So here's the thing. I cried a little this morning.

My husband had run out to take B to school. I grabbed my ipod and uploaded the recent emails. One was from the church I occasionally attend that I haven't been to in months.

The senior pastor was recently diagnosed with non-Hodgkin's lymphoma. He started a blog so that the parishioners could follow his progress while he receives treatment. It's called "Rick's Journey."

I decided to take a quick glance at it...just a glance. I scrolled down and spotted a photo of Pastor Rick sitting in the chemo chair with the IV hooked up under his shirt to what I fathom must be a port.

He wrote about how he was sad to lose his hair; his mother had always loved his blond hair. That did it for me.

The thing that I don't talk about much, but which is probably well-known even outside of the medical field, is that doctors and nurses train themselves not to feel much for patients.

In my case, though, I learned to do this was when my dad was dying. He had lung cancer and was primarily my responsibility. The unspoken message from his side of the family was that this was the expectation. So I had to get down to business and be a single mom to my daughter, work, go to school, take my dad to appointments and check on him daily to make sure that he was clean and hadn't fallen on the floor. I was 26, and I think I handled it pretty well.

There wasn't much time for any emotions to set in. I did what I had to do. After he died, there was the task of cleaning out his house and preparing to sell it. I still didn't cry, not even at the wake or funeral. I was chided for that.

Fast forward to about 5 years later, when I was working at my first ICU job. There was a man in our cardiac unit who also had cancer but was in remission. I placed my papers and supplies for the night at the desk across the hall from his door. I could hear him talking with his wife, and I listened to him intently. It took a few minutes to set in, but some connection formed in my mind--suddenly it was my dad talking again. The next ten minutes were spent in the bathroom, which was right behind another nurse's desk. I felt pretty awkward when I finally came out of there as I tried to look nonchalant. But I'm sure it showed on my face--when I cry I get blotchy.

This morning was one of those days that sickness got to me again. It rarely happens. I can't let it. Some of the patients I take care of have end-stage cancer and come to my unit for a last ditch effort at a few more quality months. My job is to give them hope, because that's what they're there for. To do anything less would be to fail them. I read the H&P's that the doctors have written, learn their stories, ask them about their families. Then I push it back so it doesn't get in the way.

But sometimes it's nice to be reminded what it feels like to be a normal person who knows how to properly grieve--to let down the protective wall. And that's why I decided to write this today. The silly posts are safe in draft for the moment. Thanks for listening.

Coldicidal

"Coldicidal"* (adjective)--to falsely state that you are suicidal on a cold night in order to secure a warm bed in the ER and possibly an admission to the psych unit, where you will receive blankets and 3 square meals a day.

A middle-aged man walks into the ER gripping his chest and complaining of pain. That combination of moves immediately buys him a gurney.

The standard chest pain work-up is started--EKG, IV, labs, vital signs, chest x-ray.

The doctor enters the room and does a history and physical:

How long have you had chest pain for?

A couple of weeks, off and on.

Did you drink anything tonight?

I had a couple.

Okay. Did you do any drugs tonight?

No.

Have you used cocaine?

Yesterday.

Tell me about your living situation. Where are you living right now?

Nowhere.

Are you living on the street?

Yeah.

About an hour later all the tests come back normal. We're not going to do any exploring for blood clots or what not. All signs point to one thing. He is discharged "home."

You got a bus pass?

No, we don't give those here.

The other hospital gave me one.

Well we don't do that. You can call someone to come get you or you'll have to walk.

The obvious question is "why do you have money for cocaine but not for a bus pass?", but I bite my tongue.

He gets dressed and comes out to the nurses station, casually leaning on the counter.

Anybody here got change for the bus?

No sir, we don't give change here. You can go back and ask registration if they have it.

A minute later the phone rings.

Why did you send him back here to get change? We don't have money for him! He's asking for a dollar sixty.

We meant you could MAKE change, not give change.

Unsuccessful, he ends his short-lived conquest for money and exits to the waiting room.

