the week with my dad

i haven't mentioned my favorite patient in a while. you may be scratching your head thinking, "geesh, she talks about nurse patient all the time!" but truly, my favorite patient always has been and always will be my dad.

we had quite an interesting week. i saw my dad more than usual. we had one spontaneous visit in the emergency room at the hospital. and one planned date on friday with a visit to his electrophysiologist followed by an all day adventure to mount vernon's infamous tulips! all in all, it was a good week i suppose.

let me back up a bit. since last year's bout of heart problems, my dad has been doing fairly well. there are always minor tweaks to his medications and bouts of gout that cause problems. there have been respiratory infections and antibiotics and steroid doses - all of which effect my dad's overall heart health and his labs (ie. his kidney function and fluid volume in his body). but to sum things up, he's been stable. and we've all enjoyed it! (which is why i haven't written about him in a while). until this week. on wednesday morning, my dad wasn't feeling well. for him to admit that, he must have been feeling fairly shitty! so in typical dad fashion, he got dressed, went to his restaurant, and completed his tasks before allowing my mom to drive him to the ER in what he thought was atrial fibrillation (an irregular heart rate). somehow, i beat them there and got him all checked in. it's sad, but i know my dad's medical history better than my own. and only because we walked out of there in about two hours, i can say it was a pleasant visit. we had a very kind, intelligent resident and without any interventions, my dad's heart rate dropped from the low 100s to his paced rate of 70 beats per minute.

friday's appointment was less thrilling. my dad's health is perpetually declining. and to hear from physicians that indeed he is sick is always a bit disappointing, terrifying, and sad. it's not that they flat out say, "he's sick and unwell." but they do call in the specialists. because my dad's heart rhythm is complicated by a heart attack, heart failure, arrhythmias, and a pacemaker/defibrillator that has faulty leads (yes, the company screwed up - only they can't really re-call wires that grow into one's heart muscle), anytime my dad comes in for some tweaking (as they call it), they call in the defibrillator representative to help make the adjustments. i've always known my dad is one in a million, but i'd prefer if he was normal and didn't need all these bells and whistles!

after his appointment and some changes to his medications, my dad and i filled the day with activities to fulfill me. we went to my coffee shop (where i hang out every day). and then drove to mount vernon. as always, there were talks about cars. i need a new one and there's nobody better than my dad to discuss the issue. but also, we talked about my life and some of my struggles. and for someone that i don't give very much credit to for being kind or thoughtful, he did a damn good job of listening to me talk and even cry. i felt very supported and am very appreciative. imagine my delight when i even convinced my dad to go to the lululemon outlet with me in burlington! it was like the icing on the cake; i was one happy camper.

white blood cells and neutrophils

imagine my surprise on monday morning when i logged into the computer to complete my daily routine - check labs, write down the day's medications, look up recent vital signs, read a physician's note - and instead of seeing a BIG FAT ZERO where the white blood cells are located and another BIG FAT ZERO where neutrophils should be, i saw numbers! for the first time since nurse patient's admission, i saw NUMBERS! nurse patient developed an immune system overnight. her blood was no longer composed of ONLY red blood cells and platelets and plasma (which are also low due to her disease and transplant). somewhere, circulating in her system, were a few white blood cells - a glimmer of an immune system! the first real glimmer of hope. of success. of possible life. nurse patient's physician's assistant got to tell her before i did; she beat me to sharing the good news. i guess the PA walked in while nurse patient was on the commode, half naked and vulnerable, and she shared the news right then and there. there were tears. nurse patient cried while on the toilet and the PA cried happy, celebratory tears in her yellow isolation gown, mask with plastic eye shield, and blue non-latex gloves. must have been quite the sight to see! the rest of the day was exciting. nurse patient had a bit more spark - still not liveliness, positivity, or enthusiasm. but more stubbornness, orneriness, and more spice (piss and vinegar my mom would say). here's to white blood cells and neutrophils!

christa's dating sitcom

i once crossed the street while breaking up with a boyfriend when i ran into the ex that literally broke my heart, swallowed up the pieces, and threw them to the curb. instead of acknowledging one another's presence with at least a smile of recognition, he pulled his raincoat hood up over his head, slightly covering his eyes, and walked by within inches of me - as if i never existed. the poor boy i was breaking up with at the moment... he thought i was devastated (when in reality, i've just never felt so awkward).

sometimes i wonder if my life should be turned into a sitcom. i think it would get good ratings. some very comedic things happen to me.

i date. i've had a few serious relationships. but really, it's not like i date A LOT. by no means am i some crazy party girl. i'm rather conservative and cautious. but seriously, i run into men i've dated ALL OVER the seattle area. and i hate it. sometimes i too hide. and other times i can't avoid the awkward hello.

recently, i was at the climbing gym with friends when a quirky little dude with curly hair and glasses came up to say hello. we had been out for coffee once. and although we shared two hours of conversation, i don't think either of us were too interested. we left things up in the air. i was supposed to get back to him after a trip to LA to plan a second date, and i let things fall through. so imagine my embarrassment when i ran into him while in spandex with friends from work...

