Kapachino

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!

These Days Will Happen

I had a wonderful weekend, slept great, and was refreshed all day Sunday. I was ready to start the week.

Well, last night I could not fall asleep for hours. My parents keep the house way too hot to be sleeping upstairs, and yet for some reason I didn’t think to go down and lower the thermostat. Therefore I tossed and turned, kicked covers and twisted sheets. Cleo was restless too; someone somewhere was setting off remnants of Independence Day firecrackers, and that got her trembling and needy for my attention. 

I think that today wouldn’t have seemed so bad if I weren’t so tired the whole time. But I was and it did. It was the first day at this job when I actually felt inadequate, and thought, “What have I gotten myself into?”

First, I made a mistake by not flushing a patient’s PEG tube when I unhooked it for him to take a shower, because then it got quite clogged and my preceptor had to work long and hard to fix it. (Sorry for the jargon, I’m too tired to explain.)

Later I was helping transfer a patient to a stretcher and the Patient Care Assistant (PCA - like a nurse’s assistant) told me that she had better take my place because I wouldn’t do a good job. Now, I know I’m small and don’t look strong, and no I haven’t had years of experience like she has, but that doesn’t automatically mean that I don’t know what I’m doing or I won’t do a good job. I don’t enjoy being looked down on.

Then, about an hour before the end of the shift, one of my patients had a period of unresponsiveness, change in vital signs, and copious amounts of bloody stool. I am leaving out many other details that I’m sure you don’t want to hear about. We were in a frenzy taking care of him, so I didn’t have time to get my thoughts together before giving report to the next shift. On our unit, we tape record our reports. I hate doing it in the first place, because I picture all the nurses sitting around listening to my voice and whatever stupid thing comes out of my mouth. But giving report isn’t something you’re really trained to do in nursing school, and I always feel like I’m just bumbling through. If I have time, I like to write down everything I’m going to say. But a crashing patient equals no time, which equals a really embarrassing report.

After the long bus ride home, I finally had a few hours to myself. I wanted to get some things done, but I couldn’t move myself from the couch. David stopped by to see me on his way home from playing golf, and we hung out for a total of 15 minutes. Then I told him he had to leave because I need to go to sleep (hopefully) in order to do this all over again.

My days aren’t all like this, and I hope that tomorrow is better. Sometimes I do wonder why I didn’t choose something easier. I think I have a pretty good idea, though. It’s going to be worth it.

On the Long Week, My Dog, and Medical Devices

Ah, Friday. It’s a good day. Not as good as Saturday, or Sunday, but still good. And this has been a long week.  Not just with work, although that gives me very limited time to accomplish anything else. But with getting the bridesmaid dresses ordered (requiring two separate trips to the shop), a weekly indoor soccer game, dinner with a friend, and finally getting myself organized and settled in my parents’ house, I have had very little time to relax. David came by the house last night briefly, but that was the first time we’d seen each other since Sunday. So yeah, long week.

It’s been kind of nice to be living with my parents again, although strange at times. Cleo seems to like it here for the most part, although she won’t go in the kitchen and I had to carry her up the stairs the first time. She gets so scared of new rooms and hallways. But since my room is upstairs, I had to get her used to it. She has slept with me almost every night since I got her, and it’s very comforting for me to have her there.

The first night I carried her to my bed, and she didn’t move from it until morning. Then she was terrified to get down. The second night she came up the stairs with a lot of coaxing, but she trembled most of the night. The third night I felt too bad for her and let her stay downstairs on the couch. But I didn’t sleep well that night without her, and so I’ve started to make her come upstairs again. Last night I was so happy because she cuddled by my side with my arm slung over her the entire night.

Work has been great this week. I think I am really starting to get the hang of it. I have been taking care of two patients almost entirely by myself, and I think I’m ready to move on to three because there has been a significant amount of downtime. I passed a milestone today in that I accessed my first port-a-cath successfully! This is a device that many oncology patients have inserted underneath their skin on the chest that enables us to give chemo, fluids, draw blood, etc. without having to find a vein every time. While the patients aren’t in the hospital or having treatment you can’t really see it. But in the hospital we access the port with a needle.

I’m at home right now waiting for David to come pick me up. We’re going on a date, and I’ve been looking forward to it all week! It felt so weird to put on regular clothes just now. I haven’t worn anything but scrubs and athletic clothes since last Sunday. 

Happy weekend!

How I Spent My First Month’s Pay

• Gave my tithe to my church
• Paid a huge chunk of money on my credit card bill
• Car insurance and phone bills
• Miscellaneous gas and food
• Donated to my four monthly charities (Compassion, Tabor College, support for two friends who are missionaries)
• Bought my cousin’s wife a baby shower gift
• Bought the CD Ampersand by Derek Webb and Sandra McCracken
• Paid to have my address changed on my driver’s license
• Premarital counseling

• Bought Coldplay tickets. Yes!

