Thursday, June 30, 2011
A patient was admitted with a severe exacerbation of a chronic illness. She was young, very young.
I was on night shift that week. The patient was admitted during the day and I came in for my first shift that night. She did okay that first night. I was concerned about her, but there were other patients that were sicker and she was not my primary focus.
During the day on hospital day 2, she got worse. So when I came in that night I spent a lot of time with the patient and her family. I did my best to educate them regarding her chronic illness, but this was not an easy task. The patient and her family didn’t speak English. Unfortunately I am monolingual. The nurse had already had some communication issues with the family. There were also legal issues. The patient was living with a man, who we thought was her husband, but turned out to be her boyfriend, so legally he wasn’t the power of attorney and everything had to go through her brother. So the boyfriend couldn’t give consent, he couldn’t sign any papers, he couldn’t help us. The brother was very involved, but he worked and wasn’t a constant presence like the boyfriend.
Throughout the night she continued to get worse. In the early morning she began what we call “crumping”. I needed to explain a lot of very serious medical things to this patient quickly. I needed to place a central line, an arterial line, start her on some heavy medication, and I had very little time before it was going to be too late. The problem though, was that I needed consent. She was wide awake and I can’t do any of these things to her without permission. And I can’t get her permission because I can’t talk to her. Only the boyfriend was there and he can’t legally help me. We tried and miserably failed at using the interpreter phone (I loathe this machine!!).
Anger consumed me. This patient was going to die simply because I did not know the words to save her.
I spent an hour trying to converse with the patient and her boyfriend through that blasted blue phone. Finally, she was so sick that she became delirious and was now mentally incompetent to make a decision and I could do to her what I wanted. But by this time, it was almost too late. I called my Attending doctor for that week, and at 4:00 in the morning he came in to help me.
Not ten minutes after the arrival of my attending the patient coded. We had to emergently intubate her, place a central line, begin pressors, and pray to God it wasn’t too late. She had a little baby.
She stayed with us for over a month. During that time she coded 3 more times, ended up getting a trach, developed many infections, and just didn’t seem to be making the progress we wanted. She transferred to a larger hospital and stayed there for an additional 6 weeks.
I do not believe in miracles, but somehow, this patient beat the odds.
I’ve been on nights this week, so I slept all day. When I came in to work tonight they said she came back today to visit, to say thank you. They said she looked wonderful. She was strong and healthy. She said her baby just had a birthday. The attending doctor who came in that night was on today and he saw her. He said it was amazing. He said the moment he saw her he was sad that I wasn’t here. He said we saved her that night.
Tonight I again find myself without words. But tonight it is not anger that consumes me.
I suppose I’ve been somewhat overwhelmed lately. I don’t always handle stress and change well. I get easily frustrated when things aren’t just so-so. I want everything to be in its place and perfect and right. I’m grounded in structure, routine, consistency. So, despite the fact that I’ve spent the last 29 months in perfecting the art form of moving, it still upsets my balance.
And yet, amid the chaos, amid the turmoil, amid the commotion, there is one consistent presence. A presence so powerful that she can calm inner-emotional storms, so powerful that she can face obstacles that I turn away from, so powerful that a simple apartment can be transformed into my home in less than 12 hours.
I am faced with situations everyday that remind me how lucky I am. Even still, I grow complacent and take for granted the amazing blessings that I’ve been granted.
So, I’d like to take a moment and say that I am blessed beyond words to have Jackie Dodgen Sanders as my mother. From the day I was born until this moment and beyond, I have always been received with love and encouragement and compassion and joy. She has always been there for me and that alone is priceless. She has been a best friend, a confidant, a cheerleader, a champion, a mom.
Thank you for always loving me, always believing in me, always supporting me, always being proud of me, always listening to me and trying to understand me, always encouraging me, always championing my cause. Thank you for building me up and teaching me to be who I am today. Thank you for the life you created for me. Thank you for the warmth you create in the home you’ve always made. Thank you for the confidence you instilled in me. Thank you for the Godly example you’ve always been. Thank you for your strong work ethic, your giving spirit, and your selfless attitude. Thank you for being my mother.
Tuesday, June 28, 2011
The older I became, the more paraphernalia I got in the mail: information packets, posters, postcards, t-shirts, key chains, bumper stickers. I kept a lot of that stuff, decorated parts of my room with it. There was one postcard in particular that seemed to stare at me every day. It was simple, it didn't say much, it was just two words: Aim High.
But as life occurred and choices were made, the military was not a part of them.
I went to college, graduate school, an internship, night school at a community college, and then back to graduate school. And with each degree I earned I continued to be haunted by thoughts of the military. I continued to get e-mails, postcards, and letters. I would travel to conferences for work (Los Angeles, St. Louis, and Honolulu), and the haunting would continue. I would see professional peers in uniform and find myself feeling envious and disappointed that it wasn't me.