last week, a similar thing happened. i was at a climbing gym in bellevue. i've never dated anyone in bellevue; i thought i was in the clear. but NO. there too, i ran into someone i knew - a rather nerdy gentleman i met last summer in my glacier climbing class. he was my age, balding, and from the czech republic. he pursued me, quite intensely, despite my disinterest. and i had to say NO at least four times to his efforts. even though i turned around the moment i saw czech boy (while i was climbing with a different guy friend), he found me moments later. and we ended up climbing in an awkward threesome for almost an hour!

this relates to nursing. in some crazy strange way. i promise. i hate when different worlds collide - when your work life gets tangled in your personal life.

nurse patient works with my ex-boyfriend's (the real heartbreaker) current girlfriend. i've known this from about day two of caring for her. in fact, there is a photo of aforementioned girlfriend in my patient's room. how weird is it that i get to see her face on a daily basis at work?

if that's not weird enough... follow this if you can. a friend of mine from work, V, her sister-in-law, is best friend's with ex-boyfriend's girlfriend AND with nurse patient. because V knows the entire saga, she has told her sister-in-law not to allow ex-boyfriend's girlfriend to visit on days that i work. and up until now, V's sister-in-law has avoided visits on shifts that i work too.

BUT... last week it happened. i walked into nurse patient's room and V's sister-in-law (who i recognize from photos) was sitting at the bedside. we made eye contact (and in that moment seemed to acknowledge the unspoken tension amongst all of us - because surely, nurse patient KNOWS too). before things could get too awkward, i introduced myself like a mature woman. but inside, i was dying! thanks to the yellow gowns i have to wear, no one could see the sweat stains. and thankfully, the dialogue in my brain has no volume and was kept just to myself. but really?!? must i run into friends of ex-boyfriend's girlfriends while taking care of nurse patient who is also friends with ex-boyfriend's girlfriend. that is too much coincidence if you ask me.

pray for me... that this week i do not actually see ex-boyfriend's girlfriend. then i might literally call ABC or NBC and ask if they need new ideas for a series!

mood lighting

this week, a nurse on our unit, as she was leaving her patient's room said, "is there anything else i can help you with?" to which her patient responded by grabbing her hand and placing it on his erect penis. her response, "i can't help you with that, but i surely will turn off the lights and give you some privacy!"

day off from nurse patient

for the first time in two months, i got to work today and did not have the nurse patient. she had been assigned to another nurse on my unit the two days prior and so, for his third day, it's not really fair to change his assignment. and to be honest, there was a tiny sense of relief in my heart knowing that i had one day off from caring for a very sick patient with whom i have become very close.

this evening though, her nurse asked me for assistance. he knew the patient trusted me and felt comfortable in my presence. so together we gently assisted the patient back to bed after an embarrassing mess was made. her respiratory rate had increased with the work of climbing into bed and in just moments, i could tell her health had severely declined since thursday when i cared for her last.

tomorrow, i will have the nurse patient. i requested for her to be "mine." and i'd be lying if i didn't acknowledge that in me there is a bit of worry that by tomorrow morning, nurse patient might be in the intensive care. that i may never get a chance to be her nurse again. that patients only survive so long without an immune system and with metapneumovirus, with multiple bacterial infections - gram negative rods and gram positive cocci resembling chains (that's how the lab talks about germs - crazy!).

not sure what i will find tomorrow morning, but i hope i find nurse patient in room 46... where she has been for months. and where she is "healthy" enough for my care.

manicure

when i became a nurse, i had no idea what i was getting myself into.

that's not totally true. before i went to nursing school, i volunteered in kolkata, india and saw some pretty gruesome and horrifying things. there were maggots crawling out of wounds and hiding under tissues; we played hide and go seek with tweezers for hours. and more than once i saw prolapsed uteruses hanging between women's legs (at the time, that sure confused me; i wasn't sure what i was looking at). sorry to be graphic, but it's true!

but in the US, i have not seen these things. perhaps it's because i am on oncology nurse. thankfully, we avoid maggots and uteruses in oncology. but i have seen and done some other strange things.

this week i was humbled by helping my patient with a manicure. imagine being so sick that you don't realize (or even care) that there are things under your nails even a gardener would cringe at. with delicacy, so as to avoid embarrassment, i told my patient it was time for some pampering (we HAD to do something about the poop situation under her fingernails). i filled a basin with hot, soapy water and grabbed a toothbrush (that i promptly threw out so as to NEVER be used in her mouth) so my patient could go to town. sadly, she didn't even have the energy to take care of business herself. So, i gave my first manicure. there was no polish. just 10 minutes of soaking, scrubbing, and "pampering."

some of my nurse friends and i always joke about being sick (we have to make light of the situations we see). we have promised one another that if one of us is dying, we will take care of the hairs on chins and keep lady parts clean. those two things are critical to one's dignity at the end of life. this week, i have added a new task to the important list. please, please - someone get the poop out from under my fingernails!

