Grateful

Working in a veteran's hospital you see a lot of things. A lot of substance abuse, mental health issues and alcoholism... PTSD is rampant in our patient population. It can be a rough place to work sometimes. It wears you down. People are bitter and angry and broken... lost and many times forgotten. 

It is not uncommon to have patients in our unit that have no visitors during their entire hospital stay. It is also very common to have families with very complicated backgrounds and delicate family dynamics. Often times we are not only caring for our patients but we are caring for their families too.  I think one of the reasons I fell in love with the VA is because of the people. One of my deepest passions in life is to show people their value and their worth. I think that is one of the things I have always valued about my faith also. Jesus was a man who loved people... the worst people too. The rejects and marginalized people that no one else wanted to fight for... he fought for them. 

If anything I hope that would be the one thing I can show people. That they are worth it. That they are valued... but most of all, that they are loved. 95% of the time it is not easy working with the patients in my hospital. There are moments though where it clicks and the 5% makes up for the rest. The moments where I am able to step outside of my own crap and realize that these guys are just hurting, broken people who need good care... those are the moments that matter.

I had a patient last week who was unlike the others. This patient had a large, close family. This patient did not have substance abuse in his background. He was a physician and a professor at a very prestigious medical school in the area. Still he chose to come to the VA for his care. His wife was saying how much he appreciated the care he received at the VA and she expressed how grateful she was too. Through foggy, tearful eyes she stroked her dying husband's hair and told him to keep fighting... and that she loved him more than anything in this world. She said that he was her best friend and that she was so grateful for everything he had given her in their life together. The love she had for that man was pouring through every tear she cried and the pain she was feeling was tangible.

It broke my heart and I had a hard time holding it together as I managed the care of this extremely sick man. She asked me how long I had been working in the unit and asked if I liked my job.

I stopped what I was doing because I wanted her to know how much I meant what I was about to say. 

"I love my job. It is an honor to serve these guys. They truly have given so much and the fact that we are able to cater to our veteran's in such a specific way really is so special. I love knowing that we can give back in that way... and especially that we can give such good care to people who often times are not appreciated or understood. I really love what I do and even on the hard days I am still grateful that I have a job where I can show someone that they are valued by the care that I give."

She looked at me and smiled ever so slightly as tears began to fall down her cheeks. 

In the midst of an incredibly exhausting week it was a 5% moment and even now... days later it brings a bittersweet joy to my heart and it reminds me of just how lucky I am.

 

Image Credit

My Shameless Plug

I have talked about "my girls" on here a lot. They recently made a big move to the great state of Texas but they used to live in Colorado.

This is my best friend Ami and two of her little girls. My last post had a picture of her oldest.

This is her husband Andrew. Two of Andrew's brothers back in Colorado are in a band called The Host Club. I have been following their music for some time now and I can say they are pretty darn awesome.  They recently made it to a top 5 list on a radio station in Denver and will be playing at an event called The Big Gig 2011, alongside My Chemical Romance, Blink 182, Rancid and more.

Check them out on their Facebook Page and if you like their music you can download their E.P. on iTunes! (It's less than $4!)

My August Pledge

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I have raved about GradyDoctor on this blog before. I still remember the first time my bff Kelly showed me her blog and the first thing that I said was "What?! She's a doctor AND she's an attending?!"

I could not believe that someone so encouraging and down to earth and humble and genuine could actually come from the medical world and not only that but was a top dog in the medical world (which in my neck of the woods tends to = you think you are God). That probably doesn't say a whole ton about my general experience with physicians. I guess that's not 100% fair because contrary to popular belief I love a lot of doctors I have worked with and continue to work with today.... but I digress.

All I'm sayin' is that GradyDoctor is somethin' special and this is exactly the kind of thing that proves my point. Recently she did a blog post about negative self talk and how people are gonna hate... no matter what there are enough people in this world to shoot us arrows.... to cut us down... to belittle us and make us feel small... so why do it to ourselves? I think women especially have a hard time with this. We constantly complain about how we are fat or ugly or not smart enough or good enough. I know I do it all the time. So, that being said I have decided to take a pledge, along with a handful of other GradyDoctor followers. For the rest of August I have pledged to have no more negative self talk. 

