Just a few more posts about death, I promise.
When I was 19 and living in a van, with a really great ex, I adopted a little puppy. She was six weeks old, a little black fur ball, and was so small she couldn't go up stairs by herself. She grew up to be this incredible dog, who was always loyal and dependable. I didn't have to use a leash after she was four months old, she learned lots of tricks, and she got along with most dogs and kids, but wouldn't take any crap either. She barked at the door when people came over, and liked to pee in the basement sometimes, but these were her worst flaws. She was always so cool in public, I would take her to festivals and pretty much everywhere I went. She was so mellow, she got left at more than one garage sale; where we all jumped out of the car to check it out. After perusing and buying goods, we would drive away, realizing a mile later that Zu wasn't in the car. I would freak out, flip a u-turn, and there she would be, standing in front of some guys garage, waiting for me. I'd lean over and open the door, and she'd hop in. We'd speed off down the road, as a group of people would chuckle at the scene. Good times.
My dog is now 14 years old. She was diagnosed with heart failure a couple years ago, and her life was graciously extended with dignity by the modern marvels of an ACE inhibitor and a little blue hydrocodone pill. Her symptoms started with this random collapsing when she was exerted. The first time it happened I was walking with friends from the gym, and Zula just fell to the side, laying there, breathing hard. It happened a couple more times, and I thought that perhaps 12 years old was the end for her, and this was just a natural progression. My husband told me to take her to the vet, and she was prescribed some meds that gave us some more good years. (Thank God someone in the family has sense to see the doctor!) Her quality of life has been excellent, despite occasional exertion seizures and accidents, she is always happy and loving. She is the best girl.
Zu-zam has lost a dramatic amount of weight in the past month. She has stopped eating and when she stands up, she wobbles back and forth like a drunken sailor. Her time is near, and I am trying to make her as comfortable as possible. She needs to be carried down the porch stairs to do her thing, and I bring her up again, laying her on a blanket that belonged to my sister. She won't even eat bacon, and we all know this is an ominous portent. I would like her to die at home, in her sleep. But, I don't know how it will all play out.
I tell people at work about her, and they all are sympathetic. One person tells me to use propofol under the skin, another says phenobarbitol, and yet another tells me to bring home an IV kit and some potassium. This is all well meaning, and shit, yes, we all want to save some money, but I'm not going to kill my own dog. I want to be the griever, not the agent. My role is to love and cherish her, not plan for and give her the best death. This is a new arena for me. I have had personal losses, but most have been sudden and devastating. I have not had to watch anyone get weaker and more feeble, except my Grandma, who was comically proactive, planning her own wake from the music and the food, and finally passed away the morning of the event.
It makes me glad that she is not in pain, and still wags her tail when she sees me, but I still lay down on the floor and cry heavy tears thinking that soon she will be gone. I know that she is "just" a dog, but she is part of my family and she has been with me through the most fundamental changes and progressions in my life. As a nurse who deals with death all of the time, It is surreal to have this in my own home. I have been to the morgue twice in three days this week, wrapping the bodies of two people whom I was with when they died. Still, this exposure doesn't prepare me for the loss of my baby and best friend. At home, laying with her, I easily slip out of my day job, and envelope her with inconsolable arms. Thanking the Gods that there is someone else who can lead us through any tough choices we may have to make ahead.
Friday, April 30, 2010
Saturday, April 10, 2010
the power of now
0700
Me:'I hope I get someone super sick today...God, is that wrong?'
Husband:'No. But it's weird.'
Anyone who really knows me understands that myself and my family have been having a rough year or so. Tragic events, coupled with strained relationships, have made me very close to the self-help section at Barnes and Noble. It is a startling event when you realize that whenever you go to the library (after your therapy session), you are consistently drawn toward books about spiritual enlightenment, comfort food, and hot, teenage vampires. Anyway, my point is, that yes, I have had some Lifetime Channel moments, and I am pulling myself through, one trip to the bookstore, and one blog entry, at a time.
Along my journey of self reflection, I found the pinnacle of modern spiritual growth, Eckhart Tolle's The Power of Now. The point to this book is pretty simple and is not rocket science (Monica), but easily missed in our daily rat race. He says people in American society don't focus on the present, and instead, dwell on the past, or think about the future. He writes that the mind evolved as a helpful mechanism for humans to develop strategy, and assisted us in ultimate survival; but has since taken over. We think of our minds as our self, when really, many of the thoughts are crap repetitive tapes cycling through our head. This rang true for me in some ways, and I started to make an effort to sweep away nonessential thoughts, and to think of my mind as a tool, not as my true self. (My mind likes to talk a bunch of bullshit, and so do I in daily conversation)(ask anyone)
Being in the now takes the effort to quiet the mind, and just be aware of where you are. A section of the book mentioned that in emergencies, you have to be completely present, and that your mind is useful to get you through the event, but it doesn't throw out a lot of it's regular rambling. This struck me as I read. I realized that one of the reasons I like working in the ICU, is that I have to be present and in the now most of the time. I do well in that now. I like to call ahead to get challenging patients, and I want to fill my day running to catch up. Sometimes it can be overwhelming, and I don't need the action everyday, but I love that feeling. I am strong and useful, and am becoming expert at anticipation and reaction. I feel empowered when my movements are instinctual and correct: drugs, ACLS stuff, airway patency, arrhythmia's, knowing how to look calm in front of families. I feel at home with this self. When I was at the bookstore looking for meditational insight, I did not realize that I had already carved a niche at work where I did have some sense of self and inner peace. (You just have to ignore the blood, shit, and festering wounds - then, voila! - Nirvana)
In real life, I am still working on trying to swim through the constant chatter of shoulds, needs, wants, and all of the baggage that goes on in family life. Finding those quiet moments with kids as enthralling as my day job. Loving my kitchen again, really smelling and seeing the soil as I turn it over in the garden. Finding joy in the little things that don't involve gore and vasopressors. These are things I am working on.
