Just a one-line vent

Ok, maybe more like one paragraph. Or two. Or... Fuck it.

Sometimes this place is so achingly sad I feel like I carry it around physically - as if it accumulates in my bones and changes the way that I move. I feel so much heavier after a few days of sadness around here. There is just so much hope. It kills me.

An aside: I don't like saying a patient "expired". I hate how that sounds so much. How about, "they've been trying to die for a month and finally won"? Or "patient died"? We call it a time of death, why do so many people say such quaint, stupid things around death?

I can't help but feel like I'm a cog on a conveyor belt sometimes. I love my job a lot, and sometimes I hate it a lot. Probably not for the reasons you'd think.

We can't do much about long term un-interpretable suffering. I can help you with pain as long as you're able to say something or look uncomfortable, or give me some kind of sign. If you're in a long term altered state of consciousness, sometimes we can't tell. Did that hurt? When you moved your arm there, were you trying to tell me something? I can't tell for sure. I am trying so hard to make this comfortable for you, while your loved ones crowd around and sit in the waiting room and talk, try and figure out what to do - what the chances are, what they mean. Can you hear all this? Do you know what they're saying? If I somehow miss a sign that you're terribly uncomfortable, that this is prolonged and endless torture ...

... Would you forgive me? ... hell, will you forgive me?

Sendoff to the other side, and go Oklahoma City Thunder

The last time I wrote about dying, it was because of long nights spent
with a patient. Again, I've spent the last few nights caring for
someone who is dying. She's been married for 50 years. She and her
husband immigrated (emigrated?) to the US in the fifties and started
off with nothing. People shunned them for being interfaith (she
was/is Catholic and he was/is Muslim, in the fifties). They married,
stayed in the US. Visited their extended families overseas. Enjoyed
each other very much.

Her husband is an adorable accented little old man. He's been
sleeping here every second. They've had friends come visit them
occasionally, but they don't have much family left. He is planning to
go back to his home country once she is gone. Last night he slept in
a recliner next to the bed, holding her hand the entire time. Every
time we turn her in the bed she reaches out for his hand until she
finds it again.

I came in early today for a coworker and sat in there with him for
almost an hour, while he talked about her and their life together.
Then he started asking me questions. I told him I was born in
Oklahoma City. Then he brightened and started talking about the
Oklahoma City thunder and how they take their series against the San
Antonio Spurs home tonight and they have such an exciting team. I
promised him I would come in and watch as much of that game tomorrow
as I have time to watch (I am working tomorrow, too). My friend and I
bought this guy dinner and he was so gratified. He hadn't eaten all
day and it seemed I couldn't think of a better way to spend my money.

So if any of you out there could spare a thought for this guy and his
lovely wife, please do so.

And GO THUNDER!

You don't say??!!

So I admitted a lady and we were trying to get her paperwork figured out.

Doctor (to me): do we know why her husband isn't the medical power of attorney?

Me: the woman's adult children said they don't trust him and that he's got a history of having heart attacks when he gets stressed out. He was just in there talking about how it's not a big deal that she's in respiratory failure because she's just his second wife.

Doctor: oh, sounds like a gem. Does she have any other past medical history?

Me: just a history of depression...

Toys in the attic he is crazy...

But holy shit, I am shaken up by it. I had this guy all night. I feel for the guy, I really do. He's been in the hospital for over half a year. Half. A. Year. I can't even imagine that. Anyway, I kept trying to convince this guy to let me give him a bath. He kept saying no, and I finally reached an agreement with him that I'd give him pain meds beforehand so it would be easier, and he said yes. So I have his bath drawn up (it was absolutely worth negotiations, he was disgusting and needed a bath so, so badly).

I took off his blanket. He sat up in the bed, one hand fervently swinging at me, the other pointing at me. He's so agitated veins are popping out of his forehead.

