An Unnecessary Thank You

In my last post I mentioned I had received a letter from a family member of a cancer patient thanking me for my "help." As I also mentioned I don't feel I did anything extraordinary, but I did what I do, and will ALWAYS do for my patients. This is why I chose oncology and why I can be an oncology nurse.

Yes, it tears me apart when a patient and his wife get discharged after just being told to go to the beach, spend time with your loved ones because all avenues of treatment have been exhausted and goodbyes are less than a year away, like I did on Friday last week. I shed a few tears of my own with them and hugged them goodbye, really pissed off there wasn't anything else I could do for him, angry that this stupd disease existed.

This stupid disease can scare even the strongest and bravest at any moment, even those with very promising outcomes, like my other patient. He needed 3 cycles of chemo and had tolerated the first cycle just fine, but this second round he was hit with chemo-induced nausea and vomiting (CINV), and it scared him so badly he wanted me to stop his infusion pumps and discharge him at that instant. We talked (and I don't consider myself funny, but for some reason others do and my sense of humor has become an asset in oncology) and laughed, even left the building for a little bit. In the end, he survived his second round of chemotherapy and gave me a huge bear hug before he left the unit to go home upon discharge.

I am always touched by the large and small gestures of cancer patients and their families. It reminds me even for those who I can't help save, perhaps the support and care I gave them helped ease their mind and pain for just one second.

Anyway, here are the letters I received from the family...

"I would like to acknowledge Beth for being such a kind,compassionate and informative nurse. She has provided patient X, who has cancer and is struggling with this, has renewed my hope in our profession. The time, care and true understanding of a pt's needs made me proud to have met her."

and (same family, different person)

"I wanted to thank you for going above and beyond, showing sincere compassion for patient X when he needed it. You are an incredible nurse, and my family is thankful he was in your hands."

and the letter they wrote to my boss...

"Dear (ElizaBeth's Boss),

I wanted to thank you for being kind to patient X, although I know you treat everyone like that-I would just like to recognize your thoughtfulness.

Also your nurse Elizabeth Hxxxx, (I hope I spelled it correctly), showed patient X empathy, warmth, and understanding during a difficult time. Despite having other work to attend to, she took time to destress patient X by walking him outside, which made all the difference. She had to stay late to chart and never complained about it, instead she held patient X's hand and talked with my family. She admitted she is a newer nurse, but one would not be able to tell. Her thoroughness, motivation and skills preceded her. She is your best asset and thought you should know how wonderful one of your own has done.

On behalf of patient X, my family and myself-thank you!"

It was extremely kind of this family and unnecessary for them to recognize me like this and I appreciate their kind words more than they will ever know.

Round 5....

was in my opinion a fail!  Monday started off well with the race and some additional running, but then Tuesday I was asked to work over, Wednesday I was scheduled 12, Thursday I tried to get back on the horse, but by Friday I got bucked off.  Friday I had my first float shift to a leukemia floor (and no it's not the same stuff as on my floor) for 8 hours only to have the boss call and ask if I could stay over for a total of 12 and then with the full moon Saturday and Sunday the patient's went crazy!!  When it was all said and done I worked 63 hours.

Although, running was not the focus of my time for the week I feel the work I put in with my patients was well worth the trade (I'll even share a letter I got from a patient's family in another post).  I don't feel I went above and beyond or did anything I wouldn't normally do. 

Mon AM: 12.3 (0.73 mile warm-up, 5k race, 3.42 mile cool-down)
Mon PM: 5.05 (8:33/mile a little bit harder than an easy run)
Tues: OFF
Wed: OFF
Thur: 11.62 (8:40/mile - long run)
Fri: OFF
Sat: OFF
Sun: OFF (very glad, but tired this work marathon was over for 2 days)

Total: 23.92 miles

Mad At The World

Sometimes being an oncology nurse sucks -- a lot!

