If I'm no worse for wear, if I lived through it to tell the story, if I'm better off now, if I've moved on and found love elsewhere, if I'm not hurt or angry....
Then why on Earth does it fester like a nasty wound?
5.31.2010
5.09.2010
Thoughts on Hospice and Other Things
(This was a journaling assignment for the CNA program I just completed)
Hugging a woman, tearfully grateful that no one was hurt when her house burned down one Christmas taught me that I am, in fact, not the center of the universe (a shocker when you are 17).
Hunters found the body of a sweet old veteran with Alzheimer’s who had gone missing out in the sticks a month after we had called off the long, extensive search for him. When the coroner's report revealed he had likely been alive during the days I had been working on the search, I cried my heart out. The “what-ifs” bothered me for a while, but I came to believe that we can only do our best for people, and even then, we can’t save them all.
Having “situational awareness” and “keen observation skills” drilled in to me during my training as a search and rescue volunteer and EMT soon seeped into my daily life, immersing me in all the beautiful little details of life that many people are too busy to notice.
I learned to wear my seatbelt, never smoke, use a helmet, avoid drugs, practice safe sex, and never drink and drive the hard way: by taking care of good people who suffered the consequences, in the ambulance, the ER, the OB-GYN clinic, the spinal cord injury / traumatic brain injury rehab hospital, hospice. As a result, though, I have a deep-seated, emotional commitment to those rules that is very difficult to break.
Feeding an older man struggling with Parkinson’s who had accomplished things in his lifetime such as interviewing Martin Luther King Jr. reminded me to respect the wisdom and dignity of those who’ve been here for a while.
I witnessed grace beyond anything I could ever imagine attaining, in a nun embracing her last moments on Earth.
Sitting by wives, husbands, children, brothers, sisters and friends as they spent their final few hours and days with their loved ones, inspired me to make a conscious effort to never take someone I care about for granted.
And in the last minutes of my last hospice clinical, sitting alone with a woman in the still silence of her room, holding her hand as she took her last peaceful breaths, affirmed that death is not to be feared. Walking out the hospice doors and back in to my own life, reminded me that the world goes on without us.
They say we are in a profession of giving. I believe it is an honor and privilege to help those who invite us in to the most private aspects of their lives; to have them trust us, our skills, our hands, our minds, and most importantly our hearts when they need help the most. I believe that in giving care as your life’s work, you receive so much more back.
Near the end of my first shift at hospice, walking out of a room as the sun dipped, beautiful, rich singing suddenly filled the hall. It was coming from one of my patient’s rooms. Curious, I knocked and entered. I realized it was a woman singing prayers in Hebrew, emanating from a stereo on the bedside table.
The patient’s daughter, sitting at her side, explained that the woman with the otherworldly voice was her own daughter – the patient’s (we’ll call her Eileen from now on) granddaughter. She was an opera singer and college student. When she flew in to visit a week before, she sang these Jewish blessings for her grandmother. Although Eileen was nearing death, suffering severe dementia, and often incoherent… she made one thing clear to her family and grandchild… “blessings,” she had repeated over and over again. So the granddaughter sang for her for hours. Before she had to depart back to school, the family recorded a long CD of her singing for Eileen to enjoy over and over again.
Later I returned to Eileen’s room with dinner. Her daughter had gone home for the evening so it was just her and I. She required total assistance, likely would only have a few bites, and was down to just saying the word “yes” at this point. I paused as I uncovered her meal. It was Friday evening - Shabbat eve. Friday evening and Saturday comprise the Jewish sabbath. I grew up in a Jewish household, and knew that this meal held special significance to this woman who clearly valued her faith.
“Eileen, you know, my father is Jewish. I even got close to my bat mitzvah. I remember some of the blessings, but it’s been a long time. Would you like me to try to say a blessing over dinner?”
“Yes,” which was her invariable reply now. I wondered if she comprehended what I was talking about, and if she did, if she really intended to say “yes.” I reasoned that at worst, she’d think I was crazy, and at best, I’d help a dying woman uphold an important spiritual ritual.
I went ahead, held her hand, and let the prayer loose in the sing-songy nature of Hebrew blessings. I hoped that I didn’t butcher it as we sat in silence for a moment or two afterward. I was probably eleven years old the last time I had recited it.
“Perfect,” Eileen whispered – the only time I’d heard her say anything besides “yes” in my 24 hours with her as a patient.