All is quiet in the ER now. It's the middle of the night--just a few patients with tests pending--time to relax, break out the magazines and suck on popsicles stolen from the patient food stash in the break room, check email on Blackberries. The phone rings again. It's registration.

This patient you just discharged says he's suicidal.

There's a camera in the waiting room, and we can see him on the monitor pushing buttons on the vending machine. And even more interesting to note is that he has somehow found change for the vending machine.

Here is the precise point where his new diagnosis changes from "atypical chest pain" to "coldicidal":

1. It's 30 degrees outside.
2. He's homeless.
3. He's both hungry and suicidal.

Security proceeds to escort him through the exit door.

Better luck next time sir. By the way, this incident will be dictated into your permanent record, so you won't be getting any paper psych scrubs to wear anytime soon.


*Full acknowledgment and credit belongs to "Officer Frank the Tank" for coining his entirely original term "coldicidal." I promised I'd make him famous. Ha ha. Are you happy now? ;)

best med rec this week by far

Medication reconciliation done on a 14-weeker prego who came in with shortness of breath:

1. Methadone

"I can tell you all about it--dose, how long I've been taking it, where I go to get it..."

"Are you taking prenatal vitamins?"

2. Oh yeah, I'm taking those

3. I have an inhaler, but I lost it.



"Do you have an ob/gyn?"

"Yeah."

"Who is it?"

"I can't remember the name."

Father: "Do you mind if I go out? I left my kid in the car."

It's 3 a.m., and they just made runner-up for the Parents Of The Year award. Almost tied with the parents of the 6-week-old who fell off the bed because "he rolled a little." Send more nominations to me. The contest is ongoing.

Rude Pencil

I found this pencil while unpacking some boxes in my room. Yes, that's right, I am STILL unpacking. That is beside the point.

I never really noticed or cared much about it--probably got it for free from some job fair back when I was a new grad--but now the message is so poignant to me, I am going to place it in one of my memory boxes so that it will last forever. Go on Southern nurses, remind me how rude us Northerners are. Wait a minute, I can't really consider myself a "Northern Nurse" anymore, now can I? Well, I will always be one in heart and spirit. Love live EICU!

sepsis of the profession

I recently discovered this fascinating line in The Emerald, a short story by Donald Barthelme. Being a critical care nurse, I could not help but be drawn to it.

For those of you not in the medical field, sepsis is a life-threatening full body reaction to an infection in the blood. That's a very simplified definition.

The dialogue contains a journalist, Lily, who is filled with disbelief at the sight of a 7,035 carat emerald speaking to her. She is told that disbelief is the sepsis of her profession. It hampers inquisitiveness. It kills the news story.

Indifference is the sepsis that plagues the nursing profession. How many times have I heard "I'm just here for the paycheck," or "I just do my 12 hours and go home?"

I guess it's because so many nurses have let go of the polished-white nursing shoe attitude that causes them to spring out of school proclaiming "I'm going to help someone!"

After several occasions of being threatened with a full airborne urinal, one can only muster so much patience and good-natured caring attitudes.

Maybe it is indifference that enables us to carry on with the job, though. To learn to not care about so many insignificant little things, to not take so many words to heart, to let them go in one ear and out the other. To be able to go home, sit down with a bowl of ice cream in front of the TV, open a book, read about someone else's life, and forget about the day where you successfully fended off an old lady who simultaneously wanted to bite you and get her pants off so that she could play tug of war with her foley catheter.

Orientation Classes at the New Job (Dialysis Lecture)

My mind is slowly sliding down from doodling dementia into a catatonic cave. Get those eyes up! No, better yet, hoist that heavy lump attached to your shoulders and look straight at the fluorescent lights overhead that mockingly glare as if to say "We will not let you sleep, but will annoy you enough to make you want to sew your eyelids shut!"

The problem here is that my brain has exceeded its daily learning capacity. Like an overstretched stomach that spews forth its contents in rebuke, my neurons have hung an invisible "Do Not Disturb" sign across my forehead.

There is only so much information that can be forcefully crammed into my brain before it comes seeping out from my ears.