Me:'I hope I get someone super sick today...God, is that wrong?'
Husband:'No. But it's weird.'
Anyone who really knows me understands that myself and my family have been having a rough year or so. Tragic events, coupled with strained relationships, have made me very close to the self-help section at Barnes and Noble. It is a startling event when you realize that whenever you go to the library (after your therapy session), you are consistently drawn toward books about spiritual enlightenment, comfort food, and hot, teenage vampires. Anyway, my point is, that yes, I have had some Lifetime Channel moments, and I am pulling myself through, one trip to the bookstore, and one blog entry, at a time.
Along my journey of self reflection, I found the pinnacle of modern spiritual growth, Eckhart Tolle's The Power of Now. The point to this book is pretty simple and is not rocket science (Monica), but easily missed in our daily rat race. He says people in American society don't focus on the present, and instead, dwell on the past, or think about the future. He writes that the mind evolved as a helpful mechanism for humans to develop strategy, and assisted us in ultimate survival; but has since taken over. We think of our minds as our self, when really, many of the thoughts are crap repetitive tapes cycling through our head. This rang true for me in some ways, and I started to make an effort to sweep away nonessential thoughts, and to think of my mind as a tool, not as my true self. (My mind likes to talk a bunch of bullshit, and so do I in daily conversation)(ask anyone)
Being in the now takes the effort to quiet the mind, and just be aware of where you are. A section of the book mentioned that in emergencies, you have to be completely present, and that your mind is useful to get you through the event, but it doesn't throw out a lot of it's regular rambling. This struck me as I read. I realized that one of the reasons I like working in the ICU, is that I have to be present and in the now most of the time. I do well in that now. I like to call ahead to get challenging patients, and I want to fill my day running to catch up. Sometimes it can be overwhelming, and I don't need the action everyday, but I love that feeling. I am strong and useful, and am becoming expert at anticipation and reaction. I feel empowered when my movements are instinctual and correct: drugs, ACLS stuff, airway patency, arrhythmia's, knowing how to look calm in front of families. I feel at home with this self. When I was at the bookstore looking for meditational insight, I did not realize that I had already carved a niche at work where I did have some sense of self and inner peace. (You just have to ignore the blood, shit, and festering wounds - then, voila! - Nirvana)
In real life, I am still working on trying to swim through the constant chatter of shoulds, needs, wants, and all of the baggage that goes on in family life. Finding those quiet moments with kids as enthralling as my day job. Loving my kitchen again, really smelling and seeing the soil as I turn it over in the garden. Finding joy in the little things that don't involve gore and vasopressors. These are things I am working on.
Wednesday, April 7, 2010
TFMITW - The Foulest Man In The World
Disclaimer - This entry may contain profanity. I have censored some of my recent posts as I have been publishing some of my stuff on nursing blog forums, which tend to be more scholarly, and try to be serious/conservative in nature. This is despite the fact that a lot of real life nursing deals with crap and bureaucratic bullshit. I for one, love swearing and crass commentary, and have felt, well, almost suffocated by these fucking boundaries of professionalism.
TFMITW lives in my unit. He won't die, but he also won't get better. He teeters on the edge of life and death all the time, and when he is doing ok, he is rude, is always on his fucking call light, and is always, hideously incontinent. His stench is unbearable and it permeates to your very core when you take care of him for the day. He also refuses to turn, refuses to cough and deep breath for pulmonary hygiene, always is screaming for pain medication, and worst of all, if he doesn't have his speaking valve or call light handy - clicks incessantly with his mouth like a horny Spaniard. He is now basically paralyzed, has an ever oozing trach, and needs everything done for him. Wiping his nose, feeding him, flossing his teeth, "milking" his rectal tube, changing the channels, and moving him repeatedly one inch at a time - "No! Too much, back toward you! Get the wrinkles out, Oh God I hate the wrinkles. Oh my rectum hurts, it burns! I need more dilaudid! Oh Christ, I just crapped again." This is your day with TFMITW. Oh God it burns.
He is the bane of the unit and we trade him off like canned spinach. I have to assign him to people, and will trace it back to the last time someone had him. Sometimes I have to go back over a month in order to make it fair. This whole junior high bullshit pisses me off. People will sigh heavily, whine uncontrollably, and beg to pass him off. I mean he isn't pleasant, but seriously, groveling?
