So much to do...the time is coming too soon.

So I just downloaded picture off my camera, and they date clear back to the first of the year....  How can that be.  That means I haven't really blogged anything in the present time in months.  Sad sad news.

And really there is so much other things I should be doing now, like PACKING!! But the plan is to get some boxes this afternoon and then maybe I can get started with that one.   The other thing I have on my planner today is that my coworkers are through us a Going Away party!  Isn't that so nice.  They are like my family away from family.  They were the ones that threw my baby shower and spoil me like crazy.  I'm really going to miss them so much. I've made some really great friends here, and I hope that they take the opportunity to come stay with us for a vacation sometime.

As the time has gotten closer for us to move, I have been really much more sad than I had ever thought that I'd be.  I mean really Chad is done with school and I no longer have to be the main breadwinner.  I thought I'd be jumping up and down.  But I realize that I'm going to have to find another job, and I can't even imagine finding the great friends and work environment that I've found at Pullman Regional Hospital.  And the customer service is always great!  I'm so proud to be a part of it.  The staffing is ideal and I'm not sure there are other facilities that are as dedicated to customers instead of making a profit as they are.

I was able to do my year evaluation with my boss the other day, and she was so encouraging to me.  She was told that me that I'd be able to survive just fine in a bigger ICU, where I'll be having a phone interview next week.  It makes me nervous.  So say some prayers for me please.

But with all of this said.  Chad and I are really excited to starting this part of our journey...(and realize that we should have been even tighter on our budget and not have had as many student loans).  Isn't that always the way it goes though.  You don't realize until when you have to start paying them back how much there is to pay.  But it'll be nice that I can get a job also and just focus on the loans and pay them off faster. The other thing that we're loving already is the housing market and cost of living being more what we're used to.  Just waiting for all our financing to go through for the house that we found and have negotiated on.  So again pray that I get hired for the job, so that for sure we can get our loan!!  Yeah I don't have an ulcer from worrying about this at all.  I'm just extremely happy (blessed) to have our house in Pullman all set to close on the 14th of May.  Now just to go start packing.

The man that exploded!

So there is so much for me to catch up on blogging about, but I figure I need to write about my experience last weekend at work before I forget all the details.

So on Saturday I had to work which means I was 37.5 weeks along in my pregnancy. I was having a steady morning with a discharge order for one of patient right at the start of the shift. I usually am pretty fast about getting all the paperwork done and really did jump on it fast and let my patient know when a good time a right could come pick her up. I though everything was under control and so I sent the other nurse in the unit I work in to eat some breakfast since one of her patients was just taken to surgery. So I'd really not have many patients I needed to watch (3). Well that what I thought.

So shortly after I sent Cindy to eat breakfast, my other patient(who had his bladder removed due to bladder cancer and had a illeostomy) called complaining of not feeling well. (He was trying solid food for the first time that morning since surgery) So I thought, we just pushed this a little fast, it was scrambled eggs though. So usually a nice soft food to start out with is great, but I pulled back his table and saw some drainage on his gown. So I thought I better investigate....So I pulled back his gown to see a full JP (Jackson Pratt) drain. (Basically it's a depressed bulb hooked to a tube inside his stomach area to drain out blood and other stuff out of the surgery area). So I went and got the container to empty the drain and when I popped open the little tab to empty it..It started spouting out!! I was so surprised. I hadn't had that happen in all my years of nursing. I even told him, "I haven't had that happen to me in the 8.5 years I've been a nurse." I also noticed that his other dressings had more drainage on them than they had earlier. I figured I better go double check what I had for an order to either change the dressing or reinforce them. My patient then started telling me that his abdomen really was hurting!!! I could tell because he was getting up pacing the room because it hurt more to sit or lay down!! He has a history of asthma and had been having quite a strong cough, which is a good thing to do after surgery to move air throughout the lungs and avoid getting pneumonia, but I kept telling him it wouldn't hurt as bad if he'd take a pillow and squeeze it against his stomach as he coughed. Well I hadn't had very good luck getting him to do that all morning.

Well off I went to find this man some pain med... I knew he was horribly uncomfortable. So I got the rest of his morning meds with them, cause he was running a high blood pressure and should probably get his blood pressure meds, right. Well after giving him the Demerol he stood back up and was starting to pace a little as I was preparing and scanning the rest of his meds, when he told me he was going to be sick. (BTW, I never like any patient telling me that) So I jumped to the closet where we have basins and dumped whatever the rest of the contents were out and rushed to get this basin to him. As he turned around on the other side of the bed to grab the basin, I heard this POP POP SquiSH!! and simultaneously saw his gown ballooned up to rival the pregnant woman that I've become!!

At that point I realized a few things: 1. I had a pretty good idea what had just happened. 2. I didn't have anyone in the unit that I could yell for. 3. I hadn't put on my Vocera badge that I usual put on every morning that makes me connected to the rest of the employees in the hospital. 4. I had to get some help some how and take care of my patient!!

