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.

does life get worse than this?

some people, their lives just couldn't get any worse...

we have a patient. he had a transplant more than 2 years ago. it worked. he had some quality time. he retired. he travelled the world with his wife. he lived life, in case it didn't last much longer. until sure enough, this year, he relapsed.

he arrived on my floor more than 6 weeks ago with a positive attitude. he needed ANOTHER transplant. this time however, he got VERY sick. he had a respiratory virus that compromised his respiratory function to the point he needed to be intubated and ventilated (essentially, he was on life support). he got dialysis when his kidneys stopped working. and we all thought he would die.

but, he persevered. his family remained by his side. he fought. he got extubated. he's doing his physical therapy. and occupational therapy. and speech therapy. and swallow therapy. but he's not "healthy" enough to transfer to rehab quite yet. his health, although still compromised and susceptible, is getting better. his life was improving.

until thursday evening. when his wife returned home from a day at the hospital to find their 23 year old son unconscious, unresponsive, not breathing. she did CPR until the paramedics came. and she rode with her son in the ambulance, to the same hospital her husband nearly lost his life just weeks before. after resuscitation, medications, and dozens of tests, it was discovered that the 23 year old boy had no brain activity. his overdose had caused multiple organ failure. there was no hope for recovery.

on friday afternoon, a stoic and feeble, man - my patient - protected his immune system with a gown, gloves, and mask and was wheeled off my unit and onto another to say goodbye to his only child. at 4:30 PM, care was withdrawn. life support was stopped. and the 23 year old boy died. before his father. before his grandparents.

i'm not sure life gets much worse.

um, no thank you.

it's my day off and still i cannot escape work! i got a call at 6:23 AM to see if, just by chance, i wanted to come in for my 9th shift out of 11 days. um, no thank you. but thanks for the wake up call.

oh, and just in case i didn't get the message... i got another desperate call around noon, this time interrupting my book reading at starbucks. would i like to come in at 3:00 for what we call a "princess shift" (just a 4.5 hour shift). um, no thank you, yet again.

please don't call tomorrow!

so very special

yesterday, in the middle of the day, as i was pacing around the nursing station, i saw two folks out of the corner of my eye. at first glace, i recognized them, but couldn't register who they belonged to. i meet SO many family members, so many caregivers, and tons of visitors. certainly, i can't keep them all straight. i'm lucky if i keep my patients straight! just kidding - sort of!

anyway, the two folks happened to be the parents of my friend and patient, jamie, who died two weeks ago. she and her family were from portland, so i couldn't fathom why they would be up here, in seattle and back on my unit. when i asked, i wished i hadn't. they drove from portland all the way to seattle to pick up their 29 year old daughter's ashes. what a horrible trip! what a horrible task.

with brave, tear stained faces all-around, we hugged. and exchanged thank you's. "thank you for being a wonderful nurse to jamie! you were one of her favorites." and my response - "thank you for allowing me to be a part of a very special time in your lives. i will never forget jamie. she is one of those patients, one of those people... so very special."

used up and cried out

i've had several hard days lately. this morning was no exception.

typically, i arrive to work at 6:45. i start getting paid at 7. i usually see my first patient by 8:00 - 7:30 if something is urgent. but today, my shift started with a bang. i was assigned 3 patients (we usually get two, three is our maximum). and one of them was to be sent, via cabulance, home to hospice at 9 AM. that's not very much time to complete all of the work that should have been done over the weekend to facilitate the process. my other two patients were typical - persistent nausea, chemotherapy, at least 20 morning meds each. of course, they both wanted showers and their linens changed at 8:30. but i decided meeting a dying mr. m and his family was more important. imagine how awkward it is to walk into someone's room, someone i have never met, and send them home to die only minutes later. it's strange. and hard.

but i did it. and i did a good job.

and when my job was done, i locked myself in the bathroom and cried.

mr. m is a 60 year old man. in 1999, he had a heart transplant. he and his family have known illness. they have known hospitals. and they've all known suffering coupled with courage. mr. m's transplant gave him 11 additional years, but they too were riddled with illness - with congestive heart failure and cardiomyopathy (the same diagnoses as my dad). and cruelly, due to one of the immunosuppressants mr. m has taken for 11 years now (to prevent rejection), he developed a lymphoproliferative disorder - a disorder that can be treated with stem cell transplant. mr. m and his family had hoped that yet another transplant - this time NOT a solid organ transplant, but a stem cell transplant - would prolong his life. would give him more years as a husband to his wife. and more years as a father to his son.

but since his admission (for a life threatening blood infection), he has gotten sicker, not stronger. his heart has gotten larger and boggier. his body has weakened, making it incapable of surviving chemotherapy and transplant. and so, with the support of his family and an amazing crew of palliative care doctors, mr. m made the courageous decision to change his goal of care from cure to comfort. what he wanted most was to go home, to be in a place of comfort, surrounded by family and love. and that is what i facilitated today. i helped a dying man complete his final wish.

sounds rewarding. maybe. but not so much.

really, it's just sad. mr. m was pale this morning. his breaths were labored. he was barely alert enough to nod his head yes or no when i asked if he was in pain. his family desperately wanted him to drink water and to swallow his pills. but i had to tell them his days of drinking and swallowing are over. oxygen tubing was in his nostrils. diapers hugged his emaciated body. fentanyl (a pain medication) seeped into his veins. and his eyes glazed over.

i didn't get to know mr. m. i never met him when he was healthy. i only met him during one of his most intimate and vulnerable moments. i supported his wife and his son through one of their hardest transitions. and it lasted only 2+ hours. mr. m and his family were out the door by 9:20 AM.

but you know what, i used up all my nursing energy in those 2+ hours. and i had very little kindness left for the rest of the day and for my two other patients. i felt used up. cried out.

and now i will go to sleep. rejuvenate. and do it all again tomorrow.