"48 years," he said. "We've been married for 48 years." His wife, in the bed, managed a weak smile from under the stiff plastic mask pumping 100% oxygen into her lungs. With the hat on his head declaring service to the U.S. military, and a Bible in his hand, he sat at his wife's bedside - close enough to see her and yet far enough to feel the wall of illness separating them - for almost my entire twelve hour shift.
The day was busy. We floated in and out of the room to and from CT scans and MRIs, each time we left, he made sure to tell her he loved her, and leave a kiss on her forehead. As her results came back, showing a small hemorrhage in her brain, and as the hours past, and I checked her declining neurological status, he sat, calmly talking to family, hardly batting an eyelid at the bad news.
He doesn't understand, I thought. He doesn't realize that his precious wife, who he painstakingly cares for at home, might not see tomorrow.
I approached the resident, telling her of the patient's declining mental status, and high risk for respiratory failure and need for mechanical ventilation. "You need to talk to the husband, give him a heads up," I say, all the while knowing that the words from her would undoubtedly come out wrong; twisted by medical jargon, a foreign upbringing, and lack of experience. But I was busy, I needed to catch up on things from my other patient, she was a second-year, she could handle it.
But, as I suspected, when I returned to him, I could see the confusion in his eyes. "What is this doctor talking about? Intubation? A ventilator? Isn't that mask breathing for her?" Things hadn't gone well. I sat down, and for a good while, explained to him and his son, what the blood in her brain was doing, how, if the bleed grew, it would cramp her brain, drowning it, keeping oxygen out, making it harder and harder for her to stay awake. The ventilator might become necessary to keep her alive, if that happened, and her brain stopped working as well because of the stroke.
Some people stop there. Why continue? You've gone above and beyond to give them fair warning -- why tell them that even thought the venitaltor might save her now, it might prolong suffering that she won't recover from? Her brain might get better, and then we'd all be thankful for the tube, the breathing machine, right? But what if it got worse, and she didn't wake up, and we, as we do so often, find ourselves with little else to do but pull the plug? Would she want to live on life support, in a nursing home for her remaining years, with little to no brain function? Or would it be better to just leave things as they are now, to let her pass quietly in her sleep?
But I had to, and I did. He loved her so much, and the last thing I wanted, was for him to visit tomorrow morening and find her garishly altered, with a tube in her mouth and a machine breathing her -- without having at least a warning. I didn't want him to miss his last conversation with her -- I wanted him to know, and see, just how sick she was.
He and his son talked it over. They said, if she needed the tube and the machine, that they'd want to be called first -- no matter the hour. Hopefully she wouldn't need it, they said. I agreed. It was a wise decision, a good conversation. They understood. He understood. When I left the room, I was glad I had taken the time.
Later, walking past, I caught a glimpse of him. Hat off, crouched in the chair by her side. His eyes looked tiredly at her, I could see his fear. For the first time, he realized her life wasn't as secure as he thought. While I never doubted my decision to inform him of how critical things really were for her, my thoughts haven't left him these past few days. I can only imagine what he feared -- losing her, meant losing his wife, his companion, his friend -- 48 years worth.
My thoughts are to my own life, my own relationships. What decision will I make when it's my time? Will I push hard, asking for everything, knowing that I'm only prolonging the inevitable? But, if I make it to 48 years, will you be able to blame me? 48 years is a long time to love someone.
Tuesday, July 21, 2009
Wednesday, May 13, 2009
Should I stay or should I go?
Today, life is demanding answers from me. One, really, in many different areas: do I stay or go? Today, it was in reference to my job.
I just returned home after a meeting with the Shared Governance Research Council, a nursing organization within the Nursing Department of most hospitals, of which I'm a member. Today, instead of just listening to the drivel of information, I presented a proposal for a research study I'd like to and have been working to carry out with two Bioethicists whom I work with.
The meeting went well, and we received approval to move to the next step, but the thing I carried with me was just how much time I'd have to commit. This study would be merely the beginning of an entire research path, a laundry list of studies that would, undoubtedly enhance my resume and experience far beyond my years or education, but will also take...a lot of time.
