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  1. January is National Cervical Health Awareness Month and a chance to raise awareness about cervical cancer prevention. This cancer is slow-growing, and you may not have any symptoms, making it “the silent killer”. About 13,000 new cases of cervical cancer in the U.S. will be diagnosed in 2019, although it is highly preventable because of current screenings and vaccines. Who Gets Cervical Cancer? All women are at risk for cervical cancer, but it most often occurs in women over age 30. The human papillomavirus (HPV) is the most common cause and the primary risk factor. Other risk factors that increase the risk of cervical cancer include: Smoking Having a weakened immune system Chlamydia infection Being overweight IUD use Multiple full-term pregnancies First full-term pregnancy under the age of 17 Family history Diet low in fruits and vegetables Using birth control pills for 5 years or longer What are the Symptoms? Early cervical cancers usually do not have any presenting signs or symptoms. As the cancer becomes invasive and grows into nearby tissue, the most common symptoms include: Abnormal vaginal bleeding, such as bleeding after sex, bleeding after menopause, bleeding and spotting between periods and having periods that are longer or heavier than usual Unusual discharge from the vagina, which may contain blood and occur between your periods or after menopause Pain during sex Since these signs and symptoms occur with other gynecological disorders, it is important to seek healthcare for any of the above. What Tests Prevent Cervical Cancer or Finds It Early? Fortunately, cervical cancer is highly preventable and there are two tests that either prevent or provide early detection. Depending on your age, your doctor may recommend a Pap test (or smear), or an HPV test, or both tests together. The PAP test is one of the most reliable cancer screening tests available. It screens for cervical cancer only and detects pre-cancers and cell changes on the cervix that can be treated so cancer is prevented. The HPV test looks for the HPV virus that can cause precancerous cell changes and cervical cancer. Let’s take a look at the testing guidelines, according to the CDC. If You Are 21 to 29 Years Old You should begin Pap testing at age 21. If your tests are normal, your doctor may tell you to wait and have your next Pap test in three years. If You are 30 to 65 Years Old Your doctor will determine the best testing option for you. Pap test only. If results are normal, you may be told to wait three years before your next Pap test. An HPV test only. This is called primary HPV testing. If your result is normal, you may be told to wait five years until your next screening. An HPV test with the Pap test. This is called co-testing. If both results are normal, your doctor may tell you to wait five years until your next screening. If You Are Older Than 65 You should continue Pap and HPV testing as your doctor recommends, even if: You think you are too old to have a child Not having sex Your doctor may tell you that you don’t need to be screened anymore if: Your screening test results have been normal for several years, or Your cervix has been removed as part of a total hysterectomy for non-cancerous conditions (i.e. fibroids). You can review a full version of cervical screening guidelines here. What Are Recommendations for HPV Vaccination? HPV is a group of more than 200 related viruses, with more than 40 being spread through direct sexual contact. There are around a dozen HPV types that can cause certain types of cancer, including cervical, anal, oropharyngeal, penile, vulvar and vaginal. Current CDC recommendations for vaccination are as follows: Children and adults ages 9 – 26 years Routinely recommended at age 11 or 12; can be started as early as 9 years of age Recommended persons through age 26 who were not previously vaccinated Adults ages 27 through 45 years of age The vaccine is now recommended for all ages 27 through 45 years. Clinicians should discuss with patients in this age group who were not adequately vaccinated earlier if the HPV vaccination is an option for them. HPV vaccination may provide less benefit in this age group because more people have already been exposed to the virus. If You Are Pregnant HPV vaccination should be delayed until after pregnancy. But pregnancy testing is not required before vaccination since there is no evidence vaccination will affect pregnancy or harm a fetus. For more information about HPV vaccination, visit the National Cancer Institute’s HPV vaccination website here. Where Can I Find Free or Low-Cost Screening Tests? People who have a low income or no health insurance may be able to get free or low-cost cervical cancer screening through the National Breast and Cervical Cancer Early Detection Program. To learn more, call 1-800-CDC-INFO or visit: CDC - Cancer. As a nurse, you often have the opportunity to educate patients on what they can do to prevent cervical cancer. Education is a key prevention strategy, as cervical cancer is the easiest gynecological cancer to prevent and is highly curable when detected early. Additional Information American Cancer Society-Cervical Cancer Month
  2. jeastridge

    Breast Cancer Simplified

    My phone lit up with a message from a friend in a nearby town. “Let’s get together for lunch this week.” I responded with, “Sure, what’s up?” Her answer made me sit down. “Breast cancer.” Breast Cancer Statistics The “C” word is met with foreboding by us all, but breast cancer brings along with it a special dread to women: possible breast-altering surgery, treatment that can include chemo and radiation and the increasingly less likely risk of death. With statistics showing that according to the National Cancer Institute (NCI), “12.8% of women born in the United States today will develop breast cancer at some time during their lives,” and “2.6% of women in America will die of breast cancer.1 As scary as that statistic is, the NCI emphasizes that the same numbers also show that there is a 7 out of 8 chance that an individual woman will NOT have breast cancer in her lifetime. All the statistics invite us to careful monitoring, including regular mammograms after age 40 or 50 for women with average risk. Additionally, many physicians recommend genetic testing such as for BRCA gene if there is a higher than average family history of breast cancer or any ovarian cancer. How to Reduce Your Risk All women have the opportunity to adhere to healthy lifestyle choices that can help decrease their chances of getting breast cancer including2: Limit alcohol. Greater alcohol intake=greater risk. Don’t smoke. Weight control. Physical activity. Breastfeed. Limit duration and dose of hormone therapy. Avoid radiation and environmental pollution. Treatment Options As professional nurses, we often get asked questions about breast cancer and treatment options. Unless we are actively working in the field, we are not usually qualified to answer questions and often must refer to others or to reliable published material. However, it is important for us to stay up-to-date and understand some of the more recent changes in breast cancer treatment. Staging According to LaCosta Brown, RN, MSN, OCN, a nurse navigator for breast cancer, a lot has changed in staging breast cancer since January 2018. Previously, staging involved one sheet of paper, one chart essentially, and noted tumor size (T), nodal status (N), and metastasis (M). The TNM staging method had been around for a number of years and served as the guide to defining surgery and treatment options. However, for the past 2 years, grade and biomarkers are also taken into consideration. The total picture is the TMN + G + B. Grade Grade refers to how abnormal the cancer cells are when examined under a microscope and range from G1 - Well-differentiated (low grade) to G3 - Poorly differentiated (high grade). Essentially, the higher the grade the faster the spread of the disease. Biomarkers - HER2neu Biomarkers include estrogen receptors, progesterone receptors and HER2neu (Human epidermal growth factor) status. 80% of tumors are hormone-positive and thus respond to treatments that help to curb their growth, treatments that include drugs like Tamoxifen and Arimidex. So if cancer responds to hormones, it is Estrogen or progesterone positive and therefore would respond to these drugs that specifically work to slow down and impede tumor growth and spread. These long term “chemo pills” are generally used for 5 years. This anti-hormonal therapy can prevent breast cancer re-occurrence. HER2 is a protein that when present can cause cell growth and survival. Being HER2 positive opens up the possibility of treatment with Herceptin or Perjeta. HER2 presence is considered, according to Brown, as a “foot on the gas. It is go-go. The treatment modalities of Herceptin and Perjeta put on the brakes and slow or stop the growth of the tumor cells.” According to the CDC, if cancer is the “house” the 3 markers are “keys” that can help treatment get inside and destroy or slow down the cancer cell. If the “house” doesn’t have any one of the 3 keys, it is called “triple-negative.”Triple-negative breast cancers, or those that don’t respond to anti-hormonal treatment, make up less than 20% of all breast cancers. Along with surgery, the treatments include chemotherapy.3 Immunotherapy for breast cancer is also a growing field and one where promising research is being done. The new methods of precision evaluation breast cancer include genetic profiling of the tumor specimen and are much more specific and helpful in terms of specifying treatment options and helping patients decide how to proceed. New Treatment Options In years past, radical mastectomies were the treatment of choice for most breast cancers. As medical knowledge and treatment options have developed in recent years, more women are able to get simple lumpectomies and follow that up with the appropriate treatment given their staging. They may be able to have sentinel node identified at the surgery for biopsy instead of removing all the axillary nodes, reducing the problem of lymphedema of the arm after surgery. My friend and I met for lunch and talked at length about her plans for surgery and follow up treatment. Along with the technical and medical conversation, we reconnected with each other’s lives, offering one another emotional and spiritual support, realizing that as important as all of the staging and drugs and treatment info is, so also is the support we offer one another when going through diagnosis and treatment. References American Cancer Society- https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html Mayo Clinic - Breast Cancer Prevention: How to Reduce Your Risk - https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676 Centers for Disease Control and Prevention: Triple-Negative Breast Cancer https://www.cdc.gov/cancer/breast/triple-negative.htm
  3. NutmeggeRN

