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Topics About 'Death And Dying'.

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  1. spotangel

    THE SCENT OF DEATH

    I froze by room 650 as I wheeled the med cart. The scent hit me. The overpowering scent of flowers candles and incense. The smell, I associated with death. This was a very familiar smell to me. I had lost both parents as a teenager and this was the smell in the viewing room that was filled with flowers, wreaths, candles and incense. I hated it with all my heart. Two decades later, the smell was hitting me right outside Ms. Watson and Ms. Grey's hospital room. I parked my locked cart and went in to investigate. The smell was not around Ms. Grey's bed but around Ms. Watson's bed. Ms. Watson lay sleeping peacefully, the early morning sun gently glowing on her face like a mother's caress. The scent was overpowering and I slowly backed out of the room. I went to the nurse's station and sat down, my mind whirling. What should I do? This was not the first time; I had smelt death on this telemetry unit. The first time was a few months ago when I was taking care of a very sick septic patient John Perkins. I smelt it around his bed and was puzzled. I did not connect the dots and thought I was being overly sensitive. I thought I imagined the smell and ignored it. He was a full code and coded two hours later. He did not make it. I began getting the smell more and more frequently before patients coded. Some made it, some didn't. I cursed this "gift" of sensing the angel of death. I tried very hard to ignore it. I dared not speak up about it as I did not want to have a Salem witch hunt or my coworkers look strangely at me. I wanted to be part of the crowd and blend in and not create waves. My conscience started pricking me. Maybe, if I had told someone else, we could have been better prepared. Maybe, I could have setup the suction machine on the wall, ready to go; maybe I could have asked the telemetry monitor room to observe that pt's rhythm more closely. I beat myself up every which way without relief. One night I sat pondering about this wondering aloud about why I, who was so uncomfortable with death and dead bodies, was given this gift. I argued loudly with God as my kids were sleeping soundly and my husband was at work. I got tired eventually and went to sleep. The next day, I resolved to do things differently. I decided to be proactive. I went in to work with a plan but of course did not smell anything for almost a week! God had his own plan--! On a Friday, I smelt death outside a single room. The smell was overpowering in the room. There was not a single flower in sight, so I was sure of what I smelled. I quietly checked the suction (which was not set up in readiness---my pet peeve) and set it up ready for any emergency. I then went to the nurses' station and rolled the emergency cart to outside that room. The patient crashed within the hour. We successfully resuscitated her and transferred her to the CICU. She was forty five years old and the mother of three. Later, when the patient's primary nurse asked me how I knew to get the equipment in readiness, I told her that I had a" feeling". She believed me as us nurses are famous for our feelings and intuition. The team noticed me doing this before unexpected codes and started joking during report at shift change. They would finish report and then ask "Annie, any feelings?" and snicker! I took it in stride .There was an older wise nurse from the "Islands" who suspected that there was more stuff going on that I was letting on and once gently asked me. I told her not to label me a witch and told her. She told me simply, "Annie, don't fight it. It's a gift not a curse. Use it to help others". I still was not sure as patients still died, so what was the point of the gift. I did not realize why I got this gift until Ms. Watson room took on the now familiar smell of death. Ms. Watson was a walkie talkie with three daughters that she always talked about. I had met one of them Beth, who came every day after work. I enjoyed watching the mother daughter interaction as they teased each other and joked about the hospital food and planned for the upcoming summer. Ms. Watson was a renal patient waiting on her shunt to mature and had come in with hyperkalemia with tented T waves on her EKG and chest pain. Her pain had subsided and she was waiting for a cardiac catheterization as her Echo had shown some possible issues in her heart. She was chest pain free but there was a possibility that her Potassium would go up again, hence the wait and monitoring. Her other daughters lived out of state but called every day in the evening without fail. Beth was walking out of the room and saw me park the emergency cart outside her mother's room. Ms.Grey had been discharged and was waiting for her son to pick her up. Puzzled Beth asked me, "Who is that for Nurse Annie?" I attempted to give her a vague answer but I could never lie convincingly! She saw something in my face and persisted with her questions. I told her that I was being extra cautious. She bought it for the time being. Later she asked me seriously, "Annie there is something you are not telling me. Please, tell me." I did not want to freak her out so I kept it simple. "You know Beth how nurses are very intuitive. I just feel we should be extra careful with your mother and monitor her more closely." She read between the lines, looked me straight in the eye and asked me, "What should I do?" "Get your sisters to come and stay with mum for the next few days." She nodded her eyes filling. The next day she called me from work. "Annie, I took a couple of days off to stay with mum. My sisters are flying in. The three musketeers will be there in the evening! Don't tell mum". That evening I spoke to the nursing supervisor and got permission for the family to stay in the visitors lounge at night past visiting time for the next few days. Thankfully telemetry was slow and her roommate bed remained empty which was surprising as those beds filled like hotcakes. I told Beth about getting them permission to stay. She was very grateful and introduced me to her sisters. I left for my weekend off with their laughter ringing in my ears as they surrounded their mom who was ecstatic that they girls had surprised her! I came back on Tuesday to find an empty bed. I was surprised as she was supposed to have her cardiac catheterization that day. I asked around but no one knew as the weekend crew was off. I took the admission discharge log and checked it. My heart leaped to my throat when I saw the Monday 3 am entry. Ms. Watson had died. I was in shock. I pulled Beth's number from the paper chart that was still there. Drawing a deep breath as she picked up, I carefully said, "Beth, this is Nurse Annie from the hospital. Can you talk?" I heard her crying and then she told me what had happened. Ms. Watson was fine all weekend and insisted that the girls go home but they all refused. So they kept watch at the bedside, talking softly in between with mom when she woke up. At around 2.00 am, Ms. Watson had a massive heart attack and arrested. She was coded for almost an hour and declared dead at 3 am. Beth told me, "Nurse Annie! I do not know how to thank you. Mom's last three days on earth were her best and she never looked happier. The memories in this last three days with our mother will comfort us. We have these memories thanks to you. Bless you for giving us that chance to be with mum. I think she is at peace and so are we." I was too choked up to speak. A month later, I received a bouquet of flowers with a thank you card that said, "Mum thanks you from heaven! We thank you too!-Beth, Pam and Sara". I treasure that card more than a paycheck! Once I moved from acute care, I did not get that scent again. I hope I don't either! Since Ms. Watson's death, I realized that my gift was to be used to help the patient, family or staff to get prepared. I never knew what the outcome would be but I knew now that every patient got a fighting chance to live or die in peace. As a nursing supervisor covering that same unit, I still see some of the nurses I worked with, who remind me that before we had a rapid response team or a cardiac arrest team we had Annie's ESP!
  2. TheCommuter

    Death Happens. Get Used To It!

    Here's a truthful horoscope for you: we're all going to die! Before we get started, ask yourselves the following question: What exactly is it about death and dying that disturbs you? Once you pinpoint the source of your fears, keep in mind that other people who once had the same reservations have moved on to become stellar nurses with solid careers in the nursing profession. If you cannot identify what it is about death that makes you fearful, that's also okay. It's probably a sign of our modern times. Let me explain further. In previous generations, death still remained a sad and dreadful time for people who saw family members die. However, the main difference between the past and the present is the fact that death and dying used to be highly visible, very out in the open, expected, and an accepted part of life. During yesteryear, 'passing away' was a personal event when people died at home encircled by loved ones who said their goodbyes. The surviving kinfolk lovingly gave post-mortem care at home in the hours after death. In the modern 21st century, the vast majority of death now occurs in healthcare settings such as hospitals and nursing homes. In other words, death has mostly been removed from intimate home settings, so many people fear what they have not seen. American society now does too efficient a job at hiding death from view and this contributes to making death seemingly creepy to some. Is it bad for you to fear dead bodies? No. Your fears are actually normal due to the society in which you were probably born and raised. Regrettably, death is all around us, and you will need to become acclimated to it if you plan to work in most areas of nursing. Don't worry, because you'll start to become more familiar with death as you get more exposure. You'll actually be relieved by some deaths and saddened over others. Although death will never be easy on you, it will get easier over time. What do you do if a patient dies? It depends on the code status, healthcare setting, and situation. You would immediately call for help if you find a dead or dying patient who is a full code at a hospital. Press that code button, call the rapid response team (if available), lay the patient on a board or hard surface, initiate CPR, and so forth. The sooner you summon assistance, the quicker your patient's room fills with people to help with the resuscitative effort. Patients who have current DNR/DNI orders are dealt with differently. We want to notify family promptly if the patient is in the process of actively dying. In an ideal textbook world, someone would remain with the dying patient until family arrives to ensure the person doesn't die alone. Dying patients who are on hospice or end-of-life care receive comfort care such as frequent turning, bed baths, pain control, oral care, and other measures to maintain dignity before death. When the patient dies, someone makes a pronouncement of death. In the state where I practice nursing, pronouncing death is within the RN's scope of practice. Some families want to spend time with the body, so we give them time for that. What happens with the dead body? The nursing department is usually responsible for post-mortem care such as cleaning the body and rendering the patient fit to be seen by any family members who may want to say goodbyes to their loved one at the bedside. At many hospitals, the nursing department is also assigned the tasks of placing the deceased inside a body bag, attaching toe tag identification, and transporting the body to the morgue. The mere thought of dead bodies might send chills up and down your spine right now, but I assure you that dealing with death will become easier with the passage of time and the accrual of more exposure. After all, death is a natural part of the circle of life. Don't let your fears deter you from nursing.
  3. It was shortly after labor day when I walked into the emergency room to see a client who had been found unresponsive and rushed to the hospital. I walked to the front desk, identified myself, and requested to see him. The woman behind the desk smiled kindly at me and asked: "Are you family?" I opened my mouth to respond and closed it again I did not know how to answer. This client, who had I known for 5 years, had no family. When a coworker visited him in the hospital weeks before, she had been present when a staff member asked him about family members. He had been very clear on the fact there was none. Was I family? When my normally calm administrator called me, her voice broke when she asked me to go to the ER to check on him, as she had just gotten a call from a very upset and worried aide. She had known him for much longer than I had, had gone to see him recently in the hospital, and was genuinely upset. It was her that had visited him a few weeks ago in the same hospital. Clearly, she was his family. Was I family? His aide was upset because she cared for him and had been with him more often than her own child. He has suddenly declined, and he needed her. She had come at all hours of the day and night, paid and unpaid, to care for him. She was scared. Of course she was family. Was I family? I had spent my drive there thinking of him. But I had also thought just as much about the girls in my office, all who had gotten out of their beds to care for him late at night, supported him when he was sad and angry, and loved him through it all. Girls who answered the phone at 1 am when he needed something, who talked to him during the day when he called for reasons that weren't really reasons. Of course, they were family. Was I family? She asked again. Yes, I replied. I am part of his family. And after the kind liaison sat me down and handed me tissues, I sat with him til it was time for me to go tell our family he was gone. When I arrived back at my office, I hugged, cried with and held our family, as we mourned one of our own. I don't say this enough, but I thank God for our family I wonder sometimes if other nurses or medical professionals go through this. I know we are taught not to form intense attachments to patients as it could cloud our judgment. I feel like my attachment to some has actually helped. Knowing them as well as I do has let me pick up on little things I may not have otherwise. These bonds have allowed my staff to care for patients in a way they normally wouldn't be able to. For patients like this one, who had no one but us, how does one walk into his home on a regular basis and not feed the basic human need for human connection? Isn't it part of our job to care for the client both physically and emotionally? Mental health and physical health can and often do go hand in hand. No one should be alone in the world. Especially not when so many people go in and out of their home every single day. Honestly, I feel like many nurses and medical professionals do. Doesn't everyone have that "one patient"?
  4. RobbiRN

