terrible horrible no good very bad day

i had a terrible horrible no good very bad day on thursday. do you remember that book? anyway, in the midst of running around like a chicken with my head cut off, i got a phone call from our secretary who said in her very pleasant, calming voice, "christa, your daddy is at the front desk!" i didn't care that i was in the midst of admitting a new patient who needed five kinds of chemotherapy while on my shift, drawing blood from a 19 year old with a hematocrit of 19, and caring for the VIP nurse patient who has requested me to be her personal nurse. i dropped all tasks and zipped to the front desk. just seeing my cute little dad pacing at the front desk made my day. his demanding that we walk down 5 flights of stairs despite his cardiac disease and new flare of gout in his foot (making walking painful and hobbly) only made me laugh and love him more. he is one of the most stubborn people i have ever met. and i take right after him!

Source: imremembering.com via Jocelyn on Pinterest

horrible tragedy

lots of bad things happen at my job. we have more deaths on our unit than any other unit in the entire hospital. but rarely do horrible things happen to people with whom i work.

last night, a horrible thing happened to a colleague. i almost can't think of anything more terrible. a mom-to-be called in sick last night for her shift today because she was in the hospital. one would think, with only three to four weeks until her delivery date, that she was delivering early. perhaps everything would be fine. premies born just a few weeks prior to their due date are typically a-okay. but this poor woman called in sick and had bad news to report. somehow (and i don't know the details and cannot fathom the situation) she lost her baby.

nurses on my unit cried. some of us tried to figure out scenarios in which this tragedy could happen. other were too stunned and shocked to speak. i came home last night and felt out of sorts, more so than usual. i felt devastated for this nurse (and to be honest, i don't care for this woman - we do not get along and i do not think highly of her nursing abilities). but i would not wish this loss on my worst enemy. when i thought about why i was aching so badly, i decided it's because i am an empathetic person. it's my blessing and my curse. i feel for others so much that sometimes i hurt when others hurt.

you know, my job is sad. but typically there is warning before someone's demise. illness precedes death on my unit. but this loss feels more tragic because instead of preparing for a challenge with the possibility of a bad outcome (as patients do prior to transplant), pregnancy prepares mothers for blessings, for change, for ten wiggly toes and soft-as-a-baby's-bottom skin.

i left work last night with a new appreciation for labor and delivery nurses. my dear friend emma used to work on the labor and delivery unit in my hospital. we always used to joke about how our jobs are so different, almost polar opposites - she brought little ones into the world and i assist older ones out. but sometimes, i guess our jobs aren't that different. we don't like to acknowledge it, but sometimes nurses, nurses like emma, have to do my job too. sometimes little ones pass. and i am so sorry for my colleague that they do.

an honor

at 7:45 AM today, after i had already received report on all three of my patients and started planning my day, the charge nurse sat down beside me and said something like, "we have a dilemma." that's never a good way to start your day. but it turns out, it was an honor to be a part of the dilemma. the nurse patient that i cared for last week asked the nurse assigned to her for today if it was possible that i care for her instead - in essence, do a patient switcheroo. so, despite being incredibly annoyed and frazzled for a bit, i switched my assignment. and two nurses were happy. my patient got me, and i got a compliment (another one).

feedback

i think as a whole most people are pretty bad at feedback. i don't know why but i find that the people i work with are horrible at giving both positive and negative feedback. this is stupid. shouldn't it feel nice to give someone a compliment? and shouldn't negative feedback be given so we all are aware of our weaknesses and have the ability to work on them?

recently, i got report from a new grad. she's been a nurse on my unit for less than 4 months. but her report at the end of her shift is superb. she paints a perfect picture for me so that there are no surprises when i walk into my patient's room. i know what is going on and feel prepared for my day. not to mention, loose ends are taken care of. the room is stocked, my patient is comfortable, charting is complete. all in all, it's great to pick up a patient from her. so i told her. and i hope i made her day - gave her a bit of self-confidence and motivation to keep working hard.