    Choosing the 4th Option

    As a school nurse for 20 years, I have had more than my fair share of kids who have been diagnosed with cancer. I have had kids win the battle and lose the battle. Some had intensive therapy regimes, with every side affect possible and some blew through treatment with little side affect. Some have survived and some have not. I live in a little town that is seemingly overwhelmed with pediatric cancer diagnosis but when I try to clarify numbers with epidemiology, I find we are not higher than we should be statistically. Tell that to a parent and child whose whole world has been turned upside down. And now it is personal. My grandson to be (my sons soon to be stepson) has been treated for a brain tumor since he was 6 months old, he is now 5 �. Multiple surgeries, countless rounds of chemo, radiation, a shunt..... Recently there has been increased growth of the tumor. We met yesterday to discuss the results of his latest MRI. I was able to meet with the team from his Children's Hospital. What an amazing group of people. I have interacted with them over the years, as a school nurse, but this time it is personal. After his appointment 2 weeks ago, they were given several options to consider. Radiation, oral chemo at home or a six week clinical trial at St Jude''s. Or do nothing. An unimaginable choice. They sought out pastoral counseling, and spoke with parents who have been down this road with their child. They wrestled with putting their child through intensive disease based therapy, knowing the end result will not change. Or suspending treatment. Worrying they were giving up on their child. These are young parents. She has been a single mom her whole adult life, with an 11 year old who has clearly been impacted by his younger brothers illness. My son stepped into this situation early last year and has been a bedrock for her. They were friends in high school and now have a new relationship as adults. But he, MY (32 y/o) baby, hurts as well. He lost his dad at a young age and really struggled from the time he passed the age his dad died at, until about a year ago. They have not had it easy as young adults. They have become a strong force and a united family. And now it is going to change. She (and he) have chosen to enjoy this little man as long as they can. And they had the blessing and clear support of the team at the hospital. They were reassured they can change their mind at any time, and they will ALWAYS be a part of the Children's Hospital family. As a health care professional, I was moved by their empathy and understanding. As his grandmother, I am devastated, but strengthened, by their clarity and comprehension that this lil' guy has a limited time with us and it is up to us to give him the life a normal five year old. We will move forward from here, with periodic visits to assess growth of the tumor. They will now start to consider end of life care decisions.DNR, POLST, MOLST...there are too many acronyms to be had in medicine. These are by far the hardest decisions any parent should ever have to make. I applaud the team for being forthright and not sugarcoating that this is an issue to be dealt with. And I applaud my son and his fianc� for not backing away from the difficult conversation and inevitable decisions. We will be strong as a family but, There should never have to be a 4th option. EVER.
  4. SoldierNurse22

