perspective is a lovely hand to hold

Its not supposed to be this way.  Its just not.

       Its not supposed to be my family member lying on the sterile white sheets, a sheen of sweat on his feverish brow.  The creak of the old hospital chair I am sitting in stirs him and he opens his eyes.  Seconds later he is sitting on the side of the bed, throwing up the contents of his already empty stomach. I change my gloves, adjust my mask and put a cool rag on his neck. I hit the call bell and stay with him as he continues to dry heave.  His normally tan skin has paled, the circles under his eyes darkening with the lack of sleep and pain.  I click the button on the machine, willing the narcotics to take away the misery for a little while.  After a few moments, he lays back and covers his eyes, minutes later a soft snoring fills the room. 

       I shake my head. This sucks. The only thing keeping me sane is that the Doctors and nurses know me and let me see for myself what the plan is. I know the antibiotics, the pain medications, and what he can get for nausea. I can recite his WBC count and know his cultures are negative so far…But, that makes no difference when he is doubled over in pain.

       A couple hours later and he reappears-not the pain stricken, miserable patient in the tiny room- but my brother.  His laugh echoes as we watch a sitcom, share a funny story and gossip.  He sips gingerale and declares he feels better.  My heart wants to believe him but I know the cycle is about to come around again. 

      Minutes later, I watch he starts deteriorating again.  I push the call bell and alert the nurse as he leans over the basin.  The nausea sweeps over him so quickly, taking his breath away and leaving him exhausted.  I wish to the heavens I had a pocketful of zofran and phenergan to give him as soon as the symptoms start.  I don’t and I have to sit and wait with him for the nurse to arrive.  All night we repeat the ritual.

       A couple times he drifted off to a fitful sleep and I found myself watching him with worry.  Is this what its like?  My brother was on a med/surg floor with meningitis, in stable condition and I was sick with worry.  What must my patient’s family members feel like? To be admitted into our unit, except for the occasional odd admisson, our patients are critical, barely out running the grim reaper.  For the millionth time, I try and imagine how awful they must feel.

       I look at my brother curled up in the sheets- his face, even in sleep, adorned with a grimace.  I watch him flip over and I swear again to try everyday to be the nurse I hope my family has when they are in the hospital.

“Can you hold me together?

Can your love reach down this far?

Can you hold me together?

Cause without You holding my heart

I’m falling apart

Falling apart “

- Royal Tailor

     Today I lost a patient, Today you lost your mother.

     My report in the morning warned me of what was ahead.  No one warned you, did they?  You lost your mother. Of course, you knew she was sick.  You knew her heart didn’t beat like it used to. But, death doesn’t choose prepared people and despite her illness- this was unexpected.

     You were hunched next to your dad, your college sweatshirt serving as a tissue for your tears. Your brother sat next to you, his eyes vacant as if the truth had not yet breeched his mind.  It was hard to grasp- the ICU monitor’s lights lied as they showed a heart beat and breathing pattern.  The truth was we suspected that she had already slipped away. Death, the hardest kind to grasp, had stolen her.  A machine breathed for her, another machine was keeping her blood flowing- but she was no longer alive.   You hung your head and avoided my eyes as I tried to give you all space and time with her but continued to silently work to do everything I could to support what was left.  We all knew the invitable was coming.  One by one, the doctors trickled through- their faces guarded and sympathetic.

     The pulmonologist shook his head and placed his hand on your shoulder.  The apnea test was positive, she was no longer breathing on her own.

     The cardiologist  took a deep breath and looked you all in the eye and was truthful- the prognosis was grim, very grim. Her blood pressure was fading and the machine was the only thing keeping the heart working.

     The neurologist had the final word and his eyes were sad as we performed test after test to confirm what we all already knew. Your mom had already slipped to another place of rest.  The machines were no longer simply assisting but now working in the absence of life.

     Your dad, your brother and you decided to remove the life support. I stood with your family, the doctor, social worker and respiratory therapist as we literally unplugged what was left of your mom’s life.  I wanted to cry. I felt so much sadness and pain for your family.  I wanted to help in any way I could… but I realize that as sad as I feel over the loss I have no idea what you were going through. No clue.

     I lost a patient today, but today… You lost your mother.

July 23rd 2011- (written a couple monthes after starting as a Cardiac ICU nurse…)

I’m studying.
Studying a book on how to save lives.
I didn’t save yours.
We tried so hard. You got everything we could give.
Everything.
30 of us crammed in a room only large enough for 10.
We worked so hard.
We did everything right to keep your heart awake.
But it kept falling back asleep.
We watched life slip from your eyes.
We hung on until there was nothing to hang on to…

Today you died under the watch of 30 people.
30 people who went home to their families while yours was devastated.
30 people who will block your death from their minds so they can do it all again tomorrow.
I don’t cry much- Its not in my nature.

