...a tiny, absolutely gorgeous girl...she looks like Judy Garland .
17, with a two year old baby.
She showed up here in heart. lung and kidney failure.It turns out that she has a big piece of yuk in her heart that has seeded itself to her lungs and her kidneys. She is a meth addict, and shoots the stuff; and she pulled out her own infected tooth a few weeks ago. Seemed like a good idea at the time, I guess.
So now she's sitting in our unit, pissed as hell because we took out close to a half liter of infected fluid from around her heart,so she's now able to breathe again and awake...but the drain hurts. (Another 350 cc of drainage in 2 hours. Her heart is now working fairly well...no longer tamponaded, so she can breath, and her heart is working well. )
She really doesn't care that she is in danger of emboli to her brain; that her kidneys may be permanently damaged.
"Can I get something for my anxiety? I was supposed to see a psychiatrist to get started on good drugs."
"Can't she get some narcotics?" her mom pipes up.
"Here. Let's give you some IV Toradol..it's great. Works really well for pain."
(Toradol is an IV version of ibuprofen, and anti-inflammatory.)
Within seconds of the drug being put into the IV, she nods off, head drooping like a daffodil in the rain. Her mom sighs in relief.
Trust me..the pharmcodynamics of the drug don't work that way; it's all in her head. She got "something" pushed into a vein, so it "works"
How do we fix this one?
She'll be asking for narcotics again in the morning, as will her mom...
Someone must be taking care of the baby.
Monday, February 29, 2016
Tuesday, February 09, 2016
A few days ago, I read a really nice blog post by another critical care nurse about how we carry our patients with us...
and it resonated.
http://www.huffingtonpost.com/sonja-mitrevskaschwartzbach-bsn-rn-ccrn/letter-to-patients_b_9034024.html
I've always thought of this relationship we have with our patients and families as something really profound; that our interactions change us, in ways we often could not have anticipated, but would never (or at least for me) would avoid even when incredibly painful in the moment.
I've written a lot over the years for myself in exploration and expiation: poetry, short stories, short essays. I've written a plethora of policies and procedures to help others render care safely and according to specific standards of care. I have read and and been informed by extraordinarily erudite and lovely writers like Lewis Thomas, Richard Selzer, and most especially Oliver Sacks, who taught me just how much our experiences with patients require compassion and incisive thinking, both.
My metaphor is this....of course I carry you all with me..you've tattooed yourselves upon my soul.
and it resonated.
http://www.huffingtonpost.com/sonja-mitrevskaschwartzbach-bsn-rn-ccrn/letter-to-patients_b_9034024.html
I've always thought of this relationship we have with our patients and families as something really profound; that our interactions change us, in ways we often could not have anticipated, but would never (or at least for me) would avoid even when incredibly painful in the moment.
I've written a lot over the years for myself in exploration and expiation: poetry, short stories, short essays. I've written a plethora of policies and procedures to help others render care safely and according to specific standards of care. I have read and and been informed by extraordinarily erudite and lovely writers like Lewis Thomas, Richard Selzer, and most especially Oliver Sacks, who taught me just how much our experiences with patients require compassion and incisive thinking, both.
My metaphor is this....of course I carry you all with me..you've tattooed yourselves upon my soul.
Writing is something peculiar...sometimes we do it out of need to express an opinion, sometimes to change an experience into something other...something tolerable, something "useful".
For me, it's a way to take the many memories I have of patients and families; great outcomes and horrendous ones. It's a way to explain the very weird world of critical care to people in my life who are not involved in health care, who have no knowledge of the very separate world of a hospital. It's equally important to me to validate the experiences I've had as a nurse, in critical care , for more than 30 years, during a time of great change...and to celebrate the colleagues I've been so fortunate to work with.
I've found some other ways to work with the "bad" stuff over the years...working with a hospital ethics committee, for instance; and doing an enormous amount of reading.
And writing things for myself sometimes in journals.
I ended up in Taos, NM more than decade ago as a result of being part of a hospital ethics committee, just after a devastating divorce. My director of nursing was kind enough to pay for the vacation time and the costs of the workshop. At the time, I thought I was going to learn about how to write about ethical issues in health care.