    A Tale of Two Deaths

    There is a story in Japanese folklore that goes back into an era in which they practiced "Ubasute," the abandonment of the elderly. When there were too many mouths to feed and not enough food to go around, impoverished farmers would take the oldest, most decrepit member of the family deep into the forest and abandon that person there to die alone. In one version of the story, a heavy-hearted son is carrying his mother deep into the woods. Through his tears, he notices that she is reaching up and breaking branches from the trees and dropping them onto the path behind them. He asks what she is doing, and the old woman replies, "Omae ga, kaeru toki no michi shirube da - They are markers to guide you when you return home." Even as she is being carried to her death, she is not angry or thinking of her own dilemma. Her only concern is for her son's well-being. Despite the pathetic context in which the story plays out, I'm profoundly impressed by this mother. She is sacrificed due to the lack of resources, but her final hours are marked with unselfish love. My own mother died suddenly of an aneurysm at the age of 57. I don't remember her ever being sick a day in her life. She was a nurse for years before getting two Master's degrees and becoming a nursing instructor. Between classes, she took a fellow instructor and some students out to her car to give them some boxes of apples. She collapsed while lifting a box from the trunk. Her best friend and her own students started CPR before EMS arrived. She regained consciousness briefly before coding again in the ER. Our family was aware of her general wishes, and we made the decision to stop life support soon after brain death was confirmed. Advance directives were relatively unknown in those days. Ironically, a few months before her death, Mother made a single entry in a journal, reminiscing about her life so far. The last paragraph closed with these words: "If I ever get into a situation where I would need to be dependent on machines, I do not want to be kept alive. Please be sure there is a 'no code' on my chart." We found the journal a few days after she died and took some solace as her words confirmed that we'd made the right decision. The story of Ubasute and my mother's death strongly influenced my thinking before I went into ER nursing where I see death on a regular basis. There are some who argue that it is also courageous to struggle, to fight for life until the last breath, even when we have been reduced to a persistent vegetative state. They readily avail themselves of the full force of our medical prowess. On the far end of the spectrum, others see life as more than sustained physical functions, more than a heartbeat and the ability to consume nutrition and produce excretion. They want, or need, a certain level of quality to continue. For them, letting go is courageous and possibly unselfish. While I don't judge those who believe differently, I won't try to hide my bias as I share the stories of two of my patients, each representing opposite extremes in decision making about the end of life in a health care setting where "everything" can be done: Glen The crumpled little figure lying on his left side is a sad reminder of the frailty of our humanity. Glen has a long, complicated medical history with multiple system failures and corresponding medical interventions to prop him up for another round. His once healthy five-foot nine-inch frame is down to ninety-two pounds. A plugged J-tube protrudes from his abdomen, with some yellowish liquid soaking through the dressing. Duoderm covers a massive stage three sacral decubitus. A pastel plaid pair of bulky heel protectors hide chronic foot ulcers. His extremities are severely contracted. A Foley catheter drains a scant amount of thick, dark urine. He hasn't spoken a word since a stroke six years ago. He responds to noxious stimuli, but he does not follow commands or assist with his care. He makes no eye contact. A long-term care facility sent him to the ER be evaluated for possible aspiration pneumonia. A woman who appears to be about sixty bustles into the room. She looks flustered and anxious. "Is he alright?" I'm a little taken back when Michelle looks the visitor in the eye and says, "No, ma'am. He's not alright. Is there anything here you see that is alright?" Michelle is not unkind. She is simple and more honest than most caregivers would be in answering this question. She's right of course, but many will judge her harshly for telling the truth. The visitor does not seem offended, but she doesn't respond. Instead, she goes to Glen's side and pushes his hair from his forehead, saying "I love you poppa." He does not respond to her. She produces POA papers and states "they" want everything done. We initiate an aggressive sepsis workup, including a D-dimer which prompts a VQ-scan to rule out a PE because his renal function precludes the coveted CT thorax. Two hours later, sepsis and pneumonia are his primary admitting diagnosis as he goes to ICU with several infusions running. Despite continued aggressive care, Glen does not recover. A code blue is called six days later. The first few compressions break his ribs, and his detached sternum floats freely. Frothy blood running up into the ET tube suggests that broken bones have punctured a lung. After 20 minutes of ACLS, five rounds of epinephrine, and two defibrillations for a possible "fine v-fib," the unsuccessful resuscitation effort ends. Esther An eight-six-year-old female arrives from home in a wheelchair. She's on 2 liters of oxygen via nasal cannula and clearly in respiratory distress. Esther's daughter-in-law, Jennifer, is her primary caregiver. Her only son, Jake, has an hour drive ahead of him to get to the hospital. They produce a living will and a valid DNR. The patient clarifies that she is open to medications and oxygen therapy, but she does not want bi-pap, intubation or resuscitative measures, including emergency drugs like epinephrine. We tell her that without aggressive treatment, she may die very soon. She answers, "That's why I went to the trouble of getting these papers. I've lived a good life. I've already had the bonus round. We've talked this over, and if this is my time, then it is my time." She agrees to basic labs, a CXR, IV solumedrol, IV fluid, and increased oxygen, but refuses any kind of a mask because she wants to be able to talk clearly. Jennifer is the most courageous family member I've ever seen at the bedside of a dying patient. There is no way to improve on what she does. She silences her phone and puts it in her purse, giving Esther her undivided attention. When Esther gets too weak to talk, Jennifer keeps her engaged, reconstructing meaningful moments of her life for her, telling story after story. "You were so good with the kids granny. The will never forget all the days you were there for them in the early years. You gave them so many happy memories, like that blow-up pool you got Jason when he was six. Jessica still talks about the weekend you took her and her friend Emily over to St. Pete Beach for her 8th grade graduation. She came to me that night and said you are the coolest grandmother ever." We are nearing the hour mark, and I can see that Esther may not be able to hold out for her son to get here. Jennifer tackles this obstacle too with incredible poise and grace. "It's okay, granny. I know you are trying to hold on for Jake to get here, but you know he loves you. It's okay if you need to go now. He'll understand. We all love you, Esther." Esther tries to smile as her head slumps forward, and Jennifer quickly steadies her back on the pillow. She quietly runs her fingers through Esther's hair. There are only a few agonal respirations before the breathing stops altogether. I silence the alarms, feel for a carotid pulse, and confirm what Jennifer and I both already know. I shut off the oxygen and removed the nasal cannula. Esther's face is peaceful. I hug Jennifer and tell her she is incredible. I've seen hundreds of deaths. Calm, anticipated and accepted deaths usually happen at home or in a hospice facility. Death in the Emergency Department is usually intense, arguably brutal, and sometimes frantic. Some deaths are shocking and tragic when a child or healthy adult dies unexpectedly. Most people, like Glen, die for really good reasons. I've seen so many like him, they are soon forgotten. I'll never forget Esther, and her last hour filled with courageous love on both sides. If it is even permissible to put the two words together, Esther's death is beautiful. I won't judge those who chose differently, but I already have an advance directive. The people in my life know where I stand. When my time comes, I will be honored to follow my mother's conviction and Esther's noble example.
  5. Spritenurse1210

    How I learned compassion.

    "When he saw him, he was moved with compassion, came to him, and bound up his wounds, pouring on oil and wine. He set him on his own animal, and brought him to an inn, and took care of him." The parable of the good Samaritan, Luke 10:34 There comes a time in every nurse's life when they must go against society's social norms and care for what I call "society's undesirables." My definition of society's undesirables is the homeless, the mentally infirmed, the physically handicapped as well as criminals. In short, the kind of people that every day Americans would consider beneath them. In the course of my short career I have cared for all of the above. One patient had particularly touched my life both personally and professionally. Her name was Reva and she was a convicted felon. She lived for a year after she was paroled in her 17th year of a life sentence for the murder of her infant daughter. Reva came to my unit after being admitted for pyrexia, low white blood cell count and end stage lung cancer. Her emaciated cancer-ridden frame barely even made a dent in the hospital bed when my fellow nurses and I helped her off the gurney. Her husband, a formidable man with an air of arrogance loomed in the doorway as we helped her get settled in. "Do you know who I am? I am a pastor at the state penitentiary." He stated, "I'm a man of God. Don't think you can mess with me because God will punish you for persecuting me." I looked over at my patient, who by this time had began to clutch her side and gasp softly, "Reva, enough of that, you're not getting anything for pain. The nurse is here to make sure I'm comfortable. You need to just be quiet." Calmly I stated "Sir, I'm here to make sure she is taken care of. She is my patient. If you insist on preventing me from caring for her then I will have you escorted out of the hospital by security." He slammed his massive hand on my shoulder and yanked me closer to him by my scrub shirt. "You better not talk back to me you little heathen, or I will show you how God deals with disobedient women." I quickly pressed the staff emergency button located on the tracking device that was issued to me at the start of my shift. The sound of thudding sneakers became louder and louder as he threw me into the wall. Three security guards stormed in with our house supervisor and my charge nurse in tow. The charge nurse helped me up as security escorted the screaming husband out of the room. I dusted myself off and with only minor bruises I continued with my assessment. "You're the first one to actually stand up to him" Reva said, teary-eyed. Her unkempt appearance and strong body odor as well as bruises in various stages of healing explained everything. "I suppose I deserve it, because of what I had done in my life. I'm just not worth anything to anyone." Placing my hand in hers I continued to listen to the confessions of a dying woman. "I killed my baby girl. She was just so beautiful. I never imagined anything so beautiful would come from me. After years of hooking, cocaine and heroin, I had been given a gift from heaven, and I destroyed her!" Huge tears rolled down her cheeks as she described to me how in a drug induced stupor she killed her daughter. Hysterically crying she looked at me, "I was afraid I would corrupt her, and sentence her to a life of drugs and prostitution. I am so sorry, I'm so sorry! Forgive me Father, oh sweet Jesus forgive me!" Wiping her tears, I told her that I would care for her, and that I am not here to judge. After medicating her for pain, anxiety and starting her IV fluids, I stroked her hair while she drifted off to sleep. Later that night she became unresponsive. Searching through her chart I found her DNR orders and living will that stated she only wanted care and comfort measures. I closed her chart and shut myself in the staff bathroom to have a good cry and talk to God on her behalf. "Please dear Lord, forgive this poor woman, who I'm sure that was shown no kindness in her lifetime. Please show her what a loving Father you are. Greet her with open arms, give her peace. Amen." After washing my face and hands I continued on with the rest of my shift. About 0400 Reva began Cheyne-Stoking. Sitting at her bedside after finishing my rounding I brushed her forehead with the back of my hand. She fixed her eyes on the ceiling and raising her arms up she whispered, "Oh Jesus, Jesus!" Her face softened and she had passed with her lips curved upwards in a slight smile. My prayer had been answered. I called her husband to tell him that she'd passed. "I'm not coming back up there after how you people humiliated me. You just do whatever you have to do with her. I will have your job by the way." He continued on, "Why don't you call her scum-bag mother, maybe she will have more sympathy for her." Her mother was just as devastated by her death. "Oh she's finally dead, is she? Send her to Degraff Funeral Home. I will identify her body there. Do you know if it's expensive to cremate someone?" Disgusted, I hung up the phone. Bryan and I bagged and tagged her and sent her down to the morgue. The rest of the shift continued on without incident. After giving report I made my way down to the cafeteria for a much deserved breakfast and hot cup of tea. I learned that night that no matter what, it is my duty as a nurse to provide holistic, unbiased and professional care to all members of the human race. I'll save the judgment for God. Name changed
  6. nutella

    There is nothing we can do

    When I entered the nurse's station, I immediately felt the typical business of a weekday morning. The morning rush during which everybody tries to get a handle on all the tasks for day was unfolding. One of the nurses looked at me briefly and said, "Good that you are here - Something needs to happen - This patient has cancer from head to toe and the family is in denial. The patient is not a full code but there is nothing we can do." Sounds familiar? Working as a palliative care nurse in a hospital is like no other nursing job. My job is to look at the patient and their family in a holistic way, to look at the bigger picture and to address nursing needs or general care needs that are related to serious illness and frequently at the end of life. Nowadays, many of our patients in the hospital have specific needs related to serious illness and require a different skill set. I carry around a small bag with papers and informational material - my stethoscope is neatly tugged in there as well - it lives in a zip lock bag ready for use together with all the information brochures and papers. My work outfit does not include scrubs, I am mostly a conversation nurse, although there are times I do "hands on" nursing care. The patient I was asked to see to assess for palliative care needs appeared very sick when I entered the room. Only half awake, the face sunken in, breathing shallow and faster than normal, the skin glowing in this yellow-greyish undertone that tells you right away something is wrong. A variety of drains and intravenous lines around him. His wife who sits next to him in the recliner chair is hesitant when I introduce myself. She agrees to talk with me and points out that her husband has been confused the last days and tried to pull out IV lines and the Foley catheter, which is the reason she stayed overnight. My biggest and most important tool is listening - I have the luxury to provide "time" while patients and their families tell me their "story." His wife tells me a typical story and tries to sum up neatly. The last several years that have been consumed by the initial cancer diagnosis with all the usual tests, surgery, radiation, chemotherapy. Uncounted visits to the city teaching hospital close by that is known for expertise in cancer treatments. Many days sitting in the hospital and waiting for lab results to show up, waiting to hear from the oncologist, waiting to know what comes next. Months on end with frantic activity in which being a cancer patient's wife turned into an unpaid full-time 24/7 caregiver job. True - there were also some months during the last years when things seemed better but life never returned back to where it was before he was found to have cancer in an advanced stage. Instead of traveling for fun, visiting family, and getting together with their group of friends to play cards, they were now experts in navigating the large hospital in the city, knew all the different times during which traffic is unbearable, developed preferences for one of the food courts and got to know the oncologist, nurses, aides, lab technicians, and the cashier at the food court. His wife continues to paint the picture that reflects their journey for the last years. The change of identify from the "retired couple with grandchildren" to a member of the "cancer tribe" with specific rituals and unwritten rules. The many talks she had with other spouses in a room united in hope but also united in the unspoken fear and worries. "We did everything they told us to do. Never missed an appointment, faithfully showed up for lab work, scans, check-ups." The last two months, she noticed that things were changing. Granted, they had been going to the cancer center for years and were now very familiar with what it means when the doctor tells you "I have bad news - we found something on the scan that does not look good" or "I am afraid that the chemotherapy is not working." It never meant to her that things might now be going into a different direction overall. To her, it meant that there will be "something they can do", although she realized that the cancer was slowly taking over his body. "He is definitely much weaker now, he has not gotten out of bed in weeks, it was already very difficult at home the last weeks. I have to do everything for him, he sleeps a lot." Her face gets sad and for a second I can feel the desperation when she continues to outline what has bothered her the most for the last weeks: "You know, you are good enough as long as they can treat you, while they are doing surgery, giving you chemo and radiation. But when there is nothing left and the cancer spreads they just throw you away. One day I called to talk to the new oncologist to tell that there were problems and that we had gone to the local emergency department because the city is too far for him now that he is so sick. I was told to talk to hospice. Just like that." We talked some more and she made it clear that she appreciated everything they were able to do for her husband. But it bothered her that there was no transitioning period, that the oncologist she had trusted and who was empathic had left the teaching hospital - she never connected with the next one. And she felt "passed off", "thrown away" and obviously abandoned. They never had a sit down about what would be important in case the illness progresses and spread further or what could lie ahead. "Of course they talked about do not resuscitate but you just don't know what comes next or what to do." It did not help when it was suggested to her to talk with hospice. "They want me let him die." It also started a whole chain of other reactions and events all based on the sudden feeling of abandonment by the department and institution that had been their second home for the last years. Obviously, there were many missed opportunities for conversations. When he became unable to tolerate food and TPN was started it was helpful but it was a milestone and would have been a good time to sit down. When they found metastasis after the extensive surgery that left him with a variety of bags and attachments it would have been a good time to talk about "what if" and "how much are you willing to go through for gaining more time." The patient's wife felt not prepared for what her husband had been knowing for a while. His continued functional decline and the continued unwell feelings including pain, nausea, vomiting and general discomfort were clear signs for him that he was not doing well and he became tired of being sick and unwell. For his spouse, his decline meant mostly more activity and more "things to do" but did not connect her with the fact that he was approaching the end of his life. When she realized, it was like the moving universe suddenly came to a full stop. Caring for him and taking care of all medical appointments, managing his illness and drains had moved her along like a conveyor belt where "you just keep going." She pointed out that she was not in denial, she knew that death would come but it did not have much meaning until the physician said "hospice". The constant activity shifted all her focus and thinking towards "doing" with no reflection about the bigger picture. When she was not busy with his 24/7 care and coordinating providers and treatments, she was so tired that she would just sleep or distract herself watching TV. Now that her main caregiver activity was to sit with him and talking to his care team, her emotions and thinking were catching up. From non-stop activity to full-stop. Her mind and heart re-connecting what had been mostly an intellect based experience for her. I validated her feelings and expressed sadness. As human beings, we want to feel connected and we want to know that the other person cares. People want to tell their story; they need to talk about how they feel and do not want to feel "thrown away." Many transitions do not go well because conversations happen too late and do not include "what if" talks. I sometimes hear "come on - they must have realized he is dying" - but reality is that our society does not view dying as a normal part of living and physicians view their job mostly as "treating" and have a lot of discomfort when they need to talk about the fact that dying is not optional - which is why many tend to have conversations that are not effective or hurtful. "Your cancer is progressing despite the 3.line treatment - There is nothing else I have for you". And when the patient and family starts to show distress followed by "do not lose hope - there is always something new, it may be just around the corner and I will look into clinical trials" while knowing very well that all of this is not an option and this is the time to prepare and do ensure that the time that is left can be spend in the most meaningful way. Sounds familiar? Physicians often feel that they are taking away hope - but what does that really mean? Often enough, the helplessness and the lack of skills to have a conversation that does not "turn bad" leads to passing the bucket to a different provider or the hope that "the family will realize." Some providers have become skilled in avoiding a conversation and elevate the "having a purposefully vague conversation" to an art so they fool themselves and others that "I have put it out - they are not ready to hear what I am saying." Obviously, I am advocating for earlier and better conversations. It is not about "taking away hope" or "stop fighting." When somebody has a serious illness that very well may turn terminal, it is important that the physician sits down and has a conversation that focuses on goals, values, preferences, trade-offs, strengths. It is important to stop the conveyor belt of "treatment" and to pause early on to reflect, build the relationship in a different way and guide patients and their families along. Thinking needs to shift from considering all treatments possible to pause and evaluate the benefits and if the treatments and care plans are actually congruent with the patient's overall wishes and goals if "time left" is limited regardless of maximizing treatment. When death is not avoidable in the near future, we should focus on finding out how much the person is willing to go through and what are acceptable trade-offs for gaining more time. Those structured conversations do not have to be long, when done early on and regularly they might be only 20 minutes long. It helps the family to understand what their loved one wants and opens the room to discuss what is important at a given time and which treatments and care plan match that goal. Instead of focusing on "what we cannot do" focusing on "what we can do" as a healthcare team. There is actually a lot we can do when somebody approaches end of life: We can help you to find out which care plan and treatments match your needs and preferences. We can help you to maximize your comfort and allow you to spend the time that you have, however long that may be, with more quality especially when comfort and avoiding suffering is most important to you. We can still hope and fight - not for a cure or to maximize the lifespan - but for the most comfort and quality to make the time that is left most meaningful. We can give the gift of time and listen. We can care and sit with patients and their families throughout this time. We can re-assure them of their choices especially when they feel ambivalent about comfort care. There is actually a lot we can do! There is nothing we can do-article.pdf
  7. maryloufu

