I do not miss my dad on Father’s Day. I miss him on all the other days.
The funny days having a new puppy, the tough days struggling through
nursing school, the exciting days moving to Ireland, the stressful days
interviewing to come back to Canada. The boring days of car shopping,
the celebratory days of graduating, the busy days of working, yes, I
missed him all those days. I do not miss my dad on Father’s Day.
Showing posts with label death. Show all posts
Showing posts with label death. Show all posts
Sunday, June 15, 2014
Thursday, March 28, 2013
Intimate Insight
I know that these images and this story are making the rounds on social media these days, so my apologies if you're feeling inundated. I felt that these images were too profound and raw and beautiful to pass over.
It is one of the most heart wrenching photo essays I've had the privilege of seeing. I think it shows so poignantly the suffering, strength, love, hope, fear, and anger that features in the struggle with such a devastating diagnosis. To me, these photos express very clearly the questions that we struggle to form when we ask about cancer, and I believe they show the answers to those questions. A few of Angelo Merendino's photos from the website are shown below. In my opinion he is a brilliant photographer, and she a powerful subject.
It is one of the most heart wrenching photo essays I've had the privilege of seeing. I think it shows so poignantly the suffering, strength, love, hope, fear, and anger that features in the struggle with such a devastating diagnosis. To me, these photos express very clearly the questions that we struggle to form when we ask about cancer, and I believe they show the answers to those questions. A few of Angelo Merendino's photos from the website are shown below. In my opinion he is a brilliant photographer, and she a powerful subject.
Saturday, February 19, 2011
Voice of Reason
Watch the full episode. See more Need To Know.
Every time I read or see a well thought out piece on end-of-life decisions, it makes me want to go into palliative care medicine. Yes, I am a trauma/critical care junkie--but I also love the holistic approach and paradigm shift that palliative care provides. They are my yin/yang areas of love and interest in medicine. The ability to reach out and pull someone back from the brink---or the skill and wisdom to let go and let be when that is what a patient wants.
I think that Atul Gawande is an excellent writer and though he is a surgeon (i.e. from the specialty that probably gets slammed the most in the media with regard to these issues) he has an amazing grasp of these dichotomies.
I have droned on about end-of-life issues on this blog before, I know, but his article on the matter is a work of art as far as I am concerned. If you haven't already read it, you should. And then you should make your friends read it. And your parents. And your siblings.
I will now step off my well worn tiny soapbox.
Saturday, January 1, 2011
Another Boring, Eye-Rolling Year in Review
I was getting excited about doing a year in review post until I read Michelle Au's blog this morning which said;
Don't worry, I'm not going to do an actual "Year in Review" post, because I do think that treads the line between boring and inviting people to kind of roll their eyes at you, because for God's sake, no one wants to hear your blow-by-blow of the year when you already keep a blog, for chrissake.
Which is probably a good point and should have steered me away from doing one (as I could probably take a tip or two from the superwoman-queen-blogger-extraordinaire-specialist-mother-of-two-sarcastic-hilarious-book-publishing-Asian-woman).
But screw it.
If you want to be bored and roll your eyes, please, read on! Or if you are new to the blog, consider this a mini-montage to bring you up to speed without having to sift through countless whiny posts about studying.
I actually don't see Jan 1st as the great big marker of time in the sky like many people do. But this year, I was by myself on New Years Eve (a first). This allowed some time to really reflect, and gave me the self indulgent space to read through the last year of posts to see what things I ought to keep a little more in the forefront of my mind when I think: 2010.
Because in a lot of ways, 2010 was a really exciting wild ride of a year (even though most of the time while I was in it, life seemed quite mundane). I don't want to look back and only remember one long study session.
The Highlights:
--Becoming an auntie to TWINS! On Jan 1st my brother and his wife had two lovely, healthy twins named Maximus (Max) and Ella. And though they are Gerber quality, they are not 'designer twins' despite the trend.
--Hearing Dr. Robert Gallo speak. Crazed Peta People and boundary-less audience members aside, it was a thrilling lecture. He's pretty much the equivalent to a medical deity, yet he comes across as a very humble, curious, sincere gentleman.
--Seeing one of my favorite artists, Hawksley Workman perform. It was a rush, amplified by the small venue size and cluster of Canadians (despite London location). Sometimes you just have to say, "screw the budget, let's fly to England to see one of our favorite musicians". Life is short, after all.
--Having my choice in medicine reaffirmed by seeing a woman with Parkinson's discuss deep-brain stimulation therapy. A big rescue lecture for me when I felt like I was drowning in self-doubt and frustration at deciding to come to medical school.
--Getting to perform my first surgical assist! Ok that was a big one so it deserved a bigger font. And thus my choice in medicine was reaffirmed this summer again and again. I completely lucked out this summer, getting to work with some of my favorite nurses and docs one last time. It is such a joy to actually look forward to going to work.
--The other big one, catching my first baby! I know it is cliché to be all wide-eyed and full of enthusiasm as a medical student, but wow those were some hair raising moments of wonder. I know that with time all these firsts will fuse into the routine of day to day practice, so I am going to try very hard to remember and embrace some of the magic that practicing medicine can hold.
--Moving into a lovely apartment with my lovely Manfriend, Tobie. So moving in together was a major event, especially since we hadn't even been dating a year--but the leap of faith for both of us has proven to be a wonderful choice. One of the things that isn't so much an event, but an unfolding, is getting to live with this stellar human and learn more about him and how we function as a unit. That is actually one of the most amazing parts of 2010. [Warning: sap alert.] Tobie is such a quality man and partner that every night (except the ones when I am fraught with pre-exam thoughts) before I fall asleep I give thanks for this relationship and all that it has brought me. It's true. I am so lucky in love. [Sappy portion of post over.]
--Going to a Canadian city I've always wanted to see--Montréal--and getting to eat (among other outta sight meals) my first, real Poutine. The other wonderful part of that trip to Tobie's homeland was spending a spectacular day at Le Nordik spa (I think music comes on with that link so be aware office cubicle readers). If you ever go to Québec you must visit at least those two locations. I will suggest that you do that in the opposite order, however.
--Spending some quality time with my BFF thanks to a last minute flight and aeroplan points.
--Riding in my brothers newly built AC Cobra. I am so *not* a car person but WOW WAS THAT EVER FUN!!!!
The Lowlights
Naturally, the year had some low points. In fact, as I read through a lot of the winter/spring posts I see that I was somewhat unhappy (disillusioned? highly stressed? homesick?) for a few months there. I think a big reason for that was the gleam of adventure and starting a new life here had worn off somewhat right around the time when my dear friend and mentor, Nancy, died. What else can I say about this? Losing a loved one is hard, and it is only made harder when you are thousands of miles away from them while it is happening.
Course when I think of that time and those events all the other lowlights sort of pale, but I suppose that all things are relative and other difficult challenges presented themselves throughout the year. I lost more patients this summer in the ED than I am used to---some were stranger, sadder deaths for some reason. Most of them I didn't write about but sometime I will. There was my anatomy spotter debacle, living in ant infested hospital lodgings, not getting to spend much time with my family this summer, and missing Tobie for our months apart.
But how about not dwelling on the negative? Yes, I'd hate to end on a downer note. Taking stock of the year I see that 2010 was a year where I celebrated births and mourned death. I jumped in cold rivers and hiked on hot mountains trails. I kissed and cried, drank beer, sweated on a weight bench, celebrated and ruminated. Spent a night wearing a plunging neckline and more days than I'd like to remember in sweatpants. Cooked and walked, plucked the mandolin strings, and watched movies on airplanes. In a year, isn't that the most one can hope for? I'd say so.
2011? Bring it.
P.S Next January I promise not to do a Year in Review post!
Don't worry, I'm not going to do an actual "Year in Review" post, because I do think that treads the line between boring and inviting people to kind of roll their eyes at you, because for God's sake, no one wants to hear your blow-by-blow of the year when you already keep a blog, for chrissake.
Which is probably a good point and should have steered me away from doing one (as I could probably take a tip or two from the superwoman-queen-blogger-extraordinaire-specialist-mother-of-two-sarcastic-hilarious-book-publishing-Asian-woman).
But screw it.
If you want to be bored and roll your eyes, please, read on! Or if you are new to the blog, consider this a mini-montage to bring you up to speed without having to sift through countless whiny posts about studying.
I actually don't see Jan 1st as the great big marker of time in the sky like many people do. But this year, I was by myself on New Years Eve (a first). This allowed some time to really reflect, and gave me the self indulgent space to read through the last year of posts to see what things I ought to keep a little more in the forefront of my mind when I think: 2010.
Because in a lot of ways, 2010 was a really exciting wild ride of a year (even though most of the time while I was in it, life seemed quite mundane). I don't want to look back and only remember one long study session.
The Highlights:
--Becoming an auntie to TWINS! On Jan 1st my brother and his wife had two lovely, healthy twins named Maximus (Max) and Ella. And though they are Gerber quality, they are not 'designer twins' despite the trend.
--Hearing Dr. Robert Gallo speak. Crazed Peta People and boundary-less audience members aside, it was a thrilling lecture. He's pretty much the equivalent to a medical deity, yet he comes across as a very humble, curious, sincere gentleman.
--Seeing one of my favorite artists, Hawksley Workman perform. It was a rush, amplified by the small venue size and cluster of Canadians (despite London location). Sometimes you just have to say, "screw the budget, let's fly to England to see one of our favorite musicians". Life is short, after all.