good day

i sent my nurse patient for emergency surgery last night. it's crazy. we avoid surgery like it's the plague during transplant. in fact, we avoid any invasive procedures... even simple ones like pricking patients' fingers for blood sugar checks. any damage to skin creates a porthole for infection to enter the system. hence, i was more than surprised! i was shocked. followed by insanely busy! when the decision was made.

within minutes of the consent being signed, i had phone calls from the OR wanting an extensive report. there were emergency platelets to order and administer to reduce the risk of bleeding. i had stat labs to draw, a type and cross to be sent in case of a need for blood transfusions. not to mention all of the other medications she needs on a daily basis that keep more than busy.

i left last night with a sense of doom. for the procedure, the nurse patient would get general anesthesia which requires intubation. with a risk of difficulty extubating (especially in someone with known respiratory issues - she has metapneumovirus, a common cold). because her body is not making it's own platelets, she is at a HIGH risk for bleeding - despite the three bags of platelets i administered. not to mention, her risk for further infection (she already has positive blood cultures causing fevers) increases with incisions and manhandling. nurse patient has ZERO immune system... and won't for at least two to four more weeks. so, in my doom and gloom mind, i envisioned an intubated nurse patient, bleeding out, and septic from infection to "greet" me in the AM.

but, to my surprise (and delight), nurse patient was a-okay this morning. aside from being pissed that her night nurse put a bed alarm on her so that every time she got up to use the commode, an alarm signaled (and it's incredibly loud), she was okay. in fact, she was better than okay. the pain caused by the infection that was drained during her surgery had decreased. and in the end, today was another busy, but good day.

keep the good days coming!

potentially lethal error

recently i have found lots of errors at work. sometimes they are minor. tums from the day before are still left at the bedside. an IV medication is hung an hour late. somebody is supposed to be NPO (nothing by mouth), but they eat breakfast. these errors can delay treatment or put a hiccough in the day. but unfortunately, i have found some larger errors lately too. yesterday was a BIG one. a potentially LETHAL error. made by a new nurse. and i can't help but be dumbfounded as to how much responsibility we have as nurses and how much potential we have to harm. i also can't get over the fact that this nurse passed nursing school, the NCLEX (our certification test), and 6 weeks of orientation on our unit.

during shift report, the off-going nurse was telling me about her night with nurse patient. i was logged into the computer, assessing her labs. when i saw a critically low blood sugar at midnight, i inquired. the nurse slowly revealed what had happened. not until minutes prior had she realized her mistake. here is what happened:

at 1926 on friday night, before i left, i checked nurse patient's blood sugar. it was 276. this is high. the night nurse said she would notify the doctor and get some insulin orders. so, i left. assuming all would be well. LESSON ONE: don't assume.

the night nurse was ordered to give 3 units of insulin. we have special insulin syringes. they are miniscule. 3 units is barely a measurable volume. however, the night nurse chose a regular syringe. instead of drawing up three units, she drew up 0.3mL of insulin. she delivered 10 times the ordered dose. LESSON TWO: use the correct syringe.

not until midnight labs did the blood sugar get checked again. at this point, the patient's blood sugar was 51. this is critical! night nurse re-checked the patient's blood sugars at 0158. the result was 60. still critical. at this point, the night nurse woke up the nurse patient and offered her juice. when night nurse asked nurse patient if she could re-check her blood sugar later, nurse patient refused. LESSON THREE: never let patient's refuse care that is for their safety. the protocol for low blood sugars is to re-check every 15 minutes until levels return to normal.

the next re-check was done more than 4 hours later at 0636. by this time, nurse patient's blood sugar had recovered. she was back up into the 200s (which according to the orders, meant she should be getting more insulin). the night nurse told me this and said she would give the patient 2 more units before she left. my response, "i don't think so. please do not touch the patient. i do not feel comfortable with your giving her ANY insulin. i don't trust your blood sugar assessment. and i don't want to give the patient ANY insulin at the moment, until we sort this mess out." LESSON FOUR: giving feedback to nurses may result in tears, but it is essential.

i took the new nurse into the medication room, showed her the two syringes, drew up 3 units and 0.3mL and asked her to compare the difference. she laughed (not quite the response i was looking for). concerned about my patient, i ended my teaching moment and decided to proceed with my day. i rechecked my nurse patient's blood sugar; indeed, it was elevated. so i told the doctor it was high but that i was refusing to do anything about it. high is better than critically low. i did not want to give any more insulin at the time. LESSON FIVE: communication with physicians is important. documenting that communication may be even more important - to protect your license. the night nurse never once documented that she notified the on-call physician of the patient's critical lab result.

until i suggested it, the night nurse was not going to write an incident report. LESSON SIX: when you fuck up, you acknowledge it. you write an incident report, not to get yourself into trouble, but to alert someone that the system is unsafe. that somehow, you were able to make a potentially lethal error. and it could happen again unless someone assesses the system and implements safety guards.

so help nurses and our potential to hurt people.

toes crossed

the cells are in! i gave a double cord blood transplant to nurse patient on friday. happy new birthday! 278mL of cells (that's less volume than a soda) were infused in less than 45 minutes. and they may potentially save my patient's life. keep your fingers (and your toes) crossed...