some people, their lives just couldn't get any worse...
we have a patient. he had a transplant more than 2 years ago. it worked. he had some quality time. he retired. he travelled the world with his wife. he lived life, in case it didn't last much longer. until sure enough, this year, he relapsed.
he arrived on my floor more than 6 weeks ago with a positive attitude. he needed ANOTHER transplant. this time however, he got VERY sick. he had a respiratory virus that compromised his respiratory function to the point he needed to be intubated and ventilated (essentially, he was on life support). he got dialysis when his kidneys stopped working. and we all thought he would die.
but, he persevered. his family remained by his side. he fought. he got extubated. he's doing his physical therapy. and occupational therapy. and speech therapy. and swallow therapy. but he's not "healthy" enough to transfer to rehab quite yet. his health, although still compromised and susceptible, is getting better. his life was improving.
until thursday evening. when his wife returned home from a day at the hospital to find their 23 year old son unconscious, unresponsive, not breathing. she did CPR until the paramedics came. and she rode with her son in the ambulance, to the same hospital her husband nearly lost his life just weeks before. after resuscitation, medications, and dozens of tests, it was discovered that the 23 year old boy had no brain activity. his overdose had caused multiple organ failure. there was no hope for recovery.
on friday afternoon, a stoic and feeble, man - my patient - protected his immune system with a gown, gloves, and mask and was wheeled off my unit and onto another to say goodbye to his only child. at 4:30 PM, care was withdrawn. life support was stopped. and the 23 year old boy died. before his father. before his grandparents.
i'm not sure life gets much worse.
Saturday, April 9, 2011
Thursday, April 7, 2011
um, no thank you.
it's my day off and still i cannot escape work! i got a call at 6:23 AM to see if, just by chance, i wanted to come in for my 9th shift out of 11 days. um, no thank you. but thanks for the wake up call.
oh, and just in case i didn't get the message... i got another desperate call around noon, this time interrupting my book reading at starbucks. would i like to come in at 3:00 for what we call a "princess shift" (just a 4.5 hour shift). um, no thank you, yet again.
please don't call tomorrow!
oh, and just in case i didn't get the message... i got another desperate call around noon, this time interrupting my book reading at starbucks. would i like to come in at 3:00 for what we call a "princess shift" (just a 4.5 hour shift). um, no thank you, yet again.
please don't call tomorrow!
Wednesday, April 6, 2011
so very special
yesterday, in the middle of the day, as i was pacing around the nursing station, i saw two folks out of the corner of my eye. at first glace, i recognized them, but couldn't register who they belonged to. i meet SO many family members, so many caregivers, and tons of visitors. certainly, i can't keep them all straight. i'm lucky if i keep my patients straight! just kidding - sort of!
anyway, the two folks happened to be the parents of my friend and patient, jamie, who died two weeks ago. she and her family were from portland, so i couldn't fathom why they would be up here, in seattle and back on my unit. when i asked, i wished i hadn't. they drove from portland all the way to seattle to pick up their 29 year old daughter's ashes. what a horrible trip! what a horrible task.
with brave, tear stained faces all-around, we hugged. and exchanged thank you's. "thank you for being a wonderful nurse to jamie! you were one of her favorites." and my response - "thank you for allowing me to be a part of a very special time in your lives. i will never forget jamie. she is one of those patients, one of those people... so very special."
anyway, the two folks happened to be the parents of my friend and patient, jamie, who died two weeks ago. she and her family were from portland, so i couldn't fathom why they would be up here, in seattle and back on my unit. when i asked, i wished i hadn't. they drove from portland all the way to seattle to pick up their 29 year old daughter's ashes. what a horrible trip! what a horrible task.
with brave, tear stained faces all-around, we hugged. and exchanged thank you's. "thank you for being a wonderful nurse to jamie! you were one of her favorites." and my response - "thank you for allowing me to be a part of a very special time in your lives. i will never forget jamie. she is one of those patients, one of those people... so very special."
Monday, April 4, 2011
used up and cried out
i've had several hard days lately. this morning was no exception.
typically, i arrive to work at 6:45. i start getting paid at 7. i usually see my first patient by 8:00 - 7:30 if something is urgent. but today, my shift started with a bang. i was assigned 3 patients (we usually get two, three is our maximum). and one of them was to be sent, via cabulance, home to hospice at 9 AM. that's not very much time to complete all of the work that should have been done over the weekend to facilitate the process. my other two patients were typical - persistent nausea, chemotherapy, at least 20 morning meds each. of course, they both wanted showers and their linens changed at 8:30. but i decided meeting a dying mr. m and his family was more important. imagine how awkward it is to walk into someone's room, someone i have never met, and send them home to die only minutes later. it's strange. and hard.