--Having my choice in medicine reaffirmed by seeing a woman with Parkinson's discuss deep-brain stimulation therapy. A big rescue lecture for me when I felt like I was drowning in self-doubt and frustration at deciding to come to medical school.
--Getting to perform my first surgical assist! Ok that was a big one so it deserved a bigger font. And thus my choice in medicine was reaffirmed this summer again and again. I completely lucked out this summer, getting to work with some of my favorite nurses and docs one last time. It is such a joy to actually look forward to going to work.
--Moving into a lovely apartment with my lovely Manfriend, Tobie. So moving in together was a major event, especially since we hadn't even been dating a year--but the leap of faith for both of us has proven to be a wonderful choice. One of the things that isn't so much an event, but an unfolding, is getting to live with this stellar human and learn more about him and how we function as a unit. That is actually one of the most amazing parts of 2010. [Warning: sap alert.] Tobie is such a quality man and partner that every night (except the ones when I am fraught with pre-exam thoughts) before I fall asleep I give thanks for this relationship and all that it has brought me. It's true. I am so lucky in love. [Sappy portion of post over.]
--Going to a Canadian city I've always wanted to see--Montréal--and getting to eat (among other outta sight meals) my first, real Poutine. The other wonderful part of that trip to Tobie's homeland was spending a spectacular day at Le Nordik spa (I think music comes on with that link so be aware office cubicle readers). If you ever go to Québec you must visit at least those two locations. I will suggest that you do that in the opposite order, however.
--Spending some quality time with my BFF thanks to a last minute flight and aeroplan points.
--Riding in my brothers newly built AC Cobra. I am so *not* a car person but WOW WAS THAT EVER FUN!!!!
The Lowlights
Naturally, the year had some low points. In fact, as I read through a lot of the winter/spring posts I see that I was somewhat unhappy (disillusioned? highly stressed? homesick?) for a few months there. I think a big reason for that was the gleam of adventure and starting a new life here had worn off somewhat right around the time when my dear friend and mentor, Nancy, died. What else can I say about this? Losing a loved one is hard, and it is only made harder when you are thousands of miles away from them while it is happening.
Course when I think of that time and those events all the other lowlights sort of pale, but I suppose that all things are relative and other difficult challenges presented themselves throughout the year. I lost more patients this summer in the ED than I am used to---some were stranger, sadder deaths for some reason. Most of them I didn't write about but sometime I will. There was my anatomy spotter debacle, living in ant infested hospital lodgings, not getting to spend much time with my family this summer, and missing Tobie for our months apart.
 |
| Quality accommodation, courtesy of your local hospital. |
But how about not dwelling on the negative? Yes, I'd hate to end on a downer note. Taking stock of the year I see that 2010 was a year where I celebrated births and mourned death. I jumped in cold rivers and hiked on hot mountains trails. I kissed and cried, drank beer, sweated on a weight bench, celebrated and ruminated. Spent a night wearing a plunging neckline and more days than I'd like to remember in sweatpants. Cooked and walked, plucked the mandolin strings, and watched movies on airplanes. In a year, isn't that the most one can hope for? I'd say so.
2011? Bring it.
P.S Next January I promise not to do a Year in Review post!
Wednesday, November 24, 2010
Engage with Grace
Things we are grateful for this year
For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.
The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.
At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important -- and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.
This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.
So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful.
Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go”– it is a work of art, and a must read.
Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.
Thank you to TEDMED for letting us share our story and our vision.
And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.
We share our thanks with you, and we ask that you share this slide with your family, friends, and followers. Know the answers for yourself, know the answers for your loved ones, and appoint an advocate who can make sure those wishes get honored – it’s something we think you’ll be thankful for when it matters most.
Here’s to a holiday filled with joy – and as we engage in conversation with the ones we love, we engage with grace.
To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.
For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.
The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.
At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important -- and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.
This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.
So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful.
Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go”– it is a work of art, and a must read.
Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.
Thank you to TEDMED for letting us share our story and our vision.
And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.
We share our thanks with you, and we ask that you share this slide with your family, friends, and followers. Know the answers for yourself, know the answers for your loved ones, and appoint an advocate who can make sure those wishes get honored – it’s something we think you’ll be thankful for when it matters most.
Here’s to a holiday filled with joy – and as we engage in conversation with the ones we love, we engage with grace.
To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.
Sunday, August 1, 2010
Failed Resus
So glad he called it early.
It was an unwitnessed arrest of grandpa, the 8 year old called 911 because mom was out on a run.
Seeing people quietly in shock is more disturbing than watching people grieve loudly and dramatically.
It wasn't a messy code, like they usually are. It was just very apparent from the start that our efforts were in vain. We tried but, as the name implies, asystole is a hard rhythm to come out of.
We had a medical student start with us today, I went in the resus room after we'd all cleared out and found him in there with the patients daughter, a hand on her shoulder. I was impressed. We worked most of the day together but I didn't tell him that I was a medical student as well. He's actually a legit student, where as I am kind of more like a hospital crashing renegade medical student.
On the other side of the equation I did get to witness a birth yesterday, and I was happy to feel tears in my eyes when the baby finally emerged. I like getting an unexpected jab of emotion at work, it makes me feel less like an ED-Bot who works unflappably at putting out tiny fires all day but gets no major satisfaction out of a lot of it. The doc I was with said I can catch the next one. I have since been creeping the maternity admissions.
And now...I need to cook dinner and let my shoulders relax.
It was an unwitnessed arrest of grandpa, the 8 year old called 911 because mom was out on a run.
Seeing people quietly in shock is more disturbing than watching people grieve loudly and dramatically.
It wasn't a messy code, like they usually are. It was just very apparent from the start that our efforts were in vain. We tried but, as the name implies, asystole is a hard rhythm to come out of.
We had a medical student start with us today, I went in the resus room after we'd all cleared out and found him in there with the patients daughter, a hand on her shoulder. I was impressed. We worked most of the day together but I didn't tell him that I was a medical student as well. He's actually a legit student, where as I am kind of more like a hospital crashing renegade medical student.
On the other side of the equation I did get to witness a birth yesterday, and I was happy to feel tears in my eyes when the baby finally emerged. I like getting an unexpected jab of emotion at work, it makes me feel less like an ED-Bot who works unflappably at putting out tiny fires all day but gets no major satisfaction out of a lot of it. The doc I was with said I can catch the next one. I have since been creeping the maternity admissions.
And now...I need to cook dinner and let my shoulders relax.
Sunday, July 25, 2010
Do Not Resuscitate vs Do Not Treat
I have been staring at this shade of grey quite a bit lately. When a patient's care shifts from 'do everything possible to keep them alive' to 'do not resuscitate' things are pretty black and white. Or so it seems. But where is the line between 'do not resuscitate' and 'discontinue treatment'?
I know that I am not wading into anything new here when it comes to the ocean of medical ethics, but I've had two cases in the past two weeks that have caused me to look at my own practice as a nurse, and the decisions I will be faced with as a physician. And I can't help but wonder if my smugness and confidence will disappear when I am the one who needs to make the call. Or will it be easier because there will be a greater distance between me and direct patient care?
Look, I know it is easy to judge orders as a nurse. We are wrapped in a protective covering of arms-length responsibility when it comes to patient care decisions. Now before people start hopping up and down I am not saying that nurses don't hold a great deal of responsibility, they do. It is just for a different aspect of the care. I have to check myself when I feel the inevitable eye-roll that comes with certain orders, or my frustrations with care plans that I don't agree with. But he bottom line is that the physician who guides the care plan is the one who is taking the risks. This I need to remind myself of, from time to time.
Yesterday I took care of someone who went from fidgeting with his bedclothes and asking to go home, to someone who was becoming less responsive and confused, to someone who was dead. And somewhere along that trajectory we all had to accept that we were not going to save him. I don't like the fact that at the beginning of my shift I was explaining to his sister that we were just doing some tests and rehydrating him, to at the end of my shift saying that we'd do everything we could to keep him comfortable.
I didn't like looking down at his purple, blue, and red arm where he'd been poked so many times already that day for blood work knowing that still more blood was going to be drawn from that site before the end of the night.
I didn't like that I didn't have time to give him a proper bath, put lotion on his feet.
I didn't like the fact that before his shit encrusted blue jeans hit the floor his children had already cleaned out the pockets for cash.
And I didn't like disagreeing with the doctors orders. Keep on the monitor. Repeat blood work. Push fluids. And yet I remind myself that it is not my medical license on the line, he was just doing his job to ensure that no one could fault his management, he reminded me that a "DNR was not an order not to treat". I get it, and to be honest, I went down that road last week already in a similar situation and I didn't feel like arguing anymore. He's actually a good physician who really takes the time to discuss the issues with family members, and he is not delusional when it comes to recognizing the point when medical science has gone the distance but simply petered out.
It's just that he gets to leave. And we are there at the bedside. Seeing the family members mesmerized by the lights of the monitor. We are the ones who have to look away from the blood pressure readings that are 59/30...53/31...50/28. We are the ones hanging the next bag of fluid that is certainly not going to drain out of the catheter. We are the ones putting the O2 sat machine on over and over again when the patient keeps pulling it off. We are the ones turning him back and forth to keep the unmoving blood from causing sores, listening to him moan in pain with any movement.
I envied the doctor last night when he finished his orders and walked out the automatic doors. I looked from the door, back to the monitor, and to the patient's sisters crying at the bedside. It was one thing to know that if he stopped breathing or his heart stopped we were not meant to intervene...but right up until that point were we improving his quality of life or just going through the medical motions?
