My Heart's Desire

Just once, I would like to tell my patient's families the way things really are.  For once, I want to open my mouth and have Hugh Laurie's sarcastic wit pop out and tell them what I really think.  For once I want to say, yes I know you think this is all about you, but how do you think the dying patient feels?   Do you think that would hit home for some of these people?  I doubt it.  To say it wasn't a good night is putting it mildly.  It was awful.  I was called to do a stat hospice start of care (the irony doesn't escape me), and became promptly embroiled in family drama-none of which was about the patient.  Perhaps I am a touch jaded this week.  Bring on Friday, I'm ready for a break.

photo Google images

Pass the Cheese, I've Got the Whine!

You can win some people over and then there are those who will always be impossible to please. Those squeaky wheels irritate the hell out of me. I've long ago forsaken the nurse as handmaiden to the physician. Even most docs I know treat us in a more collaborative manner these days. I just wish others would get the message. There are still people who think it's OK to treat the nurse poorly. When it happens in someone's home, I get the hell out. You don't have to talk to me more than once like that. Luckily, we have management that takes those problems seriously. When it happens in a hospital, it's a little more dicey.

I admitted a patient the other day who passed away during the admission. There was a delay in getting the new admitting paperwork from hospital registration. The chaplain was not very pleasant to deal with regarding this delay but without the new digits, there couldn't be a proper chain of custody to transfer this patient to the morgue and then the funeral home. If I had to choose a word to describe this woman, it would be harridan. I'll wait while you click on that word to see the definition. There. Great word, isn't it? I'd have said bitch, but she's a chaplain, and I'm working hard these days to stay out of hell.

At this particular hospital, the 24/7 chaplain handles all the releases and interacts with the family. The chaplain took it upon herself to denigrate the hospice staff me to the family for this delay. Which pissed off the family. Jeeze Louise, if I could have done the registration myself, I would have. What should have been a 2 hour admission turned into a two hour admit with a 2 hour death visit. The family had a laundry list of requests and kept me hopping. After 4 hours, one of them said to me, "so let me get this right, my loved one was a hospice patient for 2 hours and you're going to bill us for this." "Right?" "Well, not exactly" I answered. "We're going to bill her insurance- NOT YOU. In return, you and your family will get 13 months of bereavement services." Sheesh. I'm plum out of good will. If I bump into this chaplain again, I'm gonna let her know how I feel. I don't care how many crosses she has around her neck, she's going to need them all to fend me off. If she is going to behave in this manner, she needs to take her costume off. I'd have let her have it if I hadn't been working so hard to keep a lid on this family's emotions.

I've been lax in doing too much of anything except work this week. I've had so many problems to solve in the off shift that really need addressing during the day. This is my biggest gripe- the lack of a time out. I'm whipped and officially, work is over. The paper work is up to snuff and I don't go back until 4 PM Monday. I've got better things to do this weekend.

Speaking of better things, I need to thank Sue B for the GIANT bag of black fleece for knitting warm and fuzzy things for a special soldier in our lives. Wow Sue. Thank you so much! There will be thrummed items for Pat really soon and I'm certain, he'll be glad to have it. He deployed last week but we're still not sure exactly where. When he gets this stuff, I'll be sure to tell him of your generosity.

I've purchased the beads, the proper sized needles and wound the precious skein of cashmere for Odessa. I said screw working on my off time today and even knit the swatch. I unwound my swatch because I may need all of that yarn and don't feel like wasting cashmere. I'm close enough on the gauge and plan to cast on tomorrow, right after I thread a couple hundred beads onto my yarn. I've always added beads one at a time with a small crochet hook, but this time, I'm going to do it as the pattern is written.

I cheated on my local yarn store and went somewhere new today. Damn, they had everything including Malibrigo, Prism, Rowan, Koigu and hell, I forget. The choices were so astounding, I practically swooned in that place. I went in to buy beads and left with 3 different colors of beads (when I only need one) and 3 skeins of yarn. What the hell? Maybe I'm crazy.

Our House

I'm taking this time out to stop and smell the flowers. Literally. I had a bit of an unpleasant morning with some issues that popped up at work that legally, I can't speak about except to say, I don't recall. To make myself feel better, I went to Trader Joe's and bought Oatmeal Raisin Druid Circles, Sharfenberger chocolate, a Viennese Lemon Torte, fat laden salami and real gouda cheese. On the way home and just around the corner from TJ's, I stopped at Ewenique Knits.

Still feeling bad about above said issue which we still can't speak about in this paragraph, I bought 2 skeins of Jitterbug (I love that stuff), 2 darning needles, a pattern, a sheep shaped gauge measure and some stitch markers. Miraculously, only 6 druid circles later, I feel much better now. A bit bloated, but better.

