Thursday, March 27, 2008

job opening

So, last night. Blah. It was my first night using the brandy-new computer charting system recently unveiled at work. It wasn't too bad, but added a lot of time and confusion and discomfort to my charting process at work. I didn't have any huge problems with it, although I'm fairly sure I only charted about 12% of what I was supposed to. In the midst of the confusion, and the weirdness of no longer having paper MARS (it's all electronic now) I missed my patient's chemo dose. So it ended being about three hours late. In the morning when the managers got there they all flipped out and I stayed late writing an incident report and feeling like the sloppiest stupidest nurse ever. BUT by that point in the morning I was numb and sad and annoyed and just sick of looking at computers at all.

My patient died last night...not the missed-chemo patient, a completely different patient. A young man I'd cared for over the past several weeks. I wasn't his nurse last night but spent some time helping the family and was able to have a nice talk with them before I left in the morning.

Meanwhile, the ICU admission that I got was the furthest thing from the cakewalk DNR/DNI hemonc patient that I expected. What exactly do you do when your patient rips her leads off, smacks you out of the way, and insists on leaving the unit to smoke despite the fact that her lips and hands are blue and her oxygen saturation is 68%? I wish I could just say fine, go ahead then, and come on back when you're ready to accept our help. Uff.

Anyway. Tonight is definitely a Pagliacci's night. Yes, I use food as a coping mechanism. Is that so wrong? It's cheaper than crack.

Sunday, March 16, 2008


On my unit, we rarely see the newly-diagnosed cancer patients. By the time they arrive on our doorstep for transplant, they've been through at least a round or of chemo, sometimes even a prior transplant, and definitely been indoctrinated by the Clinic with at least a rudimentary knowledge of self-care and a set of expectations for their transplant. Many patients have done their own extensive research on their disease, the treatment options, facilities, etc. So while I still answer a lot of questions and do a lot of patient-educating, it is usually from a very matter-of-fact place. It may sound cold to say this, but in reality, my patients are cancer patients first, and then become real people to me second. It's inevitable...the first thing you learn about someone is their disease, their treatment, their lab values. You focus on this and then later the details of them take form...they are also someone's mother, or sister, or teacher. In their 'other life' they spent the majority of their time gardening or traveling instead of getting chemo and puking.

Last summer, working in another medical-surgical ICU, a young woman was admitted and immediately assigned to me, as I happened to have a lot of oncology experience. She showed up at the ER with some vague complaints, nothing too troublesome. She had hoped for some pain meds and a comforting, routine explanation for her headaches. After all, she was young and otherwise healthy. She was starting a new job the following week and wanted to be ready to jump into it. Then a routine blood test revealed a type of blood cancer in an advanced stage of crisis. Within 24 hrs, she had been admitted to the ICU, had two invasive central lines placed, undergone a procedure which removed all her blood from her body and separated the white blood cells, and heard words like "cancer," "leukemia," and "chemotherapy" thrown around.

By the time I meet her, she is feeling okay but her eyes are nearly swollen shut from crying and her voice is hoarse. I tell her the experience I have in oncology, in particular this type of cancer and treatment, and ask her if she wants to talk about anything or ask me anything. She mutely shakes her head, then whispers, "I don't even know what to ask. I just have stupid questions,"
"There are no stupid questions at all," I say.
"Well, I don't even know how to act. When other patients find out they have cancer, do they just cry all the time too? Is that normal?"
"Oh my god of course it is!" I told her. "It probably wouldn't be normal if you didn't cry!" Later, she asks me:
"Will you tell me something? No one else will tell me this, but have you ever seen anyone with this disease get better? No one will tell me if I could die. All they tell me are numbers."
How do you tell someone who is barely in her mid-20s that yes, she could die? That unfortunately, you see more people who die from this than who get better? That some of the things she is going to go through are going to make her want to die?
"It's cancer. The treatments for it are really really hard. Yes, you could die. But you could live, too. People do, and I've seen them. It's one day at a time, sometimes one hour at a time, and sometimes that's the best we can tell you," and I even get a bit teary as I squeeze her hand, till one of us makes a silly joke to break the mood and laugh a little. I tell her what I often tell patients, how I've seen how amazingly strong she is, and how much love I've seen surrounding her from her family and friends, and that more important that any medicine we could give her. When I say this, I believe it a little more than I usually do. I think I say it almost as much to comfort myself, and to give myself hope, as much as I do for her. She is a person to me first, and a disease second, even incidentally. She worries about losing her gorgeous long hair and makes jokes about the revealing hospital gowns, she wears funny socks just because she can and her friends start a blog for her. And knowing how dangerous it is, I let myself hope. Really hope. Some people do get better from this. So why not her? It has to be her.