    A different perspective

    When the ambulance rolled up to the ER, I could see the EMTs doing chest compressions on my dad. I remembered a guy his size who had coded when I was working on the floor- that guy did not make it. I started to shake and sob loudly. The ER nurse came over- I told her I would not interfere but I did not want to scare people in the waiting room- she said, "just give us a chance to work on him." She took me inside to the family room. About an hour later I stood at the nurse's station and listened to ER code him for what seemed like forever. He could not keep a good heart rhythm going. I felt sure that they would quit trying to save him at any time. I could see the lack of hope on their faces. They were very kind to me but I have given that look before and I knew what it meant. After some time he went from no rhythm to critical. He was moved up to CVICU (cardiovascular intensive care unit). After they got him settled in they let the family come back to see him. I felt bad for crying and asking 1000 questions that were politely answered. I know how busy the nurses are but I shamelessly asked everything. I could plainly see the bottom line every time I mentioned how long he was down at home and that he had to have prolonged CPR- they shocked him 10 times. They worked to keep his heart beating and tried to get rid of the PVCs and keep his blood pressure at the right spot. I just wanted to hide under the desk in the corner. So many people told me if I needed anything to let them know- but what I needed was someone to fill the emptiness that burned from my clavicle to my stomach- an emptiness that is still there burning me alive. I have always been a proponent of having a good cry as a cathartic experience- but the cleansing will not come. Now I just have a sore face and really cloudy contacts. My dad was on a vent and many meds to keep his heart beating, his pressure up, one for sedation, a paralytic. Later he would have to have meds to get his blood pressure down, potassium, magnesium, antibiotics. He never once woke up- I stood at his side until late in the night singing him songs, telling him that I wanted him to fight and stay alive to watch his grandchildren grow up. I thought about telling him that if he needed to die that I would understand- but I just could not say the words. One night I stayed until 5 in the morning, convinced that if I left he would go into Afib and he would die without any family at the hospital. On day three the doctor told us that there was no brain activity and asked us what we wanted to do. There is no clever acronym for the steps to follow when you are going to take your Dad off of life support- they just tell you to take all the time you need. Well, how much time should we take? What is proper and respectful? They are making you set the timeline for when his heart will stop and his breathing will stop and the color will leave his face. Then all you want is one more hug that is returned or one more I love you from his lips- but that is not going to happen. When you are ready you go up to the nurse's station and tell them - just like you were at a restaurant and it is time to pay the check and clear out. At some point, after it is over you are going to leave your father's shell in that bed waiting for the funeral home to come to pick it up. This is especially hard to do when all you really want to do is lay down on the floor and cry. You know that you are acting like a fool holding his hand and telling him that you love him. This is the last time you will see those eyebrows that look just like your own and the shoulders that used to carry the whole world for you. And then you leave the hospital, confused and empty. It is definitely a different perspective- I hope you never have to be on this side of the bed.
  8. Hope4us

    The Little Round Thing

    When I started that day it seemed the paramount thing to me just to get rid of the dress bypassing my state board exams. My clinical rotations had become routine stuff after two years. My mentor hardly bothered to check on me anymore. I thought I was ready to be released into the real world of nursing, until that day! Hectic! Four call lights were ringing and they were all my patients. The aide on my rotation was taking extra long time to give a bed bath when I needed her help, it seemed to me. I had a pain shot in one hand, but I looked into room 369 on my way past to say, "Sylvia, I'll be right with you." I turned off her call light. When I came out from giving the shot, Sylvia's light was on again. I stepped in. She was sitting on the edge of her bed with her arms on her raised side table, gasping for breath as she had been for the eight days she had been in the hospital. She was what we called a frequent flyer with advanced COPD. She usually rallied after a week or two in the hospital and went home again. "I need a little round thing out of this drawer," Sylvia told me. The drawer on her nightstand was open and I fumbled through it, wondering when the aide was going to be available to do this stuff I didn't have time to do. I couldn't see anything round in the drawer. After eight days the drawer was quite full of papers and silverware, jam and salt and pepper packets, whatever Sylvia wanted to hang onto. It was so hard for Sylvia to get air to talk that all conversation with her had to be yes, no questions and I was in a hurry. I told her I'd be back. I turned off her call light as I went out the door. When I came out from giving the next pain shot, three call lights were ringing. One of them was Sylvia's. The aide was nowhere to be seen. I felt a little impatient. I put on my smile and stopped to wash my hands as I entered the room. A deep COPD grunt of disapproval came from Sylvia. She did not have time for me to wash my hands the grunt said. "Now," Sylvia gasped, "you find it!" I began to ask questions as I dumped the drawer on the top of the stand. I showed her as I put each thing back in the drawer, one at a time. "Is it a pen or pencil?" No, her eyes said. "Smaller?" Her eyes registered frustration. "Shorter than a pen?" Yes her relieved eyes told me. "Wider?" Yes. By then I was to the bottom of the stack. The only thing in the whole drawer that could be called round was her glasses case, and it wasn't really round. I held it up. Sylvia motioned for me to put it in the drawer and flipped her hand towards the door as if she was the queen and I was a disobedient servant whom she had no further use for and she was sending me out of the room. "Your breathing is much worse," I told her, "I checked and you have taken everything you can take but the nebulizer. I'll bring it to you right away." I was surprised how much air and energy Sylvia was able to muster to spit out a very decided and upset, "No!" "You don't want your nebulizer?" I asked with genuine surprise. "No!" This time it was louder and more determined than before. "Just find the round thing," Sylvia hissed at me with a gasp between each word. "I'll be back after I give another shot," I told her. I had to work to keep the impatience out of my voice. By the time I had the shot ready, Sylvia's light was on again. It was still on when I was done. The aide wasn't back yet. I stepped in the room again and went to Sylvia's closet telling her, "I'll look some more, but I don't really know what I'm looking for. It would help if you could tell me more about it." "Yellow." I came up with nothing round and I had gone through the whole room now. I could see nothing yellow anywhere. Tears came to Sylvia's eyes, and I understood see she was trapped in her body and helpless and didn't even have enough energy to cuss at me. I softened as we stared at each other. I told her, "There is a very patient man down the hall who has been waiting for a pain shot. I need to take care of him, and then I will come and ask you some more questions and try to understand what you need unless the aide can come first. One of us will come, okay?" It was not okay. She shook her head. She grunted about the man who didn't need me as much as she did. She was serious and she was helpless. As for me, I was starting to feel like maybe I did need my uniform and it seemed to fit a little better than it had earlier in the day. It took more than a change of dress and passing exams to make a nurse I was thinking. After I gave the next pain shot there was only one light ringing. It was Sylvia's. I heaved a very big, impatient sigh and tried hard to remember the lesson in class on how to deal with difficult patients. Cooled down, I went to Sylvia's room more relaxed. It was quiet. Nobody was waiting for me this time when I went in. I could spend some time with her. She was lying back in her bed! "Sylvia!" It was extra quiet. It wasn't just because I turned off her call light. There was no wheezing sounds - no difficult breathing sounds. In a flash, I was at the bedside taking Sylvia's carotid pulse. It was barely there. I grabbed at the automatic BP cuff, put it on her arm and hit the button with one hand while I got the bed ready for CPR with the other. I had heard a faint breath when I put my ear to her nose. As I picked up the phone to call for help the BP read 30/10. Then it hit me with a repulsive shudder that rocked me from head to toe. DNR. Sylvia was a do not resuscitate patient. I quickly checked her pulse again. Nothing. I hit the blood pressure button. As my mentor flew through the door into the room, the blood pressure monitor read nothing. No heartbeat. No breath. No blood pressure. I have never felt more frustrated in my life in twenty years than I did at that moment when I was not allowed to start CPR. I even thought of trying it, just in case, for a split second. My mentor looked like she felt about how I did. The doctor came in right away. The family was called. The mentor, aide and I cleaned Sylvia of her incontinent bowel and bladder mess and got her all ready for the family visit. We put on crisp clean sheets and combed her hair and made everything look as natural as we could for the farewell. We were in a hurry to have it done, knowing the family was rushing to get there to say their good-byes. "Why rushing?" I wanted to know. They were the ones who didn't want her resuscitated. They had all agreed. Now they were rushing to see her when it was too late for anything but good by. "How could they do a DNR?" I asked again. It was so upsetting to me. I looked at the mentor as we left the room. "The only other thing I feel bad about is that I didn't find her little round thing," I told her. "Her nebulizer?" my mentor asked me. "What!" "Sylvia calls her nebulizer a little round thing. She always sneaks one in from home. The doctor knew her condition would improve with the new stuff and he also knows she didn't take hers as it is prescribed so she wasn't supposed to have any at the bedside, but she always gets one smuggled in from home. She doesn't like the new stuff. Last night the aide found her contraband and put it in her glasses case. We were going to ask the doctor what to do this morning." I stayed behind in the room as the mentor went out. I opened the drawer and took out the glasses case. I shook the little round thing out of the case. It had a yellow band around it. It seemed to me my student uniform fit me perfectly. I had an examination to make before I ever faced nursing board exams. I had to examine me and what life is all about. What rights do patients have? What rights did I have? Why didn't we start CPR? If I had found the nebulizer what would I have done? How would I have treated the patient? If she had found it, would it have given her a little more relief? Would it have given her minutes to live? Would it have held her over to her IV dose? Would she be wheezing away right this minute? "I'm sorry Sylvia. I'm sorry I didn't find your little round thing. I'm sorry you died in here all alone. Your need was more important than the patient man down the hall waiting for his shot just like you told me with your eyes. I didn't believe you and I am sorry, Sylvia." Name changed
  9. YelenaV

