garden hoses

WARNING: this is crass and hilarious!

on monday, i answered the call light of a patient i have never met. i was trying to be helpful. but when you answer another nurse's call light, you never know what you're gonna get. when i was a brand new nurse, i never wanted to answer call lights. i was always so nervous that i wouldn't be able to handle the situation i walked into or answer the questions asked. but seven years later, i feel like i can manage most things. or at least know when i am in over my head.

this time, i walked in on an overweight gentleman profusely sweating. he was pacing around the room and looked pretty uncomfortable. i noticed that his IV pole had many bags of fluid hanging - some of which were actually connected to his foley catheter. just by assessing his IV pole, i knew that the man was receiving bladder irrigation. i know that people who require bladder irrigation for blood clots that form in their bladder and thus clot their urethra need LARGE foley catheters, not unequal to a garden hose. i would recognize the waddle from miles away (imagine walking with a garden hose coming out of your urethra. yup, OUCH!). but i didn't really expect the answer i got to my question: "what can i do for you? you look uncomfortable."

the patient said in an angry, serious voice, "of course i am uncomfortable. i have a forty pound dick!"

as a new nurse, i would have blushed and scurried about the room. trying to help him get situated. offering to call his nurse or physician.

but now, i laughed and said, "i don't think any man wants one that big, huh?"

oh come all ye faithful

today i cared for a woman on comfort care. she had been transitioned to comfort care yesterday because her prognosis is poor. but strangely, the team of medical professionals doesn't know EXACTLY what's going on with her. they cannot REALLY explain her decline. yes she has HHV6 in her cerebrospinal fluid. and yes her scans show substantial changes to her gray and white matter in her brain. but we cannot explain away WHY this happened.

but the WHY plays no part in how i care for my patient. and so, i did my very best this morning to make her comfortable and ensure her safety. i had been told that she was fairly unresponsive; that sometimes she says yes or no. but that her responses were not reliable. but i continued to talk, to explain what i was doing. and when i was done with her bedbath, i decided to tidy her room. now that our goals of treatment had shifted, there were things i could remove. and ALWAYS, ALWAYS there are things to straighten, dispose of, recycle, and organize. which the OCD in me enjoys. so i indulged...

my tidying revealed a CD player and christmas CDs. i decided to put one in. the first one was VERY peppy and almost felt inappropriate for the situation. so i changed it instantly to something more appropriate. christian christmas carols. the very first song to come on was "oh come all ye faithful." and although i haven't been to church in years and christmas has lost some of its meaning for me in the spiritual sense, i knew every word. and to my surprise, so did my patient. my dying, very sick, confused and nearly unresponsive patient began to sing. i felt flabbergasted. and amazed. touched. and saddened. and so, i sat with my patient, held her hand, and despite having a not-so-beautiful singing voice, sang every word to the entire song with her, for her, and to her.

visits at work

i don't know about other people's jobs. but mine is pretty inflexible. if i have a doctor's appointment, even if it's at 7:45 in the morning, i have to call in sick for a 12 hour day. or, if i need to pick up a friend at the airport, i have to make them take a taxi. i'm not aloud to come and go on a work day. i can't have a lunch break and go grab a bite at a local place. it's kind of a bummer. and makes work isolating and a bit inconvenient at times.

that's why when people visit me, it makes my ENTIRE day! it breaks up the 12 hours and makes work feel manageable. visits happen infrequently. but boy when they do, i LOVE it! sometimes my dad pops his head around the corner after he's gotten a blood draw. and to make the visit last longer, if i'm not busy, i walk him to the parking garage. fun, huh? it might not sound exciting, but it's the BEST. i feel so loved.

this sunday, a friend called and offered not only to stop by for a visit, but also, to deliver me my favorite coffee from my favorite coffee shop. what a friend! she even knows my drink by heart. and to avoid embarrassing myself, let's just say, it's not a simple drink. THAT is a good friend. seeing emma at the front desk made me smile. and having the opportunity to sit and chat with her for AN HOUR was the icing on the cake (not to mention, i got paid to hang out with one of my favorite people.... shhhh!).

it didn't even matter that the last two hours of my shift were crazy. i was caffeinated. and i felt loved...

thank you emma!

heart ache

today is the first of four days off. i slept in until 7:45 - even though my body naturally awoke at 5:45 (the brutal time i slip out of bed to prepare for my 12.5 hour day). and i've already started laundry, made a foot long to-do list, and am at my coffee shop sipping on a triple shot sugar free vanilla latte (they accidentally made me my drink with an extra shot - eek!). it feels grand.

work has been hard for me lately. i could blame the mistake(s) i've made. say that my confidence is shaken. my spirits are down. and perhaps that's part of it. but i also just want to say - my job is HARD. even the easy days - they're HARD.

this week, i cared for a 29 year old man/boy. in april he noticed a lesion on his tongue. he thought it was a canker sore and waited for it to go away. then he went to the dentist, and they were worried about it. but he waited for it to go away. and it never did. now, i don't know all of the details. but it wasn't until september that he was actually diagnosed - with stage IV tongue and neck cancer. and although further testing and more scans were ordered, still... he waited for it to go away.

today, the man/boy (who is really a scared and angry kid coping poorly in an adult body) will get a tube placed in his abdomen in order to feed himself. he can no longer swallow. he can't even open his mouth wide enough to brush his teeth. his tumor is the size of a softball and it has erupted through his cheek and jaw. he is hugely disfigured. and the tumor, once hiding under his skin, has stretched and pulled and finally broke through - leaving a bleeding, oozing mess. it's AWFUL. he won't talk - not just because it's hard and painful, but because he's mad. he is 29. when i was talking to our 60+ year old crass secretary about my patient he said this - "he's a kid. he should be out getting laid. and instead, he's stuck in the fucking hospital with attractive women taking care of him. he's pissed. and dying." it's true. he won't make it. his cancer is too advanced. it's inoperable.