but i did it. and i did a good job.
and when my job was done, i locked myself in the bathroom and cried.
mr. m is a 60 year old man. in 1999, he had a heart transplant. he and his family have known illness. they have known hospitals. and they've all known suffering coupled with courage. mr. m's transplant gave him 11 additional years, but they too were riddled with illness - with congestive heart failure and cardiomyopathy (the same diagnoses as my dad). and cruelly, due to one of the immunosuppressants mr. m has taken for 11 years now (to prevent rejection), he developed a lymphoproliferative disorder - a disorder that can be treated with stem cell transplant. mr. m and his family had hoped that yet another transplant - this time NOT a solid organ transplant, but a stem cell transplant - would prolong his life. would give him more years as a husband to his wife. and more years as a father to his son.
but since his admission (for a life threatening blood infection), he has gotten sicker, not stronger. his heart has gotten larger and boggier. his body has weakened, making it incapable of surviving chemotherapy and transplant. and so, with the support of his family and an amazing crew of palliative care doctors, mr. m made the courageous decision to change his goal of care from cure to comfort. what he wanted most was to go home, to be in a place of comfort, surrounded by family and love. and that is what i facilitated today. i helped a dying man complete his final wish.
sounds rewarding. maybe. but not so much.
really, it's just sad. mr. m was pale this morning. his breaths were labored. he was barely alert enough to nod his head yes or no when i asked if he was in pain. his family desperately wanted him to drink water and to swallow his pills. but i had to tell them his days of drinking and swallowing are over. oxygen tubing was in his nostrils. diapers hugged his emaciated body. fentanyl (a pain medication) seeped into his veins. and his eyes glazed over.
i didn't get to know mr. m. i never met him when he was healthy. i only met him during one of his most intimate and vulnerable moments. i supported his wife and his son through one of their hardest transitions. and it lasted only 2+ hours. mr. m and his family were out the door by 9:20 AM.
but you know what, i used up all my nursing energy in those 2+ hours. and i had very little kindness left for the rest of the day and for my two other patients. i felt used up. cried out.
and now i will go to sleep. rejuvenate. and do it all again tomorrow.
typically, i arrive to work at 6:45. i start getting paid at 7. i usually see my first patient by 8:00 - 7:30 if something is urgent. but today, my shift started with a bang. i was assigned 3 patients (we usually get two, three is our maximum). and one of them was to be sent, via cabulance, home to hospice at 9 AM. that's not very much time to complete all of the work that should have been done over the weekend to facilitate the process. my other two patients were typical - persistent nausea, chemotherapy, at least 20 morning meds each. of course, they both wanted showers and their linens changed at 8:30. but i decided meeting a dying mr. m and his family was more important. imagine how awkward it is to walk into someone's room, someone i have never met, and send them home to die only minutes later. it's strange. and hard.
but i did it. and i did a good job.
and when my job was done, i locked myself in the bathroom and cried.
mr. m is a 60 year old man. in 1999, he had a heart transplant. he and his family have known illness. they have known hospitals. and they've all known suffering coupled with courage. mr. m's transplant gave him 11 additional years, but they too were riddled with illness - with congestive heart failure and cardiomyopathy (the same diagnoses as my dad). and cruelly, due to one of the immunosuppressants mr. m has taken for 11 years now (to prevent rejection), he developed a lymphoproliferative disorder - a disorder that can be treated with stem cell transplant. mr. m and his family had hoped that yet another transplant - this time NOT a solid organ transplant, but a stem cell transplant - would prolong his life. would give him more years as a husband to his wife. and more years as a father to his son.
but since his admission (for a life threatening blood infection), he has gotten sicker, not stronger. his heart has gotten larger and boggier. his body has weakened, making it incapable of surviving chemotherapy and transplant. and so, with the support of his family and an amazing crew of palliative care doctors, mr. m made the courageous decision to change his goal of care from cure to comfort. what he wanted most was to go home, to be in a place of comfort, surrounded by family and love. and that is what i facilitated today. i helped a dying man complete his final wish.
sounds rewarding. maybe. but not so much.
really, it's just sad. mr. m was pale this morning. his breaths were labored. he was barely alert enough to nod his head yes or no when i asked if he was in pain. his family desperately wanted him to drink water and to swallow his pills. but i had to tell them his days of drinking and swallowing are over. oxygen tubing was in his nostrils. diapers hugged his emaciated body. fentanyl (a pain medication) seeped into his veins. and his eyes glazed over.
i didn't get to know mr. m. i never met him when he was healthy. i only met him during one of his most intimate and vulnerable moments. i supported his wife and his son through one of their hardest transitions. and it lasted only 2+ hours. mr. m and his family were out the door by 9:20 AM.
but you know what, i used up all my nursing energy in those 2+ hours. and i had very little kindness left for the rest of the day and for my two other patients. i felt used up. cried out.
and now i will go to sleep. rejuvenate. and do it all again tomorrow.
