Hospice

 A Hospice patient...This has never before been a big thought for me. If a patient was a hospice patient as a CNA, I helped the nurse turn the patient, bring the family coffee and kept the patient comfortable. It's a whole other world when you are the RN in charge. I knew the day would come eventually. The thing about when this day hit, it was during one of my worst weekends when I was dealing with personal issues. When I came to work trying to fight tears from my own downs, they let me know I'd be taking our patient on hospice care...The nurse who assigned me to that patient selected me personally because she thought I would do a really great job with the patient and family. I appreciate her intent, but it was the last thing I wanted to take on that day. I headed into it. I saw my other three patients first and saved the hospice patient for last. I knew I'd want to spend some time in there making sure the patient was comfortable and talking with the family. I wanted to not be rushed. I walked into the room and my heart dropped. Here was a gentleman that two days ago was alert and oriented, a walking, talking gentleman who came in for a UTI. Here  he laid pretty much unconscious with a tearful, concerned looking daughter next to his bed side. Something in me kept me together and all I could think to myself was "God are you testing me right now?" It seemed unreal and hard. I spent probably about half an hour in there taking care of the patient (repositioning, hygiene, pain medication) and trying my best to talk to the family. They kept on asking "how much time do we have left" and  I wasn't sure. Sometimes we get feelings when we see some specific signs and symptoms, but I wasn't able to give an accurate estimate. I called the MD to update them when she got the chance and the family went home. A while later I got the phone call from the wife. I could hear the sadness in her voice when she explained to me for 15 minutes how to care for her husband, what he likes to eat, what he doesn't like, which ear to talk into because his hearing is the best in that ear...and so on. It was probably one of the saddest conversation but also one of the sweetest listening to this woman who had been married to him for half a century explain to me how to take care of her husband. It was then I decided being the RN taking care of a patient in this condition was not only hard to see, to be extremely conscientious of every move and word was draining and to be the point of contact for each arriving family member was extremely hard. Later that night a nephew and his wife arrived to spend time with the patient. I knew they had arrived because as they leaned on the bed to kiss my patient, they accidentally set off a bed alarm that was placed on a bed. We set these in the hospital to alarm us if a patient who is at high risk to fall , tries to get out of bed without staff in the room. This patient didn't need a bed alarm. His body was lifeless and he was pretty much unresponsive. We were giving him morphine to keep him comfortable and watching respirations. When the bed alarm went off, my heard dropped. All I could think on the way to the room was this patient literally collapsed (fell off the bed) and died. I think it's the EMT in me that expects scenes to be gruesome. It was one of the worst feelings. When I arrive another RN had beat me to the room and all looked well in the room with the exception of the shocked family. It scared the life out of them. I let them know what had happened and left the alarm off. I spent another half of an hour in this room talking to the family. They were very nice and had a lot of questions. The one question they asked me that stuck with me was, "can he still hear us?" I got goosebumps as I replied, "definitely, hearing is the last sense to go". They thanked me for my time and I stepped out to give them some time alone. It was quite emotional night and I managed to keep it together. I felt most of the night though like someone had kicked me in the chest. It got even worse the next day...

If you think dealing with a mourning family is hard...It was even harder to deal with one of the sons who came in the next day. The first thing he said to me was along the lines of, if his (referring to the patient) oxygen isn"t going down and he is holding on it's going to be forever and I might as well just go back to work, it was a waste of my time coming down here...This is ridiculous. I couldn't believe this man was acting like this, in the room where the patient could have heard his every word. Could you imagine if a family member acted like you taking a couple days to pass away was such a big inconvenience to a job? I was so in shock. I spoke firm to this man and encouraged him to return to work and we could call him or he could call us if anything changes. I ignored his other shitty remarks while in the room. When I stepped out I had that feeling in my chest again and all I could think was , did that man really just act like that. I wanted to give him piece of my mind. Had I been a family member maybe I would have, but I didn't want to cross any lines, especially in the patients room. 