    Little Brother

    It was a story I'd seen before: 19-year-old airman, T-cell lymphoma, air evac'd from overseas after a plethora of symptoms led to the discovery of his cancer .I headed boldly into the room, my orientee close behind me. A young black male, no older than my younger brother, sat in bed, large headphones on his ears. A teenaged boy slept on the couch. Both of them looked up as I entered the room with suspicion in their eyes. I introduced myself. I asked about his pain. His voice was quiet, his eyes avoiding mine, his body language closed. As I assessed him, listened to his heart, listened to his lungs, checked his pulses and asked him questions, he muttered his replies, his eyes flickering downward toward the white sheets on his bed. He was distant in his answers, as though replying from somewhere out of his body. Unruffled, I reminded him of his NPO status for his pending bone marrow biopsy that morning and headed back to the computer to chart. Poor kid, I thought. He's clearly afraid. I showed my orientee how to chart the assessment, put in the vitals, and together, we continued on our way. An hour or so later, the physicians called. They were ready for the bone marrow biopsy. My orientee and I premedicated the patient for the procedure, took our time with answering his questions and put him in the hands of the oncology fellow, a short, bubbly lady physician who was only too happy to answer his questions and hold his hand. My orientee and I returned to our other patients. An hour later, he returned to the floor. He was just in time to order breakfast. I gave him the menu and he called downstairs for his food as I stood next to the bed. Once again, we asked him if we could get him anything, and upon his denial, we encouraged him to call and headed on our way. Forty-five minutes passed. We returned to the room to see him and he had no tray. I called downstairs to order; the kitchen had closed. No more diet techs were leaving for the wards for food delivery. My 19-year-old bottomless pit would have to suffer through the next hour and a half on an empty stomach, all because the diet techs were too lazy to bring up his tray. This was not right. My orientee once more on my heels, I took to the elevators, the two of us storming the galley. I was frustrated and outraged on behalf of my patient. As we entered the galley, two young enlisted sailors met us at the door, ready to deny us entrance. I don't know if it was the determination in my eyes or the fire in my tongue that convinced them to open the doors to the food prep area, but there we were, donning hairnets and traveling through the forbidden bowels of the basement. The sailors took me to their civilians counterparts, the phone-answering folks and those responsible for assesmbling and dispatching the trays to the inpatient wards. "Ma'am, the kitchen is closed." A civilian was barreling my way, her tone haughty. "My patient didn't get his tray. I'm here to get it for him." I said, turning to face my opposition. "I'm sorry, ma'am, the kitchen is closed." She insisted. I squared off. "And I'm sorry, ma'am, but I'm not leaving until I get his food. You still have food out in the prep area. I'll put the tray together myself. But understand this--I'm not leaving without his food." I replied evenly. Her eyes darted from my face to my rank. I was just another second lieutenant at the time, one of hundreds at the command, but apparently the gold bar was enough to convince her that I'd take the matter higher if it wasn't dealt with immediately. "All right." She conceded. Within ten minutes, we were on our way back upstairs with our hard-earned tray. My orientee brought him the tray, presenting it like the trophy it was. He barely looked at us, murmured a thank-you as we left his room, both of us admittedly disappointed at his response to our heroic efforts. A half hour later, his call bell rang and we returned to his room. The pain from the biopsy was intense, much more intense than I'd seen in any patient before. I got an order for breakthrough pain meds, overrode the order in the Pyxis and began to push his morphine. As I delivered the dose, he began to whimper, suddenly asking me to stop. "What's wrong?" I asked. "It burns!" He exclaimed through tears. I felt irritation flash through my chest. Here I was bending over backward for this kid, charging the kitchen and fighting with the pyxis and putting on my happiest face, and he was complaining about the pain meds he had just been crying for? I choked back my frustration and flushed the line, the pain abating instantly as the saline replaced the narcotic. At the desk, I explained what had happened to our intern, who rolled his eyes. "Fine. Percocet. It's not nearly as strong or as fast-acting, but if he can't take the IV narcs, it's the best I've got." I returned to the room, provided the once again overridden med, and left the room after making sure he was all right. Not so much as a thank-you followed me to the nurse's station. For the sake of my orientee and my pride, I held it together. On the surface, I was frustrated with his lack of response to my compassion. I was irritated by his apparently impervious take to my Herculean effort to make him comfortable. What I wouldn't realize until much later is that I was really just afraid. The shift continued similarly. I did my best to reassure him, to calm him, to sit with him, but he wanted none of my empathy. When his mother arrived, he collapsed onto her chest, and I was relieved that he finally had someone who he trusted to fall against. But the frustration I had felt earlier still grated against me and against my genuine efforts to secure a good rapport. The next day, I had him back. All day, I medicated not his pain, not his physical body, but his fear. With incredibly diluted IV pushes of dilaudid, I realized that I numbed his mind from the reality of his physical state and induced the sleep that spared him from the mental agony of his cancer. My coworkers, nurses and doctors alike who were familiar with the situation, sighed in a similar frustration. When was this airman going to man up? When was he going to accept this diagnosis and snap out of it? We aired our grievances privately to each other, and I though I knew full well that what we were witnessing was simply the ineffective coping mechanisms of a patient who was not yet truly an adult, his inability to accept our kindness and his own disease still poked at me like a thorn in the side. Perhaps I'm becoming too jaded, I told myself. Perhaps it's time for me to get out of oncology. Weeks later, he returned to our ward. He was early for his chemo admission, still withdrawn and difficult to illicit even the most basic responses from. It was as though he had regressed to his early teenaged years under the stress of his disease. He was not my patient, but when he reacted to his blood transfusion on the weekend, I, as charge nurse, assisted his primary nurse and my good friend in collecting the necessary samples and setting up the IV fluids that were warranted. He was just as I remembered him from before: a quiet, whimpering little brother, afraid, alone now that his mother was 500 miles away, and painfully withdrawn. But this time, I recognized the emotion that hid behind the veil of my old frustration. It had been fear. I was afraid that, as a nurse, my care was ineffective and inadequate to soothe his fears. I was afraid that I didn't have the emotional capacity to calm him. I was afraid that if I were to find a way to reassure him, I'd lose the bubble that insulated me from the cruel reality of my patients' often grim conditions. It was fortuitous that I had the weekend to consider these facts, because today, Little Brother returned from the PICU to our ward. Despite my hesitation to take him as my patient, all the other nurses were busy. His care fell to me. I prepared myself emotionally for the long haul. I was exiting another room when I saw the PICU nurses in their maroon scrubs returning down the hall with an empty wheelchair. I got a quick follow-up report, bid them farewell and met my tech outside the room. We entered together, fully ready to continue cajoling this adolescent-like young adult into cooperating with our care. To my shock, he sat up on the bed, fully emerged from his blanket-like cocoon, and he smiled as we entered. "Good afternoon. How are you feeling?" I asked him. He looked me square in the eye. "Much better, ma�m." He replied. I almost fell squarely on my fifth point of contact. He spoke! "Any pain today? Any nausea?" I asked. He shook his head. "Nope. I've been able to eat now and keep it down for a day or so." And on went the discussion. I set up his IV antibiotics, explained what they were, and as I did so, he talked. We found that we both had very particular taste in water of all things. While he preferred bottled, I was staunchly in favor of tap. He told me about a girl on facebook who had friended him. "Do you ever have it happen where you see someone and you know you've met them before, but you don't remember when?" He asked. "It's awful, isn't it?" I empathized. "Oh, it's terrible!" He exclaimed. He told me about how things were going outpatient, about how he missed his mom, about how he was glad to be back on our floor because he had been lonely in the PICU. I listened and nodded, interjected my opinion when it seemed warranted, and eventually, as I programmed the pump for his vancomycin, he asked me a question. "How do you do this?" He asked, his tone suddenly serious. I stopped my work and made eye contact with him. "What do you mean?" "I mean this." He said, looking around. "How do you work with people who have cancer and diagnoses like this all day?" I sighed. It was a question I'd been asking myself a lot, lately. "Well, I guess practically speaking, people are going to get sick. I figure they'll get sick whether I'm there to help them or not, so I'd rather be there and have a chance at making it better than just giving up." I said. He nodded, visibly chewing on my words. I continued. "As for patients--I guess I can't really come at it from that angle. I know it's got to be difficult to be young and have cancer, especially when you were in such good physical shape before. I have a friend who survived leukemia and he told me he had similar struggles, but y'know, he's healthy now. He's been in remission for a few years. It's not like this diagnosis is a death sentence." He nodded, his eyes flickering with the thinly veiled hope in my words. "I just hope it doesn't come back." I wanted to tell him it wouldn't, but I knew better than to make promises. So I nodded in return. "Me, too." "I was so angry when I found out I had cancer. I mean, why me? Why am I the one who gets this at nineteen?" He said. "It's just not fair." I was amazed at what I was hearing. To listen to him discussing what he had been feeling and what he had been through was therapeutic to be certain--for him and for me. "No, it's not." I agreed. "I guess I'm just coming to terms with it now. I didn't realize I could be depressed and angry." He told me. "Acceptance usually comes after going through many stages, and not always just once. It's not quite as tangible or definable as some people will have you believe, and it's very normal to go back and forth. Some days will be better than others." I reassured him. He nodded. "I'm just ready to get this chemo over with." The rest of the shift only improved. Every time I went to see him, I stuck around to talk. He made me laugh, I made him laugh, and eventually, I'd say goodbye and see him in the next hour only to repeat the previous interaction with different jokes and discussion topics. By the end of the day, I introduced the night nurse and said goodnight, genuinely looking forward to seeing him again. So tonight, I sit here to write about things that I know I must remember. The girl who graduated nursing school two years ago and found herself unwillingly placed on an oncology ward met me today. She shook me by the shoulders and reminded me that pain is often masked in anger and fear, that sarcasm and cynicism do not often improve patient outcomes, and that a little patience with the most difficult patient goes a long way. She reminded me of the longsuffering nature she had entered her field with, of how she could often see through the coping mechanisms that those more experienced and more calloused had lost the ability (or at least the willingness) to identify, and how she had hoped as a young nurse that she might never lose that talent when it came to understanding the pain of others, however masked or distorted. Tomorrow, the day will dawn new. And I'll return with the most knowledge, the most skill and more compassion than I've ever known to the care of Little Brother and countless others like him.
  5. Ecmoking

