Week Five

Week five felt a little easier: 5am wasn't so early. Respiratory rates didn't take so long to count (or even to remember to take in the first place for that matter). I didn't have to use my cheat sheet to find the code for the bathroom, pantry, utilities closet, or coat room. My love/hate with the thermometer-taker subsided. My string cheese, handful of wasabi wow trail mix, and protein shake is the perfect combination of calories and quickness to keep me running for the shift. 

Week five was exciting: During the morning shift change, I found out one of my patients was getting a thoracentesis that morning and I all but got on my knees and begged to be able to watch. A huge long needle and catheter going into the pleural cavity through an intercostal to drain some nasty gross fluid accumulation out? Yes please! My patient was a 68 year old woman with a long history of meth use who had just found out she had cancer in her liver that is ultimately going to kill her. Whether it was the meth or the cancer I'm not sure,  but her right lung was completely diminished thanks to about 3 liters of interpleural fluid surrounding it. She was a sweet, sad woman who was only then realizing the extent to which she ruined her body... and her life, it seemed, by the conversation I overheard when her 30+ years-estranged daughter called on the phone. The doctor who came to do the procedure was happy to let me watch and when he cleared it with the patient, her one request was to ask if I would hold her hand. Sweet, sad woman. Her little lung came up on the ultrasound - both lobes visible. Three needles, one incision, and a 1L bottle full of tea-colored fluid later... she laid back to recover and I simply had to tell her that I know she felt like crap, but hell if her hair wasn't looking like the day she last got it did. Sweet, sad smile. 

Week five was a win for the English majors of the world: A patient in for another all-too-frequent ERCP was counting down the minutes until her husband showed up so she could discharge. To pass the time a bit I prompted a conversation about the book she was reading next to her bed. Guess whose bed that book is living by now? I'll let you know how it is in my next installment of book reviews ;). 

Week five was a lesson in what not to do when it's time to let your parents be in comfort care: Well. Actually that's that really what the lesson was here, but I'll go with it for now. A son in grief over his 80-something year old mother's deteriorating condition was constantly attempting to feed her despite chronic aspiration and extremely impaired alertness and orientation. He wanted normal routine vitals to be taken, nutrients to continue, morphine to subside. He wanted attention from the Attending. None of the "young doctors" to treat his mother back to health. This difficulty is not really a nurse's burden to bear (although of course we are involved and drawn into the discussions... and, possibly, have a voice with the family where the doctors are unable ). It was sad to watch all of the wheels come off like that when there was so clearly a way forward towards making her comfortable. The importance of THAT lesson is only going to become more underscored as I experience it in my own sphere. But the real nursing lesson for me this week is there are few things more beautiful than when a palliative patient is resting comfortably. I must have stared at her for minutes at a time for signs to tell me what would make her head relax more...for her breathing become less labored... her arms and legs supported... her fingers interlocked. She mumbled indecipherably to me through closed eyes when I said good morning the second day I had her as a patient, but I knew that she understood all that was going on around her. And at least for the times the suite was quiet and there was no family or doctors to squabble over care plans, she was peace-filled.

Week five left me in awe of the era of medicine we live in: The PICC nurses let me watch them put a new central line in for a patient downstairs. We don't get much of those on my floor, so this was a real treat that my clinical instructor Angel totally hooked me up with. I want to explain this whole process step by step, but this post is starting to feel wordy. Suffice it to say... I'm sure I looked ridiculous in my sterile hat and mask, but as I watched on the ultrasound as that tricky little wet noodle line got pushed in from the arm and across the shoulder... chest... and paused before registering its decent down into it's new superior vena cava home, I felt overwhelmed with gratitude for this art of healing through science. 

Week five reinforced that life is not fair: My first glimpse of my 18 year old cancer patient was walking in on him halfway off the bed, supporting himself up with one hand over a yellow-gatorade-vomit-soaked sheet on the floor. 6'1, good muscle tone, not one strand of hair left anywhere on his body, pale as all get out, and a smile to make you forget about the grapefruit sized tumor on his knee. I can't really talk about him more than this other than to say I think it's bullshit that an 18 year old kid is stuck in a dark boring hospital room during summer watching crappy daytime tv to pass the time when he wants to be out in the world trying to become something "cool" like a criminal investigator. It's unfair. Even for a dodger's fan. 

And lastly, week five made me realize I want to work as a registered nurse. Not as a CNS, not as an NP. Those roles will come, surely. But I really want to work as an RN along the path to getting there. 

