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."
Tuesday, May 31, 2011
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.
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.
Monday, May 30, 2011
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.
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.
Thursday, May 26, 2011
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.
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.
Sunday, May 15, 2011
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.
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.
Sunday, May 8, 2011
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!
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!
Monday, May 2, 2011
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).
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