The sad thing now is that he doesn't really bug me anymore. I actually feel bad for him, and have found out over time, that we actually get along pretty well. He calls me Nurse Ratchet. I set limits, tell him no, and say "Jesus Christ TFMITW, give me a fucking break!" He likes this. I am the one who got him out of bed for the first time in two months and took him outside - for a cigarette, of course. The light shone in his eyes as his son held the smoke to his crusty lips, and he winked at me as the sun played on his face. He was so grateful for that moment, and I felt pretty good about it. Then later, we had to go upstairs and replace the large rectal tube that he is always shitting out as he has no more rectal tone. sweet.
He always asks when I am coming back. He has a couple nurses who don't treat him like crap, and he wants to know who is coming on after my shift. He doesn't understand why he always gets a different nurse, and gets depressed and angry that no one listens to him. He doesn't mean to be TFMITW, but alas, it is his fate. He is an asshole, and if he was more proactive and nice, he probably would have gotten better care from everyone. People look at me in horror when I say that I don't mind him. "Well, why don't you just take him all the time then?" they ask smugly with sarcastic smiles. Well, for one thing, bitches, he is a patient and deserves care despite his physical and personal flaws. We all need to do our share and deal with backtalk and crap. So you too, can get off your ass, deal with his needs and find a way to communicate and help him so that he doesn't call you every five minutes. Plus, I am getting tired of coming home and taking a thirty minute shower which includes a complete nasal flush.
TFMITW is looking like crap again by the way. It is nice when he is stuperous and can't get his shit together enough to call for help. But it is sad listening to his confused and rambling hallucinations. He is half the asshole he was, and this is an ominous sign. He is on pressors and is dependent on the vent all the time now. I think that many people on our unit might be happy if he was listening to "smooth jazz", but I would miss him. (Well, I'd miss him as a person, not necessarily taking up a bed for god damned ever)
Good luck TFMITW.
TFMITW lives in my unit. He won't die, but he also won't get better. He teeters on the edge of life and death all the time, and when he is doing ok, he is rude, is always on his fucking call light, and is always, hideously incontinent. His stench is unbearable and it permeates to your very core when you take care of him for the day. He also refuses to turn, refuses to cough and deep breath for pulmonary hygiene, always is screaming for pain medication, and worst of all, if he doesn't have his speaking valve or call light handy - clicks incessantly with his mouth like a horny Spaniard. He is now basically paralyzed, has an ever oozing trach, and needs everything done for him. Wiping his nose, feeding him, flossing his teeth, "milking" his rectal tube, changing the channels, and moving him repeatedly one inch at a time - "No! Too much, back toward you! Get the wrinkles out, Oh God I hate the wrinkles. Oh my rectum hurts, it burns! I need more dilaudid! Oh Christ, I just crapped again." This is your day with TFMITW. Oh God it burns.
He is the bane of the unit and we trade him off like canned spinach. I have to assign him to people, and will trace it back to the last time someone had him. Sometimes I have to go back over a month in order to make it fair. This whole junior high bullshit pisses me off. People will sigh heavily, whine uncontrollably, and beg to pass him off. I mean he isn't pleasant, but seriously, groveling?
The sad thing now is that he doesn't really bug me anymore. I actually feel bad for him, and have found out over time, that we actually get along pretty well. He calls me Nurse Ratchet. I set limits, tell him no, and say "Jesus Christ TFMITW, give me a fucking break!" He likes this. I am the one who got him out of bed for the first time in two months and took him outside - for a cigarette, of course. The light shone in his eyes as his son held the smoke to his crusty lips, and he winked at me as the sun played on his face. He was so grateful for that moment, and I felt pretty good about it. Then later, we had to go upstairs and replace the large rectal tube that he is always shitting out as he has no more rectal tone. sweet.
He always asks when I am coming back. He has a couple nurses who don't treat him like crap, and he wants to know who is coming on after my shift. He doesn't understand why he always gets a different nurse, and gets depressed and angry that no one listens to him. He doesn't mean to be TFMITW, but alas, it is his fate. He is an asshole, and if he was more proactive and nice, he probably would have gotten better care from everyone. People look at me in horror when I say that I don't mind him. "Well, why don't you just take him all the time then?" they ask smugly with sarcastic smiles. Well, for one thing, bitches, he is a patient and deserves care despite his physical and personal flaws. We all need to do our share and deal with backtalk and crap. So you too, can get off your ass, deal with his needs and find a way to communicate and help him so that he doesn't call you every five minutes. Plus, I am getting tired of coming home and taking a thirty minute shower which includes a complete nasal flush.
TFMITW is looking like crap again by the way. It is nice when he is stuperous and can't get his shit together enough to call for help. But it is sad listening to his confused and rambling hallucinations. He is half the asshole he was, and this is an ominous sign. He is on pressors and is dependent on the vent all the time now. I think that many people on our unit might be happy if he was listening to "smooth jazz", but I would miss him. (Well, I'd miss him as a person, not necessarily taking up a bed for god damned ever)
Good luck TFMITW.
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