    My Father, His Final Lesson

    I remember the day we went to the oncologist with my father. The doctor came in said hello, and before he finished sitting down, he had delivered the bombshell, "you have less than 6 months to live." I remember being so angry at him, and me the meek person I am, let him have it. I proceeded to tell him, and without expletives, that he is the sorriest physician there was and would ever be, me the new nurse who started his practice less than six months ago. We waited while they copied my father's records. My father just beat a run with colon cancer just two years prior. He had a colon resection and they did not do chemo afterword's because the doctor's "THOUGHT" they got it all. My dad's attitude now was "**** em" look what these smart-ass doctor's know." Little did I know this was the beginning of a most surreal journey. Now my dad was a self-made and educated man. As a child, he grew up in the depression in New York. He had a ninth grade education. I remember him telling me that he got expelled from school because he got into a fight with his principal. He was a tough guy. His favorite sayings to me were "never take any crap from anybody because once you do you will take it your whole life." Although that was his main premise for life he became a very successful businessman. He had a life that few could match. Let's just say my relationship with him was hot and cold. He always talked yatta, yatta, yatta. He loved people, I remember being embarrassed many times by his social charisma. We disagreed about everything. I used to joke with him "are you sure I'm your son." We would both laugh because I was adopted. I had told him from the beginning "dad you have had a life many only read about. Let it run its course, it is the quality of your life, not the quantity that matters." This drove him nuts. Anyway, he had called in many of his markers and he was treated with experimental meds, the whole nine yards. It was almost three years since he was diagnosed with terminal Lung cancer, which spread from his colon. My dad was doing pretty good. He had been on the experimental drugs with none of the usual side effects. I took care of him just like I was taught to in school. He was my patient. I was the teacher. Little did I realize that he was going to teach me. Then he got the word. The PO meds he was on weren't working anymore so he had to start conventional chemo treatments. During the time he started the what he called "the hail Mary pass" He spent his days playing tennis and spending time with me. My dad and I were becoming friends. I was at home on a Thursday. My father called and he was in a state... I had never seen him act this way, Hell I only remember seeing him cry once when his mother died when I was eight. When I get to his house he's frantic, pacing the floor, grabbing his head and chest, he sits me down and doesn't say a word. He tried several times to talk but the words didn't come out. I thought he was having another TIA. Finally, he was able to speak and what he told me shook me to my core. He told me he was going to die very soon. Have you ever had a patient tell you that" I'm going to die tonight" and of course you think yeah whatever, by the end of your shift THEY WERE GONE? Well, this is what hit me... and as if looking through a hazy pane of glass I could see my dad realizing for the first time that he was going to die. The surreal part was we were arriving at the same realization, at the very same time. I knew all the Kubler -Ross stuff and all the intellectual mumbo-jumbo but, emotionally for the first time we let it in, the finality of death. Both of us sat there for what seemed forever. He suddenly stood up, rearranged his clothes, looked at me and said: "I don't want to kept alive on machines unless YOU FEEL this is only temporary." He had started giving me exact specifications as to what he wanted and didn't want. After his directions were finished we just sat after that not really talking. I was realizing that after all the years of fighting with him it took cancer for us to finally respect one another and became very close friends. The next day he was back to his same old self-talk, talk, talk, except now he was reminiscing as if he was double checking his life. He in his 73 years never said I am sorry, not to me or anybody that I can remember. That day we went for a walk and guess what he apologized, it didn't matter to me for what... I knew at that very moment he would be leaving me soon. When we got back his wife, my stepmother, said to me," is your dad OK? he has been acting very strange the last few days." It was Saturday night around 9 pm when I got the call at work from a policeman informing me that my dad "went down " at a restaurant and that they were taking him to the hospital. I remember just staring at the code cart directly in front of me. I slowly walked out of work and drove to the hospital. When I came to the ER doors I could hear the defibrillator charging. I also heard a very familiar voice, it was my Paramedic friend from nursing school. As soon as she saw me she started crying and kept saying I'm Sorry, I'm sorry. She had held her arm up and dropped the EKG paper of how many times they had shocked him in the field. We walked and hugged and she took me back to see my dad. I was almost elated when I saw who the doctor was who was running my dad's code as if It was my only last moment of delusion left to keep me sane. The Nurse in the room was phenomenal. I couldn't believe what she was doing and how much of it, yet she was completely calm except she needed another eight hands. You could smell the burnt skin. My dad woke up after being shocked over 75 times. He looked at me. He couldn't talk because of the ET tube. I picked up his hand and asked him if he wanted to fight a little longer he nodded yes, I told him I remembered what we talked about as if reading his mind, He closed his eyes and that was the last time I had any further communication with him at all. The doctor got him stable enough to take to CCU. My stepmother said to me "I hope he doesn't die tonight because it is your sisters birthday." I tried talking to my stepmother about making him a DNR after he coded a couple more times but all she could say to me was "I can't make that decision, I don't want him to suffer, but You are going to have to make it. Of course, it being my sisters birthday I can't get a hold of her. During the next couple of hours, I had signed the DNR papers still hoping to get in touch with my sister. It was early Sunday morning when I spoke with my sister. It would be some time before she got here, so we just waited. Well, my dad had other plans as if to remind me that enough is enough he started to code, and the nurses that were taking care of him were on break, my stepmom comes out and tells me they're putting pads on him again. As I am walking into the unit I hear the defibrillator charging. I popped my cork. Well, let's just say that the hospital staff will at that hospital not make that mistake again. I had gotten my stepmom and withdrew everything. Even as a nurse I knew all the right words and lingo to help somebody else in that position but for me I was numb. The enormous weight of helping my dad die with dignity and following his wishes was crushing my soul. I was tormented, of course, it didn't help when my sister arrived and yelled at me "you killed my father." So much drama. It wasn't until almost six months later when the doctor in the ER saw me and asked: "how are you holding up." That was it, out of know where I was crying like a baby. That poor doc was just standing there and I could see he was like Oh **** what did I do. For the first time since his death, I allowed myself to grieve. I didn't know why then. Then it hit me, something my dad said to me in his dissertation of directions. The day he told me he was going to die very soon. He told me "don't blame yourself for anything, what you are going to do for me is the hardest thing you will ever have to do but at the same time the greatest act of love there is." My fathers greatest lesson to me has helped me more as a nurse than anything I have learned or will ever learn in caring for patients. His love for people made him sensitive towards their needs. It gave him a great insight into them as an individual. We as nurses today live our work lives in a state of constant flux. Just when you think there could not possibly be another piece of paper to fill out there is. Just when you think you have enough meetings to go to and enough committees to be a part of there is more. The reason there is more is that we take care of people. Yeah, there are some real pieces of work out there, but they are people. My patient, my father taught me that I as Nurse I am going to help people die, and to do that with dignity and compassion. If my dad didn't take me on that journey with him I don't think I would still be a nurse. I feel honored to have been a part of so many people's final journey. Each and every time I learn something. Yeah, we have to do our jobs effectively and objectively and take care of all the litigious issues, but alas we are taking care of people. Thanks, dad for helping me to a more sensitive and caring nurse. Thanks for helping me to see the individual needs of a patient on a daily basis, and most importantly Thank you for teaching me how to deal with and help others deal with the final journey. I miss you, dad.
  6. nkochrn

    Reflecting on the Above and Beyond

    The very first time I ever stepped foot into an oncology office was the day my Dad was diagnosed with Stage IV Melanoma. The only thing I could think as I sat there was, "Why does anyone decide they want to become an oncologist or even work in a place like this?" These people have actually made the choice to work with one of the most dreaded diseases there is, every day. They have to tell people this disease is going to end their life, tell families their loved one's time is limited, and give them the statistical odds of survival. The second time I entered an oncology office was again with my Dad, this time for a second opinion. That long wait from the time you are seated in a tiny exam room to the time the doctor actually enters the room seemed so much longer and harder to sit through than the wait at any other doctor's appointment I've ever had. Our experience in this office was much more positive, because we were given hope. My Dad was not treated like just another statistic with a 5% chance of being alive in 5 years. We learned about more treatment options and heard stories of positive outcomes. My mom and I were feeling a little better about the situation when we walked out of that office with a plan. My Dad was admitted to the ICU a week later and started his Interleukin 2 treatments. We were blessed with some wonderful, caring, and skilled nurses. They checked in on my Dad frequently and monitored him closely. They not only did everything they could to make his stay comfortable, but they always asked if there was anything they could do for us. They offered us snacks and drinks and really went above and beyond to make us comfortable. The team of nurse's on this particular unit had taken the initiative to make their own pamphlet with information about the treatment. They gathered information from previous patient's experiences to help give their patients the best education on what to expect. The team of doctors and nurses encouraged him and let him know how impressed they were with how good he was tolerating the treatment. The team of nurse's that took care of my Dad really made an impact on me and has really made me take a hard look at myself as a nurse. I felt confident that my Dad was receiving some of the best care there is while he was hospitalized. I've so many times heard someone say, "This isn't a hotel," and I know I too am guilty. They didn't have to offer to bring drinks, snacks, extra pillows, or blankets to us as visitors, but they did. This seems like such a small simple gesture, but it really meant a lot. The little things that we tend to complain about as nurses can make such a big impact on a family dealing with a difficult situation. The nurse's didn't have to create that pamphlet for their patients, but they did. It's hard to understand just what the patient's family is going through until you ARE the patient's family. These nurses went above and beyond even while working in one of the toughest specialties I could imagine and I have great respect for them. I hope someday I can make just a great as impact on someone else as they have on me.
  7. littlemammanurse

