert Street Regina, SK, S4S 3R3) for anyone wishing to make donations. We also encourage those who are interested to consider becoming a blood donor or a member of the bone marrow donor registry. "If love could have saved her, she would have lived forever."

just fyi

i worked all weekend - saturday, sunday, and monday. after just two days, i figured i had given a couple of hundred of medications. so, just out of curiosity, monday morning i decided i would count the number of pills i administered in a 12.5 hour shift. if i calculated correctly, by monday evening, i handed out 93 pills in total to 3 patients (an average of 31 pills per patient). just for fun, i also gave 9 intravenous medications (one being a super toxic chemotherapy) and one blood product (platelets).

i'm embarrassed to admit, i still can't get myself to take a multivitamin every day. forget calcium and vitamin D. my patients are required to be pill-pushers. i admire them and their iron stomachs. it's no wonder folks with cancer are skinny; there's no space in their bellies for food after they've taken their medications.

casual conversation

imagine having a casual conversation about a heart transplant? now imagine that casual conversation about YOUR DAD getting a heart transplant?

i’ve been thinking about what to write and how i feel about this for more than a week now. and I still don’t know what to say or how to feel.

I have never imagined that my father would get a new heart. first of all, it’s a very strange thing to imagine. even though medical advances allow such surgeries, i just never imagined that someone i know and love dearly would need any such thing. i’ve never wanted anyone i love to be sick enough to qualify.

when my dad was near death more than twelve years ago, there was brief mention of a heart transplant. to be honest, i don’t know exactly why we did not proceed then, when his heart was incredibly weak and attempting to heal from seven bypasses and a massive left sided heart attack. but i sort of remember talking to a social worker (we didn’t like her) and discussing the idea. and i sort of remember that the fact my dad is a recovering alcoholic was a strike against him. needless to say, he did not get a transplant. instead, he healed and recovered far better than any doctor might have guessed. he has done exceptionally well, in large part due to his stubbornness and diligence and in part because of his brilliant medical team.

but, now we are at a crossroads i guess… to transplant or not to transplant? really, we’re not there yet either; like i mentioned, this was a “casual” conversation. my dad is still “healthy” enough to function with a very high quality of life. but sometime, nobody can tell us when, perhaps in the near future, he may not be “healthy” and we may need to think about options. in terms of a heart transplant, obviously, the decision is out of my hands. it is out of the medical teams’ hands. and ultimately it is out of my dad’s hands. truly, whether or not my dad (or anyone) gets a vital organ is in the hands of someone or something greater than us. to get a heart transplant, somebody must die. and of course, it has to be the perfect someone – someone who matches your blood type and i’m assuming all sorts of other markers.

during my dad’s appointment last week, his nurse practitioner sat and calmly discussed transplant with us. she looked at some of my dad’s most recent tests to see if his “scores” are low enough to make him eligible. she asked his blood type because blood type O waits the longest on the list (my dad thinks he is A positive; so am i). she talked about some of the risks (cancer from lifelong immunosuppressants) and about some of the success stories.

while she talked, i sat in disbelief. tears welled in my eyes. for once, i didn’t have a lot to say. i couldn’t have gotten words out. my dad assumed my quiet and sadness meant i didn’t want him to get a transplant, that i am vehemently opposed to him taking the opportunity away from someone who is younger, sicker, with more life ahead (because this is something we have discussed in the past). but really, i think i cried because i was terrified. because if we’re talking about transplant, my dad is really sick. to me, it means that a heart that has served him for 65 years and loved my mom, my sister, and me for our lifetimes (albeit in strange and sometimes unsatisfying ways), might not beat very many more times. certainly not as many beats as i would like.

now my future - my dad’s future - looks a little different. instead of a gradual and steady decline like i have mentally prepared myself for, there is hope for something better. the possibilities are more complex and anything but casual.

a sweet thank you

dear christa,

thank you so much for precepting me and teaching me very patiently. i am so blessed to get a chance to be taught by you today because today is my last day here, so your thorough teachings make sense. i was jealous with ruth [her classmate] because i knew you were really good at it [i had precepted ruth a few days in the past]. i think you should become a nursing educator… i want to be a wonderful nurse like you. i’ll keep trying… oh, i need to pass the nclex first and get a job. thank you!

