I have often heard that the last sense to go is hearing. I have also heard the same about smell and touch. I don't know really what is the truth. I have experience with the end of life, and I still really don't instinctively know what people can hear or taste at the end of life. I do know that I am a fanatic about patient oral care, and that I insist on music or the white noise of CNN with my sedated patients. But, I also know that I have no real qualms with taking shop while cleaning up a code brown when a patient is sedated and intubated. There is also a never-ending joke about how in the ICU we are happy to have sedated patients when there has been a large amount of bean dip or cruciferous vegetables consumed the night before - it is easy to blame the man in the bed. I refrain from talking about a patient's condition or prognosis, but am not inhibited when discussing another nurses sex life, or what my weekend plans are. I often take personal calls in sedated person's room, and will chat while drawing blood or giving meds. I like to think the personal commentary breaks up the monotony of unyielding beeps and alarms that are part of the ICU experience.
This is probably crap, and I am a horrible person for dehumanizing my patients, and I do get paid a fair amount of money per hour, so there is really no excuse for not maintaining strict professional standards. Still saying this, I don't really buy that my people are there enough to hear everything that is going on around them. Most will wake up after they are extubated and say that they don't remember anything, and I like to think that maybe I gave them some good dreams talking about my wicked hangover, and the fun love making I (I mean my fellow nurse - of course) had the night before.
Wednesday, May 19, 2010
Wednesday, May 12, 2010
boyfriend update
A year or so ago I wrote a post about some of my boyfriends at work. I am sad to say that one passed away, and I am just stunned that he could actually be gone. I thought he would be around forever. He deserved a quiet demise like falling asleep after a cigarrette and a burger, and forgetting to put his oxygen back on. I will visualize that that is how he actually went.
You will not be forgotten, and you made me laugh so many times- Thanks. I know that you are going to enjoy the lightness of afterworld.
I wish I had bought him the ham sandwich he asked me for the other day.
You will not be forgotten, and you made me laugh so many times- Thanks. I know that you are going to enjoy the lightness of afterworld.
I wish I had bought him the ham sandwich he asked me for the other day.
Monday, May 3, 2010
A rant
This is going to be a bitchy post.
I normally don't talk smack about people (aside from residents and administrators, who are obviously exempt from this, and just from their job description, need to be heckled occasionally), but I feel the need to express some anger and frustration - and that, I will do now, with you dear reader. I think that most professions generally protect their own. Unless someone is a total jackass; teachers, lawyers, doctors, and nurses will give one another the benefit of the doubt. Publicly broadcasting someones incompetence is a politician's job, and not mine, but, with discretion- I will share this complaint.
OK, yes, I talk about death a lot, and I promised only a few more posts (a lie), and here is another one. Not particularly about death, but more about dying and dignity, and not the political hot potato kind. Dying with dignity to me means: not dying alone, not being a carnival show, having privacy, being comfortable, and having an intuitive person watching over you. Some nurses and doctors get this, and some are fucking oblivious. In the ICU this is a scary/sad thing. I believe that for many nurses, when a patient dies, there is a big difference in care when they are alone, rather than with family present. This goes for physicians/nosey med students too. When there is no family we are more likely to poke and prod, take random blood pressures, talk about how pissed we are at our spouses, and gossip about hospital drama. I know that I am less sensitive when there is only my sedated or stuperous patient - but the key is that I KNOW I am not being delicate at that moment - when under it all, I still am in touch with the current of the room, the patient, and my role as advocate. I can get right back there, where often times I don't know if some other nurses can feel it at all.
