Tuesday, August 31, 2010

THE NIGHT I'LL NEVER FORGET

In the early 1980’s, I spent many nights working in the intensive care units of hospitals in Orange County. My children were small and I’d found a way to work and still be home with them during the day when they needed me. My husband would come home and care for them in the evening on the nights I worked. My shifts were twelve hours long, from seven in the evening to seven in the morning, and I was able to make the same amount of money two days a week that I made in a forty hour work week at my prior job. I worked for a nursing registry that sent me to different hospitals each night, and this particular night I was working in Garden Grove.


Each hospital had their own distinct way of handling the registry nurses. Some of the charge nurses would assign the registry nurse the easier patients to care for and give the more complex patients to their own staff. Other charge nurses would give the registry nurses the most difficult assignments and let the regular staff take it easy.

The charge nurse in the Garden Grove Hospital assigned the most critically ill patient to herself, which was a tremendous relief to me. The patient was a twelve year old boy who had been hit by a car earlier that day and suffered a horrendous head injury. His head was swathed in a huge white turban of gauze and his eyelids were bruised purple and swollen shut. Drainage tubes emerged from the gauze and were connected to a glass bottle which was filling with pinkish liquid indicating it was cerebral spinal fluid mixed with blood.

A tube was inserted through his mouth and into his lungs, and connected to a respirator that did all the breathing for him. Intravenous lines ran into both his arms and a foley catheter kept his bladder empty as the clear yellow urine slowly drained into a bag hanging on the side of the bed.

The boy didn’t move a muscle, and the charge nurse rarely left his side. The ICU was a tiny one with only four beds, so we were all in close proximity to the critical situation and were there to help when the need arose. She would call one of us over to stand guard when she absolutely had to take a bathroom break, but the rest of the time she was the one right there with him.

His parents and older sister wandered in and out all night long. They’d stand by his side and stroke his hand, speaking softly to him, crying and hugging one another.

Around three in the morning, the boy’s heart monitor and blood pressure readings changed significantly, letting us know that he was dying. We rushed to the waiting room and called for his family to come in. They stood at the bedside as he died, weeping uncontrollably. His sister cried out, “Do something! He can’t die. He’s the only brother I’ve got.”

Oh, how I wish we could have done something. All we could do was watch and weep ourselves. It was out of our hands. I can’t think about that little boy or his family without tears coming to my eyes still.

I walked out of the hospital at the end of my shift and thought I would never set foot in one again. Be still, my soul.

Monday, August 30, 2010

APPALACHIA IN ORANGE COUNTY

In my part-time work as a hospice nurse I’m often sent to see patients I know little about. I view it as an adventure and also as an opportunity to put the pieces of a puzzle together. One day in early summer, I was sent to see an elderly lady in Orange County, California, who was dying of end stage dementia. The only information I was given was her name, address, and telephone number. I looked it up on my street map since it was in the days prior to GPS, and made my way there. I turned into an ordinary working class neighborhood of one story ranch style California homes, located the street and found the house number on the mail box at the curb.


This particular house sat at the end of a long driveway and was obscured from view by many fruit trees and tall weeds in the front yard. I retrieved my medical bag and notebook and started down the drive. Lined along one side were several junk cars that seemed to be slowly rusting into the ground. The house came into view and seated in a rocking chair on the front porch was a very fat, old, toothless man smoking a pipe. He smiled at me as I walked up and told me to “just go right on in the house”.

I opened the door and stepped inside. I’d only taken a couple of steps when I had to stop, not sure whether what I was seeing was real or a hallucination. The house was dark, dirty, and dreary. What were formerly drapes now hung at the windows in shreds that resembled ropes. To block out the light, someone had taped big pieces of cardboard to the windows, and old sofas lined the walls of the living room. Once my eyes adjusted to the dim light, I realized there were bodies covered with blankets lying on the sofas. Various bodily noises were frequently being emitted from these lumps under the covers, the odor in the house attested to the origin of the noises.