Thank You Note from Hannie

BEST thank you note EVER! Oh my gosh I cannot stop laughing. Remember the days when 8 bucks and one to grow on might as well have been a million?

WSP: A Look Back...

I'm flying out to DC tomorrow to see my dear friends Sean and Shana get hitched - and it has gotten me thinking about how SIX years have gone by since I first met this band of crazies. It all started with my Semester at Sea roommate Liz who did a semester in DC after we got off the ship. Almost all my DC friends (except my gays and coworkers) come from some connection to that initial WSP 2005 group (which we affectionately called The Bartlett Administration at the time - and of which Sean was/is POTUS and Shana, then, FLOTUS). Anyway here we are 6 years later, and I couldn't help myself from going back through pictures now that I have some back from storage and realizing how it feels like EVERYTHING has changed, NOTHING has changed, and... above all... how often we were in costume.

This is the earliest group picture I could find, but I definitely remember pictures from the EOS apartment days and the "tiki" party someone threw. (Does anyone have those? Send them to me and I'll add them!) Anyway I believe THIS Halloween was at Callanan and Erika's apartment in somewhere VA, right? PS Who is that blonde girl next to Liz? What man did she belong to? 

 

These pictures are from right after Liz, Rachel, and I moved into 548 - was crazy hats not the first party we ever threw there?? I think it was...

Of course the next right move was to evolve in complexity from hats to full-on 80s, which we did QUITE well. What I remember from this night is setting up a PROJECTOR in the living room to blast 80s music videos on. And streamers. Oh my god I worked for EVER on those twirly streamers all over the ceilings. I also remember Steve "Big Guns" Allen and his Navy buddies showing up in normal human clothes and proceeding to raid Liz's wardrobe for "80s" looks. And, as always, flip cup in the kitchen and Callanan ending up amongst the trash. 

Shamrock Fest. I want EVERYONE to know that I really REALLY restrained from publicly revealing the pictures I have in my arsenal from Shamrock Fest. I think we made it to two Shamrock Fests as a crew and I cannot stop laughing at why that was deemed the BEST POSSIBLE TIME for Muffin's homemade empanadas to make their first entrance. Also noteworthy - remember when POTUS and Muffin like legit RACED up that stupid climbing wall in the middle of the parking lot? Good GOD.

 

Another Halloween - at Muffin and Sweeting's place near H St. Corridor. I. HATE. HALLOWEEN. But I think I finally was a good sport and put on like a Minnie Mouse costume at the last minute. Regardless, Roman's costume definitely takes the cake on this one for me. And also this is where I first start seeing Tiff show up in pictures! (Other than Memorial Day in Orient... which I can't find my pictures of!) 

Ok now for some nice ones... Birthday in Monticello, TRADEMARK picture of us on the barrels on the North Fork, Cute one of Liz and I on the Speaker's Balcony, and a Family Thanksgiving Dinner shot (in an effort to represent ALL the MANY family meals we enjoyed together... even the all-out Christmas Brunch where we had the unexpected Fire Department guests show up. Oops.) And OF COURSE the last time we got all gussied up for Phil and Tiff's wedding :)

I'm sorry if this post feels disjointed or exclusive to those of you who don't know anyone in these pictures... but for me it is amazing reminder of the history I have going into the weekend ahead with these dear friends. Having TOO MANY hilarious pictures and memories to chose from is one of the best problems I can think of to have. All of these memories are made even sweeter when I think about the last time I was in DC which was for the trial (and wouldn't you know it - the only picture I could find from that trip was one of Muffin drinking BOONES (!!!!) on his couch after the trial went in recess for the day). All of these friends (including others outside DC, specifically Clint who has actually been by my side for three years longer than WSP friends) have been there from the morning we found ourselves in the hospital waiting on Rachel to wake up... to showing up at 548 to help move us out around the horrific scene the house had become... to supporting us in dealing with the media and detectives and laywers... to sitting in the court room EVERY DAY of the trial despite needing to be at work. Well.. happy days are here again, Bartlett Administration! It is going to be a GREAT weekend of celebration and I cannot WAIT to see you all.

UPDATE: I just found these that are either relevant to the aforementioned memories OR just couldn't be left out... Disfrutan!

The climbing wall at Shamrock Fest... WITH MUFFIN AND POTUS en route!

Muffin and his empanadas!

I found Orient pics! 1st comes love, then comes marriage, then the baby in the baby carriage = Phil and Tiff

How does one comment on perfection such as this?!