No one had died during my first shift. Midway in to my second shift, I heard the toll of the bell, marking the passing of a patient, out in the hall while caring for someone. Although it was not our patient, I asked to help with postmortem care since I hadn’t seen it yet. One of the nurses guided me and explained the process. The patient who had passed was in her mid-fifties. I noticed that both the nurse and the CNA were about the same age. I wondered if they ever mulled it over… if it ever bothered them to see people their age die or if it just made them grateful to be well. It was striking to watch the healthy, able-bodied nurse deftly attend to her duties, standing over a deceased woman of the same age whose body had been ravaged by cancer for years.
“You put up one hell of a fight, Jill.” the nurse said reminiscently as she pulled the sheet over her face. We closed the door and went back to work.
In the last hour of my last shift, the CNA I was following pulled me in to one of our patient’s rooms. Her condition had rapidly declined in the few hours since I’d seen her last. The CNA said she thought she was very close to passing, and since the woman was alone, asked me to stay with her. I sat by her side as I talked to her softly, just letting her know I was there and she wasn’t alone. She had a bible at her bedside, so I read a few passages.
Her hands and arms were cold, she had no radial or brachial pulse, and her carotid pulse was so weak and irregular it was hard to detect. I followed the pattern of her breath as I smoothed her hair from her forehead. She would be apneic for as long as 20 seconds, give a few labored breaths, and stop breathing again. Cheyne-Stokes? She did have congestive heart failure, among other things of course.
It struck me that I could assess this woman all I wanted, name her conditions, consider the pathophysiology going on, whatever, but the best thing I could do for her is sit by her side and just be present. I don’t think many people want to die alone. As the last minutes of my shift drew near, the CNA returned to the room with a stack of charts.
“I’m going to finish my charting up in here,” she said, and it was understood between us why. I was so grateful that I didn’t need to leave this woman alone in her final moments. I said goodbye to the patient, thanked the CNA for all of her help, took a deep breath and walked out the door as I heard her soft voice offering comfort to the dying woman.
Hugging a woman, tearfully grateful that no one was hurt when her house burned down one Christmas taught me that I am, in fact, not the center of the universe (a shocker when you are 17).
Hunters found the body of a sweet old veteran with Alzheimer’s who had gone missing out in the sticks a month after we had called off the long, extensive search for him. When the coroner's report revealed he had likely been alive during the days I had been working on the search, I cried my heart out. The “what-ifs” bothered me for a while, but I came to believe that we can only do our best for people, and even then, we can’t save them all.
Having “situational awareness” and “keen observation skills” drilled in to me during my training as a search and rescue volunteer and EMT soon seeped into my daily life, immersing me in all the beautiful little details of life that many people are too busy to notice.
I learned to wear my seatbelt, never smoke, use a helmet, avoid drugs, practice safe sex, and never drink and drive the hard way: by taking care of good people who suffered the consequences, in the ambulance, the ER, the OB-GYN clinic, the spinal cord injury / traumatic brain injury rehab hospital, hospice. As a result, though, I have a deep-seated, emotional commitment to those rules that is very difficult to break.
Feeding an older man struggling with Parkinson’s who had accomplished things in his lifetime such as interviewing Martin Luther King Jr. reminded me to respect the wisdom and dignity of those who’ve been here for a while.
I witnessed grace beyond anything I could ever imagine attaining, in a nun embracing her last moments on Earth.
Sitting by wives, husbands, children, brothers, sisters and friends as they spent their final few hours and days with their loved ones, inspired me to make a conscious effort to never take someone I care about for granted.
And in the last minutes of my last hospice clinical, sitting alone with a woman in the still silence of her room, holding her hand as she took her last peaceful breaths, affirmed that death is not to be feared. Walking out the hospice doors and back in to my own life, reminded me that the world goes on without us.
They say we are in a profession of giving. I believe it is an honor and privilege to help those who invite us in to the most private aspects of their lives; to have them trust us, our skills, our hands, our minds, and most importantly our hearts when they need help the most. I believe that in giving care as your life’s work, you receive so much more back.
Near the end of my first shift at hospice, walking out of a room as the sun dipped, beautiful, rich singing suddenly filled the hall. It was coming from one of my patient’s rooms. Curious, I knocked and entered. I realized it was a woman singing prayers in Hebrew, emanating from a stereo on the bedside table.
The patient’s daughter, sitting at her side, explained that the woman with the otherworldly voice was her own daughter – the patient’s (we’ll call her Eileen from now on) granddaughter. She was an opera singer and college student. When she flew in to visit a week before, she sang these Jewish blessings for her grandmother. Although Eileen was nearing death, suffering severe dementia, and often incoherent… she made one thing clear to her family and grandchild… “blessings,” she had repeated over and over again. So the granddaughter sang for her for hours. Before she had to depart back to school, the family recorded a long CD of her singing for Eileen to enjoy over and over again.
