Let's Talk About Organ Donation, for a moment.

I just lost a friend who was given extra years of her life due to someone's gift. She received lungs about a decade ago from a man who had the courage to donate, and recently, at the age of 33, went into an episode of acute rejection, aspergillis infection, and had also developed cancer in her abdomen.

I miss her terribly, and am in shell shock.
I can't even imagine what your family is feeling.

Please, if you haven't, register yourself as an organ donor. If nothing else, I got more years of knowing my friend. She was a beautiful soul, a real fighter, and will be missed by many.
Anne James Ferrari, you have touched the lives of so many. I am so lucky to have known you. Spread your wings my friend, and remember us here. We'll see each other again.

Please, donate life.

And for those of you still here, live every day. Carpe goddam diem.

Here's a photo of her and her beautiful sister (who is also becoming a nurse. I love you, Beth):

The Cycle Continues

I'm backdating this blog entry, mostly because I like having Anne's sunshine smile at the top of my blog.

Friday, the 10th, I spent my first rotation in Labor and Delivery. Here's a summary of the experience:

My brand-new clinical instructor is moving very quickly towards us, somewhat breathless.
"Okay, Nicole, you and (male MEPN) are in the delivery rooms, and everyone else is in Post-Partum. Go change into these scrubs. And the women in those two rooms are pushing. Hurry!"

My cohort and I look at each other, high-five, and nod. Neither of us even had time to register nervousness- I mean, I had never seen a vaginal birth, only a C-section, and we have had about three lectures on pregnancy. New scrubs on, we stepped out, ready for the day.
For about ten minutes the nurses we were working with hemmed and hawed about the number of students allowed in one room, and I told him to go ahead- as a male, I know it's more difficult for him to be accepted into a delivery room. Not today. He merged right in to the room, needed and accepted. He had only been in there two minutes, when I hear a call for, "Hey can I get another person in here?!"
So I stepped in.
"Um, I'm a student, what can I do?"

A nurse looks at me, "Grab that towel and go hold her leg so I can hand tools to the doc."

The patient is in a traditional hospital-birth supine position, her husband is at her side. They are super cool, and very calm, all things considered.
"Hi, nice to meet you. I'm Nicole." Contraction.... "Okay, breathe deep with me, ready?"
And that was it. Off and running. It's 7:15 am, and I am helping hold this woman's legs open for a difficult birth, trying to remember what I can about fetal heart rate decelerations, next to her husband (who is also totally rad), watching the doctor work, realizing that this baby is in a little bit of trouble. And I'm watching the baby's head crown.

Holy Shit.

And I thought, silly me, that the head would be way smaller than it was.
The OB was very calm, and grabs the vacuum to help get this baby out. I see the FHR (fetal heart rate) is about 70.
Not so good.
Doc, very slowly but firmly. "Get Peds in here. Now."

A team of 3 superhero nurses emerge from the ICN, ready. They're setting up oxygen support, and the warmer.
The woman pushes again.
"Call Dr. XXXX. Get him in here." I realize that she's calling for the attending.
"Okay, now push. Hard. We need him out of there."
Attending arrives, steps back close to the ICN nurses.
Our laboring mama listens. Another nurse is pouring mineral oil and olive oil on the crown of the baby and on mama's perineum.
And all of a sudden, I realize just how huge that head is, because it's coming. Fast.
And just like that, there's another person in the room.
"Floppy baby."
Not a good thing.
He's blue and floppy, and the cord was wrapped around his neck, twice. Not 2 seconds into the world, this little guy is under a warmer, being rubbed down, suctioned, and bagged with oxygen.
The trio of superheros is working, hard.

It's almost too much to absorb. I look at mama, I look over at baby, and then I look down at mama and she asks me (and the doc), "Did I tear?"
It took every ounce of my consciousness not to look incredibly shocked.
Um, yes.
The OB: "It's not that bad."

Apparently, it's not that bad, but I have never seen a vaginal birth and I could not believe what a "not-that-bad" tear looked like. And the amount of blood that was associated with this process I was NOT prepared for.

I keep myself together, "Yeah, not that bad. How are you doing?"
And then I look at dad. "How are *you* doing?"

We start bantering, like we had known each other for a while. I glance over at the busy trio and the once-blue baby. He looks pink, to my relief. It's been almost 10 minutes.
Then we hear it... He cries!
I sighed, audibly. Everyone in the room noticeably relaxes.