Trash, newspapers, and junk were piled everywhere. I wondered where I would find my patient in all of this, then finally located her lying in a hospital bed in what would have been the dining room of the home. She was clean and her clothing and bed linens were clean as well, much to my surprise and relief. I took a disposable plastic barrier from my bag and placed it on top of a stack of newspapers so I had a sanitary place to put my bag and notebook. I was getting ready to examine the patient when I heard footsteps coming down the hall. Expecting to greet the patient’s son, I was dismayed to find myself face to face with a man wearing only a towel. He’d apparently just come from the shower. When I inquired if he was the son, he said no, and shouted out the son’s name.

Soon, Billy appeared. He was a younger version of the elderly man on the porch. Billy wore overalls that were filthy, and he didn’t have a shirt, so I was treated to the sight of major chest hair and pretty foul body odor.

Billy greeted me with great enthusiasm and said he was just about to get his mom up to the commode by her bed and then I could do my exam. He lifted the lid of the commode, and I was again dismayed to see it was filled almost to the brim with bodily waste. Apparently it was the real source of the odor in the house. Billy explained without apology that the toilet wasn’t working so he couldn’t empty the contents of the commode. I didn’t bother to ask what the rest of the residents of the house did when they needed to use the toilet.

I finished my exam, checked the patient’s medications, and gave him some more supplies to help him care for his mother. I stood up to write my nursing notes as I balanced them on the patient’s chart, as there wasn’t a clean place to sit. I exited the house as soon as I could.

Billy met me outside with a paper bag. He thanked me for the visit and told me there were homegrown tomatoes in the bag. I thanked him for the gift and said homegrown tomatoes were one of my very favorite things, and I took them to my car. Once home I scrubbed them with soap and water and laid them on paper towels in the kitchen to dry. That’s where they stayed until my husband decided to eat them, telling me I was being silly not wanting to touch them. I couldn’t bring myself to take even one bite, and still wonder what kind of fertilizer grew such beautiful tomatoes.

Friday, August 27, 2010

Day One of Diet and Exercise Plan

Here I am in Yosemite, hiding half of me behind John Muir. Today is the first day of the rest of my life. Heard that before? Well, it is. Today I am starting my training program to climb up Mt. Sinai in January 2011. While in Yosemite this week I started on the "Dan Diet" and lost three pounds. The Dan Diet consists of eating one sensible meal a day, and two snacks consisting of fruit. One day we split a spinach salad for lunch and we also nibbled on pistachios during the day. Thank goodness the Dan Diet also allows red wine or I'd be in big trouble.

Okay, I need to loose some serious lb.'s before this walk up the mountain which is 7,500 feet altitude. My knees and feet are bothering me. It's time. Also, we did some hiking uphill in Yosemite and I got really winded. The altitude was only 5,600 feet where we were hiking. Big wake up call.

Here's the plan: Dan Diet, walking 30 minutes a day (for the dog), and doing serious cardio on the exercycle and the eliptical when it arrives.  I'll keep you'all posted. (You'all primarily being me, since I think I'm probably the only one that reads this. Maybe I should title this blog Dear Diary?)

Friday, August 20, 2010

Side Show Mary

Mary, a lady in her late thirties, was admitted to our unit for help with weight loss. She’d been the circus fat lady for one of the major big top circuses for a number of years, but once she’d gotten so heavy she wasn’t able to walk, she became bed bound in her home. A family member finally called the fire department and when they arrived, they sawed around her door to make it wide enough to get Mary out, and then brought her to our hospital. When she arrived, we weren’t able to get an accurate weight but knew that she was well over 750 pounds. Our transportation gurney weighed 250 pounds and when we loaded Mary on and took her to the freight scales, the needle buried on the other side of 1000 pounds.


In those days, there weren’t any king size hospital beds available for patients so the engineering department of the hospital bolted two hospital beds together for Mary. When we needed to provide Mary with care, we would have to climb up onto the bed with her; otherwise we couldn’t reach far enough across her body to properly bathe her. Bedpan time was a major event. It took several nurses to get the pan positioned correctly underneath her and then to get it back out again and clean and dry her.