I had an event the other day where a new orientee was being trained by and older, very experienced nurse. The patient was placed on comfort care over the phone by their DPOA. The family opted out/was not able to be present for his death, (Granted, he probably had a colorful life, any may not have been the most angelic character, as his ending diagnosis was Hep C and alcoholism) and he was going to die alone. We all knew this, and shortly before I came on shift, his medical care transitioned to comfort rather than cure. I was to assume his care four hours later at 8pm, and in the meantime I was the floating helper nurse. (I will admit that I did remark: "Christ, another trip to the God-damned morgue, fucking great.") (I am not a saint). I went by his room a couple times and noticed that his door was wide open, revealing the bright yellow, bloated form that he had taken. Making sure he had soft music in the background, I shut the door gently each time, only to find it wide open again later. I hear the two nurses in charge of him wondering aloud why is oxygen levels are so high, they thought he would die so much sooner. The new nurse was eagerly watching his monitor for cardiac changes, oohing and gasping when he would have a sinus pause or a bout of arrhythmias. This is pretty cool for a little while, but after a while got annoying, especially when I noticed that his blood pressure cuff kept going off, showing a BP of 30s/20s. I asked why they were taking his blood pressure, and they couldn't give me a good answer. I said "The guy is on comfort care, give him a break!" They said they would stop it, and I let it go - with an eyeroll, and a meaningful look at the nurse next to me. Finally, 8pm comes.
I am the charge nurse and also have this guy. After I make the rounds, I go into his room. I see this man alone, fairly obtunded, with all the bells and whistles attached to him. I call the covering doctor for a morphine drip, which all my comfort patients receive, even for a small dose per hour (which you had better do for me too). I take off all of his extra leads, his BP cuff, his oxygen monitor, and I wash his face. I notice that his oxygen is blaring 6 liters in his nose, and turn him down to 1 liter per minute (No wonder his sats were so high!! (dumbasses)). I hang out with him for a while, swaying to Kid Rock after I change it to the country station, since he is obviously not smooth jazz.
All of this should have been done before me. I notice that after he had been placed on comfort care, his vitals were still written down every fifteen minutes for the next two hours. This irritates me.
Soon his heart rate slows and I go into his room. I stand next to him and sing him a song as he dies.
I took him to the morgue with the goofy escort guy (It was swell. Yeah right, the morgue sucks. I should get paid hundreds of dollars an hour when I have to go there and shove bodies around). Whatever.
I pulled the nurses aside individually the next day and told them that this was not the way to do comfort care and that I was upset about the way that this patient had been treated. They both bristled and made excuses, and I know that we are not on our game all of the time, so I am letting it go now. However, if I am in that bed, please give me a different nurse.
This is a rant really saying that an expected death should be as peaceful as possible, and that the care of the patient shouldn't be lessened if they end up dying without friends or family present. They should have a sensitive hand stroke their hair, and someone there to dream a little of the good person that they were.
So I will leave you with the song I sang, by a lovely woman named Joules who lived on Lopez - I think my guy liked it.
My clothes are ragged and torn,
you know as sure as your born,
that they've been loved and worn for many years.
And from the mud on my toes,
to the way my hair grows,
I see that everyone knows I'm living free.
Cause living free is the only life for me.
Yeah living free is the only way I'm gonna be.
Some see the dirt on my hands
and they just can't understand
how I can live on the land, but that's OK.
I tried my hand at their schools,
but they was acting like fools,
restricting life with dumb rules,
that's not for me.
Cause living free is the only life for me.
Yeah living free is the only way I'm gonna be.
(Jazzy ending)
I normally don't talk smack about people (aside from residents and administrators, who are obviously exempt from this, and just from their job description, need to be heckled occasionally), but I feel the need to express some anger and frustration - and that, I will do now, with you dear reader. I think that most professions generally protect their own. Unless someone is a total jackass; teachers, lawyers, doctors, and nurses will give one another the benefit of the doubt. Publicly broadcasting someones incompetence is a politician's job, and not mine, but, with discretion- I will share this complaint.
OK, yes, I talk about death a lot, and I promised only a few more posts (a lie), and here is another one. Not particularly about death, but more about dying and dignity, and not the political hot potato kind. Dying with dignity to me means: not dying alone, not being a carnival show, having privacy, being comfortable, and having an intuitive person watching over you. Some nurses and doctors get this, and some are fucking oblivious. In the ICU this is a scary/sad thing. I believe that for many nurses, when a patient dies, there is a big difference in care when they are alone, rather than with family present. This goes for physicians/nosey med students too. When there is no family we are more likely to poke and prod, take random blood pressures, talk about how pissed we are at our spouses, and gossip about hospital drama. I know that I am less sensitive when there is only my sedated or stuperous patient - but the key is that I KNOW I am not being delicate at that moment - when under it all, I still am in touch with the current of the room, the patient, and my role as advocate. I can get right back there, where often times I don't know if some other nurses can feel it at all.