Still have some to spare! I’m liking this “real job” thing. Even though it does wear me out, it’s also very fulfilling. I had the option of taking the holiday off, but I chose instead to work to save up more personal time. I was a little jealous when David texted me at 11 a.m. saying he had just woken up. I responded, “Do you realize that you’ve had a full night’s sleep since I got up this morning?” I didn’t have much sympathy when he told me he was still tired!

Busy weekend ahead of me, and I hope to have much to report at the end of it!

Early Monday

I was woken up at 3:45 a.m. by the two 100+ pound dogs that I’m taking care of this week, Teak and Riley. They wanted to be fed, and there is no more sleeping when they want to be fed. So I got up and did just that, and then I stayed awake because my alarm was scheduled to go off at four. It’s only fifteen minutes, you may say, but when that fifteen minutes comes as early as it does it makes a big difference. So I was annoyed.

But, as usual, I got to work and everything was great. Two cups of coffee and I didn’t feel the sleep I was missing until about 1 p.m. when we had an inservice. Today I was assigned a patient all to myself, and I think I did pretty well. Although I must admit, she was not demanding at all. I spent the majority of my time today with my mind wandering to wedding plans.

On the way home I stopped at the grocery store, and I was strolling the aisles in my own little world. The song “Jack and Diane” was playing on the loudspeaker, and I was singing along to myself. As I rounded a corner and looked up, there was an older woman coming towards me, an employee, and at that moment we were both audibly singing, “Oh yeah, life goes on…” when our eyes locked. We could have been embarrassed, but instead we just smiled and walked on.

The Week So Far

On Monday night I went out and bought a bunch of pairs of scrubs in Caribbean blue, our required color. This is not a popular color for scrubs, but I found it at an awesome store in Katy. There was a friendly Indian woman there who owns and runs the place, and by the end of my shopping experience she was giving me marriage advice and showing me all of her receipts for the day.

On Tuesday my preceptor was off and my backup preceptor was late, so I ended up working with a girl who has only been a nurse since January. Although she was very nice, she was also extremely disorganized and I did not much enjoy working with her. That night David and I went and spent some time with our good friends Megan and Peter, who were in town for a wedding. The highlight of the night involved Megan and I getting completely made fun of for the fact that in high school we listened to ska music and skanked. Don’t know what that is? You’re cooler than I am.

Wednesday my preceptor was off again and I sat with the unit secretary. It was boring, but at least I got to sit down. That night David and I went to visit his aunt and uncle in Sealy. David is very close to them, and his aunt has pancreatic cancer and is not doing well. It was good that we went.

Today my preceptor, Christy, was back and we had a good day. She is allowing me to do more things now. Tonight I am returning to my apartment. I have been away for over a week house- and pet-sitting. I miss Cleo and my bed.

I am really exhausted. 4:30 a.m. comes really early.

First Day on the Unit

I woke up at 4:45 a.m. and got home at 5 p.m., and all I’m thinking at this moment is that my legs and feet are very tired.

Today I met my preceptor, Christy, and basically followed her around the entire day. She is extremely nice, but I don’t think she quite understands the concept that I am an RN with a license (yay!) and I can actually do stuff. It wasn’t until the end of the day, when she was getting behind, that I finally told her, “You know if you need help with anything I can do something for you.” She said, “You can give meds?” Um…yeah, I’ve been doing that since the second semester of nursing school!

She won’t be my only preceptor, because she doesn’t work every day. But I really liked the unit and the people, and I’m sure I will love it once I get more involved and obtain more autonomy. I already requested my vacation days (August 1-3 for my good friend Ellen’s wedding in Kansas, and of course October 3-12!), I have my own locker with a lock and my name on it, and I know all the secret codes. I just need to get my hands dirty!

P.S. I promise that all my posts won’t have to do with nursing from now on!

I Passed!

Although I thought the test went well, I was still so nervous to check the results. A thousand scenarios had developed in mind around how I would react if I failed. I am very grateful that I don’t have to find out. I’m an RN!

If I hadn’t passed, I think I would have been overcome with stress. I might have had an aneurysm. Because I start on my unit next week, and first of all, how embarrassing to have to go back and tell my manager that she hired the nurse who couldn’t pass the board exam. Secondly, I have to move by the end of the month, which is in about two weeks, and that includes repainting my room. Third, I get married in what? Three and a half months??? I only have to put together practically the entire wedding in that amount of time. If I had to worry about studying for and passing the NCLEX in another 45 days…I don’t even want to think about it. But I don’t! I passed!