assholes

for the last two days, i've taken care of a very kind gentleman. he is sick and weak. and he is a dentist.

being the judgmental person i am, i assumed he would be smart, inquisitive regarding his health, and perhaps a bit arrogant. i don't know why. but sadly, that's my perception of physicians. i don't like caring for medical professionals. we make bad patients!

but he was none of the above. he thanked me for every last task, despite being in pain and feeling miserable. he called me sweetheart (which i actually hate and think is disrespectful of my age and professionalism - but that's another story), i think in a kind tone. and my day with him was pleasant.

his wife however. she was a different story. a total nightmare. seriously, i wanted to shoot her. thankfully, she only arrived at 5:00 pm - so i had just 2.5 hours with her. but honestly, she may have been the most annoying person i've cared for.

her husband returned from a procedure quite sedated. he needed to be transferred from a stretcher to the bed. and she sat and watched us, commenting every 2 seconds, accusing us of almost dropping him (which we didn't), reminding us to be careful of his leg (duh, i've spent the last two days with him helping him out of bed and transferring him. i know he's in pain. and i'm not going to be careless and intentionally hurt him), and asking why i needed to do certain things i was doing (like log-roll him over soiled sheets to protect his skin from laying in shit). i can't make this lady sound annoying enough. i cannot describe the tension in the room. the other nurse i had in there with me to help just kept looking at me with this look, like "really, is she being so inappropriate?"

the worst comment...

eventually i helped the dentist to the commode. when he was finished, i helped him stand and proceeded to clean his backside. she said, "i would offer to do that, but you got training for this, right? i mean, you get paid to do this after all!" i could hardly contain myself. "really, you think i went to nursing school to learn how to wipe butts?"

i don't get paid enough. i don't mind wiping behinds. if i ever need help cleaning myself, i'll be thankful to have a nurse that does so gently and with respect. it's not the ass-wiping that makes nursing challenging, it's the assholes i sometimes deal with! (excuse my language).

lessons from a patient,

the patient was ME.

yesterday, i was a patient AGAIN. and can i just say, what a strange experience! that role reversal feels so weird.

without going into graphic details, let's just say, i had some polyps removed from a private place. and it required general anesthetic. i'm fine. all is well. "a forest of polyps" was removed and i should be good as new.

but wow! how weird to be in a gown, with my hiney sticking out. with an IV in my arm. with drugs fogging my brain and blurry vision taking over the room. an hour or two of my life went by without my awareness. people poked and prodded me. a machine breathed for me. and i woke up to a quivering jaw and chattering teeth.

being inquisitive and curious, i asked all sorts of questions, even in my drugged stupor. how did i respond to the sedation? am i a light-weight, as i expected? did i have any irregular heart rhythms while i was being monitored? did that annoying beeping mean that my oxygen saturation was low? "no, please don't give me demerol for my extreme shakes. i will be fine, eventually." "did someone let my mom and friend know that i am okay?' i'm such a chatterbox, even when sleepy and drugged.

but i learned, AGAIN, that i don't like being a patient. medicine and procedures, nurses and doctors, gowns and needles make people feel extremely vulnerable. the nurse didn't really soothe my anxiety; she did not explain everything that was going on. everything felt a bit rushed. before i knew it, before i could ask all my questions, i was OUT, three sheets to the wind.

on a regular basis, i walk into a patients room expecting that my patients KNOW what i am doing... certainly they've had chemotherapy before. of course they've had a blood transfusion. this far along in their treatment, they must be familiar with blood draws and IV antibiotics. right? WRONG!

my patients deserve more from me. they deserve more thorough explanation. they deserve to have ALL their questions answered. they deserve to feel safe and confident in their care. they deserve my best, each and every day, each and every time i walk in their door. here's to better nursing in my future....

timing is everything

once again, this is not nursing related...

it's mountain related.