I looked at the automatic doors again. They had closed.
The physician had done his duties and I had to keep doing mine.
I know that I am not wading into anything new here when it comes to the ocean of medical ethics, but I've had two cases in the past two weeks that have caused me to look at my own practice as a nurse, and the decisions I will be faced with as a physician. And I can't help but wonder if my smugness and confidence will disappear when I am the one who needs to make the call. Or will it be easier because there will be a greater distance between me and direct patient care?
Look, I know it is easy to judge orders as a nurse. We are wrapped in a protective covering of arms-length responsibility when it comes to patient care decisions. Now before people start hopping up and down I am not saying that nurses don't hold a great deal of responsibility, they do. It is just for a different aspect of the care. I have to check myself when I feel the inevitable eye-roll that comes with certain orders, or my frustrations with care plans that I don't agree with. But he bottom line is that the physician who guides the care plan is the one who is taking the risks. This I need to remind myself of, from time to time.
Yesterday I took care of someone who went from fidgeting with his bedclothes and asking to go home, to someone who was becoming less responsive and confused, to someone who was dead. And somewhere along that trajectory we all had to accept that we were not going to save him. I don't like the fact that at the beginning of my shift I was explaining to his sister that we were just doing some tests and rehydrating him, to at the end of my shift saying that we'd do everything we could to keep him comfortable.
I didn't like looking down at his purple, blue, and red arm where he'd been poked so many times already that day for blood work knowing that still more blood was going to be drawn from that site before the end of the night.
I didn't like that I didn't have time to give him a proper bath, put lotion on his feet.
I didn't like the fact that before his shit encrusted blue jeans hit the floor his children had already cleaned out the pockets for cash.
And I didn't like disagreeing with the doctors orders. Keep on the monitor. Repeat blood work. Push fluids. And yet I remind myself that it is not my medical license on the line, he was just doing his job to ensure that no one could fault his management, he reminded me that a "DNR was not an order not to treat". I get it, and to be honest, I went down that road last week already in a similar situation and I didn't feel like arguing anymore. He's actually a good physician who really takes the time to discuss the issues with family members, and he is not delusional when it comes to recognizing the point when medical science has gone the distance but simply petered out.
It's just that he gets to leave. And we are there at the bedside. Seeing the family members mesmerized by the lights of the monitor. We are the ones who have to look away from the blood pressure readings that are 59/30...53/31...50/28. We are the ones hanging the next bag of fluid that is certainly not going to drain out of the catheter. We are the ones putting the O2 sat machine on over and over again when the patient keeps pulling it off. We are the ones turning him back and forth to keep the unmoving blood from causing sores, listening to him moan in pain with any movement.
I envied the doctor last night when he finished his orders and walked out the automatic doors. I looked from the door, back to the monitor, and to the patient's sisters crying at the bedside. It was one thing to know that if he stopped breathing or his heart stopped we were not meant to intervene...but right up until that point were we improving his quality of life or just going through the medical motions?
I looked at the automatic doors again. They had closed.
The physician had done his duties and I had to keep doing mine.
Friday, April 16, 2010
Happy National Health Care Decisions Day!
I have harped on this matter before so I won't ramble on too much about it today.
I just think it is very important for us to give some thought and discussion to how we would want to be cared for in the case of a medical emergency, and what are wishes might be for resuscitation, organ donation, and life support.
Working in the emergency department I have had the unfortunate opportunity to witness families struggling with these decisions on behalf of their loved one who has suddenly become incapable of making their own choices regarding heath care interventions.
Even if you are a young person you ought to let your family know your end of life wishes, like organ donation or not, and what measures you'd like taken to keep you alive.
It is an uncomfortable topic but will give some relief to your loved ones if they at least have an idea of what you'd want, should an unfortunate circumstance befall you.
Take a moment and look at these websites for some guidance in making your wishes known.
http://engagewithgrace.org/ and http://www.nationalhealthcaredecisionsday.org/
And if you want a worst case scenario of what really can happen, wander over to Dr. Grumpy's blog and see how it impacts not only the family of those involved, but also the health care workers. This is an important post on the matter.
I just think it is very important for us to give some thought and discussion to how we would want to be cared for in the case of a medical emergency, and what are wishes might be for resuscitation, organ donation, and life support.
Working in the emergency department I have had the unfortunate opportunity to witness families struggling with these decisions on behalf of their loved one who has suddenly become incapable of making their own choices regarding heath care interventions.
Even if you are a young person you ought to let your family know your end of life wishes, like organ donation or not, and what measures you'd like taken to keep you alive.
It is an uncomfortable topic but will give some relief to your loved ones if they at least have an idea of what you'd want, should an unfortunate circumstance befall you.
Take a moment and look at these websites for some guidance in making your wishes known.
http://engagewithgrace.org/ and http://www.nationalhealthcaredecisionsday.org/
And if you want a worst case scenario of what really can happen, wander over to Dr. Grumpy's blog and see how it impacts not only the family of those involved, but also the health care workers. This is an important post on the matter.
Monday, April 12, 2010
Death Be Not Proud
Enough of trying to pretend that I am coping well. I am not.
There are a few workplaces in this world where you might have the wonderful advantage of a colleague who is always willing to help you out. This is the person you can call in the middle of the night, when you are alone in the clinic and suddenly overwhelmed with a septic child and casualties from an ATV accident. This amazing colleague does not ask questions or complain that she's exhausted, she just gets down to it. Her experienced and gentle hands start the IV while her stern voice gets a room full of hysterical teenagers under control.
I was lucky enough to have this colleague become my friend. She taught me how to make blue cheese bread twists out of the limited groceries we had access to in the Arctic. She rented a boat with me so we could see the icebergs up close, feel the gravel of a glacier under our feet, and bob alongside seals for the afternoon. She taught me to fish and she taught me how to do a proper head-to-toe assessment on a neonate.
Fortune continued to smile upon me. This woman generously invited me to her home in New Zealand, letting me use her place as a base while I travelled around exploring the beautiful landscape of the South Island. She introduced me to her friends and colleagues and they embraced me as an honored guest.
Eventually she became one of my wisest confidantes, and I was truly blessed for this. She listened to my dreams, and encouraged me relentlessly to pursue them. She would write to me, telling me to push on when she knew that my determination was faltering. She sent me gifts when she was far away reminding me of how proud she was. She was one of the few people on this earth truly in my corner, championing my successes and lamenting my failures. When the first round of medical school rejections came, she pushed me back into the ring to keep trying.
She never married or had children. Her spouse was adventure and her children were the thousands of sick babies she held in her arms. Her entire career as a nurse was devoted to the vulnerable and weak, the poor and the forgotten. She spent years volunteering in Zimbabwe , Vietnam, Cambodia and Myanmar. In New Zealand she worked in a special care babies unit and in Canada she took care of First Nations and Inuit communities.
She took me under her wing during my first contract as an outpost nurse in the Arctic and tirelessly answered my endless barrage of questions those first months. If it hadn't been for her I am sure I'd have left the North with my tail between my legs, succumbing to the crushing weight of inexperience and fear.
Mentors and kindred spirits do not come along very many times in ones life.
In Nancy I had both.
She died from cancer on Thursday April 8th, 2010.
Now that she is gone there is an empty void left in this world and in my heart.
Death be not proud. You have taken a shining star, a selfless healer, a wise woman, a sister, a daughter, and a friend.
Nancy I pray that you may now see all of the hearts you've touched, the lives you've saved, and minds you've inspired. Rest in peace my dear friend.
There are a few workplaces in this world where you might have the wonderful advantage of a colleague who is always willing to help you out. This is the person you can call in the middle of the night, when you are alone in the clinic and suddenly overwhelmed with a septic child and casualties from an ATV accident. This amazing colleague does not ask questions or complain that she's exhausted, she just gets down to it. Her experienced and gentle hands start the IV while her stern voice gets a room full of hysterical teenagers under control.
I was lucky enough to have this colleague become my friend. She taught me how to make blue cheese bread twists out of the limited groceries we had access to in the Arctic. She rented a boat with me so we could see the icebergs up close, feel the gravel of a glacier under our feet, and bob alongside seals for the afternoon. She taught me to fish and she taught me how to do a proper head-to-toe assessment on a neonate.
Fortune continued to smile upon me. This woman generously invited me to her home in New Zealand, letting me use her place as a base while I travelled around exploring the beautiful landscape of the South Island. She introduced me to her friends and colleagues and they embraced me as an honored guest.
Eventually she became one of my wisest confidantes, and I was truly blessed for this. She listened to my dreams, and encouraged me relentlessly to pursue them. She would write to me, telling me to push on when she knew that my determination was faltering. She sent me gifts when she was far away reminding me of how proud she was. She was one of the few people on this earth truly in my corner, championing my successes and lamenting my failures. When the first round of medical school rejections came, she pushed me back into the ring to keep trying.
She never married or had children. Her spouse was adventure and her children were the thousands of sick babies she held in her arms. Her entire career as a nurse was devoted to the vulnerable and weak, the poor and the forgotten. She spent years volunteering in Zimbabwe , Vietnam, Cambodia and Myanmar. In New Zealand she worked in a special care babies unit and in Canada she took care of First Nations and Inuit communities.
She took me under her wing during my first contract as an outpost nurse in the Arctic and tirelessly answered my endless barrage of questions those first months. If it hadn't been for her I am sure I'd have left the North with my tail between my legs, succumbing to the crushing weight of inexperience and fear.
Mentors and kindred spirits do not come along very many times in ones life.
