i work tomorrow. and tomorrow is the day before nurse patient's second transplant (we call it day -1). she will be getting two doses of radiation during my shift in preparation for the double cord blood transplant she decided to get- because although the risk of failure is higher, the possibility of engrafting comes earlier than had she waited for the german donor. and my patient is SICK. she KNOWS she is sick. and i worry that she is giving up - allowing medicine to control her instead of playing an important, motivated, and determined role. she's tired. and weak. and scared. and NEEDS for this to work. quickly.
i work friday too - her transplant day (we call it day 0, a new birthday of sorts). i will be infusing two bags of precious cord blood that two generous mothers donated to the world of cancer patients. and although i have NO control over how this scenario plays out, i feel a small sense of responsibility. i have cared for nurse patient every shift i have worked since february. we have formed a bond. and if this does not work out (which i fear), i will be devastated.
in some way, nurse patient motivates me to come to work. i feel like someone needs me. she and her husband feel safer when she is under my care. and i feel proud of my job well done. on monday evening, nurse patient's husband said to me, "christa, you are the best!" my response, "i enjoy caring for _ _ _ _ _. you make me want to come to work and do a good job. i only wish you were healthier!"
Wednesday, March 28, 2012
Friday, March 23, 2012
graft failure
ahhhhh. today is friday! and i am not working. yay for not working fridays!
i worked the last three days. and, as always, it was interesting. sad, challenging, frustrating, but interesting nonetheless.
here's the update (and an explanation about why my heart hurt this week): the nurse patient is sick. she is 34 days past her transplant date and she still has no white blood cells. what that means is, her transplant failed. we call it graft failure. and it is very rare. people die on our unit frequently; but it is rarely due to graft failure. deaths on our unit are due to infection and/or graft versus host disease. but the nurse patient's body did not accept her donor cells and because we killed her bone marrow permanently with HUGE doses of chemotherapy, she is incredibly vulnerable. very sick. and has high, high risks for mortality. her only chance at survival is a second transplant. and this is COMPLICATED.
this week, we had several lengthy meetings about the nurse patient's options - some with the patient, some without. what it boiled down to is a race against the clock. the longer the patient is without an immune system, the more likely she is to die of something (and it would be something stupid - like the common cold she has acquired - or a fungal infection). there is only one potential donor in the whole world and he is in germany. for some unknown reason, he is unable to donate until april 17th (which means the nurse patient would likely develop an immune system 2-3 weeks after the transplant date of april 17th). unrelated donors have high rates of graft versus host disease, but it is not a risky transplant - typically, people who get unrelated transplants at least engraft (except for in the case of nurse patient's unlucky first transplant). her only other option is to get a double cord blood transplant; these stem cells come from cord blood donated by delivering mothers. this type of transplant has a higher risk of graft failure, but the cells are ready NOW. nurse patient could get her cells within one to two weeks - which is great. BUT engraftment (developing an immune system) takes longer with cord blood transplant - anywhere from three to four weeks. so, what is the right decision?
nurse patient was presented with these options. there were very blunt discussions about her risk of dying before cells are made available to her. and she was told of all of the risks associated with each type of transplant and the race against time (remember, she is a pediatric transplant nurse - she KNOWS the risks). but the doctors could not sway her in any one direction. amongst the team of physicians, there was a 50:50 split. there is no conscensus. hence, the nurse patient had to make a decision all on her own. her husband, being a lay person, had very little advice or opinion on the matter. so, the weight of the world was on nurse patient's shoulders. she asked me what i would do and all i could do was be honest. i would cry. i guess i wasn't super honest. i think what i would do is pack up and go home to die. but as a mother of two teenage daughters, i guess nurse patient HAS to live. she has to chose one of the two scary options. and once she does, i told her she has to believe it is THE VERY BEST OPTION.
i worked the last three days. and, as always, it was interesting. sad, challenging, frustrating, but interesting nonetheless.
here's the update (and an explanation about why my heart hurt this week): the nurse patient is sick. she is 34 days past her transplant date and she still has no white blood cells. what that means is, her transplant failed. we call it graft failure. and it is very rare. people die on our unit frequently; but it is rarely due to graft failure. deaths on our unit are due to infection and/or graft versus host disease. but the nurse patient's body did not accept her donor cells and because we killed her bone marrow permanently with HUGE doses of chemotherapy, she is incredibly vulnerable. very sick. and has high, high risks for mortality. her only chance at survival is a second transplant. and this is COMPLICATED.
