slavery

i've never thought of nursing as slavery.  but in a way, depending on how patients treat us, it could be considered a form of it.

i cared for a psychologist the last two days.  at first, i thought he was nice.  we had a thing or two in common.  he's a hiker and climber, a member of the mountaineers.  but after spending just a short amount of time with him, i realized this man is a control freak.  i am too.  i appreciate straight lines and tidy hand-writing.  if given the choice, i prefer doing things MY way.  but i don't believe i mistreat people because i am particular.  i know i respect other folks who do things for me.  i say thank you in a genuine tone when someone makes me my coffee or bags my groceries.

that was not the case yesterday.

this man HAD been very sick.  he was admitted for acute renal and liver failure related to a new diagnosis of lymphoma.  he had nearly died just a few weeks ago, hooked up to machines, getting dialysis.  in the blink of an eye, he lost his independence.  but just as quickly, he began to improve.  by the time i met him on thursday, he was just using a walker to ambulate.  but otherwise, he had regained most of his strength.  i do not know what his baseline personality was like, but his current personality is royally F%&**$#d up.

just some examples:

he asked me to tie his shoes.  so i did.  then he proceeded to say, "you know, normally i tie the loops a little bit tighter."  i asked if the shoes were too loose, if he felt like he would trip.  he said, "no, i just tie the loops in a tighter knot, so they don't untie."  WTF?  i really wanted to say, "you know, i've been tying my own shoes since i was four; i think i've got this covered!"

when he asked me for assistance in the shower, i agreed to walk him to the shower bench and to take off his compression hose.  they are a challenge.  but i was not about to help an independent 60 year old man bathe.  sorry.  i draw the line.  i agreed to standby, in his room, tidying his linens, so that i could help him dry his feet off (a task he may actually not be able to do independently).  but when he called for me and i entered the bathroom, he was sitting naked, with a washcloth on his junk.  once again, WTF?  his hands work.  why the hell didn't he put on his own gown?  gross!!!

just another example, i'd get him all situated in bed, call light in reach, water bottle in hand.  then i'd ask if he needs anything else and he would say "no, you're such a good nurse.  i have everything i need."  within 7 minutes, he'd call again and say, in a gross, commanding, dominating voice, "could you increase the heat, just the slightest bit!"  i would do that.  and leave ASAP.  but without fail, he'd call again, in less than 15 minutes for another irritating chore.  i swear to god, he just wanted me in his room all day, waiting on him hand and foot.  i don't get paid enough for that!

i'm embarrassed to admit it.  but i am reading fifty shades of grey.  it's a horrible book, promoting the concept of women as submissive to men (and sadly, i can't put it down, despite being a staunch feminist).  i couldn't help but feel like my patient was attempting to dominate me, like he thought i was his slave, his submissive.  only, there was nothing sexy about it!  i was irritated and grossed out ALL day.

Source: en.wikipedia.org via Lesley on Pinterest

smell

our senses are amazing.  all five of them.  but every now and then, i'm taken aback by one of them.

on monday, i cared for a 74 year old man.  he looked a bit more frail than his 74 years, hunched over a walker, pale and disheveled in hospital pajamas.  but he smelled dignified.  and in an instant, i was reminded of my grandfather.  who died more than 12 years ago.

i feel bad admitting this, but i don't think of poo (his nickname) that often.  and if so, it's more of a fleeting thought than a realistic, tangible memory complete with longing and ache.

as i left my patient's room and passed by his sink, i saw a familiar green bottle adorned with a gold cap and the signature polo emblem.  my grandpa used to wear so much polo cologne it was almost as if he bathed in it.  the "collector" that he was, his bathroom always had numerous green bottles.  it was the obvious, standard father's day, birthday, and christmas gift.  and i realized why my head was flooded with thoughts, taken back a decade in time.

all because of my sense of smell.  