    A Goodnight Kiss and A Bedtime Story

    I thought I would share this touching story with you. I work on a Palliative/Oncology/General Medicine floor and work mostly nights. We mainly have geriatric patients, but we do have some younger children that are on our floor as well. There is this one special little girl who touched my heart. The nurses on the floor had warned me that she doesn't sleep at night and is constantly ringing on the call bell. It's a busy floor, so I knew that it was going to be a long night. Well, this night, in particular, I was pretty busy, and sure enough, this little girl was ringing on the bell non-stop. No matter what I did she just kept ringing that bell. I finally asked her after the 20th time of ringing the bell why she wasn't sleeping. She has cancer and is in pain, and most of the time she just wants to be readjusted in bed to a more comfortable position. She told me she couldn't sleep. Well big surprise I knew that already. I sat down at the edge of her bed and asked what I could do to help her get to sleep. I asked if she had any nightly rituals that she used to do at home that helped get her to sleep. She told me that her mom would tell her a story and give her a kiss goodnight to get her to sleep. So I told her a story and gave her a kiss goodnight and sure enough the rest of the night she slept and didn't ring the call bell! This continued the next few nights that I had her. I would tell her a story to kiss her goodnight and she would sleep. Well her cancer got worse and a few nights ago she was dying. I was on the floor that night and didn't get her as a patient. Just as she was about to slip away her mom came up to the desk and asked for the nurse that told her daughter stories every night to get her to sleep. The nurses all told her that it was me. I had just finished my rounds and saw her standing at the desk waiting for me. She asked if I could tell her daughter a story even though her daughter had now slipped into a coma. Her mother began to tell me that her daughter loved my stories and before she had slipped into a coma would always ask for me on the night shifts to come and tell her a story. I was busy, but I knew that it would help the patient's mom feel more at peace to give this one last request to her daughter. I walked into the room, sat on the edge of her daughter's bed and began to tell her daughter's favorite story about a princess and a sleeping dragon. As I told the story I held her daughter's hand, and I could see her daughter struggling to breathe. Just as I got to the end of my story I heard her taking her last breath. I got up kissed her on the forehead, like I had usually done and she passed away right after. I was glad that I took that one moment out of my busy night to grant a last request to such a sweet little girl. It was hard, and I cried. These are the moments I love being a nurse!
  8. EmptytheBoat

    Projectile Vomiting just prior to death

    I've had two cases within the last few months, pt. w/projectile vomiting just prior to death, both cancer patients. I've explained this to the families as the body's method of expelling the buildup of toxins from the cancer. In both cases, the episodes of projectile vomiting caused much family consternation and anguish, tainting the otherwise smooth, peaceful transition into the next life; and leaving this Hospice nurse with a feeling of inadequacy and helplessness. I'm asking for your input. How do you explain the projectile vomiting to families? Is there anything you do to prepare patient or family for this possibility? Is there anything you do to try to prevent or do you think it may be prevented? Thank you for your time, I wish you all the best. God Speed!
  9. CalNevaMimi

    Dad's Final Gift

    It was not a difficult decision to pursue a career in nursing when my first career came to an abrupt halt. I had been an elementary school teacher for six years, enduring two layoffs and finally a school closure. None of the schools had any sort of medical staff. My nurturing character and lack of aversion to bodily fluids gave me the qualities necessary to handle the non-emergencies of five to twelve-year-olds. Consequently, at age forty, I found myself sitting in a class of future nurses, most of whom were almost half my age. Little did I know that the most difficult challenge was yet to come. It was summer. I was half-way through my nursing program. One day I came home and my husband told me that my mom called and the news was bad: Dad's got terminal lung cancer. I started the grieving process from the moment I heard the news. Nursing school had already given me some insight on the horror Dad would experience with this dreadful disease. The grim thought of him basically drowning in his own tumors and fluids was horrendous. The impending pain I knew Dad would feel bothered me the most. I felt helpless at first, but then decided to less selfish; my feelings would need to wait. I needed to be strong and practical for my parents because they would need it. I would be there for my mom, who would have many questions regarding medication, side effects, what to expect, and how she would help with pain. Dad was accepting of his fate and opted for no intervention. He would be under hospice care at home when the time came. The day after I heard the news about Dad's cancer, I went back to class and braced myself for the lecture: Death and Dying. Really. I left the classroom twice in tears. How was I going to make it through the future lecture on lung cancer, with the color Power Point which would no doubt have pictures of tumors? The more I thought about it, the angrier I got. I decided to work as hard as possible in spite of cancer and to honor my dad's bravery. Somehow, I wanted the experience to make me a better nurse. There were more tearful trips out of the classroom for me in the following months, but I accepted them as a part of the grieving process. During clinical days at long term care facilities I gave care to many elderly residents who were probably someone's mother or father. I treated my patients the way I would want my dad treated. I held many hands and listened to several life stories. I sat by a dying woman's bedside and talked to her as if she could hear me. I learned to accept death as a part of life. Some of my fellow classmates were undoubtedly better at procedures than I was, but I felt as if I had an insight that could not simply be taught. This insight would be Dad's final gift to me. Dad never spent a dying night in the hospital. Thanks to hospice nurses, who are angels in disguise, and my amazing mom, Dad was able to live out his last days at home. Those days were spent visiting with family overflowing with love and laughter. Dad was so proud of me when I graduated from nursing school first in my class in academics. He was proud of me when I passed the NCLEX two months later. He was proud of me when my license arrived in the mail. Two days later, I was proud to be the daughter of such a brave man when he died. I have heard people say, "When God closes a door, He opens a window." Yes. In my case, that is very true. A few weeks after Dad passed away, I had my first nursing interview for a school nurse position. They hired me on the spot. Thanks, Dad, for the inspiration, insight, and renewal of faith that anything is possible.
  10. SoldierNurse22