When I first started on my floor a few moths ago, one of my first patients was a young man (a baby in my eyes, significantly younger than me who was definitely in my opinion, just starting out in life) who had a wife and a 17 month old baby.  I had had patients near my age before, but never this young.  As the weeks went by I got to know him, his wife, his parents, his in-laws and his siblings.  They became part of our unit almost.  They slept on floors, cots, chairs, anything they could find to just get a few more moments with him.  He had beaten cancer once at 19, but it had come back and it was moving faster than I had ever seen cancer move before.  He spent a month with us, before I discharged him the week before Easter and told him "I hoped I'd never see him again." 

He came back in less than a week to my dismay and he was worse than ever.  The doctors told him it looked bad and they didn't think he could handle another round of chemo, unless things changed.  I watched him fade away before my eyes, until God finally took him earlier this week.  It was a blessing.  He had held on for so long, fighting for his family and for the long life he should have had, but he couldn't do it any longer and with just a few gasps for air he passed and was gone. 

I had a wave of nausea pass over me and I almost broke down in the medication room, but I managed to close my eyes and take a few deep breathes.  I reminded myself "I had to keep going."  I had patients to take care of.  I was calm on the outside but a turmoil of emotions on the inside as I tended to my patients and helped the family through the aftermath, as best I could. 

The night took forever and when daylight crept through the hospital windows signaling my shift was nearly over, I felt so relieved.  I had to get the hell out of there.  I stopped at the store at 8:30-9:00am and bought a six-pack of beer, under the circumstances beer for breakfast seemed the way to go.  I made it through one before I fell asleep exhausted. 

I woke up angry that a child so young had to grow up without knowing what an amazing father he had, a man who apologized to his mother about a week before he passed saying "I'm sorry, I didn't do more mom." 

I couldn't email anybody or call them that day.  I hid from the world.  I wasn't up for talking or sharing.  I never am when things like this happen.  My anger was of course, full throttle, not that he died when he did, but that it had to happen to him at all.  I spent most of my time wondering what the hell God was thinking and what more I could have done to help him. 

I finally, dragged myself out of my hole on Tuesday to go to the track, not to do the workout, but to go back and face the world.  Seeing my friends was really nice, a few knew something was wrong almost right away and when I told them they hugged me and told me they were sorry.  It was a short conversation, without a lot of dwelling or details.  I couldn't deal with a heart to heart, but just the short talk took a load off.  I ran absolutely terrible.  I was too hot, I couldn't breathe, I felt sluggish and completely blew the workout.  All those awful feelings though meant I was still alive.

Even in the moments of road rage, the crappy track workouts, the pain in my feet, the cotton mouth, the tears and the unimaginable sorrow that accompanies loss I'm not dead and I still have a lot to do with my life yet.

The First Day

After nearly two full weeks of training and orientation I was finally scheduled to work on my unit.  It was a 12 hour shift (7a-7:30p), so when I got up at 5:00 am, I knew by the time I got home around 8:30 pm I was gonna be wiped.  It was so great to be back and see so many familiar faces.  It was a whirlwind of a day and of course, problems arose all at once rather than consecutively.  I spent a large part of the date observing IV drug administration and getting all my passwords set-up for the time clock, the computer, the pyxis machine (it's like a pop machine, but it dispenses drugs at no charge). 

I had my first up close and personal experience with an Indiana pouch.  I think those things are so cool!  Patients that have an ostomy bag on the outside of their body that can smell and must be emptied often suffer from self-image issues, but this internal pouch is pretty sweet for those who need new bladders.  The stoma itself just looked like a second belly button off to the left of my patient's abdomen.  The patient said catheterizing himself at regular intervals was pretty painless too.

We've added tele to our floor since I was there as an undergrad and reading EKG's has become more common.  I didn't care for them in my first undergrad and I still don't much enjoy counting the little boxes and trying not to go blind as I measure the PR interval or the QRS complex, but I am definitely better at it after spending two full eight hour days reviewing the material earlier in the week. 