They bring the little guy over to mom and dad, and let them say hi, but he was on his way to the ICN to be watched for a little bit. Both mom and dad are medically savvy, and they nod. Mom looks tired. Baby looks pink, warm and dry. He looks a little mad after being suctioned, and he's probably a little dazed.
"How long were you in labor?"
She looks at me. "31 hours."
My male MEPN companion and I look at each other and our jaws drop.
"Um, can I get you some juice?"
She laughs, and nods. "Yeah, that'd be great."
The OB is busily sewing up the tear. This mama had an epidural, which she relates is what helped her make it through. It's not even 8am yet.

And that was the beginning of the day. Literally, 2 hours later, I'm watching a C-section, then an hour after that, I'm holding the legs of another woman who didn't get an epidural because her baby was on the fasttrack into life. First baby, and she only pushed about 5 times. She tore, too. And let me repeat, NO epidural. Her baby came out with a loud cry, pink, and feisty. Good sign. The doc was trying to numb her up to sew her back together. Again, not a bad tear, but on my first day, it was pretty shocking.

At that point, I thought to myself, "Is there a third option?"
If I invent anything, it's gonna be a baby transporter beam, a la Startrek.
And I had a hell of a lot more respect for all the women I know who have gone through this process.

I then spoke to my Godsister, who is a NICU (ICN) nurse, and she relayed to me that usually women with epidurals tend to tear more often because they can't feel pain, so they don't allow themselves to stretch enough. Makes sense, naturally, when it gets too painful, you stop, take a breath, relax, let yourself stretch, and then begin pushing again. Huh. I am going to ask my prof about this (not that I don't trust my godsister, I just want to ask my professor).

L&D started with a rush of emotion.

So on the same day that I was there for 3 new people coming into the world, someone I really loved transitioned to another one.

Which is a wild head trip for me.

In the past few weeks I've lost a lot of people I've known. See my prior post about one group, but I also lost Shane McConkey, who was a trick skier filming in Italy, and fell. One of his skis didn't pop off, which screwed up his balance and from what I understand, his parachute was tangled in his ski. So he fell. 400 feet. He was only 39, and he was the most bitchin' landlord I ever had- he used to come over and drink beers with us, and his wife Sherry used to come visit as well. I remember how excited she was when she told us she was pregnant. Shane was awesome- he knew I was trying to improve my skiing and offered to ski with me, which floored me. Shane was a legend- he was Squaw's guy, and he was a friend to so many, and so down to earth yet nutty and fun. Total prankster, and totally loveable. He leaves behind his wife, Sherry, and Ayla, his daughter.

Too much.

It's a cycle. I haven't confronted death in a long time, and I've never seen birth like what I saw on Friday, so I guess it's time for reflection.

For a Patient.

Because I could not stop for Death,
He kindly stopped for me;
The carriage held but just ourselves
And Immortality.

We slowly drove, he knew no haste,
And I had put away
My labor, and my leisure too,
For his civility.

We passed the school, where children strove
At recess, in the ring;
We passed the fields of gazing grain,
We passed the setting sun.

Or rather, he passed us;
The dews grew quivering and chill,
For only gossamer my gown,
My tippet only tulle.

We paused before a house that seemed
A swelling of the ground;
The roof was scarcely visible,
The cornice but a mound.

Since then 'tis centuries, and yet each
Feels shorter than the day
I first surmised the horses' heads
Were toward eternity.

-Emily Dickinson


Morpheus

Oh, Morpheus, give me joy till morning
For my forever painful love:
Just blow out candles' burning
And let my dreams in blessing move.
Let from my soul disappear
The separation's sharp rebuke!
And let me see that dear look,
And let me hear voice that dear.
And when will vanish dark of night
And you will free my eyes at leaving,
Oh, if my heart would have a right
To lose its love till dark of evening!

Alexander Sergeyevich Pushkin


"There's no place like home."
-Dorothy Gale, from Kansas.

Honoring one of my favorite patients, who will probably not make it 48 hours.
I think she recognized me for a second today. She smiled, for just a moment in her confusion and pain.
And then she simply said, "I want to go home."

Maybe I'll see her tomorrow. Maybe not.