    Deep In The Dark

    "Mrs. R? Which room?" I asked in return. "Room four." Ms. O, a plump, pleasant woman of African origins, replied. Her thick accent and tendency to say things with a smile seemed to smooth a much-needed salve over my less-than-lovely evening. The oncology grind was getting to me, wearing on nerves that could snap at anytime, like an anvil held up by cheap dental floss. The loss of a 23-year-old newlywed to lung cancer the week before had hit hard. It was far from my first patient loss, but it had affected me more than any other. To make things harder, Little Brother was back with us, struggling after his last round of chemo. He was keeping his chin up, but watching him pace the wards at night made me anxious. Those factors combined with the cocky, "do-it-for-me" attitudes of a few of my coworkers and the against-odds hope for a permanent change of station (PCS) found me wishing myself anywhere but work. "Sure. I'll be right there." I replied. I pulled up the MAR, checked the orders and headed to the Pyxis. I drew up dilaudid, my old ally, almost robotically. Dose check, label, flush, heparin lock and alcohol swab. Ready to roll. I headed down the hall toward room 4. I was admittedly much more content on nights than I was on days, staffing issues aside. There's something I enjoy about tending midnight. Her concerns are about comfort, about sleep, about a patient's fears and hopes for the next day. I love it when the lights go down in the hallways, when patients finally get to lose themselves in much-deserved slumber, when my friends and I sit around the call bell answering machine and play Uno until the wee hours of the morning. And tonight, I'm the narcotics queen, I told myself wryly as I entered room 4. The pungent smell upon entering reminded me that Mrs. R had throat cancer and a trach. As I neared the bed, I took note of a small, frail woman who lay entrenched in bed as though she were a cork in a bottle. Blankets protected her from the cold of the hospital air, enveloping her in a sea of white. "Hi, Mrs. R." I said. The little lady smiled thinly. "Ms. O tells me you're having pain." Her little head, sparsely populated by white hairs, bobbed. "I've got some dilaudid for you." Relief flooded her dark brown eyes. "Can you rate your pain?" I asked. She held up six fingers, then seven. "Six to seven?" She nodded again. "All right. Let's see if we can knock that down." I replied. I deliver her dilaudid, flush, and was in the process of heparin-locking her port when Ms. O entered the room behind me. Mrs. R began to gesture, but Ms. O was at a loss as to how to interpret her needs. Looking a little frustrated, Mrs. R wrote down what she needed on her clipboard and Ms. O thanked me for giving the pain med. I asked if she needed help and she declined. "All right. Call if you need me." I offered on the way out. A few hours later, another push request comes in for Mrs. R. "Man, that poor lady." I told Ms. O. In the time between pushes, I had been fulfilling my charge nurse duties by reviewing every patient's history and plans of care, preparing for report in the morning. Mrs. R had metastaticc ancer that had spread to her larynx. The trach had been her only option to prolong her life as the tumor threatened to completely close off her airway. She was set to meet with hospice come morning to finalize her discharge plans and then head home. "I know." Ms. O sympathized. "She's a nice lady." She observed. "I think so, too." I drew up more dilaudid. By now, the lights were down, the halls were dim, and the rooms were dark. I tiptoed into Room 4, plunging into the dark. "Hi, Mrs. R. I've got some dilaudid for you again." I said as I reached reflexively for the string to turn on the over-bed light. It was at that point that I realized Room 4 was the only room that didn't have an over-bed light. The only light in the whole room was the harsh fluorescent controlled at the wall switch. "I'm going to have to turn on the overhead light, OK?" I asked, unable to see my patient but preferring to inform her before the lights blinded us both. "Here they come." I said as I switched them on. When the lights came on, I was relieved to see that Mrs. R had her eyes closed. She opened them slowly. I had already drawn off her heparin lock and was in the process of flushing her port. "Is that pain back up to where it was before?" I asked. She nodded, exhaustion in her eyes. "Still in your neck?" I asked. She nodded again, then motioned toward her face."Face, too?" I asked. She nodded, a smile back on her face telling me she was relieved that someone understood what she was trying to communicate. "Did the dilaudid work well the last time?" I asked. She nodded emphatically. "Good. We'll get this dose in and check on you in about 30 minutes, all right?" She smiled gently. I finished pushing the dilaudid. Before I left, she mouthed "thank you" from the bed. "You're welcome, ma'am. We'll be back in a little bit to check on you." She mouthed "OK" and I turned off the light. Midnight came and went. The witching hour slipped by. Before I knew it, it was nearly time for shift change. As I prepared the report sheets and the assignments, Ms. O joined me at the desk. "Mrs. R would like some dilaudid." Ms. O said, pulling her glasses down her nose and giving me a smile. "Not a problem." I replied. "I'll be right in." One more trip for the narcotics queen tonight, I told myself. In Room 4, Mrs. R sat up in her chair next to her bed. She leaned against a pillow, partially asleep. When she heard me approach, her eyes opened. "Up to the chair for a bit, Mrs. R?" I asked. She nodded groggily."Does it help the pain?" I asked. She shook her head and motioned for her clipboard. She wrote as I pushed dilaudid. "I can talk a little bit. The bed was wet." She had written. I glanced at the bed, which appeared dry. Noting my confusion, Mrs. R pointed to Kleenex in a pink bucket that sat on the bed. It was then that I saw the mucous draining from her trach, a stream of gooey brown dripping down her chest. "Oh, I see. Do you want me to change your sheets and clean you up? We can get you back to bed if you'd like." I offered. She shook her head no, looking away despondently. "I hear you may be going home today." I said, glancing up at her. She nodded distantly. "Are you ready to go home?" I asked. Mrs. R shrugged. She met my gaze with mournful eyes. "No one to go home to." She said in a low whisper. And at that minute, I forgot my PCS request. I forgot my lazy coworkers, the grouchy day shift that was just beginning to arrive, and the emotional trials of the past several weeks. The lonely little woman in front of me captured my full attention. She had no one to care for her at home. She was dying of a painful, ugly cancer. Her every whim was suddenly my only concern. "I'm sorry to hear that, Mrs. R." I replied, at a loss. When I first became a nurse, moments like that were incredibly awkward. I searched high and low for what to say to comfort patients that were ensnared deep in the depths of that deadening depression. Eventually, I realized that sometimes in moments like those, all a nurse can do is be there in the silence with their patient and hope that the knowledge that another person has heard and validated their suffering is enough to alleviate it, at least for a while. At least long enough for them to realize they aren't really alone. "It's cold." Mrs. R said, her voice a low whisper. Her quiet comment drew my attention to the cocoon of blankets around her. "I know. Unfortunately, our blanket warmer is broken." I empathized, my mind suddenly snapping into gear. "I can get you some hot packs, though. Would you like that?" I asked. Mrs. R's eyes lit up and met mine. "Yes." She replied. "Not a problem. I'll be right back." I said, hep-locking her port and heading across the hall to the storage room. I grabbed three hot packs and three pillowcases and hurried back to Room 4. At her bedside, I activated the hot packs, slipped them into their pillowcases and handed them to my patient. She closed her eyes as she took the first one, placing it in her lap. The second one went under an arm, the third under the other. "Better?" I asked. "Better." She nodded. I wasn't quite satisfied. Her blankets, which had previously been over her head, had slipped down behind her back and the chair. "You know, we have some knitted caps if you'd like them to keep your head warm." I offered. Her eyes lit up again and she nodded. "Sure. Any particular color?" I asked with a smile. She shook her head and smiled dimly. "All right." I cajoled. "I'll find one that I think you'll like and I'll be right back." Down the hallway, I slipped into the assistant manager's office and pulled out the bags of colorfully knit caps, donated from some saints who surely have no idea how much their contributions meant to our cold, bald oncology patients. One of the caps was baby blue and fuzzy, promising to warm the head that wore it. I took it immediately. I rifled through the bags a few times, trying to decide what colors she would like. Was she a fan of pink? That can be hit or miss. What about blue? Nope, already had a blue one. Green? Brown? Red? Yellow? When did picking the best cap become more complicated than taking the NCLEX? Finally, I came across a white, purple and light-purple striped cap. I smiled. It was bright and looked like spring blooming on yarn. Perfect. I returned to her room and held up her options. "Which one would you like, Mrs. R?" I asked. Instantly, her eyes jumped to the purple one. Her fingerpointed to her decision. "Purple it is." I said, sliding the cap over her head. "Anything else I can get you, ma'am?" I asked. She shook her head and gave me a smile as bright as her hat. "Thank you so much," she said. It was my honor to smile back into her eyes. "You're very welcome. We'll check on you soon and make sure your pain goes down. Get some sleep?" I half-suggested, half-asked. She nodded, resting her head on her pillow, that smile still on her lips. I gave report, finished my charting, checked my patients and headed down the hall. I had walked a few paces past Room 4 before I turned on my heel and took a few steps back. Mrs. R sat up in her chair, sleeping soundly, her purple cap jumping out against the clean white of her blankets. Nothing could change her diagnosis, her situation or her permanently ease her pain. But that purple cap, vibrant like Easter in the dimly lit room, reassured me that while I couldn't reach all the lost and lonely, one of them slept just a little bit warmer deep in the dark of my ward.
  11. SoldierNurse22

