I am an Registered Nurse. It’s more than that though. It’s part of who I am.
So because it’s Nurse’s Week I’ll start like this…
I graduated with a BSN in 1996. Before I became an RN I was a flight medic in the USAFR and worked as a CNA. I grew up knowing I wanted to be a nurse. I waffled with being a teacher at few times but regardless, A professional caregiver.
I’m pretty sure I’ve just always know my purpose in life was and is to be a caregiver. I’m the oldest and only girl with a brother, a step-brother and a long lost-half brother. I’ve always taken care of people. I love what I do professionally. Truly. But it does wear on me. I’ve always been a more “heightened and aware.” And I’m a worrier. Toss in what I know And do because of my role of mother, wife, daughter, sister, friend, colleague and sometimes it feels like too much caring.
I’ve worked in multiple work settings and specialities. I’ve worked in level one trauma rooms and seen combat trauma. That’s only to say that I’ve seen a lot of blood and guts. I’m not too squeamish. I’m a pretty tough nut, most of the time… But every nut cracks.
For the past 4 years I have worked in Home Hospice Care. Last night I was on call. I went to bed early, feeling edgy and irritable. About 1:30 a.m. My work phone rang, from the answering service.
I got up and synced the patient’s chart and returned the call, to the oldest son of the 64 year-old patient.
I was familiar with the patient and aware that he was “actively dying,” which generally means hours a day.
The patient was having difficulty breathing and having pain. He’d given everything he could for medications. I instructed him to give 10 mg of morphine. I told him he could repeat that in 15 minutes, “if your dad is still in distress.” Our call ended so I could call the doctor to get orders his meds liberalized. It was 1:59 a.m.
Anticipating a visit I went and got dressed, then brewed a k cup in my favorite to-go mug.
I sat down to read the patient’s chart while I waited for the doctor to return my call.
After 30 minutes passed, I had the doctor paged again.
About 15 minutes later I received another call from Josh, the night shifter at the answering service, has been forever. He and I exchange friendly banter and he pokes fun at having to waking me up, from years of professional familiarity.
He also happens to be person trying to reach the doctor for me.
“Hey, I got another one for you.”
And I still haven’t heard from Dr. N., I playfully responded.
“You may not have to. This message is regarding the same patient, this time from “Bernie.”
I knew this was his wife.
The message is: “She was calling to report his death at 2:20.”
“Wow, that was really quick. Thank God.” I said, not completely, surprised, but feeling a sense of empathy and urgency reach out to this new widow.
Adrenaline starts to flow.
His chart told me that 24 days, he was diagnosed with “aggressive” metastatic pancreatic cancer.
That just six weeks ago he had a routine scheduled surgery. His pre-op work up and exams were normal, down a few pounds. At his post-op appointment 2 weeks later, they noted a significant weight loss. Concerning, he was sent for lab work, and then further non-invasive diagnostics. His prognosis was grave… 3-4 weeks. He lived just 24 days. Dr was pretty spot on with him.
Prior to this diagnosis he lived a reasonably health life and managed quite well, but was disabled. I learned while was there that he and Bernie were married for 25 years, this past August.together for 30. That their family was blended, with 5 between them; 4 sons and a daughter. “Lots of grandkids.” I wondered about the details of their courtship. Wondered if he ever cheated.
I learned that Greg Jr, their oldest son was here from North Carolina. The other 4 are local. He came home for the family meeting that was requested by his parents. They gathered together with their 5 kids told them the grave prognosis.
I learned that Greg Jr’s oldest child, almost 14, is battling leukemia after a 3 year remission, but has had it since he was 2 years old.
Josh told me that he had called the doctor on her personal number, but wasn’t able reach her.
“I guess I don’t need to reach her for orders now. But when you reach her please give the message the Patient died at 2:20.”
“Will do. Good-night”
“Thanks, I said. Night.”
I packed up and punched in Bernie’s address in my GPS. 9.3 miles. 23 minutes.
On my drive over, I calculated how much sleep I got…I’d only been asleep for a couple of hours, and it was restless. We went to bed early to watch a video that’s part of Day 1 Bootcamp. We watched 2 quick videos taking less than 10 minutes, then started a 20 min video.. I made a few comments, my husband per usual remained silent. I could hear him breathing… Then he started snoring.
I arrived and was greeted on the porch by Greg Jr. I walked in the front door to a living room, where the hospital bed was set up for the patient. Bernie was sitting in a recliner beside the bed. She was tearful and tried to get up as I came in. I noticed that someone had covered the patient, including his face, with several blankets. Unusual, I thought. I scanned the room and the faces as I made and accepted introductions.
The walls and their tears told a thousand stories. All stories you and I know or have heard, or can at least relate to.
Greg Jr followed me in and proceeded to apologize that the patient was in “this condition” but he and his brothers cleaned him up “as best they could” but just couldn’t do it anymore. He explained that nobody wanted to see him like that so they covered him with the blankets.