Whatever happens, I am grateful to her and her family for allowing me to help them. I am grateful for their love, which teaches me to love in kind.
And I hope that when she does go home, she finds peace.
Sometimes, holding someone's hand is all you can do.

Namaste.

Love, Bluegrass, and Tears.

Ah yes, 5th week of "schedule A's" quarter, and I'm deep in Med-Surg nursing. Still on the transplant floor. Still doin' my thing.

Last weekend I rode on a float in the LOVEfest parade down Market St in SF. If I could find a photo of me on the Spundae/Skills float, I would, but alas, I was in my EMT pants and a T-shirt, although I had my hidden orange fur and sparkley pants in my bag. I was supposed to volunteer from 11am until 4:30, and ended up staying until 6pm. We had so many calls- lots of overly intoxicated people on various substances, and I was running around with oxygen on my back trying to help them. Doing the quick assessments was actually kind of fun, because it brought back my EMT skills and I was surprised at how comfortable I felt in that environment. A lot of people thanked us. Afterwards, I found some friends and danced until about 7, went home, and drank a margarita. Sweet.
Sunday I went to Hardly Strictly Bluegrass since it was only a mile or so from the house, and had a fantastic time just chillin' with close friends. Listening to Iron and Wine play was magical, as was dancing with the girls to Greg Brown. Awesome day.

Today was a tough one at the hospital. Last week, I took care of a patient who was hoping for a good diagnosis. He didn't get one. He has an inoperable state, and at this point, he has been referred to Hospice care. He'll be here for a few more days, and I'm going to try to be with him tomorrow. His wife is phenomenal, and I cried with her for about 20 minutes this afternoon. There's not much time to give, but what I have, I will.
I can't go more in depth, but that still makes me tear up. Knowing that your parter is going to pass, knowing that you are going to pass- given "time" to do what you need to do... Is it a blessing? He has the opportunity to say what he needs/wants to the people he loves, yet it's limited.
His wife looked at me and asked, "Why is it that we only find out who truly loves us when we're sick or dying? Life is so short- time goes by so fast and we keep promising each other that we'll get together, and it takes something like *this* to make it happen. Why?" She paused, looked at me, and said, "Enjoy every moment you can. If you learn nothing else as a student, enjoy every moment you can."
That's when I started crying.
I hugged her.
In the middle of the hug, my stupid cell phone started vibrating, and we both laughed and laughed. Perfectly ludicrous.
They've been married for 40 years. I've been with my boyfriend for 2.
My heart aches for them.

And then there is that question: how *do* you go back into the hall and help your patients after that? How? My heart was heavy, but I got elbow-deep into poop (literally- and discovered a pressure ulcer and worked to prevent skin breakdown) and tended to the needs of someone else who is, very literally, dying.

Inoperable.
Bad word on our floor, but seemed to be the word of the day.
Sigh.

All we can do is love openly, celebrate the time we have, and be here for each other.
Those words from my NP friend echo through my head: "There's not a day that goes by where I don't hug a patient or am there for a patient. I give good news and bad news. When I've lost my ability to emote, then it's time to move on from this."

I'm just getting into it, and it's heartbreaking and beautiful all at the same time.

This weekend I'm at a wedding. A beginning. I think I need it.

Firsts, Escapes, and Anniversaries.

First of all, if any of you readers are applying to MEPN right now, congratulations on finishing. Tonight at midnight is the deadline, and I remember all to well scrambling to get it all in.
In fact, the GRE made sure that I was late by a week, but somehow it all worked out. Have faith that yes, indeed, it will work out for you.

Non-MEPN stuff: I went to my first same-sex wedding in the beautiful Genessee Valley area of California. My friends Julie and Abigail tied the knot in the best ceremony I've ever been to, out in the middle of nowhere on their property past the North Fork Feather river.

Almost all of my river friends were attending, and I had a weekend of margaritas, sleeping bags and dust boogers that made my fall happy. This weekend, I'm volunteering in the med tent at the LOVEfest, hosting a few women at my house who are going to Hardly Strictly Bluegrass, and just unwinding. The Gourds are playing, and they play the best version of Gin and Juice (which, incidentally, Will plays on his banjo). So will Emmylou, Iron and Wine, and Poor Man's Whiskey. Sweet.

I miss Will. He's in Houston, doing hurricane relief, still. Probably there until December.