but i just felt the need to share a little snippet of news regarding mount rainier. the bushwhacker class i took offered two mount rainier trips. somehow, despite wanting to be on the second trip (with a teacher i preferred and dates that suited my work schedule better), i ended up on the first one - the holiday weekend. as aforementioned, we summitted! all 8 of us pushed our bodies to the limit. and it felt incredible. and, hopefully without sounding cocky, can i just say - i still just can't believe i did it! i had the opportunity to fly OVER mount rainier this last weekend when returning from boise and it's just SO massive.

but...

i just heard from a friend who was on the second trip. and sadly, they did not summit. they started their climb with amazing weather. things were going fine. the snow was in good condition, they were making good time. and then, at 12,700 feet, one of the climbers got AMS - acute mountain sickness. nausea, vomiting, headaches, weakness - not good symptoms to have on a 45 degree slope with crampons your feet! the entire team had to turn around.

of course, as a nurse and just plain old caring person, i would have been concerned about the climber's health. i would have offered water. food. any medications i had in my emergency kit (advil, tums, and immodium!). but also, i would have been incredibly disappointed. sad. angry even. it would have been my second failed attempt. and although i knew it was a possibility and i would have dealt with it, i am SO, SO, SO thankful that i did not have to experience that turn-around, that "failure," that non-summiting experience.

timing is everything. someone or something greater than myself made my summit possible. the stars were aligned. i was with the right group of people. the conditions were great. my body worked that day, when it might have not on a different one. and i summited rainier. sometimes luck plays such a big role in life - i feel so lucky!

mount rainier

i've tried to keep this blog thing to mainly work-related, nursing things. then, my dad got sicker in the last year and i broadened my topics to all health-related issues, even if they were personal. but i have something to report that is not related to nursing and is only loosely related to health (if you call carrying a 50 pound backpack, sweating like crazy, pooping in a stinky outhouse, and achieving a personal goal 'health').

drum roll please.....

after a very long and round-about journey, i summited mount rainier this last weekend. on july 2nd, at about 10:15AM, i stood on top of a mountain that i have looked at my entire life.

i am not sure when this goal came about. i've always loved staring at mount rainier as i cross i-90. one of my favorite things about traveling to far away destinations is coming home to seattle to be welcomed by the green surroundings, lake washington, the puget sound, and the many mountains that make up my state. but rainier, really? why did i have to choose to summit the tallest mountain in washington? is it because i am crazy? determined? or truly passionate about climbing mountains?

in the last several years, i have become more adventurous, outdoorsy even. i have dated a few boys that challenged me to do new things. three summers ago, i camped for the very first time. i sort of liked it. i think that summer i spent 3 nights in a tent – they were the only 3 nights i’ve spent outdoors ever, in my whole life, until this summer. a few months after that boy, i held my first ice ax with a different boy. we tried to look cool, but neither of us really knew what we were doing or how to use an ice ax safely. i did however stand on some cool peaks (mailbox, granite, mount barring, and naveho de toluca in mexico) - which, i guess you could say, "piqued" (get it?!?) my interest in hiking. dare i say climbing!

but this rainier thing came about two years ago. after some serious soul-searching, i made a bucket list. it included some random life goals (learn to ride a bicycle, shave my head, and run a half marathon). but i also created a plan for the year 2010 – the year i would turn 30. i jokingly dubbed the year "the year of christa” and it turned into just that – a year to celebrate myself! i spent time and money on healing and growing, and challenging myself to prove that i am strong, capable, and independent.

i went to bali with my friend kate. we spent one week doing yoga twice daily and eating the most glorious meals at a beautiful resort. i went to therapy more often than i’d like to admit. and i got massages. i exercised to clear my mind and to strengthen my body. and i started hiking to prepare myself for the biggest goal of all – to summit rainier. in january of 2010, i committed myself to mount rainier by signing up with alpine ascents for a guided late season, september climb. it would be a three day adventure unlike any before.