Wednesday, March 30, 2011
110%
there are some patients on our unit who have been there for months; it must seem like lifetimes to them. some of those patients are a pleasure to care for; they are sick - but independent, kind, and fun to be around. and of course, sadly, there are some longterm patients that you just don't want to care for. they are SUPER sick, dependent on others for every and all tasks, and often emotionally draining.
on sunday night, before the worst schedule in my nursing career, (monday, tuesday, thursday, friday, monday, tuesday, wednesday - 12 hour shifts), i secretly hoped to myself that i would have a good assignment. "please, pretty please, don't let me have room 2." sometimes i feel like i just don't have it in me to work hard; i don't have the physical, but mostly the mental, capacity to give 110% - to give a very sick and needy patient all the care and kindness that they deserve.
sure enough, monday morning finds me with two longterm-ers. the first is E - a 32 year old female from canada. she has two children thousands of miles away. her first transplant failed. she has spent 50+ days in the hospital. celebrated a birthday. had multiple infections. and is now getting chemo AGAIN for transplant #2. she is a joy to care for. we're approximately the same age. she's sarcastic and fun. and although she is SICK, with no white blood cells (hence no immune system and highly susceptible to germs), she is independent - what we nurses call a walky-talky.
my second patient... well, not so walky-talky. my patient lives in room 2. literally. lives. he has been in the hospital for more than 2 months. his transplant didn't go as planned either. he developed severe mucositis which compromised his airway. he coded. they did chest compressions. they broke ribs. and he survived on a ventilator for weeks. he is now recooperating. breathing on his own. but that's about all he can do independently. he needs help turning in bed to prevent pressure ulcers. he needs help ordering food from the cafeteria and feeding himself once it has arrived. he has tubes in orifices. needs to be cleaned up frequently. has pain issues. and because of his complex course and stent in the ICU, he is not quite back to baseline. he is emotional and needy. he's 43. and sad. he cries all the time. and needs a nurse's very best - their 110%.
and to my surprise, despite my lack of faith in myself, that is what i gave. my very best. my 110%.
life has been everything but perfect for me in the last few months. sickness has plagued my family. i've spent more time at the hospital than residents in their first year. heartache has been a regular friend to me. but despite my exhaustion and emotional overload, i took good care of the patient in room 2. dare i say it, i even enjoyed my two days with mr. H. i'd like to say that i always give 110%. but to be honest, i don't. i can't. it's not sustainable. but it sure feels good to deliver.
on sunday night, before the worst schedule in my nursing career, (monday, tuesday, thursday, friday, monday, tuesday, wednesday - 12 hour shifts), i secretly hoped to myself that i would have a good assignment. "please, pretty please, don't let me have room 2." sometimes i feel like i just don't have it in me to work hard; i don't have the physical, but mostly the mental, capacity to give 110% - to give a very sick and needy patient all the care and kindness that they deserve.
sure enough, monday morning finds me with two longterm-ers. the first is E - a 32 year old female from canada. she has two children thousands of miles away. her first transplant failed. she has spent 50+ days in the hospital. celebrated a birthday. had multiple infections. and is now getting chemo AGAIN for transplant #2. she is a joy to care for. we're approximately the same age. she's sarcastic and fun. and although she is SICK, with no white blood cells (hence no immune system and highly susceptible to germs), she is independent - what we nurses call a walky-talky.
my second patient... well, not so walky-talky. my patient lives in room 2. literally. lives. he has been in the hospital for more than 2 months. his transplant didn't go as planned either. he developed severe mucositis which compromised his airway. he coded. they did chest compressions. they broke ribs. and he survived on a ventilator for weeks. he is now recooperating. breathing on his own. but that's about all he can do independently. he needs help turning in bed to prevent pressure ulcers. he needs help ordering food from the cafeteria and feeding himself once it has arrived. he has tubes in orifices. needs to be cleaned up frequently. has pain issues. and because of his complex course and stent in the ICU, he is not quite back to baseline. he is emotional and needy. he's 43. and sad. he cries all the time. and needs a nurse's very best - their 110%.
and to my surprise, despite my lack of faith in myself, that is what i gave. my very best. my 110%.
life has been everything but perfect for me in the last few months. sickness has plagued my family. i've spent more time at the hospital than residents in their first year. heartache has been a regular friend to me. but despite my exhaustion and emotional overload, i took good care of the patient in room 2. dare i say it, i even enjoyed my two days with mr. H. i'd like to say that i always give 110%. but to be honest, i don't. i can't. it's not sustainable. but it sure feels good to deliver.
leg
just thought i'd write an update about patient B, the orthopedic surgeon. he is now a "below the knee amputee."