My wise and colorful imagination quickly drew an image, as I pulled down the covers to check his pulse. There was no need. He was clearly dead. That image is captured in my mind. Horrified. I was appalled that the family had to see their beloved man exit such a beautiful life in such a gory style. Not his choice I promise you. Nobody would want their loved one or themselves to go in such gory exit plan.
Not appalled at anyone or anything, because nothing could have changed this situation. He was home were he and his family agreed he would die. He was offered hospitalization yesterday as it became evident that death was near. That he had transitioned. They all lovingly declined, agreeing to maintain his wishes to die in his home. They loved and cared for him thru his last breath. Pam S. His hospice case manager was spot on with her assessment, care and teaching yesterday during her extended visit. Exceeding the standards of care for comfort measures only.
I was there within 2 hours of their first call. Still hadn’t heard from the doctor. But Greg Jr gave him the morphine as I instructed and before I talked with the Doctor, who I have now assumed sleeps soundly. The patient did die as comfortably as we could reasonably keep him and by his wishes to die at home. So really she wasn’t there for me, but it wouldn’t have made any difference in the outcome. Shit was happening. All the right things were done, exceedingly well even. It just sucks that they had to see him like that. I wish I could take that away for them.
I’ve thought a lot about this family since getting home this morning. I think now I would tell Greg jr to pour the whole bottle of morphine down his throat and then ask everyone to quietly leave the room and close the door. Suggest that the scene is going to be graphic and gruesome and there’s no need to bear witness. That He really wouldn’t want you to see him that way. Even if I did Though, they probably wouldn’t have left him.
So all the choices were made correctly to meet everyone’s goals, right? So in essence, it’s a perfect case scenario. Any data collection done from my charting will indicate that. And from an objective view point I know that it went smoothly. His story from diagnosis until death, although tragic went exactly as they planned. The end.
They even had a party for him last week, to celebrate his life. They pulled together quite a shindig from the stories they shared, but what stood out for me most was that they invited 35 people, but 100 showed up. Bringing more stories and memories, and assorted foods to share. That means something, right? It speaks volumes to me. This man leaves a great legacy. His story is done and but it hasn’t ended.
Much like I feel about my marriage. Its done, but the story hasn’t ended. We are just now really starting to write the next chapter. At a preschool pace.
Doctor called me as I pulled in my driveway. Apologized and explained that she was sound asleep and proceeded to explain that I should have called her again and again. Until I reached her. I listened and thought it wouldn’t make a difference. I offered no argument after she said, “I only got one call.” That was a lie. Our call ended without any flair or flavor.
Now I wish I could tell her that it’s not my job to wake her up. But anyways, done with her.
I gathered my things and dropped them as I walked in, the kids just stating to stir for school. I went to my bathroom stripped my cloths and got into the hot shower. I wanted to wash away the smell of blood that was stuck in my nostrils and rid my mouth of the metallic taste. I did not have any exposure to blood, it was just that bad…
i wrapped a towel around me and headed to dress as my husband came out of the room. He greeted me with a kiss and commented that it was odd I showered early. He continued on to get his coffee and start his day in the kitchen.
I dressed and got the kids out the door.. Did my charting and poked away at this post all morning, all the while writing a draft and outline for a new Standard of Care, for a future situation like I’ve been telling about. Really that’s all I can do. Right? Make a better plan than we already have, I see the things we could have done better now, in hindsight. Or maybe now I know what more to anticipate.
It took a while for my husband to recognize that I was upset. He didn’t even ask if I’d “made a visit” but acknowledged that I showered early. I Told him a made a death visit. I tried to share what happened. But he wasn’t really listening. It was running late. He had to get going for work. I’m too tired right now to contemplate that one right now. Maybe I just take things to personal?
Then, after he kissed me good-bye, said we exchanged “I love you’s,” he was smiling as he was rushing out the door.
It overwhelmed me again. I just don’t think he gets it…
And wonder who’s going to take care of me?
This has been a long shitty day after a shitty evening. Which ended when he fell asleep, during a 20 minute affair recovery video.
So I’m done poking away on my iPad. My wrists hurt. I’m exhausted and have smoked too much today. I’m nursing a quick beer and going to bed.
I am the only one able to take care of me and I’m not doing a great job these days. I’m going to make a daily effort to ask for help and make my needs more clear.
Right now my most basic need is sleep.
I talked to my husband. Told him I need to go to bed. That I’ve not been asleep yet. I’m Working on close to 40 hours with little sleep.
I’ll talk with him about falling asleep last night and how it has left me feeling. Maybe after some sleep it won’t matter as much.
I’m going to run this thru spell check and try not to edit so I can get it posted and close this day.
Gonna enjoy this cold Rolling Rock on what finally feels like spring!
Cheers, Greg Sr. I suspect you lived a bold and beautiful life!