After our initial meeting last summer, I could count the number of precious weeks that she was actually out of the hospital versus in it. She died last week, in my ICU. I wasn't her nurse but I don't know if I could have been. Even though I feel like I should have been. For her. I had trouble even helping her nurses with her, because I found myself just staring at her face, her swollen-shut eyes and her bald head, searching for traces of that brave, funny girl I met last summer.

Scaredy-cat nurse

I'm not one to wax philosophical and claim that I live my live by nebulous quotes and cliches, but I recently read that Ralph Waldo Emerson said, "Always do what you are afraid to do." And I was just thinking that maybe I've unintentionally done that.

I was a wee young nurse tech buckaroo roundabout five years ago, wide-eyed and scared to death just to walk into a patient's room on the oncology unit I just started working on. I would rehearse to myself how I would greet the patients and introduce myself, just so I wouldn't sound silly, and I lived in fear that eventually a patient would say to me, "What are you doing here? You obviously don't belong here, you don't know what you're doing." Mercifully, and shockingly, that never happened. I would walk past the ICU rooms and glance furtively in, trying to discern the actual patient from the spaghetti-tangle of wires, lines, and blippy-beepy machines, and shake my head. Scary. Crazy. If asked to assist an ICU nurse with turning or cleaning her patient, I remember gingerly lifting lines or wires simply to hold the patient's hand, always keeping one eye-ball glued to that ET tube as if a hiccup might dislodge it, causing the patient's untimely and messy demise and of course it would all be my fault. I imagined that I could never work in the ICU, I didn't have the knowledge, or the drive, the stamina to handle being that on-edge and stressed out all day long.

To make a long story short, I of course ended up as one of those crazy ICU nurses. I guess it was a combination of being fascinated by what I didn't understand...the physiology, the pharmacology, the intensity of the human situation, that drove me to want to figure it all out. It was probably a little bit of, "Hey, if Nurse XYZ can do it, then so can I!" And maybe you could boil it down to that little quote, "Always do what you are afraid to do."

And now tonight I'm going to be in charge...not a huge thing, there are no special classes or knowledge or certifications required, and the amount extra that I'll get paid will barely pay for my end-of-stretch pizza. But something makes me want to try it. I think it's a little bit the sense of ,"Ok, what's next?" I attribute that to the fact that I am an eternally lazy person, and I must always be working towards a next big goal or my motivation falters and I slip into a boring rut. So, after RN, ICU RN, what was next? Charge RN, I guess. And of course, CCRN ICU RN, coming soon :) I used to think I would hate being in charge, and there's still a chance that I might be right. After all, I don't think I'm a manager-type person...I don't like organizing things, I don't particularly like telling other people what to do, and although I've been working on, I'm not as assertive as I'd like to be. I'm much more content to remain quietly in the background, mostly doing my own thing. But hey, it'll be an interesting change, a new perspective at work, and at least I can say I tried it.

Thursday, March 13, 2008

Dog hospital

Something strange has been happening in my wiener dog family... when Ted went to the vet to get his teeth cleaned, Tessa got sick with some nasty GI virus. When Tessa went to the vet to get her teeth done, Ted got sick with some nasty GI virus. How weird is that? What is going on? My normally healthy little dogs are rarely sick, despite the nasty bits and pieces they occasionally try to snack on during our walks. So, yet again, I am making boiled chicken and rice to sooth the tummies of my little dogs, giving them lots of cuddles, very frequent trips outside, and washing the rugs. Tessa is doing better after her dental surgery and it appears that she can still keep her tongue inside her mouth (one worries about these things as the old girl loses more and more teeth).

Monday, March 10, 2008

Puffy eyes

I have lots to say, its swimming around in my head and as soon as I have a little time off I think I'm gonna spew it all on here.

I've been working a lot. My patients are young and they are dying. I cried last night at work, for only the second time in five years there. Of course, I've cried on the way home plenty of times, I've cried during Dawson's Creek and Law and Order cathartically for my patients, but sometimes...even if you try to be professional and do you your job and keep in inside, it creeps up on you. Thank goodness for kindhearted colleagues who simply pat you on the shoulder, make you a cup of tea, hand you a box of tissues, and tell you to walk and away and take a little break.

More later. When the eyes are a little drier so I can see what I'm typing.