In Nancy I had both.
She died from cancer on Thursday April 8th, 2010.
Now that she is gone there is an empty void left in this world and in my heart.
Death be not proud. You have taken a shining star, a selfless healer, a wise woman, a sister, a daughter, and a friend.
Nancy I pray that you may now see all of the hearts you've touched, the lives you've saved, and minds you've inspired. Rest in peace my dear friend.
Wednesday, March 17, 2010
One Year
Today is the 1 year anniversary of my dear friend Jody's death.
Having a close friend die at a young age certainly has caused me to reflect on the delayed-gratification path I find myself on. I try and think of the moments that are making me happy now instead of the constant stare fixed on the horizon.
Nursing degree. Pre requisites. MCAT. Admissions. Medical school. Residency. Fellowship.
I can't help but feel that constantly having long term goals seems to trivialize the present, because the present is always a stepping stone. I know that it is important to keep moving forward but how does one do that while also cherishing the moment?
I do wonder sometimes what 'life' I am carving out here in Ireland. No car, no money, no job. I am tethered to campus and my books all the time. Slightly out of sync with most of my classmates who are much younger with very little 'real world' experience and no idea of what medicine is actually about.
I used to travel, and write, and play music, and work, and ride, and ski and now what? What void in my life did I think that becoming a doctor was going to fill? What unsettled part of my spirit thought medicine was the answer?
What happens if I die of cancer-of-the-everything like Jody at age 40? Will I look back on this decade of sacrifice, work, poverty, and all-encompassing career development and be happy with my choices?
I damn well better be.
Having a close friend die at a young age certainly has caused me to reflect on the delayed-gratification path I find myself on. I try and think of the moments that are making me happy now instead of the constant stare fixed on the horizon.
Nursing degree. Pre requisites. MCAT. Admissions. Medical school. Residency. Fellowship.
I can't help but feel that constantly having long term goals seems to trivialize the present, because the present is always a stepping stone. I know that it is important to keep moving forward but how does one do that while also cherishing the moment?
I do wonder sometimes what 'life' I am carving out here in Ireland. No car, no money, no job. I am tethered to campus and my books all the time. Slightly out of sync with most of my classmates who are much younger with very little 'real world' experience and no idea of what medicine is actually about.
I used to travel, and write, and play music, and work, and ride, and ski and now what? What void in my life did I think that becoming a doctor was going to fill? What unsettled part of my spirit thought medicine was the answer?
What happens if I die of cancer-of-the-everything like Jody at age 40? Will I look back on this decade of sacrifice, work, poverty, and all-encompassing career development and be happy with my choices?
I damn well better be.
Saturday, March 6, 2010
March is Tough
This March marks is the 1st anniversary of Jody's death, and the 8th anniversary of my Dad's death.
I find that, for the most part, grief over these events does not fall on predicted days or during likely hours. It sneaks up on me and catches me when I least expect it. Finding a photograph or remembering a moment that flashes in front of my eyes, triggered by a seemingly unrelated event.
It's easy to get buried in all of the urgent unimportant things in life and forget to notice the non-urgent important things.
I find that, for the most part, grief over these events does not fall on predicted days or during likely hours. It sneaks up on me and catches me when I least expect it. Finding a photograph or remembering a moment that flashes in front of my eyes, triggered by a seemingly unrelated event.
It's easy to get buried in all of the urgent unimportant things in life and forget to notice the non-urgent important things.
Here's to taking a moment to pause and be grateful for being alive.
Hey AMG! Remember that trip?!? :)
Saturday, January 30, 2010
When It Isn't A Stranger on the Table
This past week our case has been a 61 year old gentleman who presents to the A & E (Accident and Emergency here in Europe) with crushing chest pain. Naturally we've been working through the histology of heart muscle, the conduction system, the cardiac circulation. There have been graphs of enzyme releases and numbers relating to action potentials scribbled down. Pharmacology and receptors discussed ad nauseum.
I couldn't put my finger on it for a few days, but I felt out of touch with the lectures and the PBL discussions. Strange for me because the emergency nurse still living inside me loves cardiac presentations and interventions.
Then it dawned on me. My dad died of a massive heart attack.
I know it is probably immediately obvious to most people why I was a little dissociated from the learning this week. But it truly was a surprise for me because we were examining this presentation at such a microscopic level that I truly didn't see the forest for the trees.
So to remind myself, and to all the academics out there that there is a human, a soul, a spirit that gives breath and life to the myocytes we spend so much time looking at slides of...I am reposting the story of my dad and his final heart attack. Because it is something we all need to remember, for every troponin level we're anxiously waiting for so we can turf the patient to CCU or home, there is a family that is also anxiously awaiting those results.
---
When my dad laughed, it was a borderline giggle. As manly a giggle as you can imagine, but a giggle nonetheless. He really let loose though, usually turning his head to the side and scrunching up his shoulders while his whole body shook.
In a word, he was a 'character'. A prankster. Not mean or hurtful pranks, but anything he could get a good story from.
He would perform last-minute pranks, ones that involved no prep or props. Like sticking his big toe on the back of the scale when my mom was weighing herself, or telling the kindergarten kids that rode his bus that there were "two Friday's this week" so he'd be there in the morning to pick them up. My sisters current event for social studies class one day was that the "Pope had turned Protestant" thanks to my dad. He hid pork chops in the pockets of his friends coveralls on a Friday afternoon so that come Monday when they got back to work there'd have a nice surprise with their morning coffee.
When my uncle was particularly proud of his new television set my dad went out and bought a universal remote which he'd bring to their house and use to turn the volume up and down at infuriating intervals convincing my easily flustered uncle that he'd made a dud purchase.
One of his more elaborate stunts was when he surprised my mother on the 'throne' and snapped a picture of her, developed the photo and then cut it to fit in her wallet. I was at the supermarket with her the day she pulled her credit card out and with it came flying the photo of her on the toilet, landing right on the scan pad.
He loved it when I'd get engrossed in something scary on t.v. He'd sneak behind the couch and just as Hannibal Lecter was closing in he'd startle me with a "Haarr!" while I came a foot off the cushions, screaming and yelling "DAD!"
One Monday morning my dad's alarm clock went off for work and he didn't shut it off. His girlfriend thought it was odd because he was always up with the first crackles of the morning news. She turned over to ask him why he wasn't getting up and discovered that he was dead.
I was starting my first day of a community practicum in nursing school that day. I had been dreaming that I was at this odd wrecking yard which was more of a wrecking yard for people, not cars. There were these large looming pieces of ramshackle machinery and I was getting a tour. Just as the tour guide got to a group of Dachau-esque ovens and said "this is the crematorium" the phone rang, waking me up. I was shaking out the images from my disturbing dream but felt something else must be wrong because the phone never rang this early in the morning.
I picked it up to my mothers voice on the other end. She asked me if Benje was with me, I said yes. She said, "honey, your father died today, I'm coming to get you to take you to his place".
I don't remember many clear details from that day. But a few things are still with me. Sitting at my dad's kitchen table with my aunties and his girlfriend, my dog Cubby moping and whining around the house. A petite brunette who worked for victim services gave me some pamphlets and I remember thinking "what a shitty job you've got lady".
I had a professor in university who was a beautiful soul that had seen many tragedies in her time as an ER nurse in Toronto and Edmonton. On a shift when one of my fellow students saw her elderly patient die, Madeline sat us all down and told us how she helped families manage grief. Again and again she stressed that we ought to encourage families to make physical contact with the deceased, show them it is OK to touch their loved ones hand, or stroke their face. Her belief was it helped make the abstract concept of death more concrete. It gave tangible proof to push denial aside and let the beginnings of grieving grow.
The funeral home was at the end of a quiet street in the small town near his acreage. We were sitting in the funeral directors office discussing the upcoming autopsy and the cost and logistics of transporting a body back for viewing. I was tuning in and out. Wait, the medical examiners office? I had been to autopsies there. I hurried that thought out of my mind.
He informed me that I could save 600$ if they could have his ashes FedEx'ed to the church after the autopsy, rather than transporting the body. I howled with laughter, "Fed Ex!!??" I thought that was hilarious . Who knew you could have your ashes sent by priority courier? I was chuckling still when he answered me with a most stern, "yes". I glanced around the room and seeing that I was the only one who found this funny I stifled myself with a "hmfpf" and stared down at the balled up kleenex in my hand. When the funeral director finally asked me if I'd like to see my father I nodded and followed a few feet behind as he led me to the back of the room which served as a chapel.
I stood at the threshold. The length between me and the table which supported my fathers body seemed to stretch out to an impossible distance. The floor was gray linoleum and empty but for the body at the opposite end. To my left light streamed in through the dusty venetian blinds that were half open. On the right were brown padded chairs with metal legs stacked on top of one another.
The funeral director said he would step out to give me some privacy.
I just stood there staring straight ahead. I wasn't sure what to do. I wasn't sure if my legs could get me to the table. One side of my head was yelling "No! No! No! No!" and the other was hearing Madeline's voice telling us about encouraging families to have contact with the body. No way did I want some maladjusted grieving, stunted acceptance to befall me.
I edged forward and arrived at his side. His face was bluish gray. A small trickle of blood was dried in his ear. His mouth was hanging slack and he had enough stubble to warrant a shave. The white blanket was pulled up to his chin. It wasn't my father. The man who was my father had a mischievous twinkle, and was quick to laugh. This thing in front of me was an abandoned carcass. An evacuated shell. I saw that with his soul, his essence gone that he really had very little to do with his body. His skin and bones and eyes and mouth were just part of a complex interface required by his spirit to interact with the rest of us (who are also trapped by the same limiting coveralls). I knew that he had not come to an end because having a heart stop beating could not cause such a dramatic metamorphosis to a vessel.