this week, we had several lengthy meetings about the nurse patient's options - some with the patient, some without. what it boiled down to is a race against the clock. the longer the patient is without an immune system, the more likely she is to die of something (and it would be something stupid - like the common cold she has acquired - or a fungal infection). there is only one potential donor in the whole world and he is in germany. for some unknown reason, he is unable to donate until april 17th (which means the nurse patient would likely develop an immune system 2-3 weeks after the transplant date of april 17th). unrelated donors have high rates of graft versus host disease, but it is not a risky transplant - typically, people who get unrelated transplants at least engraft (except for in the case of nurse patient's unlucky first transplant). her only other option is to get a double cord blood transplant; these stem cells come from cord blood donated by delivering mothers. this type of transplant has a higher risk of graft failure, but the cells are ready NOW. nurse patient could get her cells within one to two weeks - which is great. BUT engraftment (developing an immune system) takes longer with cord blood transplant - anywhere from three to four weeks. so, what is the right decision?
nurse patient was presented with these options. there were very blunt discussions about her risk of dying before cells are made available to her. and she was told of all of the risks associated with each type of transplant and the race against time (remember, she is a pediatric transplant nurse - she KNOWS the risks). but the doctors could not sway her in any one direction. amongst the team of physicians, there was a 50:50 split. there is no conscensus. hence, the nurse patient had to make a decision all on her own. her husband, being a lay person, had very little advice or opinion on the matter. so, the weight of the world was on nurse patient's shoulders. she asked me what i would do and all i could do was be honest. i would cry. i guess i wasn't super honest. i think what i would do is pack up and go home to die. but as a mother of two teenage daughters, i guess nurse patient HAS to live. she has to chose one of the two scary options. and once she does, i told her she has to believe it is THE VERY BEST OPTION.
Wednesday, March 21, 2012
dear heart
Source: bitsotruth.blogspot.com via christa on Pinterest
my heart hurts today. and it's too tired to comment. but just know, sometimes i wish i didn't care. that would be easier.
Monday, March 19, 2012
i quit fridays
last friday, i had a shitty day. i almost cried at work. i swear, fridays are bad. always. i should never work fridays.
in the last year, we have hired approximately 20 new nurses. that means, on any given day, the floor is staffed with a mix of experienced nurses AND brand new nurses. but most of the time, the majority of nurses are NEW. and that means, often, i am one of, if not, THE most experienced nurse. and that is scary. i am confident in my skills. and i can mutli-task. but i cannot handle every situation. and certainly, i do not want to handle ALL of the hard situations, ALL of the time. but, so be it...
last friday, of the fourteen nurses staffed, i was one of two nurses that had three patients (everyone else has one (if in the ICU) or two (if on the floor)). i often get three patients, because i can handle three patients just fine. but typically, a three patient assignment is a mix of "healthy" patients; they can care for themselves, take oral medications, and perhaps, are close to being discharged from the hospital. not my three patient assignment.
i had a relatively stable patient (my nurse patient) who needs lots of emotional support (more on that later), a woman who had been discharged from the ICU a few days prior and needed the assistance of two people to get in and out of bed, and a surgery patient who is bedbound, with a naso-gastric tube, and at least 4 pressure ulcers. to add insult to injury, all three patients were in isolation - two in droplet (for respiratory viruses) and one for MRSA (a skin infection i'd rather not contract). that means, to complete any task in any of my patients' rooms, i had to gown up in a yellow plastic gown, where gloves, and for two of the three, don a mask over my mouth and nose. i was a sweaty mess in no time...
i knew as soon as i saw my assignment, i would have a shitty day. the isolation alone makes it challenging. you can't zip in and out of rooms; when one patient calls, you have to de-gown, wash hands, and re-gown. it adds time and inconvenience. but the intensity of the three patients together was totally inappropriate. the charge nurse, instead of offering help or suggesting a change in the assignment, did nothing. and i grew angrier by the minute. i had a surgeon yelling at me on the phone, a patient crying about her failed transplant, and a sick, vulnerable man, in need of turns and complicated wound care - that when eventually performed with the assistance of another nurse too more than 90 minutes!
