Ouch

We have a coffee shop in our hospital and several weeks back I picked up my tea and headed to my unit. But on the way up I managed to hurt my neck. Couldn't tell you how.

I went home that day, goodness the pain was intense. But it gradually eased up and I went back to work after a bunch of days off. I got lucky that I had cardiac patients and it wasn't hard on my neck and got through my couple of shifts. 

This last week however, I had a typical ICU patient and managed to tweak my neck again. Goodness it hurts. I get this shocking pain down my neck, through my shoulder and down into my fingers. I know I pinched a nerve at about C6-ish. Confirmed by the ER MD. No test though, so don't really know why exactly it happened.

Regardless, I lost another day of work and had a couple more days off afterwards so I rested as much as I could - doing my physio to help myself.

But to no avail, still hurts like a mother sucker - so I let my family MD know about it and so now I'm on modified duties. Also, I need to have physio and a chiropractor would be helpful, but can't because everything is still shut down. Sad face!

Had to work last night, thankfully we had an ICU patient that didn't require any pushing/pulling,turning/lifting - a nice stable DKA for me thank you very much.

Even having a pt like this caused pain - but at least it was manageable. We'll see what this weekend holds as it's my weekend to work. So this should be interesting to say the least.

Wish me a speedy recovery.

When the will is overrun by family decisions

How does it come to be that families can make the decisions for family members in critical care, when they themselves have made it known what they would choose for their life and their death?!

When someone comes in for a fairly basic surgery (albeit an emergent one) and have a perioperative MI and when they are woken are told what has occured and that they require a cardiac catheterization - to which they decide that they would prefer to not undertake this.

The surgeon (or whoever it actually was - a MD none the less) had a frank conversation with said patient and indicated that the catheterization wasn't performed, that a major heart attack would occur.

The patient, in right mind, made the decision that they would not have this procedure performed, even if that meant that they would have a heart attack.

Then advised that they could die if this occurs, the patient indicated that that was alright and that should a heart attack occur, no CPR/defib or intubation occur. Meaning that nothing should be undertaken if a heart attack is to occur and survival not be possible.

Now the twist in this entire story is the fact that the health care person who had this conversation, and could write it down and make it official, DIDN'T WRITE AN ORDER!!! All they did was put it in their notes. Friggin idiot!

So of course this person had a massive heart attack and went into an unsurvivable cardiac rhythm (VF to VT) and they called a code and managed to get this person back.

Then of course it's family who decides what the next steps will be. Even though the family find out what the patient said to the MD, they still decide to do everything in our power to get this person through this.

Now after some time has passed, this person is basicly a vegetable - doing very little more than lying in bed and existing.

I feel for this patient - ending up in this state after indicating exactly what they don't want and because of an oversight, ended up having everything done they didn't want. Now they have to live with the consequences of this and what their family is choosing for them.

If I were them, I'd come back and haunt my family after I actually get to die. That's the least that they deserve for making me suffer as a vegetable in bed. Such a pity of a life. No quality at all.

Heart to heart

As I've indicated, I work in a combined CCU/ICU and so there are times when I have to take care of people who have heart issues as their main issue. That's what I got to take care of one shift, I started out with a completely different assignment but because of my workplace accomodation, didn't have to remain on that assignment and was traded for someone else's. I ended up with a little old lady (LOL), a 96 yr old gal who had a NSTEMI - perfectly stable thankfully. More of a watch and see. She just wanted to be medically managed and be made better. That's what she got in the end.

My other bed was empty at the beginning of the shift but I was told that I would be getting a new admit from the ER. Another NSTEMI but with an extensive cardiac history and was on chemo for some kind of cancer that metasticized elsewhere. Never a good thing. Chemo is HARD on the body I say, and of course that also takes a toll on the heart.

He was a sweet old sole. When I first met him, in the first 10 minutes became significantly unstable. I spent my entire shift on the phone calling the most responsible physician (MRP) for orders or follow up - this that and the other thing. I felt like I was calling them constantly. All for good reasons too. Turns out that ER didn't bother to tell me that this fellow had an inferior MI and the good ER docs went and ordered Nitro and morphine for my fellow. Now this is VITAL information for a person who is to take care of ppl like these. Shame on me for not asking really. I figured this type of info a person would readily share with someone else. But nope....

When I got report from the ER nurse I was advised that she had given Nitro and my fellow's chest pain (CP) had been relieved with this. So when he came to me complaining of CP again, I went and did what my previous counterpart did and give Nitro. Well if I had been told about the inferior bit I certainly wouldn't have done this! It did as expected and relieved his CP but also sent him into cardiogenic shock. So I spent the rest of my shift trying to keep him alive because of the unintended consequence of this action.

