Remember...

Years have somehow dissolved away.  Stories and moments with patients beyond words have come and gone.

This past year I have been in an intense fellowship.  I have gotten to interact with patients in a new way and so many stories remain untold.

But let me share a few with you.

Homeless. Poor life choices. Body wasting away.  Too sick to leave against medical advise he was jailed in the hospital room.  No appetite and man a few words.  Weeks he was there.  I had the honor of being his provider.  Visiting him and talking with him if only for a few minutes each day.  No one came to visit him.  Not a single visitor.

Talking to him, he grew up in poverty...and where was his family now?  What led to this life?

One day I brought him something small...something to make him smile...and it did.  A spontaneous grin and hug.  I didn't know that would be the last time I saw him...  I went off service and he left the hospital...at least for a time.

But he came back and I didn't know it.  And then he was gone.  Gone.  Alone.  His spirit disappeared though his body remained.  I didn't know.  Did anyone other than the working know of his departure? This man.  His life.  I will remember him.



Only in her early midlife, her wrinkled and weathered face displayed hardship and abuse while her enlarged abdomen and intoxicated appearance told of her coping mechanisms.  But her eyes, bright blue and beautiful.  That is how i will remember her.  Frequent flyer, eyes rolled when she came in...but then it stopped.  Gone.  I tried to find her on the streets near her "McDonald" home.  She lost. Did she survive the winter?  Does she know that I cared?  I had the honor of being for her provider a few times.  She is a person.  She is cared about.  Hope that she's still on this earth.  Hope that she is taking better care of herself.  Hope that she knows she is valuable.


This prestigious university hospital was his last hope and I was his provider.  Me.  Diligent and caring wife at the bedside, they fought as a team alone in an unknown city.  But medicine can't fix everything and he slow drifted away.  Kind, soft spirit...I couldn't fix him.  Consults, thinking outside the box...nothing helped.  Too sick to fly home, he spent his last days here.  Visiting the couple one last time, my heart broke.  Despite the war inside his body, he was still so strong.  As I said goodbye, he embraced me and thanked me for my help.  My help?  If only there was more to be done.  It's one thing losing a patient as a nurse, it's another as a provider.  My insides screamed to think of a miracle, but there was none.  None.  And he never made it home.  As I waved goodbye, I told him I would not forget him.  Never.  Impact.

I had a great weekend! =0)

Shock

Sometimes I wonder about this job of nursing in critical care. Part of me loves the action and yet nights like the past two make me count the days till I am through and at the same time thirst for more knowledge and skill and want to keep working in critical care.

A man disfigured from a fall with purple skin taut around his eyes. He could not see yet he begged to get up. Nose packed with dried bloody cotton…forehead swelling. I wonder what he looked like before. Blood pressure low, but the man...awake and moving. Something was wrong ...but what? Blood pressure falling and the man wants up...he is getting cold and clammy. Doesn't he understand that sitting up will just make his BP drop? Calling doctor and it takes forever to hear back. She laughs a bit and seems flustered. Doesn't she understand the gravity of the situation? Blood pressure plummeting. Yes he runs low normally, but something amiss. Why are all the other nurses busy? Finally some Dopamine after imploring and here comes the nurse who is following me...she helps...past time for me to leave, but how can I? Patient is anxious and aggravating everyone, yet he knows where he is at. I ask him...he says his mouth is dry so I give him a swab with water on it...no more cause he's NPO. Filling out admission paper work half way and trying to give report. Blood pressure dropping, but the other nurse doesn't seem concerned. Is it right...that BP? He is getting quiet ...that's not good...his heart rate is dropping...oh NO!!!!! Running into room and shouting down the hall, I go for help. Crash cart and CPR....calling doctor and pushing meds...calling his friends (for he has no relatives)...this is not good. NG tube down and bright red blood...breathing for patient and pumping his chest. Bells ringing, people shouting. Tension. Tears and shaking. Where is that doctor? Running down hall to meet with his friends. It's over, the end...the man with the purple bug eyes. Maybe a cousin or two out east...he was supposed to get better not worse! With tears in her eyes, his friend proclaims "He just said last week he wasn't ready to die!". And now here he lies. He was fighting...fighting for his life those last few minutes.

Shock...trembling, with dry tears....Shock is right...my state and his. People say there is nothing I could have done differently, but it feels wrong. Doctors and others failed him, but so did I. He was going into shock from loss of blood...still bleeding inside...I wish I would have told the doctor THIS IS Serious. I mean she knew it was, but....well...I could have been more firm and told her he needed surgery.

Finishing his admission paperwork I push forward…a bit irrational now that he is gone. Sad. Heart breaking. Tears flowing now. This cute little man...now gone. Why?

The dead who have a heart beat

What a tragic weekend. Upsetting yes. I know that I am hardened by my job a bit...that my humor has changed although most of me protests it. If I didn't, I would not have survived. How could I? Two patients I took care of were dead. Yes they were breathing and had a heart beat, but that is about it. I have to ask myself...why? Why did their families allow them to suffer for so long like this? The only other responses out of them is a grimace to pain as they are turned while the other occasionally will just start shaking his head no...seeming to scream..."I'm done! I'm hurting! Stop!". So you try to make them comfortable and give them pain meds, but you know in the long run you are taking care of some of their last hours. Thankfully, both families after weeks have decided to finally let their loved ones go...but I hope it's not too late. Blank stares with eyes open yet glaze...I wonder if they can hear me? I try talking to them, but it’s so hard. Both wives and families don't even come to visit! Not a single one all weekend long! These dying men, left to themselves. How terrible. So I don't think about it...I just provide the loving care as best as I know how…kind of like taking care of an overgrown doll.

