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.