a pat on the back

a letter sent to my manager...


I hope this note finds you well.

I’m writing today to share a comment from one of our transplant donor coordinators, Leah. This week, two of your nurses worked with us on a potential cornea donation and they made an impression on her.

Leah writes, “RN Christa and RN Lauren were both very proactive and pro-donation. (They) Wanted to support the family the best they could. They were great, despite their patient being a MRO d/t lymphoma”.

The decedent’s family was very interested in transplant donation but due to the patients illness, it was not possible. Christa and Lauren did everything they could to make donation happen.

It’s interactions with champions like Christa and Lauren that keep us excited about donation and happy to be working so closely with hospital staff, like yours. We can’t do it without you.

Please feel free to share this note of gratitude as widely as appropriate. They both deserve a pat on the back.

this was a nice thank you for just some of the hard work i put in last week.

he sails on

it's been a long time dear blog...

i could make excuses. but in reality, i've been avoiding this space on purpose. i haven't wanted to process work life or real life (and now more than ever, the two feel very connected). it feels too hard. so i've just been letting things mull over in my mind, wreck havoc on my soul. some days i show up at work, just because i have to. and some days, i do my best. my very best.

the last week i had more amazing moments that i can count. more than i could ever share in writing. how lucky am i? when i contemplate job changes and career goals, i feel blessed to have been a part of amazing nursing moments. life moments. that remind me why i do what i do. why i was meant to be a nurse.

on wednesday of last week, after a fantastic birthday celebration that included 30 miles of backpacking in two days, i arrived at work to find one of my favorite patients on comfort care. strangely enough, i cared for david for the first time exactly one year prior.

comfort care is a blessing and a curse. i love taking care of people on comfort care. for some reason, i feel at ease with people when they are dying. i enjoy participating in families biggest, hardest, sometimes most beautiful moments. but of course, comfort care is sad. there are usually tears. shared memories and the best of stories. there is noisy breathing. and morphine. endless questions with difficult answers. often of which i do not have the answer to. but i'm good at saying i don't know. i'm good at answering the questions i can. and my calmest and kindest self appears. and it feels nice (especially when lately i've been a grouch).

i spent much of my 12 hour day in david's room. his wife, daughter, and son-in-law were present. there were visits from social workers, palliative care physicians, and friends. and there were snuggles (i love when loved one snuggle with their family members as they are dying; it's the most beautiful intimate moment to witness). there were stories - boy were there stories. david had spent many a year on a sailboat. in fact, he and his wife raised their daughter on a sailboat i believe. they were adventurers. kind and giving people. the kind i would like to be when i grow up. seriously. i'd be ecstatic if i could impart just a little bit of david and a whole lot of barbara in my life.

david's wife is the epitome of an angel. i can't imagine a better wife. she lived and breathed for david. his every pain was hers, and his every success was celebrated (i will never forget one time i was caring for david and he successfully pooped in a bedpain; barb celebrated as if he had won a gold medal in the olympics. and david, in his most cynical, dry voice said, "barbara, anyone can take a shit?!? but to her, it was noteworthy. celebratory. if she had had balloons, they would have been blown up. if there was cake, she would have lit a candle). barbara told me that over the course of the last year, david had been in the hospital 173 days. and while he was out-patient, there had been 150 clinic appointments. she was there for every one. every day. she never left his side.

david died peacefully in his sleep the evening after i cared for him. he and his family have touched me. deeply. if they are able to carry on with such grace, so too must i.

the BIG stuff

i participated in a beautiful thing today.

most of my patients are bald. it doesn't even phase me anymore. i don't expect to see hair. when i have patients with full heads of hair, i think it's weird - like something is wrong with them.

but every now and then, i am asked to shave someone's head. maybe she had some hair; short hair that has grown since her last round of chemotherapy. or stubble that seems to itch as it too falls out. but rarely, maybe never, have i shaved someone's head who has NEVER lost their hair. never have i shaved someone's head and made them cry.