The next night I had this patient I knew he was going to pass at anytime. Patient's get this gray look to them and start to have a hard time clearing secretions out of their throat and an even harder time breathing. He passed close to 2am that night after I had left. His family was so appreciative of the great care and I was thoughtful of the experience, drained from the emotions and still in disgust of the patient's son. 

My next two hospice patients would come last Sunday. It was a completely different scenario the patient's family were completely in denial of the fact the family member would pass away soon and that was a really hard place to be in. I think that I possibly handled it a little better than I would have if I hadn't already had my first hospice patient as an RN...but I can't be sure of that.

GOODBYE

 *One of my older blogs from when I worked in Dialysis.

I'VE ALWAYS KNOWN THE IMPORTANCE OF SAYING GOODBYE. I NEVER WANTED TO SAY IT TO SOMEONE BECAUSE TO ME GOODBYE MEANS FOREVER. I'D RATHER SAY SEE YOU LATER...ANYTHING BUT GOODBYE. WHATS WORSE IS NOT SAYING ANYTHING... NOT EVEN GOODBYE TO SOMEONE...AND NEVER SEEING THEM AGAIN. TWO MEN THAT I HAVE KNOWN HAVE PASSED AWAY WITHIN A COUPLE WEEKS OF ONE ANOTHER.

RED-MR. HOLDEN WAS MY FIRST PATIENT TO GO INTO CARDIAC ARREST AND PASS AWAY A COUPLE HOURS AFTER I LEFT WORK. SAKARA YEM WAS A CO-WORKER WHOSE DEATH REMAINS SECRET BY THE FAMILY. I WASN'T EXTREMELY CLOSE TO THESE TWO MEN AS I AM TO PERHAPS A CLOSE FRIEND OR FAMILY MEMBER...BUT THEY WERE A REGULAR PART OF MY LIFE.

RED WOULD MAKE MY DAY AND WAS ONE OF MY FAVORITE PATIENTS TO TALK TO AND BE AROUND. DON'T EVER LET ANYONE OF A MEDICAL STAFF TELL YOU THEY DON'T HAVE FAVORITE PATIENTS OR THAT ITS UNETHICAL TO HAVE A FAVORITE AND MAY LEAD YOU TO TREAT THAT PATIENT BETTER. IF THAT IS SAID ABOUT ME...IT'S BULLSHIT. I TREAT ALL OF MY PATIENTS LIKE THEY WERE MY OWN GRANDMA OR THE GRANDPA I NEVER REALLY HAD. IT'S JUST THAT WITH RED WE HAD THINGS IN COMMON AND GOT ALONG REALLY WELL...PLUS WAS ONE OF THE FEW TO NOT TORTURE THE MAN IN PLACING HIS NEEDLES FOR TREATMENT. I ALWAYS TEND TO MIGRATE TOWARDS MY EXTREMELY OLDER MALE PATIENTS AND IN SOMETIMES FEEL IT'S BECAUSE THEY FILL THAT VOID OF NEVER HAVING A GRANDPA AROUND ME. THE DAY THAT RED PASSED AWAY WAS ONE OF THE WORSE DAYS AT WORK AND FAILURE OF THE WATER SYSTEM AND SOME ELECTRICAL AGGRAVATED ME TO THE POINT OF RUNNING OUT OF THERE RIGHT AT 1230PM WHEN MY SHIFT ENDED. RED HAD TO BE TAKE OFF OF HIS TREATMENT BECAUSE OF POWER FAILURE AND WAS SITTING THERE RESTING WHEN I LEFT UNTIL THE NURSE COULD RESUME TREATMENT. I DIDN'T SAY BYE TO HIM...NOTHING...A COUPLE HOURS LATER HE WENT INTO CARDIAC ARREST AND I NEVER GOT THE CHANCE TO SAY ANOTHER WORD TO HIM. MY LAST MEMORY WAS TALKING TO RED'S WIFE AFTER THE INCIDENT AND FEELING SO INCREDIBLY HURT INSIDE FOR HER. I CAN'T IMAGINE BEING HER. I HOPE I NEVER EXPERIENCE WHAT SHE DID.