and you know what? seeing ALL of this sadness weighs on my soul. i'm a fit, strong woman. i'm muscular and can run and squat and climb. i can carry lots of weight. lots of burden. (and for this, i am thankful. i don't take my health for granted. not after seeing so many people without it). but eventually, after seven plus years of this... after seeing more dead bodies than i can count. after hearing so many heartbreaking stories and comforting too many distraught patients and loved ones... your legs weaken. your shoulders hurt and hunch over. your muscles quiver. and your heart aches.

coffee break mid week

i find myself in coupeville, washington again. i was here just two weeks ago while on bereavement leave. but today, i squeezed in one more visit to my man friend as he completes his last week of clinicals here, working with one of the few town's physicians. it's peaceful here. sitting in a quaint little coffee shop - all of the locals chatting and catching up on the morning's gossip.

THIS is the kind of respite i need between each shift. i'm a ferry ride away from the real world. and yet, i feel like i'm on vacation. there is NOTHING to do here. i arrived at about 6:45 last night and i will leave by 6:45 tonight (because i worked a half day yesterday and i work tomorrow). i will do nothing but eat phad see ew noodles from the ONE thai restaurant, sleep tight in a warm bed, and drink coffee.

i wish i could come here after every shift. i worked 4 hours on sunday, 12 hours on monday, 5 hours yesterday, and i work thursday, friday, monday and tuesday (all 12 hour shifts). and i don't want to. i want vacation. sometimes it's hard being a grown up, with a stressful job that requires so much brain and too much heart. it's really hard to motivate myself to work so much, with such sick people.

for now, i'm gonna get back to sipping coffee...

bereavement vacation

i wanted to post an update. about my patient. the one i wrote about last. the patient i made "extra" comfortable with morphine (i'd like to see it as that, instead of as me making the biggest error of my nursing career). i worked with him last on sunday. and i learned that my patient passed away peacefully on tuesday surrounded by family, friends, and members of his church.

i'm still on bereavement leave. my schedule is such that taking off these three shifts for bereavement means i don't work until tuesday. and although EIGHT entire days off is a nice mini-vacation, it's still not enough to heal one's heart from the loss of a grandmother, the loss of a patient, and all of the past and future losses in my career as a nurse on my unit.

i NEVER want to take bereavement again; i do not want to suffer any more losses. but i will say, this bereavement vacation is doing me well.

BIG mistake

yesterday, i made a BIG mistake at work. i've made mistakes before.

but this, this was the BIGGEST mistake i've ever made. there were potentially lethal side effects. and i cried like i've never cried before. in fact, i freaked out once i realized what had happened. and i fessed up immediately to the prescribing nurse practitioner and to the attending so that we could rectify the mistake, if it was deemed necessary.

i want to describe every last detail. all of the events that led up to hanging the write medication at the wrong concentration, hence overdosing my patient on morphine. but there are TOO many details. it's never one thing that leads to mistakes. it's a string of little things that typically leads to a disaster. and unfortunately, i'm the last link - at the bedside, closest to the patient, with the most potential to do harm even while trying to help. i want to explain away how it happened. to prove that i did ALMOST everything right. that i had THE very best intention in mind - to provide pain relief to my dying patient who was gasping for breath and whose wife was finally ready and willing to accept comfort care. but i hope that YOU (whoever YOU are) know that i am a safe nurse. that i don't practice carelessly. that i respect medicine and nursing and all of the potential mistakes that could be made. but i don't want to type a novel. i already did that in my documentation of the error yesterday.

suffice it to say, i gave my dying patient more morphine than was ordered. and although i had a second nurse double check my hanging of the potent medication minutes after i hung it, it was not until 6 hours later that the error was caught. and by this time, my patient had had more than 60mg of morphine. for those of you who know medications and dying, this is NOT an unreasonable amount of morphine to keep a patient with air hunger comfortable. Ten mg of morphine per hour is however, a VERY large dose to START a continuous morphine drip. i should have hung the morphine at 2mg/hr and instead, due to hanging a 5:1 concentration bag instead of a 1:1 concentration bag, my patient received FIVE TIMES more than was ordered.

here's the good news. i made this mistake on a patient who was VERY uncomfortable. he was in multi-system organ failure and his death was imminent, whether or not i made an error. his response to the LARGE dose of morphine suggests that his body "needed" the relief. he tolerated the morphine well; morphine causes respiratory depression and even with LOTS of morphine in his system, his respiratory rate was within normal limits. and without ALL of that morphine, my patient might have continued to be VERY uncomfortable.

here's the other good news. the nurse practitioner and the attending were VERY nice. they actually played a part in allowing this error to happen. and while i was sobbing and pouring my heart out (saying, "this is my forte. i'm good at dying. i'm so mad that i made this mistake because it's something that i am so passionate about"), they complimented me on my nursing skill. on my ease at discussing difficult subjects with very vulnerable people. on anticipating orders and advocating for my patient.

here's the best news. my patient was okay (as "okay" as a dying man can be). once the mistake was revealed, it was decided to leave the medication at the current rate of 10mg/hr. the patient was comfortable. his wife (and the other TWENTY family members and friends) was content with her decision to stop curative treatment and start comfort measures. she was at peace, seeing her husband calm. and although my shift was over before he passed, i know that i played a part in helping someone to die peacefully - which was my aim all along.

it's kind of ironic. i should be at work today. i am scheduled to be there. but my grandmother passed away on saturday in switzerland. and i'm taking bereavement. i get my next three shifts off. and you know what, i need a break. i need to grieve the loss of this patient, whom i had cared for numerous times. and i need a bit of time to heal my conscience of this mistake.