last week, i called an attending and asked if i could give her some feedback. let's get some things straight here. attendings are head honchos. they have been doctors for years and have worked their way up the ladder. they are in charge of other physicians; considered experts in their fields. but that doesn't mean they are perfect! and it certainly doesn't mean they are exempt from feedback. but my guess is that attendings don't get feedback very often, let alone from a nurse. but i called to tell her that i felt that as a patient's nurse i should be included in discussions of prognosis and family conferences. she had just told my patient that her cancer is VERY aggressive and there are no more options for her. in essence, she told my patient she was going to die - soon. but she didn't have the thoughtfulness or the decency or the foresight to include me or recognize that i would be walking in to the tears and the questions and the what-if scenarios. she didn't take to my feedback very well. she said, "are you new around here?" as if only a new nurse would be so stupid as to question an attending.

yesterday i received feedback. and it felt great. i've been caring for this patient for the last three days. she is an experienced oncology nurse. and although that heightens my anxieties about doing things perfectly, i cared for this patient as i care for all of my patients. and as i said goodbye last night, she said in a serious tone, "you really are a fabulous nurse!" when you work really hard and invest more than just your time and energy, sometimes your whole heart, positive feedback recharges you in a way that keeps you going.

fun fact

some nurses go their entire careers without giving blood transfusions. i, on the other hand, work with a patient population who requires transfusions VERY, VERY frequently. chemotherapy kills cancer cells, but also, destroys/stunts the body's ability to make red blood cells, white blood cells, and platelets. so, we give them to our patients thanks to other people's generous donations. in 2011, my unit gave 5,784 blood products! here is the breakdown of products in case you are interested:

red blood cells - 2,504
platelets - 2,985
fresh frozen plasma - 253
cryoprecipitate - 17
granulocytes - 25

patient quote

direct quote from patient:

"shitting is like dying. when you've got to go, you've got to go. but you never know when it's going to happen!"

best thing i heard all day.

downward spiral

last week at work we lost 7 patients in 8 days. it all started with that code that i participated in. from there, it was a downward spiral. i don't know what, if anything, i want to say about it. except that i think it's the worst week we've had on our unit - maybe EVER. thankfully, i didn't know all of the people who passed away.

one person in particular was very special; he had had his transplant over two years ago. over the course of his transplant life, i had cared for him numerous times. several admissions and several discharges. he was kind and fun; he spoke with a spanish and gay accent (not sure which was stronger!). he and his partner had been together for more than 17 years and their love was special and long-lasting (and this week could now be recognized with a marriage in washington, yay!).

sadly, this much-loved patient was admitted on new year's eve. he arrived in his new year's eve underwear (red boxer briefs with decorative hearts worn only once per year for over a decade). he had fevers and his blast count was through the roof (blasts are immature white cells that essentially mean your cancer is back with vengeance). while being treated for infection, the patient developed a horrendous fungal infection. mostly we see fungus in people's lungs; and although he had fungus there too (which by itself can be deadly), the new fungal infection took over his skin. he had lesions all over his body. at first they started out benign - like acne. but they grew and spread and became discolored. soon, he was in pain and oozing all over.

now, i've seen MANY people die. and in india and at bailey boushay (hospice for folks with AIDS), i saw some really atrocious things. but never before have i seen a death so devastatingly ugly and miserable and disfiguring. somehow, this amazing man outlived his prognosis. but this last weekend, my patient lost his battle. actually, i hate that vocabulary. he didn't LOSE anything. people who are cured from cancer don't WIN. everyone who gets cancer gets royally FUCKED (excuse my language). and everyone i know with cancer fights like hell. WIN or LOSE - it's totally out of a person's control. this patient WINS in my book, because he died without regret. with loved ones by his side. and having done everything in his power and within his control to stay positive, optimistic, and invincible until the very end.