I thought for a moment that he was probably watching me, maybe circling above me somehow. I slowly reached my hand forward, intent on touching his shoulder. As I watched my hand get closer the moment of contact occurred. At that exact second a car horn blasted outside the windows. I jumped into the air and felt the rush of adrenaline hit my fingertips.
And with that I was laughing and waving my hand in the air.
"Hey Dad! Nice one. You got me!!"
So dad, if you're reading blogs out there in the ionosphere, this ones for you.
I couldn't put my finger on it for a few days, but I felt out of touch with the lectures and the PBL discussions. Strange for me because the emergency nurse still living inside me loves cardiac presentations and interventions.
Then it dawned on me. My dad died of a massive heart attack.
I know it is probably immediately obvious to most people why I was a little dissociated from the learning this week. But it truly was a surprise for me because we were examining this presentation at such a microscopic level that I truly didn't see the forest for the trees.
So to remind myself, and to all the academics out there that there is a human, a soul, a spirit that gives breath and life to the myocytes we spend so much time looking at slides of...I am reposting the story of my dad and his final heart attack. Because it is something we all need to remember, for every troponin level we're anxiously waiting for so we can turf the patient to CCU or home, there is a family that is also anxiously awaiting those results.
---
When my dad laughed, it was a borderline giggle. As manly a giggle as you can imagine, but a giggle nonetheless. He really let loose though, usually turning his head to the side and scrunching up his shoulders while his whole body shook.
In a word, he was a 'character'. A prankster. Not mean or hurtful pranks, but anything he could get a good story from.
He would perform last-minute pranks, ones that involved no prep or props. Like sticking his big toe on the back of the scale when my mom was weighing herself, or telling the kindergarten kids that rode his bus that there were "two Friday's this week" so he'd be there in the morning to pick them up. My sisters current event for social studies class one day was that the "Pope had turned Protestant" thanks to my dad. He hid pork chops in the pockets of his friends coveralls on a Friday afternoon so that come Monday when they got back to work there'd have a nice surprise with their morning coffee.
When my uncle was particularly proud of his new television set my dad went out and bought a universal remote which he'd bring to their house and use to turn the volume up and down at infuriating intervals convincing my easily flustered uncle that he'd made a dud purchase.
One of his more elaborate stunts was when he surprised my mother on the 'throne' and snapped a picture of her, developed the photo and then cut it to fit in her wallet. I was at the supermarket with her the day she pulled her credit card out and with it came flying the photo of her on the toilet, landing right on the scan pad.
He loved it when I'd get engrossed in something scary on t.v. He'd sneak behind the couch and just as Hannibal Lecter was closing in he'd startle me with a "Haarr!" while I came a foot off the cushions, screaming and yelling "DAD!"
One Monday morning my dad's alarm clock went off for work and he didn't shut it off. His girlfriend thought it was odd because he was always up with the first crackles of the morning news. She turned over to ask him why he wasn't getting up and discovered that he was dead.
I was starting my first day of a community practicum in nursing school that day. I had been dreaming that I was at this odd wrecking yard which was more of a wrecking yard for people, not cars. There were these large looming pieces of ramshackle machinery and I was getting a tour. Just as the tour guide got to a group of Dachau-esque ovens and said "this is the crematorium" the phone rang, waking me up. I was shaking out the images from my disturbing dream but felt something else must be wrong because the phone never rang this early in the morning.
I picked it up to my mothers voice on the other end. She asked me if Benje was with me, I said yes. She said, "honey, your father died today, I'm coming to get you to take you to his place".
I don't remember many clear details from that day. But a few things are still with me. Sitting at my dad's kitchen table with my aunties and his girlfriend, my dog Cubby moping and whining around the house. A petite brunette who worked for victim services gave me some pamphlets and I remember thinking "what a shitty job you've got lady".
I had a professor in university who was a beautiful soul that had seen many tragedies in her time as an ER nurse in Toronto and Edmonton. On a shift when one of my fellow students saw her elderly patient die, Madeline sat us all down and told us how she helped families manage grief. Again and again she stressed that we ought to encourage families to make physical contact with the deceased, show them it is OK to touch their loved ones hand, or stroke their face. Her belief was it helped make the abstract concept of death more concrete. It gave tangible proof to push denial aside and let the beginnings of grieving grow.
The funeral home was at the end of a quiet street in the small town near his acreage. We were sitting in the funeral directors office discussing the upcoming autopsy and the cost and logistics of transporting a body back for viewing. I was tuning in and out. Wait, the medical examiners office? I had been to autopsies there. I hurried that thought out of my mind.
He informed me that I could save 600$ if they could have his ashes FedEx'ed to the church after the autopsy, rather than transporting the body. I howled with laughter, "Fed Ex!!??" I thought that was hilarious . Who knew you could have your ashes sent by priority courier? I was chuckling still when he answered me with a most stern, "yes". I glanced around the room and seeing that I was the only one who found this funny I stifled myself with a "hmfpf" and stared down at the balled up kleenex in my hand. When the funeral director finally asked me if I'd like to see my father I nodded and followed a few feet behind as he led me to the back of the room which served as a chapel.
I stood at the threshold. The length between me and the table which supported my fathers body seemed to stretch out to an impossible distance. The floor was gray linoleum and empty but for the body at the opposite end. To my left light streamed in through the dusty venetian blinds that were half open. On the right were brown padded chairs with metal legs stacked on top of one another.
The funeral director said he would step out to give me some privacy.
I just stood there staring straight ahead. I wasn't sure what to do. I wasn't sure if my legs could get me to the table. One side of my head was yelling "No! No! No! No!" and the other was hearing Madeline's voice telling us about encouraging families to have contact with the body. No way did I want some maladjusted grieving, stunted acceptance to befall me.
I edged forward and arrived at his side. His face was bluish gray. A small trickle of blood was dried in his ear. His mouth was hanging slack and he had enough stubble to warrant a shave. The white blanket was pulled up to his chin. It wasn't my father. The man who was my father had a mischievous twinkle, and was quick to laugh. This thing in front of me was an abandoned carcass. An evacuated shell. I saw that with his soul, his essence gone that he really had very little to do with his body. His skin and bones and eyes and mouth were just part of a complex interface required by his spirit to interact with the rest of us (who are also trapped by the same limiting coveralls). I knew that he had not come to an end because having a heart stop beating could not cause such a dramatic metamorphosis to a vessel.
I thought for a moment that he was probably watching me, maybe circling above me somehow. I slowly reached my hand forward, intent on touching his shoulder. As I watched my hand get closer the moment of contact occurred. At that exact second a car horn blasted outside the windows. I jumped into the air and felt the rush of adrenaline hit my fingertips.
And with that I was laughing and waving my hand in the air.
"Hey Dad! Nice one. You got me!!"
So dad, if you're reading blogs out there in the ionosphere, this ones for you.
Sunday, March 22, 2009
This Is Why We Do It
She was a beautiful woman in her late 40's. I was a disheveled and sweaty triage nurse. Our waiting room was overrun with people holding their bellies, foreheads, children's hands, and cell phones. There were no beds in the department. There was a large stack of charts waiting to be brought in, and still another chart buzzed through the printer.
I looked at the chief complaint: "food poisoning".
I called her to the triage station from the waiting room but she simply lifted her head, brown hair covering most of her face.
"Do you need a wheelchair?"
"Yeah."
I wheeled her in and looked at her flushed cheeks. She didn't look well, but then again, if she had food poisoning she probably had high velocity liquids coming out of her from all angles. I asked her what she had eaten, a hamburger and caesar salad. Ooooh. Hamburger. Not good. She had vomited once in the parking lot. No diarrhea. Her heart rate and oxygen were normal. Afebrile.
No meds, no allergies. She told me she had a history of hypertension but her doctor had recently taken her off her meds because she "needed to lose 10 lbs and then be reassessed". She only looked about 10 lbs overweight, if that. Her BP was 208/110. Umm...
"Do you have a headache?"
"Yeah a little bit."
"Visual disturbances? Double vision? Spots? Stars?"
"No."
"Chest pain?"
"No."
"Do you feel lightheaded? Dizzy?"
"Yeah."
Ok. Symptomatic HTN. No beds. Except for trauma bay. I asked the acute side nurse if she'd mind me popping this food poisoned lady into the trauma bay, just for a few minutes so I could get her on a monitor, get an EKG, and do a more thorough assessment. Her pressure was high and I was just not sure what was going on with her. "Do what you have to do" was the reply from the harried nurse who already had her hands full with a query stroke and 2 cardiac patients.
I wheeled the patient into the trauma bay, her repeat pressure was 168/78, HR 97, O2 98%. Now I was feeling sheepish for using our hallowed trauma bay for yet another puker and pooper. I asked her to turn from her side onto her back so I could hook the oxygen tubing behind her ears. I pulled the dark hair from her face. Her head turned in my direction, clear blue eyes stared up at me as she murmured, "I need to lay on my side for a minute". Her eyes rolled back in her head and she began to seize. Her face began to turned blue, first just around the mouth, then spreading up her cheeks, an unnatural mauve. Her husband used his body to keep her from rolling off the other side of the bed.
"I need some help in here!" as I pulled up the side rails and grabbed the bag valve mask for oxygen.
Within minutes two other nurses were at the bedside with a doctor in tow. Instantly we set about our duties.