and today i did. my patient is a sweet, very sick woman. and her husband loves her like nobody else. he came to me today and said, "i think today's the day. can you shave Ts head?" i responded with an of course. and then he surprised me. he said, "when you're done with her, will you shave mine?" i chuckled a bit, awkwardly, because i've never shaved anyone's head who doesn't have cancer. but why not? what a loving, kind thing to do for your wife - to show solidarity in the hardest of situations.

we took selfie's before. and my patient cried. and as the buzzer buzzed, she closed her eyes. her shoulders heaved. and her sobs were audible. it took me a while to complete the task. she had beautiful, thick hair. and to my surprise, i killed the batteries in not one, but two of our automatic razors. which meant, i couldn't complete Ts husband's head. which was okay. because he left for an hour and got a barber to do a better job that i ever could have done.

but the best part was the reveal. my patient stood up and faced the mirror with courage. she held her husband's hand and she looked and touched her fuzz. and she cried again. i watched as she and her husband cried together. and i cried too. for getting to witness such love. for being a part of peoples' lives during such BIG stuff.

grief and loss

i've been having a rough time lately. like really rough. and although i don't really want to discuss it, i do want to discuss how my experiences with anxiety, sadness, and depression may have benefited a family member of one of my patients.

yesterday i had the honor of caring for a 47 year old woman dying from her AML. she had had one transplant with relapse almost immediately following. despite more chemotherapy, donor lymphocyte infusions, and radiation, medicine could not cure her. even her second transplant failed to deliver a miracle.

by the time i got to work yesterday, my patient, her husband, and her mother had decided to change their goals of care from cure to comfort. what that means to me is - they made a good decision. a brave decision. the most loving and respectful decision for a very sick and tortured body and soul. by the time i met my patient, she was unable to respond. her drug-induced sleep looked peaceful and her expirations made soft sighs. as her fingers and toes turned blue, her husband sat beside her, holding her hands and whispering into her ear. it was a beautiful thing to witness. that is the beauty of my job. sometimes i am fortunate enough to watch death approach peacefully and for loved ones to grieve and cope in beautiful ways.

as the three of us watched a woman get closer and closer to her last breaths, we talked about the pain of losing a loved one. about how to cope with that loss. and her husband asked me what i do after hard experiences. it was so interesting - the timing of this patient and his questions. i am experiencing loss now. i am in the midst of BIG grief. and so i was candid. i told him to find healthy coping mechanisms. to try any and all he knows of. to be open to the love and support of friends and family, even when it feels foreign to accept it. to try therapy. massage. acupuncture. hypnotism. whatever works. can trying new things to be healthy ever be bad? try writing. exercise. support groups. church. reading.

my patient's husband and i came up with a good list. and i think we're going to use them all...

sink or swim

so, i'm precepting yet another new nurse. this one is a bit older than the wee-ones i've been teaching, just out of college, barely old enough to drink. nursing is this lady's second career. and i'm nervous she will need a third.

i've prepepted MANY nurses. i wanna say at least 20. maybe more. and all of them have turned out decent. a few, exceptional. but this one leaves me concerned. and i feel horrible about it.

new nurses (even experienced nurses) get six weeks of one on one training with me (or another preceptor on our unit). over the course of these six weeks, i do my best to impart my nursing wisdom and teach not just the policies and procedures on "how" we do things, but the "why" behind the things we do too. our goal is that after orientation, we have shaped, molded, and created a SAFE nurse - one who is not only capable of caring for a patient's complex needs but also, one willing and aware of when to ask for help if she/he is in over her/his head. some people feel nervous to ask for help, as if needing assistance is a kind of failure. but the scarier person is the one who doesn't know that help is needed.