With tentative goals to move on to another place and type of nursing around this time next year, the meeting, which should have come as good news, turned out a bit unnerving.
I feel like a major review of my priorities is in order. What is most important to me, what will make me stay, what do I really hope to get from this job and place and experience?
But while thinking on it, I started to wonder what makes nurses, in general, stay in one place. Nursing retention rates are extremely low, and although improving in some areas, continue to persistently disappoint. A recent study (perhaps I'll site later, but a tad spent to find it just now) found that nurses who are involved in extracurricular hospital-wide activities, given autonomy and leadership in projects are more apt to stay longer than those who aren't.
While this is true for me -- as far as the unit goes, I've essentially capped my learning there, what's holding me is financial and project-commitments -- it's still difficult for me to pin myself down for sure. Starting a Master's is even a daunting task, simply because it'd tie my here for three years at minimum -- a period of time away from family, which I'm not too thrilled about.
Job, relationships, life in general, it just seems like I have to start figuring out where I want to settle, to stay...to invest. Part of me thinks I'm too young, but with a birthday around the corner, and a two-year-anniversary of nursing a few weeks after that, I'm starting to think I'm getting close to the place where I need to decide.
I just returned home after a meeting with the Shared Governance Research Council, a nursing organization within the Nursing Department of most hospitals, of which I'm a member. Today, instead of just listening to the drivel of information, I presented a proposal for a research study I'd like to and have been working to carry out with two Bioethicists whom I work with.
The meeting went well, and we received approval to move to the next step, but the thing I carried with me was just how much time I'd have to commit. This study would be merely the beginning of an entire research path, a laundry list of studies that would, undoubtedly enhance my resume and experience far beyond my years or education, but will also take...a lot of time.
With tentative goals to move on to another place and type of nursing around this time next year, the meeting, which should have come as good news, turned out a bit unnerving.
I feel like a major review of my priorities is in order. What is most important to me, what will make me stay, what do I really hope to get from this job and place and experience?
But while thinking on it, I started to wonder what makes nurses, in general, stay in one place. Nursing retention rates are extremely low, and although improving in some areas, continue to persistently disappoint. A recent study (perhaps I'll site later, but a tad spent to find it just now) found that nurses who are involved in extracurricular hospital-wide activities, given autonomy and leadership in projects are more apt to stay longer than those who aren't.
While this is true for me -- as far as the unit goes, I've essentially capped my learning there, what's holding me is financial and project-commitments -- it's still difficult for me to pin myself down for sure. Starting a Master's is even a daunting task, simply because it'd tie my here for three years at minimum -- a period of time away from family, which I'm not too thrilled about.
Job, relationships, life in general, it just seems like I have to start figuring out where I want to settle, to stay...to invest. Part of me thinks I'm too young, but with a birthday around the corner, and a two-year-anniversary of nursing a few weeks after that, I'm starting to think I'm getting close to the place where I need to decide.
Sunday, February 22, 2009
Nice RN Pick, Obama!
I knew I voted for Obama for a reason.
Although it mildly annoyed me that he mentioned nurse in the same category as janitor and garbage man (two admirable, but unskilled job titles) in two of his debates, I figured he'd be pro-RN by the ANA's endorsement of him, and his campaign's ability to think out of the box (all RN's have that quality).
But today, I found this article confirming Obama's love for nurses.
It's an exciting article proclaiming Obama's selection of Dr. Mary Wakefield, PhD, RN, FAAN to director of the Health Resources and Services Administration.
Finally, a position filled with a worthy candidate, in a job I'd like to have one day.
If only I could get a hold of her resume so I could figure out how she got there...
Needless to say, will be eagerly watching her work in the HRSA, specifically to see if she has the same view as I do, that universal healthcare in the US will never work without first establishing a stronger network of medical homes, in the form of free-low-income clinics. What good is universal healthcare if no MD will accept it?
We'll see. Maybe I could fanangle my way into her office for an interview.