Friday, February 29, 2008

Hellooo *echoechoecho*

Remember me? I don't post around here much anymore. I would make excuses that I haven't had much interesting or exciting news to report, but as evidenced by past blog posts, I seem to have been quite capable of posting about completely irrelevant or boring topics in the past.

Maybe I'm a little burned out on writing about nursing topics, or about my patients. There's something so private and intimate about the situations that I'm sharing with my patients, they're experiencing such painful, terrifying, or life-altering experiences, that it often feels like a betrayal or even just a belittling act to write about them in my blog. They own their illnesses and their experiences, its not really mine to share with anyone. And of course we are all intimately familiar with HIPAA...I would always change any revealing details of my patients and most of the time anyone I write about is a composite of several patients. But it is often those small, identifying details about someone or their story that makes the story special, or interesting, and to change those details simply for the point of sharing the story takes something away from it. Of course I realize nursey blogging can also be about the nursing experience, and being a nurse, rather than the patients' stories, but it is also pretty hard to separate the experience is defined by the other's, and vice versa.

So...on to the nursing content...I'm taking a CCRN study course this spring so I can take the exam in early summer. I'm not terribly excited about the study course except that I get paid for some of the hours and it is essentially the external motivation that I need to make myself study to take the exam.

Tonight I'm off work but I'm playing nurse to a sick little dachshund...she seems to be suffering from some kind of GI upset...frequent bouts of emesis and liquid stool through the day today. In laymans' terms, I'm discovering puddles of poo and puke in various corners of my home, and now both the kitchen and the bathroom rugs are in the laundry. But our favorite Auntie to the doggies delivered us some dinner, so I wouldn't have to leave the sick puppy alone, and I cooked up some extra bland chicken and rice dinner for her. She seems to be tolerating the dinner so far...and sleeping comfortably on the couch.

Friday, February 08, 2008

Seacaucus, sawcaucus.

I'm going to caucus for Obama because I don't believe there should be a woman as president. They are too emotional and generally have bad judgment. Not to mention, they are terrible drivers.

I.Am.Totally.Kidding. Well, except that that driving thing. Women suck at it.

Does anyone else remember back in the day, when it was considered rude to ask someone who they were voting for, that it was none of their business? Because I'm not sure why the phlebotomist who drew my blood today felt like it was totally okay to ask me who I would vote for. So I told her that convicted felons aren't allowed to vote, so at least I don't have worry about it. Because I'm too lazy to look it up, anyone have any good links that help explain Obama's policies/plans for healthcare reform? Sure, he may be inspirational and full of hope, blah blah changecakes, but I'm too cold and dead inside to be swayed by a moving speech or a touch of inspiration. I want plans.

And also...I am NOT defending the misogynistic theocracy of Saudi Arabia, but I have to play devil's advocate on this article, "Saudi Cops Grab U.S. Woman..."

Sure, it might be a bit crazy to a lot of the world that unrelated men and women cannot be together in public, but thems the rules over there. So this American woman knowingly broke the law, and goes to jail for her offense, and uhm...? Sorry. Maybe I just have a problem with her because when the power goes out in your office, you GO HOME for the day. Whee! Day off. What was she thinking? You do NOT break the law simply to get a little more work done for the day. Sheesh. Maybe a night in jail helped loosen her up a bit. Kidding. Again. Totally. Kidding.

And, Mr. Restoftheworld? You do not get off poking fun of Saudi's silly laws against women or highlighting an amusing anecdote to show how "backwards" those people are. In the same article, substitute "woman" for "racial minority"...are you still scoffing and smirking and shaking your head? Or are you sending in UN Peacekeeping forces and demanding universal human rights? Anyway. But at least they don't let women drive over there... IAMKIDDING! Get a grip.

Let's is where should apologize for not updating lately. I'll try harder in the future. But to recap: Love my "new" job again, nightshift rocks, TESOL class lots of fun, cancer patients depress and inspire me. I'm considering taking the CCRN, being charge nurse, going to Turkey, making mini Turkey meatloaf muffins, going to Egypt and Jordan, and a retirement plan. I knit Foliage from (and I love it!), a feather and fan pattern baby blankie and matching hat, and I'm working on a long grey scarf and another baby hat. I'm totally addicted to Law and Order, it's like TV crack, and I can't turn it off. Ever.

Sunday, January 20, 2008

Just something to make you smile on a Sunday morning...

