Sunday, June 23, 2013

The Art and Science of Nursing

When I was in nursing school my teachers would always talk about the "art and science of nursing". The marriage of scientific knowledge and the intuition we have as caring professionals. Back then I understood it on an intellectual level, and I saw it in the experienced nurses who, due to years of hands on nursing, had this way of balancing their care with scientific precision and  compassion that drove everything they did. Over the years I have learned it more myself but it wasn't until last night that I realized just what my teachers meant all those years ago.

When I walked into work last night and saw my assignment, I knew there was a potential to have a rough evening. My patient was a young man I knew well. A guy who had been diagnosed with ALS many years ago... a disease that slowly takes away all ability to move, eat, go to the bathroom and breathe on your own... eventually even takes away the ability to speak. It is fatal and it is characterized by this "trapped syndrome" where your mind is completely alert and aware and yet your body is a hollow shell of what it used to be. In all honesty... ALS is my very worst nightmare.

I had been told that my patient was at a point in his disease process where he was not willing to participate in nursing care. No turning, no bathing, no suctioning... basically we were there to give pain medicine and offer sips of water and such... but only when he asked. He was still able to talk through his trach, despite being on the ventilator and he would let us know what he did and did not want. Oh great.... I thought to myself... this is gonna be a fun night.

If I had been given this assignment four years ago when I began my nursing career, I would have had a large amount of anxiety surrounding his decision. As a nurse who knows the implications of not turning your patients (bed sores that go down to the bone) and not suctioning your patient (pneumonia that could kill you) and the list of other things that this guy won't let us do... how do you just not force it on him and take care of him the way I know I should? I remember having these dilemmas as a new grad.

Now... four years in, I realize that I have begun to understand that age old wisdom my nursing instructors were trying to impart in each one of us. This man that I cared for last night is a man who is dying... not only that but he is dying from a horrible disease that leaves you completely paralyzed. You can control nothing. Not your body, your environment, your position... everything in your life is in the hands of a health care professional that doesn't know you from Adam. And sadly... most of the time, with chronic patients... nurses and doctors avoid them because they can come across as being needy and demanding... all in an effort to cope with the loss of autonomy they have had. So... you are left with a grumpy, isolated patient who tries to demand even more as a reaction to his surroundings and refuses to do the things we know need to be done... and often times you have a nurse who just wants to get in the room and get out.

So, last night I knew that this is where I needed the art of nursing. Instead of explaining to him why I needed to turn him, I asked him when he wanted his pain medicine. Instead of running out of the room at every chance and trying to just get my work done and get on with my busy day... I sat in the room and watched Ricky Lake and chatted with him about his time in the service. We watched the news and talked about the recent CIA scandals and the depressing state of our government. We laughed over remembering the taste of dimetapp as a kid and I told him about the time I puked all over my poor grandma when she made me drink theraflu when I was sick.

The funny thing is that I can't remember the last time I had such a good night at work. It was peaceful and slow and it felt good to actually connect with this guy. At the end of the day I was really thankful for him and our time together and I could tell that he was thankful to have a nurse that didn't force him to have his sheets changed or try to convince him that he was getting too much pain medicine. In the end I have a feeling that our time together did more for the both of us than my turning him ever would have. He actually looked happy when I said goodbye to him this morning... and I think it was because someone sat and treated him like a person instead of a patient for once.

So... four years in I am finally getting it. I'm still learning it and will probably continue to fine tune that artful skill of knowing what lines are hard and fast and which can be blurred around the edges a bit. I will say one thing though... my nursing instructors would be proud :)

Sunday, June 16, 2013

Gluten Free Peach Cobbler Recipe

Over the past two years I have noticed a decline in my lung capacity. My running just hasn't been the same since I had a bout with chronic bronchitis back in late 2011. Despite the many rounds of antibiotics, steroids inhaled and in pill form... nothing has seemed to work and till this day I still have this obnoxious wheeze at the end of my cough. I am slower than ever and my inhaler is my best friend whenever allergy season is here. 

All that to say... my doctor recently told me to go gluten-free thinking maybe it was a gluten or a wheat allergy that was the culprit of my debilitated lungs. I have now been gluten free for a few months and I'm not sure if I'm truly noticing a difference. However, Chris does indeed have a gluten allergy... I have yet to be tested. So, we might as well go down the rabbit hole together and thus the new gluten-free kick.