What should have happened was that they should have taken him straight to our sister hospital and figured out his heart issues and tried to help him. But they said no so we had to hold on to him until morning when the cardiologist could force sister hospital to take him. Which  happened and so I started shift two with him post transfer from sister hospital - being told that his 5 vessel CABG done almost 20 yrs ago had basically all clotted off and his heart was pooched. There wasn't anything they could do and stopped their PCI and sent him back to us.

So sad to come on shift to a sweet fellow and hear that there wasn't anything they could do for him. Kick in the pants I tell ya. So I went in to my patient, and had a frank heart to heart with him about what HE wanted. I asked him if the guys at the sister hospital had told him what they found, they did thankfully and so I asked him what he wanted out of all this. He understood that his life was in jeopardy, even if he did survive this current event. He told me that he just wanted to spend more time with his family. He was a father of three and still married. He indicated that if he could just get another month or two, that was all he wanted.

So I spent the rest of my shift, trying to make him comfortable and trying to prolong his life as best we could. I made it to the end of my shift and when I came back on he was still in my CCU. So another shift was started together.

I started this new shift in good spirits, he was requiring less heart support than when I had left and things were looking up. During the day shift I guess the Docs had a good discussion with him, after I had laid some seeds about CPR and intubation - that would he really want to pass with us pounding on an already impaired heart? That it wouldn't be a good death and he would still end up dying likely. So I was happy to see that post discussion with the Docs that he had decided a NO CPR/Dfib/Intubation for his care. I think he made the right decision, certainly for him anyways.

In the middle of the night things turned south though. Of course it all happened just as I was coming back from break He began to have ischemic events and his heart rhythm changed as did his BP - requiring more support to support it.  I called the MRP and advised them and they came to assess him. I started him again on an antirhythmic and bolused him twice, hoping that he would convert. We kept at it for several hours and he did come out of the atrial flutter into atrial fibrilation but not for long unfortunately. I let the MRP know of this and she indicated that she would have to come perform a cardioversion. I let her know that I wasn't sure his heart would survive it, given that he's so clotted everywhere and he's having ischemic events right now and going into poor rhythms - ones that really are unsustainable.

So we decided together that we would call in his family and let them be together. I had to seek out approval for this because of the pandemic and no visitors are allowed unless death is expected. And although my fellow wasn't actively dying it wasn't expected that he would survive. And who knew if he even could survive with or without the cardioversion.

I had a frank conversation with my patient again about the impact of cardioversion - how it hurts like hell (don't know it personally but professionally) and we don't even know if it will improve his chances of survival. So he asked if he could speak with the MRP to ask this. Shockingly the MRP put this task onto another Doc - saying that it should be the cardiologist who has this conversation with him. But of course I find out after the fact that the MRP who said this IS a cardiologist herself!!!! That's what happens when you're too new and don't know everyone! So when I left my final rotation shift, my patient was still on the antirhythmic and requiring a cardioversion but wanting to speak with the Dr.

I came back several days to find out that when the Docs did go and talk to him he decided to not take the cardioversion and decided that he would live out his final days with his family surrounding him. I found out that this, however, took several days to come to fruit because palliative care Docs wouldn't take responsibility until pushed to.

But at least he got to palliative care and can spend the rest of his days surrounded by his family - the way he wanted it.

How the times have changed

So I know that my last update was like 3 years ago. Feels like the time has flown. I really thought that I was going to keep up with the blog but that fell to the wayside when my life kept taking turn after turn.

I was kindly "advised that NICU isn't the place for me to do nursing" - all because my cares on teeny tiny babies was too slow. Sheesh I was learning. It's not like I did any placements in NICU but I was expected to know how to make such tiny babies eat and be fast when changing their diapers or changing their linens.

So I essentially gave up on my dream - I gave it a shot at least and came back to my family. We spent some time figuring things out. I had to work for an agency and do part time work as a RPN/LPN until my NNAS (National Nurses Assessment Service) - for them to determine whether my education and experience is enough to receive equivalency for the college in my province to give me the ability to practice as a RN. That process took about 9 months and thank the Lord that I did (I'm pretty darn lucky as far as I've heard).

Then I started working in an ER (third busiest in my province) while I was taking MORE education - my critical care certificate (CCC)... so that I would be more prepared for what I would see in the ER or IF I wanted to move to the ICU, that I would be prepared for that as well. I was planning to stay in the ER but was getting screwed over where I was. They were promoting people to the more serious area before me - ones who had less nursing experience, were in the ER less time than me and didn't have the CCC - hell one of them didn't even have cardiac care 1 - which would mean that these people would at least have the knowledge, skill and judgement to take care of people who are under continuous cardiac monitoring. So I cut out of there and started applying to hospitals in the area in which I live. I got several job interviews and in the end, got a job offer during one of the interviews in fact! I ended up taking the ICU job - started that in January.

