Kapachino

Contrasts

I just got a call at work today from the husband of a woman I took care of almost every day for a month, who we sent to hospice last week. She passed away this morning, only 43 years old.

I’m so glad she’s not in pain anymore, but I keep picturing her husband at her bedside, sweetly taking care of her. One time I came in the room to see her sleeping, but propped up on the table in front of her was a card that said “Honey” on it for her to read when she woke up, while he sat and watched over her. He doted on her.

And I’m getting married in four days and boarding a plane to Hawaii. This is life, isn’t it? I wish everyone was as happy as I am right now, but some people are very, very sad. Sometimes when I think about it, I feel guilty for not being sad too.

Making It

I wish I had more time to update you, but my goodness life is a whirlwind right now. Last night I went to David’s for the evening and it was the first time we’d seen each other in four days. We watched DVDs of “The Office,” indulged in chicken fried rice, and worked on wedding favors. I really needed a night like that.

The wedding is in eight days - wow, my heart just started pounding - and somehow I think everything is going to come together. There are still a bunch of details to get out of the way, but thankfully I have this weekend off. Although I do have to work three days next week.

Speaking of work, it has still been really tough lately. Everyone is saying that our patients are sicker than ever, we are almost always full, and we don’t have enough nurses. Some days it feels like an ICU, except that in the ICU each nurse only has two patients, while we have four, five, sometimes even six. At the beginning of this week one of my patients died who I’d been with for three months. Yesterday another one I’d become attached to was transferred to hospice. She was in so much pain that she couldn’t even concentrate to say goodbye.

My days “off” right now are not restful; they are chock full of errands and tasks to complete. Here is what I did on my last day off, Tuesday, for example:

• Final gown fitting
• Pick up ring
• Pharmacy
• Buy makeup
• Work on favors
• Haircut and updo trial run

Not to mention that the traffic since Ike has been exponentially worse than ever due to many stoplights being out and free tollways. Sooo…

All this to say that I can really use a vacation. Luckily I have one coming up!

My First Hurricane

When I was younger and I first learned that my mom had lived through a hurricane, I was in awe. I couldn’t believe she had survived. I think that in my mind, hurricanes were more like massive tornados.

Nowadays, we have hurricanes in the gulf like every other week. If one comes our way, to most people my age it is an excuse to get off work and have a hurricane party. Unfortunately, if you work in a hospital that is not the case.

I’m a member of the “ride-out” team on my unit, which meant that when I went to work on Friday, I packed a suitcase and wasn’t allowed to leave. I was told that I had to work a 12-hour shift, which I am not used to. Ordinarily, around 3:30 p.m. I would have been leaving the hospital for a weekend’s break (considering I worked last weekend and have to work next weekend). Around 4:30 p.m., still working, I said offhand, “Whew. Now I remember why I don’t work 12-hour shifts.” The 60-something year-old nurse walking by then asked me, “And how old are you? Honey, suck it up. I’m at least 30 years older than you!” Another lady walking by said, “They just don’t make ‘em like they used to.” When I mentioned this exchange to David, he said, “Did you tell them, ‘You don’t understand, I get tired a lot?’” I think he was making fun of me too. Whatever.

I made it through my shift, then went down to the cafeteria to eat with some of my fellow nurses (including the 60-something year-old nurse who I’m really quite fond of and calls herself the grandma). It was during this meal that I was enlightened to a whole lot of unit gossip and history that I was unaware of. Stuff that I will NEVER share with the internet, no matter how interesting it is.

I was pretty much beat after dinner, so I headed to bed. I was lucky that I actually had a bed to sleep in. I shared an unoccupied hospital room with another nurse from my unit:

We just got new mattresses on the beds, too. I had felt them with my hand and they felt pretty nice, but let me tell you that sleeping on them was a different story.

There were exactly two positive things about sleeping at the hospital: 1) I got paid for the entire time I was there, and 2) the commute was significantly easier than usual. In the morning I took a measly shower, threw my hair up in a wet bun, and walked down the hall to begin what I thought would be another long shift.

I was starting to go crazy being trapped in that place, and I really didn’t want to stay another night there. Thankfully, someone from the recovery team was able to make it in. I gave everyone my biggest puppy dog eyes and made noises about how this was already my 5th day to work, and I’m getting married in three weeks and have a lot of work to do, blah blah blah, and they let me go home! Of course, the precondition to that was that I promised to come back for my regular shift on Monday.

Main Street, right outside the medical center, on my drive home:

I drove straight to David’s house, where his whole family and some friends were gathered because his was the only house in the area with power. I collapsed on the couch. After dinner, back on the couch, I was falling asleep and David made me decided I should go home before dark. At home, I went straight to my bed around 8:30 p.m., and slept hard for about 11 hours. I feel so much better today.

Apparently it stormed pretty bad last night. I thought the worst was over, but this morning our streets were flooded and we discovered more leaks in our roof. We took a walk after things started to get better.