Anyway, I was sitting at the nurse's station with about 45 minutes left of my day when I heard this strange noise that kind of sounded familiar to me, but I couldn't place it.  Out of the corner of my eye, around me, I saw a few nurses jump up quickly and call out a room number as they headed down the hall.  It registered at that point what it was.  "Oh sh*t!!"  A code blue really?  On my first freakin' day back, just when I was almost done!!!"  I jumped up and hauled ass down the hall to the patient's room.  It had been the tele monitor alarm indicating the patient's heart rythm was a flat line.  I was thinking two things, man I am not ready for this and if I was going to be in on this code, I definitely wanted to do compressions or bag the guy.  No way was I gonna put the central line in, if needed or push atropine, epinephrine, etc into said line. 

Luckily, when I got to the room, it turned out the patient was trying to get up to go the bathroom and had pulled a wire.  CHEESE AND RICE PEOPLE!!!  I was relieved, no code today for me.  I went back to my desk and prayed I would make it to 7:30 pm without any more codes or craziness.  The full moon was Saturday, not today.  I had a chance at normalcy and freedom still. 

Exhausted at 7:45pm I dropped off my time sheet and headed for the elevators.  I made it down to ground floor and had to get through the J building to get out by my car, but before I escaped I could see a couple looking a little confused.  I knew they were lost and I debated stopping.  I stopped.  They were lost and I ended up taking a ten minute detour into another building and up the elevators to escort them to the appropriate floor.  They told me their daughter was extremely sick and while I was exhausted, I wasn't sick and no one I loved was either.  The extra few minutes it took to help them were well spent. I left them in the waiting room of the unit their daughter was being transferred into and headed back out.  Finally, made it to my car a few minutes after 8:00 pm.  I was ready to head home.

Day 1: DONE

The Panic of Waiting

Uggghhhhh!!!!!  This week has just been something!  I can't find the word to describe it, but man it's been a doozy.  It started with the doctor's appointment I had scheduled for Monday to have that lump checked out and then Thursday was the mother of all tests for me.  Yes, the NCLEX.  It was absolutely awful for me and not just the test but the majority of the day and even part of Friday.

I scheduled the test for 0800 and received instructions to bring my a printed copy of my test code and my driver's license and be there by 0730 to check-in and start on time.  I printed everything out the night before and of course the damn printer ran out of ink before I got all the pages printed, so after a cartridge change and 2 more tries I got it.  I went to boot camp and as usual with the cold weather, my truck doors froze shut, so I made a mental note to check the doors at 0630 on test morning to make sure I could get in -- I did, no major problems. 

Got to the test center on time and waited to check in.  As if I and the other eight or so people weren't nervous enough, they all but patted us down and drew blood beforehand.  They called my name and I had to get fingerprinted, have my photo taken and have a venous palm scan.  I was then asked to remove my watch and any jewelry (no scarf) and place it in a locker.  They then asked me to roll up my sleeves, pull the front pockets of my jeans inside out and turn around stick my hands in my back pockets and prove there was nothing in there but my hands.  The monitor then gave me a dry erase board that I was not allowed to erase anything on and I was not allowed to write anything on until the test began.  Writing on the board ahead of time is brain dumping and is considered cheating.  There would be a camera above me monitoring me the entire time and if I wanted a break I had to raise my hand and wait for a monitor to come escort me out of the test room.  I was not allowed to get on my phone, use a computer or leave the building.  The monitor asked if I had any questions and then escorted me to the computer. 

Now, I was nervous of course, when the day started, but after all that I could feel my heart just banging in my chest, my palms weren't sweaty, they were drenched.  My ears were hot and it was hard to hear.  My level of anxiety was right below that of an attack and I was about to take the biggest test of my life.  This was gonna be rough.

I took my time going through the tutorial and tried to calm down, but my heart just kept hammering.  My stomach was on fire by this point and I didn't know what else to do, but begin the test.  I repeated positive affirmations over and over " You can do this.  You are gonna pass this test."  Nothing was working.  I can't even remember the test question at this point, not that I could repeat it anyway, but it wasn't as easy as I hoped it would be and I couldn't decided if it was because I wasn't sure or my brain was just so panicked.  I somehow got through the first 25 with a few "select all that apply," which is a very high level question, so that's a good thing.  I checked the clock on my computer, one hour had passed!  I had been taking my time, but this was crazy.  If I only did 25 an hour, I would only get through 150 questions.  There were as many as 265!  I would never get through all the questions.  I had to be found competent in as few as possible. 