MEPN stuff:
Last week we had rapid response on our floor 4 times, once for someone with 10/10 chest pain and shortness of breath with a low O2 sat- ended up that patient didn't have an MI (heart attack- or "myocardial infarction," an "infarct" being an area of dead tissue due to lack of oxygen). And then another patient had Atrial Fibrulation alternating with Sinus Tachycardia. It was a chance for me to be the EMT on the floor; when the docs said, "get oxygen tubing" I already had it and the christmas tree (the attachment that allows us to connect tubing to oxygen). I also ended up printing out the ECGs for them. Yay! That was exciting.

Also firsts, some not so good: first long-term patient death. Sigh. Remember, yes, my info is changed due to HIPAA, so I don't always get to tell you everything that's happened. I will say this, the patient's room always smelled wonderful, due to aromatherapy, and I loved being in that room, regardless of how good or bad the day was for him. I took care of this patient about 3 days. He was waiting for a miracle, was young, needed more than one organ. He died waiting in the ICU from a massive internal bleed. His platelets were always low, and the clotting factors were always at critical values. And there were reasons for that, but it doesn't make it any less sad.
I haven't cried yet. I need to share this info with another MEPN who cared for him even more intensively than I did. The info I'm giving you, public, is different than what really happened, but it affects me nonetheless. I spent last Friday thinking about this person and remembering interacting with his family.
My heart felt heavy.
It's different, you know, when it's someone you've met briefly, than when it's someone you've helped out with on a day-to-day basis. Someone you've advocated for, watched the doctors go in and talk to, watched the discussion by the teams as to whether they're going to get what they need or not.

I started my first IV, a 20G on someone who's a "hard stick" and I nailed it. Proud? No: Glowing. I hate needles, and I faint when people come near me with them, so I'm uber aware of how I treat people with them, and I'm all about being a phlebotomy pro. I always used to get the hard sticks at Planned Parenthood, and now I feel like I did well with someone in the acute care setting, and I'm willing to go further.

A MEPN saved someone's life last week. She noticed a fever, and essentially caught early sepsis on someone. It wasn't someone who had had a ton of patient care experience; she was just very observant and very dedicated. And she's smart.
One small light, a small flickering flame that glows just enough for one person to see can change the world.
I hope that if I ever get sick I'm lucky enough to have this person as my nurse. She's awesome.

It's that time of year when we're getting sick, sore throats, tired - even though our schedule has eased up. Our first test is tomorrow.
MEPN is tough. Many of us have gained weight, lost partners, lost sleep.
There's a lot I'm editing, but more will come to light later, when I'm done with this program.

For now, it's all about the basics, the day to day stuff, the hopeful living and breathing and learning that we all do together.

For you applicants, think about nursing, and imagine yourself with someone at they're most vulnerable moments. Yeah, you'll hear a lot of jokes about "wiping ass," - which incidentally I do a lot- but think about being with someone when they're vulnerable and need that help. What an honor it is.
If you can't see it as an honor to be with someone when they're so sick they can barely take care of themselves, then this pathway is not for you.
If you feel that you have enough love for the entire world, with a little left over for yourself at the end of the day, then by all means, walk through the fire and do it, because it's worth it.
What a fucking honor. Every day.
The light in me honors the light in you. Namaste.
Whatever your reason is, let is shine forth in your essay, and best of luck.

A Vignette.

I think today my emotions are catching up with me. I was completely devoid of any feeling until I decided to go work out, and while on the elliptical, after being up since 5am, a Genesis song came on- "Follow You, Follow Me."
The tears started coming. Just waves of tears, which kept coming until the woman on the machine next to me startled me by asking if my workout always counted backwards from 60 minutes. Startled, I choked out an answer, "Um, I don't know- I was off in la-la land. Sorry."

Thankfully the workout was almost done.
And when I got home, the tears started running down my face again.

Today was relatively easy, as far as patient care goes, at least I thought.

This vignette has been haunting me (stuff is changed so that I don't violate HIPAA):

The nurse I'm shadowing and I are in a patient's room. Yesterday we've determined that although he understands some English, when it comes to medical procedures and medicine in general, Spanish is the best language to communicate in. He's lived in the US quite some time, very kind, mild mannered, and he is very sick with an organ failure and transplant rejection. He's having problems- including a very high fever, and they don't know why, although it might be due to a bacterial colonization of his rejected organ.