    Down to Sleep

    I remember one day when you were receiving blood. I went into the room with your primary nurse to double-verify. You were sitting on the couch, that same smile greeting us as we entered. "Let's get the good stuff running, sir." I said. "Is it good stuff?" You asked, the corner of your mouth pulling into a smile. "The last time I got blood, it was Air Force blood on my way over from Germany. I felt weaker immediately." I laughed. "The inhumanity to man." I empathized wryly. You smiled wider. "I think my H&H actually dropped, LT." You are clearly picking up on our medical lingo and using it well. I verify the blood, exchange a few more quips back and forth with you, and say farewell for now. The next few months pass quickly. I am rarely assigned as your nurse. It's the way the winds of fate blow, but I know you because I know your smile. I know you because of the way my techs, particularly my corpsmen, talk about you with fondness. You're the one who keeps a loaded squirtgun under your pillow and attacks without mercy when they enter your room for 0400 vitals. You're the one who tells one of my corpsmen, who continues to fail his physical fitness tests, that you're going to help him pass when you can run again. I know the sight of the top of your head passing the nurse's station, a tirade of sarcasm trailing behind you as transport wheels you to radiology, MRI or CT, your least favorite places in the world. You return to us with stories, aptly told in that fluently cynical manner, mere words weaving together a play-by-play of the chaos downstairs. Oh, it'll be a good day if you don't have to go back tomorrow. Chemotherapy begins. You're feeling good. It's the start of induction and you're invincible, like many I've seen before you. We push you through a few rounds of chemo, and overall, you're holding up well. Pain, aches, a few fevers. Everything we usually see. Antibiotics start. Your fevers subside. Looks like everything's even-keel here. Your optimism is waning with every ache and pain you develop, but we reassure those symptoms are normal. It's the first day you're assigned to me and my orientee, who is familiar with you as all of us are. We come in to see you, do your assessment, give your meds, tend to your needs. You're in one of those moods--you're not up for guests. We place the sign on your door and warn off all would-be visitors: not today. In the afternoon, you spike a fever. Shortly thereafter, we go into your room to hang an antibiotic. Your words are slurred. Your mentation is altered. Your mind is between our world and another we cannot see. Your wife looks at me and my orientee with worry in her young eyes. I page the Oncology team immediately. I update them on your status. As I'm on the phone, my orientee returns to the desk. You just...urinated in the bed? The worry in your wife's eyes has invaded my orientee's. Something is wrong. The team orders a fluid bolus. I argue with them. They need to assess you. Something isn't right. The "nursie hairs" on the back of my neck are standing on end. Something just isn't right. The physicians come down the hallway, all four of them in a little herd moving in your direction. I follow on their tails. They do an assessment, talk to you and your wife. Your mentation has improved, but your temper is short. You don't want anyone in your room. The doctors take some offense once we get outside. I know you're just a modest man and embarrassed at what has happened. But that lurking sense nags at me. Why are you suddenly so aggressive? That isn't like you,either. We continue your care and you apologize to my orientee and then, more broadly, everyone on the ward--nurses and corpsmen, that is. My orientee graciously assures you there's nothing to worry about. We all do. Life goes back to business as usual and the shift ends anticlimactically. Two days! Who knew paradise could be so simple? There's nothing like a little break from the hospital drag. I spend my time cooking, bike riding, buying groceries, packing for home. I have a four-day pass coming up for the holiday and the plane can't take off soon enough. All I have left are these two days off and three more days of work before I'm home again. When I return to work, I'm told almost instantly of your transfer to the ICU. Your condition is grim from what my coworkers tell me. I hear their words, their descriptions of what has happened registering logically in my mind, taking an observant seat in the part of my brain that computes the nursing and medical and physiological sides of my work. Your wife, crying comes to us, asking us to pray for you, encouraging us to come see you. You're not in good shape, but come, she asks. And we do because we know she needs us--she needs someone else--to see. So in waves, we come. We give a quick report to our fellow nurses with a grim tell-all at the end: "...and that's about it. I'll be back soon. I'm going to see the Major." For several days, I work on going to see you, but, just as when you were my patient, I am steadfast in my commitment to my assignment; the pain assessments, medications, and concerns of my patients come before my own desires. Days one and two of my three-day streak pass and I am unable to escape my ward long enough to make the trip. Your wife continues to migrate to our ward, to your old room, to sleep. She updates us, we reassure her that we're behind her, she goes back to you. Finally, today, day 3, I join Ms. Lewis and 1LT Torres, who are bound for the ICU to visit. Your wife is in the hallway, talking with some of your family members. We pause a moment, talk to your wife, and then myself and Torres take a few bold steps into your room. And then everything I heard from your wife, I see with my eyes. And now, I know. You're intubated, that smile interrupted by a life-saving tube that forces your chest to rise and fall unnaturally. You have an IJ, a femoral line,and a Hickman. The standard BP cuff, SpO2 sensor and cardiac monitor tell us about your heart, which, fatigued from some unknown antagonist, tried to stop working a few days back. The waves on the screen tell me a story about rising Troponin and the cath lab--the same story in your wife's eyes. You're unshaven, which would never have happened were you awake. You're laid out in bed, your heels buoyed by heel guards, pillows below your knees and elbows, turned off your back slightly to one side. Your skin is discolored and purple, bruised from IV failures. You're edematous throughout your body; your hands are a dusky purple. Torres talks, her words like a radio playing indistinctly in the background. She takes your hand on the other side of the bed. I reach for your hand. You're cold; most unlike you. I watch as the ventilator forces you to breathe, and instead of seeing a grotesque tube that most families see, I see the tube that's saving your life. I gaze over the mess of wires and IV lines and thank God for their presence, because as terrifying as they are, they're the reason you're still with us. Torres falls silent. I take the opportunity to tell you that I'm the other one here with you, that we're praying for you, that you're strong enough to come back to us. Torres adds quietly, "Everyone is praying for you." I take a breath as your ventilator pushes air into your lungs and exhale as you exhale. We linger a few moments, promise to return, and slip out of the room. We hug your wife again, repeat our promise, and retreat to our ward. I went home that night, finished packing for my 4-day pass and went to bed. As I fell asleep, I prayed that God would wake you up again. I prayed for your wife, for your family, for your tired, worn-down body. I prayed and thought about you and fell asleep just after midnight, your memory heavy on my mind. Home passed in a beautiful blur of family and friends. When I returned, I was told that just the night before, you had been declared brain dead and taken off of life support. This is the best eulogy I can write you. I could drone on about how you will be remembered, about how you will be missed, about how you were an example even in sickness to all of us who had the pleasure of knowing you. But none of this would do you justice. So I will remember you, I will miss you, and I will follow your example. When the time comes, I will be there with your wife, your family, and my fellow nurses at Arlington to lay you down to sleep for the final time. And one day, I trust that I will see you again when we all wake with the morning light.
  12. ellebilo