Source: sephora.com via Jeremy on Pinterest

ACLS

i passed my ACLS class on friday.  we had a mock-code that i led and my patient survived after numerous shocks and the administration of many, many medications.  but i must say, i would still prefer that my patients not code on my watch.  mainly because my instinct is to let someone die.  but also, because codes are chaotic and stressful.  here's to never needing to use my ACLS skills! 

gummy bears

there have been too many hospital dates to count as of late!  this new man who is courting me (in and out of the hospital) is very nice.  and according to all of the ladies i work with, who have caught glimpses of him in the hallway, very attractive to boot.  hence, i am one lucky nurse.

but yesterday's hospital date was over the top.

last friday included a hand-delivered, made-perfectly-to-order coffee and a well-deserved break outside in the sun.  there are always smooches snuck in stairwells or hallways.  and typically one very giddy and cheery nurse returns to her unit, due past her allowed 15 minute break.  that's hard to beat!

but yesterday, yesterday was special.

the hospital man not only visited and brought ME treats, but also, he brought treats to my friend.  do men know that's the way to win over women?  to know and care for their friends?  hospital man brought me tootsie rolls and for my friend, M, he brought a small pack of gummy bears.  "cute," you say!  but it's more than cute.  it's special.  here's why:

M, is one of my bestest friends.  she's a nurse on my unit.  and crazily enough, she's had cancer and has had two stem cell transplants.  thank the good lord, she had a better outcome than the majority of my patients.  and she is now more than 7+ years out and in complete remission.  but her treatment left her in menopause and hence, infertile.

medicine is miraculous though.  and with the help of an egg donor (her sister) and lots of hormonal injections self-administered into her buttocks, IVF has made M pregnant.  two fertilized eggs were placed in her uterus in the hopes of implanting six weeks plus two days ago.  and TOMORROW! she will find out if she is pregnant with one or two "gummy bears."  you see, that's what M has called them - her potential children.  they're gummy bears.  and hospital man (who until yesterday hadn't even met M) knew about M and the gummy bears and was thoughtful enough to bring her a treat (and not just tootsie rolls - GUMMY BEARS!).  how freakin' cute is that?!?

keep M in your thoughts tomorrow.  and pray for the gummy bears.  1 or 2.  red, yellow, orange, green, or clear.  as long as they're healthy!

Source: google.com via Catalina on Pinterest

unhealthy lady parts

i had a mostly shitty day.  and it ended even worse than shitty.  i think i might have killed a baby raccoon.  i don't like animals that much; but i've never wanted to kill one.  and it didn't help that i was giving a ride home to a friend of mine and when i screeched on my brakes, she literally started wailing.  i didn't know humans could cry so instantaneously.  it was ridiculous. 

anyhoo, back to nursing.  i started my day with three patients today, all of whom were in their early 30s.  none of them were transplant patients.  they all had some sort of gynecologic cancer.

33 yrs old - cervical cancer with metastases to the lungs and abdomen.  i sent her home on hospice at 10:45.  i had never met her or her family.  but i had to discharge her, say goodbye, and wish her "peace."  i mean, seriously, what was i supposed to say.

31 yrs old - newly diagnosed ovarian cancer status post L ovary removal (in addition to an 18 pound mass that was removed from her abdomen) with an open abdominal incision draining lots of fluid

34 yrs old - breast cancer post op day +1 status post a L mastectomy with 2 bulb drains

i'm NOT a gynecology oncology nurse.  nor am i a post op nurse.  i was in over my head today.  and in over my heart.  i dislike caring for folks my age, especially women with gynecological cancer issues.  does it get worse than that?  could a woman be any more vulnerable?  i helped a 34 year old woman try on a bra for the first time since her entire left breast was removed; we looked at her scars together.  it made me sad.  and grateful for my health.

at 5:45 tonight, i admitted another patient.  a 39 year old male.  he's getting a transplant in 6 days.  he's too young too.  but at least i understand transplant patients.  and at least he doesn't have any unhealthy lady parts.   

holiday code

around 4:30 yesterday evening, there was a code on my unit.  i was hanging blood in a patient's room when i heard the irritating alarm sound.  it goes off frequently.  but more often than not, it's an accident. so we don't always take it seriously.  but when it kept sounding, i excused myself from my patient's room to check out what was happening.  

