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.