i can't put the day into words. unless you're a nurse on my unit and get the insanity of the assignment, you won't understand how busy i was. but let's just say, i didn't chart a single thing until after 2PM. i got a twenty minute lunch break and nothing else in my 12.5 hours. and i checked my email only ONCE to verify my plans for the evening (i often check my email numerous times during a shift). i had at least 3 nurses offering assistance (which is great, but when you're so swamped, it's hard to even figure out what, how, and when to delegate). and everyone knew i was the busiest and most stressed out.
i hate fridays. most people love them. but i swear, i never want to work another friday again. i quit fridays.
until the 30th when i am scheduled to work another one!
in the last year, we have hired approximately 20 new nurses. that means, on any given day, the floor is staffed with a mix of experienced nurses AND brand new nurses. but most of the time, the majority of nurses are NEW. and that means, often, i am one of, if not, THE most experienced nurse. and that is scary. i am confident in my skills. and i can mutli-task. but i cannot handle every situation. and certainly, i do not want to handle ALL of the hard situations, ALL of the time. but, so be it...
last friday, of the fourteen nurses staffed, i was one of two nurses that had three patients (everyone else has one (if in the ICU) or two (if on the floor)). i often get three patients, because i can handle three patients just fine. but typically, a three patient assignment is a mix of "healthy" patients; they can care for themselves, take oral medications, and perhaps, are close to being discharged from the hospital. not my three patient assignment.
i had a relatively stable patient (my nurse patient) who needs lots of emotional support (more on that later), a woman who had been discharged from the ICU a few days prior and needed the assistance of two people to get in and out of bed, and a surgery patient who is bedbound, with a naso-gastric tube, and at least 4 pressure ulcers. to add insult to injury, all three patients were in isolation - two in droplet (for respiratory viruses) and one for MRSA (a skin infection i'd rather not contract). that means, to complete any task in any of my patients' rooms, i had to gown up in a yellow plastic gown, where gloves, and for two of the three, don a mask over my mouth and nose. i was a sweaty mess in no time...
i knew as soon as i saw my assignment, i would have a shitty day. the isolation alone makes it challenging. you can't zip in and out of rooms; when one patient calls, you have to de-gown, wash hands, and re-gown. it adds time and inconvenience. but the intensity of the three patients together was totally inappropriate. the charge nurse, instead of offering help or suggesting a change in the assignment, did nothing. and i grew angrier by the minute. i had a surgeon yelling at me on the phone, a patient crying about her failed transplant, and a sick, vulnerable man, in need of turns and complicated wound care - that when eventually performed with the assistance of another nurse too more than 90 minutes!
i can't put the day into words. unless you're a nurse on my unit and get the insanity of the assignment, you won't understand how busy i was. but let's just say, i didn't chart a single thing until after 2PM. i got a twenty minute lunch break and nothing else in my 12.5 hours. and i checked my email only ONCE to verify my plans for the evening (i often check my email numerous times during a shift). i had at least 3 nurses offering assistance (which is great, but when you're so swamped, it's hard to even figure out what, how, and when to delegate). and everyone knew i was the busiest and most stressed out.
i hate fridays. most people love them. but i swear, i never want to work another friday again. i quit fridays.
until the 30th when i am scheduled to work another one!
Monday, March 12, 2012
hooky
i'm playing hooky today. and although i am thoroughly enjoying myself, i feel terribly guilty. i was raised catholic and this guilt thing really gets in the way of having a good time! i decided i deserved a day off. i've been working extra hard lately and after having been away all weekend, i wanted a day to myself.
this is what i am recovering from...
climbing beside my instructor, matty p, at playground point in leavenworth
rappelling down a cliff after a hairy sit-and-spin maneuver
my mountaineering boots and a figure eight with a back up knot - amazing that this little knot holds me!
this is what i am recovering from...
climbing beside my instructor, matty p, at playground point in leavenworth
rappelling down a cliff after a hairy sit-and-spin maneuver
my mountaineering boots and a figure eight with a back up knot - amazing that this little knot holds me!