The view from our front yard, after the water began to recede:

Cleo and I on our rain walk:

So I’m just hanging out today, wondering if I’ll even be able to make it to work in the morning. I’m hoping not, due to the flooding and the curfew, but I’m not getting my hopes up. My thoughts on the whole ordeal? Hurricanes are not fun, and I hope this is our last one for a long time.

Not A New Subject Yet

I was really wanting to talk to you about something other than my job and my wedding today. But, not yet.

I have been taking care of patients completely on my own for about a week and a half now. One patient I have been the primary nurse for since about a month ago. I have built a strong relationship with her sister (she herself does not speak due to a stroke). Last Friday through Monday I took care of three patients, all of whom I knew and had taken care of before.

Today, after one day off, I arrived at work and the first thing I noticed was that my patient for the past month wasn’t on the floor anymore. After questioning, I found out that she was transferred to ICU yesterday, having become septic. That was a downer.

Then I received my assignment for the day and I was given four patients, all brand new who I knew nothing about, and two were due for discharge. You might think that’s a good thing, because they’d be leaving. However, discharges and admissions take a lot of time. There is paperwork, medication reconciliation, fulfilling doctor’s orders, and preparing them to leave to take care of. Both of my patients wanted to leave as soon as possible, and the beginning of the shift is always busy anyway.

A little bit later, the doctor of a patient I had over the weekend came to the unit and informed us that after he was discharged last night (against medical advice), he went home and shot himself in the head. Wow.

After I got through all of that, the day got better. And tomorrow, I hope to come to you with something completely new and random!

I Love My Job…I Love My Job…I Love My Job…

Even when I have to wake up at 4:30 a.m. on Saturday morning to go.

Even when I have to clean poop out of an opening it shouldn’t be coming from.

Even when the hospital shuts the water off on our floor without telling us, so that everyone goes to the bathroom and is unable to flush for hours and hours, and the rooms and hallways start to smell.

Even when one of my patients spits up phlegm every five minutes into a cup that he leaves sitting at his bedside, and I have an attack of dry heaves in the bathroom just thinking about it.

Even when another patient vomits all over himself and the floor.

It’s worth it when they all tell me how glad they are that I am their nurse, but I would be lying if I said I wasn’t looking forward to going home at the end of the day, eating burgers, and hanging out with my fiance and my dog. I love my job, but some days I don’t like it very much.

Normal Sinus Rhythm, Please

Want to know what I’ve been up to? No problem:

The Six Second ECG

For the past three days, instead of working on the unit, I’ve been in class learning how to interpret EKGs. My brain has had just about enough! It’s also difficult to concentrate because this is something I will rarely encounter on my floor. So I’m trying to learn it well, but if I don’t get to practice, then I’ll probably just forget.

Day Off?

I worked all weekend, then had a frantically busy day yesterday. Last night I was tired through and through, but could I rest? No, there were cake consultations to attend and invitations to design. Luckily I had today off, so I could get rested (or so I thought).

Despite being an emotional wreck for most of the day, I did manage to accomplish some things. First, I got fitted for undergarments at Nordstrom and OH MY WORD if you haven’t done that, go. It will change your life. Purchased all my underwear for the wedding and then some.

Second, I finally found a paper store that had what I wanted: plain white, smooth finish, thick paper without a watermark. You would think that such a product would be easy to find, but you would be wrong. The store is FasClampitt and today I am in love with it. We also got envelopes there.

Third, went shopping with my mother-in-law-to-be and found her a beautiful outfit to wear to the wedding, then took it to be altered.

Fourth, to kill time I stopped by Old Navy and bought a cheap swimsuit for our honeymoon.

Fifth, I met David at the jewelry store where he bought my engagement ring and discussed wedding band options. It seems that if I want the band to fit against the ring and look like a set I will have to get it custom made, which will cost $400-500. If I don’t do that, I will be wearing two mis-matched rings. What would you do?

Finally, David and I had dinner at Mama’s Cafe, and it was very good. And when I said goodbye to him (since we were in separate cars) I almost cried because we hardly ever get to see each other, and I have another looooong day of work and errands tomorrow. That would have made about the tenth time I cried today (only slightly exaggerating). See? Emotional wreck.

It’s not my impending marriage that is doing this to me, though - it’s the combination of hormones (the perfect scapegoat), wedding planning, and above all: MY JOB. Are there any new nurses out there who can empathize with me? I seriously love it and wouldn’t want to be doing anything else, but I just can’t explain how physically and mentally draining it is. I know I’ll get used to it, but I haven’t yet.

Anyway, if I’m going to be asleep by 8 p.m. I better get going.

Death and Life

David’s aunt Sue died on Friday night after almost three years of battling pancreatic cancer. It’s a very close family so if you have a moment, please say a prayer for them: her husband Ralph most of all, her two sons Brian and Michael, David’s father Bill, her brother, and the rest of the family. I will be singing at her funeral on Wednesday morning. I’m honored to do it, and also quite nervous. I can get emotional.

