Frailty of Life

So....I really want to blog about the experience I had this morning in a code. An experience so bad that it left me questioning if I want to stay in this world I have lived in for several years: The World of Medicine. A 36-year-old female with breast cancer suffering from complications from a lymphectomy. There were those of us on the ICU team that had been working on her for hours before one of us hit the blue button that would signal the hospital switchboard operator to make the overhead call of "Code Blue", then there was the general crowd that shows up when the code is called. Those of us that knew the story tried to resuscitate the young woman with faces that were streaked with tears. One of my colleagues came to check and see if I needed any help, and saw that I was crying, so he offered to relieve me. Her mother was already there, but we kept her alive until the "rest of her family" got there. When we realized our efforts were futile, the Nursing Supervisor went to get her family. Allowing the family at a resuscitation attempt is kind of controversial. Is it cruel? But studies have shown that families deal better when they see the effort we are putting in to save their loved one. So while I hate it because it does not always allow me the mental distance from the situation, if it helps them, so be it. But nothing prepared me for this. Her weeping husband. And her nine-year-old daughter who was wailing in pain and anguish. I tried to count the number of ceiling tiles in the room. I inspected my shoes. I didn't have to look. By now, my hands hold within them the rhythym of breathing and I can deliver breaths at a steady pulse while intentionally not looking. But this time that didn't stop the tears. This time it was my family I was seeing, no matter where my eyes tried to focus.

I could not get John's face out of my head. Or Evan's voice. My reasons for living. And undoubtably, the husband and daughter were hers. They were robbed by the intricacies and the mysteries of the human body. And like us, I am sure they had plans for their future. The husband had been out of town, and didn't know that he would never see his wife again. I still cannot get the image of his pained, tear-streaked face pressed to her cold, pale, lifeless one. The picture serving as a study in the contrast between death and life. And her death proved something to us all. She was in the MICU, the unit of the hospital to which I have been assigned for going on the past 2 months now. Our MICU is new. State-of-the-art facility and equipment. Staffed with the A-team of the medical world. Even we therapists are a select few. We are all oriented to the unit, but non-hackers weed themselves out. But this morning, nothing we had to offer could have been enough for her. Which is scarier than you could imagine, because it humbles all of us. It shows us that we cannot fix everything with almost unnecessary cruelty. And while we are all there, working our demanding schedules to pay for kids' tuitions or the new family minivan or the plasma tv that society tells us we need, we are forced to face the idea that we are away from the very ones we are doing it all for. That life is frail, and would it be better to be at home, snuggled in bed with our spouses or waking in the morning to sloppy kisses from our young children. Because as we were witnessing at that very moment, life could have other plans for us.

Guilt and Sadness

Before I know it, Summer will be gone. Evan will be back in school. And starting tomorrow night, I am back to the grind. By the time I get off of work on Monday, it ill be time to head to another quarter of classes. And at the end of the Summer, this baby of mine will be 8 years old. I know I will not be getting a break until we are both off for Christmas.

I look at those brown eyes and I miss it all: the sloppy kisses and macaroni and cheese faces after dinner. The cuddling and giggling. Getting his bubble bath ready at night. Making sure he learns math. And I look at the stretch of time ahead of us and I realize that by the time I finish medical school, this little boy will be 13 years old. Is it worth it?

I had a talk with Evan just now, asking him if he wanted Mommy to go to school to be a doctor, even though it is going to take a long time. He looked at me with those big brown eyes and said yes, very emphatically. When I asked him if he would still think I was a good Mommy if I continued to be away, he said yes again. I asked him why he wanted Mommy to be a doctor, and he told me that he has the smartest mommy in the world, and he knows I can do it. So now I am sitting here at my desk typing this, amidst the crepe paper flowers and finger-painted rainbows he has given me from art class in school, and I have found out the truth.

I am so very blessed. For some reason, whatever higher power is out there has decided that I am deserving of this amazing little person in my life. How lucky could I be?

I Did A Good Job

We went to the grocery store as a family, which is usually a mistake. For the first time in a long time, little Evan was very well-behaved. When I told him no to the sugary crap because it wasn't "good for our bodies" he replied with an "Oh, okay". He helped me keep track of what we needed here at the house. Overall it was a nice experience. When we get to the checkout, he asked for a candy bar. I thought it over and said he could. Hershey bars were 2 for $1. He got 2.

Later we get home, and I have finished putting the groceries away. He comes up to me with this huge smile on his face and hands me one of the candy bars. I ask if he is sure he doesn't want to save it for another time. He shakes his little head and says, "No, Mom. This is for you because you did such a good job picking out groceries."

Endless Downloads, Cracker Crumbs, and More

OMG.

I hadn't been into my office in days. I have instead been vegging out with the laptop on the sofa, which is infinitely cooler than the office in the absence of AC.

So today, I walk into my office only to discover that my desktop on the big computer is covered with icons for those free game trials you can download online. I have spent all day getting those off of there and making the computer like Fort Knox so I won't ever have to do that again.

And Chhez-Its. All over. The carpet beneath my feet looks like a pale shade of orange because they are ground into the carpet. They are between the keys of the keyboard, in the mouse, everywhere.

The kid is now banned from the office.

Failure

Sometimes I have the autonomy to override a doctor's orders. Sometimes I do not. This weekend was an example of a time when I did not. It was also an example of the concept that just because we can do something to prolong a life doesn't always translate to we should. A lesson in medical futility and ethics. I have been assigned to the MICU for the past 6 days. The sickest patients in the hospital were once again in my care, as is happening even more frequently now.