“Stay awake, don’t rest your head
Don’t lie down upon your bed
While the moon drifts in the skies
Stay awake, don’t close your eyes

Though the world is fast asleep
Though your pillow’s soft and deep
You’re not sleepy as you seem
Stay awake, don’t nod and dream
Stay awake, don’t nod and dream”

        The day outside is gray.  Its hues are reflected on you as you lay still, quiet among the absolute chaos surrounding your bed.  Line after line is attached to you, linking you to a network of medications that are doing most of the fighting for you.  Your losing ground faster than we are gaining it despite our best efforts.

       A little more color slips from your cheeks and your pressure drops.  We search blindly for signs that your heart is still working and find nothing.  I give you a shot of epi and someone does compressions to help your heart perfuse.  We call for extra hands as we continue to work on your tired body.   Another line is placed, another medication is added and your fragile heart starts beating again.  

      We draw more blood, try to straighten your room, settle you in the bed, let your family come in…  To their credit and yours- they ignore the absolute disaster that encompasses you and rush to your side.  They whisper to you softly as we continue to work.  I watch them from the other side of the bed…I can’t imagine what it must be like for them to see you, their mother, grandmother, sister disguised by wires, tubes, lines.  Your bed is nearly obscured by the code cart, the balloon pump, and the ventilator.  Your body is wrapped in a warming blanket to keep you from becoming hypothermic. They tearfully grip your hand and then quietly exit the room, leaving us there alone with you. Placing faith in our skill and knowledge, clinging to the hope that we will work tirelessly to save you.

Time creeps past as we attempt to stabilize you in the most liberal sense of the word… It doesn’t work.  Any remote color you had left disappears from your lips and your oxygenation plummets despite machines doing the work for you.  Your pressure soon follows and we again begin to rapidly code you.  The night shift nurses arrive to help and we jointly change positions to give each a breather.  I take over compressions and feel with horror as your bones break beneath my hands. I continue, we push more meds, we give liter after liter of fluid and once again your heart beats weakly on its own.   You were losing blood from somewhere and we gave you unit after unit of blood.

Last time I saw you it was 8pm and they were whisking you off to the OR emergently to see if your bleeding could be stopped. They gave you a 5% chance of making it out. 

The aftermath of codes are often more hectic than during as we rush to find what is causing your heart to stop beating.  Doctors are pushy, nurses irritable, people are often rude and hostile.

 The stress of saving a life is hard enough- the stress of keeping you alive is sometimes even harder.

Dear moon,

I’m staring at the stars.

Dear sun,

Your showing all my scars.

Deep night,

Conceal my insecurities.

Dark shadows,

All my sunshine flees.

~ K.M. Stolk

“Leave it all behind, Leave it all behind,

 Leave it all behind, Leave it all behind.

I have what you need, but you keep on searching,

I’ve done all the work, but you keep on working,

When you’re running on empty, and you can’t find the remedy, just come to the well…” - Casting Crowns

It was different this time.  I knew it as soon as I walked into the room.  This was my third or fourth round of taking care of the tiny lady lying quietly in bed.  Her poor body wracked with infections that she fought off only to have them return with even more malice.  Every time she came to my unit, her once bright eyes were a little dimmer, her smile less pronounced and her personality more disguised by medication and pain.   She had been admitted time and again with low blood pressure, irregular heart rate, and now another raging infection. 

                Her body held even less weight than the last time I saw her, though it did not seem possible.  Her petite frame showed every bone and her skin held bruises from every touch or bump.  The first day we worked to stabilize her blood pressure and I let her rest as much as possible. 

           The next day, I couldn’t bear to go in her room.  Her pain was out of control no matter what I gave her. After 3 rounds of heavy narcotics and seeing no results I got the doctor to start a PCA pump to deliver pain medication even more frequently. Her discomfort was overwhelming.  Every part of her tiny body was in agony. 

          At one point I stepped out of her room for five minutes to grab something after I had just repositioned her and returned to find her whimpering.  She opened her eyes that were filled with tears and said, “Oh. I’m so glad your back. I can’t take it, I can’t take it. I am so uncomfortable.”  My eyes burned and I tried to avoid looking into her eyes once so trusting, now vacant and glazed with misery.

        She muttered over and over phrases that were jumbled as the narcotics stole what was left of her coherent mind.  She was literally beside herself with pain and could find no relief.   I did everything I could to help her.  She was miserable in any position and it was torture to move her.  She was literally writhing in the bed and I… I felt helpless.  I drugged her with everything I had, turned her carefully, fluffed the pillows, gently moved her limbs…to no avail.

            I found myself fighting back tears even as I clenched my fists in anger.  I wished more than anything that her doctor would walk through the door. I wanted to grab his shirt collar and yank him to the bedside and yell at him.  What were we doing to this beautiful little lady?  Why was this torture never ending? What was the goal of care?  This sweet lady, everyone’s favorite patient, was dying and no one seemed to notice.