(isn't that horrible? we often define people by their diagnoses or misfortunes. the diabetic in room 2. the schizophrenic lady in room 64. medicine is cruel.)
anyway, patient B's colleagues decided that saving his life was more important than saving his leg. his "stump" (again, not a very nice description or technical term) is still open, ravaged by infection. and sadly, he is still fighting for his life. on a ventilator, unaware of his loss, he is trying to survive.
patient B has already lost his leg; let's hope he does not lose his life too.
(isn't that horrible? we often define people by their diagnoses or misfortunes. the diabetic in room 2. the schizophrenic lady in room 64. medicine is cruel.)
anyway, patient B's colleagues decided that saving his life was more important than saving his leg. his "stump" (again, not a very nice description or technical term) is still open, ravaged by infection. and sadly, he is still fighting for his life. on a ventilator, unaware of his loss, he is trying to survive.
patient B has already lost his leg; let's hope he does not lose his life too.
Friday, March 25, 2011
my patient and friend - jamie
i could have written this post on monday, after i learned that my patient passed away. but for some reason, i haven't been able to write. i don't know what to say.
i met jamie in november of last year. i began caring for her prior to her transplant and continued to care for her long after. she had several admissions to the hospital. her first visit was about a month long - chemo, transplant, mucositis, pain, infection. her transplant course was never uncomplicated. her subsequent visits were for more infections, for infusions of granulocytes, immunoglobulin. she returned with respiratory issues - lung nodules. sadly, her first transplant failed. her 29 year old feisty body did not accept her donor cells and hence, jamie never regained an immune system. infection after infection, complication after complication, riddled her weakened body. but never once did jamie lose her spirit, her optimism, or her sense of humor. she always had a smile to share. even on saturday, when i admitted her to uw one last time.
it's strange, almost every time jamie got re-admitted to the hospital, i was her nurse. it's like the powers above assigned me to her care. we enjoyed one another. it was easy to care for jamie - even when she was critically ill - because her pleasant demeanor and sarcasm made my shift enjoyable. i'd like to hope that jamie enjoyed my presence too; i'd like to think that she felt safe and cared for when i was her nurse.
jamie was sent via ambulance from seattle cancer care alliance to uw for low blood pressures and fevers. the report i received over the phone from the nurse made her sound sick, but not critical. i was not worried about the admission or her safety; instead, i was looking forward to catching up with what felt like an old friend. upon arrival though, i recognized that jamie was sick - very sick. her oxygen saturation was low. she was breathing rapidly, hungry for air. her blood pressures were low, despite fluid boluses. and her heart was racing. but even then, jamie smiled.
i settled jamie in to uw for a few hours, before my shift ended. we got more fluids ordered, antibiotics hung. she went down for a chest x-ray. an ekg was performed at the bedside. blood and platelets were ordered. potassium was being replaced. after just a few hours of work, i felt like i had done my best nursing care. i had thought of every last thing - even the little details. a commode chair by the bedside with toilet paper within reach (so that she wouldn't have to walk the extra steps to the bathroom). a stash of her favorite fruit punch gatorade. non-skid socks to prevent falls.
and despite my every effort (and the fantastic nursing care that followed me), jamie coded that evening. her young, tired body decided to stop working - it had been through TOO much. the team of nurses and doctors did all they could - they intubated her and got her heart to start beating again. amazing drugs increased her blood pressure. machines kept her alive. until her wonderful family was able to be at her bedside. on monday, with courage and bravery, jamie's family watched her take her last breaths. with borrowed strength from their daughter, they said goodbye. tears were shed. smiles upturned. stories and memories shared. it sounded beautiful - it was not all sadness. those that knew jamie could not mourn her loss without celebrating her beauty. aunt b (jamie's amazingly kind relative) says it best on jamie's caringbridge page:
I would like to take this opportunity to thank everyone for all your love and support of Jamie these last months as she has literally fought for her life. Your words of love and encouragement kept her strong. Unfortunately, the cancer prevailed. We lost our sweet Jamie on Monday March 21st with her family and friends surrounding her. To those who could not be there to say goodbye, she knew how much you cared.
Jamie amazed those around her (especially the medical staff) with her strength, stamina, and positive spirit to the end. I know I speak for all of us who love her when I say that she will be greatly missed.
We love you Jamie, you have truly touched many lives and we are better people because of you. Thank you for that. You will be in our hearts forever.
Goodbye sweet Jamie
Aunt B
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