So I had the patient lay down on the bed, cause he was still talking and being coherent!! And I used his phone to call the Clinical Coordinator (House Supervisor). So she got there shortly after I pulled back my patients gown and saw intestines peeking out from under the dressing that used to be taped on all 4 sides!! Wow I really hadn't seen that one coming from the my first clues, and I sure didn't think that anything that drastic would happen before I could get his pain under control and take a look at the dressing myself.

I'm just amazed at the team work that comes from working in this little hospital as I had the hospitalist at the bedside and he never left, and two nurses(Cindy and Nikki) assisting me at the bedside while the Clinical Coordinator (Sandy M) contacted the surgeon on call and a 2nd OR crew to come do surgery. It ran very smoothly and patient did well and maintained that high blood pressure clear through. (I never thought I'd be so happy to see someone hypertensive.) Within about 40 minutes we had him intubated and sedated/paralyzed, while the surgeon came and placed his intestines back in in abdominal cavity for transport to the OR, where he under went a major antibiotic washing and they remade his illeal conduit too (the first one was looking a little dusky in color). I was amazed though to see the intestines and how they were filled with air and fluid and that I could see some of the fluid in the intestine as the surgeon placed them back in the abdomen. (Sorry if that grosses anyone out.)

Later I asked the hospitalist and the surgeon how many times they had seen this happen and each of them had said about 3-5 times in their careers. One is a retired gentleman that just does on call surgeries for us and was in the army (I think). The hospitalist had seen most of his in his residency.

So far the outcome is good and my friend is on the recovery. He was extubated on Monday and he took a few steps at the bedside yesterday!! We've come to be good friends and he told me that I needed to be his nurse everyday. "If I've got to be in here, so do you!" he says. Well he gave him self the name of the exploding man (and okayed me writing this blog) as I talked to him about the thoughts that he had as this happened to him. I felt bad, cause I can imagine that would be the worst nightmare to have to live through and then have to live through the increased pain that comes with another major surgery in such a short time frame.

Recently I've had some really sick patients come my way and people have started labeling me as a problem child or a poop magnet. But I'm so excited that with the last 3 ventilated patients that I've helped take care of...they all got better. Well the other 2 have gone home and this one is on the mend.

This was definitely not what I expected to have happen to me coming to work on Saturday, but what an interesting experience I won't be forgetting anytime soon!!! I hope I didn't gross anyone out. I just wanted to keep some of the details for my memory sake, cause hopefully I don't have to see that again.

Pompe's disease

It's been interesting today as I've been at work, I was able to take care of several patients that were outpatients. For those of you that aren't in the medical ring, these are patient that either have a minor surgery/procedure or infusion and then go home in the same day.

Well I had two infusion patients today that had enzyme replacements. One patient has Pompe's disease and has know since about 1997. This patient comes in every 2 weeks for about 5 hours of an infusion of an enzyme replacement therapy that is thought(still in research stages) to at least decrease the difficulties with Pompe's. (People with disease, have difficulty breathing and their muscle deteriorate and so it make them difficult to move around from place to place and some even have electric wheelchairs, if the disease isn't caught and treated.) But the patient still feels like his health is declining slightly, but doesn't dare stop the study because of how fast the decline
would be if he did. I didn't mention that the infusions cost about per infusion $30,000. And they get infused every 2 weeks, $60,000 a month, over $720,000 a year. Can you imagine!!! Crazy and the study doesn't pay for those infusion either!! Thank heaven for insurance!!

Well this patient helped me to learn all about this disease process, cause I haven't seen anyone with it and haven't studied about it since nursing school, but here at Pullman Regional, we are willing to participate with the study of the drug and the paperwork involved. People from several hours away will travel here to get the infusion, cause more local hospitals won't participate in the study and do the necessary work.

But it was interesting to hear from the patient about how there are lots of disease processes that have similar signs and symptoms that Pompe's does, So any of the muscular dystrophies, or even MS, have been found to be misdiagnosis at first. He even told me that infants that die of SIDS may have Pompe's too, cause of the difficulty breathing symptoms. Amazing! I had no idea, but after talking with the person, it make perfect possible sense. Not that I'm 100% convinced that all of these disease processes are really Pompe's. And all it takes to screen is a simple blood test. Now my friend Jade (HEY!!) just had an interesting post about what can possibly happen with blood draws from an experience with her husband. Sorry Ben!! But it's something to think about, and he asked me if I was going to have my baby tested. Gave me lots to think about, and for sure I'm going to ask the Dr. about it on Thursday!!

Hard decisions

So I've been meaning to write something on my blog for a few weeks about an interesting experience that I had at work. I really love my job. Even though Chad could be surprised to hear that. Cause I tend to complain about all the bad at the time when I get home after my 12 hour shifts.