Well, yes, and no.
As it turned out, first of all, we were forced to do many sorts of writing exercises, ranging from short paragraphs to essays. I had always thought that I was pretty darned good at writing the typical term paper or technical exposition (many years of policy writing, plus a degree in technical writing had assured me that I was "ok" at those things.) As it turned out...I actually had a whole lot more to say, and was encouraged to write more personal reminiscences. I was critiqued in ways that told me that I actually had a real voice, and value. That was extraordinary.
I met in this workshop, and was incredibly fortunate to work with the late Ellen Meloy, who took the whole genre of science writing/personal memoir to a level I had never imagined, full of humor and quirkiness and intellectual rigor.
At the same time I also joined an online community of people who originally had joined a "dating site' which very quickly evolved into a remarkable writing community. Shared blogs, daily haikus, weekly short pieces on one word...the inspiration and feedback was incredible fun and highly creative. There are still a hundred+ of us who have met in person, and connect online, although it's changed in texture.
Two years later,after that writing workshop, I found myself in the Middle Rio Grande area of New Mexico, making a new life in the high desert very, very far away from the lovely, verdant, sometime cold and dark northeast. In retrospect, that was very probably the bravest thing I've done in a lifetime...to just pack up the Subaru with the dogs and the the coffee grinder and some clothes and just head out to an unknown job/place/life. At the time, it seemed simply the thing I needed to do.
I've been here for almost 10 years now, and I still think that there is a "reason" I've been drawn to the Southwest, this barren, water starved pace so full of history and myth, and a "reason" I've spent the last 10 years working in pediatric critical care, and a "reason" it's time to get back to writing.
More later about my inspirations and aspirations. It's hard to know where to start in this recreation of this blog, although I'd welcome you to "follow' me and see where it goes.
I would leave you with this quote from Ursula LeGuin, and extraordinary writer of 'speculative fiction.
A story is, after all, and before everything else, dynamic: it starts Here, because it’s going There. Its life principle is the same as a river: to keep moving. Fast or slow, straight or erratic, headlong or meandering, but going, till it gets There. The ideas it expresses, the research it embodies, the timeless inspirations it may offer, are all subordinate to and part of that onward movement. The end itself may not be very important; it is the journey that counts. I don’t know much about “flow” states, but I know that the onward flow of a story is what carries a writer from the start to the end of it, along with the whole boatload of characters and ideas and knowledge and meaning — and carries the reader in the same boat.
For me, it's a way to take the many memories I have of patients and families; great outcomes and horrendous ones. It's a way to explain the very weird world of critical care to people in my life who are not involved in health care, who have no knowledge of the very separate world of a hospital. It's equally important to me to validate the experiences I've had as a nurse, in critical care , for more than 30 years, during a time of great change...and to celebrate the colleagues I've been so fortunate to work with.
I've found some other ways to work with the "bad" stuff over the years...working with a hospital ethics committee, for instance; and doing an enormous amount of reading.
And writing things for myself sometimes in journals.
I ended up in Taos, NM more than decade ago as a result of being part of a hospital ethics committee, just after a devastating divorce. My director of nursing was kind enough to pay for the vacation time and the costs of the workshop. At the time, I thought I was going to learn about how to write about ethical issues in health care.
Well, yes, and no.
As it turned out, first of all, we were forced to do many sorts of writing exercises, ranging from short paragraphs to essays. I had always thought that I was pretty darned good at writing the typical term paper or technical exposition (many years of policy writing, plus a degree in technical writing had assured me that I was "ok" at those things.) As it turned out...I actually had a whole lot more to say, and was encouraged to write more personal reminiscences. I was critiqued in ways that told me that I actually had a real voice, and value. That was extraordinary.
I met in this workshop, and was incredibly fortunate to work with the late Ellen Meloy, who took the whole genre of science writing/personal memoir to a level I had never imagined, full of humor and quirkiness and intellectual rigor.
