3rd Day

It seems not to be until the next day that the exhaustion of a 12+-hour shift hits me. My limbs feel heavy, and my whole body feels kind of depleted, and I just feel like lying very, very still. During the shift, though, and when I get home at night, I'm mostly all peppy and bouncy, except that my feet just start to hurt. I'm all revved up on adrenaline and this uncanny cheerfulness.

I also hate to even think about my varicose veins. I haven't been able to bring myself to wear support hose in July. But I really, really will once it's September. Or, you know, October. I'm not really claustrophobic, but my legs seem to be. They hate the thought of being closed in the tight grip of an industrial-strength sheath of nylon and lycra. "No! no! no!" they cry out piteously in their squeaky little leg voices, "Air! Air!"

We had three patients on Friday. There was good old Mr. B, who said that the fireworks were, indeed, quite impressive from his hospital room window on the 4th--the best he'd ever seen, even. He looked kind of terrible, somnolent and stubbled and diminished-looking. He said he was feeling incredibly fatigued and sleepy, and I could tell it was kind of freaking him out. So then I started feeling anxious about it too. But Julie, my preceptor, said that at this point in his course (2 days after his bone marrow transplant, after more than a week of nasty-ass chemotherapy), that kind of misery was, unfortunately, pretty well expected, but we'd keep a close eye on him in case he had anything cooking. His temperature actually did get up to 99.3 mid-afternoon (and for somebody with essentially no white blood cells, any little bit above normal is considered a real fever), but to my relief it came back down again promptly. He also got a unit of blood, since his hematocrit had dropped below 25, and we were hoping that might pep him up a little, but it really didn't. His friendly family--wife and two teenagers, a daughter and a son--came in the afternoon, all wearing green shirts for some reason and looked like a doting matched set, but after a little while they just left so he could sleep more, which was all he felt like doing.

Then there was Mrs. R. She'd been needing a sitter because she'd been delirious and trying to get out of bed unaided, and I guess that a couple days before that, she'd been pulling out her lines. The night nurse gave us report, though, and said that overnight, she'd mostly been quiet, sleeping on and off, and that the sitter hadn't had to do anything. And for our 12 hours, she was absolutely the picture of lucidity--thoughtful, wryly funny, gentle. Her very short hair (still growing in after chemo?) was messy from her being mostly bedbound, but ended up looking rather downtown and stylishly tousled, and was remarkably soft to the touch. She had wide, striking eyes in a pale, pale face. She was in her 70s, and her breast cancer had recurred, widely metastatic now. She had had terrible belly pain and vomiting from the tumor invading her small bowel and causing an obstruction, but they'd managed to place a stent to hold open her duodenum, and at least her GI symptoms were now largely resolved. The physicians talked together about having the conversation with her and her family: we think that it's time to stop trying for a cure and shift care to "CMO" (an acronym I actually hadn't heard before but from context could tell must mean "Comfort Measures Only"). The conversation didn't happen Friday, though. I couldn't tell whether they were stalling, or whether their given reason (to wait to talk to the consulting specialists to have the whole picture) was real.

In the afternoon, somebody brought Mrs. R two perfect peony stems--one a full-blown dark magenta bloom with a ring-shaped golden yellow center, and one a plump pink bud ready to open at any moment. She was terribly hoarse, and could barely do more than whisper, but she managed to ask me if we could do something with them. I was the only one in the room, and so I said I thought that unfortunately, since this was an oncology ward, we might not be able to have them in water in the room, but I would check. "Or just put them somewhere!" she said. I think she just wanted to make sure that such beautiful flowers would be enjoyed by somebody. I asked Julie, my preceptor, though, and it turned out that Mrs. R's white counts were fine, and her roommate had just been made a hospice patient that morning, so the peonies could stay in the room. I peered into the locked clean utility room (I don't have an OFH ID to swipe in, so I have to ask a staff member to let me in when necessary) to try to figure out something we could use as a makeshift vase, but the water pitchers were kind of too squat (and distinctly unlovely), and the only other thing that seemed like it might work was the white plastic urinal bottle for male patients. It was the right size, and even had kind of a graceful shape, but I couldn't bring myself to subject the flowers to the indignity. Finally I took a couple more swallows from my 2/3-full Diet Coke and poured the rest out, rinsed the bottle, tore off the label, and brought it in to Mrs. R's room. It was just right.

Finally there was Mrs. T, coming in under her own power, for a carboplatin desensitization. She'd had a possible allergic reaction to it before, at an earlier point in her treatment for ovarian cancer, but other therapies had failed, and the tumor was growing in her belly again, making her feel bloated and achy and taking away her appetite. So now it was time to try the carboplatin again, which meant following an elaborate and very carefully paced protocol to reintroduce it while monitoring her closely. Mrs. T, too, had very short hair ("When I had chemo, all of my hair fell out..." [significant pause, raised eyebrow] "All of it."), which suited her nicely. She was dressed in casually preppy clothes and seemed remarkably relaxed and cheerful for someone who was in to receive a flow of a medication she might be allergic to directly into her bloodstream (for the purpose of treating her recurrent potentially lethal cancer). She explained, though, that her symptoms had been bugging her so much lately that all she wanted to do was get the show on the road and start getting more chemo. She'd even talked her doctor into squeezing her in so she could get it a week earlier than originally scheduled.

We weighed her and measured her, drew another chem panel to verify that her creatinine continued to look great (which it did), pre-medicated her per protocol with Claritin and Benadryl and some other meds I'm forgetting. She'd taken some stuff the night before and that morning, too. And then Julie (clad fetchingly in the brilliant blue gown and special purple gloves used to protect nurses giving chemo) started the carboplatin infusion. Fortunately, it went great. Mrs. T decided to keep her own clothes on, so she was sitting there on the hospital bed as if in Chemo Cafe, in her jeans and blue and white striped button-down (unbuttoned a bit so we had could have access to the Port-a-cath in her chest), reading glasses on her nose, sedately flipping through the newspaper and making pleasant conversation with us when we came in to check on her or hang the next bag of stuff. Her vital signs stayed steady as Gibraltar, and she had no complaints besides a bit of boredom (we developed a running joke that the next time Julie and I came in, we'd do a song-and-dance routine for her). Would that chemo were always so uneventful.

And me, well, I had some more moments of feeling overwhelmed and ridiculously inept, but I think maybe I'm starting to get a little bit inured to the feeling, because it didn't bother me quite as much. And Julie is so very nice about it. Toward the end of the shift, she apologized for being scattered and then (apparently having been looking at my resume again, which was sent to her when she agreed to precept) said something about how even though I hadn't done hospital nursing, I'd done so many high-level nursing things. "You could have come in with a real attitude, with all the things you've done," she said, and gave me to believe that she's seen some real attitudes in her time, "but you're so humble!" I was kind of floored. It hadn't really occurred to me to give myself points for humility, which feels, I must say, very well earned. But I'm grateful and relieved that she sees it that way.

The hardest part now is going back to my dumb temp job. As I get going with clinical, I find have less and less patience for mindless clerical tasks (well, actually I guess I have some patience for the truly mindless stuff, because then I can at least think about something interesting--what's truly killer is the deeply tedious clerical tasks that nonetheless require attention and thought). I get so antsy sometimes I have to get up and walk around a little so I can stay in my skin. And refrain from yelling "WHO CARES?!" at my computer screen.