POTUS and FLOTUS

Orient, NY. The most relaxing place on earth because there's nothing else to do but relax.

Or make out with guys in canoes... (You're welcome!)

A New Axiom

Two tests on Wednesday of this week had the whole cohort spun up into a tizzy. It can be said that our type thrives on stress, so maybe that's what contributed to the tension everyone created for themselves. All that talk had me in a semi-panic when I realized how much I took to heart the idea of "balance" in this craziness and didn't study at all during 4th of July weekend. Yet from that temporary psychosis, a new axiom emerged: The most important thing is to become a kickass nurse.


But part of getting to that place is the growing pains of not being there yet. Not even close. I forget to count respiration rate on vitals all. the. time. Then what?! I've just been faking it on the charts. I even got semi-called out (in a nice way) by the nurse I was with this week and I still faked it. UGH! So stupid. I also have "student nurse" insecurity - I hate making the patient wait or try again just because I'm retarded! So embarrassing. *SO* humbling.

I've just never been challenged like this before. I've always been good at what I do or stayed away from what I suck at. This whole process is a blend of those two. Because of this, I am grateful to have some life experience and a not-fresh-out-of-college maturity level to fall back on. I'm OK with my weaknesses to improve on. I'm even okay with them being publicly exposed! The most important thing is to become a kickass nurse. 


On the floor this week, I recognized a family member of a patient about to get discharged into hospice care. Suffice it to say that was bizarre for both of us, but ultimately a great reminder that this work is not isolated. The patient probably has another week or two in her so for now the highest priority was pain management. She was in a lot of it. But the PCA and I began to give her a bed bath anyway - gently with the warm towel over her swollen legs... firm grasp over her shoulders to roll her on her side... whispering encouragement that it was almost over... loosely locking my fingers in her hand as we waited for the EMTs to ready her transport. She was not able to formulate many words between her drowsiness and difficulty orienting herself, but she offered a decisive "thank you" before she left.

I hope I'm the kind of nurse who will always consider it a privilege to participate in personal care. For now though, I hope I'm the kind of student who remembers the most important thing is to become a kickass nurse.

The Type of Life Being Led

Harold: What is wrong with you? I don't want to eat nothing but pancakes, I want to live! I mean, who in their right mind when given the choice between pancakes and living chooses pancakes!?

Dr. Hilbert: Harold, if you pause to think, you'd realize that that answer is inextricably contingent upon the type of life being led... and, of course, the quality of the pancakes


Firstly, let's agree that this quote from the movie Stranger than Fiction from a few years ago (and previously posted on this blog way back when) is hilarious and a comedic high point for Dustin Hoffman and Will Ferrell's characters in the film. It makes me laugh on a basic level... but moreover I love how they scratch up against the concept of how we CHOOSE to live our lives. Doesn't choosing between pancakes or life truly depend on the individual pancake up against the individual life? 


On the floor this week I had patients who have made decisions that have brought them to a place where they just might chose pancakes. Diabetes and alcohol abuse and Hep C and failure to thrive. And I had patients this week who, like Harold, want to live. 


An elderly partially-English speaking patient with beautiful long hair, a husband with kind eyes, and grandkids to get home to came into the hospital with ankle and knee pain. She left with a shiny new walker. I worry about if the walker will serve as more of a hindrance than a help to her longevity as she comes to rely on it more and more. But her eyes were bright, her medication was minimal, and her eagerness to get back to living her life with her family is proving to be more important in patient outcomes than I ever realized. Before she discharged, she told me in broken English that I chose a wonderful profession that will really help people - and to guard my smile and optimism closely. 


Another patient had been battling breast cancer since 1997 and done everything in the medical arsenal to kill it; unsuccessfully. She's one of a very small group receiving experimental chemo treatments now, and came to us because of pneumonia risk. Short of breath, exhausted, weak. She vomited up her breakfast the moment she attempted it, and wearily told us that that hasn't been a symptom for her until this new therapy. The chaplain was doing rounds shortly after and she invited him in for communion while I was in there for vitals. I made myself scarce in the corner of the room while he spoke the Lord's Prayer over her and I literally forced tears back into my eyes, willing them not to spill in front of the patient. I wondered at what drove her to fight for 14 years like this, but when I heard about her two doctor daughters and saw her teenage granddaughter sitting by her bed later in the day, I understood that the decision was inextricably contingent upon the type of life being led.