An I.V is placed in her arm, valium goes in. No pulse. The OPA is inserted and we are bagging her. Her rhythm shows v.fib. The skin of her arms begins to mottle, and as I cut off her shirt I see that her chest is also mottled, no demarcation line though. I stick the quick look pads to her chest and charge the defibrillator.
When was the last time I hit the shock button? Why is this lady dying on us?
I see her husband standing with his eyes fixed on the head of the bed, mouth slack but eyes attentive, seeking. Just then another nurse offers to walk him outside, he agrees.
"I'm clear, everyone is clear. Shocking!"
And thus began the long hour of CPR. 13 shock deliveries, 8 doses of epi, a dose of magnesium sulphate (during a brief Toursades episode) and one dose of atropine.
We would get a rhythm, then a pulse, then back into v.fib. It was a roller coaster. We had no idea why this was happening--she could be a bleed--but was it hemorrhagic or ischemic? Was she an acute M.I? We had no labs so couldn't determine if it was her electrolytes. Pulmonary embolus?
We had intubated her successfully on 2nd attempt with a 6.5 after the 7.0 was a no go. With the intubation and bagging her sats remained 100% and we kept CPR going throughout. The numbers were running through my head...she'd been down now for over 60 minutes, she was getting 25% circulation of oxygenated blood thanks to the CPR, we'd given her enough joules of energy and epinephrine to power a leg of the Boston marathon and we still didn't know what was happening to her. What were we saving now? Would she be on a vent with severe brain damage the rest of her life? Would she even take to a vent? When do we call it? With enough epi on board I've seen PEA last for ages. After such a long time the heart is just twitching, it has no intention of ever beating again.
The lab attempted to do an EKG but due to mechanical interferance from the monitors and defib pads (which I was not about to remove any time soon) the print out was basically unreadable.
Her pupils were fixed and dilated. She is frighteningly cyanotic despite what our monitors were telling us.
She went into sinus rhythm. Tachycardic but sinus. We prayed that this time it would continue for longer than a few seconds.
It did.
The paramedics had arrived to take her to the Big Hospital. Her color began to improve, her cheeks no longer dusky. The mottling on her arms faded as they returned to a pale pink color. She was taking the odd breath against the tube.
We packed her into the ambulance, the doc and I at her side. We pulled out of the parking lot just as the respiratory tech pulled into the lot. Gotta love rural emerg. I attempted to fill in the gaping holes in the charting as the ambulance careened along the rainy streets. The paramedic student bagging her.
We arrived at Big Hospital and went through the usual song and dance with the dragon-lady triage nurse:
"Who is this patient? Where are you guys coming from?"
"We're from Small Hospital down the road, we talked to your ED doc who accepted her, this is the cardiac arrest we're bringing in..."
"I have never heard anything about this woman."
"Well, as you can see, she is intubated and unconscious. We've been working on her for over an hour. She needs a STAT CT among other things and time is of the essence, she could crash again at any moment before we know what is going on with her..."
*Large audible sigh from Dragon Lady.*
"Fine, roll her into trauma bay 1".
'Thanks."
We get her into the trauma bay, give report to the nice accepting ER doc in shorts and the cranky ER nurse with green streaks in her hair. The RT saunters in in his scrubs and PUMA's, looks at the tube and remarks, "the tube is too small". I stifle a remark about his genitals and point out that it has provided her with adequate oxygenation thankyouverymuch pointing out her color and sats. Asshole. I am so not in the mood.
Doc and I walk down the hall where our paramedics are anxious to get us back to our hospital before they go on another call. We see her husband and young son walk into the waiting room. Both Doc and I say goodbye to him. I shake his hand and say something about hoping for the best outcome for his wife. He walks in a daze to the quiet room with the teary eyed boy trailing behind.
We return to the department.
I call the CV-ICU everyday.
Day 1: She had been to the cath lab, showed a 30% occlusion in her LAD artery. She had had two stents put in, and was still in an induced hypothermic coma so neurological status was unknown. Outcome did not look good.
Day 2: Still intubated and in coma. Body temp not rising despite cooling protocol cessation.
Day 3: Still intubated but some periods of wakefulness, responding to voice.
Day 4: The nurse comes on the phone and I ask again how Mrs. D is doing. I explain that I was one of the nurses involved with her code at Small Hospital.
"Oh I am looking at her right now, sitting up and having coffee with her husband."
A sputter from my end of the phone comes as the reply.
"Yeah, none of her doctors can believe her recovery. She has no neurological deficits at all. Well, she has some amnesia from the night of the arrest. She remembers going to the movie but nothing about the dinner or afterward. But that is probably a blessing, who would want to remember any of that? You guys did great work on her out there at Small Hospital!"
I tell her she has no idea how much I needed that news this week, thank her and hang up. My eyes are filling with tears of joy and relief.
I am still stunned and thrilled at this outcome. I cannot remember the last time I was part of a successful resuscitation. Scenes from that night keep replaying in my head and all I can do is shake my head with gratitude that she is alive today.
This is why I love my job.
We would get a rhythm, then a pulse, then back into v.fib. It was a roller coaster. We had no idea why this was happening--she could be a bleed--but was it hemorrhagic or ischemic? Was she an acute M.I? We had no labs so couldn't determine if it was her electrolytes. Pulmonary embolus?
We had intubated her successfully on 2nd attempt with a 6.5 after the 7.0 was a no go. With the intubation and bagging her sats remained 100% and we kept CPR going throughout. The numbers were running through my head...she'd been down now for over 60 minutes, she was getting 25% circulation of oxygenated blood thanks to the CPR, we'd given her enough joules of energy and epinephrine to power a leg of the Boston marathon and we still didn't know what was happening to her. What were we saving now? Would she be on a vent with severe brain damage the rest of her life? Would she even take to a vent? When do we call it? With enough epi on board I've seen PEA last for ages. After such a long time the heart is just twitching, it has no intention of ever beating again.
The lab attempted to do an EKG but due to mechanical interferance from the monitors and defib pads (which I was not about to remove any time soon) the print out was basically unreadable.
Her pupils were fixed and dilated. She is frighteningly cyanotic despite what our monitors were telling us.
She went into sinus rhythm. Tachycardic but sinus. We prayed that this time it would continue for longer than a few seconds.
It did.
The paramedics had arrived to take her to the Big Hospital. Her color began to improve, her cheeks no longer dusky. The mottling on her arms faded as they returned to a pale pink color. She was taking the odd breath against the tube.
We packed her into the ambulance, the doc and I at her side. We pulled out of the parking lot just as the respiratory tech pulled into the lot. Gotta love rural emerg. I attempted to fill in the gaping holes in the charting as the ambulance careened along the rainy streets. The paramedic student bagging her.
We arrived at Big Hospital and went through the usual song and dance with the dragon-lady triage nurse:
"Who is this patient? Where are you guys coming from?"
"We're from Small Hospital down the road, we talked to your ED doc who accepted her, this is the cardiac arrest we're bringing in..."
"I have never heard anything about this woman."
"Well, as you can see, she is intubated and unconscious. We've been working on her for over an hour. She needs a STAT CT among other things and time is of the essence, she could crash again at any moment before we know what is going on with her..."
*Large audible sigh from Dragon Lady.*
"Fine, roll her into trauma bay 1".
'Thanks."
We get her into the trauma bay, give report to the nice accepting ER doc in shorts and the cranky ER nurse with green streaks in her hair. The RT saunters in in his scrubs and PUMA's, looks at the tube and remarks, "the tube is too small". I stifle a remark about his genitals and point out that it has provided her with adequate oxygenation thankyouverymuch pointing out her color and sats. Asshole. I am so not in the mood.
Doc and I walk down the hall where our paramedics are anxious to get us back to our hospital before they go on another call. We see her husband and young son walk into the waiting room. Both Doc and I say goodbye to him. I shake his hand and say something about hoping for the best outcome for his wife. He walks in a daze to the quiet room with the teary eyed boy trailing behind.
We return to the department.
I call the CV-ICU everyday.
Day 1: She had been to the cath lab, showed a 30% occlusion in her LAD artery. She had had two stents put in, and was still in an induced hypothermic coma so neurological status was unknown. Outcome did not look good.
Day 2: Still intubated and in coma. Body temp not rising despite cooling protocol cessation.
Day 3: Still intubated but some periods of wakefulness, responding to voice.
Day 4: The nurse comes on the phone and I ask again how Mrs. D is doing. I explain that I was one of the nurses involved with her code at Small Hospital.
"Oh I am looking at her right now, sitting up and having coffee with her husband."
A sputter from my end of the phone comes as the reply.
"Yeah, none of her doctors can believe her recovery. She has no neurological deficits at all. Well, she has some amnesia from the night of the arrest. She remembers going to the movie but nothing about the dinner or afterward. But that is probably a blessing, who would want to remember any of that? You guys did great work on her out there at Small Hospital!"
I tell her she has no idea how much I needed that news this week, thank her and hang up. My eyes are filling with tears of joy and relief.
I am still stunned and thrilled at this outcome. I cannot remember the last time I was part of a successful resuscitation. Scenes from that night keep replaying in my head and all I can do is shake my head with gratitude that she is alive today.
This is why I love my job.
Saturday, March 21, 2009
Lucky
I remember reading some Gary Zukav book years ago when I was in India. I was staying in this dingy 3$ per night hotel in Bangalore which had cockroaches crawling up through the sink and a single metal fan on the ceiling that rotated at a speed just fast enough to create noise but no breeze. I got to this section in the book where he said,
"If you had three minutes left to live who would you call? What would you say? And why aren't you on the phone right now?"