    Indelible Love

    Mr. P, 80 years of age, a war veteran man was admitted with a chief complain of abdominal pain and loss of appetite. Looking at Mr. P for the first time gave me an impression that he was a good looking, gentleman back in his younger days. His looks was way younger that of an 80 year old guy. He was full of energy and enthusiasm during our initial nursing patient interaction. He enjoyed imparting every thing about him and he was so proud when he mentioned his family. He had six children who were already well-off and a great wife who would always make his eyes brimmed by just mentioning her name and losing her would be the most painful event that he could not imagine, more painful than the diagnostic procedures and treatments that awaited him. Mr. P then had undergone several tests to diagnose what was bothering him. As days passed, we noticed that his abdomen was doubling its size and edema started to appear in his lower extremities. He had an ascites, one of the classic sign of fluid shifting. This was supported by the decreased value of albumin and globulin ratio revealed by his blood tests. Infusion of albumin was then initiated while seeking for the culprit causing the abnormality. Despite of the transfusion, Mr. P's condition did not improved and he began to express unrelieved pain and discomfort brought about by the fluid accumulating in his peritoneal cavity. Invasive paracentesis was performed and a Jackson Pratt was attached to his abdomen for continuous drainage. The 15 minute monitoring and the routine draining of the JP allowed me to have a more in-depth conversation with Mr. P. This had also established a more intimate relationship with his entire family but I still didn't get the chance to meet Mrs. P and I was wondering why she was never around for her husband. The frequent small talks enable me to discover how Mr. and Mrs. P had end up with each other. Mr. P was a military man while Mrs. P was a pharmacist working in their camp. Mr. P would tell the story as if it just happened yesterday with his eyes sparkling. Seeing Mrs. P for the first time convicted Mr. P that she was the woman that he would spend his life with and the rest was history. Unfortunately, it just took weeks when Mr. P started to deteriorate. His glowing face became a mirror of pain and anguish. His loss of appetite was never restored thus he became emaciated. Looking at his condition I could not help but wonder how certain malady can bring abrupt changes in one's body. I was attending to another patient when Mr. P's doctor made his rounds having with him the rest of the results of the successive diagnostics. I was not around when he extrapolated his patient's prognosis thus I was shocked when I saw Mr. P's 2nd daughter bursting into tears along the hallway and upon seeing me, she wrapped her arms around me. I was not exactly sure if I had heard it right when she uttered "he has only 2 months to live." I was stunned, as if my brain stopped transmitting the info, I just could not absorb what she was trying to convey. I stood frozen and as the ice melted in the light of reality, I was able to hug her back tighter than she did. However, I remained speechless and the hug was all I could offer that time believing that action speaks louder than words though I really don't know the exact words that she would like to hear. Liver CA. These words kept ringing into my ears. Mr. P had a liver CA despite of his unadulterated familial and social background. Even the attending physician could not lucidly explain how Mr. P acquired such detrimental illness. "Unknown cause" was the simplest answer. With this final diagnosis, I expected that Mrs. P would finally show up in able to comfort her ailing husband, but then she was not there as I hoped. Later did I unraveled the reason why when she was also admitted with difficulty of breathing not because of asthma or pneumonia but because of the cancer cells that had reached her lungs originating from her breast. All along, she was undergoing chemo and her immunocompromised state pulled her away from Mr. P. Despite of her old age and the challenges that she have been through, her face still radiated as a gentle yet jolly woman who had perhaps reached the "Acceptance Phase" of grieving. They shared a common room with three beds- the two beds especially positioned opposite each other but with distance in between giving space for others to pass through. The third bed was then placed at the middle corner for their children. Entering into room 306 gave me a sense of mixed emotion and expression. Witnessing their family battling to survive was compelling, the laughter that they made every time they reminiscence was contagious but the thought of expected death was poignant. Being in that room also made me believed that love until the end still exists. Each time that I take Mr. P's vital signs, Mr. P would always enquire how she's doing and he would always say, "you took good care of my darling first." He would always tell me to prioritize his wife in every way. Every day, Mrs. P would always find strength to get into her wheelchair in order to traverse the small space between them, for her to reach her suffering husband. As she reached the bed she will then take his hand and locked it with hers. They will say words that only both of them could hear and understand. Mr. P would in turn, brushed his wife's very thin white hair with his trembling hand. Every move they took and every word they spoke required so much effort but it didn't matter just to let each other know that they still have each other. Feeling a little bit better, the family decided to take them home. The doctors agreed and I was somehow optimistic that Mr. P would make it more than 2 months but just weeks later after they were discharged; he was readmitted, this time because of unbearable pain and further loss of appetite. Mrs. P on the other hand was also brought to a more specialized hospital to deal with her multifactor onset of complications. Mr. P looked worse than before and this time he refused to fully cooperate with the health team. He was so weak and fragile that every time I dressed his JP site and take his vital signs, the deep silence would envelope us. The presence of his children became his source of strength though I know that being with his wife would really revitalize him. One time, I saw him talking on the phone and with the looks of it, he was speaking with his wife but this time no sparkle was in his eyes rather a pool of tears flooding his cheeks while saying these words "hold on darling." After hanging up he would then insists that he just wanted to be with Mrs. P which was not possible that time. One week after, Mrs. P passed away leaving Mr. P totally heartbroken. He was discharged after recuperating a little for him to attend his love's burial. I can't imagine the pain that Mr. P had endured but the impact of losing his wife was displayed when he once again brought back in the ER. He totally refused to eat, refused to interact and most of all refused to live. He was a replica of a soldier dropping his rifle in the middle of a war. With the absence of willingness to go on and with the progressive invasion of the cancer cells, the health team could not do much but to approach him in a palliative way. Two moths and 3 weeks since I first met Mr. P, there I was reporting to the resident on duty that Mr. P was no longer responding to any form of stimulus, his O2 sat was below 85%, BP was 90/60. Oxygen was set to 10Lpm from 3Lpm, the nasal cannula was replaced by face mask to deliver sufficient oxygen. HGT revealed value way below normal and IV bolus of D5050 was ordered. I don't know how I was able to absorb every instruction that the doctors were giving despite of the fact that my emotion has reached its lowest point to the point that I almost drop my tears while administering the dextrose. Mr. P was about to reach the end of his rope, we all knew this. His children were all present that time, whispering loving words to their father, they then decided to sign the DNR which would mean no medications and treatment would be given in the event of a cardiac arrest. They have to let go and I knew it was never an easy decision to make. It was heart breaking; little did I know that my emotion was also because of the question that pop upped while I was taking care of Mr. P the whole time. "Will I also care and cry for my own father who had never been a father to me?" My duty was almost over. I then looked at Mr. P for the last time remembering every detail of his face while silently praying. I tried to smile and then gently touched his arm and said goodbye. Walking down the stairs, his eldest daughter hugged me and with her sweetest smile said "thank you." Having Mr. and Mrs. P as my patients is an indelible part of my profession. Through this couple, I have witnessed not just a moving love story but also love that overflowed from their children, friends and even relatives and most of all the unselfish and enduring love that our health team had offered and experienced. Nursing should be therefore not just an art and science but rather it should be more about love expressed through art and science. J
  13. ellifant

    My First Day With A Wonderful Lady

    March finally arrived and I was on my way to my first med-surg clinical. The instructor came to each of us assigning a patient, giving us a report on their diagnosis and sent us on our way. I was so nervous looking through a"real" chart to learn more about my patient before I entered the room to introduce myself as a student nurse and gathering as much information as I could. I had been informed by my instructor that this patient was also going to be my first care plan. Her name was Judy and she had been admitted through the ER for abdominal ascites and hyponatremia. She appeared overwhelmed and apprehensive of all the medical things going on around her. I realized quickly I was dealing with a human being who was relying on me for knowledge! I assessed from head to toe asking questions as I went along. I learned that Judy described herself as a simple woman, who didn't like doctors and whose job was to take care of her family enjoying gardening and her dogs. Her husband worked as a custodian in the hospital to provide for the family. The ascites was cultured and found to be positive for malignant cells. Her blood sugar was 322mg/dl and her blood pressure was elevated. A CA-125 result was 15250(the norm is I comforted her as best I could with no experience under my belt. We learned how to take blood sugar levels and inject insulin together. We prayed together at her request and I let her have privacy when her husband periodically came to see her. She was so courageous placing a mask of happiness on when her three sons came to visit. She informed me her husband and she slept in the living room to give their sons their own rooms. This was becoming very serious and she knew it but was still more concerned about how her family was going to deal with her illness. I stopped in to say hello as my rotation continued. I received 100% on my care plan of her and thanked her for being such a great patient. Her diagnosis ended up being uterine cancer, end-stage IV. She was discharged home and I have seen her in the hall coming in for blood work during my fifth week. She still had her same smile and said she was feeling fine, although her body language said she was in pain. My instructor informed me on our last day of this rotation that she had passed away the night before at home surrounded by her family. My heart went out to her family because they were her whole world. God just needed this angel who always smiled even when things were bad.

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