but for those of you that know me and have been following my blog, you know the year didn’t transpire as planned. my rainier goal was left unaccomplished when i over-trained and wound up hospitalized just one week prior to my climb. with severe muscle breakdown in both my arms and hugely elevated liver enzymes, it was impossible to attempt the climb. the doctors broke the news on the first of my five days in the hospital. i cried. and felt angry. but mostly, i wondered if i could have done it – if given the chance, my body would have carried me to the 14,410 foot summit.

september was disappointing to say the least. i went from being insanely active and healthy (and proud of myself to boot), to slug-like and almost embarrassed by my failure.

my nepal trip came quickly though and thoughts of rainier were put on hiatus. instead of summiting a 14,410 foot mountain, the himalayas brought upon a different challenge. a 10 day trek was a different kind of adventure - it would be walking, not climbing. my team consisted of mostly adults in their 50s and 60s. and instead of feeling like a huge challenge and lifelong personal goal, it felt doable and safe. we did hike to over 16,000 feet and after having not been able to attempt rainier, getting above rainier's elevation felt pretty damn exciting. but it was different. it was not rainier. i was not in washington. tserko ri was not the mountain i look at daily; it was not the summit i was shooting for.

so, when i returned to washington in november, i thought long and hard about attempting rainier a second time. did i really want to commit myself to the same goal? the previous year, truly every day involved some sort of training - whether it was physical or mental. and it was hard. i wasn't sure if i had had fun or if i was just hugely driven and worked really hard. my biggest fear and hesitation in trying again was whether or not i could handle another potential let down? another failed attempt? an unsummitted mountain... could i train smarter, less intensely, and more safely? could i have fun? and still be proud of myself if i didn't make it?

instead of signing up with a guide company, i decided, while in the midst of a very sad break-up and my dad's many hospitalizations, that i should take a glacier climbing class. a course would provide me with more knowledge of glacier climbing and provide me some opportunities to hike and climb with a new community of people interested in the same things. but i was NOT committing to THE MOUNTAIN. in the back of my mind, i knew the opportunity would present itself. but signing up for the bushwhacker climbing class was NOT as stressful and intimating as committing to climbing mount rainier. it felt safe.

the classes started in may. every tuesday i learned new knots and knew vocabulary words. i went on hikes with my backpack to "train." but i didn't take it to the extreme; i didn't train like it was my job. i felt that no matter how hard i trained, i had it in me to keep up with my team. and for once, i attempted to adopt the attitude - "if i didn't have it in me, and i couldn't do it, oh well!" i tried to be low-key and to keep my expectations realistic. but when the opportunity arose to join a team on rainier, i jumped! i signed up immediately. i still felt the NEED to climb rainier. i couldn't let that mountain beat me AGAIN; i couldn't let last year's attempt be my only attempt. i am NOT a quitter.

since this has quickly turned into an auto-biography, i will cut the rest of the story short. but suffice it to say, climbing mount rainier was by far, the hardest thing i have ever done. it was both a physical and a mental challenge. i carried a 50 pound backpack up 5000 feet to our base camp at camp schurman. i wore crampons and used an ice ax while roped to my team members. i spent three nights snow-camping, eating dehydrated foods, and going to the bathroom in a vile outhouse. i woke up at 1 in the morning on summit day, started climbing at 2:20 AM via headlamp, and climbed 5000 more feet to the summit of rainier by 10:15 AM. my own two little legs stepped one foot in front of the other when my mind told me it was impossible, that it was too steep, that it was not humanly possible to go on. and i cried when i got to the summit. i cried tears of joy, pride, and utter exhaustion. i cried not only because i made it to the summit, but because i achieved a personal goal. and there had been many obstacles. not just the crevasses i had to jump over...

i had thought "the year of christa" was done when 2011 started. but "the year of christa" continues. i summited mount rainier as a 30 year old gal. and although it did not happen in september of 2010, like i had anticipated, hoped, and worked towards, it happened in july - before i turn 31. and in the process, i have learned to be more flexible in my goals and expectations, more forgiving of my limitations and mistakes, and more proud of the things i achieve!