This is the pledge copied directly from GradyDoctor's Blog:

Here is the pledge:

(Place your right hand over your hip and then let your backbone slip)

I, insert your name here, do solemnly pledge to allow no insults directed toward or about myself to leave my lips for the rest of the month. This includes but is not limited to references about the following:

• butt size
• hair length
• baby weight
• belly circumference
• skin surface
• crows' feet
• height
• complexion
• salary
• material possessions
• marital status
• relationship status
• grades
• achievements in comparison to someone else
• achievements of your children
• size of your house
• make of your car
• mistake from your past
• compliments to others with reflexive insults to yourself in same breath

The good news is that you can liberally make reference to the following:

• Craziness of your own family members (but only in presence of other family members)
• Annoying quirks of your significant other (but only in absence of your significant other)
• Any person who stars on any reality television show including but not limited to any Kardashian, Snooki, the people on the Parking Wars show, and any of the housewives Real or Basketball. (Exception to this rule: "Swamp People" and the daddy on "Pawn Stars.")

***(play the anthem below and shake what your mama gave you if you commit)***

Vowed on this day in August 2011. . . . (insert your name here.)

***

If you are prepared to go on this self-hateration diet for the next two weeks and you pledge to leave it to the professionals, make your mark, people!

Go check out her post here and if you are up for it join in the pledge and lets see if we can't make August an awesome, hater-nation, free month! 

 :D

  And just for fun I will be picturing getting this look from one of my favorite little girls every time I start to hate on myself. 

haha That's my girl. :)

Ireland... Long overdue photo post

 Because I miss Ireland and I miss my Irish bff, Christine. I had some time and went through a small batch of Ireland photos. There are a lot more to sort through but these are a few from my first full day in Ireland. 

A day in Belfast. 

 An Irish roast... yummm is all I have to say.

Castles everywhere. A good majority of my pictures were taken in the car so please excuse the blur. :)

 Irish Starbucks <3

Best part of the Belfast day was a local gentlemen (who might I add was missing a few teeth) was polite enough to stop and help us when we looked lost. The Belfast accent is so incredibly thick I think we both spent the majority of the time nodding and smiling... catching only a few words here and there. He was cute though and it made me smile. :)

California is everywhere apparently.

I heart you friend. Have a Bulmers for me :) <3

The SF Marathon

This is the greeting I got as I walked through the doors of the expo for the San Francisco marathon last weekend. I have to admit I was terrified. I love SF with all of my heart but I was not eager to run the greuling  hills of this course... as I learned from Seattle hills are my enemy.

I got my gear together the day before and did my pre-race routine.... Gear check before the expo in case I needed to pick anything up last minute... Get my bib and pin it on my racing skirt and then do my gear check photo and post it to facebook.

I love this because if I am forgetting anything my fellow racing buddies will leave comments reminding me so. My good friend E. noticed that I was missing my garmin in this pic and she reminded me to take it off the charger. :)

It was a perfect morning... 60 degrees with a thin layer of clouds covering the bay. No rain or heavy fog.

I had been debating on dropping down to the half marathon distance... as a matter of fact I was sure of it at one point. I had even told everyone not to come to the race.

The day before I changed my mind... for lots of reasons and let me tell you... I am SO glad I did.

I LOVED the SF marathon... well as much as one can love running for 6 hours and 26.2+ miles.

                   There were a lot of hills...

Not gonna lie...

 I had a few not-so-nice words come out of my mouth when I saw them... and then I proceeded to slowly hike up them... but the course was beautiful!

 We got to run along the coast and through Golden Gate Park and we even got to run over the Golden Gate Bridge! It's the only marathon in the city that does that!

I met Yolanda Holder along the course... for those of you who don't know who she is... she holds the world record for most marathons run by a woman in a single year. She ran 106, I believe. What an inspiration and she was so sweet and took pictures with me on the course too!

One of the best parts of the course was at the finish my grandparents came to see me run in. My grandfather ran the SF marathon in 1982... but he did it in 3 hours 58 mintues! That's a Boston qualifying time! Now my grandpa was able to stand at the finish with me, his medal and mine, side by side. It was a truly special moment for us both. :)

I finished this marathon in 6:08... I was very happy. I set a PR (personal record)!

The best part? I am now officially a marathon maniac!!

And I was welcomed into the crowd by one of my favorite celeb runners... "Endorphine Dude"

When I received the confirmation email from the Marathon Maniacs that I was in... this is what I got...