"you LIE! YOU LIE! YOU LIE!". Ad nauseum. And I'm sitting there floored, because until then this guy has barely even bothered to wake up. I said something like, "Ok, it's going to be all right. I'm sorry you think that". That set him off. "I don't think so, I KNOW SO!" I said, "Ok, fair enough. No bath". And he instantly settled down, laying back on the bed and going back to sleep, like a switch was flipped.

Shit, it shakes me up when people are so freaking fervent, though. I'm as agnostic as they come, and I had the fleeting thought, "oh my god, this must be what people believe the devil looks like" (and maybe this just means I'm a more superstitious agnostic than most). I am not shaken up by deranged patients very often. But this guy has made the hairs on the back of my neck stand on end. Maybe the sudden superhuman strength, the demonic fervor in his eyes, maybe the blood vessels standing out on his forehead?  I don't know what freaked me out, but I am shocked he didn't spin his head around and start spewing pea soup.  I'd have had to get a change of clothes at work.  Ugh.

Happy Halloween! Oh, wait...

Quick quiz!

This is a hard one.

You get up in the morning and your wife is on the floor and not waking up. She shit herself. Do you:

A. Call 911
B. Put her in the car and go to the emergency room
C. Call a doctor (I mean, at the very least, right?)

Or...
D. Put her back to bed, and try and wake her up again at 4 PM the following afternoon. THEN when she doesn't wake up, call 911.

Guess which my patient's family did?

Sendoff to the Other Side

So, I really didn't want to come to work today. I was having a nervous breakdown over a missing/broken tooth. I had no sleep, practically. I requested to be canceled and (read this dramatically) my request was denied. I'd had a gross assignment for a few days already and was tired of feeling coated in crap (both literally and figuratively) when I came home. My patients were both kind of emotionally exhausting - both were on all kinds of life support while the families insisted there was still a point zero one chance of full recovery so, keep going!

Today, I came in to find out that in both cases, the families decided to withdraw care. This means - remove the breathing tube, stop life support, keep them comfortable, maybe send them home on hospice care if they do well enough off life support. Not immediately - one of them, the family wasn't sure when and is still talking about it (in those cases we will be gracious and give the family time). The other family - the parents of a very young woman - wanted to come later in the week and take pictures with her, so they can say goodbye before withdrawing care.

This woman was hard to make "look nice" from the moment I had her. She had continuous E.E.G. Monitoring for 4 days, which is where they paste electrodes to her scalp to monitor for seizures. When the parents decided to withdraw care, they discontinued this. She had to have her tube re-taped multiple times daily because of secretions, etc, etc (trying to not make this too gross for some of you!).  Sidebar here:  In the ICU, making your patients look nice is often secondary only to keeping them alive.  My preceptor used to always say, "it doesn't matter what happens, make them look nice anyway" and I'd roll my eyes.  It's funny how I am now totally converted to that viewpoint.  I've learned all kinds of tricks, but it's totally true - in the ICU, as long as you're not having a very hard time keeping the patient alive, they'd better look good.  You end up kind of judgy of people who are not brand-new and learning the ropes but their patients always look like crap.

We bathe patients at night here. I just spent over an hour combing through her hair to get that EEG glue out with nothing more than an icu comb and hospital soap, and my hands. It was oddly soothing, even she calmed down while I was doing her hair. I wanted her hair to look nice for her pictures for her family. I still need respiratory to re-tape her tube again so that looks nice, too, but her hair looks a million times better than when it came in, and I feel such a sense of pride for that.

I got time to process shit. I really no longer care about my tooth or any number of other crises I have going on. This afternoon, a mother and father will come to our icu to take their last pictures while their daughter is still alive. I hope I made that experience just a little easier for them. And this reminded me that I love helping families through loss. I used to want to do hospice. I don't want to now, but sometimes it's good to have a really satisfying night. It's kind of an emotionally powerful experience giving someone their possible last good bath.

I'm really glad I came to work, and even glad I didn't get canceled.  I am so stoked with the way my workweek unexpectedly ended. 

(now back to your regularly scheduled funny shit)