Although it mildly annoyed me that he mentioned nurse in the same category as janitor and garbage man (two admirable, but unskilled job titles) in two of his debates, I figured he'd be pro-RN by the ANA's endorsement of him, and his campaign's ability to think out of the box (all RN's have that quality).
But today, I found this article confirming Obama's love for nurses.
It's an exciting article proclaiming Obama's selection of Dr. Mary Wakefield, PhD, RN, FAAN to director of the Health Resources and Services Administration.
Finally, a position filled with a worthy candidate, in a job I'd like to have one day.
If only I could get a hold of her resume so I could figure out how she got there...
Needless to say, will be eagerly watching her work in the HRSA, specifically to see if she has the same view as I do, that universal healthcare in the US will never work without first establishing a stronger network of medical homes, in the form of free-low-income clinics. What good is universal healthcare if no MD will accept it?
We'll see. Maybe I could fanangle my way into her office for an interview.
Saturday, February 21, 2009
RN:MD Money Ratio.
Yesterday at work, I had a conversation with a resident that's stuck in my thoughts today.
I was returning to the unit from taking one of my patients to a test, and I jokingly mentioned to him that, as evidenced by my other patient's awkward position in bed, my co-workers had neglected to check in on her for me while I was away, as they had promised. We laughed, and he said, "If only you could clone yourself," to which I replied, "Right. If that were the case, I'd expect to get paid double."
Funny idea. He laughed, I laughed, and then he said, "Hey, don't say that. You already do get paid double what I get paid!"
"True," I said. "For now."
It's great that I get paid double what this resident gets paid. I think I deserve it -- yeah, he has 24-hour call every five days, and has to work 7 days a week, but I think I work harder. I'm responsible for the lives of two patients, and for 12 hours straight, I actually physically carry out the myriad of tests, procedures, monitoring and general upkeep that is required to get them through their ailments.
That's not what bothered me about the conversation. What bothers me, is that in five years, when this resident is out of training, his statement won't be true. In fact, he'll be doing LESS work, for more money. While I, the RN, if I stay in my current position, will be making around the same amount.
Sure, the longer you stay in nursing, the more you make. With my Union, I get a good raise every year, so by my 30 year mark, I'll be making six figures.
But that's thirty years from now.
Immediately after I uttered the words, "For now," I stopped what I was doing and thought for a second. Thirty years is way too long to wait to make a six-figure salary. And, if I believe that I'm an expert, and that nursing is a field with endless options for advancement, there's no way I'm waiting that long.
It was good to realize, that, although it might not seem so to the bystander, nurses have every opportunity to make just as much as MDs do (although, for the record, I do believe the incomes of RNs and MDs should be swapped...but that's a post for another day).
The options are endless, and often free for the taking. Get your master's, get into administration, specialize in a field and become a sought-after consultant. All of it starts with the two letters: RN.
For those of you reading who don't have those letters behind your name just yet...here's one of many programs -- it's a scholarship program from the Robert Wood Johnson Foundation and the AACN -- that hand out money to people ready to join the RN trend: http://newcareersinnursing.org/
I was returning to the unit from taking one of my patients to a test, and I jokingly mentioned to him that, as evidenced by my other patient's awkward position in bed, my co-workers had neglected to check in on her for me while I was away, as they had promised. We laughed, and he said, "If only you could clone yourself," to which I replied, "Right. If that were the case, I'd expect to get paid double."
Funny idea. He laughed, I laughed, and then he said, "Hey, don't say that. You already do get paid double what I get paid!"
"True," I said. "For now."
It's great that I get paid double what this resident gets paid. I think I deserve it -- yeah, he has 24-hour call every five days, and has to work 7 days a week, but I think I work harder. I'm responsible for the lives of two patients, and for 12 hours straight, I actually physically carry out the myriad of tests, procedures, monitoring and general upkeep that is required to get them through their ailments.
That's not what bothered me about the conversation. What bothers me, is that in five years, when this resident is out of training, his statement won't be true. In fact, he'll be doing LESS work, for more money. While I, the RN, if I stay in my current position, will be making around the same amount.