    Singing with the Angels

    There are times, however, when the patient can't improve. To our frustration, we all remember times when our patients were terminally ill. Some we didn't know very well, so the feelings inside were sadness and reverence. Some were our favorites, and we cried together with their families. Yet I learned that death is not always a failure on the part of a patient or his medical staff. There is a powerful event which when happens is able to make peace between life and death. This event is called reconciliation. After graduating with my B.S. in Nursing I worked in a small hospital in eastern Kentucky. Being born and raised in Russia, it took time for me to get used to the local accent. However, I found people delightfully simple and friendly - they tried their best to understand my Russian accent and I was often telling them funny stories about how people live in my country. That day was my regular day shift. I had 9 patients, but they were unusually stable and therefore I was rather cool, calm, and surrendered. At the end of my hallway was a room for just one patient, and earlier in the day the patient was admitted there by another nurse. I was walking down the hallway in the afternoon when I heard this patient's IV beeping. I went in to see if it was just kinked and maybe could be easily fixed. A man in his late fifties was lying on the bed with Dr. E seated by his side and a lady about 40 years old standing in the room. I was surprised to see Dr. E because it was long after the doctors' rounds were finished and this doctor was pregnant, so I knew she would not come out to the hospital unless there was a serious reason. While fixing the IV, and sure enough it was just kinked, I heard bits and pieces of a conversation. "... Unfortunately Mr. J, the picture we got a week ago and a picture we got today are drastically different... It grew to the size of a grapefruit... This is a very rapidly growing cancer..." The IV was fixed; I exited and went on to check on my own patients. 15 minutes later the IV began to beep again, and I went toward that private room, thinking about how unwise it was to give this client to another nurse, the majority of those patients were in another hallway. I quietly passed by Dr. E standing outside the room, holding the lady and talking to her quietly, trying to comfort her. The lady turned out to be Mr. J's daughter and right now she was sobbing inconsolably. I entered the room and looked at the man with some degree of curiosity, I'll have to admit. He was lying quietly staring at his sheets. I fixed the IV, but I couldn't just leave him. We both could hear his daughter crying in the hallway. I sat down and took his hand. What do you say to a man who just received his death verdict? "Are you scared?" I whispered. He looked at me and tried to smile or say something, but I don't recall that anything actually left his lips. He just looked lost. I was so young, only 21, and this was the first time I was witnessing a person's reaction to the news of his death. I felt the sacredness of this moment and I could almost hear the world pausing, waiting for his reaction. And then suddenly something broke the silence - to my ultimate surprise, it was my quiet singing. I often sang to patients: little funny songs, Christmas carols, Russian songs. But those were cheerful songs meant to brighten the day. I never sang to a dying man. And now in this room, touched by the shadow of death I was singing an old hymn: When peace like a river attendeth my way, When sorrows like sea billows roll... Mr. J closed his eyes and squeezed my hand, and to my dismay, the tears started rolling down his cheeks. Usually, I would have been afraid that I had done something wrong, but deep down inside I knew whatever I was doing now was right, and the song went on: Whatever my lot, Thou hast taught me to say: It is well, it is well with my soul... I don't remember how long I kept singing, but I remember the words that came out of his mouth finally: "Thank you! Thank you!" And I knew immediately he wasn't thanking me. When Mr. J opened his eyes, he looked straight at me and said: "I saw heavens open and angels singing. And now I know that God accepts me." This man from Eastern Kentucky probably didn't know that he practically quoted the great composer George Frederic Handel, who several centuries ago said the same very words after composing his famous "Hallelujah Chorus". His whole countenance changed. It was almost as if his confidence had returned. Chills ran down my back. I realized that I had just witnessed reconciliation between man and God. In the next several months I saw Mr. J quite often in the hospital. Sometimes I was his nurse, sometimes I would just stop by to say "Hello." When he would see me, he would say: "Here's my angel," but I knew I was no angel. I was only grateful for the privilege to be a small part of a miracle. His daughter called me when he died. Six years have passed since then. I moved back to Moscow, but in the rush of life in the capital, I still remember the lessons I learned from my encounter with Mr. J. I learned that each one of us longs for reconciliation with self, our loved ones and with God. But more important, I learned that God longs for reconciliation with us. I learned that God has a special way of talking to us, making a conversation that is understood only by Him and the person He is talking to. Other people may witness that conversation, just like I witnessed the reconciliation between Mr. J and God. One might even be a messenger of such a conversation, but this conversation is too intimate and cannot include a third person. What I remember the most is my feeling of gratitude and humility. What a privilege for a nurse to be an instrument in a healing process that is still possible even in the face of death.
  10. curlygirlie3

    Caring Vicariously

    It has been two weeks since I found out that my grandmother was in the hospital, ten days since her surgery, five days since I last spoke to her, four days since she moved to hospice, two days since the last time she was awake. For 81 years my grandmother has been a vibrant, healthy woman. Bike riding, swimming, square dancing, crafting, and enjoying time with her boyfriend filled her days in her small Florida retirement community. She must have known that she was sick. Colon cancer does not reach stage IV without a person experiencing symptoms. Waiting, ignoring, and deferring treatment was her choice; I respect that. The difficulty comes with the swiftness of decline - a sudden drop on the carnival ride that leaves one's heart in their throat. As a nurse, as a granddaughter, and as a person I want to be there for her. I want to swab her dry lips, arrange her pillows, and hold her hand. The gulf between me and her bedside is filled with geography, time, money, and obligations to my family and work. The guilt at not being there to care for her is enormous. After all, I work with cancer patients daily. I do all of the things that I want to do for her for strangers. Wait...I do it for strangers. Another family recently experienced a profound loss. I first met Ms. Smith when she was recovering from cancer surgery on my unit. She was beautiful, kind, generous, and funny. She was a gentle soul and I could tell that she had worked with children for most of her life. When I meet patients like her, my fondest hope is that I will never see them again. Don't take that the wrong way. If I don't see them it means that they are doing well. Ms. Smith was readmitted to the unit more times than I can remember with complications from her treatment. Despite losing her hair, appetite, and eventually her physical mobility, she never lost the qualities that made her so special to the staff and so loved by her family. In her last days I was her nurse. I swabbed her lips, I kept her dry, and I gave her medications to keep her comfortable. When she passed I paid my last respects as I placed her in the shroud. Unsurprisingly Ms. Smith has been on my mind for the past two weeks. I believe my memories of caring for her are helping me cope with the fact that I cannot be there for my own grandmother. I also believe that there is a nurse somewhere in Florida who is caring for my grandmother in the same way that he/she would care for their own family member. Providing nursing care for the sick and dying requires a sort of suspended reality. That is not a stranger in that bed, that is your mother, father, grandparent, or child. As a profession, we have a collective belief in the Golden Rule. This belief may be tested daily by the stresses of the job but we must never let it waiver. Somewhere out there a family member is holding out hope that you are treating their loved one as your own. To every nurse that reads this, please keep the belief in the Golden Rule alive because, one day, as I have, you may find yourself in a similar situation.
  11. spotangel

    I wish I could see you!

    Mr. Francis Ross's eyes were closed, his breathing shallow. I walked into his room. He was surrounded by his family. To the outside world they looked like a very close knit family. I knew better, bearing witness to the daily infighting inside and outside that hospital room. The reason was very simple. Francis was dying, was a DNR and the family stood to gain a lot of money. There was a tiny hitch. The ex-wife Clarissa had showed up now professing undying love for him. She claimed that he was going to get better and that she would nurse him back to health. Francis clung on to her and her words. His children could not stand her; calling her a fake, gold digger. They felt that he could not see past her honeyed talk. Matter of fact, he could not see as he was blind now. The diabetes had claimed his eyes. Francis had left his wife to marry Clarissa when he was a hot shot lawyer. His wife died a few years later and their children held that against him. Later when his luck and money were down Clarissa left him, divorced him and got married to someone else younger and richer. Francis realized his mistake, reached out to his children and mended his fences. For the next 20 years as he got sicker, his kids took turns to bring him to the hospital. This seemed to be his last visit as he was in multi organ failure. No medical treatment was working. Somehow, Clarissa found out and was back in his life. The evening before, I heard that there had been a bedside wedding. The children had found out that Clarissa was back in their father's life and were livid. Looking at the fatigue on Francis face, I gently herded the group out of the unit and went back to him. His BP was low and his labs had looked real bad. Since he was on palliative care we were giving comfort measures only as per his wishes. "Annie?" "Yes, Francis?" "I need your help." "What can I do to help you?" "I need a priest. Can you get me one?" "May I ask why?" "I want to get my last sacraments and confess. I know I am dying .Aren't you Catholic?" "Yes! Let me see what I can do. How do you feel about dying?" "What can I do? I can't change it. I want to talk to a priest." I called our hospital page operator who had all the on call and on duty pager numbers. The priest had gone on vacation to Africa and would not be back for 2 weeks. The backup number went to a message center. I called the Nursing Supervisor and asked for help. She made a few calls but could not get anyone. I then thought of calling my local parish priest who looked like a Chuck Norris double. Father Nick aka Chuck Norris, was a young and energetic priest. Bless his heart; he made that half an hour ride in 15 minutes and got preferred parking by the hospital entrance as I had called security at the front desk. Father gave him his last rites and he was at peace. I thanked father and he left. I allowed the family to take turns to visit and then leave. Clarissa left saying that she would be back after a quick shower. Four hours passed, no Clarissa. Francis condition was worsening although he remained alert throughout. It was almost time for me to leave. I gave report to RN Joan Wallace. Also updated her that Clarissa may return after her shower! I went to Francis's room. "Goodnight Francis! See you tomorrow!" "Annie will you come in here please!" I stepped closer. "Can I give you a hug? Thank you for calling father Chuck Norris (I had told him that Father Nick was a Norris double!). I feel so peaceful". We chuckled softly in perfect accord. "Sure, Francis, I love hugs! You are very welcome!" I hugged him gently as he was all skin and bones. "I wish I could see you child!" "You never know Francis, you just might! Remember our motto; never lose hope. Bye Francis!" "Bye! Annie! Bless you!" Hoping to see him the next day, I left. It took me half hour to reach home. Thankfully I got a parking on the street after a couple of drive arounds. Walking into the quiet apartment; I let a sigh of relief. The day was over. As it was summer, the sky was still bright and there was plenty of sunshine in the room. My husband had taken the older two who were toddlers then, in the double stroller for a walk in the park and was not back. As I sat down in my living room and untied my shoe laces, I froze. I could feel a presence in the room but could not see anyone. The air was still and expectant. In my bones, I felt, I knew it was as if someone was watching me. Strangely, I was unafraid and it felt peaceful and not scary. I instinctively looked at the clock. The time was 8.42pm. "Francis, if that is you, go in peace to God! I guess you can see me now! Glad you got me with only my shoes off!" I was unaware of the tears trickling down my face as I smiled at my weak joke. Just as it came, it was gone. I hurriedly removed my shoes, washed my hands and picked up the phone. I called my unit and asked for Joan Wallace. Joan picked up the phone. "Annie, you won't believe this!" she said in a rush. "Remember Francis, that sick guy in room 684?" "Yes?' "He just passed. The Nursing Attendant went to take his vitals and found him pulseless. The doctor pronounced him. He is calling Clarissa and his children now." "What time was he pronounced?" I asked quietly. "Around 8.40pm" How on earth did he know where I lived, I wondered. I sat and said a prayer for his soul. As I pondered on the visit, I realized that he had made his wish come true as anything was possible now that he no longer was burdened by his earthly body. As I opened the door to welcome my noisy family back and hugged the kids and their dad, I whispered to the still air, "It was good to see you Francis! Remember, never lose hope! With hope, all things are possible!"
  12. ICU/CCU

    I See The Light ... Lift Me Up.

    My mother also received high doses of narcotics in these end stages to keep her comfortable. As a result, she had been unresponsive for two days. I was sharing the night shift with my stepsister who gave the thorazine at 2 a.m. and told me that she would stay up while I took a nap and then we would switch. At 3 a.m. I woke up when my mother suddenly sat up in bed and quite lucidly asked for a cigarette. I looked at my stepsister and asked if she should be awake to which Kathy, shock evident on her face, simply shook her head "no". My mother told me that she was dreaming of "better places" and asked why she couldn't just go there. She remained completely awake, without shaking, without pain, until around 9 a.m. when she found excuses for each of her six children to leave the house and then she closed her eyes and died. Four years later, I was a nurse and the first shift that I was off orientation happened to be the first night shift (11pm-7am) I ever worked. I had been oriented to ICU, but was floated to the telemetry unit that night. In report, the nurse was telling me about a patient who was end-stage for some type of cancer. I no longer remember what type of cancer she had. The nurse told me that the patient would likely not live through my shift. She said that for palliative care she was receiving 10mg of morphine every few hours, which had kept her quite sedate for the nurse's entire shift. In fact, the nurse said the patient had been completely unresponsive for her. She reported that while the patient was unresponsive, she gave the morphine based on the patient's respiratory pattern, rate, blood pressure, etc. When report was finished, I went into the room to assess my patient. I put a small nightlight on by the door that cast an eerie illumination across the room. As I approached the bed, my patient said in a soft, sing-songy voice, "I see the light." I was scared to death that my patient was speaking and I felt nervous just being on my own. I shakily mumbled a quiet, "Hmmm?" Again, she said in the same sing-songy voice, "I see the light." Fear was rising quickly in me. My mind raced with thoughts back to when my mother was dying. I said nothing and walked to the patient putting on my stethoscope to do my assessment. As I leaned over my patient in the bed, she said in the same high, floaty voice, "Lift me up". Her eyes were closed and she barely looked alive! I remember taking off my stethoscope and looking around the room to see if anyone was there to witness what I was about to say. With nobody around, I mustered up the courage I needed. Again she said, "Lift me up..." With my heart pounding, I leaned over the patient and quietly said, "To the Lord?" Suddenly the patient opened her eyes and said in a strong, completely normal voice, "No! I want to sit up in bed!" I laughed until I cried!
  13. b a nurse

    A Perfect Ending to a Perfect Day

    The window curtains were wide open. I kneeled down beside her where she could hear me and I grasped her hand into mine. I closed my eyes and I began to pray for her. The hall smelled of urine and that fecal odor that always permeates every breathable space in the facility. It was usual at this particular facility. There were loud TVs and call lights on above every other doorway. Through all this hallway madness my mind was on my time constrained day. It was filled with my usual patient load plus five. I had covered for a fellow co-worker who called in sick that morning. Up until that afternoon, my day had been filled with many hurries up and wait for situations but this next assignment would put time into perspective. This particular room had two patients, both separated with a curtain. I came to her around the curtain in the second stall. My eyes fixed upon her and I instantly surmised that she didn't have much time. I lay my backpack down at the foot of her bed. I reached to grasp her hand and could only feel cold. Her eyes were half open and her mouth was drawn open. I quickly felt her forehead and it felt hot. Raising my hands up I quickly said a prayer. My hand then caressed her face and went to work. The wash basin, soap, and hot water were in hand as I began to look around more closely. There on the nightstand and dresser were religious deity pictures accompanied by small statues of the Mother Mary. A thought quickly came to mind. I instantly turned on the TV to the all Religious channel. I knew she could hear even though she had labored breathing and half-closed eyes. I was on a mission. I had to get her comfortable and ready it seemed. I didn't stop but to only clean up from my procedures. Then I settled into bathing her. Methodically I began to clean her and I could tell as she seemed to become more relaxed as I progressed. Each part of the body received its individual care. I would rinse ever so carefully and then dry. First her face, then hands, and thirdly her body. Just as I started to care for the lower half she moved her hand and pointed to the window. After a few attempts to understand her, she spoke in a very mumbled and slurred tone, "Open the window." I dropped the towel and did as she told ending a prayer once more. She went back to her unconscious state of labored breathing and rest. I then was moved to comfort her. I wanted her to be calm and the best thing I could do was hum the hymn, How Great Thou Art. Once again she seemed to not respond and didn't seem to mind that I was humming the most comforting music available to her. I soon finished up with the bath and dressed her in a gown trying to do so with little to no extra movement all the time humming to her. My clean up took little to no time. I still felt compelled to comfort her more and more. Her breathing became more shallow. The time was coming close. I finished up and went to her side. I placed my hand into hers and I bowed my head. I began to pray to the Lord on her behalf. I felt better now that she was comfortable. I could read no pain in her face or body. I exited the room to start my "end of visit" paperwork and I returned no longer than five minutes later. She had passed. She was at peace. Many days after I could only think about her and how God worked his perfect timing. Throughout my entire day with all of the schedule changes, hurries and stops I was in perfect timing to be present for her on her journey home that late afternoon.
  14. tammysmithlvn