Later I returned to Eileen’s room with dinner. Her daughter had gone home for the evening so it was just her and I. She required total assistance, likely would only have a few bites, and was down to just saying the word “yes” at this point. I paused as I uncovered her meal. It was Friday evening - Shabbat eve. Friday evening and Saturday comprise the Jewish sabbath. I grew up in a Jewish household, and knew that this meal held special significance to this woman who clearly valued her faith.
“Eileen, you know, my father is Jewish. I even got close to my bat mitzvah. I remember some of the blessings, but it’s been a long time. Would you like me to try to say a blessing over dinner?”
“Yes,” which was her invariable reply now. I wondered if she comprehended what I was talking about, and if she did, if she really intended to say “yes.” I reasoned that at worst, she’d think I was crazy, and at best, I’d help a dying woman uphold an important spiritual ritual.
I went ahead, held her hand, and let the prayer loose in the sing-songy nature of Hebrew blessings. I hoped that I didn’t butcher it as we sat in silence for a moment or two afterward. I was probably eleven years old the last time I had recited it.
“Perfect,” Eileen whispered – the only time I’d heard her say anything besides “yes” in my 24 hours with her as a patient.
No one had died during my first shift. Midway in to my second shift, I heard the toll of the bell, marking the passing of a patient, out in the hall while caring for someone. Although it was not our patient, I asked to help with postmortem care since I hadn’t seen it yet. One of the nurses guided me and explained the process. The patient who had passed was in her mid-fifties. I noticed that both the nurse and the CNA were about the same age. I wondered if they ever mulled it over… if it ever bothered them to see people their age die or if it just made them grateful to be well. It was striking to watch the healthy, able-bodied nurse deftly attend to her duties, standing over a deceased woman of the same age whose body had been ravaged by cancer for years.
“You put up one hell of a fight, Jill.” the nurse said reminiscently as she pulled the sheet over her face. We closed the door and went back to work.
In the last hour of my last shift, the CNA I was following pulled me in to one of our patient’s rooms. Her condition had rapidly declined in the few hours since I’d seen her last. The CNA said she thought she was very close to passing, and since the woman was alone, asked me to stay with her. I sat by her side as I talked to her softly, just letting her know I was there and she wasn’t alone. She had a bible at her bedside, so I read a few passages.
Her hands and arms were cold, she had no radial or brachial pulse, and her carotid pulse was so weak and irregular it was hard to detect. I followed the pattern of her breath as I smoothed her hair from her forehead. She would be apneic for as long as 20 seconds, give a few labored breaths, and stop breathing again. Cheyne-Stokes? She did have congestive heart failure, among other things of course.
It struck me that I could assess this woman all I wanted, name her conditions, consider the pathophysiology going on, whatever, but the best thing I could do for her is sit by her side and just be present. I don’t think many people want to die alone. As the last minutes of my shift drew near, the CNA returned to the room with a stack of charts.
“I’m going to finish my charting up in here,” she said, and it was understood between us why. I was so grateful that I didn’t need to leave this woman alone in her final moments. I said goodbye to the patient, thanked the CNA for all of her help, took a deep breath and walked out the door as I heard her soft voice offering comfort to the dying woman.
4.07.2010
A year is a long time...
If I were to tell you that since I've last posted, I've fallen in love and moved out of the house with my boyfriend, would you believe me?
It's hard to believe myself, especially looking back at where I was a year ago... but it's true.
Soon after my last appearance, I began working as an EMT at a local amusement park's ALS-level first aid. It was a fantastic experience. All of the other EMTs and Paramedics had their different "day jobs" in a garden variety of places and organizations... from the ER to the fire service to the private ambulances. I made a ton of new friends and connections, and learned so much from people bringing their huge breadth of experience to the table.
In particular, there was this cute, athletic EMT with big ears, blonde hair, and gray-blue eyes. We talked a lot whenever we worked together. We'll call him Ryan.
He was clearly a bit shy but we chatted vigorously over our passion for nerdy physics/disaster shows on Discovery and History. He watched "How It's Made" out of curiosity. I watched it to lull myself to sleep.
He lived in a rural community pretty far away and his day job was in a grocery store... produce department. He goes to school full-time and recently started volunteering at his local fire department. He wants to be a firefighter/paramedic someday.
One day he was scheduled to work, but was no where to be found. After 45 minutes, I called his phone number from the posting on the wall. I woke him up. His alarm hadn't gone off. He apologized repeatedly as I heard him running around getting dressed and ready. I laughed as he hung up. When he ran in embarrassed and disheveled, still apologizing, I officially decided I had a crush on him.