So I've been learning a TON working in the ICU with adults. It really is a different can of worms than working with babies in the NICU. I'm enjoying it for the most part. Until COVID hit that is.

I can't really remember how much I've said about my immunity issues (I think I've talked about it all) - but long story short - I have immunity issues. I have IgG deficiencies and I'm also taking Humira for an autoimmune condition (Hidrdinitis Supprativa - AKA Acne Inversa) - and we know that my immune system isn't the best at the best of times (though I have been lucky that I've been pretty healthy lately). So when COVID hit I requested that I not have to take any of these patients. I had a couple of good charge nurses who were alright with it until there was one that threw a fit and then I had to take it to the manager and start the official steps. So then I contacted occupational health (with whom I had sent all my health documentation to about my immune system issues) and asked them for a workplace accommodation. Of course they were giving me issues and so I took this information to my physician and asked for a letter to give them. Thankfully he did, mainly because he agreed that if I did get one of these patients and I contracted COVID, that I would likely end up on a ventilator. So once I handed in the documentation I finally got the workplace accommodation to not take any COVID suspected, presumptive or confirmed cases.

Of course there are some people, including my  manager who question why I even work in the ICU if I have such a compromised immune system. Which I mean, I get. But the thing is is that the vast majority of people that we take care of in the ICU have treatments available that I could receive IF I were to catch anything that they have. Unfortunately, at this time the same can't be said about COVID at this point in time.  I mean, even if we were to get inundated with COVID patients, there are always going to be ICU patients, or CCU patients (ours is a combined unit).  I've convinced a lot of people with this next argument - wouldn't you rather me take care of ICU patients while you take care of COVID patients (or other ICU patients), meaning that we're both on a 1:1 - instead of me working elsewhere and then that potentially means that you would be doubled with an ICU patient. Of course when people hear this aspect, they always agree and drop the argument. So I haven't been reassigned elsewhere. To which I am quite thankful for. I didn't start working in ICU to be reassigned elsewhere.

As all this is occuring, I'm trying to convince hubby to FINALLY have another baby. He keeps saying "soon" - but 11yrs have come and gone with him constantly saying "soon". This has made me quite upset with him cuz I've given him 10+ yrs to get on with the soon bit. He kept saying that I had to do this task or meet this provision - all of which I did. But alas, he still says "soon". Now he wants me to do my critical care certification - and my nurse practitioner (NP) but I've told him I won't do any of it until such a time that I am pregnant with our next bambino/ini. He tells me that because he is accepted into a training opportunity (he doesn't want me putting it out into the world where he's been accepted because he hasn't yet gone for training) he doesn't want me to be pregnant while he is away. Also, he wants to be secured in knowing that he will succeed at training and will go forward to be placed that then he'd be willing to have more children. And of course because of this damn COVID pandemic, his training got cancelled until who knows when. I just don't know if he understands how difficult it may make becoming pregnant the longer he keeps putting this off. He thinks that once and done. I'm no longer young - it may take some time and much practice to be pregnant again. Also, it hurts my feelings (not that I think he cares much of that) that he continues to put this off.

Throughout the years I have willingly put off having more babies because it was in our best interests to put it off. It would have been more difficult because we didn't have the space for more kiddos, and it would have made getting my education completed more difficult as well. Hell it was hard enough having one little one, let alone more. Though I have learned that I can muster through my education regardless of having littles running around.

I have sacrificed a TON being married to my hubby. I moved because he hated the city we were in. I have lived in a tiny house, in the basement for MANY years. I have suffered being under the same house as his family - with frequent fighting. I have put off having more children because hubby deems it so. At what point does he start giving me what I need? What he agreed to when we got married. It's not like we're hurting financially either. He told me just this past year that if I saved up like $6000 that he would agree to more - well I've certainly done that, and more! And yet he still says the same damn thing - SOON. God I hate that word. It certainly doesn't denote the same meaning it once did. But I don't know how to convince him to just say yes, now we can.

UGGGGGHHHHHHH - I just want to scream at him.

Honestly I told him that I would leave him on my bday - it happens next month. I will though, if that's what it takes for him to finally relent. I hate that it would have to come to that. But clearly his priorities for our family aren't the same as mine. I'm done putting this off. I don't want to take any longer than this has already. It's a shame that he'll have to choose between having me and having more babies or losing me because he doesn't want any more babies. Stupid that he's acting that way, also that I have to make this decision. But I will if I have to. I thought we were aligned in the important aspects, but this is clearly one major area that we don't - or do we?