    Daughter vs. NURSE: Moral Courage

    Reflection: Moral Courage Moral courage is sometimes a shared experience. I have always had the realization that sometime in my Nursing career, I would be faced with the task of assisting my patient while they receive a terminal diagnosis. Allowing the patient time to process such information, and to make personal decisions based on their preferences and needs, is just a small part of nursing care. But never in my wildest dreams, did I ever think, that it would be my very own MOTHER... sitting next to me, And while I gently held her hand... Hearing the doctor say... "YOU HAVE TERMINAL LUNG CANCER" As you can well imagine, it was such terrible news to hear. And of course many questions surfaced. You know those "What If" questions...What if we did surgery. ... What if we did radiation? BUT all we heard back from the doctor was more negativity... "IN-OPERABLE and TERMINAL"!! This diagnosis was not at all what we expected to hear. As the daughter of the patient in the room, I remained quiet, trying to simply process the news, allowing my Mother to ask questions that I knew she had. But then... the Pulmonologist began insisting that she return to the hospital and undergo a Bronchoscopy procedure. Momma looked at the Doctor and simply asked him... "WHAT IF I DON'T WANT ANY TREATMENT FOR THIS CANCER"? The response from the Doctor was.... "WELL, I think you are being very SELFISH at this point" As you can imagine I abruptly abandoned the Daughter role and "NURSE TAMMY, LVN" went into action. I quickly reminded the Doctor that this was not his decision to make. The patient has the right to be educated about her diagnosis and treatment options, and would require more time to come to reach a decision. I told him the he had No RIGHT telling any patient that they were being selfish!! He angrily stood up and left us alone in the room. It seemed like we sat there together for an eternity..on the 12th floor of the office building, studying the Houston skyline. The ride back home was so quiet. There was a lot of thinking and soul searching going on that day. The Pulmonologist's office called the very next day, with the arrangements that had already been made for the Bronchoscopy. (This doctor was persistent!!). Two long days went by, and then one day after class I sat down in Momma's room to visit. I could tell she had been really battling this decision. As her daughter, I just could not give her an answer...."permission to die". BUT approaching this situation as a NURSE... I simply looked into her beautiful face and said... "DO YOU REALLY CARE WHAT KIND OF CANCER CELLS ARE GROWING IN YOUR LUNGS"? She looked up at me, eyes wide opened, and shook her head NO... I then simply smiled at her and said.... "I THINK YOU HAVE YOUR ANSWER"!! Such a tremendous release poured from her face at that point. She quickly began living the rest her life, spoiling her family with as much LOVE as she could. She never regretted her decision. As Nurse's... we are taught to become the patients advocate. We are there to offer teaching, protection, and to offer support... taking into consideration the wishes of the patient. We must find that inner moral courage and strength to be able to help our patients...and yes, even sometimes our very own MOTHER ... make the best choices and decisions regarding their personal care and spiritual well-being. In Memory of my Mother, Sandra J. Smith 01/04/1942 - 12/22/2010
  15. Death is the reason why I decided to become a nurse. I know, it's a rather strange thing to say and I probably don't mean it in the way that most would. I don't see myself as a caped avenger, fighting death. In fact, in many cases, Death is welcome. The journey to me becoming a nurse all started with an end; I got laid off from a factory job. Where I live, the government had an initiative that would pay for your education and some expenses if you had been laid off. When I first applied to school, nursing seemed like an okay option: it fit the requirements of the financial assistance program. But then, my grandmother started failing. She had been in a long term care facility for approximately three years at this point. Her doctor had called my mother to say that she would likely not last the night. Of course, my family being how we are, we all rushed to the nursing home and were at her bedside. My grandmother's nursing home was a small one; only about 50 residents lived there. When she made it through the first night, the staff moved her into their family room. It was there we stayed, keeping vigil. The room was small and my family is fairly large. But we spent the last week of my grandmother's life in that room. I say that this experience made me decide to become a nurse for several reasons. Sure, I had already applied to school and had been accepted but I had no real concept of what the word "nurse" really meant. Watching my grandmother and the people who cared for her was the way I began to understand its meaning. When my grandmother was hot, they would give her a cold compress. If she was in pain, they would give her medication. If she was cold, they would adjust her blankets. If my family was concerned about something, they would talk with them, teach them and simply comfort them. When the time came that my grandmother took her last breath, they came in to take care of her. They talked to her as though she was still there and they had tears in their eyes when they said their own goodbyes. Since then, I have graduated nursing school and have passed my licensing exam. I am working as a nurse at a local retirement home. In the two years that I have worked there, there have been 15 deaths. I remember each one. Death is not a battle that is fought, because there can never be any true winners. But for each of those residents who have died, I have been there. Death can be many things to different people: friend or foe, adversary or companion, silent partner or looming threat. I believe that the most important thing about being a nurse is how you help others deal with death and how you can help them go through it. You are there for the dying person as well as the living.
  16. I recently spent 45 minutes talking about death, and hospice, with my husband's sister in Maryland. Her mother -a delightfully quirky 91-year-old activist who still spends her days faxing her congressmen-just signed on with the local hospice. I'm a hospice nurse, by far the most rewarding work I've done in 35 years in the profession. I'm doing my best to help them navigate these new waters. Why is hospice nursing challenging? I understand so well what she's going through-teetering on that invisible line between wanting to cheer someone on to keep trying, and allowing them to decide that it's OK to stop fighting what is inevitable for all of us. Esther has, by my estimation, months, maybe a year left in her increasingly frail body. Although she's still very sharp, mentally, she forgets things more, has to stop more often to catch her breath, and can't really muster any enthusiasm for exercising with her walker. She spends more time in bed or on the couch, wakes up later, goes to bed earlier. I see the familiar signs of someone looking beyond this mortal coil. Considering the quality of those months is, to my mind, far more important than wringing out more of them by pushing her to eat more and take more walks. There comes a time with an aging parent when you have to stop trying to make things better, and decide to just love them, respect their wishes, and be present. I think that time has come with Esther. At this stage, it's important to distinguish between what COULD be done and what SHOULD be done. Still, it's hard. Damned hard. As I remember well with my own Dad, it's easy to decide in an abstract way that you don't want to prolong life unnaturally, to trade quality for quantity. Yet, when my rapidly declining father broke his hip, I was heartbroken to hear that he decided not to have surgery (in retrospect, this would have been a miserable experience he might not have survived). I wanted to let him go peacefully, without a lot of high-tech, dehumanizing interventions. I just didn't want to do it YET. No matter how clear we are, in a theoretical way, about wanting a peaceful, dignified end for our loved ones, we're never ready for this moment to be the last we have with them. That pain is something we sign on for when we let ourselves love someone or something impermanent. Which is, alas, everyone and everything. Loving the impermanent is one of the necessary pains included in this beautiful, untidy package we call life; I've decided to learn to live with it. The alternative, to harden ourselves and not get "too attached" (a concept that has taken much of the heart out of medicine, in my opinion) is not one I care for. This is what I love most about working for Hospice-we get attached to, and often fall in love with, our patients; it's a given. And although I'm aware of how much we bring to patients and families we care for-comfort, supplies, clarification of what's important, understanding of what they're going through and what's ahead-I always feel I've received more than I give. It's an honor to be with people who are facing their own mortality. Somehow frivolous concerns seem ... frivolous; the specter of death has a way of distilling what's important in life. And being reminded of our universal mortality reminds me not to squander this life I have on resentments, or worries, or acquiring more things. I'm more aware of the beauty, and the fragility, of the world and our relationships. So, I answered the questions I hear so often. Joining hospice does not generally cause people to give up and die-often the support we give causes them to rally and live longer and more comfortably; sometimes they even "graduate." Pain medicines, used appropriately, do not cause addiction or hasten death, but the need for them often coincides with a decline that has already begun to accelerate; ideally medications relieve pain and air hunger in patients' last months, even sometimes increasing activity. And yes, there are always gray areas: How long is it safe to leave her alone? How much should we push her to eat and exercise? As always, I suggested she answer these questions from her best understanding of, and respect for, Esther's wishes, and by exploring them with the hospice staff. We'll fly out over winter break; I look forward to spending some bittersweet, heart-ful time with my beloved mother-in-law. And I hope to make sure she's comfortable, and help love her out of this life. That's the best any of us can do, and what we all hope for in our last days.
  17. 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.
  18. VickyRN

    Skin Changes At Life's End (SCALE)

    The skin is the largest organ of the body and can become dysfunctional at life's end, with loss of integrity, just like any other vital body system, with reduced ability to utilize nutrients and other factors necessary to sustain normal skin function. The manifestations of this dysfunctional state are called skin changes at life's end (scale). These end-of-life skin changes stem from ineffective skin and underlying soft tissue perfusion, increased vulnerability to external insults (such as minimal pressure), build up of metabolic wastes, and local tissue factors. At end-of-life, a person may develop skin breakdown, despite multiple appropriate interventions and optimal care, as it may be impossible to shield the skin from insult and injury in its compromised state. The acronym scale describes clinical phenomena in skin and soft tissues that occur when the dying process compromises homeostasis, resulting in skin failure. Skin failure is defined as the localized death of skin and its underlying tissues due to decreased blood flow secondary to dysfunction of other body systems, often multiple system organ failure. This failure of the largest organ can be classified as acute, chronic, or end-stage. Clinicians need to have a realistic understanding of what can be achieved, in terms of prevention and treatment of wounds, due to the declining health status of individuals with multiple comorbid conditions and/or terminal illness, as they approach end of life. As stated earlier, not all pressure ulcers at end-of-life are avoidable. A common manifestation of scale is a phenomenon known as the kennedy terminal ulcer (ktu), which is a special type of pressure ulcer that forms suddenly in dying individuals. A pressure ulcer, also termed a bedsore or a decubitis ulcer, is a lesion that develops as a result of unrelieved pressure, shearing force, or friction or a combination of these factors. It usually develops over bony prominences. The damage consists of areas of tissue ischemic hypoxia, necrosis and ulceration. Pressure ulcers are most often seen in elderly, immobilized, or emaciated patients. The sores are graded by stages of severity, from stage i through stage iv. Research is limited, but the ktu is an unavoidable pressure ulcer that develops in some individuals as they are dying, usually within 2 weeks of death and in conjunction with impaired skin perfusion. This unique type of skin failure or skin breakdown is typically found on the sacrum or coccyx, occurs suddenly (usually within hours), and is shaped like a pear, butterfly, or horseshoe. The ulcers may be red, yellow, black, or purple in color, and tend to progress rapidly to stage iii/ iv. The treatment for the ktu is the same as for any other pressure ulcer of the same stage. This has been an overview of scale, a topic that is just beginning to be researched. Not all pressure ulcers are avoidable at end-of-life, especially the kennedy terminal ulcer.
  19. CheesePotato

    Dear Nurses: Please Forgive Me

    Dear floor, ED and ICU nurses, Please forgive me. I know he's dying. I get it. I do. We were told five years. Five years on an outlier and he would be gone. We were told transplant was an option but with the dismal survival rates, we opted for rehab. He is now eight years post diagnosis. We know we are lucky have had him this long. It doesn't make this any easier. Please don't say it like it's a mantra of comfort. For reasons I don't know or even fully understand, it only makes the sting more sharp. We see it, you know. The mental status changes. The lack of control. The shuffling gate. The use of accessory muscles. We see it. And we know exactly what it means. When he can't remove his bipap to eat, we know. When he can't lower the head of his bed past thirty degrees, we know. When he can't talk, we know. We know. Forgive me, please, my many sins. Forgive me the overbearing stare and raised eyebrow. Forgive me for repositioning him and demanding another pillow for under his heels. I'm helpless, you see, to stop the very shadow that will claim him and I have nothing else to cling to. I have nothing else but what now feel as tedious, miniscule scraps of knowledge that amount to nothing. No cure. No hope. I'm lost. I'm lost. You must understand that when I nearly demand to read the orders or see the chart, when I loom over your shoulder, it is not that I don't trust you...it is that I don't trust myself. I don't trust myself to be cope, to make all the right choices, to advocate, to deal with the loss and reconcile the feelings of guilt, of doubt, and pain. I beg you to understand that I'm scared to death and helpless and a control freak and for once I can't make it better. Understand that I glare instead of cry, laugh instead of scream, and go silent when angry. It's dysfunctional, but it's my way. And I don't want to be up later at night, pacing a hole in my carpeting, consumed by nausea and a feeling of coulda-woulda-shoulda. So when you see me wandering the halls, wringing my hands, biting my lip and growling under my breath, please don't be afraid to offer a kind word. It is what I need to hear. Even if I do not acknowledge that I heard it at all. Trust me, it got through. And I will remember. You must understand that this man is precious to me--that I want to guard him the way he guarded me from myself. That when I call every two hours to demand a neuro status check it is because I am not there and I am struggling to convince myself that I really do need to sleep even after being up for nearly thirty six straight hours and you are my eyes and ears and everything else. Please see what that cranky, demanding creature is to me. He wasn't always this way--a brain sitting in an acid bath is a terrible thing. I can't control what's happening to his body but I can control the flavor of his Jell-O and so, you know what? If that means raising holy hell with Dietary so I can get red Jell-O for him, then I will. Because it's all I have. Be genuine with us. We can handle it. Know that he is the first man, since my grandfather, who treated me with kindness, and god help me, love, even though I was a crazed woman-child dwelling in a familial household, riddled with hormones and a gloomy past, laden with baggage, sociopathic tendencies and unable to form any sort of bond and yet he never left. I lived years without that bond. Years without feeling the need for the guidance and protection only a father could give. Some part of me missing that bond and loathing "daddy's girls" everywhere. But he's trying to leave me now...I survived nearly a lifetime without him and suddenly I 'm not ready. I'm not ready. I'm not ready. Know that I never encourage him to use me as some kind of threat...some unholy boogie man that will get you if you don't help him right this very second. Because, "my daughter is a trauma nurse and she will know what you haven't done right." Know that when I come in and acknowledge that, ::sigh:: yes, I am a nurse and then talk a little shop with you, I am not trying to be in your business but show you that I understand what you are trying to accomplish and understand what you are dealing with on a day to day basis. I am nothing without you and neither is he. But he is my dad. Please understand.
  20. nerdtonurse?