p.s. this seems like little news after rainier but, by the way, i summited mount baker on monday, june 20th. it was part of my training and the final climb in my glacier climbing class. had i only summited baker this summer, i would have still felt proud and accomplished. it was the hardest thing i had done prior to july 2nd! now i just feel extra bad-ass for summiting two BIG mountains in two weeks!

poop

i feel too grown up! i'm 30 years old and already, i'm taking care of my parents!

don't get me wrong. i love being there for them; it's a privilege really. after all the parenting and support they've given to me, it's certainly time for me to give back. but at the same time, sometimes i wish this wasn't happening until i was 50 and they were 80.

my poor little dad somehow developed a cyst on his knee. of course, it's on the leg that has no veins (because they used them for his 7 grafts during his bypass surgery 13 years ago); hence, he's extra swollen. and he's in excruciating pain. i found him hobbling around the house this morning and had to help him put his socks on his feet and his pants around his ankles. of course, he thinks he's "healthy" and "fit" enough to go to work today. so he's gonna hobble, hop, skip, and jump around the kitchen at his restaurant. what a crazy fool!

this morning is a bit different than the typical "escort" i provide. instead of bringing my dad to some cardiologist or wacky procedure, i'm with my mom. she's having a colonscopy. ugh. poor little thing. without need for description, we all know what that is and where they go. makes me cringe and clench just thinking about it. i'm her designated driver for after the procedure when she's all drugged up on fentanyl and versed. should be an entertaining morning!

just another day in the life of christa... nurses, doctors, waiting rooms, procedure suites, gowns, gernies, drugs, IVs, blood, gas, and a whole lot of poop!

a week of chaos

i didn't write last week because it was just too CRAZY!

now that the events have come and gone and i am more rested, i don't feel like "reflecting" on the chaos. i'm trying to get over it, not delve deeper. but i will share the "highlights."

monday of last week, i had to make that scary phone call to the mother of a 21 year old. it overwhelmed me in some way and i really didn't like being the bearer of bad news.

that afternoon, i also admitted a patient with low blood pressures - 80s/40s. She was unable to get in and out of bed on her own due to hypotension and new-onset bilateral lower extremity weakness. try safely getting a hefty woman with limp legs to the toilet after a failed attempt at a bedpan.

tuesday and wednesday i had off from work. and to be honest, i don't remember much of what transpired. but i know it involved a few tears, a visit to my therapist, and trying to get out of a date with a foreigner that reminded me of my father (poor english, balding, and black socks).

thursday of last week was the most intense. my dear, dear friend's uncle had had surgery prior in the week. and sadly, to our shock and dismay, he coded early that morning due to a swollen airway. cassie called me while i was at work to share the news. uncle john had been emergently intubated and placed in the ICU. but it didn't look good.

just by chance, my mother also had a good friend in the ICU. i know her well - when i was little, she drove my carpool and her kids and i played together making gymnastic routines in the lawn and swimming in the lake. she had donated a kidney to her sister-in-law. so while visiting and supporting cassie, i decided to visit my mom's friend also - just to check in. she was doing satisfactorily. so imagine my disbelief when i heard a code blue called in her room just hours later. could i really know two people teetering on the brink of life or death in the same unit of the same hospital just rooms away? yup. as i was running down there to offer support to her family, i ran into my mom's friend's husband. he was clueless as to what was happening. so, of course, i had to take it upon myself to share the news and walk him into the scene. 15 doctors, code cart, chaos. to make a long story short, turns out, she's okay.

that same evening though, while still working my 12 hour shift , just to keep things exciting, my fourth patient of the day "decided" to fall at 6 PM. a STAT head CT and incident report ensued. and my day ended in a blur. if i were a drinker, i would have kicked back a few!

friday brought sadness. it was determined that cassie's uncle had no brain activity. so in the morning, his courageous family decided to withdraw care and allow him to pass. an adventurous, inspirational, and beloved man died that day. a family lost their father, brother, uncle, and friend - and the world will never be the same.