I had an event the other day where a new orientee was being trained by and older, very experienced nurse. The patient was placed on comfort care over the phone by their DPOA. The family opted out/was not able to be present for his death, (Granted, he probably had a colorful life, any may not have been the most angelic character, as his ending diagnosis was Hep C and alcoholism) and he was going to die alone. We all knew this, and shortly before I came on shift, his medical care transitioned to comfort rather than cure. I was to assume his care four hours later at 8pm, and in the meantime I was the floating helper nurse. (I will admit that I did remark: "Christ, another trip to the God-damned morgue, fucking great.") (I am not a saint). I went by his room a couple times and noticed that his door was wide open, revealing the bright yellow, bloated form that he had taken. Making sure he had soft music in the background, I shut the door gently each time, only to find it wide open again later. I hear the two nurses in charge of him wondering aloud why is oxygen levels are so high, they thought he would die so much sooner. The new nurse was eagerly watching his monitor for cardiac changes, oohing and gasping when he would have a sinus pause or a bout of arrhythmias. This is pretty cool for a little while, but after a while got annoying, especially when I noticed that his blood pressure cuff kept going off, showing a BP of 30s/20s. I asked why they were taking his blood pressure, and they couldn't give me a good answer. I said "The guy is on comfort care, give him a break!" They said they would stop it, and I let it go - with an eyeroll, and a meaningful look at the nurse next to me. Finally, 8pm comes.
I am the charge nurse and also have this guy. After I make the rounds, I go into his room. I see this man alone, fairly obtunded, with all the bells and whistles attached to him. I call the covering doctor for a morphine drip, which all my comfort patients receive, even for a small dose per hour (which you had better do for me too). I take off all of his extra leads, his BP cuff, his oxygen monitor, and I wash his face. I notice that his oxygen is blaring 6 liters in his nose, and turn him down to 1 liter per minute (No wonder his sats were so high!! (dumbasses)). I hang out with him for a while, swaying to Kid Rock after I change it to the country station, since he is obviously not smooth jazz.
All of this should have been done before me. I notice that after he had been placed on comfort care, his vitals were still written down every fifteen minutes for the next two hours. This irritates me.
Soon his heart rate slows and I go into his room. I stand next to him and sing him a song as he dies.
I took him to the morgue with the goofy escort guy (It was swell. Yeah right, the morgue sucks. I should get paid hundreds of dollars an hour when I have to go there and shove bodies around). Whatever.
I pulled the nurses aside individually the next day and told them that this was not the way to do comfort care and that I was upset about the way that this patient had been treated. They both bristled and made excuses, and I know that we are not on our game all of the time, so I am letting it go now. However, if I am in that bed, please give me a different nurse.
This is a rant really saying that an expected death should be as peaceful as possible, and that the care of the patient shouldn't be lessened if they end up dying without friends or family present. They should have a sensitive hand stroke their hair, and someone there to dream a little of the good person that they were.
So I will leave you with the song I sang, by a lovely woman named Joules who lived on Lopez - I think my guy liked it.
My clothes are ragged and torn,
you know as sure as your born,
that they've been loved and worn for many years.
And from the mud on my toes,
to the way my hair grows,
I see that everyone knows I'm living free.
Cause living free is the only life for me.
Yeah living free is the only way I'm gonna be.
Some see the dirt on my hands
and they just can't understand
how I can live on the land, but that's OK.
I tried my hand at their schools,
but they was acting like fools,
restricting life with dumb rules,
that's not for me.
Cause living free is the only life for me.
Yeah living free is the only way I'm gonna be.
(Jazzy ending)
Friday, April 30, 2010
Puppy Love
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.
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.
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.
Sunday, March 28, 2010
The ugly cry
The other day we let a patient die. He had been dependent on the ventilator for a couple months, and no matter what we tried, he still needed tons of extra oxygen and pressure (peep) to keep up his oxygen sats. He was always anxious and frequently requested anxiety medication. He had a trach but couldn't talk, didn't have the ability to write, and was literally trapped in his body. He was miserable, his family was torn apart, and his girlfriend was by his side all of the time with a look of heartbreak in her eyes.