I was telling this news to one of the “seasoned” nurses on my unit today who has worked oncology for 21 years, and has had a lot of experience with grieving families. She asked, “Was she a Christian?” I replied that she was, and then her face lit up. She said, “I always use this analogy: When a baby is born the process is very ugly, painful, messy, and hard. But the end result is something beautiful and alive. For a Christian, death is the same way. The process of dying to this world is sometimes painful and ugly, but on the other side is peace and joy. And those that are left here can take comfort in knowing that they helped her make it there.”

When I heard that Sue had died, what I felt was sadness for her family. The more I think about it, the more I hate death. But God hates death too. In the story of Lazarus being raised to life, Jesus arrives to the home to find the dead man’s family grieving. They say to him, “Why didn’t you come sooner? If you would have been here he wouldn’t have died!” They are mad, frustrated, saddened, and confused. This is followed by the famous verse, “Jesus wept.”

Many times people interpret this verse to show how Jesus empathizes with us and knows what it’s like to feel all of the emotions that we feel. I believe that is true, but I see this verse differently. I believe that Jesus wept because there he was, physically in their midst, the resurrection and the life, and yet they are grieving! He is saddened at their lack of trust in him, because he is ALL ABOUT LIFE!

I don’t mean to say that grieving is bad. I think it is good and necessary. But hope. Hope and trust in God. And praise Him that we don’t have to live forever in these imperfect bodies, in this sinful world. Praise Him for his power and goodness and His perfect plan working out perfectly for those who love Him. Praise Him for newness, praise Him for redemption. Praise him for joy ever-increasing forever. Praise Him for life!

Code Blue

My patient with the low potassium had a seizure yesterday right at the end of my shift, and a code was called. It was my first code to experience, and it was scary. I ran to the room because I knew they would need me there, as her nurse. The alarm was blaring. People were everywhere. I was being asked all kinds of questions. Someone yelled to me, “She needs Ativan now!” Her sister was crying and yelling. 

Thankfully the patient never stopped breathing, and she slowly recovered. She hasn’t been the same since. She is either sleeping or confused and agitated now. But while all the commotion was going on, I realized that I cared for this woman and her sister, who I have taken care of for the last two weeks, and she could die at any time. It made me very sad.

Today I took care of her again, along with two other patients, none of whom will probably recover. One of them reminded me so much of David’s dear aunt, who is at the end of a fight with pancreatic cancer, that it was hard to look at her at times. I chose this path, and I know it will be hard. I think that I can handle it; I hope I can. I hope I can also retain my softness and compassion. It’s a fine line.

I’m so glad it’s the weekend. I’m ready for some distraction.

Another Nursing Incident

I wasn’t going to bore you with stories from work again, but again something happened. Yesterday I was taking care of the same patient that I have had for at least a week now. And every day, her potassium is low. Every day the doctor makes rounds in the morning, sees that it is low, and orders us to replace the potassium through her IV. Yesterday her potassium was 1.5 (normal is 3.5 to 5.0), which is a critical level because abnormal potassium can cause life-threatening heart rhythm problems. Nurses worry when it drops below 3.

The day before, her potassium had been 1.8. I was with my preceptor that day, and she informed me that although it was low, it was best if we just waited for the doctor to make his rounds instead of calling him. She said that he is very particular and hates to be called about things like low electrolytes which he can take care of on rounds. Yesterday, my preceptor wasn’t there and so I was more or less on my own. I waited for awhile for the doctor to make rounds, but he didn’t come. Finally I consulted another nurse. She also told me not to call the doctor for low electrolytes. So I didn’t.

I recorded my report, and in it I said that her potassium was 1.5 and so the next shift should keep an eye out for the doctor. When the nurse from the next shift heard my report, she came flying out of the room. She asked someone, “Is her potassium really 1.5 and nothing has been done about it all day? Did I hear that right?” And all of a sudden I was being bombarded by nurses asking me what was going on and why I hadn’t done anything about it.

I told them what my preceptor had said to me the day before, and what the other nurse had told me that day. Apparently I asked the wrong person. They wanted to do a formal patient safety report, so they went and talked to the nurse who gave me the advice. I was really upset because I like her, have to work with her frequently, and it was not my intention to get her in trouble. I was also given a “talking to” by more than one person.

They ended up asking the nurse practitioner on our floor to write an order for potassium replacement. The nurse who gave me the advice caught me before I left and said that she had put the patient safety report in her name. She said, “I personally still wouldn’t have called him. That’s my professional judgment. Reason being her potassium is low every day, the doctor is aware of it, and he is expecting it to be low again today. But anyway, I’ve been a nurse for 12 years and I can take the heat. Don’t worry about it.”

Everything ended up being ok, but it was very frustrating to have such an incident happen to me right at the end of my shift, when I thought I had had a good day. But I learned to never take one person’s advice if I’m not comfortable with it, and to always be an advocate for the patient even in the face of grumpy doctors.

Today her potassium is 1.6 and I had someone else call the doctor for me!