Another patient…already dead…face blue…blood coming out of mouth…yet still has a faint heart beat. She’s been without oxygen for too long. Heart slows down…family won’t let her go…more epi…more atropine…more cpr…she is back…well sort of…her heart is beating…but she’s not there. The family is praying for God to heal her…I can hear them out in the hall. Yes…God can heal her but will he? He would literally have to bring her back from the dead! She’s in her 60’s. Yes that is younger, but what a mess! Does the family know they are offering up a curse? They don’t understand. Unless God completely healed her…even if we stabilized her heart and blood pressure…she would be a vegetable…nothing more. Why do they torture themselves…seeing their mother in such a terrible state? Alarms and tubes and blood and shouting and pain…it would have been so much more peaceful to die with family all there letting her go…instead it will probably be a war death…fighting and fighting with beeps and strangers till her heart finally says no more.

Yes, I am more distance from pain in some ways...but not really...I just have a different perspective. It might sound terrible to wish for death for a patient, but you haven't seen what I have seen...the agony and pain....the body without a spirit...how could you wish to keep on going? I used to think there was much more of an ethical dilemma when taking someone off a ventilator...(there are in a few cases), but mostly there is none. I guess I have hardened my heart in one way so unexpected...to keep nursing and caring for those patients whose families won't let them go.

A priceless gift

This past weekend at work I saw my smiling, but very sick patient I had a few weeks ago. Because of insurance reasons, he was still on our floor, but I didn't know it until walking past his room...there he was sitting in a chair off the ventilator looking like a different, much healthier man! When people are on breathing machines, they can't talk and sometimes you wish that you could just hear their voice and have a conversation with them. Actually I specifically remember telling this patient I wish I could just hear his voice and encourage him that one day he would have it back. Well as I walked by he remembered me and spoke!!!! Such a strange phenomenon. A large and rougher man, I expected a deep, coarse voice. To my surprise, in a cheerful alto tone he greeted me...smile on the face. He is going to make it! What a priceless gift!

I just held her hand

This weekend was filled with many emotions.

I think I realize how much I love smiles. One patient that I had both last weekend and this...he just always smiled. How can one smile when you are on a vent and trapped to a bed? I really don't know, but he did. How can one keep such a good attitude? But he did. I think he is one of my favoirte patients and I hope he gets well...all the way better and never smokes again.

Then there was another one...a man whose life is forever changed. A clot to the head and this talkative, active middle age man is slient except for "yah" or the occasional blurred words. His wife is prepare, but not really. How can you not just cry yourself to sleep?

A lady...I never really knew her, but there I was...watching her die. So sad. She was an older lady, but death? Already? She wanted off the vent and it was clearly in her living will. Her heart had stop at the begining of my shift and we got her back with a few meds and some pushing on her chest...but she was done. I wonder if she realized that when she squeezed her son's hand affirmatively, she would not live past the night. Did she know she would die? How could her son walk away...not even saying goodbye? I know...he was grieving in his own way. I wish I could have talked him into staying. So there I stood...and although the doctor ordered it...it was me who told respiratory to pull out the tube and it was me who stopped the Neosyn which was keeping her BP elevated. I wish she would have spoken as I held her hand. All the interaction was me giving her a drop of water before she slipped into a deep sleep. I held one hand and the pastor the other...part of me even wonders why I called him though. Have you ever seen someone die? It just happens... Attempting to offer words of hope and singing songs to this stranger. Who was she? What was she like? Her family doctor said she was one of her "favorites" as tears gathered in her eyes. A phone call to the son...he talked on the phone to his dying mother...you could tell she heard for her breathing increased and she had a facial expression...then it was down hill. I held her hand for an hour...her heart was strong...and she slowly slipped away little by little. When does the soul leave? I really don't know. But I held her hand and the tears in my eyes....no family by her side...no ceremony or event...alone...she died...and the world didn't stop...it barely knew she was gone...and I just held her hand

19 year old boy

I worked extra this week...came in for just a few hours, but ended up staying more. How can you leave with a family distraught and people crying in agony? Their grandson with CP was dying...and they had made him a no code. I couldn't quite understand it all because well...his quality of life wasn't so great...he could barely say ''yes'' or ''no'' at full capacity and was so dependant upon his family, but they loved him so much. His Grandfather was literally loosing it. How could I help? What could I do. The tears and boxes and boxes of tissues. The pastor came, but I guess the Grandfather isn't a Christian and it wasn't helping him. So I tried to get someone else to talk to him...a pastor at the hospital because well...they are supposed to be good for all religons and I had to tell him not to speak of Christianty to the Grandfather...what? I guess it was my choice. It just seems wrong...so confussing...maybe this was the Grandfather's chance to accept Jesus...but I didn't want him to be forced into it and he needed support. Was this playing God? So confussing. That was last night. I wonder how the boy is doing. He was so young. Wonder if he is still hanging on. So much love there was for him. I don't understand. And there I was...feeling numb and well...half way immune to their cries. But at the same time my heart went out to the living...I wanted to do all I could to help them...help ease their pain. That's why I stayed longer...how can you just leave like that? You can't!