Dying with dignity

I always call my patients "my lady" or "my guy" when I'm talking about them to other people. Part HIPPA and part taking ownership of their care while I'm taking care of them. I had a pateint that I thought was the coolest lady. She was admitted with extensive blood clots in the lungs. She was in her late 80's and like my grandma had all her wits about her. She was doing ok the first night. Some pain if she moved around too much and 4L of oxygen. Her daughter spent the night. I'm all for family members hanging around as long as they don't impede care (and for all you hospital visitors out there...constantly asking someone if they're ok does not do them any favors, trust me). My lady's daughter was appropriately concerned but not overbearing. My lady was a lady of her time, didn't want to be a bother. She had seven children and walked around on a broken ankle for two days once before she went in because she thought it was a sprain and...you guessed it, didn't want to be a bother. Also she was no stranger to pain so when she said it hurt...you took her seriously. And she was funny. She had a fake right eye and she told me it doesn't always shut when she sleeps because she didn't want me to be alarmed. And then she laughed. That first night I got to know her and two of her daughters. I'm glad I did. As I was getting ready to leave, she was having more pain and needing more oxygen. I thought about her as I was getting ready for bed and I wondered if she would be intubated (on a ventilator) when I came back.

She wasn't in the room when I came back. She was at the cath lab getting a heart stent. A clot had moved to the heart and she had an MI. My lady had made the decision to be intubated and in her words "give it a whirl" to live. She came back from cath lab very unstable. She had received clot busting meds as well and was at extreme risk of bleeding. Her blood pressure was too low and heart rate was too high. It took some time to stabilize her. I talked to her family and they made me be glad to be a nurse just by saying that their Mom had felt safe when I was there. Its hard to describe what that means when someone says they feel safe leaving their loved ones with you.
I worked my tail off to keep her stabilized and hopefully to get her back to her old self, but when I saw her labs the next morning, my heart sank a little. They weren't too terrible, but after a while, you know when things are trending the wrong way.

My lady had a pretty explicit advanced directive. She didn't want long term intubation and if she wasn't going to be able to return to her baseline, she just wanted to be let go. And her children knew and respected that. Seven children and they were all on the same page. Its so refreshing to see that.

They woke her up during the day and she was able to see her family, but she was so unstable that they resumed the sedation. They gave her one more night. I almost got floated to another unit that night but I got pulled back to ICU and got my lady back. I was glad and the family was too. I kept her comfortable that night. I talk to everyone including the sedated and the dying and she was no different. She was doing ok on the vent and medications and sedation, but I knew if some of those drips were turned off it wouldn't take long and I expressed as much to the two daughters I got to know. They he'd already made the decision to take the tube out if she wasn't doing any better. She wasn't. They asked if they should call people and I said yes.

They called all the family in and took the tube out. We leave some of the medications on for comfort. She woke up and was able to see her family all around her. They hung out and talked to her and told stories. Then the medication keeping her blood pressure up was turned off. It took about an hour after that for her to pass. And while its always sad, it was a really beautiful way to go. I have seen a lot of death doing what I do and some of it is ugly but this was the way it should be. She didn't struggle and she was loved.

I don't think Ill ever forget that family

Orientation

So I survived. My orientation and first shifts on my own were surprisingly fluid. Is it because I'm finally experienced enough to go with the flow and ask questions without worrying that someone will think I'm stupid? Is it because the hospital I work at is amazingly forward when it comes to orienting travel nurses? A bit of both, I suspect. I've heard horror stories of being thrown into the pit with next to no training and expected to turn out excellent patient care. And people think travel nurses suck. I would ask you to go about your daily nursing life with no training on the charting or equipment you're using and not knowing where any supplies are and see how you do. Just two short days of good solid orienting is all an experienced nurse needs. I got three at this place and I already feel like I work there as a staff and not a traveler. My prior experience in every hospital has helped me get to this point. I used the computer system in Minnesota and the vents and IV pumps in Florida. And, as always, I am learning everyday at this new place.

An aside: I was involved in a code on my second night. Thankfully not my patient, but I jumped in as we tend to do. Seeing that the big parts were taken care of, bagging, IV starting, meds and of course CPR..I did the documentation part. It was awesome to watch these nurses run this code. Since I had to document, I had an eagle eye on every aspect. This was one of the smoothest codes I have ever witnessed.