    The Patient I Failed

    She knew what she wanted. She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself. So, she wrote a Living Will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted. Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor. The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke. She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart. Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat. The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it." I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existent, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent. Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better. She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken. And so was mine. The-Patient-I-Failed.pdf
  21. Chancub

    Through the Eyes of An ICU Nurse

    Everyone copes with things differently, but often times I write to help me cope with the difficult woes of my job. I often don't share, but this time I thought, why not let some of you guys have some insight into the life of an ICU nurse? If it wasn't for the outpouring of love and emotional support from my coworkers, I often don't think that I could do it, and I think as a team they are incredible and mean so much to me and have taught me so much, so thank you. 10/8/16 You'll never know how much you affect me. You'll never know that I had to step out to get some air and call my own mother, just hear her voice, and be thankful that I still have her in my life. You'll never know that I went home and cried my eyes out in my shower thinking about the struggle and loss your family is going through. I bring you water and tissues, you thank me.... it's the least I can do. I stand by you and hold your hand, and hug you as you sob. Your selfless decision to let your mother go peacefully is the most beautiful and difficult decision you could've ever made...I wish you could believe and understand how incredible and courageous that act of love looks like from the outside, even though you're broken and shattered on the inside. You stand by her side as we turn off life support. She was loved. You'll never know how much that sad look in your eyes and the glisten I notice on the verge of tears, eats me up inside. You offer me food, with a cracking voice, because you're incredibly selfless and have no appetite. You sit next to your son and read him a story knowing this may be the last time. You beat yourself for not being there, blame yourself for his disorder. I tell you it wasn't your fault, it's genetic, as you look away from me with tears in your eyes. You ask if he will ever be able to breathe again on his own, I wish could tell you yes, but his muscles are deteriorating and his disease is unforgiving and undeserved. You hold his hand wishing for these final moments to last forever, you try to cherish them. 8/16/16 Your youngest daughter was rolled onto our unit unresponsive. She was pronounced brain dead by the attending; you fall to the floor, a blubbering mess, demanding to have the test redone because you swear you saw her eye move; it didn't. I help you off the floor as you are bawling into the blanket that she used to sleep with every night. I am left there by the attending to pick up the pieces of families' and friends' broken hearts. You have a large family, I keep explaining what just happened to each person that re-enters and asks questions. They are all so thankful for the honesty, even though it's the last thing anyone wants to hear. You so desperately want to understand why she is dead if her body is still functioning on life support. I re-explain, but you can't comprehend, you keep asking yourself why? Each time a little piece of my heart is with you, I wish desperately that she could just wake up and be your baby girl again; but she can't, she never will be. I watch you as you stroke her head gentle as tears roll down your cheeks; "just one more day," you wish you could talk to her just one more time. You yell at her to "Wake up! Please, please wake up", you beg and plead. I give you your space, you need these final moments with your daughter. I secretly cry in the bathroom for you. I am there for you, I support you, and my heart hurts for you. I will never forget you. You'll never know how much you affect me. You'll never know how privileged I feel to be your ICU nurse.
  22. Gold_SJ