SAKARA WAS 25 YEARS OLD AND GOING TO NURSING SCHOOL HERE IN WASHINGTON. HE IS THE TECH WHO DID MY TRAINING TO GET ME BACK INTO DIALYSIS AFTER MY THREE YEARS OFF. HE WAS A VERY GOOD TECHNICIAN. HE WAS VERY QUIET AND VERY HEALTHY. HE WAS A LOT CLOSER TO THE GUYS THAT WORKED WITH US OPPOSED TO THE WOMEN BUT HE GOT ALONG WITH EVERYONE. HE WAS A PRETTY COOL GUY AND ALL OF THE PATIENTS LOVED HIM. THE FAMILY WILL NOT SHARE WHY HE PASSED AWAY BUT IT CAME TO A BIG SHOCK TO OUR CLINICS. FOR SOMEONE SO YOUNG AND SO HEALTHY IT JUST SEEMED UNBELIEVABLE. THE LAST TIME I EVER CAME IN CONTACT WITH SAKARA I WAS DISAPPOINTED WITH HIM BECAUSE HE WANTED SOME HOURS SO HE ASKED FOR ONE OF MY SHIFTS...WHEN I TOLD HIM TO GO AHEAD AND TAKE IT HE BACKED OUT AND I ENDED UP HAVING TO WORK ANYWAY. I TOLD HIM TO NEVER ASK ME AGAIN SINCE HE'D GOTTEN MY HOPES UP...PRETTY MUCH IN A JOKING/SEMI SERIOUS WAY...AND THAT WAS PRETTY MUCH THE LAST THING I SAID TO HIM. NOT SERIOUS OR TRAGIC I KNOW...BUT THE POINT I AM MAKING IS YOU JUST NEVER KNOW WHAT YOU SAY OR DO IS GOING TO BE THE LAST IMPACT/IMPRESSION ON SOMEONE BEFORE THEY PASS AWAY. YOU NEVER KNOW IF YOU WILL SEE THEM AGAIN.

I LOVE TO HEAR THE PATIENTS AND THE WAY THEY REMEMBER RED AND SAKARA. I HOPE THAT EVEN HALF AS MUCH OF THOSE GOOD THINGS ARE SAID ABOUT ME WHEN MY TIMES COMES.

I ALWAYS TELL STEVE TO SAY BYE TO ME BEFORE HE LEAVES AND MAKE SURE WE KISS OR TELL EACH OTHER "I LOVE YOU" BECAUSE YOU NEVER KNOW WHAT WILL HAPPEN. I FEEL LIKE I COULDN'T LIVE WITH MYSELF IF IN A TIME OF AN ARGUMENT ONE OF US WALKED OUT MAD... IF WE SAID BAD, HURTFUL, OR NOTHING AT ALL TO EACH OTHER ...AND SOMETHING HAPPEN TO EITHER ONE OF US.... IT GOES FOR ALL THE PEOPLE AROUND US. I'M TRYING TO LET PEOPLE KNOW I LOVE THEM AND CARE AND NEVER LEAVE THAT DOUBT IN CASE I NEVER GET TO TELL THEM THAT AGAIN. IT'S SURREAL. IT'S UNKNOWN. IT'S OVERWHELMING. YOU JUST NEVER KNOW. SO SAY WHAT YOU MEAN TODAY. TOMORROW IS DEFIANTLY NOT PROMISED.

Shit My Patient's Say...

"Your voice sounds just like my 5 year old grandson"

"I never take my earrings out, but then they get so crusty that it is hard for me to take them out and wash them so I just leave them"

Referring to me: "Are you a a volunteer" "Are you old enough to be a nurse"

"Since you've seen me naked sitting on the toilet you might as well come home and meet the family"

"Is your hair naturally that blonde and black?"

"Ill just put on some dry underwear then put my pj's back on" (The pj's are soaked in piss)

"Oh ya!" When I have to remind them to flush and clean their hands after using the restroom.

"I bet you can bat your eyelashes and men will do just about whatever you want" Speaking to me, I wish.

The ask what car I drive and after I reply a truck, "Oh, is that your husbands?"