i've been worried about this new nurse since the beginning. on our third week together, i started to voice my concerns to our assistant nurse manager. by week four, i spoke with the head honcho. and now, at the end of six weeks and with two more 12 hour shifts added to extend orientation as a continued trial, i feel in over my head. as if i have nothing left to teach. that perhaps this woman is just incapable of learning. that she is too nervous, forgetful, or dumb to be a good nurse. at the end of tomorrow's shift, i'm supposed to meet with our manager and help decide if our unit is just "not a good fit." that's what she's calling it. but basically, she means we might fire her. and i will have played a HUGE role in that decision.

typically more than one person precepts a new employee. but after three shifts with another preceptor, this new nurse expressed that she and i had a better relationship. that my teaching methods worked better for her. that her other preceptor added stress instead of relieving it. so here i am, her only teacher, with only hours left to teach... and i don't want to go to work tomorrow.

wish us luck. it's sink or swim time tomorrow...

two firsts

i had really wanted to write about this incident when it happened, when all of my feelings were raw and fresh... but it happened the week before i left for asia. and i was busy working TOO much, packing, and scrambling to see family, friends, and a baby being born!

there are certain milestones in a nursing career. i'm guessing they're different for each type of nursing. but for an oncology nurse some of them might include - first admit, first mistake, first death, first code. i've been a nurse for more than EIGHT years now; hence, i don't experience firsts very often anymore. but on september 26th, i had a first. i did CPR on a patient. now, i have had my patients transfer to the ICU (when they are VERY sick). and i've had patients die, more than once while i was in the room - sometimes with family present and a few times with just me in the room, witnessing the last breath. i've even had my own patient code - two different times. but each time, other people responded. the first time, i was still a brand new nurse and was in such shock, i'm not sure i could have stated my own name. and the second time, another nurse walked into the situation (a blue patient) and started the rapid response that led to CPR and intubation and eventually, days later, to death.

but this time, i did the CPR.
(WARNING: this is not for the faint of heart - which means, i probably shouldn't read it either)

it was such a strange day. i was precepting a new nurse (as i do frequently these days). she was on her last few weeks of orientation so she was mostly doing all of the work. she's a rockstar newbie (because i trained her as a nursing student!). but anyway, i left the unit that morning to complete my annual CPR training. in front of an evaluator, i had to demonstrate that i know how to do CPR. i did two minutes of compressions on a dummy and was given my gold star. i passed. and just a few hours later, at about 1PM, there was a code on my unit. a young patient flatlined. dozens of people filled the room. and i assumed my normal position - delivery supplies, finding chairs, kleenex, and water bottles for family and loved ones who are hysterical in the hall. but i did not do CPR. i wasn't needed at that time. there were plenty of nurses in the room. and to be honest, i'm scared of CPR. i don't even know if i think CPR is ethical... on my unit that is. even when our patients survive codes, the likelihood of them surviving long term is miniscule. and CPR breaks ribs. it's violent.

but in the afternoon, i sat with other nurses discussing codes and CPR. and i admitted out loud that i've been a nurse for a long time and have never done it. in my head, i started to regret not volunteering during the code. i thought that perhaps it's something i should be able to say i have done.

so, when we had another code in the evening, this time with a different patient (the previous patient survived the code and the day), i decided it was my time. perhaps it wasn't that conscious of a decision. i had been in the room, handing nurses syringes and priming tubing when someone started to round up a few folks to do 2 minute rounds of compressions. there weren't many volunteers. so, i jumped in. my anxiety was present - me and my little sidekick. i announced to the physician running the code and to the respiratory therapists that this was my first time. that if i was doing it wrong they should let me know. but in we went. and before i even knew what i was doing, i was thumping on a man's chest. his lifeless body jumped with each compression. and blood spewed from his orifices. all codes are different. but this one, it was particularly messy. he must have been bleeding internally so with every compression, a fountain of body fluids sprayed in the air. the respiratory therapists at the head of the bed tried to contain the fluids, as they were bagging the patient (breathing for them). but it was to no avail. there was HIV positive blood everywhere.