because someone/something had decided that i was superwoman and could handle more...

to end my work week, one of my three patients on friday evening began to suffer from chest pain. so instead of lazily charting, spacing out at a computer screen, and taking the time to say goodnight to each of my patients, i ran around the unit like a chicken with my head cut off. there were numerous emergency meds, STAT orders, tests, and blood draws. it's a strange thing to watch someone in pain, perhaps having a heart attack in front of your very eyes, and to be unable to stop it. and it's even weirder to go home before the conclusion, not knowing how the story ends.

saturday morning, i went hiking. ALONE. i spent 4 hours outside in misty rain and clouds. i had brought music to listen to, in case i needed "company." but truly, the noise was too stimulating. i needed silence. i needed to breathe in fresh air and blow out a week of chaos.

dreaded phone calls

i'm not a parent, but i know about every parent's worst nightmare - that something has happened to their child, that they are ill or in danger, or god forbid, dead. i know about dreaded phone calls because when i was 12, my mom got one. it was harborview (the best hospital for the worst cases - trauma) and they called to have my mom come and identify her daughter. it was a friday night. my mom and i had been watching the miss america pageant. my sister was headed to her high school's soccer game. sadly, she and her three friends never made it there. two teenagers died that night; thankfully, my sister survived (she was intubated at the scene of the accident and had brain swelling). and although it was over 18 years ago, i will never forget that phone call. and neither will my mom.

this week, i made that phone call. and it sure felt horrible.

a 21 year old patient on my unit was in the midst of his transplant. well actually, he had been transplanted 6 days prior. but he was in the midst of the worst part. the previous days of chemotherapy and radiation were catching up to him. without an immune system, his body could not heal any of the damaged and dying cells. the lining of his entire GI tract - from his mouth to his anus (that's how i always describe it to patients) - was raw with mucositis (inflammation, ulcerations, and pain that is difficult to treat). and for some unknown reason, he began to have difficulty breathing. it's likely that his airway was so swollen that he could not safely or easily pass oxygen. and within minutes, he was in a very dangerous situation.

i was not the boy's nurse (i say boy as if he is some little thing, but as a 30 year old, 21 now seems so young - too young for cancer). but i was helping his nurse - drawing STAT labs, finding doctors, getting emergency medications, and of course, making phone calls. with one glance at the patient, it was obvious that he was terrified. he was gasping for breath. he could not sit upright enough. he was restless and i swear the pathetic, terrified look on his face said, "i need my mom." i asked his nurse if his parents were somewhere in the hospital and she said no. so i asked if i should call them.

i didn't realize what i had offered until i left the room to go dial his parents' phone number. what would i say? what does one say to a parent as their son is on the brink of crashing, requiring intubation, and possible CPR? how do you tell a parent that their son is dying? and that he is alone? i didn't have much time to think. and likely a rehearsed conversation wouldn't sound any better than a non-rehearsed one. so i dialed and his mom picked up.

i don't remember exactly what i said. but it went something like this:

"are you Cs mom?"
yes

"hi, my name is christa. i am a nurse on the oncology unit where you son is a patient. i am not currently his nurse, so i have very limited information. and i am so sorry to be making this phone call. but i wanted you to know, that C is having difficulty breathing. we are moving him to the intensive care unit to be more closely monitored. he is surrounded by doctors and we are working very hard to keep him safe. i think you should be here. do you have someone who could drive you?"
i can drive myself; i'm on my way

it was a quick conversation - a minute, maybe two. but it was the most difficult phone call i've ever had to make. sometimes, i hate the phone.


*** for once, my story has a happy ending. well, at least it's happy so far. after many, many drugs and many, many interventions, the 21 year old boy ended up NOT getting intubated. his swollen and bleeding airway somehow managed to stay open. and he continued to breathe on his own. he is now 11 days post transplant and closer to healing, closer to recovering from transplant, and closer to remission! ***