mihoko, spu nursing student

a sweet thank you note i received after precepting a nursing student for an eight hour shift. i should admit that in the morning, i only begrudgingly agreed to have her tag-along with me. i hadn't wanted to teach every little task. it takes extra time and typically, requires more patience than i think i have. but apparently, i did a decent job. and, at the end of the day, i felt honored (if not a little guilty for initially having been so grouchy in the morning) to have had the chance to show a student the nuances of nursing.

who will have passed away

i'm not at work today - which is fantastic! - but i can't help but think of work. i wonder what i will find tomorrow at 6:45 when i walk on the unit. i wonder which of my patients will still be there. and who will have been discharged. but mostly i wonder, who will have passed away.

two weekends ago, i sent a 32 year old woman to the ICU. she has been on our unit for more than 100 days. i believe i have written about her before. her first transplant from her brother failed; her body did not accept the new stem cells. and so she sat, on our unit, hugely susceptible to infection. she had infections and other complications; graft versus host disease riddled her skin and gut (which makes NO sense because she did not even accept the graft and thus, should not have mounted a graft versus host disease response - but such was her luck).

anyway, we attempted a second transplant. she was "healthy" enough to undergo more chemotherapy. the cells came, once again, from her brother. and this time, her body welcomed his cells. in fact, she welcomed them so quickly (it normally takes 2-3 weeks for the body to accept the cells into the bone marrow and have them start functioning) that she, again, got graft versus host disease. we started her on steroids, to calm the GVHD. but of course, steroids are brutal and cause all sorts of other problems. they cause steroid induced diabetes and most significantly deconditioning and muscle wasting. my sweet little patient started to require a walker to ambulate safely. her husband had to help her with the most mundane of tasks. and then, she developed a life threatening problem - pulmonary hemorrhage. her lungs began to bleed. sadly, her sick, sick body could not compensate or heal the lung tissue.

so, two weeks ago, the 32 year old mother of two (her sons are five and two years old) was intubated. and while machines have been breathing for her, her body has gotten sicker, instead of healthier. she has accumulated liters and liters (pounds and pounds) of fluid. she is sedated so that she does not fight the machine breathing for her. she is not awake; she cannot communicate. she cannot see. and sadly, so so sadly, she will never see her husband or children again. i know this. the doctors know this. and her family has become more and more aware of this grim, dismal situation.

when i left on friday, people were in tears. kleenexes filled garbage cans. friends flew in from far away places. goodbyes were being said - some out loud, some in silence.

we withdraw care on people when there is no hope left. sadly, i fear there is no hope in this situation. the only hope i have is that her kind husband will be strong enough to let her go. that he will be brave enough to tell his five year old son that his mommy is no longer here on earth. i have hope that my patient's husband has enough support to take the necessary steps to walk on a airplane without his family intact and carry his sons back home. i have hope that this man will grieve and eventually heal. i have hope that my patient's death will be peaceful and that her spirit will live on in the hearts of the three men she leaves behind.

tune up success

my dad likes to talk about his heart like it's a car. of course he does. he's a man. and he loves cars. when his doctors ask him to explain his symptoms, he uses words like rev (as if his heart is an engine) and i swear he's said "zero to sixty" when he describes his walking speed and stamina.

well, he's been discharged from the hospital. this was a four day stay. thankfully, he was only in the ICU for two days. they removed that ugly swan catheter from his neck on tuesday and hence, he did not require intensive monitoring. now that i think of it, that catheter was much like a dip-stick. it measured fluid (oil) levels in the body; he of course had too much water, not not enough oil. so they didn't exactly change his oil, they drained it. he lost 8 pounds in 5 days.

tiddly got discharged on thursday evening. by friday, he was back in the kitchen, working at the restaurant. of course he was. his engine feels better circulating less fluid. here's to tiddly's new and improved motor!

back in the hospital

so, we're back in the hospital. this time for a scheduled "tune-up." my dad is actually in the ICU, which is strange - he hasn't been in the ICU for 12 years, since this whole story began. thankfully, this is a controlled setting. it was a scheduled admission. his cardiologist has a month of in-hospital rotations and is currently my dad's attending; she admitted him so that she could be in control of his inpatient experience too. i love other medical professionals who are control freaks; i totally understand their desire to be in charge.