"Andrea, at last you have found refuge, a place where you can call home, where the Insane can feel Sane again, and once again be treated like a normal human being."

"Welcome To The Marathon Maniacs InSane AsyLum!!!!"

I wish you all could have seen the smile on my face when I read those words.

I could not have been more proud.

Marathon # 3 is on the books and this girl is officially Marathon Maniac #4171!!

P.S. I may be a maniac but I am not as crazy as this guy who literally did the entire half marathon on crutches! Now that is crazy indeed.

Welcome to the ICU... the end

It is now day three of my week. I haven't slept much and the last 48 hours have taken a lot out of me.

I wake up to a text message from a fellow night-shift co-worker who was working a day shift. 

Things were not going well... my patient was not doing well.

They were about to transition him to comfort care.

I read those words and my heart sank. It hit me like the weight of an elephant on my chest.

I stepped out to my balcony and began to pray.

"Lord please give us a miracle. Be with his family now. Be with my patient... please Lord."

Tears begin to fall and I feel a deep sense of loss. 

I have never been impacted by a patient this way. It is hard to explain.

As a nurse your job is to heal people... in any way you can...
but this time I had no answers... this time I had no control and I felt helpless.

I go to work and he is still alive. 

Things are worse now... I have never seen lab values like this. 

I have never had a patient as sick as this. 

There are no answers... 

Just sickness...

I began my shift with his minister at the bedside. Reading him the Psalms...

"The LORD is my shepherd, I lack nothing.

 He makes me lie down in green pastures,

he leads me beside quiet waters,

 he refreshes my soul.

He guides me along the right paths

   for his name’s sake.

 Even though I walk

   through the darkest valley,

I will fear no evil,

   for you are with me;

your rod and your staff,

   they comfort me.

  You prepare a table before me

   in the presence of my enemies.

You anoint my head with oil;

   my cup overflows.

 Surely your goodness and love will follow me

   all the days of my life,

and I will dwell in the house of the LORD

   forever."

I go through the motions... his family is there... his grandson asks me,

 "How long would he have lived if he didn't get the original surgery."

I take a deep breath.

"My dear only the Lord knows the answer to that."

He nods and grabs his grandfather's hand.

"I love you papa" and he leaves the room.

A while later his wife has a discussion with the ICU team.

It is time. He is not getting better... she wants him to be comfortable.

We give everyone time to say goodbye and I explain to the family what to expect.

And then... one by one... I proceed to remove the medications that are giving him life.

At the end he is left with sedation and pain medicine only.

His family joins in a circle of hands... praying and singing over the man that they have known for years to be grandpa, dad, brother, husband.

Within minutes the monitor shows nothing but a ragged line... he is gone.

He has passed.

I enter the room and find his wife...

"I am so sorry but it looks like he has passed. I will call the physician to come in and confirm."

She begins to cry harder.

"I am so so sorry for your loss." I place my hand on her shoulder.

She waves her hand as she covers her mouth and I step away to inform our ICU fellow that he is in asystole. 

After some time... after his family have said their goodbyes... they leave in a state of shock.

I am left with this man that I have to clean and take the morgue.

My patient.

A man that I have cared for and fought for. 

A man that I don't really know... but a man that I desperately wanted to live.

In that moment I feel lost.

I feel like a failure.

I am confused and frustrated.. but most of all I am devastated.

We are supposed to save people. 

We are supposed to heal them...

but sometimes the Lord calls us home... sometimes medicine is not enough. 

Sometimes we don't have answers...

and sometimes it just isn't our fault...

it is just their time.

As I prepare my patient's body for the morgue... I grieve...

I grieve for his family... I grieve for the loss of life.

And in that moment I realize that I have experienced the truth depth of nursing...

 in a way that I never have before.
I begin to feel the tears of the ugly cry and I have no reserve to hold back. 

My charge nurse encourages me and thanks me for caring so much for this man.

With help from co-workers I get my patient in the body bag and begin the trip up to the morgue.
I am silent and somber and as I walk the empty halls of the hospital all I can think is, 

"Welcome to the ICU dear... 

Welcome to the ICU."

Welcome to the ICU... part two

It is day two of my week and I come in to work early to check on my patient.

He is back from surgery and is on CVVH... a form of dialysis.