Sure, the longer you stay in nursing, the more you make. With my Union, I get a good raise every year, so by my 30 year mark, I'll be making six figures.
But that's thirty years from now.
Immediately after I uttered the words, "For now," I stopped what I was doing and thought for a second. Thirty years is way too long to wait to make a six-figure salary. And, if I believe that I'm an expert, and that nursing is a field with endless options for advancement, there's no way I'm waiting that long.
It was good to realize, that, although it might not seem so to the bystander, nurses have every opportunity to make just as much as MDs do (although, for the record, I do believe the incomes of RNs and MDs should be swapped...but that's a post for another day).
The options are endless, and often free for the taking. Get your master's, get into administration, specialize in a field and become a sought-after consultant. All of it starts with the two letters: RN.
For those of you reading who don't have those letters behind your name just yet...here's one of many programs -- it's a scholarship program from the Robert Wood Johnson Foundation and the AACN -- that hand out money to people ready to join the RN trend: http://newcareersinnursing.org/
Sunday, February 15, 2009
6 Months?
August 31, really? My last post?
It's hard to believe that 6 months has passed since I last looked at this site. I'm not surprised, just shocked at the visible passage of time. Apparently, I should just admit that I'm a horrible blogger. Done.
Life, for me, has continued. As a nurse, I feel increasingly confident. I've passed my year mark and am nearing my second anniversary. I sought out an advanced certification (ACLS), and am working on taking the CCRN exam ( a test that certifies my as a critical care RN). I've joined the AACN, and am running a monthly journal club out of my unit with a goal of publishing some research in the next year. I'm enjoying my work, my co-workers and looking to the future with good feelings.
For my patients, things have stayed the normal course. A repeat-patient that I took care of over the course of the past year and half, a pretty little lady with a bad pair of lungs, passed shortly after Christmas. It was sad to see her sisters, who I had gotten to know during my care of her, so distraught at the eventual realization that she just wouldn't pull through this infection, this time. I miss them, even though I know that death was the only, better option for her painful struggle.
I've had a few significant sickies...a GI bleeder I fought for who got to surgery too late, an overweight, but super-sweet woman who fought (and beat) sepsis, and a pair of ARDS patients whose families both decided to withdraw care, during the same shift, within 15 minutes of each other.
These are the people who make it through the cluttered memory of my 12 hour days, and the exhaustion I feel afterwards. Families and patients who, for one reason or another, keep me running, and yet make me smile days later. The ones who I remember, and mourn with, and yet, encourage at the same time.
All in all, it's good to be a nurse right now. I haven't spent a stray thought on the economy, I've grown in my role on the unit, and I'm thrilled to be spending extra time giving back to my co-workers, and my patients.
Will try to stay in touch more frequently...:)
It's hard to believe that 6 months has passed since I last looked at this site. I'm not surprised, just shocked at the visible passage of time. Apparently, I should just admit that I'm a horrible blogger. Done.
Life, for me, has continued. As a nurse, I feel increasingly confident. I've passed my year mark and am nearing my second anniversary. I sought out an advanced certification (ACLS), and am working on taking the CCRN exam ( a test that certifies my as a critical care RN). I've joined the AACN, and am running a monthly journal club out of my unit with a goal of publishing some research in the next year. I'm enjoying my work, my co-workers and looking to the future with good feelings.
For my patients, things have stayed the normal course. A repeat-patient that I took care of over the course of the past year and half, a pretty little lady with a bad pair of lungs, passed shortly after Christmas. It was sad to see her sisters, who I had gotten to know during my care of her, so distraught at the eventual realization that she just wouldn't pull through this infection, this time. I miss them, even though I know that death was the only, better option for her painful struggle.
I've had a few significant sickies...a GI bleeder I fought for who got to surgery too late, an overweight, but super-sweet woman who fought (and beat) sepsis, and a pair of ARDS patients whose families both decided to withdraw care, during the same shift, within 15 minutes of each other.