    A Death's Memory

    Mm a new day, the young woman thought. A small quirk to her mouth as she jogged up the stairs. Today was her first shift of seven: three earlys, a late, then two night shifts. Not tooo bad for a roster, but you know she did always prefer the nights, the pay was so much better. If fact Sam was in the middle of her postgraduate at Bunderburg hospital's children ward. Her confidence now after eight months had greatly expanded and she had grown quite comfortable with her co-workers, as unique as they could be. Pushing open the door, the twenty year old let it slam shut behind her; the bang echoing down the stairwell as she half ran down the hall, checking her nurse's watch. Dammit late again! At this rate she was going to give herself one of those lecturable reputations. She'd always been this way, such a daydreamer. It would be only fifteen minutes to the clock and she'd be panicking her way to work, grabbing her faded work bag and running up the stairs from her car like there was a pack of dogs after her. Just five minutes earlier and she could have taken the lift like a 'normal' person, but no she had to make it difficult for herself. Swiping her key card, she popped open the door and collapsed on the nurses station, head propped between her palms. "Wow you just made it," The dry sarcasm from the other paediatric postgraduate of the year Anthony. He could be such an old man, Sam thought. Poking her tongue out at the tall brunette, getting a raised brow in response. It was probably because he was older she mused absently. Not that twenty-three was that much older then twenty, but still, the day all fun got sucked out of her life well...she'd pronounce herself dead. There was a giggle, "You know I can't see how hard it is to arrive ten minutes before work, compared to right on the hour." The female teasing coming from no other then her preceptor Cecelia, an absolutely gorgeous woman. She had long red hair, pinned up impeccably by gold butterfly pins, perfectly manicured nails and a pale slightly freckled face powdered to perfection. Sam inwardly groaning jealous, but seriously how could anyone have that much time to work 'and' look like that? The thirty-two year old was inhuman. Personally she was more the tomboy if she had to give herself a label, short black hair, plain hazel eyes and certainly no makeup to be seen. She internally smiled as she followed the pair into the handover room. Although Cecelia was so eccentric and childlike it was impossible to hate her for it. Sam watched as Cecelia smoothed down her navy skirt. The red-headed clinical nurse having perched herself on the end of a chair, her ankles were crossed cutely while her pale hands folded together as she looked expectantly to the tall male in the room. Seemingly unaware of the grey eyes Anthony remained standing, a small furrow in his brow as he flicked through his assignments. During the night and late shift there was only one Registered nurse rostered, with the occasional assistance by the Enrolled nurse. It was very different from morning shift, where there were two Registered nurses. Therefore Anthony had the whole workload last night. Wasn't so bad, as by her print out there were just four patients today. Yippee! A bludge shift, uncommon these days. "Not so much has changed since yesterday." The man reported his low voice sounded nearly bored. "The little girl in two was febrile at four o'clock, but it's settled now." "Need any paracetamol?" Sam asked. "No." A small glower sent her way. Well sorry for being curious, she thought annoyed. Tapping her foot impatiently, wanting to get up and talk with the parents boarding. Anthony was such a drag in handover. No gossip and he 'hated' being interrupted. He'd get that grouchy expression like right now and stand there like a fool for a few seconds; it was as if her words completely made him lose his train of thought. "Anyway..." He finally continued, "Gentamycin levels need to be done today on Jason and hopefully Leeigha can go home after review. It was a small fall and her neuro obs are fine." The short but specific handover continuing, it not long before Anthony had finished. "Oh it's going to be a lovely day today!" Cecelia cheered clapping her hands together as she smiled. "Don't jinx it." Sam hurried. That was the last thing they needed. A flood of croupy babies, then they'd never get to sit down. Respiratory observations galore. Yuck. "Samantha that is so superstitious, don't you feel dumb when you say that sort of thing?" Anthony's tone held slight bemusement. His haughty behaviour always got on her nerves. "It's true it 'can' happen." She protested. "You don't tempt God's sense of humour man." Sam huffed "That and you know my name is Sam. Samantha's so...old." "Sam is a boy's name." Anthony rejected, causing her brow to twitch. 'That little...' he could never help himself he always had to refer to her by her birth name. It really drove her crazy, but on the other hand, it did make Cecelia giggle like she was now. Sighing she caved, it was never worth the battle. For some reason Anthony never lost this argument and she'd just end up in a bad mood. Stubborn prat. Standing, she slid past the tall nurse in the doorway, picking up her first chart to claim. Flipping it open as she searched for antibiotics. "Uh..." The tone of Anthony's voice making her curious, tilting her head to the side, to see he looked quite uncomfortable; his mouth set, jaw clenched slightly. "Are you alright honey?" The concerned voice of Cecelia, making him grimace. "Yes fine. There was just one other thing. One of the children is making a mess." Sam snorted, she couldn't help it. 'Right, well that was ridiculous. This 'was' a children's ward what else did the small things do other then make a mess?' "Don't worry we'll clean it up." Cecelia breezed with a winning smile. Eyes lifted skyward "You don't understand. I mean a massive mess." He opened his arms in example, "Repeatedly all night." "There's only two that can walk." Sam observed, "Surely you saw them?" "If I had, I wouldn't have said anything. I was just sick of cleaning up. They all seemed to be asleep when I checked. It was just...odd." "Now who's getting superstitious?" Sam mocked, grinning slightly. "Tch, whatever. Have a good shift." The man dismissed, picking up his satchel and letting himself out. Sam waving as he exited. Only to puzzle over his words afterwards, for Anthony that had to of been the weirdest comment he'd ever made since they'd met eight months ago. "Who did you want?" Cecelia asked, leaning over to tap on the chart she'd laid out on the desk. It causing her to blink, her mind dragged away from the young man's foreign words. "Hm? Oh! This one please?" She begged, getting a laugh from the bubbly woman. "Another surgical? You'll have to grow fond of medical one day." "Yeah it's ok, but I like the rehab and encouraging part of surgical you know? You can actually help. Medical it just all seems so focused on antibiotics and waiting for it to kick in." She rambled. Truthfully she adored kids, so loved whatever she got, but she did like looking after post appendectomies and fractures. It was fun to see someone get quick fast, whilst keeping them motivated. "Be careful you might leave us for rehab one day." The pretty lady sung, having gathered her charts to her chest to walk over to the other desk. "Heh, doubtful." Why would she desert children? They were too much fun, adults complained so much. Two days later Rocking up to the ward, dutifully with less then two minutes to spare. Sam peeked around the entry-way trying to spot Margaret, Anthony's preceptor who she was working with today. Everyone pretty much just rotated and worked with whoever was rostered, but if you were stuck, it was your preceptor you cried too. Sheepishly she decided she got the better end of the stick. Cecelia was heaps of fun, Margaret was ready to retire and had ah...a little less patience one could say? But then again Anthony seemed to adore the greying brunette. So who knows? Maybe management really had paired them up with their personalities in mind. "Hellooo!" She called. "Sam really? Must you wake everyone up? It's not even daylight yet." Margaret's familiar grouchy voice causing her to spin around. She sighed, meeting the sharp eyes of the aging Clinical nurse. Oh yeah little miss fun killer. Really intelligent, but so strict, she felt like she was at school camp all over again. "Sorry, forgot how loud I can be." She apologised. Grinning a little sheepish, as she rubbed the back of her neck, thankfully spotting Anthony a few moments later and hurrying his way. Saved! Handover time. Well. That 'had' been what she'd been thinking. The wide eyes of Anthony making that immediately change. Whoa looked like he'd been stung by a bee. "What the hell did you do to your hair?!" The horrified tone causing her to flush in embarrassment; glaring slightly as she reached up to subconsciously tug at a purple-red strand. "Obviously I dyed it. Not like it's any of your business." She snapped. Regretting already her bold mood, damn Cecelia, it had been her idea. The playful woman had picked the colour and everything yesterday, it had seemed somewhat fun, after all she'd never changed her appearance before. "But I liked it black." He wasn't serious? Moron. Like what he thought mattered? "I'm not even speaking to you now, so report. Chop chop." She ordered, acting the words out with her hands. "I was only telling the truth." Anthony stated folding his arms irritable. Sam finding her temper boiling over, pointing at the frustrating man, "Listen, I don't give a crap over your point of view. Your clothing sense sucks, so why would I take your fashion advice?" Blinking as the guy only smirked. "Thought you weren't talking to me?" Oh...oh she could kill him. Pulverise him! She fumed, he was tempting fate she swore it. Unable to even verbalise a response, she growled and sunk back into her chair, arms crossed sulkily. "Hmph. Now what are you two arguing about?" Margaret grumbled as she pottered in. The lady did not have a sense of humour, but she did lecture them when they fought...which felt like every time they were remotely near one another. "Hair. Naturals better." Was Anthony's blunt reply. Of course he'd say that, play up to the older lady who never dyed her hair to her knowledge. Seeing Margaret smile, Ugh. "It's a fad dear." Margaret seemed to soothe, before setting down her old leather purse on the desk and wait patiently for their handover. Anthony immediately acting on autopilot and begun handover. The young woman squinting as she scanned the notices, glances to the tall brunette occasionally as he spoke, still a bit too annoyed to comment like normal. There was something weird about the guy today, he looked so pale. "Oi. Are you sick?" She suddenly piped up, getting an aggravated glower. "No. I'm fine, the kids just played up most of the night again. Can you let me finish?" Sam sighing but was quiet this time, he was in a worse mood then yesterday by the looks of it. She played with her newly trimmed hair, as she absorbed the information from the taller postgraduate. Not being long before it was over, the girl dragged into a discussion on the ward's duty list by Margaret, who found it completely ridiculous that staff were forgetting to sign it off. The woman umming and ahhhing in all the right places, unable to see what the big deal was, but apparently it looked great for their quality improvement measures during audit period. "Samantha come check this antibiotic with me." The rougher voice of Anthony interrupting, allowing her a quick escape. The girl grinning as she waltzing around the desk and after him into the treatment room. Puzzled when finding nothing out on the desk "Sooo whatcha want to check again?" She queried miffed. The guy's shoulder's only shrugging, "Nothing, I want to ask how the shift was yesterday." Laughter glinted in her eyes, oh so that was it, too cowardly to mention it before his beloved preceptor. "Eh it was fine. We just picked up in the playroom that was all." Irritation flashed over his features before Anthony shook his head slightly. "Weird. Just be careful." The man exiting, leaving her confused. And what was 'that' suppose to mean? She wondered. Aw why was there noise? Sam inwardly groaned. Complaining to herself as she dragged one of her soft pillows over her burgundy head. The young woman cuddled up in the comforters, lashes flickering as she was dragging unwillingly into consciousness. It sounded like her phone. Her nose crinkled, slowly rolling over and blindly smacking her hand on the bed side table in search for the bloody thing. What sane person rung at this time of the hour? Slender fingers caught onto the corner of the vibrating, piercing device and she pulled it over before her eyes. Staring at the number. Private. Ha! Like she was answering, she thought groggily, pressing the silence button and dropping her hand with the phone to her stomach. She was not coming into work for some other department today. She knew it was kinda rude, but she already worked fulltime and overtime held little interest to her. Lying there she begun to doze off, only to be reawakened by her small phone all over again. Groaning, she just tapped ignore again, letting it ring out. By the third time she had had enough, scowling she re-raised the phone sitting up slowly, one of the straps from her nighty falling off her shoulder. Private. The word glaring back at her and Sam finally groaned lifting it to her ear answering. "Hullo?" She mumbled thickly. "Samantha you answered." Motionless a whole heap of words rushed through her mind, but she eventually kept her temper...well sort of. "Excuse me? It's fricking three am in the morning!" "I know." "Anthony I hate you." She spluttered, rubbing at one of her darker eyes. Three am, she couldn't believe it. "I need you to come in." "Huh? Aw come on, ring Margaret. Please? Pleeease?" Her words more a whine. "No. She will not believe me." "Believe what?" Sam exasperated, "You need more staff right?" "Mm" Well that was suspicious, "Anthony..." "Just get yourself here. I'll tell you then." Worry washed over her "But um..you're ok right?" "No." The phone shutting off leaving her in a half panic, half rage. If this wasn't Anthony, she'd probably ring the night supervisor, but this was him and he was the most unshakably guy she'd ever met. It must be serious. Jumping out of the bed, half falling over some of the books on the floor, she yanked off her nightwear and begun to dress, she should get there fast. Barging through the door, completely out of breath, her eyes found the fellow postgraduate. He was leaning over the desk, hands framing his face hiding it from view, head bowed. "Anthony? Hey you ok?" She asked in worry, hurrying over. Her chest still rising and falling at a fast rate thanks to her sprint fest getting here. Reaching out she clasped his upper arm, feeling him stiffen but relax moments later. "Yeah." The mumble low. Sam jerking her hand back to rest on her hip, "Wait one minute you just said-" "I know what I said." The man straightening to partially face her, one hand was pressed to his forehead. The girl paled, blood it was spilling from his temple down his cheek and jaw. Her horror must have been obvious because he relaxed back against the desk. "I fell over, it's not that bad." "Why haven't you got your butt down to Emergency mister?" Sam stressed. Reaching up to push away the hands and get a better look, slightly surprised he allowed the action. It was a laceration, but like he'd said just a smallish one, around four centimetres. "Pressure will do fine." He stated, shoving the blood-stained swab back over the injury. "What did you do?" She fussed, darting to the treatment room and back with some supplies trying to wipe away the blood and giving him clean white swabbing to replace the soaked stuff. "Clean the playroom. Just..." He hesitated. "I lost my balance, slammed my head into the sink." Sam snorting, "So you called me in for that?" She asked. Slightly teasing him for being so childish, Anthony had never seemed the type to need babying over anything. "No." The man gritted out, eyes flashing with irritation. She mustn't have looked too impressed because he continued. "There's something in that room." He muttered. "Come again?" "Something is destroying it, I spend hours cleaning it. Hours." His flat words making her roll her eyes. "Be realistic. Unless you're letting the kids play most of the night, there's no reason it'd take that long." She lectured. The guy was silent, not responding to her statement. Sighing she spun on her heel making a beeline for the place that was causing so much drama. Sam not expecting the male to chase after her catching her wrist and jerking her to a stop just outside the glass doors. "Ow." She muttered in reproach, glaring back at him. "Well don't be an idiot; you're not to go in there." "Anthony." "Yes." "If you don't tell me what your problem is, I'm going to ring the supervisor. You're acting crazy." She stated bluntly. The brunette was wincing but let her go, Sam rubbing at her sore wrist as she studied the troubled man. "You shall think me even more so after this." He got out, but kept going. "I never believed in hauntings or any of that make believe nonsense. However the past three nights? I've had things exploding in there, toys, books... I've fallen over so many times" He was unsure "I'm ready to resign." Sam gaped, "No way, quit? You can't. You love it here." The man lifting a finger, "Correction I did. Now I don't." Was he crazy? She pondered eying the silent twenty-three year old. "You are saying some 'ghost'- "She mocked with her fingers. "Is destroying the room?" "Tch well I'm not letting any of the kids in there." He pushed up his jumper exposing the variety of bruises to her startled gaze. "That and I'm not doing this to myself." His sarcasm was evident, but she couldn't help it. Looking into the playroom from where they were standing, it seemed fine to her. Just toys littering the floor. Breathing out in despair, she reached out and pushed open the doorway, ignoring the guy's frown and stepped inside, looking around herself. Walking around the couch she sat down, hearing the door creak open and footsteps as Anthony followed her, standing at her side. He looked rather anxious in fact. Minutes ticked passed, "Sorry to tell it to you, but... nothings happening." She commented, stretching her arms out above her head yawning. "Maybe you aren't having enough sleep?" "I..I don't understand." He actually looked distressed. Feeling bad for him, she stood poking him in the shoulder, smiling slightly "Hey don't worry about it, I'll help clean up." She offered. Walking over to the toy boxes bending and scooping up the bright colourful Dora Explorer toys and blocks to toss them back in. Seeing out the corner of her eye Anthony slowly getting to work with the bookshelf, ten minutes passed as the pair busily packed away all the young children form of entertainment. From trucks to speed cars, hoola-hoops and jack-in-the-boxes. There was everything that would make this room one of the most exciting ones in a hospital from the eyes of a young boy or girl. Leaning down to pick up a rather over loved plastic lion, time seemed to stop. Sam's eyes widening as ice water felt to pour down her back, goosebumps rising over her arms and the nape of her neck. There wasn't even a sound and then the world seemed to literally explode. Objects flew across the room, the girl dragging her arms up to protect her face terrified. The air pressed in on her making it feel like she couldn't breathe ,before abruptly she was shoved back, arms waving as she toppled over to land on her poor backside. Silence, everything lay scattered across the floor, maybe even messier then when she'd begun. Trembling she didn't react, fear it had overwhelmed her. "Samantha." The worried words heard from some metres away. Gingerly she moved her neck, spotting Anthony on the floor against a golden yellow wall. She didn't respond, but she could feel thick gluggy fluid between her fingers, the hot liquid soaking through to her legs. Slowly she lifted her hands up, crimson red. It took her a few moments to realise what it was before she screamed. In seconds hands had hooked under her arms and lifted her to her feet dragging her to the entrance of the play room. Anthony unevenly trying to shush her, remind her about the babies down the hall. Sam a shaking mess as she was pulled out of the playroom, frozen feeling like she was going to be sick. Blood it was everywhere. The slick fluid clinging to her skin, running down her arms and legs. Anthony was holding her shoulders as if to stabilise her, truth being he actually was. She swore she would've passed out if she didn't have another person's presence so acutely evident. Lifting a bloody hand she wrapped it around his wrist, tears had escaped her eyes, but she didn't speak. "Are you hurt?" The man question stressed, "I should NEVER have let you go in there." He was cursing to himself; his self hatred was beginning to wake her out of the shock she was in. "Hey." She murmured quietly. He was still raging. "Oi! Idiot." She hissed. "Stop already I'm ok." The male went quiet before shaking his head. "You're bleeding everywhere. We have to get you downstairs." The rushed words actually making her laugh, it a completely unexpected reaction by his expression. "It's not mine." "What?" "Seriously." She affirmed. Pushing the supportive hands away and lifting her own out before her shuddering. "I think. I just need a shower." Anthony wrapping an arm around her lower waist and guided her quickly away from the room, to the end of the hall. Leaving her in the bathroom and disappearing. Sam immediately shoving her long loose pants down her legs, to step out of them; disgusting by the thick gooey material. In the end left just in the blood soaked underwear. Stepping over to the sink she started to wash her hands, scrubbing hard, wanting to get the blood out of her short nails. There a slight sound of startlement, "Really Samantha. Some notice would be nice." The annoyance causing her confusion, before she snickered realising the guy was having a sulk over her state of undress. Bemused as a towel was promptly pegged at her head. Catching it she wrapped it around her waist, turning. "What sort of nurse are you?" She teased. The atmosphere between them somewhat strained. Even through her joking, neither of them seemed to know how to speak of what had just occurred. "We didn't kill anyone did we?" Samantha asked suddenly a little nervous. "Kill...? Excuse me." Her words apparently having freaked Anthony out as he took off. No doubt to do a headcount on his current patients. Sam meanwhile stepping into the shower and pulling the curtain shut, stripping off her shirt and underwear, turning the water on full ball. She could hear nothing but the rain of water and her own breathing. Her hazel eyes watching as the crimson stained liquid swirled down the drain, there seemed so much of it. She shivered, had Anthony made her crazy? "They're all well." Her co-workers voice making her sigh slightly in relief, that was all they needed. To discover they were actually a pair of crazy blacking-out murderers. Twisting off the water, she reached out through the curtain to grab the towel she'd hung on the hook beside the wall. Feeling it handed to her, the woman dried and wrapped herself up. Ab;e to then push across the curtain, lifting a brow jokingly "So any idea for clothing?" "Got some already. Those scrubs that Cecelia keeps here. You know how terrified she is of looking messy." Sam giggled, but obliged, taking them and dressing in the shower, before stepping out. Quiet, she slipped past Anthony who was busy shoving all her clothing into a plastic bag. The two then hurrying past the scary playroom to dump themselves down into chairs at the desk. "So? Any plans?" she mumbled. "We should probably ring someone." "Never heard of such a great idea." The fellow postgrad's voice was sarcastic. Her eyes slanted, "Well we have to do something." "Right. If you couldn't believe me, how is management?" He had a point. The girl running her fingers through her damp hair anxious, "Just...don't want anyone hurt" Her voice a whisper. "Maybe it will just go away eventually." She propped her chin in her hand, as she toyed with a manual before her. Was it a ghost? A shared er...mental moment? Depressed she pondered all the situations, shivering a little, it sure had felt real. She'd thought she was going to die. Like all the air was going to be sucked out of her. "We can just keep out of the place till morning. Like you said, nothing has happened at day time." "You're right." Sam looking up to the cameras monitoring the ward in second nature. Pausing in alarm as she saw something white flicker in one of the screens. "Anthony." She hissed alarmed. "What?" "There!" The girl pointing up at the LCD, the man frowning but followed her finger. The pair watching in mild horror as a person walked around in the playroom that had just scared the bejeebers out of them. "It's a kid." She whispered. "How'd they get in there?" "It's not a patient." Anthony snapped defensively, but he didn't look well, pale and drawn. The girl glancing back to the display screen, he looked rather young in fact. Five to seven years old maybe? It was creepy, he shimmered on the screen as he walked around the playroom picking up toys, only to drop them moments later. Sam starting as suddenly he seemed to look right up at the camera, her heart constricting. He could see them? "Impossible." Anthony suddenly stated, as if reading her mind. The two worried as the child continued to stare at the camera. It felt like he was watching them, the child motionless, swaying slightly, his form shifting and flickering around the edges. "O..Ok I want to go home." She admitted creeped out. "I'll cover it up." Anthony decided, standing to toss a towel over the screen removing the ghostly watcher from view. Covering her face she shuddered, the pair spending the rest of night in a weird silence. The only sound being paper as she flicked through the occasional magazine, or Anthony typing and his coming and goings to the patients around them. As even she could not bring herself to go home and leave Anthony after what had just happened. If she was in his place, she'd tie him down if she had to, before letting herself be left all alone. Morning Standing at the playroom door she studied the floor in some disbelief. Water it was puddled right in the centre of the room. The woman remembering how hours earlier it had been dark sticky blood. "See. It's like it never happened." Anthony murmured from behind. "Yeah." She agreed uncomfortable. "Let's go. The others can fix it." She nodded in agreement. She had no desire to step in there, even with the warm sunlight that spilled across the floors. The pair heading to the handover room, finding both Margaret and Cecelia sitting down in wait. "Morning" Sam greeted with a small smile. "What on earth are you doing here?" Cecelia asked in surprise, "Aren't you late shift today?" "Mm yeah, I forgot something so came in to grab it." The girl lied, sitting down beside them. The red-haired Clinical nurse smiling, reaching out to tug at her hair "So cute" She enthused. The words making her blush. Well at least one person liked her hair change. "She spilt coffee all over her clothing, so she's wearing your scrubs." Anthony murmured. "Oh I completely understand." Cecelia waved off, shuddering for a moment, "Can't look messy." She was an odd one, Sam decided, but only smiled. Watching as the pale Anthony handed over the night events, leaving out their one big drama. At the end she couldn't help herself "Hey Cecelia. Just wondering, does the playroom ever weird you out sometimes?" Anthony looked rather annoyed she'd spoke of it. Cecelia however just giving a half smile glancing to the older nurse Margaret. "Well you find over the years here, there's a lot that happens in there." She laughed seeming rather carefree over her words. "Sometimes I swear I hear crying." Margaret appearing just as unsurprised "It was probably Richard." "Richard??" Sam and Anthony queried as one. "A young boy, he died in there a long time ago. Most of the staff have seen or heard something over the decades. He was a lovely little child, his parents died in a car accident and he followed after them. Very sad, I remember looking after him, but that was over twenty years ago." She was thoughtful "It's been some time since anyone's mentioned the playroom in that way." Margaret mused. "You aren't serious?" Anthony muttered. "I didn't say I believe in all those rumours or stories, but sometimes I'm certain I've seen him." Margaret explained blandly. Sam shivered, creepy creepy the old nurse was making her nerves even worse. "Why would a kid haunt anything?" She grumbled. Kids were fun, loving bundles of energy, it sounded ridiculous. "They say he thought we were keeping his parents away from him. He was an only child, no visitors, so he never liked the nurses, such a lonely child." Margaret lamented seeming saddened for a moment but only smiled moments later. "Anyway, enough of this nonsense, I have work to do." The woman clambering up to her feet and shuffling out the door, not even comprehending the horror she'd left in the pair of postgraduates. Cecelia laughing "Don't worry about her teasing, she's told me that story a million times." The thirty-two year old winking "And I've never seen this Richard, just some harmless fun. Margaret I think enjoys scaring the new nurses." She stood tapping her chin as she stared at the roof "After all a little boy, ghost or not would be harmless. It's a fun story." She cheered. "Keep passing it on, a little ghost tale livens up everyone's day." The mother of two walking out, her bright eyes full of laughter, Sam exhaling painfully, "How am I ever going to do night shift again." She half wailed to the room. Anthony making a face, eyes distant however "You think that's all it is? Some memory of a lonely boy?" "Hell if I know. I just don't want to ever step in there again after night time." "Agreed." The two remaining thoughtful for some time, "You gonna resign?" Sam asked depressed, remembering the other's proclamation, long ago in the night. "Hm. I don't know." He stepped over dropping his hand on her shoulder squeezing it slightly. "But, I have decided I am buying you coffee." Sam confused glancing up at the other in consideration, seeing him smirk "I've realized there are scarier things then asking you out." He... She laughed, she couldn't help it, wrapping her arms around her tummy as she giggled, eyes glittering. "And here I thought you hated me, I must be pretty unobservant." "Hn, very." "Alright, coffee's on." She agreed grinning. Somewhat shocked but also pleased. Anthony was the last person she'd expected to like her. Jumping to her feet she grabbed her bag of clothing, surprised to see the blood was gone, they were just soggy with water. It was like nothing had ever happened. Heading out the door, walking side by side with the other nurse, she felt a hand ruffle through her hair. "Now you'll have to grow that dye out you know." The statement made her blink, the girl snorting and punching the man in the arm. "Oh shut it." There was little venom in her tone, only laughter. Today There was a lot of things she learnt since that dreaded night. One was that Anthony couldn't stand spicy food, also that she felt kinda good with longer darker hair and the other? Well it was that sometimes there are mysteries that can never be truly explained. As still to this day she never saw that little boy again. But even so, when walking down that hallway at night, she still shivered. Occasionally she even wondered if that night had been nothing but a silly dream. Overall? She'd discovered some parts of life really were unexplainable, and a child's tragic memory could continue on. For what purpose she'd didn't think she would ever find the answer for. Nor did she think she wanted to know. In her opinion, some mysteries were meant to stay mysteries.
  23. interleukin