Wednesday, March 7, 2012
nurse patient
*** WARNING***
this post may include what sounds like bragging. pardon. but i like/need to remember the few compliments i receive for the days i feel like crap and hate my job.
i've now taken care of the nurse patient for thirteen 12 hour shifts. that is 156 hours (that is more time than i've spent with anyone else in the last month). in 156 hours, i have administered a lot of IV antibiotics. flushed liters of chemo toxic urine. infused bags of blood and platelets. and shared many a meaningful conversations with a mom, wife, daughter, and nurse. she's more than just my patient; she's human. and she is vulnerable.
hence, getting a compliment from the nurse patient means a lot. not just because she is a nurse. but because in thirteen 12 hour shifts, this patient has likely seen me at some of my best AND my not-so-best nursing demonstrations. case in point - the other day i was teaching a new nurse how to complete a blood draw. i did all the tasks i was supposed to do prior (flush with 9cc of saline, waste 9cc of blood, attach a vacutainer, blah, blah, blah) and all of the tasks i am supposed to do post (detach the vacutainer, flush with 9cc of saline, reattach the IV, all the while keeping everything sterile). however, i forgot to draw the stupid vial of blood. idiot! i was so embarrassed! i could only laugh at myself, turn blood red, and repeat the steps - this time remembering the critical part!
anyhoo, despite my mistakes, my nurse patient likes me. it's not really a secret. she has requested that i be her nurse every time i come to work. she knows my schedule. but we don't always talk a lot during a shift. she simply trusts me and appreciates my punctuality. i make her a priority when she feels sick. and i kneel at her bedside so i don't tower over her when we are talking - so we can talk like equals.
last night, at 7:05PM when i was anxious to give report on my three patients and get the hell out of the hospital, i was still in my patient's room, cleaning her hickman (central line) and administering nausea medications. as i finished my tasks and said good night, my nurse patient said to me, "christa, you are a damn good nurse. you do good things for the world."
i went home feeling less tired, less stressed, and a bit lighter. my head was held higher and my heart a bit warmer. it feels good to do a hard job well.
this post may include what sounds like bragging. pardon. but i like/need to remember the few compliments i receive for the days i feel like crap and hate my job.
i've now taken care of the nurse patient for thirteen 12 hour shifts. that is 156 hours (that is more time than i've spent with anyone else in the last month). in 156 hours, i have administered a lot of IV antibiotics. flushed liters of chemo toxic urine. infused bags of blood and platelets. and shared many a meaningful conversations with a mom, wife, daughter, and nurse. she's more than just my patient; she's human. and she is vulnerable.
hence, getting a compliment from the nurse patient means a lot. not just because she is a nurse. but because in thirteen 12 hour shifts, this patient has likely seen me at some of my best AND my not-so-best nursing demonstrations. case in point - the other day i was teaching a new nurse how to complete a blood draw. i did all the tasks i was supposed to do prior (flush with 9cc of saline, waste 9cc of blood, attach a vacutainer, blah, blah, blah) and all of the tasks i am supposed to do post (detach the vacutainer, flush with 9cc of saline, reattach the IV, all the while keeping everything sterile). however, i forgot to draw the stupid vial of blood. idiot! i was so embarrassed! i could only laugh at myself, turn blood red, and repeat the steps - this time remembering the critical part!
anyhoo, despite my mistakes, my nurse patient likes me. it's not really a secret. she has requested that i be her nurse every time i come to work. she knows my schedule. but we don't always talk a lot during a shift. she simply trusts me and appreciates my punctuality. i make her a priority when she feels sick. and i kneel at her bedside so i don't tower over her when we are talking - so we can talk like equals.
last night, at 7:05PM when i was anxious to give report on my three patients and get the hell out of the hospital, i was still in my patient's room, cleaning her hickman (central line) and administering nausea medications. as i finished my tasks and said good night, my nurse patient said to me, "christa, you are a damn good nurse. you do good things for the world."
i went home feeling less tired, less stressed, and a bit lighter. my head was held higher and my heart a bit warmer. it feels good to do a hard job well.
Tuesday, March 6, 2012
dog slippers
i had a patient last week who had these fuzzy, woolly slippers. curious about their origin (they looked handmade), i inquired about them. i wish i hadn't. i learned they were made of her friend's dog's fur. i don't like dogs. and i don't like dog fur on my patients' feet.
