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.