A year ago I was talking at length with a recruiter. After much study and research of the different branches, the Air Force was most complimentary to me as a person and to my profession. I was very close to signing, to joining up, to being all I could be (except that's the Army). If I hadn't moved to Raleigh last summer, I was going to join the Air Force. So, why didn't I? It wasn't the right time. Various circumstances surrounding my enlistment, pay, rank, etc. weren't quite lining up. My lack of work experience combined with my advanced education made for difficult placement.
So I moved to Raleigh. I'm pursuing my goal. And despite all of that, the haunting continues. It reemerged while I was in Chicago a few weeks ago. While at the conference, I attended a lecture conducted by USAF Colonel Elizabeth Bridges (RN, PhD, CCNS, FCCM, FAAN) and it was absolutely amazing. The work the Air Force is doing in concert with our other military branches on the battlefield is truly outstanding. At the end of the 1 hour and 15 minute presentation I was ready to sign up, ready to go to the front line, ready to Aim High. I left the lecture and walked around in the expo and who did I run right into but Colonel Elizabeth Bridges. We talked. I told her how much I appreciated her service and her lecture and her work. I told her I had wanted to join and time and circumstance just hadn't worked out. She said it was the best decision she'd ever made. She said it with such certainty that I didn't question. I was in awe.
I came home from Chicago and thought about this recent haunt, but as the days turned to weeks and I reengaged in my own work, the haunting subsided. And then I got an e-mail from the Air Force saying they needed Health Care Providers; it was generated from CareerBuilder.com, but still. And then I became aware of a 19 year old man who was serving in Afghanistan. The exact account of the story is unknown to me. He was going to help a fellow soldier and misstepped. This misstep cost him both legs and an arm. They flew him to Germany and then finally to Texas, to the hospital I would be working at had I not come to Raleigh.
I've thought so much about that young man, that boy.
I do not discredit the work that I do. I do not belittle or minimize the importance it has or the families I interact with.
But I am still haunted to serve.
As the 4th of July, my favorite holiday, approaches, I have to ask myself, am I Aiming High?
She was calling to see if I was watching the show “Hoarders”. I wasn’t, so I switched over to see the chaos. We both enjoy watching this show, but this particular episode topped all the episodes we had seen before. The man on the show had such a dirty house, that it was infested with rats. The rats lived in the walls of his house. The man knew the rats were there, he said, “they were his friends”. As they cleaned they found ~2000 rats living in his house. 2000 rats!!
Needless to say, we were shocked, horrified, and disgusted. But as with any car wreck, we couldn’t look away; after all, we are nurses.
Our disgust of the rats led us to discuss other topics associated with rodents. We talked about turtles. We talked about snakes. We talked about patients.
Every patient has a story. Every patient found themselves involved with a set of circumstances that resulted in their admission to the hospital. These stories are often intriguing, humorous, and shocking. Claire told me the story of a patient she’d taken care of when she worked at John Hopkins who had an exotic snake in her home and was bitten. It was a poisonous snake which led to a critical care admission to the ICU until the anti-venom could be administered. (http://articles.baltimoresun.com/2010-01-27/news/bal-snake0127_1_snake-antivenom-cobra)
This made me think of another story I’d heard when I was at Vanderbilt. A nurse who worked in the SICU there told me the story. It was about a snake.
A couple she knew had a pet snake. They loved the snake. It was out in the house, not in a pen, not in a cage, not in an aquarium. In fact, the pet snake slept in their room with them at night. They loved the snake.
One day, they started worrying about the snake. The snake had stopped eating. They tried everything to get the snake to eat and nothing worked. Days turned to weeks, a few weeks turned into a couple months and finally the couple took their beloved snake to the vet. The vet evaluated the snake, assessed the snake, inspected the snake. To the relief of the couple the vet proclaimed that nothing was wrong with their snake.
“Then why”, asked the couple, “is our snake not eating?”
“Well”, said the vet, “your snake is fasting.”
“Fasting!” said the couple. “But why?”
And to the horror of the couple the vet replied, “your snake is fasting so that he can eat you.”
Friday, June 17, 2011
I now find myself in the position of the patient (minus the snoring dog): laying in the bed. I suppose it is a perspective I don't always think about.
My perspective is generally at the foot of the bed, looking down at the patient.
I stood at the foot of a patient's bed for a long time today. Had lots of conversations with the family.
They asked what the chances are. We him hawed around the question. I finally told them that they would probably die before the weekend was up. I hate that question. Who really knows? They thanked me for my honesty. It was just the facts.
The family talked. We talked with them. They talked with an additional service that was concurrently managing the patients care. The family talked again. And then the talking was all done.
They decided to withdraw.
I hate this term "withdraw". Generally we say we are going to "withdraw care", but this isn't true. If anything we heighten the level of care so that the patient will not suffer. What we withdraw is aggressive intervention, resuscitation, powerful medications; but not care.
We wrote the orders. Discontinued all the interventions. I called the respiratory therapist. We asked the family to briefly step out. The respiratory therapist pulled out the endotracheal tube. The patient coughed and sputtered and we cleaned them up. We made the patient look pretty. The family came back in. The spouse and child flanked the patient, each holding a hand. They kissed the loved one and said sweet words. We provided suctioning, morphine, ativan, and peace. The monitor was turned off. We do that so the family can concentrate on their loved one and not watch the monitor. We can watch the monitor in the hallway. The nurse kept me updated on the blood pressure and heart rate.