Road Trip

So as anyone reading this knows, Mark and I drove about as far as one can drive across this expansive nation last week. It was a blast. I wanted to leave at 7am on Aug 27th...haha on me. That wasn't happening. But we got to eat at our favorite breakfast joint Brenda's on the Causeway before we left. It was the first day they were open after being closed for a month. Good way to say "See ya!" to Florida.
We drove like we meant business. I should say...Mark drove like we meant business because he drove the whole way. God bless him. We suffed that Ford Ranger to the gills and rode out. After about 2000 miles we started to see more elevation changes. Knowing what we know about 4 cylinder engines and moutains, we decided to dump 250lbs of clothes on the nice lady at the UPS store in Rapid City, SD. As you can imagine, the cost of shipping 250lbs of anything is substantial. But the peace of mind and the ability to drive through the Rockies without a transmission on the side of the road was well worth it.
We made about an hour later than I predicted to beautiful Wenatchee, WA. I love planning long road trips. We saw many people and sights along the way. And we drove 3100 miles in a single cab pickup without even a hint of an argument. I swear the cab got bigger as we drove. And we were amazed at how comfortable we were.

I'd like to give thanks to a few people/things:
Droid smartphones for the free Google navigation
Pandora for all the fun music
Carl Granger for the GARMIN and for checking in on us
Costa Del Mar sunglasses for not letting Mark go blind as he drove into the Montana sunset
The Ford Ranger for running like a top the whole way
Dad for the food, fun and shelter
Stacy Greene for the laughs and the advice, shelter and tomatos
Ryan and Susanna Heaslip for the shelter and good conversation
Butte, MT Best Western for having a room available to weary travellers

One last thing about a cross country road trip...it's essential to know when to talk and when it's ok to be quiet...because I don't care how much you love someone or miss someone or whatever, if you're in a car with them for 54 hours and you talk the whole time, it would be justifiable homicide if they killed you.

The upfront cost

Some people travel for the chance to see new places, some people do it for the chance to learn new things in new hospitals and some do it for the money. Most of us probably do it for all three.

While the end result of travelling should be financial gain, the start up costs are freaking me out. Most people keep a permanent residence while they travel, but we are moving entirely. Anyone who isn't living under a rock knows moving is expensive. So the cost of buying moving materials starts adding up. Also, the costs of getting the license from another state can be anywhere from $37 (Colorado) to over $200 (most states). Setting up my own residence allows me to recieve a generous housing stipend, but I still need to pay a security deposit and be prepared to pay the first month's rent when I get there. Not to mention the cost of driving 3000 miles. I will recieve reimbursements for some of the trave and the licensure. And the housing will be paid for as mentioned above. It will end up paying out in the end and each subsequent travel assignment will cost less and less upfront. The first one is a bear!

Be prepared for such costs. I was ALMOST prepared. Thank goodness I have my wonderful mother who helped me out when I realized I didn't have the zillion dollars right away to get this going and thank goodness I have friends and family that happen to be on the way to Washington. Seeing them is priceless, so I guess I will also be reimbursed in ways that are way more amazing than money.

Getting Started

I've been playing around with the travel nursing idea since I got into nursing. I did a single stint in 2008. This was a complete disaster but in all actuality a blessing in disguise. My soon to be ex husband informed me he had cheated on me and wanted a divorce. After straightening out a few things, I headed off to Florida to see what was out there. What I did not expect to find was the most amazing man I've ever known. Fast forward two years.
With a bad economy, a boatload of debt (including $20,000 of debt from aformentioned ex) and no lease/mortage or children to worry about, Mark and I decided to try out the travel biz.
Getting started is easy although tedious. It means filling out tons of application type forms which also include the dreaded Skills Checklist. The Skills Checklists are forms which have you rate how skilled you are at a task, your knowledge of equipment, medications and the like. Most of these forms were created in the 1980's and have been only scantily updated since. I had to fill out one that listed at least 10 different types of ventilators. I had to look up a few of them. I'm suprised there wasn't an iron lung on the list. And nobody knows the names of the vents they are working with. Also a lot of the meds listed on these forms are generally not used in practice today. Unless you're heading to an underdeveloped nation, you'll never use them. I hate rating myself and the numbers are so arbitrary.
After hundred forms and only a few less phone calls, I had an interview. In Pampa, TX. Lord have mercy. I hope I never end up there.

I Googled it and this was the second image that popped up. The first was of a dirt field with no crops in it. Maybe they got blown away by the tornado. Anyway, I declined the offer. And luckily the next day, a nurse manager from Wenatchee, WA called. We had a nice interview and a few hours later I was extended an offer. I have always been drawn to the Pacific Northwest and soon we'll be on our way. We leave in one week and sometimes I feel like I'm on track to be ready to move and sometimes I think I'll never get it all done! Sleep is apparently beyond me as I have not slept more than a few hours at a time since we realized we were moving. So in the interest of time crunching, I decided to sit down and write a blog (because that will get things done).
Cheers!