anyway, my dad is breathing on his own. he can talk to us. he can get out of bed independently. he has only 15 or so wires attached to him instead of 40. and good god, he is ornery as ever. he might be the "healthiest" ICU patient i've ever seen! the reason he is in the ICU is because he has a catheter inserted into his neck that goes all the way to his heart. it enters the right atria, travels to the right ventricle, and even enters the pulmonary arteries to measure pressures and volumes in the heart. the idea of his stay here is to make him pee a ton, lessen the fluid volume in his circulatory system, and thus make his kidneys happy with increased perfusion (i realize that's a mixture of lay person talk and medical jargon). bottom line: we want my dad's congestive heart failure symptoms to improve and since it hasn't been accomplished in the outpatient setting on oral medications, might as well try inpatient with intravenous drugs!

sigh...

being a control freak myself, it's hard for me to sit here with my dad. i am not an ICU nurse. i do not understand all of this heart stuff, all of these precise measurements. once upon a time, five years ago to be exact, i was actually doing my nursing school clinicals on this unit. i spent 10 weeks here, working 36 hours a week. strangely, i got hired here too. i thought i wanted to do this - to take care of patients during acutely critical times in their life, to care for intubated, vulnerable people. then, while in india on my post-nursing school travels and celebration, i had an epiphony (at the time, i called it a nervous breakdown). i did not want to be a cardiac ICU nurse. i did not feel proud to return home and to keep mostly dead people alive on machines.

so, here i am. an oncology nurse. watching my dad in the cardiac ICU that i was supposed to work on. most of me is still uninterested in working in an ICU setting. all of me knows i never want to return with my dad (or anyone i remotely care about for that matter).

the allure of overtime

i think i might be in a work slump. sometimes when i am in a life slump, i take the majority of it out on my job. my attitude gets lousy (maybe lousier). my colleagues bring me tootsie rolls in the afternoon to make the time pass more quickly. i escape the unit with nurse friends to take a walk in the fresh air during shifts. and i dread going in, especially for stretches of three days in a row.

but, there is something about overtime that i just cannot pass up. no matter how sick i am of nursing and cancer and vomit. i've become a greedy little gal. and i almost always say yes to the overtime call. work doesn't feel so bad when i am making one and a half times my normal hourly pay (double time if it's on a weekend). in fact, work feels great when i'm getting paid what i think i deserve! and it's always a good excuse to treat myself to something special. one overtime shift equals new socks (which i love more than fresh flowers) or a fancy dinner out with friends (dinner anyone?).

so, i guess i get to buy some new socks soon. cuz i'm going in for 8 hours of overtime tomorrow.

in sickness and in health

today i saw a 32 year old gal walking the halls on my unit, hand in hand, with her equally young husband. he was carrying her oxygen canister while she, with her bald and shiny head, was slumped over a walker inching at snail pace.

i couldn't help but think - i doubt either of them dreamed of this moment. but vows are vows. and it's a beautiful thing to see a partner support their other half during their hardest and scariest times.

morbid

wanna know how a nurse thinks?

i was at yoga doing dead body pose (lying on the ground, palms up, eyes open) when i heard an ambulance with its sirens whiz by the studio. i bet some yoginis didn't even notice the disturbance. but my first thought was, "i bet whoever is in that ambulance is dead." and what coincidental timing! when i was little, my mom taught me to pray for whoever was suffering in an ambulance - for the victim to get the help that they need promptly and to eventually be safe and sound. now i am so cynical that i do dead body pose to relax and assume all injured folks are goners.

closer to dying

i feel like everyone is dying every day. like today, i am closer to death than yesterday. and tomorrow, i will be closer to dying than today. it's a negative outlook on life, i get that. but i can't help how i feel.