sure enough, someone was grabbing the code cart and running down the hallway.  when i got to room 12, i saw one of our patients looking gray and still; a woman whose room i had been in only hours before to help give a bedbath at which time she was alert and oriented, chatting with her children.  she was a bariatric patient (meaning she was large in size and required a ceiling lift to get her from a bed to a stretcher).  and apparently she coded during this transfer (i believe they were trying to get her downstairs for a CT of some sort).  the room was crowded by a cot (for her two daughters to sleep on), an oversized bed, AND a stretcher.  there was hardly any room for people, let alone a code cart.  CPR started.  commands were being yelled.  and in the midst of a code, i recognized a school friend of mine shouting orders (we went to high school together and she is now a fellow at UW, doing a rotation with heme onc); we made eye contact and she waved.  

there wasn't much for me to do in the way of helping.  there are usually TOO many people in a code situation.  lots of gawking and curiosity.  i like to make myself useful.  so when i saw her 21 and 22 year old daughters crying in the hallway, i got them folding chairs and kleenex (small gestures).  and brought liters of fluids be administered.  and saline flushes to push drugs.  i grabbed the doppler machine to find pulses (that never became present).  and chatted with a brand new nurse who had a dear-in-the-headlights look about her, as if she will never be the same after having worked this particular shift and having witnessed this situation.  

is it appropriate to say a code ended well, even if the patient died?  apparently, as CPR was being performed and life-sustaining efforts were being made, the family discussed that their mother would not want to be on life-support.  her longterm prognosis was poor.  and her quality of life had already not been good.  so with courage and great sadness, they gave permission to stop.  with the nod of a head and the words, "time of death..." a woman passed.  there were tears in the hall.  amongst family.  and one nurse.  the patient's nurse.  mine welled in my eyes, but never dripped down my cheeks.    

as a side-note to this already sad story, i couldn't help but be aware of the fact that the patient's nurse (who might i add carried herself very professionally) must be suffering in a big way.  it's always terrible to lose a patient; to have cared for someone so intimately and then to witness their death - especially when it is such a gruesome end.  but this nurse holds a special place in my heart.  i mentioned her earlier this year.  at eight months pregnant, she went into labor and delivered a dead child.  she held her tiny one in her arms, breathless and heartbeat-less, just a few months prior.  and as i assisted the nurse in post-mortem care, wrapping a lifeless body in plastic and sealing a human life in a body bag, i couldn't help but worry that the nurse would not be okay.  that she would go home and crumble.  that even though she is courageous, she may not be able to return to work.  because who can function after such great loss.  

my fourth of july was nice, up until the code.  and it ended in a nice way, after work.  but for a few hours, it sucked.  codes on the fourth of july are not good.

cancer lessons

The Things I Wish I Were Told When I Was 

Diagnosed With Cancer

-  by Jeff Tomczek, a 28 year old freelance writer who was diagnosed with leukemia at the age of 27.  He now has no trace of leukemia.  

Your relationships are about to change. All of them. Some will get stronger. They will probably not be with the people you would expect. The people you want to handle this well might not be able to for a variety of reasons. Some of the reasons will be selfish. Some of them will be entirely innocent and circumstantial. All of them will be forgivable because no one plans for cancer. Carrying bitterness or anger won't help your recovery. Fighting for anyone to stick with you won't cure you. Those who can, will. 

You will be determined to have more energy than you do. You will convince yourself that you are thinking straight, are able to handle all of this and do not need anyone. You will run out fuel. Your body will change first and your mind will follow. You won't lose your mind, memories or sensibility. It will all come back. But, you will be different. You will never have the same sense of self. You should embrace this. Your old self was probably really great. Your transformed self will be even better. Give into what is happening and trust it. 

You are going to feel fear. Even if you are normally stubborn, confident and seemingly invincible you will finally find yourself admitting that you are scared of something. Cancer is scary and incredibly confusing. The unknowing will eat at you worse than the disease itself. You'll need distractions. Music and sleep will probably be the ones you resort to most. Reading will become difficult. So will watching TV or movies, having conversations, writing and basically everything else. They call it "chemo brain" for a reason. You will feel normal eventually. Just a new kind of normal. When you feel afraid let yourself lean on those around you. Cry. Be vulnerable. You are vulnerable. There will be time for strength, but never admitting weakness will cause anxiety to mount and your condition to worsen. Let it all out. Yell if you need to. Sing when you feel up to it. Sob uncontrollably. Apologize for your mood swings. Treatments and prescriptions will often be the cause of them. The people that love you will understand. 

