heart vaca

haven't posted much lately.  not much to say.

as you might imagine, going to work after losing a patient whom i cared for for three months feels different.  i feel less motivated to work hard.  i kind of want to protect myself from getting close to anyone else, from losing any other amazing human beings.

timing in life is funny.  on may 19th, our hospital launched a new charting system.  it has changed MUCH of our practice.  and is taking A LOT of getting used to.  and in preparation for this change, i volunteered months ago to be an "expert," a super-user if you will.  which, if you knew me would make you laugh because i SUCK at all things computer.  but i took extra classes.  and volunteered to assist staff in the change.  so, for my last two 12 hour shifts, i've done NO patient care.  instead, i walk around the unit, asking nurses and physicians if they need help charting.  i re-write physician orders and serve as a liason between staff and the new computer system professionals who pace around out unit, expert in the computer system but oblivious to our unit and the way in which it functions.

in some way, sitting in front of a computer and helping healthy nurses chart (instead of caring for sick people struggling to survive) feels good.  it's kind of like a mini-heart vacation.  i wouldn't say i enjoy it.  it's kind of boring.  and lame.  and i'm not even that great at it.  but a heart vaca was in order.

so, thank you CPOE (computer physician order entry)!  

sympathy cards

"they lived and laughed and loved and left...  and the world will never be the same."

i have a favorite sympathy card.  there's an empty bench with a little red bird sitting on it.  it's simple.  and beautiful.  and expresses what i feel about loss just perfectly.  

and i sent it to nurse patient's family today. 

to husband, 18 year old daughter, and 13 year old daughter-

i cannot express in words how sorry i am for your loss.  

i feel so fortunate to have met and cared for nurse patient over the last few months.  work became a special place for me where i felt privileged to care for a much loved, respected, and brave woman.  despite being so sick and confined to the hospital (which often squelches peoples' true self), i feel like i got a glimpse into nurse patient's spirit.  undoubtedly, she was an amazing and courageous woman!  i so admired her strength and determination.  she fought with every ounce of her being.  and i know, beyond a doubt, if fighting and determination were enough, she would have waltzed out of the hospital, head held high, ready to face the world with her precious family.  unfortunately, health isn't solely determined by bravery, courage, and determination.  

work feels different without nurse patient's presence.  i will miss caring for her and being a tiny part of her world.  thank you for allowing me in to your family, for trusting me to care for your wife and mom.  watching you love and care for nurse patient was a beautiful, beautiful thing.  witnessing a bond so strong and a love so deep is a true honor.   i feel blessed and privileged to have known nurse patient and will forever remember her.  

please know you are in my thoughts and in my heart - today, tomorrow, and always.  

sincerely, 

christa 

prostitute

Source: someecards.com via christa on Pinterest

last week was sad.  i cried.  a bunch.

it just so happened to be nurse's week.  so we got giant, gooey cinnabon cinnamon rolls at work.  which pleased my belly.

and a friend sent me this.  and made me laugh.  out loud.  very hard.

what doesn't kill you

this has been a hard week.  i've felt all sorts of things.  and i've cried several tears.  so when my mom sent me a link to this video and told me to watch something about kelly clarkson, i kind of balked and decided to check it out another day.  then, my friend emma showed me the same video the next day.  and i wept.  i cried for little children everywhere who suffer from pain and illness.  for children who face death.  and for kids all around the world who are forced to be far braver than anyone should have to be.    i cried knowing that sometimes, no matter how brave, cancer doesn't always make you stronger.  sometimes it kills you.

(sorry to be negative/realistic; it's been one of those weeks)    

anyway, this is an AMAZING video.  kids are so strong.  and courageous.  and brave.  they have positive attitudes.  and rock baldness.  they inspire me.  

and the nurses that care for them are equally as AMAZING.

happy nurse's week!    

time of death

nurse patient died last night at 19:02 surrounded by friends and family.

the real goodbye

a few hours after i posted my last message, my friend, marian, called me from work. she's more than a colleague. she has become one of my best, most supportive friends. and she knows how i feel about nurse patient. that's why she called. i assumed that marian was calling to give me the same update that i had heard yesterday from my charge nurse friend - that nurse patient was starting dialysis, that she is getting sicker, and is now in multi-system organ failure. this in and of itself is bad news.

but today, there is more. marian called to tell me that nurse patient's husband and family have decided to withdraw care. what that means in laymen's terms is to "pull the plug," to take away all artificial life support and allow the body to slip away. i was shopping in eddie bauer when marian told me. i cried while pacing back and forth, blue dress in hand. i was not in shock. just utter disappointment. why did transplant fail nurse patient? why is she dying TODAY? when i am not only NOT at work. but when i had called in sick. because i am legitimately sick. and shouldn't be on my unit. "what should i do marian" i pleaded.

