Because Sometimes I Just Want to Talk About My Day...

I'm an innate debriefer, I always have been. It's a trait that often comes in handy as a teacher, but sometimes stinks when all you come home to is a cat. I'm not in the habit of talking to animals as if they were people unlike some folks are. Sometimes I just want to talk about my day.
I went to work this morning and got assigned to a male patient in his 40s. He had been admitted during the night from a rural hospital where he had presented to the ER with chest pain and difficulty breathing. On xray they had found a widening of the mediastinum and determined that the man had an aortic aneurysm. After all, he is have a history of marfans (a genetic connective tissue disorder that makes people prone to aneurysms).
Upon more testing at our hospital we found the aneurysm was 10.5 cm (the biggest I had ever seen) and so large that it was compressing his trachea (hence the difficulty breathing). When I arrived on shift, I was immediately asked to order and transfuse blood products, draw labs, complete an echocardiogram and prep. for surgery. Unfortunately I didn't the blood products hadn't arrived before I had to bring my patient to surgery. His airway had become so tenuous that we just couldn't delay any longer. I can still see the look on this man's face as we emergently wheeled him into the OR, he knew his chances were slim.
I had no sooner returned from the OR after dropping off my patient when I heard another nurse calling for help. I entered the room to find her manually ventilating her patient who was in respiratory arrest. During and after a rather chaotic intubation, the patient vomited the dreaded coffee ground emisis, the signature of a GI bleed. Only minutes later we found ourselves doing CPR and pushing ever vasopressor known to man. Ultimately the patient was resuscitated, but I'm not holding my breath about his long term outcome. Resuscitation is trauma in and of itself, one that I'm not sure a 91 year old man would want to or should have to endure.
Then as if multiple rib fractures from compressions weren't enough, we just had to go and start a central line in his neck. I'm all about working at teaching hospitals, but I have to say my arms and my back are still aching from standing in awkward positions with my hands under a sterile drape holding some guys head for over an hour.
My original patient never returned from OR before change of shift this evening. As I was setting up the room for his return I happened upon a "get well" card from his young son. It said: "I love you daddy. I hope you don't die. Could you please stay alive for me? I'll give you my whole allowance." (There was a wadded up dollar bill inside the card)

It's Not About the Dog

Last week I go a phone call from my mom at 5:30 am. She was in tears as she choked out, "Our little friend has died." I racked my brain for a minute desperately trying to figure out who it could have been but finally gave up and asked.
It was "Joshie," her itty bitty pocket dog. Joshie was the puppy of two of her previous dogs, a pom and Chihuahua; tiny and yappy indeed... In recent months the poor thing had developed congestive heart failure that was being managed by the finest "puppy cardiologist" around. Evidently the little guy had developed worsening shortness of breath during the night and mom had taken him to the emergency vet. She left him there for only a few moments to drive my grandmother home and that is when he finally died. She was ridden with guilt. "I never should have left him alone."
My mother isn't the most emotionally stable person in the world. Past experiences involving my mother and loss had me worried about how she would handle this. To make a long story short, she was devastated. My sisters and I spend several hours over the next couple of days with her sobbing on the phone.
I spoke with her one evening after classes and was quite surprised at what she said that day. "I know it's kind of ridiculous to be this distraught over a little dog. I'm scared, what am I going to do when Granny and Grandpa die? I've concentrated my life so much on those few things that I don't really have any friends. I put so many expectations on that dog, I thought he would be around forever to accept me, to greet me when I get home; but he couldn't, he was just a dog. The truth is that I'm alone with nothing in my life that is that meaningful."
Wow, she was dead on! She went on to describe a conversation she had with a neighbor in her driveway and then how she invited the little neighbor girl over to teach her how to crochet, a Bible Study Fellowship group she wanted to join... It's not about the dog indeed. If we just take the time to keep listening, we might find that out.

Heaven is Laughing...