           I never give up on my patients, and have never felt someone was not worth fighting for.  Every life is worth it.  But, she was done fighting, she was ready to rest.  What was the plan- to restore her to her former health?  Her admissions were more and more frequent and I had heard the doctors say more than once that she was in her last year of life.  So we send her home in a couple weeks, even more weak, even more debilitated?  What happens when she is admitted again for infection- which she undoubtedly would be?  When will the doctors be honest and say- this lady deserves more than anything a dignified death.  She deserves to be comfortable, rested and surrounded by her loving family. When will they see that the goal of care needs to be making her last days her most comfortable? Instead we continue to poke and prod.  We scan her body, check her blood, place lines.  We push medications and pull on her tired limbs.  We force food and run dialysis on her. 

We make it our job to place another temporary patch on an already failing life.

Today.  I hate my job.

“Here…wash cloths, towels, soap and a throwback razor.” I said as I set my patient up at the sink.

“Throw back razor? What is that?” he said with a furrowed brow. 

“Old school… look at this thing.  You can see where the hospital cut costs!” I answered laughing. 

My patient laughed and we joked about a few other things as I tidied his room.  He was young.  Only in his late 40’s, slight in stature, with an easy smile. He was friendly, polite, and never complained.  He remembered my name and appreciated anything and everything that I did for him.  He was truly a wonderful patient.

Wonderful, but he broke my heart everytime I looked at him. The first day I took care of him and I looked for a new IV, I could see the scarring.  The needle tracks that had hardened the veins and made our job even harder.  This was his second heart attack and had nearly cost him his life. He was recovering nicely but his extracurricular activities would need to stop or we would see him again. 

I feel useless when I am taking care of someone like him.  I feel so inadequate to help. My heart breaks for him, his children, and his wife.  Addiction. A shattering word. Devastating for anyone around it. I struggle so much with what to say, how to say it when in his face I see the reflection of myself and anyone else who has ever misstepped. Maybe drugs are not the problem for some- but we all stumble.  

As I meandered in and out of his room, I couldn’t help but think of all he was missing, would miss, by using drugs and alcohol.  His heart had taken a huge hit with this last heart attack, it would never recover its full capabilities again.  He may not survive another MI.  He could miss out on his children’s graduations, weddings.  He may never hold grandchildren, or share retirement with his wife.  He may needlessly miss the most important parts of his life. 

Needlessly, his life could be cut short.

I said goodbye as I headed home tonight- knowing he would be transferred out and a new patient would be waiting for me when I returned in the morning.  The grand cycle of in and out. 

I could only say my goodbyes and send him out with the hope and prayer that he realizes how much he has to live for.  And, that it doesn’t involve a needle.

The curtain was drawn in my patient’s room as I opened the door. Knocking softly, I heard muffled singing and a quiet, “Come in.” I skirted the curtain and walked into the room. My patient was sitting in bed, her lunch tray across her lap. She smiled at me before returning her gaze to her husband who was hopping around the foot of her bed.

A big grin was from ear to ear as he hummed and sang lyrics intermittently, snitching food off her tray and dancing to his own theme music. I laughed and said, “Dinner and a show? Wish I had gotten here earlier!” My patient shook her head and said with a smile, “Gosh. He is like a cartoon character!”

They had been waiting in our ICU for over two weeks for surgery but had been getting bumped by the surgeons repeatedly. Frustrated as they were, they never once complained about the Nurses and treated each of us with respect. The husband was jovial and friendly to everyone. He knew my name way before I was ever his wife’s primary nurse. She was more reserved and laid back, quietly taking it all in. All weekend as I flitted in and out of the room, I felt like I was in the presence of family. I felt I was hearing my dad tell my mom corny jokes and her, “Oh PLEASE.” as she rolled her eyes and smiled.

The similarities in personalities between my parents and the couple were uncanny and I kept making excuses to visit with them. It was like being home in a small way.

As I was checking on her a final time before I gave report to the night shift, I mentioned that they reminded me of my parents. They were pleased and the jovial husband promptly quizzed me on my parent’s stats. He was 12 years older than my dad but when we started comparing- the answers surprised us both.

His birthday was January 14th- My dads birthday.

They had of 5 children- Same as my family.

Spent a stint in NJ, almost exactly where my dad was born.

The wife was from the shore originally.

The similarities delighted him and he proceeded to discuss how he wanted to visit my dad next time he went up the Shore. I told him to try the Sweet potatoes since that was our specialty and he started telling me about an article in the Virginian Pilot about Yams. As he talked I realized something…

The article he referenced about sweet potatoes?

That article had been written based on my dad and his expertise.

Its a small world after all.

http://hamptonroads.com/2009/12/eastern-shore-farmer%E2%80%99s-sweet-potatoes-add-variety-traditional-tuber