It was a typical death. Deep shallow breaths, a fast heart rate, low blood pressure. Then, the heart rate begins to fall and there are long periods of time between each breath. Then the heart stops and there is no more breathing.
I put my stethoscope on. I listened to the silent chest. I took my stethoscope off, nodded my head, and said the words the family had feared all day, "they're gone". There were tears, but they had peace. The patient had fought a long time and didn't want to suffer anymore. Now, there was no more suffering.
I don't know why I stand there, but I always do. The nurse in the room is more than capable of handling the situation without me. All the orders are written and she won't need anything more from me. And there are other things I could be doing. But I almost always stay and observe.
Maybe it's morbid of me to say, but there is something...... I don't know the word. I'm not sure of what the word is. But there is something in that moment when death occurs that is somewhat awing, so extremely surreal yet unmistakably absolute. There is a deafeningly quite peace that falls.
I suppose it is easier to watch death when I don't know the person, when I'm not the one suffering a loss.
So that was my day, my short shift in the unit. The one thing I accomplished today.
I don't know why I always talk and blog about death. Maybe it's simply the avenue I use to release the events of today so that I can encounter the events of tomorrow.
Monday, June 13, 2011
For the majority of my life, I’ve had long hair. Long hair is familiar, comfortable, easy, safe. I can wear it down or pull it up and back. It’s what I know, it’s what I do (pun intended).
I’ve always equated long hair with being feminine, with being pretty, with being beautiful. I’m not a girly-girl and I’ve never been overly feminine; so my hair has always been my saving grace, “my crown and glory”, the thing that made me beautiful. Overtime, it’s become a crutch, a hiding place.
My whole life people, sometimes perfect strangers, have made comments to me about my hair, “you have the most beautiful hair”, “you can’t pay for color like that”, "you are so blessed", etc.
Don’t get me wrong, I appreciate the comments, the compliments, and the reactions. But I think I started identifying who I was by my hair. My beauty, my femininity were all dependent on my hair and how it looked.
The reality is, I do have pretty hair, but I also have thick hair. It takes 20 minutes just to dry it with the hair dryer and I still haven’t even “fixed” it yet. Long hair also gets in the way of blood and “stuff” (trust me, you don’t want to know). I don’t want my hair getting in blood and “stuff”. So when it’s long I just end up pulling it back all the time. What’s the point of having long hair when I’m just going to pull it back?
But truthfully, I’m not pretty because of my hair. I’m pretty because of my character, my dry sense of humor, my intelligence, my nurturing way with patients, my amazing self. I’m not feminine because I have long hair, I’m feminine because I’m female, because I’m a girl, because I have a sensitivity and a gentle nature about me.
Today, I’m happy with my short hair. I can’t say I will be tomorrow, but it won't be because I'm not feminine or girly or beautiful.
Taking a break from all your worries sure would help a lot
Wouldn't you like to get away?
Sometimes you want to go - where everybody knows your name
and they're always glad you came
You wanna be where you can see - our troubles are all the same
You wanna be where everybody knows your name
You wanna go where people know people are all the same
You wanna go where everybody knows your name
I don't know that I will ever feel as at home anywhere as I did, and still do, there.
But I'm starting to. And I'm so very thankful for that.
Wednesday, June 8, 2011
There are so many things that have happened this past year. So many things I meant to write about.
My recent trip to Chicago for a conference, my first MLB experience while I was there (the White Sox won! the Cubs were out of town), eating a phenomenal lobster and crab dinner, hosted by vendors, who paid for the whole outrageous thing.
I could also tell you about the fact that I’m moving…again. The 6th time in 30 months. I’m tired, excited, irritated, and getting really good at this. I’m moving out of my amazing townhome to a really great apartment. It’ll be an adjustment as I haven’t lived in an apartment in over 7 years and I'm really going to miss my garage and running with Ruthie on the 14th green (our backyard). But I'll be closer to work and the dog park, my commute to church will be shorter, I'm just as close to a Wal-Mart and Target; so overall it'll all work out.
Moving again doesn't do very much to make me feel more settled. I have such a deep craving for roots, as I've written about before (why I bought my condo in Oklahoma, why I've done so many silly unprofitable things the last 30 months). I was talking to a friend last night and she laughed at me, "for someone who sure hates change you sure do move a lot". The irony in what she said was not lost on me. This came after a discussion I had with her about my future plans, i.e. where I'll be a year from now (hopefully westward), but who really knows what these next 12 months hold.
Raleigh has been good to me these past 11 months. I have few complaints. There are definitely a lot of things in my life I needed to get sorted out, to tend to, to prune and nurture, to heal. Raleigh has allowed for a great deal of that.
I'm working a 24 today. The ICU is slow tonight. I can faintly hear the pumps beeping and the monitors alarming from my office. I did some extremely minor "surgery" today (fun bloody stuff). Who knows what this night holds for me.
But one thing I know for sure, I am blessed.