    The Immeasurable Fortitude of Mothers

    After returning from vacation, I was assigned to "Robert", a 24 year-old suffering from septic shock, multi-system organ failure and late-stage muscular dystrophy. He was maxed out on chemical and ventilatory support. In his room, the wasted young man lay in the center of large specialty bed. His angular contracted body was dwarfed by a puffy blue mattress that appeared to be in process of swallowing him whole. During his short life, Robert had been hospitalized multiple times. But this would be his last, his body slowly surrendering to a bacterial juggernaut unconcerned with strong wills or the code of human decency. Alongside the bed sat Robert's mother. She was short, her face drawn. She stood when i introduced myself. A meek smile betrayed none of her accumulated heartache. Her grey eyes hid none of her fatigue. I asked her about Robert's life and she began to talk about the photos that were taped to the room's bulletin board. In one, a frail red-haired little boy wearing water wings was splashing in a backyard pool. In another, he was in a toboggan, wedged between the knees of an adult. With his mother's eyes, he was staring directly into the camera. A third photo showed him in a wheel chair crookedly holding an ice cream cone, ready to take a lick. This was Robert's third day in the ICU. But because the bed was large and Robert's mother so small the only physical contact she could manage was stroking his arm. I left the room in search of the stool we usually keep in the unit. Unable to locate it, I grabbed a heavy box of computer paper and plunked it down at the bedside. "Would you like to kiss your son"? I asked her. I pulled Robert over and then helped his mother onto the packed box. With heartbreaking tenderness, she kissed her son's face. The following day, this mother decided it was time for her son to rest. With him held firmly in her arms, we extubated. The boy passed quietly, finally free from his incarcerating body. Ive been an ICU for 16 years. I am no longer intimidated by clinical complexities or traumatic injuries. To me, they're just variations on themes which oblige me to perform the technical balancing act until a body, hopefully, regains its footing. Today, I am motivated and rewarded by the challenges of assessing and interpreting the behavior of loved ones who suddenly find themselves thrust upon life's razored edge. For me, therein lies the power and privilege of being a nurse.
  24. Jacqueline.Damm

    The Gift of Hope

    Weeks after nursing school ended and I had passed the boards, I found myself in a newer community hospital in the most multifaceted unit that I've (since) ever worked. Our patient population ranged from general medical and fresh postoperative patients on one wing to hospice care and those suffering from cancer on the other. It was Christmas Eve and I had hurried onto my unit with a heart as heavy as stone. Being my very first Christmas as a registered nurse, I could think of a million and one other places that I'd rather be. I collected my usual 7-8 report sheets with a sigh and gazed down each hall from the main nurse's station desperately searching for a glimmer of hope. Each wing glowed as fluorescent as each day before without an inkling of holiday spirit. Sterile was the first word that came to mind. Sterile, cold and empty. My charge nurse stared down the hall, sighed and rose from her seat after report. I watched as my comrade in teal waltzed down the hall in a sort of trance, switching off numerous lights to dim the halls and stations. Each click echoed in unison with the rings of monitors, call bells and voices, all so far from comfort and so horribly near to loneliness. The holidays can manifest in multiple ways throughout the patient population. Some individuals are torn from family due to illness when others have been far removed from love for a long time. There are some who need somewhere warm to lay their heads whereas others had a home, but their families could no longer care for their needs. Regardless of race, creed, character or status, I could feel every soul in each room pulsing with a need to feel loved and cared for. I visited my rooms in the evening rush, scribbling my name on every wallboard and issuing a request for patients to call when assistance was needed. Then slowly, almost hesitantly, I walked into the familiar room of a man suffering from an illness that was killing him in the slowest and most excruciating of ways. I needed this room to be the last room to round on in my initial greeting of that Christmas Eve. With each popping sound, my Danskos made as they hit the floor I could feel my heart beating out of my chest, aching in a way that scared me to the bone. It was the ache, that fear, the one that told me there was nothing I could do to help this man but to make him comfortable as the time of his death drew near. I've always hated feeling powerlessness and being out of control. It is not my choice, nor my duty to make this choice for anyone. It is my abilities that can and will comfort them in those times, and with that, I must make my peace. He laid there in his bed, shaking and shivering as his monitor rang loudly, alerting me of his erratic tachycardia. My pulse quickened as I watched each QRS complex draw closer and closer to the next, then just as suddenly as it rose, it would slow down into comfortable sinus. I exhaled loudly. His head turned with a quick whip and through his glistening skin and grimace, I saw this incredible grin begin to appear. "It's been a few days since you were here." He chided playfully. I could only nod at first, working to find the air to vibrate through my vocal cords. 'It has been too long.' I smiled as I looked around his room. 'I see that the CNAs have decorated your room since I was last here.' He nodded proudly and then began to cry, his chin quivering uncontrollably. I rushed to his side and begged him to tell me what was ailing his spirit. "Someone's sweet daughter brought me this," he held up a hand-made glass ornament. "For me," he said in utter disbelief. "Why me?" This young man asked me, completely perplexed and spent from his constant fevers. 'I think she knew, deep down in her heart, that you truly needed a Merry Christmas.' This dear man only nodded, patted my hand and gave me leave very subtly with a wave of his hand. "I'll be ready to talk later," he said painfully, "I think I need a few minutes alone." I turned one last time before leaving his room, watching him gaze at his gift as if the meaning to life and his suffering was bubbling up inside of that glass ornament. The shift carried on its normal routine in some aspects, but something amazing happened at about 3 AM. My charting was near completion, medications had been passed, no one was calling for pain medication, and everyone was sleeping soundly in their beds. It was as if a deep peace washed over the unit, even the nurses were feeling quiet and thoughtful. Once again my pulse quickened as I felt my entire person being called to his room. I could almost hear his turmoil in my head and feel it through to my core. I rose from my warm seat at the nurse's station and headed down the hall. His Christmas decorations glittered outside the door in an almost warming glow. The miniature tree was something close to dream-like and perfection in such a sterile and cold place. All of that negativity I had been brooding over had melted off of me like the winter cold. In a near panic, I feared I had roused this poor man from sleep and hurried back to the door. It was so quiet and peaceful in that space, he just had to be sleeping. "Please don't go," his whisper cut through the silence with aching haste. "Please... Sit here with me". His eyes were brimming with large tears and that strong chin began to quiver. I didn't know what to say, but I tried: 'I... I thought you may need a friend or some company. I didn't mean to wake you, I know you need your rest." He grabbed my hand tightly and squeezed it with all his might. "I don't want you to go." He paused. "In fact," he sniffled back tears, "I was just thinking... How much I love each and every one of you." I leaned forward and stared straight into his eyes. I could see nothing but warmth and truth. 'We truly care about you, your life and all of your goals. We wanted to help you get strong enough to be home with your loved ones tonight.' He shook his head, openly unashamed of his weeping, "This is where I am supposed to be tonight." With conviction and poise, his face changed to the most serious and yet sincere look I'll never forget. "The moment you walked in here and smiled at me. I knew I was going to be okay, even if just for the night. Your kindness has given me hope. So, at least... I know I will live to see this Christmas Eve. Can you sit here with me? To give me strength? I can't do this alone anymore." Surprising myself, I was only able to nod because I had begun to cry myself. At that moment I could see his strength, his pain, his heart and the true nature of his spirit. In the beginning, this was just another shift to me. But to him, I was providing him strength, hope and a means to fight another night, maybe even another day. It's funny. At the time, I thought he really needed me. But, to be completely honest, I really needed him. I needed his strength and his faith in me to remind my self-doubt and fear that I have a gift. That I have the ability to help encourage and restore hope in the hopeless, faith in the faithless and power in the powerless. The care we give and the words we use acts as a channel where there is an opportunity for more than just our capabilities to shine through. Whether you believe in God, Allah, Buddha, juju, paying it forward, or any other positive force in this World, there (to me) is no doubt that something greater is at work in us and through us. We are a means. We held hands until another fever arose and he began to uncontrollably shake, wincing in pain. It was then I had to break the strength in that hand grasp and rush for medications that would help him fight for his life. It may have been dangerous on my part, but at that moment I took his illness personally. Until hand-off that morning, it was my and his personal battle to live, to live as long as he could through that Christmas morning with as little pain as possible. Before heading home I stopped to see this man, this epitome of fight and life, light and hope lying restfully in his bed. The sun shone through the window and covered him in a blanket of warm light. That's how I remember him. That's how I remember hope. When I forget, I pause. I think of his furrowed brow, the strength in his hands, the plea in his voice, and the resounding "Thank you," he whispered as we watched that gorgeous glow of his tiny Christmas tree.
  25. kurisuchine08

    The Broken Man

    When I went to work that day, it was with a heavy heart. I was preoccupied with my own thoughts and was just wishing that I could just go through with my shift as peacefully as I can. Little did I know that I was about to receive a wake-up call from reality. Little did I know that I was about to be slapped with the cold truth that I really was living a sheltered life. My problems were so little compared to what others are going through. This, I was about to find out that day. Hopeless- that's the first word that came to mind when I met him. I've seen many people who suffered from all types of illness and go through such excruciating pain, but none exhibited the same look of hopelessness that I saw in that man's face. It was the look of a man who has accepted that his life has come to an end. It's the expression of a man whose spirit has been broken. It's the look that would later haunt my dreams. What do I know about drug mules? Nothing much, I guess. I see them in the news all the time. Desperate people who, in exchange of food in their bellies, chose to be drug couriers. At that time, I would just shake my head, and say, "such a pity." Then life goes on for me. But now, I doubt I could just dismiss this as easily as I did back then. This man had tears in his eyes while trying to push out all the drug capsules he was forced to swallow. These capsules were as thick and long as your average man's thumbs. Imagine being forced to swallow 97 of these and again being forced to squeeze all of these out of your body. It was pure torture to witness this. It makes one wonder what drove this man to do such thing. But then again, the answer comes back to mind. It's the same thing that made me work away from my family. It's the same driving force behind every expatriate worker: to be able to provide a better future for one's own family; to be able to keep food in their growling bellies; to be able to provide roofs over their loved ones' heads. It's for his and his family's survival. But being without means to do it the legal way, he subjected himself to be used by drug syndicates, those vultures which prey on desperate victims. He allowed them to defile his own body, risking his own life and his family's safety. Who is to say, he did the wrong thing when it was the only option he was dealt with? Yes. He, too, is a victim. As a nurse, I was trained to provide care and comfort to our clients. It is my job to make sure that I ease my patient's suffering and help him make the transition from sickness to optimum health. But how do you nurse a wounded soul? How do you help him when he has lost the will to help himself? It destroys me to know that no matter how much care I give him, he will still be sentenced to die. I am my patient's advocate but I, too, am bound by the rules that govern the land. Someone callously remarked, "Why do you care that he should sleep peacefully tonight, when we all know he is going to die anyway?" I really wanted to rush at him and rip out his tongue. It was all I could do to rein back all emotions I felt. i went home that day carrying with me those terrible pictures in my head. Despite the exhaustion, I slept fitfully. I kept seeing that face of hopelessness. How do I go through these experiences unscathed?