He kept pulling out tubes, and over time it became clear that he did not want artificial nutrition or invasive lines. All the medical disciplines came to see him and he made it known that he wanted to be removed from the ventilator and for us to let him go. He had been fighting this for over two months, and it was clear that he would never leave his room. His family understood and accepted this, and his girlfriend was more hesitant, but ultimately, she accepted his decision, and a date was decided upon. I was charge nurse that day, and I was assisting in the comfort care process with a new-ish nurse. It is a trick to balance sedation and comfort with dying patients. You want to give them enough to sedate and comfort them, but you can't suppress breathing and actually be the death mechanism itself. (tricky). He had about eight family members and friends in the room when we started. He was given a bolus of versed and fentanyl and when he was comfortable, we disconnected him from the ventilator. We covered his trach site with some humidified oxygen, and watched him for signs of discomfort or fear. His family gathered around him, anxiously watching his face, waiting for the moment he would escape from his body. We gave him some extra sedation a couple times, but really it was a lovely passing. For his final and greatest journey, he was able to know when his time had come, all of his closest people were showering him unconditional love and support, and he was comfortable the entire time. What a blessing.
His oxygen sats slowly lowered over the next hour, his cardiac rhythm widened, and shortly after, he was in PEA. Soon had no cardiac activity. His family was told that he had passed, and it was an emotional time for them all. I was in and out of the room through the day, helping out and answering questions when I could. It was also taco day for the nurses, and I spent some time in the back getting the fiesta together while I oversaw the unit. Later, his nurse went for lunch and I stayed in the patent's room to act as family support and explain the process of what happens to his body after they leave. I stood close to his girlfriend on the side of the bed who was still holding his hand. Her eyes were red rimmed and moist, but she was calm. They had been high school sweethearts who reconnected fifteen years ago. They never married, but lived together and loved each other as life partners. She was the one who would go home to an empty house, clean out his belongings, and figure out how to carry on. His daughter began to gather up her family and say goodbyes to friends who came to be with them. I stood by the girlfriend and took in this scene of goodbye. I got weepy as they all took turns kissing the patient and waving in parting to his ladyfriend. She still sat by him holding his hand as they drifted out, the daughter was the last to leave, signaling to the partner that she would call her, her hand as the telephone to her ear, and she walked out the door into the hall. This moment was profound. This ritual of death, mourning, and goodbye. I was so there; I was both observer and participant. I found myself in the partners chair, holding his hand watching all of the others leave, and being left dreadfully alone. A flood of emotion welled up with me. My little tears turned to rivers, I began to literally heave and sob. This moment, that had been replayed over generations, centuries, since the beginning of humanity, was unfolding before my very eyes. I was hit with the full force of these very human emotions and experiences, and in that instant, I rolled in this emotional tsunami.
What a blessing.
I looked out the window and tried to pull myself together. I grabbed some tissue and dried my eyes, squeezed the girlfriend's other hand meaningfully, and walked out of the room, trying to keep these emotions in check. Then with red rimmed eyes, I went to the break room and ate a taco. My coworkers asked me if I was OK. I nodded and sat down. We all ate in silence for a while. The moment passed, I ate my tacos (delicious), dealt with the unit, wrapped up his body, and had the room cleaned. The day was done, I went home and had a beer or three. I kissed my family, read the kids books before bed, snuggled with my husband, and felt incredibly grateful. I slept without dreams.
I told my friend Jaime about this emotional experience I had, and my uncontrollable visceral reaction. She matter of factly said "Ahhh, that was the ugly cry". The spontaneous, overwhelming emotional response that possesses both body and mind. A labor pain of sentiment that strips away all personal discretion and composure, revealing the raw, pure soul within you. I was able to explain how real that moment was for me; how it symbolized humanity, mortality, unhindered love and loyalty, the true complexity and beauty of relationships. I tied it together with one encompassing word: Lovely.
It was amazing to witness such a power, such a time of incomprehensible sadness, mixed with love and hope, and to see this dance of human relationships. I was truly present for that striking moment, and it will stay with me forever.