This week I was really craving a cobbler of some sorts... and lets be honest... who doesn't love a good cobbler? Well, since I came across the most wonderfully ripe and brightly colored peaches I couldn't help myself but to buy up 3 pounds worth in hopes of making a gluten free recipe work. I looked up a few gluten-free cobbler recipes and decided I didn't like any of those... so I made my own.

You could also probably very easily make this recipe work with regular flour if you didn't want to make it gluten free. I used sorghum flour because it is on the sweet side and works well with desserts. 

Gluten Free Peach Cobbler

6 ripe yellow or white peaches ( I used a mixture of both)
1/3 cup sorghum flour (could also substitute with all purpose gluten free flour or regular flour)
1/3 cup gluten free oats 
1/2 cup brown sugar 
1/3 cup butter 
1/2 teaspoon almond extract
1/2 teaspoon vanilla extract 
2 tablespoons white sugar
1 teaspoon baking powder
1/2 tablespoon cinnamon
1/4 teaspoon nutmeg

Preheat your oven to 375 degrees. Slice up the peaches in relatively thin slices and line the bottom of your Pyrex or ceramic baking dish. Sprinkle 1 tablespoon of the white sugar onto the peaches along with the vanilla and almond extract. 

Mix all of the dry ingredients together in a bowl except 1 tablespoon of the white sugar that is already on the peaches. Cut small tabs of the butter into the dry ingredients and mix together with a fork .
You want it to get crumbly in the bowl so it has that cobbler consistency when you layer it on top of the peaches. 

I cooked the cobbler with the lid of my dish on top. It kept the flour moist but it also made the cobbler pretty runny. If you left it uncovered it might be better but you just have to be careful because many gluten free flours brown very easily. 

Let the dish cook at 375 degrees for about 20 minutes. Check periodically to make sure the top is not burning. 

When you see the juice from the peaches bubbling up, you know it is done. Serve with a side of your favorite vanilla ice cream and voila! Beautiful gluten-free cobbler for dessert. 


Sunday, June 9, 2013

Note to Self: His mercies are new every morning...

Right now I am supposed to be reading “Ladies and Gentlemen, to the Gas Chamber” and every time I switch my browser to my school's page I just can't seem to get up the mental fortitude to go there. I keep thinking about the week that I had... four very long twelve hour shifts in a row. Lots of homework and lectures and tests and papers in between. Death. I am tired.

I have been a nurse in the ICU for four years now come this July. I still remember when I started this blog as  a new grad about three years ago. It doesn't feel like it has been that long but the weariness in me reminds that it has. 

I thought yesterday was going to be a good night. It has been a really rough week and my stress levels have been physically impacting me and I feel at my wits end. I needed it to be a good night. It started off with a perfectly wonderful conversation with my patient's family members about the perils of quitting smoking. We laughed over the crazy things we would all do during our peak addiction days just to get a cigarette. Laughing over things only an ex-smoker would be able to laugh about. It was nice to connect with the family, you could see that despite the severity of the situation... there was an ease. A trust that they felt things were moving in the right direction and knowing that their loved one was in very good hands. It was nice and despite my exhaustion I was thankful. 

Then not an hour into the shift I hear his wife yell out, "He's bleeding!" and immediately the flood gates open. Ruptured esophageal varices that eventually found its way out of his mouth and nose with force. The next four hours were a furry of attempting to get the bleeding under control with massive transfusions of blood products and a procedure to clip the bleed in his GI tract. His poor family was ushered out to the waiting room and I felt horrible. 

No, this is not a good night. Not for me... and definitely not for them. What is so difficult sometimes is knowing that despite how hard you work and all that we do to save lives... sometimes it fails.
Sometimes people die of lung cancer, probably from the 40 years of smoking a pack a day.
Sometimes people die from a GI bleed from years of binge drinking and a failing liver as a result. 
Sometimes death is peaceful and wonderfully fitting.... and sometimes it is not.

This week it was not. 

So for now, I just don't have it in me to read "Ladies and Gentlemen, to the Gas Chamber" or anything else that talks about death and sadness. Right now, I will stop and say a prayer for that family and I will spend some time here and I might also need to give these girls a call... their smiling faces and silly laughs always make the world a little better. 

Maybe tomorrow will be brighter and the world will feel a little less heavy and burdened...