A patient was admitted on Wednesday night, and by Thursday, it was well-known that there was nothing we could do for him. The name was familiar to all of us, but none of us could place his face. Disease had ravaged his body until there was little with which to work. I am not going into detail about the disease process or any other fact that can be used to identify this patient because I want to protect him as I am legally obligated to. But he was very, very ill. I watched as a parade of specialists for just about every body system in a human organism came and went from his room, speaking with his family.

I'm sorry. There is nothing more we can do.

We will provide him with comfort while he makes this final journey.

We will allow him to die with dignity.

I made sure he had enough oxygen, then went on to other patients of mine. Patients who were not breathing on their own, hooked to my ventilators. Not much time passed before another specialist came to see the patient. The patient, on top of everything else, had a raging infection. Sepsis. He wanted me to suction the patient, something we don't usually do for the dying patient because it is so uncomfortable for them. I asked him to explain why. His follow-up was that we were going to suction him, and then intubate. Within 15 minutes, the family wants to do everything. Put him through the medical gauntlet. The doctor seeing the patient for his infection bypassed the cardiologists, nephrologist, pulmonologists, neurologist, and oncologist. Told the family we could fix him.

My experiences with family members facing the loss of a loved one have taught me something. You must be very careful when you walk into the room of a dying patient. Because any tiny word you utter can be misconstrued as hope. Hope where there is none. And they grab onto to that like a life preserver, and hang on to it. To the layperson, this would seem like a gift to them. Instead it makes it worse. The patient passes away anyhow, after they have thought it was not going to happen. From the minute we know that death is looming, our care shifts from the patient to the ones left to live. Every action becomes about them. Making it easier for them. Never more difficult. The have enough difficulty to face.

We failed that family. We didn't do what we should have done for the patient.

We intubated. I hooked him up to the machine that would breathe for him. I stood at the bedside and cleared mucus from his chin and smoothed down his hair while the ventilator hissed and puffed behind me. In that instant, I realized who he was. One of our regulars, I would always save his breathing treatment for last because we would always end up talking about his military service and kids. Through all of his admissions, he never forgot that my son's name is Evan. He would always light up and ask me if my Evan was still driving me crazy. He always called me his "Breathing Angel" because he said I always seemed to show up in the same instant he was thinking about calling for a PRN treatment. I tried on several occasions to explain to him that it was probably due to the fact that he was due for his medication and less about me. "In fact," I would tell him, "I'm actually really mean in real life." He would always giggle and shake his head, telling me he couldn't believe it.

I almost didn't recognize him through all of the tubes and lines.

Within 5 minutes of intubating him, he tried to go into cardiac arrest. We brought him back. I heard his ribs crack during CPR.

By the time I had reported for the next day, he was on continuous dialysis. We had given him the maximum amout of medication allowed to maintain his blood pressure. Dopamine. Levophed. Vasopressin. I was no longer able to maintain any sort of oxygen saturation on him. We had to insert an arterial line in his femoral artery, in his groin. His body temperatre was 88 degrees. We had him wrapped in heated blankets and a warming system so that only his face was visible. He had a rectal tube inserted that was draining blood. 10 IV pumps going. About the only drug category we didn't have covered was sedation. Through all of it, he didn't need any.

The family still was clinging to the hope that we could fix him. Despite the fact that we told them repeatedly that it was gettting worse. They held fast to that life preserver. I left my shift praying for his death.

By the time I reported for my shift the next day, he had died on his own. It took 6 nurses and me to remove all of the lines and tubes. His body released every fluid in it. There was a piece of tissue that I assumed to be a part of his trachea that came out when I removed the endotracheal tube.

I didn't cry. Instead I hated my job. I was upset that I didn't put my foot down for him and advocate for him. I realize that even if I had, and refused to participate, they would have just called another of the therapists. This was one of those that I could not override.

I still feel like I failed my patient. I wasn't his Breathing Angel anymore.

What if Atlas Shrugged?

Considering what is going on in our world, I have been pondering this question. In Atlas Shrugged, Ayn Rand tells the story of the "Producers" of society, and the world that saps the life out of them.

Who are the producers? We are. The people who go to work every day and perform a function from which society can derive some benefit. This could be in the form of a beautiful opus that we all enjoy, a knowledge of medicine and the power to heal that comes with it, or a delicious meal that we can cook for others. Whatever the contribution, we make one. What is our thanks? We get taxed. We pay through the nose. If we put our foot down, we are "selfish". Don't we want to help our fellow man? When is enough enough?

I want to put my foot down. I want to say "No more!". I am sorry that the Jones' next door do not have health coverage. I truly am. But since when is it my responsibility to pay their bills? Did they lose their job do to the collapse of out auto industry? Well, I tried to help. They were selling their ability to make cars and I contributed to their cause by purchasing a new vehicle.

Now Obama is wanting to tax our health benefits. My gut reaction, in the face of even more taxes, is to quit. I obviously will not be doing that, but I want to. If we all did, the powers that be would have to find another way other than taking it out on the hard-working people who break their backs to make this world go round.

I think I need to revisit my old dog-eared copy.

#@$%^&*()

Obama is thinking of taxing our insurance!

Seriously? I worked 142 hours on my last paycheck, instead of the 72 hours to which I am obligated. I went without sleep for days, worked until my feet were screaming with pain. I did this to gain a little financial edge in light of the upcoming new quarter at school (in other words, new tuition bill and new set of text books to buy). Of that, Uncle Sam took over $1900. One thousand, nine hundred dollars. There are certainly people who live on less than that per month, but that is what I paid out in ONE PAYCHECK! If my insurance is taxed in addition to this, I will not be able to stand it!