Friday, March 2, 2012
no balls
i took care of a young patient yesterday. she has a history of substance abuse use and somehow, we thought giving her a transplant was a good idea. i would never suggest that an addict doesn't deserve or shouldn't get a transplant. but certainly, it's a challenge. i would say the majority of our patients end up on anxiolitics (used for nausea prevention and anxiety) and narcotics (for bone pain, abdominal pain, mouth pain, etc.). and of course, these drugs are in high demand amongst users and get a pretty penny on the streets.
it would be one thing if this young gal had a good support system. but she doesn't. she has a boyfriend who is non-compliant with our hospital's rules. and as the nurse, i was told to watch my patient swallow ALL of her medications so that he doesn't steal them. even then, i wasn't sure things were happening appropriately at all times. patients can pocket meds in their cheeks for quite some time. but instead of checking my patient's mouth after she swallowed, i decided that if her loser boyfriend was desperate enough to steal half dissolved narcotics from a cancer patient he supposedly loved and cared for, so be it. i almost wished he stole all of her meds (including stool softeners) and gave himself a raging case of diarrhea!
the most interesting part of my day with her yesterday was when her bronchoscopy was cancelled. we were supposed to do a rather invasive procedure at the bedside. i was to give her boatloads of medication to sedate her and pulmonologists (lung doctors) were going to stick a camera down her nose and throat and into her lungs. for four hours prior to the procedure, she was supposed to abstain from food or drink. but the physicians caught her eating a bite of mac 'n cheese. instead of telling her right then and there that the procedure was cancelled, we went along with our plans... she and i both thought the procedure was a go at 4pm. at 4:10 though, the physicians walked in the room and called it off. i was ready with LOTS of drugs in hand and the patient was "ready" as ever. so when they called it off, she got PISSED! to say the least.
there were four letter words. she called the doctors "lazy" and said they "didn't care," that they "must have better things to do." but in reality, the cancellation was for her safety. she didn't understand the severity of having food in her belly. she didn't know that she could vomit, aspirate, and cause even more difficulties for her already damaged lungs. the doctors tried to explain the rationale to her, but she was NOT listening. i've gotten some courage in my almost 6 years of nursing. so i stepped in and tried to help explain the matter, defending the two doctors at my side. but it didn't work. as the doctors walked out of the room, recognizing that there would be NO resolution to her anger, my 22 year old patient yelled after them, "what is your name anyway? you have NO balls!"
i've witnessed some interesting interactions between patients and physicians. i've participated in strange conversations between patients and nurses. but this was the icing on the cake! i would not tell a physician he had no balls (to his face). especially when the procedure was re-scheduled for this morning and he would be sticking a camera down my throat!
it would be one thing if this young gal had a good support system. but she doesn't. she has a boyfriend who is non-compliant with our hospital's rules. and as the nurse, i was told to watch my patient swallow ALL of her medications so that he doesn't steal them. even then, i wasn't sure things were happening appropriately at all times. patients can pocket meds in their cheeks for quite some time. but instead of checking my patient's mouth after she swallowed, i decided that if her loser boyfriend was desperate enough to steal half dissolved narcotics from a cancer patient he supposedly loved and cared for, so be it. i almost wished he stole all of her meds (including stool softeners) and gave himself a raging case of diarrhea!
the most interesting part of my day with her yesterday was when her bronchoscopy was cancelled. we were supposed to do a rather invasive procedure at the bedside. i was to give her boatloads of medication to sedate her and pulmonologists (lung doctors) were going to stick a camera down her nose and throat and into her lungs. for four hours prior to the procedure, she was supposed to abstain from food or drink. but the physicians caught her eating a bite of mac 'n cheese. instead of telling her right then and there that the procedure was cancelled, we went along with our plans... she and i both thought the procedure was a go at 4pm. at 4:10 though, the physicians walked in the room and called it off. i was ready with LOTS of drugs in hand and the patient was "ready" as ever. so when they called it off, she got PISSED! to say the least.
there were four letter words. she called the doctors "lazy" and said they "didn't care," that they "must have better things to do." but in reality, the cancellation was for her safety. she didn't understand the severity of having food in her belly. she didn't know that she could vomit, aspirate, and cause even more difficulties for her already damaged lungs. the doctors tried to explain the rationale to her, but she was NOT listening. i've gotten some courage in my almost 6 years of nursing. so i stepped in and tried to help explain the matter, defending the two doctors at my side. but it didn't work. as the doctors walked out of the room, recognizing that there would be NO resolution to her anger, my 22 year old patient yelled after them, "what is your name anyway? you have NO balls!"
i've witnessed some interesting interactions between patients and physicians. i've participated in strange conversations between patients and nurses. but this was the icing on the cake! i would not tell a physician he had no balls (to his face). especially when the procedure was re-scheduled for this morning and he would be sticking a camera down my throat!
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