I've been seeing these Alli ads on TV for a while now, and of course, like the skeptical nurse that I am, I've been doubting how 'easy' and 'wonderful' this drug is. Everyone knows there is no miracle drug for weight loss. Except the millions who spend billions on them every year. But anyway. As soon as I heard the description "blocks fat from absorption in your digestive track" in the advertisment, I knew this must pharmaceutical doublespeak for "shitstorm." I became determined to get my hands on a package insert from this drug in order to translate the side effects into layman's terms, since I was fairly certain the more accurate and descriptive words like "bowels let loose in your pants" and "buttmud" and "wet farts" would not be listed. However, someone beat me to this, and you should read it too...

Alli Side Effects in Layman's Terms

Saturday, January 05, 2008

More knitting, less nursing

I do fully realize that this is supposed to be a nursing blog but it's fairly devoid of any nursey content. But in between calling off sick with nasty colds and being cancelled due to low census, I haven't really worked much lately. And I actually miss working. My bank account really really misses me working, but that's another story. I was really hoping to go to work tonight but whatever crawled up my nose last night has set up camp in my head so I had to call in sick. And since this is my second cold in a month, I wonder if I have a compromised immune system, possibly secondary to leukemia? I'm not a hypochondriac, per se, however being an oncology/ICU nurse I tend to look for zebras. That's one of my favorite sayings, by the way. They say it to med students, when they are diagnosing patients. "When you hear hoofbeats, don't look for zebras," or something like that. Just meaning that always rule out the most likely scenario first. Anyway, I digress. Because I took cold medicine and my head is cloudy.

Last night I went to Pizza Hut because I suddenly needed to have me some stuffed crust pizza. And it was the most bizarre experience ever. I ordered online, and the email reply said it would take 20 minutes. So I went to pick it up, 20 minutes later. After a few minutes, someone finally comes to the counter to acknowledge me, and says it'll be a few more minutes. How magical that he knows that, I think, considering he didn't even ask my name for my order. Then a guy in mismatched navy sweats comes in, and the same thing happens to him. In the meantime, while he is waiting, he gets a call on his cell phone.
"Really? So he had another seizure? You're taking him to the hospital now?"
It was bizarre, hearing his end of the conversation. I stared at the Mountain Dew in the locked soda case and pretended I was not a nurse. After hanging up, Navy Sweats starts getting anxious and demanding to see a manager, because his food was supposed to ready 10 minutes ago. By this point, two more people have come in, are waiting for their orders, and the phone is ringing constantly. No one at all is approaching the counter to let us know where our food is. Some employee calls to another, "Can we stop taking orders?" Uhm, can you do that? I can sympathize, when things are crazy in retail or food service, you totally want to lock that door and stop customers from coming in because you don't give a shit if more money is to be made, you are making minimum wage and you are miserable. But anyway. Navy Sweats is getting all indignant and ranting about how he had better be compensated for his wait. Some woman in a crazy hat and a knee brace is trying to sympathize and make jokes. A 12-year-old employee comes out to explain that they're really backed up, running out of stuff, etc. Navy Sweats is not mollified. I'm thinking that at this point, Navy Sweats should just pop next door for some teriyaki then head home to his seizing friend. But anyway, no one asked me. Finally, his pizzas come out and the manager is all, "Uhm, just give me ten dollars." I finally got mine and was only charged half price, but then went to my car only to discover that Crazy Hat Knee Brace Lady had blocked my car in with her 1982 white Buick. Seriously. I felt like I was back in Pittsburgh for a little while.

Here's a funny story my dad told me. He was in Canada, at Immigration trying to get his work permit. Ahead of him in line was some strange looking older guy. He couldn't hear what the guy was saying, as he was kind of mumbling, but he could hear the customs agent's end of the conversation. The customs agent looked at the guy's paperwork, and said, "It says here you have a couple of felonies." The guy mumbled a little. The agent continued,
"For weapons possessions?" Now, at this point, one would assume the customs agent should merely stamp a big fat red "denied" on this dude's paperwork and turn him away. However, this particular agent is too intrigued...
"They were assault rifles, you say?" Mumble mumble.
"How many?" Mumble mumble mumble.
"Wow. That certainly is a lot, sir. Did you have permits for those, uhm, assault rifles?" Mumble mumble.
"Hmm. I can see how that caused a legal problem for you." Mumble mumble.
"No, I'm sorry, I cannot allow you to have a work permit to enter Canada with." Mumble mumble mumble. STAMP.

Thanks, Canada. On one hand, kudos to you for policing your borders. On the other hand, maybe you could have referred him somewhere else? Instead of back to the US.