Monday, July 31, 2006

What she said

Last night I asked my colleague how her patient W was doing, since I'd taken care of her for several weeks in the ICU. W had been extubated (breathing tube removed, was breathing on her own) two weeks ago, and been moved out of the ICU to floor care last week. She was starting to nod yes/no to questions but was not very interactive and hadn't said anything at all. My colleague said W was doing okay, slowly getting better, but somewhat depressed. So I stopped by to see her, tell her who I was, and that she looked a million times better, and was making good progress. She nodded a little while I spoke and seemed aware that I was there. A few hours later, her nurse found me again. "I need you again in W's room, come with me," was all she said. I went and stood near W's bed, and her nurse said, "W, tell Rose what you just said to me." I glanced skeptically at her nurse, but took W's hand and looked at her. "I want to go home," she said simply. "You want to go home?" I replied. She nodded, looking me right in the eye. And while I'm always loath to make promises to patients, I told her, "Of course you do. And of course you're going to go home. Not tomorrow, and probably not as soon as you'd like, but that's the path you're on. Every day you get stronger, and every day we all work really hard to get you ready to go home. And you're working the hardest at it. So I can hear it in your voice now W, that you're getting better and you're going to go home."

Then I went back to my own patient's room [ed: another RN had been watching my patient and my monitors while I was in W's room], to continue titrating his levophed to maintain a blood pressure that actually perfused his organs with blood and adjusting the amount of oxygen the ventilator was giving him. He is really sick, at least as sick if not sicker than W had been. Some of them get better, and some of them don't, I don't know why. Maybe if I knew why then I wouldn't be hopeful when the situation was futile or I wouldn't distance myself when there really was hope.

There was also a code on the unit tonight, not my patient however. I was entering the room just as two young doctors ran onto the unit then stopped short in the doorway. "Shit, I hate it when we're the first doctors at a code. Have you ever run a code before?!" one said to the other.

Sunday, July 23, 2006

So I hear it's your birthday...

Thank you Jerry, and yes, it was yesterday! I'm officially an old lady, the big three-oh. It's a good thing, because now my knitting and sewing and old-lady name and wiener dogs all make a lot more sense. Plus, it feels kind of cool not being stuck slogging through my 20s anymore. I'm so over the 20s. The 20s were all about going to class and figuring things out and deciding what to be and what to do and what not to do. Not that I've got anything much more figured out, but I have learned things like not to keep drinking after you've thrown up (age 19), not to keep calling the boy if he stops returning your calls (age 20), how to read as little of possible but still ace the test (age 21), and how to get a real job that pays the bills (age 28). So now that I've got that stuff out of the way, I can be 30 and fabulous. And I'm going to try all sorts of new things. Already, I've been to Jack in the Box for the first time and eaten my first mussels (two different events, obviously). And it's only going to keep getting better from here!

I'm not going to tell you how hot it is here, nor am I going to complain about the weather. Contrary to popular belief (based upon the amount of people who do it), whining about the weather does not actually change it. Apparently, there are plenty of other blogs out there doing that if that's what you want to read. But I am going to mention that if you have absolutely nothing important that you need to be doing or anywhere you should be going, if you can get away with wearing nearly nothing, if you enjoy bad reality TV, and if you surround yourself with icy cold beverages, sprawl on the couch and point all the fans at you, this weather suits me fine.

I am also pondering why my neighbor, the Laundry Slut, continues to have at least eleventy billions loads of laundry to do EVERY weekend despite the fact that from April till October he NEVER wears a shirt. Tessa is currently barking up a storm at him because he's out in the yard, and even Tessa understands that public nudity is a privilege, not a right. A right specifically reserved for Colin Farrell and the Italian soccer team. And last I checked, furry Laundry Sluts were not members of that team.

Oof, I've left my post. Back to the couch, I don't think I've seen this particular episode of Kathy Griffin: My Life on the D-List.

Tuesday, July 18, 2006

I'm still here...

I haven't posted anything in a while, so I thought I'd drop in to say hey, I'm still around. Been working a lot lately, taking care of W. for a few weeks now. She's sometimes a tough patient, but I keep requesting her now, for whatever reason. Maybe because it gets easier to more experience you have with a patient, the whole "the devil you know..." thing. Maybe because the more you invest in taking care of someone, the more you have to be there for them. Last night her daughter asked me, "Is she going to wake back up? Is my mom ever going to be my mom again?" I don't know. Nobody knows. Maybe, or maybe not. There's such a super-fine tightrope we walk at work, giving realistic expectations but not extinguishing hope. Never extinguish hope, that's all some of these people have. You've got to hope for the best, because, really, what choice to do we have? Our chaplain told me once (someone else probably said this first, so I apologize for not giving credit where due), "Always hope for a miracle but never expect one."

Someone died this week. He was a cool guy. I want to link you to his obituary in the New York Times so you can read about his life and everything he did, but I'm too paranoid about HIPAA. He taught me that regardless of political affiliation, some people are just good people. He was warm, curious, funny, and open. He wanted to hear what you thought just because you thought it, not because you supported a particular party or 'side.' He wanted you to know more about politics, but he would give you a book or literature and encourage you to learn something through your own eyes then come back to discuss it with him. He found humor wherever he could. The love and compassion he inspired in his family members, evident from the way they looked at him and laughed with him was moving. He was genuine in a disarming way. When you strip away preconceived ideas and deal with people just as human beings, you are often surprised but always rewarded. It's unfortunate that sometimes it takes illness and suffering, or just putting someone in a neutralizing hospital gown, to approach that situation. So thank you sir, I feel lucky just to have met you.