i just got back from yet another doctor's appointment with my dad. and i can tell he is discouraged. he seems to be getting sicker instead of better. his heart and kidney function continue to decline despite numerous interventions and changes to his medications to improve them. he talks about life like it's already over. i listen to him reflect on his past and verify for him that he's done the best he could - that despite some really hard times, he's been a good husband, father, and man. i give pep talks to encourage my dad to keep fighting, to keep taking care of himself. but sometimes i think he's ready to throw in the towel.

i cannot speak for my dad, but i am not ready for him to throw in the towel. i need him to continue eating salt free foods. to sell his business so that he can retire and live life less stressfully. to be diligent about taking his medications and having check-ups with doctor's as often as they see fit. i need him to stick around to help me change lightbulbs. to help me buy my first car with my own money (as he so generously bought me my first and current car 16 years ago). i need him around for family dinners and to carry out ridiculous traditions that he pretends to hate. i need my dad because he is my dad and nobody else could ever fill that role.

although we are all closer to dying (in my glass half-empty outlook), i am not ready for anybody to be closer to dying any time soon.

summer vacation

i've been uninspired these last couple of weeks. nothing TOO happy or TOO depressing has happened at work. life and death simply continues on my unit.

i worked the last four days. three twelve and half hour shifts and one eight and a half hour shift. that's 46 hours in 4 days - more than a normal person's work week crammed into 4 days (just 96 hours). ugh. it's too much - even though the days were uneventful. i had the same two male patients all four days with one admission late one afternoon.

in 46 hours:
- i hung 8 bags of chemo and 12 antibiotics
- i dumped liter upon liter of chemo-toxic urine
- i checked at least 32 sets of vital signs
- i donned a yellow gown, gloves, and mask innumerable times
- i wrote 9 nursing notes

sometimes nursing is monotonous. sometimes it is unexciting. and sometimes that is a-okay with me.

yesterday, as i left work at 3:30, the sun was shining. it had sleeted in the morning. the weather has been SO strange lately. but it felt like i was leaving school for summer vacation. oh to be in school again! i was elated to have the rest of the afternoon off. and to have five more days before i have to return to the working world.

multi-cultural medicine

i love people from foreign countries. i love humans who look different from me. who have brown skin. and wear different clothes. i feel instantly drawn to people in grocery store lines or on buses who don't quite fit in with white, middle-class america. i always want to talk to those people and learn from them - i know they have things to teach me. i love discovering things about different cultures. hearing foreign languages and new english accents. i love trying new foods. and dreaming of travel destinations. on more than one occasion, i have been invited by total strangers to stay with a strange aunt or uncle on some farm in the boonies of india and nepal.

but foreign languages and accents, poor written english and poor understanding of medical terminology is NOT okay in a hospital. on my unit. when taking care of very sick patients.

my unit accepts visiting doctors from all over the world. we have a melting pot of physicians from spain, costa rica, germany, and qatar. and although i am accepting of visitors, new cultures, and learning experiences, i get incredibly frustrated with language barriers when it comes to the safety of the people i care for.

yesterday, neither my patient nor i could understand the physician in charge. she is a beautiful woman with a kind face and big brown eyes. bright fabric surrounds her face and covers her hair. and a white MD jacket hides her culture, sterilizing her, almost in an attempt to unify her with the other physicians in our hospital. on more than one occasion, i've inquired about her home country, her culture, her family life. and she is kind and thoughtful. i have no doubt that she is a good person and perhaps a good doctor in her home country of qatar.

but her english is horrible. and her accent strong. my 59 year old patient (who has slight hearing difficulties) complained that he didn't even understand the state of his health because his questions are answered in an english he does not comprehend. i too struggled all day with communication. handwritten orders were incomplete. and her poor understanding of our hospital's systems made my day everything but efficient and easy. i truly felt that i not only completed my nursing job, but also, the job of physician. i recommended changes in orders, changes in medications. i showed her where to get the correct requisitions and how exactly to phrase her english. i felt like i was tutoring. except, as a nurse, i should NOT be tutoring a doctor. i spent the day "translating" orders and guessing what she meant by "dilute the albuterol inhaler."

communication is such an important part of healthcare. and although i feel that multi-cultural-ness should be a part of everything (medicine included) i am not sure non-english speaking physicians have a right to practice medicine in an english speaking institution. i am a good nurse, but i would not go to qatar; i do not speak arabic.