I hadn't been to Beit Tikvah is over a year. I had thought about going several times, but the furthest I had gotten was to the parking lot. This last Friday marked the end of the Feast of Tabernacles and the celebrations surrounding the High Holy Days were wrapping up.
As I was driving home from clinicals, I decided to give it one last try. Long story short, I parked the car and this time actually got out. Unfortunately I locked the keys inside. I would be lying if I said I wasn't paniced. So... there I was with no choice but to go inside.
There was some ackwardness and intimidation involved in seeing people I hadn't been around in a year but overall it was good. In the end my sister was able to bring me extra keys and I'm pretty God had a nice chuckle.

A Cambodia Story

11 year old Mik Young was my 35th patient that day. He approached my clinic station in silence and took a seat at the end of the table; his gaze was fixed on the floor. My interpreters (I had two, one for English to Khmer and the other Khmer to the tribal language) asked the customary question; “What brings you to the clinic today?”

We waited several minutes for an answer but Mik just silently fidgeting in the chair. After a few minutes, one of the interpreters set off to find the boy’s mother. Slowly, the story unraveled. Mik had been suffering from seizures for the last 7 years. His mother stated that he would often have 4 or 5 seizures in a day. Mik had been seen at the local hospital for this before but doctors said they were unable to do anything for him.

Seizure medication must be loaded and titrated to maintain the therapeutic levels in the blood. This requires close surveillance and laboratory monitoring. Our little clinic was not prepared to provide care at this level or for the longer term that the boy would need. There was nothing we could do either, nothing but pray that is.

Emily, the nursing student I was working with day, called Ernie and Mary and Paige over to pray for the child. The more we prayed, the more we found out about the situation.

Mik and his mother where both Christians and attended a local house group. However, before they became believers, Mik’s parents practiced the tribal religion which included devil worship and animal sacrifices. When he was a baby, he too had been offered to the devil. In the past when the boy began to have seizures, his parents would sacrifice an animal and the seizures would stop for a while. However, since they became Christians, they no longer made the animal sacrifices and seizures got worse.

As we continued to pray, the boy’s mother joined us. Mik said he saw a light shining brightly in his face. I found myself secretly hoping it wasn’t the precursor to another seizure. We kept praying and Mik held his hands up.

Mary spoke over him and his mother. Being a Christian means that you have offered yourself to God, the devil has no power anymore. Jesus made the ultimate sacrifice; no more animal sacrifices were needed. Both Mik and his mother prayed and to God that Mik now belonged to him.

When we finished praying Mik spoke to us for the first time and said he was hungry, something his mother said he hadn’t been for quite some time. We managed to dig a up a cliff bar and he went off nibbling on it happily.

I don’t know what happened to Mik after that, but I do know that when you offer yourself to Jesus and surrender to Him, Satan has no power.

Blood, it Does a Body Good!

Over the last few days I have been studying the blood covenant and what an amazing thing it is!

Apparently in ancient Eastern culture it was the tradition that when a king or important guest was expected, an animal of high value was selected to killed in honor of that person. The blood was then poured out at the threshold of the house. If the expected guest was a king, members of the army would precede him to the town. Each house that had blood at the threshold was considered loyal to the king, where a house without the blood was considered disloyal. The kings army would either kill them or drive them out.

Now when a guest came to enter into a home, he could cross the threshold and enter into a sort of covenant with the owner of the home. The guest would not rob the home and the homeowner would be hospitable to the guest. He would feed the guest and provide for him and even protect him with his own life as long as the guest was in his home. We see examples of this with Lot and his heavenly messengers and in Rahab the harlot. Now when a king sees his subjects as loyal, as part of his kingdom he pledges to protect them. Now think of the Passover in light of this, truly stunning. Now we have the precious blood of the Lamb covering our doors and coursing through our veins inviting the king of glory to come in!