the code did not end well. the patient expired (i hate that word). and because i had chemo to hang and another patient needing things, i left in a rush, sweating profusely without time to think or process. it was about 6:30 PM at that time, and the day was coming to a close. i gave report and headed home. cole picked me up. and i'm guessing i was still a bit stunned. but i shared the news - and the scary fact that the patient had AIDS. and that there was blood everywhere. but we discussed it. and decided, i was not at RISK. i was wearing gloves while doing the CPR. i couldn't remember, but i think i was wearing a mask for all of the rounds of CPR i completed (isn't it crazy that i can't remember? adrenaline is a funny thing). nothing splashed on me that i know of. so when we got home, cole inspected my scrubs. there were no traces of blood on my clothed or naked body. i took a shower. headed to bed. and went back to work in the morning...

only to find that those involved in the code, many of them had gone to the ER that night due to risk of blood exposure during CPR. people involved to the very same extent as me had been treated and were now taking anti-retrovirals to prevent them from contracting HIV. i was flabbergasted. a bit frantic. and worried. i called cole. i called cassie. i even called my mom (the infamous worrier). and i discussed what to do with those involved the day prior. so, to appease my concern, i went to the ER to get blood drawn and to see what they had to say. it's interesting. medicine is so not standard; it varies from physician to physician, even for patients in the very same situation. the physician i saw had a completely different reaction than the physician my friends had seen the night before. she decided my risk was SO small that it wasn't worth being on anti-retrovirals for ONE MONTH! plus, anti-retrovirals make people feel like crap. and of course, i was headed out of the country.

turns out. i'm happy with my decision. i thought about my risk of contracting HIV - they say with a KNOWN needle stick exposure (which i did not have) the risk is less than 0.3%. and on my trip, i maybe had a few fleeting thoughts. but i was not distracted or scared. i wouldn't even say worried. my initial blood work came back negative - not surprisingly. and i'll follow up again soon.

so, i guess i had two firsts. my first experience with CPR. and my first potential HIV exposure.

phew. sorry this turned out to be SO long.

the gal who was afraid of saline

pardon my blogging hiatus...

i stepped away from nursing for a while! and i try (sort of) to keep this blog about my job.

as mentioned in my last post, i went to morocco in september. and then, just a week ago, i returned from thailand, bhutan, and cambodia - a most wonderful vacation and 31 days away from oncology nursing.

but i'm back. in full swing. that's how it always feels after vacation - like i never left. people are still sick. in fact, some of the same people who were in the hospital a month ago are still in the hospital now. some have discharged. and a few have died. sadly, one of my very favorite patients - nelson. on a side note, i did get to raise a prayer flag in his honor while trekking. and coincidentally, i learned when i was back to civilization, nelson died the day i honored him. i had no idea. his flag is blowing in the winds, close to the heavens, continually sending prayers.

now, on to some positive news, for once (i feel like negatively nelly, i'm always so pessimistic). i was charting at the computers yesterday when at the front desk, out of the corner of my eye, i saw a beautiful young woman that i recognized - but not quite. you see, this woman was healthy. she had a head full of curly hair. and she wore make-up. she looked only a bit like the patient i cared for long ago - the gal who was afraid of saline. anyway, i screamed, "what are you doing here?" and she screamed back, "i came to visit you CHRISTA!" she remembered my name. she came to visit ME. she didn't remember any other nurses - just me and the physical therapist (a young man who made her get out of bed every day even though she barely could, even though she didn't want to. and sometimes, they shook their booties in the hall, because that's how spicy she was and continues to be).

i cant' tell you how elated i felt seeing my patient pal, the one who offered to take me out on the town a year and a half ago. she wanted to buy me a beer on capitol hill - even though i don't drink. she said she'd show me a good time. she asked about my life. if i was still dating "that PA guy." and i asked how she was doing. if she was in remission (YES she is, yay). if she was still on immunosuppressants and steroids (yes she is, BUMMER). here's the good part, she's "healthy," for a three time transplant survivor. and best of all, she's HAPPY!

and i helped get her there. don't get to see that everyday.