A team of docs is rounding. One doctor approaches him, the others stand back, watching him like he's in a Holiday window scene. Nobody touches him, yet everyone's eyes are focused through an invisible divider. He sits at the edge of his hospital bed, mellow, calm, quiet - either too sick to care, or simply peaceful. I am curious about the physician's process, and I immediately realize how intimidating and how isolating this approach must make him feel. One doctor begins to give a history on him, the basics that healthcare providers are taught to do. Someone in the back pipes up, "Um, he speaks Spanish" (the day before a physician had just spoken English to him very slowly and loudly, as though he would instantly learn a new language if she could just increase the volume- if that we're true, I'd have Cantonese down pat by now). The doc starts over, begins to speak decent Spanish, interjecting English here and there when she doesn't know a word. I softly ask, "Entiende?" (Do you understand, sir?), to which he replies, "no," and I explain what they're saying, quietly. My heart aches.

All the while, the other doctors scribble busily. Their heads are close together, and they're bent over their charts in Gumby-like positions, looking up at each other. One of them is flipping through the chart madly, searching for test results. I'm reminded of the scene in "Alice In Wonderland" when the scribes in the Queen's court keep repeating "That's very important..."
".....`What do you know about this business?' the King said to
Alice.

`Nothing,' said Alice.

`Nothing WHATEVER?' persisted the King.

`Nothing whatever,' said Alice.

`That's very important,' the King said, turning to the jury.
They were just beginning to write this down on their slates, when
the White Rabbit interrupted: `UNimportant, your Majesty means,
of course,' he said in a very respectful tone, but frowning and
making faces at him as he spoke.

`UNimportant, of course, I meant,' the King hastily said, and
went on to himself in an undertone, `important--unimportant--
unimportant--important--' as if he were trying which word
sounded best.

Some of the jury wrote it down `important,' and some
`unimportant.' Alice could see this, as she was near enough to
look over their slates; `but it doesn't matter a bit,' she
thought to herself....."

Has he had this test? Why not? Who missed that? Why has he had this problem for this long? What's going on? Why are the results not faxed? We need to order this test!
I ask him about the particular test. He states it's been done. More than once. He'll do it again he says, shrugging his shoulders. It's not a test I'd do again. Even the physician says, "Once is enough for anyone. And you've done it more than once." A glimmer of humanity and humor shows through, eases the tension.

More fervent scribbling, heads down, focused on the papers, no touching, no smiles, just serious business.
It's comical. It's tragic. I stifle a laugh, because I honestly cannot believe how dehumanizing this process is at this point. Deep breath.

Outcome: An antibiotic changes. The group leaves. A passing good-bye from one physician to the patient. They bustle out the door to review the next person's medical history, which I know will teach the new residents a lot, and make them very good at what they do.
My focus now is to get good at what I'll be doing.

His nurse and I exchange glances. We leave the room and don't even have to say what's on our minds. As we're walking down the hall, she breathes, "Sometimes, it's kind of a circus." My chest feels heavy suddenly, and I don't know why.

Don't get me wrong- the physicians are AWESOME. They are highly intelligent, respected, and amazing at what they do. They work extremely hard, and provide excellent care. But sometimes, it seems like the teaching process can be incredibly dehumanizing. I know that bedside manner is being taught more in medical school, but if nothing else, that experience today was a stark reminder of how distant medicine and science can be.
And how frightening- Imagine being so sick in a country where you spoke most of the language, but when it comes to medical procedures, things get difficult to understand. Part of me wonders how often we think of this fact. His nurse and I discuss this point of view extensively, and check on him more often. He's not feeling very good today, and we both know that.

Two hours later, this man has a fever of 103F, and his respirations are alarmingly high. Is it the fever? If so, what's causing the fever? Is he septic?

One of the doctors, a newer MD, very friendly, told me yesterday that many of the patients die of DIC. When I ask what that is, she explains, "Disseminated intravascular Coagulation. It's horrible. Basically, they go septic, clot internally and die. Not much we can do about it."

I can't stop thinking about it. I don't see this patient getting better, not in his condition, but I'm not the provider- I'm just a student.

He tries to eat lunch, but barely puts anything away.
When I leave, he's sleeping.

And now I'm at home, trying to study, and completely unnerved. Welcome to my first reality check.

It makes me even more determined to be the best nurse I can be, and subsequently, the best provider.
And the tears are still coming.