He was the "taken" type, though. I never bothered to ask. I was too wrapped up in the absolutely awful, disgusting experience of falling for someone with too much PTSD for their own good.
One day, I was manning the water park first aid booth when a cute guy came to ask for a bandaid. We started chatting for a while. He was a firefighter and EMT from almost 400 miles away, but he actually worked with a good friend of mine. He mentioned coming back for a bandaid later after he swam and walked off. I kicked myself for not getting his number, being desperate to find a reason to detach from Army-Jerk.
Thinking he might come back for a bandaid, I wrote my name and phone number on one and saved it for him in my pocket. He never came, though. What can you do?
Several weeks later Rob, we'll call him, called me. That coworker of his that I know... yeah. He got my number from him. We talked every day for hours on end. Being desperate to get out of town and away from the ghost of Army-Jerk anyways, I decided to take the haul out to his place for a weekend. I loved driving anyways, and nothing felt more amazing than traversing the Rocky Mountains on the open road in summer, belting out songs in the car alone.
We spent the whole weekend together in his dorm on the sticky-hot Western Slope. I liked him a lot. I wouldn't have liked as much if my heart wasn't currently being torn to pieces by some other guy, but hindsight is 50/50. He still had to work... he was a tech in the local ER too... so I spent my days wandering around town and wading in the Colorado River. Honestly, I had an amazing time, alone and with him equally.
I felt like I was leaving a dream when I came home. Back to work, and all of the people and places that brought back Army-Jerk's legacy.
I just realized I haven't followed up on what happened between Army-Jerk and I. He flew out here before being discharged, we had an amazing weekend of "love" and connection... I flew out to Nashville and helped him move out of his apartment... another amazing weekend. Then he completely fucked me over. He went on a several-month long road trip wandering across the US, sleeping in his car. Among his varied activities, he fucked hookers and never bothered to tell me until after we had been together when he came back. The first time I've ever had my heart broken. I should've seen that one coming. You live and you learn... don't fall for jerks with a gnarly case of PTSD.
Fortunately, he soon left the US for the summer, allowing me to cry, scream, punch and/or burn things, listen to heart-broken country songs, date openly and generally get over it. It was a rough, rough road.
Back to Rob and I... over the next month or two we continued our little long-distance relationship. We went camping, I met his family. He asked me to make it official after I impressed the hell out of them. I reluctantly agreed. He had plans to move out to my area soon anyways. The whole thing only lasted a few more weeks though, before I got sick of the long-distance thing and I realized I wasn't that in to him.
One of my coworkers from the amusement park was having a birthday get-together with several other people from work at a nice restaurant. I got there early and sat at a bench outside waiting for others to show up. Ryan appeared, and reluctantly sat next to me... and we started talking shyly.
It's hard to believe myself, especially looking back at where I was a year ago... but it's true.
Soon after my last appearance, I began working as an EMT at a local amusement park's ALS-level first aid. It was a fantastic experience. All of the other EMTs and Paramedics had their different "day jobs" in a garden variety of places and organizations... from the ER to the fire service to the private ambulances. I made a ton of new friends and connections, and learned so much from people bringing their huge breadth of experience to the table.
In particular, there was this cute, athletic EMT with big ears, blonde hair, and gray-blue eyes. We talked a lot whenever we worked together. We'll call him Ryan.
He was clearly a bit shy but we chatted vigorously over our passion for nerdy physics/disaster shows on Discovery and History. He watched "How It's Made" out of curiosity. I watched it to lull myself to sleep.
He lived in a rural community pretty far away and his day job was in a grocery store... produce department. He goes to school full-time and recently started volunteering at his local fire department. He wants to be a firefighter/paramedic someday.
One day he was scheduled to work, but was no where to be found. After 45 minutes, I called his phone number from the posting on the wall. I woke him up. His alarm hadn't gone off. He apologized repeatedly as I heard him running around getting dressed and ready. I laughed as he hung up. When he ran in embarrassed and disheveled, still apologizing, I officially decided I had a crush on him.
He was the "taken" type, though. I never bothered to ask. I was too wrapped up in the absolutely awful, disgusting experience of falling for someone with too much PTSD for their own good.
One day, I was manning the water park first aid booth when a cute guy came to ask for a bandaid. We started chatting for a while. He was a firefighter and EMT from almost 400 miles away, but he actually worked with a good friend of mine. He mentioned coming back for a bandaid later after he swam and walked off. I kicked myself for not getting his number, being desperate to find a reason to detach from Army-Jerk.
Thinking he might come back for a bandaid, I wrote my name and phone number on one and saved it for him in my pocket. He never came, though. What can you do?
