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.