I know, it is nothing that profound at first glance perhaps. But I remember racing down the stairs and out into the dusty streets, finding an "STD" Booth (as they are called) and tracking my mother down for a strange, random, out-of-the-blue profession of admiration, love, and gratitude.
Working in the ED one gets reminded (too often sometimes) that many people never get to have those conversations before they unexpectedly leave this earth.
And so, that quote haunts me still from time to time. Who would I call today? And what would I say? What words are unspoken?
I am grateful for the phone calls and emails I've received lately regarding Jody, and grateful also for the conversations her death has inspired.
Today was Jody's funeral and thankfully the emotions and expressions were not too little, too late. Jody knew how much she was loved and respected, and in turn she made sure we knew the same.
It made today truly a celebration of her life, and not merely a declaration of our loss. I doesn't make her any less missed, but it does make all of this just slightly easier to bear.
"If you had three minutes left to live who would you call? What would you say? And why aren't you on the phone right now?"
I know, it is nothing that profound at first glance perhaps. But I remember racing down the stairs and out into the dusty streets, finding an "STD" Booth (as they are called) and tracking my mother down for a strange, random, out-of-the-blue profession of admiration, love, and gratitude.
Working in the ED one gets reminded (too often sometimes) that many people never get to have those conversations before they unexpectedly leave this earth.
And so, that quote haunts me still from time to time. Who would I call today? And what would I say? What words are unspoken?
I am grateful for the phone calls and emails I've received lately regarding Jody, and grateful also for the conversations her death has inspired.
Today was Jody's funeral and thankfully the emotions and expressions were not too little, too late. Jody knew how much she was loved and respected, and in turn she made sure we knew the same.
It made today truly a celebration of her life, and not merely a declaration of our loss. I doesn't make her any less missed, but it does make all of this just slightly easier to bear.
Tuesday, March 17, 2009
Goodbye Beautiful Friend
Todd told me that Jody might not make it through the night. The indolent DIC had caused her to have multiple pulmonary emboli and her respirations had become labored, O2 sats dropping to the 40-60% range. I found this out in the back of an ambulance as I was returning from a spiral femur fracture transfer.
Earlier, I had received a message from my ED asking me to go on the transfer. I had no time to listen to the other 2 voicemails as I raced home from hot yoga, showered, changed, and headed back to the ED for the trip. It wasn’t until 4h later that I finally listened to the remaining messages and heard the one from Todd.
Too late to catch the last ferry to the island I went home and packed. I caught a few fitful hours of sleep, got up at 4am and drove to catch the first ferry of the morning. The whole time I prayed my phone wouldn’t ring with another call from Todd.
Jody was diagnosed in October 2007 with breast, lung, brain, and retinal cancer. She had just turned 39. In the ensuing months it spread throughout her bones and internal organs but she kept her sharp wit and smile. She somehow continued to glow even as the cancer raged inside her. She’d turn to you and say, “Look at me! Look at my skin! Does this look like the skin of someone who has the cancer?” And you couldn’t deny it--she was gorgeous.
When she was raising money for lung cancer research she told me—“lung cancer is the dirty cancer. There is much less funding and fund raising for lung cancer because society thinks it is only deserving smokers that get it. Well, it isn’t.” It made me take a look at my own buried biases about obesity and heart disease, diabetes, and yeah…cancer. She never smoked a day in her life, was athletic, and a veritable fireball of positive energy. She didn’t do anything to deserve this, but really—does anyone? I am still unable to stifle a bolt of anger when I see a 60 year old obese chain smoker and think—Jody will never get to that age.
In this world you will come upon a select few people who have a spark, a light in their eyes. People who draw you into their orbit simply because they take such joy in the dance of life. Jody was one of those people. I have always been in awe of her ability to act on, seek out, and attain all of the experiences she wanted to have in this life.
Our first night shift together in the ED I knew she was my kind of woman when she told me she was learning to grapple—and was the only female in her class. Soon there were two females and our friendship grew from there.
I was able to make it back to the island on time and even had one last visit with Jody before she slipped into unconsciousness. Her breathing became wet and ragged. Several of us gathered around her with Champagne and cake, telling stories and laughing about our many adventures in Jody-land. We took turns holding her hand and rubbing her back as she continued to work to breathe.
One of the hospice nurses, Christina, set up a bed for me on a fold down chair in a common room and I curled up for some sleep after we had arranged Jody so that she and Todd could fit in the bed together. I dreamed of Madeline, my mentor and beloved nursing instructor who taught me so much about grieving and death.
Around 7 am this morning Jody took her last breath in Todd's arms as he wished her peace and love. Her nurse came and introduced herself to me as Madeline. I shook my head at the coincidence.
Jody's wedding ring from Todd depicted the symbol of the Hummingbird totem, a Haida symbol often associated with marriage. I found this excellent summary of Hummingbird symbolism, the words describe Jody with shiver-inspiring accuracy...
Earlier, I had received a message from my ED asking me to go on the transfer. I had no time to listen to the other 2 voicemails as I raced home from hot yoga, showered, changed, and headed back to the ED for the trip. It wasn’t until 4h later that I finally listened to the remaining messages and heard the one from Todd.
Too late to catch the last ferry to the island I went home and packed. I caught a few fitful hours of sleep, got up at 4am and drove to catch the first ferry of the morning. The whole time I prayed my phone wouldn’t ring with another call from Todd.
Jody was diagnosed in October 2007 with breast, lung, brain, and retinal cancer. She had just turned 39. In the ensuing months it spread throughout her bones and internal organs but she kept her sharp wit and smile. She somehow continued to glow even as the cancer raged inside her. She’d turn to you and say, “Look at me! Look at my skin! Does this look like the skin of someone who has the cancer?” And you couldn’t deny it--she was gorgeous.
When she was raising money for lung cancer research she told me—“lung cancer is the dirty cancer. There is much less funding and fund raising for lung cancer because society thinks it is only deserving smokers that get it. Well, it isn’t.” It made me take a look at my own buried biases about obesity and heart disease, diabetes, and yeah…cancer. She never smoked a day in her life, was athletic, and a veritable fireball of positive energy. She didn’t do anything to deserve this, but really—does anyone? I am still unable to stifle a bolt of anger when I see a 60 year old obese chain smoker and think—Jody will never get to that age.
In this world you will come upon a select few people who have a spark, a light in their eyes. People who draw you into their orbit simply because they take such joy in the dance of life. Jody was one of those people. I have always been in awe of her ability to act on, seek out, and attain all of the experiences she wanted to have in this life.
Our first night shift together in the ED I knew she was my kind of woman when she told me she was learning to grapple—and was the only female in her class. Soon there were two females and our friendship grew from there.
I was able to make it back to the island on time and even had one last visit with Jody before she slipped into unconsciousness. Her breathing became wet and ragged. Several of us gathered around her with Champagne and cake, telling stories and laughing about our many adventures in Jody-land. We took turns holding her hand and rubbing her back as she continued to work to breathe.
One of the hospice nurses, Christina, set up a bed for me on a fold down chair in a common room and I curled up for some sleep after we had arranged Jody so that she and Todd could fit in the bed together. I dreamed of Madeline, my mentor and beloved nursing instructor who taught me so much about grieving and death.
Around 7 am this morning Jody took her last breath in Todd's arms as he wished her peace and love. Her nurse came and introduced herself to me as Madeline. I shook my head at the coincidence.
Jody's wedding ring from Todd depicted the symbol of the Hummingbird totem, a Haida symbol often associated with marriage. I found this excellent summary of Hummingbird symbolism, the words describe Jody with shiver-inspiring accuracy...
When we assume hummingbird consciousness, our life becomes a wonderland of sensuous delights. We live for beauty, delighting in flowers, aromas, fine mist, and delicate tastes.
When it becomes our totem, the hummingbird teaches us to laugh and enjoy the creation, to appreciate the magic of being alive, and the truth of beauty.
Hummingbirds awaken us to the beauty of the present moment. As they dance the four quarters of embodied existence, they bring us medicine to solve the riddle of duality....
Hummingbirds teach us fierce independence. They teach us to fight in a way where no one really gets hurt. They teach us simple courage....
In hospice, the tradition is to open the window when someone dies--this allows the spirit to fly free. Then someone will travel upstairs to the garden on the roof and ring the bell to notify the spirit world that a new arrival is on the way.
When Todd went upstairs to ring the bell a hummingbird appeared on the roof. He marveled at the birds proximity. As Randi and I joined him on the roof we hugged and cried for a few moments before we noticed the bird had returned and hovered close by, it's tiny wings a blur. The delicate creature stayed near and we couldn't help but feel a sense of wonder and reassurance.
Jody is free now, and though we are sad she only was a part of this earth for a short time, we rejoice that we were among the lucky ones who got to share it with her.
...Only when you drink from the river of silence shall you indeed sing.
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance...
And when you have reached the mountain top, then you shall begin to climb.
And when the earth shall claim your limbs, then shall you truly dance...
Kahlil Gibran
Monday, March 16, 2009
Props to Pops
This Friday marks the anniversary of my dad's death in 2002. For me this year will be a bit sadder than most. My dad would have been over the moon had he been alive to see me start medical school. Many of the folks on his side of the family never even completed high school let alone university.