Several weeks later Rob, we'll call him, called me. That coworker of his that I know... yeah. He got my number from him. We talked every day for hours on end. Being desperate to get out of town and away from the ghost of Army-Jerk anyways, I decided to take the haul out to his place for a weekend. I loved driving anyways, and nothing felt more amazing than traversing the Rocky Mountains on the open road in summer, belting out songs in the car alone.
We spent the whole weekend together in his dorm on the sticky-hot Western Slope. I liked him a lot. I wouldn't have liked as much if my heart wasn't currently being torn to pieces by some other guy, but hindsight is 50/50. He still had to work... he was a tech in the local ER too... so I spent my days wandering around town and wading in the Colorado River. Honestly, I had an amazing time, alone and with him equally.
I felt like I was leaving a dream when I came home. Back to work, and all of the people and places that brought back Army-Jerk's legacy.
I just realized I haven't followed up on what happened between Army-Jerk and I. He flew out here before being discharged, we had an amazing weekend of "love" and connection... I flew out to Nashville and helped him move out of his apartment... another amazing weekend. Then he completely fucked me over. He went on a several-month long road trip wandering across the US, sleeping in his car. Among his varied activities, he fucked hookers and never bothered to tell me until after we had been together when he came back. The first time I've ever had my heart broken. I should've seen that one coming. You live and you learn... don't fall for jerks with a gnarly case of PTSD.
Fortunately, he soon left the US for the summer, allowing me to cry, scream, punch and/or burn things, listen to heart-broken country songs, date openly and generally get over it. It was a rough, rough road.
Back to Rob and I... over the next month or two we continued our little long-distance relationship. We went camping, I met his family. He asked me to make it official after I impressed the hell out of them. I reluctantly agreed. He had plans to move out to my area soon anyways. The whole thing only lasted a few more weeks though, before I got sick of the long-distance thing and I realized I wasn't that in to him.
One of my coworkers from the amusement park was having a birthday get-together with several other people from work at a nice restaurant. I got there early and sat at a bench outside waiting for others to show up. Ryan appeared, and reluctantly sat next to me... and we started talking shyly.
Back
It's been over a year since I've posted.
Yesterday I got a text from a random friend who had somehow discovered my blog through surfing the web, and instantly recognized the writer behind the posts. He essentially yelled at me for quitting.
I will cut to the chase and finish the story of the last patient we visited in Complications, before I even go on to explain where the hell I've been for a year.
Dr. Green, Dr. Lee and I found the surgery floor and they updated the front desk staff on the situation. Since this was Dr. Green's patient, she wanted to take care of her herself in the OR. The staff started doing their "thang" on the computer system to get the ball rolling.
"Do you operate here?" the woman behind the desk asked.
"No," Dr. Green replied, "but I keep up my credentials here in case of emergency situations like this next door."
The woman stared at the screen, punched keys, wiggled the mouse. "I'm not finding you."
The two doctors I stood next to were clearly outraged. Dr. Green began to stutter out how she had just put in more paperwork for credentialing here and received a letter confirming... Dr. Lee, in a manner only a surgeon could project stopped it all.
"I'm the head chair of the Credentialing Board here. If I need to, I approve her. Now."
Awkward silence. The lady looks confused... "I'll do what I can."
Soon Dr. Green whisks away behind the doors to start scrubbing up and I'm on my way back to the clinic. It's strange to go about the day after such an incident. I apologize to my patients for the delay, but don't want to scare them by describing why the doctor won't be able to see them for a bit.
Dr. Green returns later. She reports that she was able to manage the hemorrhage easily in the OR, without hysterectomy or any lasting concerns. Her and I return to the hospital to visit the patient in the PACU. She is post-surgically woozy, with the attentive PACU nurses at her side eager to make her comfortable. But she's ok. Dr. Green talks to her for a bit, and I don't have much to say but I squeeze her hand and move some hair from her face.
She goes home that night to her children and husband. And I go back to work the next day.
Yesterday I got a text from a random friend who had somehow discovered my blog through surfing the web, and instantly recognized the writer behind the posts. He essentially yelled at me for quitting.
I will cut to the chase and finish the story of the last patient we visited in Complications, before I even go on to explain where the hell I've been for a year.
Dr. Green, Dr. Lee and I found the surgery floor and they updated the front desk staff on the situation. Since this was Dr. Green's patient, she wanted to take care of her herself in the OR. The staff started doing their "thang" on the computer system to get the ball rolling.
"Do you operate here?" the woman behind the desk asked.
"No," Dr. Green replied, "but I keep up my credentials here in case of emergency situations like this next door."