I'm on stand-by tonight for work but I just received an 'ominous' call from my charge nurse, so I might be putting those scrubs on after all...

Monday, July 10, 2006

Tales from the Last Chance Motel

Last week at work, I took care of J., the woman who was in withdrawal and suffering from extremely altered mental status, although she was coming around a bit. I also took care of W., an engaging southern politician who said things like, "I have a five-pound appetite but a three-ounce stomach." He was a genuinely nice guy, the kind of person who, when he asks you how you are, asks you because he actually wants to know. I admitted him one night then got him ready for discharge him the next. So I came back to work this week and was guilitily pleased that J. had been transferred to another unit the day before. Then I found out that she had died that morning, a victim of her aggressive stage-four gastric cancer. And although I had discharged W., he had been re-admitted the next day but was currently on his way back home, via air ambulance, as he had relapsed and suddenly gotten sicker, so he wanted to be home to die. That night my another patient on my unit died, and I helped her nurse wrap up her body. My patient is also awaiting a celestial discharge, but remains full-code status and continues to undergo all treatments, such as mechanical ventilation, kidney dialysis, and a levophed drip (cardiac medication to keep her blood pressure up). She has gained over 80 lbs in less than three weeks, and when I move her or touch her she cries. Her tears are bloody and leave permamently stained rivers down her cheeks. Last night one side of her neck started swelling up like a baseball and we found a strange (fungal?) rash/spots across her chest. Yesterday another patient that I'd had a few weeks ago received her stem cell transplant but shortly thereafter went into respiratory distress, acute renal failure, and suffered a huge MI (heart attack). She was intubated and dialysed but her blood pH had been around 6.1 for nearly four hours. That's real BAD. So...yeah. I don't know why I'm typing all this, except that its what I mean when you ask me, "How was work?" and I say, "It was okay."

Tuesday, July 04, 2006

Wakey wakey

Although not a great photo, this is a view of the sunrise as seen from many of our patient rooms. After spending a darkened night making sure patients are breathing, whispering around sleeping family members, using a flashlight to check name bands, and ruminating over the horrors and unfairness of cancer, its always a comforting yet bittersweet surprise when the sun starts to come up, and the world outside starts to brighten. As if to say, "Things won't always be this bad."

My patient this week was going through probable benzodiazepine withdrawal, which presents somewhat similarly to alcohol withdrawal. Which is not a pretty picture. She may have taken up to 90 clonazepam tablets over six days, which is about 5 times the maximum recommended dose. She was delirious, narcoleptic, agitated, anxious, noncommunicative, impulsive...well, all that and a bag of chips. Oof. I'm drained from those three days of making sure she didn't pull out her central line, reaccessing her implanted port when she did pull it out, keeping her hands away from her foley catheter, listening to her cry, and hoping she didn't have any more seizures. Also, three deaths over the past three days on our unit, although all during day shift.

Then this morning I couldn't fall asleep because I was having this strange shooting and intense lower back pain each time I tried to lay down, which was rather bothersome. I couldn't remember hurting myself while bending or turning or lifting a patient, although it's certainly possible. All I could think of was, "Pt c/o lumbosacral pain, rated 7/10, nonradiating, sudden onset. Relieved with ibuprofen 800mg PO and diphenhydramine 25 mg PO. Reassess pt comfort q8hrs."

Saturday, July 01, 2006

It's July!

Happy July 1st everyone! I hope you all enjoy this lovely sunny summer month, the barbecues, the swimming, the sunshine. Ahh. Just, please, whatever you do, do not get sick or injured. Buckle your seatbelts, wear your helmets, cook your meat thoroughly, remember that "beer before liquor..." Do whatever you must do to avoid having to go a hospital at all costs. Because July 1, all across the country, is the first day of being a doctor for all new doctors. Don't get me wrong, the first-year residents are, for the most part, a group of highly trained, motivated, caring professionals. Ready to save lives. Just as soon as they figure out the appropriate dose of tylenol and make panicked calls to their attendings. I worked with an R1 last night was only five days old (awww!), still wet behind her cute doctor ears. So fresh and new, actually, that she was still getting ice packs for patients herself. And bless her, she was sooo sweet and caring, and trying so hard. But her comment to another nurse last night sums it all up: "You have no idea how many patients we'd kill if it weren't for you guys." (meaning us nurses! Like me! Hah! Yep, now you should be scared!)

For the past several weeks, although I've been feeling better for a few days, I've had basically a persistent headache which evolves into a migraine every third day or so, and had to take excedrin or nsaids on a daily basis. Last night, I admitted a patient from another oncology floor, a young woman in her early thirties who had mental status changes and a seizure. The nurse giving me report began by saying, "So this young woman presented to the ER last night with intractable headaches but appearing otherwise normal..." By this morning she was incoherent, unable to communicate, and thrashing in bed, agitated and unconsolable. At one point in the night she was foaming blood from her mouth because she bitten down so hard on her tongue. I had to pinch her nose shut to get her to open her mouth and stop biting her own tongue. We have no idea what is wrong with her. But yeah, I have an appointment with my doctor to discuss my headaches.