I had a few random things in a bag I brought with me from storage when I last moved. And I mean random...plunger for French press, old camera, greeting cards, mesh bag, mail, incense... and as I sorted though--a photo of my dad and I on his ride-a-mower when I was about 4 emerged. This photo floated out of my stack of paperwork and landed on the table. I had completely forgotten about it-- most of my photos are in storage about 900kms away.
I stared at it for a while then tacked it up on my fridge. I realised that his death day is tomorrow and that he died not knowing I'd reach my goal of medical school. Hadn't pieced that reality together yet. After losing a parent it seems all victories become somewhat bittersweet because that tender spot inevitably gets reactivated with each triumph. Our parents are the only people in the world that genuinely care when we succeed or when we fail. Our accomplishments to them are uncomplicated in ways that cannot be with a spouse or friends.
Many people say to me "oh, your father knows what you are up to" but honestly, I don't know if I believe that. I think (if there is an afterlife) it will be so unimaginably wonderful that our souls will be preoccupied with much more important things than hanging around earth to see if our living offspring become doctors or not. I know my father was very proud of who I was even when I was just a punk-assed 22 year old. I think a part of my wishing he were around to see me off in May stems from my desire to show him "See dad! You and mom done good!" Giving me the chance to say thank you for eating my watery scrambled eggs, letting me put rollers in your hair, and tolerating the boyfriends who wore trench coats.
It all worked out in the end Dad.
Thank you.
I hope you're riding some cosmic wave or fishing off a plentiful dock with Cubby right now.
I had a few random things in a bag I brought with me from storage when I last moved. And I mean random...plunger for French press, old camera, greeting cards, mesh bag, mail, incense... and as I sorted though--a photo of my dad and I on his ride-a-mower when I was about 4 emerged. This photo floated out of my stack of paperwork and landed on the table. I had completely forgotten about it-- most of my photos are in storage about 900kms away.
I stared at it for a while then tacked it up on my fridge. I realised that his death day is tomorrow and that he died not knowing I'd reach my goal of medical school. Hadn't pieced that reality together yet. After losing a parent it seems all victories become somewhat bittersweet because that tender spot inevitably gets reactivated with each triumph. Our parents are the only people in the world that genuinely care when we succeed or when we fail. Our accomplishments to them are uncomplicated in ways that cannot be with a spouse or friends.
Many people say to me "oh, your father knows what you are up to" but honestly, I don't know if I believe that. I think (if there is an afterlife) it will be so unimaginably wonderful that our souls will be preoccupied with much more important things than hanging around earth to see if our living offspring become doctors or not. I know my father was very proud of who I was even when I was just a punk-assed 22 year old. I think a part of my wishing he were around to see me off in May stems from my desire to show him "See dad! You and mom done good!" Giving me the chance to say thank you for eating my watery scrambled eggs, letting me put rollers in your hair, and tolerating the boyfriends who wore trench coats.
It all worked out in the end Dad.
Thank you.
I hope you're riding some cosmic wave or fishing off a plentiful dock with Cubby right now.
Saturday, September 13, 2008
I Was There, In the Room
I was just having a conversation with a friend of mine a few days ago about when people cry out in true anguish, and how those cries remain carved into your memory.
I told her of the two cases which still make me shiver when I think of them.
The first was a 43 year old woman who miscarried 14 week old twins in the department. Her absolute desolation was heart wrenching as she sobbed and cried out for her babies, apologizing to her husband, and uttering, "this was my last chance..." It was enough to move several of the staff to tears that night. I can close my eyes, and I am standing in the hall between the patient bathroom and the gyne room. A small basin is in my hands, and there are two baby boys in it.
The second case which comes to me often, was a 13 year old girl who jumped out of her second story window to sneak out to a party. She landed on her back, crushing her lumbar spine. I knew it was bad when I looked in the report room where the MD's pull up imaging results. I saw the ER doc sitting with his head in his hands. He got up and walked into the patients room, and a few minutes later the scream of despair at her diagnosis of paralysis echoed through the department. For hours she screamed and screamed, "NOOOOOOOOOOO!"
I can still feel myself standing behind that nursing station desk, the desk lamp shining on the charts beneath it, the overhead lights dimmed. My heart pounding.
I know that last night will be one of those nights now too. One that will stay with me a long, long, while.
4 teens were in a car which lost control and rolled over down a rocky embankment. The front seat occupants were both killed and the two back seat occupants were brought into the department. Both were in mild shock but physically stable. While we waited for the urine test to come back on my patient I sat and talked with her. A gorgeous girl with long curly hair down to her waist, mascara lining the contours of her face. She kept telling me she was fine and wanted to know how her friends were doing. She'd start crying softly and apologize to me for doing so. She told me the driver was her best friend, that she tried to wake her up at the scene but couldn't. "Please try to find something out about her, why isn't she here? Can I see her?"
I'd been told that her friends were waiting outside and that they didn't want her to know until she was sent home. Her urine came back clear and she was discharged. I walked with her out to the parking lot just as the parents of one of the surviving friends showed up. The night air has a chill to it now and soon we were both shivering as we walked out to the cluster, she asked me, "is she out here?" Her friends put their arms around her. I walked back into the department to grab her a blanket. Just as the ambulance bay doors swooshed closed behind me I heard her cry out "NOOOOO!!! YOU HAVE GOT TO BE KIDDING! YOU'RE LYING!!!! LYINGGGGGG!!!"
I came back out and she was being supported but her friends, she was wretching, crying, knees buckling. Her white shorts and legs were spattered with blood and on her feet the blue OR booties I'd given her. We gathered around, tried our best to support her.
After some time myself and the other nurse returned inside. I went into the staff lounge and fell asleep. I know that sounds harsh but I was running on 4 hours of sleep and the high emotional intensity of the night had sucked the remaining drops of energy from my bones.
After my break I returned to a quiet department. When the shift was over I felt the beginnings of my cold getting worse and exhaustion seeping in. Stepping outside the sun and seeing the rising mist at the bases of the mountains, I was reminded that there were things to be celebrated, and things to be grateful for. I drove out of the city limits, pulled my bike out of the back of my car. I went for a long road ride to think about the evenings events, how the feelings were going to be shaped in my memory.
My job, which can be horrible (yesterday's post), can turn around on a dime and suddenly become a high honor. When Eve Ensler writes about birth she starts with a line, "I was there in the room..."
For birth, and death, and everything in between...we are there...in the room. And that is why, I love this work.
I told her of the two cases which still make me shiver when I think of them.
The first was a 43 year old woman who miscarried 14 week old twins in the department. Her absolute desolation was heart wrenching as she sobbed and cried out for her babies, apologizing to her husband, and uttering, "this was my last chance..." It was enough to move several of the staff to tears that night. I can close my eyes, and I am standing in the hall between the patient bathroom and the gyne room. A small basin is in my hands, and there are two baby boys in it.
The second case which comes to me often, was a 13 year old girl who jumped out of her second story window to sneak out to a party. She landed on her back, crushing her lumbar spine. I knew it was bad when I looked in the report room where the MD's pull up imaging results. I saw the ER doc sitting with his head in his hands. He got up and walked into the patients room, and a few minutes later the scream of despair at her diagnosis of paralysis echoed through the department. For hours she screamed and screamed, "NOOOOOOOOOOO!"
I can still feel myself standing behind that nursing station desk, the desk lamp shining on the charts beneath it, the overhead lights dimmed. My heart pounding.
I know that last night will be one of those nights now too. One that will stay with me a long, long, while.
4 teens were in a car which lost control and rolled over down a rocky embankment. The front seat occupants were both killed and the two back seat occupants were brought into the department. Both were in mild shock but physically stable. While we waited for the urine test to come back on my patient I sat and talked with her. A gorgeous girl with long curly hair down to her waist, mascara lining the contours of her face. She kept telling me she was fine and wanted to know how her friends were doing. She'd start crying softly and apologize to me for doing so. She told me the driver was her best friend, that she tried to wake her up at the scene but couldn't. "Please try to find something out about her, why isn't she here? Can I see her?"
I'd been told that her friends were waiting outside and that they didn't want her to know until she was sent home. Her urine came back clear and she was discharged. I walked with her out to the parking lot just as the parents of one of the surviving friends showed up. The night air has a chill to it now and soon we were both shivering as we walked out to the cluster, she asked me, "is she out here?" Her friends put their arms around her. I walked back into the department to grab her a blanket. Just as the ambulance bay doors swooshed closed behind me I heard her cry out "NOOOOO!!! YOU HAVE GOT TO BE KIDDING! YOU'RE LYING!!!! LYINGGGGGG!!!"
I came back out and she was being supported but her friends, she was wretching, crying, knees buckling. Her white shorts and legs were spattered with blood and on her feet the blue OR booties I'd given her. We gathered around, tried our best to support her.
After some time myself and the other nurse returned inside. I went into the staff lounge and fell asleep. I know that sounds harsh but I was running on 4 hours of sleep and the high emotional intensity of the night had sucked the remaining drops of energy from my bones.
After my break I returned to a quiet department. When the shift was over I felt the beginnings of my cold getting worse and exhaustion seeping in. Stepping outside the sun and seeing the rising mist at the bases of the mountains, I was reminded that there were things to be celebrated, and things to be grateful for. I drove out of the city limits, pulled my bike out of the back of my car. I went for a long road ride to think about the evenings events, how the feelings were going to be shaped in my memory.
My job, which can be horrible (yesterday's post), can turn around on a dime and suddenly become a high honor. When Eve Ensler writes about birth she starts with a line, "I was there in the room..."
For birth, and death, and everything in between...we are there...in the room. And that is why, I love this work.
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