The woman stared at the screen, punched keys, wiggled the mouse. "I'm not finding you."
The two doctors I stood next to were clearly outraged. Dr. Green began to stutter out how she had just put in more paperwork for credentialing here and received a letter confirming... Dr. Lee, in a manner only a surgeon could project stopped it all.
"I'm the head chair of the Credentialing Board here. If I need to, I approve her. Now."
Awkward silence. The lady looks confused... "I'll do what I can."
Soon Dr. Green whisks away behind the doors to start scrubbing up and I'm on my way back to the clinic. It's strange to go about the day after such an incident. I apologize to my patients for the delay, but don't want to scare them by describing why the doctor won't be able to see them for a bit.
Dr. Green returns later. She reports that she was able to manage the hemorrhage easily in the OR, without hysterectomy or any lasting concerns. Her and I return to the hospital to visit the patient in the PACU. She is post-surgically woozy, with the attentive PACU nurses at her side eager to make her comfortable. But she's ok. Dr. Green talks to her for a bit, and I don't have much to say but I squeeze her hand and move some hair from her face.
She goes home that night to her children and husband. And I go back to work the next day.
3.19.2009
Complications, continued
So there I was - standing in the exam room of a regular doctor's office with a hemorrhaging patient, an attending, "Dr. Green," wrapped up in fixing the problem, and a half-stunned intern gripping an ultrasound with bloody gloveless hands.
"I need 4 misoprostol right now... and bring a runner with you" I stepped out of the room and ran to get the meds, breathlessly telling the other MA "this is not good, we need you in here" as I passed.
Immediately Dr. Green told the other MA to grab another doctor in the office, "Dr. Lee." The doc, an OB GYN as tall as tree, walked in calm and smiling, and Dr. Green showed him the image of the patient's uterus on the ultrasound screen after briefly introducing her.
"See this... on the anterior wall. I don't like it. I think this is accretia. We need to get her into the OR. Can you set that up for me?"
He gazed at the slightly fluxing screen, his eyes scrunched as he deliberated, "Will do, how are we going to get her there?"
"She's going to need a stretcher. I don't know how we're going to work that. Can you get you us a stretcher?"
"I'll borrow one. We'll figure it out." He quickly stepped out of the room. The intern flashed me a wide-eyed glance that I could read as if the words were scrawled on her face... "Can you believe this is happening?"
The office building is located across the street from a medium-sized hospital, and connected to it by a pedestrian bridge. Our practice is actually a satellite of a different hospital and is only at this particular location twice a week, so our doctors are pretty unfamiliar with this neighboring hospital. Fortunately, Dr. Lee works on L&D there all the time and knows it like the back of his hand.
Finally, Dr. Green had a chance to fully explain what the hell was going on to the patient.
"I think that the pregnancy implanted itself into the scar from your c-sections. Now you're bleeding quite a bit. I'm going to have to finish this in the operating room, where I'll have light and all the resources I need, and we can put you under anesthesia so you won't be in so much pain. Ok?"
The patient, who hadn't said a word during this entire ordeal, moaned weakly and replied, "ok."
There was a strong knock at the door moments later, and a stretcher waiting outside the door. We couldn't fit it into the exam room, so the doctor and I supported the patient as she slowly half-stumbled to the stretcher, spattering blood all over the floor as she went and leaving a trail from the exam table to the stretcher. She had probably lost about 2 units in the exam room al0ne. We covered her the best we could and took off, following Dr. Lee's lead.
Rushing across the pedestrian bridge over to the adjacent L&D floor elevator, we nearly ran into a hospital food service guy, who froze and watched us pass in utter shock.
In the elevator, Dr. Green explained to the patient, who wanted 2 more children, that a hysterectomy may be necessary to stop the bleeding and save her life. However, she added, "I'm going to do everything in my power to save you and save your fertility. I'm going to get you home to your kids and hopefully make sure you can have more kids in the future." The patient cried silently... I can't even imagine how surreal and scary this whole thing must have been.
We reached the ER. They were expecting us and had a room ready, and the nurses were obviously anxious and a little excited. It's a small ER with no trauma services, so God knows when they last had a hemorrhage on their hands.
As a million new people did a million things to my patient at once, I briefly stood at the head of the bed and rubbed her shoulder, "they're going to take great care of you." I looked into her eyes but felt she was not really there. The nurses shot me a hundred questions, and it felt strange giving a hand-off report after not doing one for so long.
I met Dr. Green and Dr. Lee outside the room as they were talking to the ER doc, but soon we were following Dr. Lee as he led us up to surgery.