At the same time I also joined an online community of people who originally had joined a "dating site' which very quickly evolved into a remarkable writing community. Shared blogs, daily haikus, weekly short pieces on one word...the inspiration and feedback was incredible fun and highly creative. There are still a hundred+ of us who have met in person, and connect online, although it's changed in texture.
Two years later,after that writing workshop, I found myself in the Middle Rio Grande area of New Mexico, making a new life in the high desert very, very far away from the lovely, verdant, sometime cold and dark northeast. In retrospect, that was very probably the bravest thing I've done in a lifetime...to just pack up the Subaru with the dogs and the the coffee grinder and some clothes and just head out to an unknown job/place/life. At the time, it seemed simply the thing I needed to do.
I've been here for almost 10 years now, and I still think that there is a "reason" I've been drawn to the Southwest, this barren, water starved pace so full of history and myth, and a "reason" I've spent the last 10 years working in pediatric critical care, and a "reason" it's time to get back to writing.
More later about my inspirations and aspirations. It's hard to know where to start in this recreation of this blog, although I'd welcome you to "follow' me and see where it goes.
I would leave you with this quote from Ursula LeGuin, and extraordinary writer of 'speculative fiction.
A story is, after all, and before everything else, dynamic: it starts Here, because it’s going There. Its life principle is the same as a river: to keep moving. Fast or slow, straight or erratic, headlong or meandering, but going, till it gets There. The ideas it expresses, the research it embodies, the timeless inspirations it may offer, are all subordinate to and part of that onward movement. The end itself may not be very important; it is the journey that counts. I don’t know much about “flow” states, but I know that the onward flow of a story is what carries a writer from the start to the end of it, along with the whole boatload of characters and ideas and knowledge and meaning — and carries the reader in the same boat.
Sunday, February 07, 2016
renaissance
I have left this blog alone and lonely for way too long!
The closer I get to possible retirement from my main gig in PICU, the more I realize that:
a) I am addicted to critical care ..the intellectual challenge of working with sick kids, the fun of working with people who are at the top of their games, the emotional rewards of helping others in extremis...I still love it.
and b) DAMN!I've been doing this for decades now, and I actually don't like working twelve hour shifts.I'd rather go home in daylight, do a little gardening, play with the dogs..
and c)what the heck else can I do with my life that gives me so much satisfaction?
and d) can I actually afford to retire at 62 anyway?
Well to work from the bottom up:
d) The answer is no, not really , unless I end up writing something that makes me a best seller. Not so likely.
c) Can't imagine,still, else I'd have done it already. Critical care nursing is pretty amazing.
b) Well..at least I work days, now :)
a) I have thought for years that I will end up like the wonderful jazz singer Alberta Hunter, working as a nurse into her early 80's before she was rediscovered . (Of course I'll have to simply be discovered, rather than rediscovered.) I will simply get shorter and shorter, more and more pithy.
All joking aside, I think there is a place for nurses to write meaningful, intellectually rigorous things about our experiences.It's a genre that has been largely ignored and/or sensitionalized.
The closer I get to possible retirement from my main gig in PICU, the more I realize that:
a) I am addicted to critical care ..the intellectual challenge of working with sick kids, the fun of working with people who are at the top of their games, the emotional rewards of helping others in extremis...I still love it.
and b) DAMN!I've been doing this for decades now, and I actually don't like working twelve hour shifts.I'd rather go home in daylight, do a little gardening, play with the dogs..
and c)what the heck else can I do with my life that gives me so much satisfaction?
and d) can I actually afford to retire at 62 anyway?
Well to work from the bottom up:
d) The answer is no, not really , unless I end up writing something that makes me a best seller. Not so likely.
c) Can't imagine,still, else I'd have done it already. Critical care nursing is pretty amazing.
b) Well..at least I work days, now :)
a) I have thought for years that I will end up like the wonderful jazz singer Alberta Hunter, working as a nurse into her early 80's before she was rediscovered . (Of course I'll have to simply be discovered, rather than rediscovered.) I will simply get shorter and shorter, more and more pithy.
All joking aside, I think there is a place for nurses to write meaningful, intellectually rigorous things about our experiences.It's a genre that has been largely ignored and/or sensitionalized.
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