saying goodbye to a patient is hard. saying goodbye to their loved ones - harder. nurse patient would likely be sedated. i could squeeze her hand. say i enjoyed caring for her. admired her bravery and courage. that i will miss her presence. and because her eyes will be closed and there would be no response, it would feel almost safe. not easy, but not impossible. but to pay your respects to the living is beyond challenging. because there are NO words to heal that kind of loss. because everything sounds stupid. because loved ones can hear. and respond. because there are unconsolable tears. and silences. and sometimes there are questions that i have no answers to. but i knew i owed it nurse patient, to her husband (and family), and to myself to grieve and to say goodbye.

so i went.

and here i am.

crying at home.

sad.

the scene in nurse patient's room: nurse patient lying peacefully amidst a sea of pillows. her green and purple striped blanket hiding her swollen abdomen. tubes coming out of every orifice. a stuffed elephant to the left of her head and a stuffed pig to her right. a breathing tube protruding from her mouth. her husband cradling her body and stroking her head. her 18 year old daughter sitting nearby, but not too close, blowing her nose. her 13 year old daughter sitting in the corner, alone, crying. michelle, her best nurse friend, pacing back and forth at the foot of the bed. and her nurse, carolyn, charting at the computer.

all eyes were on me when i walked in. nurse patient's husband softened as we made eye contact. michelle looked at me kindly. carolyn (the nurse with whom i work) welcomed me into the room. i had nothing to say. so that's what i said. "i literally have nothing to say. i came to say goodbye. and to say how sorry i am that we cannot save nurse patient." her husband said, "isn't this a wild thing?!? [long pause] you don't have to say anything. just walking in the door says enough." i squeezed nurse patient's hand while sharing with nurse patient and her family that in the last three months, i have spent more time with her than i had with any other person in my life. that i have come to love nurse patient like a friend. and that i too feel devastated by this loss.

my heart was bounding out of my chest before i walked in the room. but somehow, once in there, i felt almost at ease and had plenty to say. i asked about the stuffed animals; nurse patient's oldest told me the elephant, babar, had been the patient's as a child. it became nurse patient's daughter's during her childhood and as we surrounded the bed, she picked babar up, put a paw in her mom's hand, and said "soak up all the love babar because you will forever remind me of her." i wept. i told nurse patient's daughters how brave they both were to be at the hospital, to support their mom during this time.

i stayed maybe all of 10 minutes. and when i decided to leave, i hugged each person individually. michelle i hugged mainly because she is losing her best friend AND because she is a nurse, just like me, and has likely felt this loss numerous times. when i hugged nurse patient's husband, he kissed me on the cheek and began to cry. he started to say that he can't thank me enough, that i made a huge difference in nurse patient's life. but i interrupted and said he need not say anything. i know he appreciates me; he so freely shared his gratitude on a daily basis and rejuvenated the loving nurse in me. my relationship with nurse patient and her husband likely ended today; but i left the door open and said if he EVER needs anything, he can find me on my unit. last but not least, i hugged her girls. i didn't want to make them feel awkward. but they both willingly stood up and we shared a three-person hug. i said, "i know i don't you very well. but i love your mom. and i am sad. i know she loved you. and i know you will be okay." the 18 year old let go rather quickly, but the 13 year old held on for dear life.

i cried as i exited the room. and waved to nurse patient's husband.

and that's that.

i will go to work tomorrow like everything is okay. there will be another patient where nurse patient lies now. her family will be beginning their grieving process. but mine, mine is supposed to be complete. they teach you in nursing school to have boundaries. to remain professional, you talk only about what is relevant to the patient and their care. you don't reveal information about yourself. the relationship should be one-sided. nurse nursing patient; never visa versa. but that's not what happens. that's not the way i nurse. in some way, nurse patient nursed me. she motivated me to come to work. to work hard. to love what i do and respect myself for a job well done. and i am proud to have developed a relationship with my patient. and i'd be happy to tell my nursing professors that my tears are not a sign of weakness or unprofessionalism, but instead, a sign of compassion and humanity.

dialysis and goodbye

i called in sick yesterday for today. i have some sort of respiratory infection. and although i feel healthy enough to go to work, it's out of respect for my patients that i am staying home.

i'm unlike most folks. i HATE calling in sick. i feel like if i am scheduled to work, i should work. no matter what. especially if i feel decent. and i do. but mostly, today i am sad that i am not at work because it is one more day that i am not with or near nurse patient and her husband.