[To be continued, yet again. Sorry guys... ]
"I need 4 misoprostol right now... and bring a runner with you" I stepped out of the room and ran to get the meds, breathlessly telling the other MA "this is not good, we need you in here" as I passed.
Immediately Dr. Green told the other MA to grab another doctor in the office, "Dr. Lee." The doc, an OB GYN as tall as tree, walked in calm and smiling, and Dr. Green showed him the image of the patient's uterus on the ultrasound screen after briefly introducing her.
"See this... on the anterior wall. I don't like it. I think this is accretia. We need to get her into the OR. Can you set that up for me?"
He gazed at the slightly fluxing screen, his eyes scrunched as he deliberated, "Will do, how are we going to get her there?"
"She's going to need a stretcher. I don't know how we're going to work that. Can you get you us a stretcher?"
"I'll borrow one. We'll figure it out." He quickly stepped out of the room. The intern flashed me a wide-eyed glance that I could read as if the words were scrawled on her face... "Can you believe this is happening?"
The office building is located across the street from a medium-sized hospital, and connected to it by a pedestrian bridge. Our practice is actually a satellite of a different hospital and is only at this particular location twice a week, so our doctors are pretty unfamiliar with this neighboring hospital. Fortunately, Dr. Lee works on L&D there all the time and knows it like the back of his hand.
Finally, Dr. Green had a chance to fully explain what the hell was going on to the patient.
"I think that the pregnancy implanted itself into the scar from your c-sections. Now you're bleeding quite a bit. I'm going to have to finish this in the operating room, where I'll have light and all the resources I need, and we can put you under anesthesia so you won't be in so much pain. Ok?"
The patient, who hadn't said a word during this entire ordeal, moaned weakly and replied, "ok."
There was a strong knock at the door moments later, and a stretcher waiting outside the door. We couldn't fit it into the exam room, so the doctor and I supported the patient as she slowly half-stumbled to the stretcher, spattering blood all over the floor as she went and leaving a trail from the exam table to the stretcher. She had probably lost about 2 units in the exam room al0ne. We covered her the best we could and took off, following Dr. Lee's lead.
Rushing across the pedestrian bridge over to the adjacent L&D floor elevator, we nearly ran into a hospital food service guy, who froze and watched us pass in utter shock.
In the elevator, Dr. Green explained to the patient, who wanted 2 more children, that a hysterectomy may be necessary to stop the bleeding and save her life. However, she added, "I'm going to do everything in my power to save you and save your fertility. I'm going to get you home to your kids and hopefully make sure you can have more kids in the future." The patient cried silently... I can't even imagine how surreal and scary this whole thing must have been.
We reached the ER. They were expecting us and had a room ready, and the nurses were obviously anxious and a little excited. It's a small ER with no trauma services, so God knows when they last had a hemorrhage on their hands.
As a million new people did a million things to my patient at once, I briefly stood at the head of the bed and rubbed her shoulder, "they're going to take great care of you." I looked into her eyes but felt she was not really there. The nurses shot me a hundred questions, and it felt strange giving a hand-off report after not doing one for so long.
I met Dr. Green and Dr. Lee outside the room as they were talking to the ER doc, but soon we were following Dr. Lee as he led us up to surgery.
[To be continued, yet again. Sorry guys... ]
3.17.2009
Complications
It was a routine dilation and evacuation for a miscarriage. I was assisting the doc, passing off instruments and keeping an eye on the patient. It sounds strange but I like working with miscarriage patients, because it feels like one of the few patient populations that I can really make a difference with. They're going through a rough time, and it seems to me that having a supportive, caring but unintrusive caregiver means a lot to them.
Everything was fairly routine. The doc was a tad concerned that the patient had 3 c-sections and no vaginal deliveries - which meant she really had none of the advantages of being multiparous. If she had given birth vaginally her cervix would have been much more pliable, and we needed to dilate her to about 6 mm. I wasn't aware that the doctor had another concern in mind. We did the procedure under ultrasound guidance by the resident, which is pretty unusual. Usually no ultrasound is needed.
So we're humming along and everything is going normally... until we start applying the suction. The patient started yelping in pain. Now, pain in a D&E is normal and expected. But that little alarm went off in my head and I couldn't really decide whether the woman was just overly expressive or was experiencing an abnormally high level of pain.
I spoke to her softly and tried to soothe her - which is hard to do without physical contact, but I couldn't do that with a pair of gloves on and the doctor constantly needing me to pass off sterile surgical equipment. She continued howling.
Then, by the doctor's facial expression and the way she seemed agitated and rushed when she asked for more 4x4s or more suction or this or that... it became obvious this was far from routine... it became glaringly obvious when we started reaching about double the amount of blood and tissue I'd expect from a 6-7 week miscarriage in the suction containers.