Lift up your heads, O gates! and be lifted up, O ancient doors! that the King of glory may come in. Psalm 24:9

Shame, the Ultimate Isolator

Several weeks ago a friend and I went hiking on a Sunday afternoon. We carpooled together and she drove. Since her church was on the way to our hiking spot, I went to church with her that morning. As we were sitting in church, she turned to me and said, "What's you deal with church?"
Now mind you I hadn't spoken about church much at all with this person. I literally broke into a cold sweat as I wondered to myself what had made her ask that question and what I should say. "I don't exactly know," I said. I thought it was a pretty safe and noncommittal answer, it was also at least to some degree true. But alas, it was not a "safe" answer as the response I got was this, "Well, you should ask God."
So, there I was in church asking God to show me what "my deal" was. Surprisingly, the answer came quickly and it was only one word, shame.
As I pondered the meaning of this I was reminded of what happened when Adam and Eve ate the fruit from the tree of Knowledge of Good and Evil. Genesis chapter 3 says that when Adam and Eve ate of the fruit, they realized they were naked and they were ashamed and hid from God. Of course we know that we can't hide from God, so in reality we are only hiding God from ourselves. Shame robs us from community with Him and with others.
So where does this shame come from and what to do with it... Of course we've got the Sunday School answers, but in reality I have so much more to learn. It's only the beginning of this journey.

A Voicemail

"Hi ProM, this is Alicia. I hope I have the right number for you. I you were praying for a job for me, I just wanted to share the good news. I just signed on as a consultant over the summer. In lieu of benefits they agreed to pay me $50 an hour. I'll be working really hard but I'll make about $24,000 over the 3 1/2 months of summer. I was only expecting to find a job that paid about a third of that. Thanks for praying."

To fill you in: This student is about my own age and is pursuing nursing as a second degree (her first was environmental science). I taught her clinical group for the last rotation. She was at about a $20,000 deficit for tuition for next year and she was unsure of how she would get it. There was even talk about how she might have transfer to another school to finish, apparently God had other plans!

Moments Like These

Remember in the last post how I mentioned I was waiting for my lung transplant patient to return from the OR. Well... She got back up to the unit following her surgery in the early evening. She was on the older end of transplant recipients and I wasn't quite sure how she would do. I recovered her from surgery but then my shift ended before we could take her off the ventilator to see if she would fly.
The next morning when I returned not much had changed, she was still ventilated. Fortunately by mid morning she was ready to come off the vent. As I woke her up and put her on the spontaneous breathing trial, she became very anxious and had a death grip on my hand. Once we took the ET tube out, she began to cry. These were not tears of pain but tears of joy, she finally realized what it was that had just happened and her hope for life was renewed. She kept repeating, "I can't believe I can breathe! Thank you all so much, this is amazing."
She continued to recover very quickly following her extubation, getting out of bed only only an hour later. It wasn't long before we had her walking circles around the unit with her IV pole, 4 chest tubes, portable suction, monitor and drains in tow but remarkably no oxygen! (Of course I had packed it with us "just in case...") I can't say that she made for the most exciting patient but she was the one who truly "got it" and did her best to take great care of her new lungs. It's moments like these that give nurses the energy to keep on doing what they do.

Not Again...

At work this weekend I found myself "CRN" (the nurse who runs around and puts out fires) while I was awaiting my patient's return form surgery. About mid morning I got a call from another hospital saying that they were sending a critical patient our way. We prepared as much as we could for his arrival, setting up 12 different IV drips, ordering ventilators, etc...
The patient arrived in terrible shape and went into cardiac arrest only minutes after he rolled in the door. Once again I found myself doing chest compressions on the middle bed of our only 3 bed room, which of course was full... Again with the sequence of CPR, shock, pulse comes back, lose it again, lather rinse and repeat. In midst of all of this, his family walks in (or rather runs in). "Daddy, daddy, come back," they screamed slapping his face. We continued to try but all of us knew it was futile. The attending physician, a small Asian woman, calmingly spoke to the family at the bedside explaining what was being done and that we were running out of options. Finally we stopped, but as soon as we did the man's daughter ran up and tried to do compressions. The son then started to beat on his father's chest and the entire family began to wail. The family was middle eastern and I'm sure that some this reaction was related to thier culture and I'm sure the suddenness of it all didn't help... The little Asian doctor bear hugged the son from behind while another nurse did the same with the daughter. Just like that, it was over.

He was Right, Life is Precious...