But to understand the situation, I have to go back to when I was in nursing school. Most of you know that I went to Rick College for nursing school, which was one of the greatest blessings in my life. Not only did I get accepted to such a great nursing program, but I was able to be taught about the spiritual side of healing as well. In class we were always bombarded with the idea of nurses becoming an "advocate" for patients. This is kind of an interesting idea, cause I had never really heard this term, except in reference to our Savior being an advocate for us with the Father. Which in turn makes nurses pretty amazing by comparison.

So in my career there have been a few instances when I have felt a challenge sometimes to be able to become an advocate for a patient, whether is was just to motivate myself to do everything I knew the patient needed from me, when I was busy to making sure the patient and family have all the questions answered about up coming procedures or treatments.

So not too long ago I was able to care for a patient that was in the hospital with liver cirrhosis. This man was very sick and had severe ascites (fluid that builds up in abdominal cavity). I have taken care of a few patients in my career that have had similar severity of ascites and am very sad to say that they don't end up living very long or having much quality of life. This guy had recently had a paracentesis (using a needle to drain the fluid from the abdominal cavity) where they took of about 3 liters of fluid a few months prior to this admission to the hospital. Doctors do this to make the patient more comfortable. This helps the patients because it allows them to breath easier. Eventually the fluid comes back though. This is exactly what had happened to this man. He had eventually got sicker and sicker until he didn't want to eat any more at home and difficulty breathing and ended up with pneumonia.

It was a very long stay for this patient the their family. The patient's nutrition had been poor for so long that he would get bed sores on any area he layed on for more than 1 hour. It was a struggle for our nursing staff to even change the patient's position enough to try to avoid getting more bedsores, let alone to get them to heal. The patient finally got a short term feeding tube that went down his nose into his stomache. This helped alot with his strength, but the patient just wasn't getting better over all.

The most difficult part was that the wife and daughter really wanted to take the patient home after this stay. I really felt like this was not a realistic expectation. But after many conversations with the family I realized that the Doctor had not given them any reason to think that the patient wouldn't get better.
I know that several nurses had talked to them about a Do Not Resuscitate order. This is where when a person's heart and respirations stop, we let them pass on without using CPR and other medical interventions to bring them back. These allow someone to die with dignity and not the disaster that seems to happen when you bring someone back that has no quality of life to begin with. It was very appropriate for this man, which all the nursing staff could see would never have quality life again.

After a couple weeks the doctor finally told the wife that they needed to look into nursing home placement. This was a very internal struggle for her because her husband had said that he never wanted to go to a nursing home. Because he had said this, the daughter was totally against it and was determined to come help care for him at home. (Also the daughter didn't want us or the wife to discuss any of the test results or treatments in the room around the patient, because she thought he would give up if he knew the prognosis. This was totally not appropriate in my opinion) But I feel like the wife was more realistic about the matter. I felt even going to a nursing home was suicide too. Even us at the hospital with all the staff, we couldn't keep his skin from breaking down. I know that nursing homes don't have as great of staffing ratios as we do. The other things is that this man was 6 foot 3 inches tall, and even though he was emaciated, he still weighed a lot. I just couldn't see this daughter and wife even moving him in a hospital bed that helps some.

So with all this happening I felt like the doctor was not being straight forward with the family. What kind of outlook had he let them have? When I called to get a better idea what he thought the outlook would be, I realized that he even had a very unrealistic idea and didn't even mention the fact that he'd probably die from the liver failure.

So then I had to make a decision do I just stand by what the doctor says, or do I really tell this family what is most likely to happen....
Kind of an ethical decision. I didn't want to undermine the doctors education and say that I knew better, but I didn't think he was being realistic or up front with this family. It was so hard.

I ended up talking with the wife about exactly what the doctor had said could happen, and then ended telling her that my experiences with liver failure never turned out as good as the doctor was stating. I encouraged her to help us take care of the patient to get an idea of what would be demanded of them once the patient was at home. She was very overwhelmed with the repositioning and the flushing of the feeding tube and using the pump for the feeding tube. Really it would be overwhelming for most people. I felt that the wife was being realistic and decided that the nursing home would be the best bet. But then she had to deal with the daughter who felt that she wasn't making the right choice. What a struggle for this family. Something that really wretched at my heart strings. That night I went home and cried as I shared some of the emotion I was feeling dealing with all of these issues.

The craziest part of all of this is that I was there the day they transferred this man to the nursing home and I really felt like this was the best decision. But then I heard that the next day this man died. Things like this happen and make me wonder if I had done the right thing. What a hard thing. I thank heaven that I don't have to deal with this every day of my life.. But even though I do.. I get the opportunity to help patients and their family through some very big life changing events so better than others. It also makes me thankful for religious beliefs that help to have peace with the big decisions of life and death.