The doctor removed the suction from the cannula in the woman's cervix, and blood started flowing out of it as if it was a kitchen sink faucet at about half of it's max flow. And it didn't stop. At this point, I snapped in to the mode. That zone you get it in when you realize you have a sick patient on your hands and you have to do something about it or they may die.
[I'll finish this later, I need to study for midterms. So I'll leave you with that cliffhanger.]
Everything was fairly routine. The doc was a tad concerned that the patient had 3 c-sections and no vaginal deliveries - which meant she really had none of the advantages of being multiparous. If she had given birth vaginally her cervix would have been much more pliable, and we needed to dilate her to about 6 mm. I wasn't aware that the doctor had another concern in mind. We did the procedure under ultrasound guidance by the resident, which is pretty unusual. Usually no ultrasound is needed.
So we're humming along and everything is going normally... until we start applying the suction. The patient started yelping in pain. Now, pain in a D&E is normal and expected. But that little alarm went off in my head and I couldn't really decide whether the woman was just overly expressive or was experiencing an abnormally high level of pain.
I spoke to her softly and tried to soothe her - which is hard to do without physical contact, but I couldn't do that with a pair of gloves on and the doctor constantly needing me to pass off sterile surgical equipment. She continued howling.
Then, by the doctor's facial expression and the way she seemed agitated and rushed when she asked for more 4x4s or more suction or this or that... it became obvious this was far from routine... it became glaringly obvious when we started reaching about double the amount of blood and tissue I'd expect from a 6-7 week miscarriage in the suction containers.
The doctor removed the suction from the cannula in the woman's cervix, and blood started flowing out of it as if it was a kitchen sink faucet at about half of it's max flow. And it didn't stop. At this point, I snapped in to the mode. That zone you get it in when you realize you have a sick patient on your hands and you have to do something about it or they may die.
[I'll finish this later, I need to study for midterms. So I'll leave you with that cliffhanger.]
2.06.2009
You're Trouble.
Background: we met at the SAR team's Christmas party. He was a member about 6 years ago, and he's the best friend of the firefighter I had that brief stint with at the beginning of the summer. We didn't talk much at the party. I was pretty mesmerized though. He is disarmingly attractive... with icy blue eyes that make you get that funny feeling in your stomach. An army guy, he was on leave at the time. We didn't talk again until he was back on base, far far away in another state. We started casually chatting online.
And somehow we ended up here, about a month after we first started talking. Through several 4 hour long phone conversations and days spent texting back and forth... we're strangely infatuated. It's completely unbelievable, exciting, and terrifying. I've never found it so easy to talk to someone, and I find myself thinking about him all the time. Most of the time it just feels natural and I don't even think twice about it. But occasionally I stop, take a step back and think "what the fuck is going on?" Sometimes I want to slap myself for it.
We're in this constant tug of war because there's that weird attachment but then there's the fact that we've never really hung out. We've spent all of 2 minutes face-to-face. More importantly, he's fresh from 27 months in Iraq and just about to get out of the army. Talk about a transitional period in life. He's not ready to settle down into some big commitment when he's just trying to sort out what he's going to do now that he's out.
He's getting out late February, and was going to drive around the country a bit before finally making it back home. So we were counting on finally hanging out mid-March. Until he completely surprised me tonight with a flight itinerary. He's coming this weekend. I ran around my house like a little girl jumping and squealing.
Because I know you're reading this -
Hi there. I can't wait. :)
And somehow we ended up here, about a month after we first started talking. Through several 4 hour long phone conversations and days spent texting back and forth... we're strangely infatuated. It's completely unbelievable, exciting, and terrifying. I've never found it so easy to talk to someone, and I find myself thinking about him all the time. Most of the time it just feels natural and I don't even think twice about it. But occasionally I stop, take a step back and think "what the fuck is going on?" Sometimes I want to slap myself for it.
We're in this constant tug of war because there's that weird attachment but then there's the fact that we've never really hung out. We've spent all of 2 minutes face-to-face. More importantly, he's fresh from 27 months in Iraq and just about to get out of the army. Talk about a transitional period in life. He's not ready to settle down into some big commitment when he's just trying to sort out what he's going to do now that he's out.
He's getting out late February, and was going to drive around the country a bit before finally making it back home. So we were counting on finally hanging out mid-March. Until he completely surprised me tonight with a flight itinerary. He's coming this weekend. I ran around my house like a little girl jumping and squealing.
Because I know you're reading this -
Hi there. I can't wait. :)
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