I worked my first official day shift in 10 years yesterday. As I went into the report room to grab a cup of coffee I was met by the hospital chaplain. Within a few minutes they had managed to herd a handful of us into the room. Then, the breaking news... One of our fellow nurses had very unexpectedly had a stroke that morning. At first she had only paralysis on one site, but as the bleed in her brain got worse she gradually lost consciousness; she was dying. As ICU nurses there was a thousand things we could have done to prolong her life, but nothing we do to save it. We all knew what she would want and so did her family, she died peacefuly only a few hours later.
Of course the entire unit was in a state of shock. Deanna had been a nurse who repeatedly took on the most chronic hopeless patients; the ones who stuck around for months and usually died a very slow and drawn out death. She treated each one of these patients like family, she treated them like they still had hope. I remember one occassion when she arranged for one last flight for a dying Air Force officer. She treated life as it were precious and now in her death has shown us all that it most certainly is. You would think that as nurses we would know that, but somehow it's a little different in the context of our job as opposed to the rest of our lives. I suppose we just learn to compartmentalize?

Speechless (again)

Last Wednesday I was called in early for some overtime on top of my last night shift. It was a busy day and all of our beds were full and patient acuity was very high. Throughout the course of my 17 hours my patient assignment changed 4 times as patients and nurses came and went from my part of the unit. I found myself assigned to the units only triple room. At one point I had managed to transfer one my patients to another unit opening the only ICU bed in the hospital. It didn't stay open for long...
Within minutes I heard a code being called overhead on the telemetry. Of course I knew it would be coming to my room. Within a few minutes of his arrival the new patient went into cardiac arrest again. We worked on him for several hours: CPR, shock, IV meds, regaining a pulse, losing the pulse, lather, rinse and repeat...
The family came in said their goodbyes and time of death was called.
The part I neglected to mention until now, my two other patients sharing the room were fully awake and aware of the events of the night. They heard every word.
"You must really look at life as a precious thing," said one of my patients as I checked on him after it was all over. I could tell he was a little shaken by it as he himself had just returned from surgery for a potentially fatal aortic anneurysm. I mist admit that I felt a little guilty for being releaved that time didn't allow for much more than a short chat. But what do you say to that?

Speechless...

What do you say to:
The student who passed all his classes but cannot progress in the program because he missed the cummulative GPA mark by .o4?
The newlywed nurse who comes to work with the black eye and gets flustered over frequent phone calls from her husband while she is at work?
The woman dying of lung cancer?
The sleep deprived doctor who you're calling at 2am yet again?
The coworker who is burnt out?
The crying student who made an honest mistake that could have been very serious?
The neighbor who lost her job?
The young woman who lost her leg in a tragic accident?
The friend who calls you on the phone to tell you she's moving far away?
The panhandler on the side of the street?
Yourself at the end of the day?
The King of the Universe, the God of all creation?

Impaired Religiousity

Being a nurse I am occasionally asked the question: "Do your find yourself self diagnosing frequently?" Hmm... I suppose the answer would be yes, but we has nurses have our own arsenal of absurd diagnoses. My latest, impaired religiosity.
Impaired Religiosity: State in which a person or group has an impaired ability to exercise reliance on beliefs of a particular denomination or faith community and to participate in related rituals.
Unfortunately this sounds all too familiar. Apparently I'm not alone as there must be a fair number of people suffering from this debilitating disease or there would not be a "legitimate" diagnoses. Sometimes our impairment is related to physical things such as schedule conflicts, transportation issues, etc... Other factors may be more complex such as trust issues, spiritual distress and others. God is so much bigger than these things.
Though I am getting better at care planning I still sometimes struggle with this, we all do. But as I have sat down to think about it, I have noticed the efforts of my friends to reach out to those with "Impaired Religiosity." The guys who get to church early every Sunday to drive the vans to pick up the kids who wouldn't otherwise be able to come. The teams who tirelessly go out to lead the the mission and rest home meetings. The teachers who have probably had it up here to classroom antics and then dedicate their Wednesday evenings to leading a youth group.
This week I will challenge myself to pray and ask God for sensitivity to others and to show me how to fight back against this "disease."
After all, aren't we reminded that true religion is to care for widows and orphans?
James 1:27
Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world.