1. every time i think i've seen one of the worst things that i've ever seen, i see something else awful.
last week i was taking care of a young guy with a bunch of kids and awful head and neck cancer that was literally rotting away at him. it was truly one of the worst things that i've ever seen (see above), and i can't imagine a more painful and scary way to die. all that i could do was try to make him comfortable and pray that he would decide to become a DNR before he coded. the cancer was dangerously close to his carotid artery, and one day i walked in and he was spraying blood out of the side of his neck. i grabbed him to put pressure on the wound, which was excruciatingly painful for him. i think he could tell that things were really bad, and at this point he was trached and couldn't talk. he grabbed his little white board and started to write. at first i thought he was trying to tell me something, but then i realized that he was actually writing a goodbye letter to his wife. i can't even describe the emotions that i felt in that moment. it was sacred and terrible, and i thought for sure that he was dying. but wouldn't you know, i lifted my hand and the bleeding had stopped. the patient got to spend 6 more days with his family before he finally died. he had me copy his letter to his wife, and on the day where he slowly slipped into unresponsiveness, i gave it to her.
i keep finding myself intertwined into the most important moments of people's stories. on one hand it's a privilege, on the other a burden.
2. make a power of attorney. have everyone you know make a power of attorney. after the first month in the ICU, i found myself telling all of my friends, coworkers, and families to never let me become a trached and PEGed TBI. seriously. you can intubate me, but no trach and no PEG. i would literally rather be dead.
this week i got my first emergent transfer from the floor, a 90+ year old in a halo in respiratory with periods of apnea lasting up to 30 seconds. a full code. what started out as a fairly stable situation quickly deteriorated into an emergency fiberoptic intubation with anesthesia, and me giving poor grandpa 1 chest compression before someone finally found a thready pulse (courtesy of his pacemaker).
DO NOT DO THIS TO THE ELDERLY PEOPLE IN YOUR LIFE.
and do not make nurses commit elder abuse in the form of CPR and other forms of life-saving assault. it's just barbaric.
3. teamwork is the only thing that allows people to survive in this hostile environment. every single person in the ICU has been kind to me. they've said encouraging things, they've answered my questions, and they've jumped in to help me when someone is trying to die. i gave up the best team in the world, and i think that i may have found one just as supportive.
4. you HAVE to find the humor wherever you can, or you will go completely crazy.
in the spirit of teamwork, when an admission comes in everyone jumps in to help. nasal swab, finger stick, temperature, bath...boom boom boom. we got a patient a few days ago who had broken into a restaurant and went about cooking himself up some food, namely a few steaks. the owner came in and caught him, a fight ensued, and the patient got stabbed in the chest. he walked himself to a local hospital and told them his chest hurt, however failed to mention the stabbing. he was immediately transferred to us, where he proceeded to refuse surgery. he rolled up to the ICU, where i decided to be helpful and catalog his belongings. i recorded a couple of bags of clothes, and then came to a heavy plastic bag full of brown goo. upon opening the bag, i realized it was a to-go box of food.
it was the steaks.
and it that moment, i had the once in a lifetime opportunity of recording "bag of meat" in the patient belongings list.
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this has not been easy for me, but there's something rewarding in challenging yourself and realizing that you're capable of hard things. 12 weeks down, 2 to go.
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