when i spoke with the charge nurse yesterday, i asked how nurse patient is doing. rather non-challantly (because that's how most of us are on my unit about life and death - kind of blazay), she informed me that nurse patient is starting dialysis today. her kidneys have stopped working and without an external filtration system (to replace the function of the kidneys), she will die. sooner. it's hard to guestimate a person's timeline. but per my charge nurse and friend, she said by the weekend she would expect nurse patient to be gone.

i am scheduled to work tomorrow. and then, not again until monday. part of me is thankful that i was not nurse patient's nurse last sunday when she got intubated. then again, there is this small part of me that thinks maybe i could have helped avoid the intubation. or made it smoother. or encouraged her and her husband to snuggle one last time. or share heartfelt messages and goodbyes. then, there is this other part of me that wishes i was her nurse then. now. and when she dies. i feel a sense of control. like i might do it better. like she might feel safer to die under my care. and like her husband would be better supported (i recognize that i am under-estimating the staff with whom i work; they are all good and provide quality, kind, dignified care).

i think i need to go to work tomorrow. i need to say goodbye.

calm before the storm

my nurse patient has been in the hospital for 87 days. in those almost three months, i have cared for her almost EVERY day that i have worked. since i work 144 hours per month, i figured that i have been with nurse patient for approximately 432 hours. and when stated that way, i realized... i have spent more time with nurse patient than with any other person in my life since february. i live alone. i'm not a hermit. but there is not a single family member or friend that i have spent that much time with in recent months. hence, almost by default, nurse patient has become an important part of my life.

sunday night, i returned home from a weekend of snow camping. i walked in the door, began unloading my wet gear, and checked my email. i had 50 emails! the last one was from a friend and colleague i work with. we sometimes email one another with random personal updates. i hoped that she was emailing with news of her son or random gossip regarding a co-worker (who got knocked up, who is leaving our unit). but instead, it was a patient update. my friend and colleague recognized how important nurse patient has become in my life and wanted to update me before i walked onto my unit for a shift. in case i needed to cry. or process my feelings while at home.

over the weekend, nurse patient started to decompensate. her respiratory status became more and more compromised. she was struggling to breathe. and when you breathe too fast and too shallowly, carbon dioxide builds up in your system. the pH of your body changes. your mental status is effected. your kidneys get grumpy. and eventually, you poop out. anticipating this, the team of doctors working with nurse patient decided to pre-emptively intubate her. a planned intubation is always better than an emergent one. but it's also a horrible "elective" procedure. as a nurse, i HATE watching someone get intubated. i always feel this huge sense of sadness. a patient is losing their voice, possibly forever. i'm glad i wasn't there on sunday. i'm glad i didn't witness or hear any last words exchanged by nurse patient and her amazing husband. i fear they were the last words nurse patient may have spoken.

on monday, i had a 4 hour computer class at the hospital. it was not on my unit, but i stopped by to check in. i visited nurse patient and her husband. and as i walked in, i saw a big smile spread across nurse patient's husband's face, even through his mask! he was calm. gave me the update. and asked why i wasn't an intensive care nurse. i can no longer be nurse patient's nurse. i am not an ICU nurse. i avoid situation like nurse patient's. and although i think i am skilled enough to master the ICU skill set, i don't want to lose all of my patients. as is, i lose A LOT of patients. but once someone gets intubated, the outlook is much more grim.

i'm sad about nurse patient. last week i felt like she was making progress. i told her i was feeling optimistic for the first time. for the first time in months, i heard some spirit in nurse patient's voice as she talked to her daughters on the phone. her white blood cell count was increasing ever so slightly. and instead of feeling doom and gloom (which is my typical attitude), i had a glimmer of hope. it was strange and out of character. and honestly, on my way home, i wondered if this was the calm before the storm. sure enough...

not on my game

i'd like to think that i'm always a rockstar nurse. but honestly, some days, i'm just not on my game. yesterday i was ordered to give a medication that requires a pre level and a post level. the trough is drawn pre-administration of the drug and the peak is drawn post-administration. simple concept, right? a medication level in the system should be low prior to administration and high at its peak post administration. well, imagine my surprise when my peak came back the same as my trough. what the heck? how is that possible? does the patient metabolize the drug quickly? was the dose just too small to have an effect? nope. i forgot to give the damn thing! i hung the intravenous medication. but i forgot to unlock the clamp. hence, my patient got 100mL of saline. not antibiotic. i had to tell on myself to the pharmacist. he knows me. and he knows that sometimes i'm a rockstar. but not yesterday. like i said, i was not on my game. i blushed something awful! and my patient got her antibiotic late! p.s. i really hate the new blogger set-up. i can't figure out the layout and my returns are not working. this entry is NOT one big paragraph. i swear.