The people that love you will be just as scared as you are. Probably more. They will be worrying even when they are smiling. They will assume you are in more pain than you are. They will be thinking about you dying and preparing for life without you. They will go through a process that you will never understand just like they will never understand the process you are going through. Let them process. Forgive them when they don't understand. Exercise patience when you can. Know that those that were built for this will be there when you get to the other side and you will all be able to laugh together again. You'll cry together too. Then you'll get to a place where you will just live in the world again together and that is when you know that you have beaten this. 

The sooner you recognize that you are mortal, the sooner you can create the mentality for survival. There is a chance you might not make it. Just like there is a chance that you will. Don't look at statistics. You are unique and what is happening inside you is unique. Your fight is yours alone and there are too many factors to compare yourself to others that have had your condition. No one will want you to think about death, but you won't have a choice. You will think about it from the moment you are given your diagnosis. Come to terms with it. Calmly accept it. Then, shift every thought you have into believing that you won't die. You are going to beat this. Your mental focus on that fact will be more powerful than any treatment you receive. 

Your doctors and nurses will become your source of comfort. You will feel safe with them. If you do not feel safe with them you need to change your care provider immediately. There is no time to waste. This shouldn't be a game played on anyone's terms but yours. When you find the right caretakers you will know immediately. Do not let insurance, money or red tape prevent you from getting the treatment you deserve. This is your only shot. There is always a way. Find those hands that you trust your life in and willingly give it to them. They will quickly bring you a sense of calm. They will spend time answering your questions. There will be no stupid questions to them. They won't do anything besides make you feel like you are the most important life that exists. They will never make you feel like they don't have things in control. They will be honest and accessible at all times. They might even become your friends. You might celebrate with them over drinks months or years after they have cured you. They deserve your gratitude, respect and appreciation daily. If you get upset at them during treatment know that they'll forgive you. They get that you're going through something they can't imagine- but they understand better than anyone. They see it every day and they choose to be there because they want to make the worst experience of your life more tolerable. 

You will need to find balance after treatment. Start by seeking balance during treatment. Eat well. Sleep well. Listen to your body. Explore meditation. Experiment with new forms of exercise that aren't so demanding. Embrace massage and other body therapies. Go to therapy. A therapist will be able to guide you through your journey in ways you could never fathom. Do not be too proud to speak to someone. You cannot afford to store up the intensity of the emotion that comes with fighting a life-threatening illness. Let it out for yourself. You will begin to hear your voice changing. That voice is who you are becoming in the face of mortality. Listen to that voice. It will be the purest, most authentic version of you that you have ever known. Bring that person into the world -- strengths and vulnerabilities and everything between. Be that person forever. 

You will inspire others. It will feel weird. People you haven't spoken to since grade school will be in touch. Ex-girlfriends, former colleagues... even people you felt never wanted to talk to you again. The influx of interest in your seemingly fading life will be greater than any living moment you have ever experienced. That support is what will shift a fading life into a surviving one. Be grateful for every message. Be appreciative of each gift and each visit. There will be moments where all of this attention will make you feel lonelier than you have ever felt in your life. In a hospital room full of people with messages stuffing your inbox, voicemail and mailbox you will find yourself feeling completely alone. This is when you will realize that you could afford to have a stronger relationship with yourself. That only you walk this earth with 100% investment in you. Make the investment and use this as an opportunity to reexamine your self-worth. Love yourself more than ever and recognize how much love there is for you in the world. Then start sharing that love. You will come to see that even when you are the neediest person you know you can still be giving. Giving will make you feel better than taking. 

When you get to the other side you won't believe it. They will tell you the disease is gone. Everyone you know will rejoice and return back to their lives. You'll constantly wonder if it is coming back. Slowly this feeling will fade, but cancer will always be a part of you. It will define how you see the world moving forward. You're going to feel like the future is a funny thing to think about because the present is going to suddenly seem incredibly important. Keep moving. You'll be more productive. You'll understand who truly loves you because they will still be there. You'll want to meet new people that connect to the newly evolved version of your old self. You'll want to let go of those that don't "get" who you are now. You'll feel a little guilty doing it. Then, you'll move on. You don't have time to waste. The greatest gift you've been given is that you now understand that and you're going to make the most of every second. You're going to be the most passionate person you know going forward. Translate that passion to a greater purpose. Be fearless again.