"Your shoes are really shiny are they combat boots?" Yep I stay on my feet for 9 hours in boots. Real comfy.

"It would be nice to get an 8 hour sleep in the place, but you guys come in and wake us up so much" Well it is a hospital, not the Hilton and it's our job to make sure you are safe.

"Honey, you have to work all night? I thought you were going to come cuddle in bed with me the rest of the night" Said by the cutest 95 year old man EVER.

Insanity

One of my writings I saved during nursing school...

"She used this great, sad, motionless face to suggest various related things:

a one-track mind near the track's end of pure insanity;

mulish imperturbability under the wildest of circumstances;

how dead a human being can get and still be alive . . ."

JamesAgee

Insanity. I have not reached it by any means.

It securely latches onto overwhelmed and surrounds my every thought and dream.

It stays in sight as an undetermined fate.

I've been strapped to this insane roller coaster ride and the ride no longer has me grounded.

It has edged me up to the highest point, pushes me over the edge and has me falling miserably, sickeningly and in a whirlwind...

I'm not ready for the next climb as I anticipated it in my heart.

What an adventure I've begun.

I'm in and there is no going back or being ejected before it is over.

Being ejected would be humiliating and represent self-defeat.

I'm stronger than it.

There is no going back.

Nothing compares to this. I thought in getting on this would be similar to all others...

But in reality, This ride is one of a kind.

I thought I had experience, But I had no idea.

I thought I was optimistic and hopeful...

Now I realized I'm overwhelmed and unsure of my own determination.

I began with the end in mind and now... I can't seem to see past the next decline.

New Hopes

Picked up my coffee today from the new coffee stand I found near our new house. It's cute and little and I would rather support them than Starbucks. And every 5th coffee you get is free. Free is good. One of the girls at the stand mentioned my scrubs today and asked what I did. I told her I was a nurse at a hospital not too far away. Her little eyes lit up. She explained to me that she was done with her pre req classes and was applying for nursing school. She excitedly continued that she has been volunteering in the hospital, that her dad was a nurse and he seemed to really like his job. Then she asked me how I liked my job... (Deep breath) Sometimes this is still a hard answer for me to give. I still hold on to the resentment of how I feel like how I put my whole life on hold to do school for the RN license, how I let myself go, how I ruined relationships and how I obsessed about getting a 4.0 when at the end of the day, it didn't mean much. Sure that 3.85 meant I got a different rope on my graduation gown and it is listed on my degree, but for what I sacrificed for it...I don't feel like it was worth it. The next thing I have resentment is being new and naive again about a new career and being eaten alive by nurses who had been doing the job as long as I had been alive. I had to grow thick skin to get through them and their criticism. I thought I already had the thick skin, the balls and the attitude to get through this new nursing roll, but I didn't have quite enough. And the truth is I probably didn't have enough of that to start nursing school. The first quarter was a complete fucking shock...and then my friends and I just went into survival mode to get through the next 5 quarters. The next thing that was hard on me was working nights. It was hard on me and hard for me to sleep, the money was not worth it. So here I am on evenings. I love my floor and my coworkers. I get more pleasant patients that I adore working with than not. But since injuring my back I am dying to get over to a baby nurse type atmosphere. I know it won't be easier, but it's my passion and lets be real a 9lb baby will not injury my back. I think the hardest thing will be dealing with mom and dad and learning to read the baby who can not always tell me what is wrong. You learn that though, just like I can tell when something is wrong with my pets, you get that feeling that something isn't right... So with all this resentment and feelings I hold for this adventure I've gone through... I reply to the excited young girl that I do enjoy my job, it is worth the school and that there are so many areas of nursing...if you don't like one spot you can move to so many  more! At the end of the day I sometimes regret giving up the EMT/ Firefighter role that I was so extremely proud of, but at this point I can't complain...And I made 3 really good friends out of the whole experience. I'll probably be friends with these girls for a very long time. It's nice to have them, they are the family I've chosen...And to the young new hope at the coffee shop I hope that she has a better survival through school than me and that at the end of the day, she too doesn't resent the journey or the school loans. And don't even get me started on school loans and the cost of those damn books...