There are four IV pumps in the room.... each with 4 channels full of medications that are keeping him alive.

Christmas trees of lights and IV bags and a symphony of alarms. 

My charge nurse asks if I would like to have him back.

"Yes, please!" I want to help... I want to know what is wrong... I feel a sense of responsibility here.

 He was my patient for so long... I want to do what I can to make it better... even if it is only for my own peace of mind. There are drones of people circling his room. Doctors from every service and every free nurse is there to lend a hand. His wife is waiting to see him outside.

After group report I head to his bedside and get report from the dayshift nurse.

It is going to be a long night... he is much worse now.

There are still no answers... only speculations as to what caused this rapid decline.

One by one his family cycles in through his room. Praying for him... crying over him... kissing his head and telling him how much he is loved. It is a busy shift. Managing his dialysis, his IV medications, his vitals are mostly stable... his lab values aren't good but they don't change overnight.

I get in the zone and before I know it morning has come.

As I give report to the new dayshift nurse he begins to crash. 

His alarms chiming in telling me so...

his pressures are unstable and I quickly get the doctors at his bedside.

I do the best I can to coherently explain the last 48 hours and luckily his dayshift nurse was one of the people helping yesterday so she is familiar. 

I drive home... exhausted and weary again... but still praying for a miracle...

praying that he will make it through the day.

to be continued...

Welcome to the ICU... part one

It started out as a normal weekend shift.

Two stable patients, one of which I'd had before. 

Both vascular surgery patients, one that was two weeks out from a complicated case.

He recovered well and was slotted to be transfered out first from the unit monday morning. 

A funny guy... slightly confused but in a pleasant way. 

Had a smile like a cheshire cat and hair like Don King. 

We laughed a lot with him.

 We were all glad he was doing so well. 

His family was glad he was doing well too.

Midnight rolls around and as I enter his room something is different now. 

He looks uncomfortable... something is not right. 

He is asking for cold medicine and because he is suffering from ICU delirium I know this is not good. 

I listen to his lungs and hear crackles in the bases and wheezes throughout his upper airways. 

A sign that fluid is building up. 

I page the respiratory therapist and a treatment is given.

The symptoms don't change. 

I page the intern... three times. 

No response.

I complain to everyone around me about how much I hate July in a teaching hospital.

I page the resident and right as he comes out the code pager goes off.

"E-TEAM, 2nd FLOOR"

I quickly relay the symptoms. He orders a blood gas and says he will be back to check the results and then is off to the code downstairs. 

While he intubates the patient downstairs we try to get blood from my patient's artery... a painful but necessary process. He is acidotic.... not a good sign.

I look at my patient and he has that look.... that look of doom.

His breathing is rapid and labored.

He looks frustrated and scared.

He is getting tired now.

I can feel it in my gut... this patient is sick.... and I mean sick sick.

It just isn't adding up... something is not right.

It is one of those times when a nurse's intuition kicks in. We order a chest x-ray, bipap mask to force air into his lungs and lasix to help get rid of the fluid in his lungs. 

Meanwhile I bring the intubation kit to the bedside... I just have a feeling.

Sure enough within the hour the patient is intubated... we are inserting central lines.... arterial lines.

I tell him that it will be okay... we will put this breathing tube in until we find out what is causing his respiratory distress. We will fix this and hopefully in the morning we can get the tube out. 

I give him the sedation that was ordered and I watch him close his eyes 

as he falls into a deep chemical sleep. 

From 3:00am until 8:30am I am in the room assisting the docs with the intubation and line insertions. I am giving drugs and starting drips to maintain his crashing blood pressure.

We are drawing labs and throwing around possible causes. 

Aspiration?

A clot?

A pulmonary embolism?

An illeus? 

We run the tests and everything comes back inconclusive. 

We have no answers but the patient is not getting any better.

He is getting worse.

By the time I give report the surgical team has been in to assess. We are trying to get him stable enough to go to CT scan... and yet we only continue to add more medications to chase his crashing pressures.

I ask if anyone has called his wife? 

It is now time to go home and my patient is still not stable.

I give report amidst the craziness in the room. I thank the co-workers that helped me and as I drive home... exhausted and weary... I say a prayer for my patient.... knowing that he will most likely head back to the OR that day. Hopefully they find out what is wrong.... 

To be continued...