What a blessing.
He kept pulling out tubes, and over time it became clear that he did not want artificial nutrition or invasive lines. All the medical disciplines came to see him and he made it known that he wanted to be removed from the ventilator and for us to let him go. He had been fighting this for over two months, and it was clear that he would never leave his room. His family understood and accepted this, and his girlfriend was more hesitant, but ultimately, she accepted his decision, and a date was decided upon. I was charge nurse that day, and I was assisting in the comfort care process with a new-ish nurse. It is a trick to balance sedation and comfort with dying patients. You want to give them enough to sedate and comfort them, but you can't suppress breathing and actually be the death mechanism itself. (tricky). He had about eight family members and friends in the room when we started. He was given a bolus of versed and fentanyl and when he was comfortable, we disconnected him from the ventilator. We covered his trach site with some humidified oxygen, and watched him for signs of discomfort or fear. His family gathered around him, anxiously watching his face, waiting for the moment he would escape from his body. We gave him some extra sedation a couple times, but really it was a lovely passing. For his final and greatest journey, he was able to know when his time had come, all of his closest people were showering him unconditional love and support, and he was comfortable the entire time. What a blessing.
His oxygen sats slowly lowered over the next hour, his cardiac rhythm widened, and shortly after, he was in PEA. Soon had no cardiac activity. His family was told that he had passed, and it was an emotional time for them all. I was in and out of the room through the day, helping out and answering questions when I could. It was also taco day for the nurses, and I spent some time in the back getting the fiesta together while I oversaw the unit. Later, his nurse went for lunch and I stayed in the patent's room to act as family support and explain the process of what happens to his body after they leave. I stood close to his girlfriend on the side of the bed who was still holding his hand. Her eyes were red rimmed and moist, but she was calm. They had been high school sweethearts who reconnected fifteen years ago. They never married, but lived together and loved each other as life partners. She was the one who would go home to an empty house, clean out his belongings, and figure out how to carry on. His daughter began to gather up her family and say goodbyes to friends who came to be with them. I stood by the girlfriend and took in this scene of goodbye. I got weepy as they all took turns kissing the patient and waving in parting to his ladyfriend. She still sat by him holding his hand as they drifted out, the daughter was the last to leave, signaling to the partner that she would call her, her hand as the telephone to her ear, and she walked out the door into the hall. This moment was profound. This ritual of death, mourning, and goodbye. I was so there; I was both observer and participant. I found myself in the partners chair, holding his hand watching all of the others leave, and being left dreadfully alone. A flood of emotion welled up with me. My little tears turned to rivers, I began to literally heave and sob. This moment, that had been replayed over generations, centuries, since the beginning of humanity, was unfolding before my very eyes. I was hit with the full force of these very human emotions and experiences, and in that instant, I rolled in this emotional tsunami.
What a blessing.
I looked out the window and tried to pull myself together. I grabbed some tissue and dried my eyes, squeezed the girlfriend's other hand meaningfully, and walked out of the room, trying to keep these emotions in check. Then with red rimmed eyes, I went to the break room and ate a taco. My coworkers asked me if I was OK. I nodded and sat down. We all ate in silence for a while. The moment passed, I ate my tacos (delicious), dealt with the unit, wrapped up his body, and had the room cleaned. The day was done, I went home and had a beer or three. I kissed my family, read the kids books before bed, snuggled with my husband, and felt incredibly grateful. I slept without dreams.
I told my friend Jaime about this emotional experience I had, and my uncontrollable visceral reaction. She matter of factly said "Ahhh, that was the ugly cry". The spontaneous, overwhelming emotional response that possesses both body and mind. A labor pain of sentiment that strips away all personal discretion and composure, revealing the raw, pure soul within you. I was able to explain how real that moment was for me; how it symbolized humanity, mortality, unhindered love and loyalty, the true complexity and beauty of relationships. I tied it together with one encompassing word: Lovely.
It was amazing to witness such a power, such a time of incomprehensible sadness, mixed with love and hope, and to see this dance of human relationships. I was truly present for that striking moment, and it will stay with me forever.
What a blessing.
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