I raised my hand at that hour mark and took my break.  We had been told to take the breaks when we were ready, not when they offered.  I was escorted out of the room and had a venous palm scan done again before I exited.  I went to the bathroom and tried to collect myself.  It didn't happen.  I was not gonna get it together today.  I started thinking I was gonna fail this and how it was gonna ruin everything and how upset my parents would be.  I got a grip as best I could and re-entered the computer lab.  They checked my sleeves and pockets again and did the venous palm scan.  After, being escorted back to my computer again, I sat down and forced  myself through the next 25, continuing to take my time and even writing a few things on my board.  I started making slash marks for all the "select all's"  I was getting quite a few.  I used that to give me hope that I was doing well, trying not to jump up and run out of the lab.  Got 50 and took another break, went to the bathroom again, checked-out and back in.  Two hours gone by.

The last 25 were no easier or worse than the other 50.  I had taken around 15 "select all's" and only one math.  Those were good signs.  I remember the 75th question was pretty easy and just like that when I clicked "next" -- It shut off!!!  I had taken the minimum amount of questions.  I just didn't know if it was because I was competent or completely incompetent.  I thought to myself "there is no way the computer, could tell I was that stupid in 75 questions.  I know I am smart enough to at least make the computer work harder than that to figure me out." 

I left feeling sick to my stomach.  I was shaking, my heart was still pounding and now after 3 hours my chest was hurting too.  I drove home near tears, thinking I failed.  I felt there was so many I had guessed at and never seen before, even with the review class. 

I logged on to the website to see if it would let me register again to take the test.  Unofficially, if you can register that means you failed and if you can't that means you passed.  I pushed credit card and it allowed me to continue on with registration.  I broke down crying.  It was letting me register.  I called A and explained what had happened, mildly hysterical and completely panicked.  He tried to calm me down, but nothing doing and then I realized, I hadn't logged into my account.  The site didn't know it was me.  It thought I was a first time user!  Still panicked I logged in and tried to register.  It wouldn't let me.  It was an unofficial way of saying I passed, but I had w,orked myself up so bad I still believed I failed. 

I thought I would feel better after that, knowing I had taken the test and it was over finally, but it was worse, the waiting, the wondering.  The rest of the day my thoughts were consumed with the idea of failing.  I talked to my dad and he tried to reassure me, but nothing worked.  I found out he even called A to come over and try to relieve some of my anxiety and calm me down.  I just felt terrible all day.  I couldn't focus on my tempo run and blew it after 2 miles on the treadmill.  I went outside and barely made it through the other 2. 

I was a mess and I still am today, the morning after.  I feel sheer torture as I check and re-check the Ohio Board of Nursing hoping my status changes to "active."  The more I check the worse I feel.  No matter what the result, I am certain I will be crying my eyes out.  I can't fathom re-taking this test.

It's Not Cancer

I can't tell anyone how relieved I am at this moment in time.  I just got home from the OB/GYN and the lump I had found last month in my left breast was just as I had suspected, hoped and prayed.  It was just some fibrous tissue.  I can feel the tears behind my eyes, the lump in my throat and the tension in my jaw as I sit here, fighting my emotions trying to type this out quick.

You never think it can happen to you.  I generally feel pretty health, but when I sat down and explained to the doc what brought me in I felt very vunlnerable and weak, knowing I wasn't invincible and I could be sick, really sick.  He did a breast exam and found the lump and told me he thought it was "nothing," but just to be safe he wanted me to have an ultrasound on it.  The ultrasound as most of you know is very quick and painless, hell the gel they used was even warm.  I watched the screen and every area on my breast looked the same.  While I am not an ultrasound technician, I can figure out that when the lumpy area looked like the rest of my breast, it was a good thing.  The doctor confirmed my unprofessional diagnosis.  I thanked him and walked out of the office knowing that for the first time in over a month I would be able to fall asleep tonight knowing that lump in my breast was not cancer.