These are the people who make it through the cluttered memory of my 12 hour days, and the exhaustion I feel afterwards. Families and patients who, for one reason or another, keep me running, and yet make me smile days later. The ones who I remember, and mourn with, and yet, encourage at the same time.
All in all, it's good to be a nurse right now. I haven't spent a stray thought on the economy, I've grown in my role on the unit, and I'm thrilled to be spending extra time giving back to my co-workers, and my patients.
Will try to stay in touch more frequently...:)
Sunday, August 31, 2008
Congrats Obama.
It isn't everyday, that you get to experience emotional moments. As an ICU nurse, I am exposed to emotions on a daily basis, and yet, I can go for days without showing or feeling anything towards my patients or my surroundings. Some days, I feel very separate from my patients - most of which have altered levels of consciousness from disease processes or drugs, and multiple tubes impeding them from speaking. Weeks can pass where I have one-sided conversations only.
This week, though, I eavesdropped on a conversation that brought a few little tears to my eyes and a clump to my throat. My patient had a visitor - his first in the two days I had been his nurse. He and I had minimal communication -- he was on the ventilator, and beyond that, he had been involved in a hit-and-run accident five years ago that left him with many deficits. The best he could do to communicate was open his eyes, and he did that very little.
The visitor was his niece, and she brought with her the newspaper from that morning. She started by telling him the date and the time, and then proceeded to inform him that Barack Obama had accepted the democratic nomination on the anniversary of Martin Luther King's "I Have a Dream" speech the night before. "We're gonna do it, uncle," she said with excitment. His eyes opened, and she went on to tell him about Joe Biden, and Obama's powerful speech at the convention.
I have no idea how much he understood or didn't. But, as I listened and watched from the door, I thought to myself of how outstanding Obama's reach is -- that his words and person traveled from the convention in Denver, all the way to the bedside of a nameless man who can only open his eyes.
I'm not sure which was more valuable to me then - to be a nurse - or to be a witness to the spread of hope and change that Obama has started in this country.
This week, though, I eavesdropped on a conversation that brought a few little tears to my eyes and a clump to my throat. My patient had a visitor - his first in the two days I had been his nurse. He and I had minimal communication -- he was on the ventilator, and beyond that, he had been involved in a hit-and-run accident five years ago that left him with many deficits. The best he could do to communicate was open his eyes, and he did that very little.
The visitor was his niece, and she brought with her the newspaper from that morning. She started by telling him the date and the time, and then proceeded to inform him that Barack Obama had accepted the democratic nomination on the anniversary of Martin Luther King's "I Have a Dream" speech the night before. "We're gonna do it, uncle," she said with excitment. His eyes opened, and she went on to tell him about Joe Biden, and Obama's powerful speech at the convention.
I have no idea how much he understood or didn't. But, as I listened and watched from the door, I thought to myself of how outstanding Obama's reach is -- that his words and person traveled from the convention in Denver, all the way to the bedside of a nameless man who can only open his eyes.
I'm not sure which was more valuable to me then - to be a nurse - or to be a witness to the spread of hope and change that Obama has started in this country.
Thursday, July 3, 2008
Vacation.
And....I'm back.
Sorry no word, but things got a bit busy before I jet-setted across the globe to see my good (nurse) friend in Israel.
Two weeks running around Tel Aviv was a pretty amazing way to celebrate and complete my first year in nursing. It was a blast.
Now, I'm jet-lagged and paying for it, but will go to night shifts this evening to return to work. Am sure to have plenty of stories to re-win your interest.
Be a nurse...vacations are way better than they used to be.
Sorry no word, but things got a bit busy before I jet-setted across the globe to see my good (nurse) friend in Israel.
Two weeks running around Tel Aviv was a pretty amazing way to celebrate and complete my first year in nursing. It was a blast.
Now, I'm jet-lagged and paying for it, but will go to night shifts this evening to return to work. Am sure to have plenty of stories to re-win your interest.
Be a nurse...vacations are way better than they used to be.
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