This just in: beautiful lilacs bursting forth (the cold snap didn't harm them last night.)

My yard in spring is just so pretty. I love the color purple and this year, my irises haven't disappointed me.

This is the year I'm going to split these irises and plant them along the side of my house. There will be irises everywhere. They are the most stunning color of purple.

I can't begin to tell you what kind of tree this is. In spring it's loaded with white flowers. In the winter, red berries. This winter, I went outside to get the mail and there were dozens of birds (ala Alfred Hitchcock staging) feasting on the berries. The birds were fat and happy-obviously, there are Druid Circles for birds too.

Opportunity Knocks

Since about January of this year, I've been contemplating a change in jobs. In the current economic environment that would seem crazy to most people; the rules however don't apply to nurses. We're a special group of people because we have a critical nursing shortage and can get a job just about anywhere doing all types of work. For me, I've been pondering this problem for months. What do I do now that I've lost the heart for working in an ICU?

It's routine to work anywhere in nursing and find yourself truly in over your head in terms of managing patient load. In a critical care environment, there is an emotional component as well. We are often in ethical conflict with the decisions families make for patients at the end of their lives. They want everything possible done to delay what we often know is the inevitable: death. Sometimes, we form amazing bonds with families who prior to this were complete strangers. People sometimes touch us deeply as though they are members of our own families. This can lead to often emotionally exhausting and seemingly never ending days. It's more common now for me to dread going in to work than to embrace it. This is so sad for me for I'd enjoyed this job for awhile and now, I don't.  

I've often said that if people didn't abuse their bodies and if we all did what we were told, we (the medical profession) would be out of jobs.  We are all guilty of abusing our bodies.  Still, I am bone weary of caring for people in alcohol withdrawal or drug overdose.  Patients in withdrawal will suck the very life force out of a nurse.  Just trying to keep these people safe can be physically, emotionally and intellectually taxing.   Imagine yourself at work and having someone say F**K  U B!tc# or suck my (you know) for 12 hours straight.  I will tell you from the bottom of my little nursing heart that it is an appalling way to make a living.  It doesn't make a difference to me that when once again sane, these patients often apologize.  I care not as the damage is done.

The other aspect of my work that has impacted me greatly is caring for people at what should be a peaceful ending to their lives.  They should be allowed to go with dignity but without proper prior planning, they end up in ICU with us trying to "save" them.  I don't think people that aren't in this business truly know what it means to be very critically ill. It can be awful. Endless tests requiring often invasive and painful procedures like central lines, arterial lines, dialysis lines, procedural CT Scans, chest tubes, surgeries (and sometimes more than once), blood tests and the dreadful hourly finger prick for a blood sugar (you can't tell me these don't hurt, I know they do.) If you didn't want this but chose not to direct your care, someone else will make decisions for you. You may need advanced life support and you will have a tube stuck down your airway (requiring pretty frequent suction), a tracheostomy tube when the one in your mouth has been in too long, a gastric tube in your stomach to feed you, a bladder catheter to drain and measure urine output, a rectal tube if necessary, someone cleaning your mouth every 2 hours, someone turning you every 2 hours or the endless rotating bed that must seem like a carnival ride to really sick patients.

People experience a loss of dignity, possibly their humanity and often their minds at times like this. If you're lucky enough to recover, you may have debilitating and long term sequelae to your critical illness. Issues with fancy names like Toxic Metabolic Encephalopathy (see, you did lose your mind) and you can read about one woman's journey through her personal hell here. Who in the world knew you could suffer PTSD-Post Traumatic Stress Disorder from being so sick? There are other physical issues that follow critical illness including (another fancy name) critical care polyneuropathy. This is caused by combining high dose steroids with neuromuscular blockade (medically induced paralysis) and may leave you with long term or permanent muscular and nerve damage.

I'm not writing this to scare people (dammit, get that advanced directive or health care power of attorney!) but to give you more or less a peek into my world. I simply find myself at a crossroad where I can't torture someone's 96 year old granny one more time. You can also be at death's door at a tender age too and although incredibly unfair, this, is life. I've experienced (one too many times) the nursing of the chronically critically ill who but for our intervention would be gone and perhaps, I don't mean this unkindly, should be allowed to die with dignity. I've seen families split themselves apart because they can't make decisions or they haven't made amends with loved ones and therefore, can't say goodbye. The time to make amends is right now. Be right with the people you care about because we all know it could end in the blink of an eye.

And so, I find myself looking. I promised my friend Sister Jeanne that I would wait until spring to see if I felt the same as I did at the start of the year about my line of work. I do. I think I could be a decent palliative care or hospice nurse. I want to work with people who are in need of comfort and not rescue. If all goes well this week, perhaps I will.