Mary, who loved to eat, was placed on a 300 calorie diet. The weight immediately started melting off. Saturday was weight day and it took most of the staff to get her loaded onto the gurney and pushed to the freight scales. The hospital was very old and our unit was on the second floor. The elevator was also old and a bit temperamental. We were all afraid to get on the elevator with her, so we devised a system of pushing Mary in so her head was facing the door and she could push the elevator buttons herself. Then we would run down the stairs to the first floor and greet her when the elevator doors opened. We used the excuse that the elevator was too small to hold all of us, and we never let on that we feared it would break under the strain of her weight.

I remember the day the needle on the scale finally dipped below the 1000 pound mark, meaning that Mary weighed 750 pounds. We all cheered and clapped, and Mary even offered up a little smile for us. From then on we were able to monitor and chart her progress. The doctors had set a goal of getting her down to 300 pounds so they could perform a new surgical procedure on her. That goal was met nine months after Mary’s admission to our hospital, and an intestinal bypass surgery was performed. A large portion of the middle of her intestines was bypassed so that a good amount of the food she ate was not absorbed. Complications were terrible and she had chronic diarrhea and electrolyte imbalances. Sadly, six weeks after having undergone the surgery and now weighing 250 pounds, Mary died from liver failure. We now know that intestinal bypass surgery had a 50% mortality rate. I still feel a deep sadness when I think about Mary spending so many months eating almost nothing, finally being able to once again get out of bed and walk a short distance and losing two thirds of her body weight, only to die of complications from an experimental surgery. And that was more than forty years ago.

Monday, August 9, 2010

I'm With Anne Rice on This One

I read an interview recently with Anne Rice on why she's now finished with organized religion, and I'm with her. There have been a lot of last straws for me...the book to the left explains one of the last straws (http://www.textnovel.com/). Among other last straws is the Pastor that transferred to our church a few years ago. He's lost a lot of parishioners because of his "it's all about me" style of preaching. I'm so sick of his strutting and pontificating that I can't stand it any longer. The last, last straw for me, though, is the Nun who was excommunicated for being on the ethics committee in her hospital and agreeing to allow the termination of a pregnancy on a woman who was going to die if it wasn't done. The woman was only 11 weeks pregnant but had three young children at home. An 11 week old fetus cannot survive outside the womb, so there would have been two deaths for the family instead of one. I think that was the last straw for Anne Rice, too.

Okay, well maybe I'll give organized religion one more chance. We've attended an Ecumenical Catholic Church twice now and I'm really liking it. I feel closer to God in that small church than in the big one where the Priest has taken over. This church is truly a community. Or so it seems so far. I've always got Kabbalah on the side........

Monday, August 2, 2010

NO WINING...Nurse Story

THE LIONESS HAS NOTHING TO DO WITH THE STORY, BUT SHE SURE IS BEAUTIFUL EVEN AFTER HAVING JUST EATEN A WART HOG. I TOOK THE PICTURE!
Millie was ninety-five years old and on Hospice for end stage cardiac disease. She and her daughter, Dena, lived together in Millie’s home. Millie was weak and fatigued, but didn’t require a lot of care when she first came on service. She was mentally very alert and I enjoyed my visits with her immensely.


We’d discussed her smoking when she’d first been admitted to the hospice program. She’d tried to quit over the years and she and her doctor had agreed that there wasn’t much point in quitting now when she was at the end of her life. My opinion was the same, and I let her know that. Dena didn’t want her to smoke in the house, so she’d made a little area in the garage for Millie to go to when she wanted to smoke. Millie went out a few times in the day and evening to have a cigarette.

One day, shortly after I’d arrived for the visit, Dena walked in from the garage carrying a wine glass. She said, “Mother, how many times do I have to ask you to bring your wine glasses back into the house?”

At this, Millie’s head whipped around and she looked guiltily at me. “I like to have a glass or two of wine in the evening, is that all right?” she asked.

I smiled and patted her hand. “I like a glass of wine in the evening, too. If it’s okay with your doctor, it’s okay with me.”

Millie breathed a sigh of relief. “Oh, I’m so glad you don’t think badly of me. What kind of wine do you like?”

“Oh, my favorite is chardonnay.”

“That’s my favorite, too!” she said, beaming. “Would you like a glass?”

I chuckled at this and said, “Not right now, Millie. I’m working and can’t drink on the job. Thank you for offering, though.”

She smiled, too, and said, “Oh good, because I would have been really worried if you’d said yes.”