Restive State

It had been a whirlwind last couple of weeks. Not to mention the Holidays, which always seem to fly-by faster than a hummingbird hyped up on espresso, I've been orienting to a new job. And getting a paycheck.

The new job is amazing. While not as technically demanding as an ICU job, the intellectual, emotional, psychological and technical demands are intense. It is possible that 'cause I am new to nursing that I have yet to develop the distance that keeps floor nurses sane, that psychic armor that enables us to deal with life in this field, but it has been kicking my butt. Everyday I come home to the wife and realize how lucky I am and how wonderful it is to have a support system at home. I wouldn't be doing so hot without her.

Hell, I don't think we would have made it through the Holidays without each other. Something about this time of year tends to open old wounds, surface old memories and cause one to relive events of the last year in a harsher light than any other time. It was not a good start to the season. On Thanksgiving, my folks gave us the box they had received from the hospital where Mia was born containing her personal effects, the last remaining things we had left of her. Pictures, her beanie babies the gown she wore the day she passed on were all there along with all of the associated memories and feelings. Pain, anger, helplessness and hopelessness were all there, flooding back leaving us battered and beaten in their wake. It hurt even more to know that she should have been here with us. Thanksgiving was when she was supposed to have come home, or in the best case, when she was due. This obviously was not the plan. We leaned on each other and coped the best we could. We survived.

Christmas was better, in spite of being broke. We stayed with the folks and had a good Christmas. It was the first we had spent with them together and the first we had been there in four years. It was more for them than for us. I know that we made their year just by being there. Funny how just being there is just the thing that is needed.

Work has been both thrilling and downright scary at the same time. I'm realizing how much I know, and how much more I need to learn. You don't realize how much your past experiences color you view of the present. It is hard as a nurse to present the objective view vs. the subjective one, keeping your own emotions and beliefs out of the equation. You chafe under the constraints imposed on you because you want to tell a family member the reality of the situation their loved one is in, but can't as you're not a doctor. All you can do is steer them in the direction where you think and pray they will receive real and realistic options.

Case in point: Mr. S was an 87 y/o admitted to our floor for syncope. To this point was living an independent life in pretty good shape for being 87 years old. After examination by the doctors was shown to have fairly severe aortic stenosis (it was one heck of a murmur...). The treatment for this is an aortic valve repair surgery. They go in, crack the chest, and replace the natural deteriorated valve with a new prosthetic. Post-op, you're talking about 6-8 weeks at a minimum of rehab, immunosuppressant meds if it is a animal valve, anti-coagualtion therapy, not to mention the risk of infection and other complications of a major surgery. When you think about how huge of an insult that is to the body, you wonder if correcting the problem is really the right thing to do. I wanted to tell the patient and his family to not do it. Tell them to go home, enjoy the time they have left - which is probably years anyways, play some bingo and watch the grandkids grow. Don't subject yourself to the trauma that is open heart surgery and risk losing your quality of life in exchange for quantity. But as a nurse, I can't. I can direct them to the cardiologist and the PCP who knows him and tell them to sit down and get a realistic view of this, weigh the pros and cons and then decide. And then pray that the docs will do the right thing and not push for surgery and present the balanced view, showing the good, the bad and the ugly...

Next time, DNRs and advanced directives...maybe.

'Til later...