Friday, October 18, 2013

Quality of life verses a pulse...

Consider this...You are in an accident. You have been left with a pulse.  You cannot breath on your own; you never will. A ventilator breathes for you.  You cannot eat; you never will. There is a tube in your stomach or through your nose down into your stomach that a "nutritional supplement" will but put into to feed you. Your eyes may open; you focus on nothing; you never will. You move around in the bed some; it is only reflex movement. You have no control over your bladder or bowels. Someone will have to change your diaper. Your brain has been permanently damaged either by the trauma or oxygen deprivation. Because you are now bound to a bed you will develop pressure sores; it is unavoidable even with the BEST caretakers when you are in this condition. Honestly, with this injury (confirmed by ct scans) you will not even know that you are in this condition. You are essentially brain dead. You have no Quality of life....only a pulse.

DO YOU WANT TO LIVE THIS WAY?

Consider this...You have had a long full life but you are nearing the end. You have been unable to care for yourself for quite a few years now and have lived in a nursing home. You no longer know anyone. You wear a diaper. Someone feeds you a baby food like substance. You sleep most of the time. You no longer talk. The last time anyone heard you speak, the dementia and Alzheimer's made your thoughts come out so jumbled that no one understood at all what you were talking about. A few nights ago you aspirated some of that baby food. No one's fault but age. You went into severe respiratory distress and you are now on a ventilator. Your most recent chest x-ray shows that you are now suffering from aspiration pneumonia that given your age and health status you will not recover from. You had little Quality of life before this incident...now you have no Quality of life....only a pulse.

DO YOU WANT TO LIVE THIS WAY?

I could give you scenarios all day long.  I do not want to live this way. I do not want to be a burden. I do not want to lay around and  be poked and prodded and shifted and turned. I do not want some underpaid nurse aids talking about their weekend or their baby momma drama over me while they wash me. I also do not want my family members to live this way either. If there is no significant chance of having a quality of life, I do not want a pulse!

I see a lot of this in my clinicals. In this weeks clinical rotations, I had 3 patients whose quality of life is gone. They only have a pulse. The families had some tough choices to make.

 One of these patients, the family made the choice to terminate life support. That means that my job was to extubate (remove breathing tube in her mouth) and turn the ventilator off.  This patient passed away a short time later.  It was her time to go home to Jesus. Her family was around her with no crazy tubes in her nose and mouth when she slipped peacefully into eternity. 

Another man maybe in his late 40's has MANY health issues, he lays completely unresponsive with no hope of recovery. His eyes are glazed and his pupils fixed and unresponsive. His family does not want to make the decision to "kill" him (their words). They want the doctors to pull out all the stops and treat him as if he will make a miraculous recovery and hop on up out of that bed. They are holding on so tight that they will not even opt for a trach so that he can be ventilated without the tube hanging out of his mouth. They are not bad people. They love him immensely. They just can't let go. I wonder if they stopped to think about what they would want him to do if it was them laying in that bed with that prognosis.

The last patient was an older man riddle with melanoma that has metastasized. The cancer has taken over his body. It is only a matter of time. He can breath on his own and was intubated to make it "easier" to suction the secretions instead of running a tube down his nose into his lungs. It broke my heart to see his wife of many years stand by his bed with one had on his chest and the other clutching a tissue and dabbing her eyes. She loves him. I have no doubt. It will be hard to live without him after many happy years of marriage and even after this long tiring battle  with cancer. I could tell that she is aware that the end  is drawing near and she was thinking about the decisions that she will soon have to make. Although his quality of life is gone, he does have more than a pulse. But that will cease soon.

When my Grandma passed away it hurt my heart more than you could ever know. BUT I knew it was her time to go home to Jesus, to be reunited with my Granddaddy and Granny and Papa.  I did not want her to stay here with me if she could not have a quality of life.  No, she was not on a ventilator or anything. But we had a few options to help slightly prolong in a nutritional sense. We knew she would not want that. We brought her home and she passed peacefully at just the moment God intended. My prayers in those last days were for God to either make her better to the point of coming back home to live at momma and daddy house again (I knew that was not going to happen) or just take her home to Heaven.   I miss her SOOO much!

I know how hard it is to lose people you love. I have had soooo many people taken from me in my 33 years here on this earth and I know I will continue to lose more and more because that is life. I know how it feels to stand at that bedside and know that you do not want to let go but nothing else can be done and what you see laying lifeless with a weak pulse and a machine breathing for them is all they are ever gonna be. These are not easy decisions to make... NOT AT ALL!

Don't be selfish!! Ask yourself "Does (momma, daddy, aunt...) want to lay here this way?" I'm not saying jump the gun and DNR everyone! I'm saying make an informed decision taking into account the prognosis given by the doctors and what you feel DEEP in your heart that your loved one would have you do. IF your family member has advanced directives ( end of life wishes ) such as being a DNR or an organ donor, not wanting to be intubated or be hooked to a ventilator....PLEASE respect these wishes. I have learned that the family can override all of these things. What gives you the right!?! Why would you not respect your loved ones last wishes?!?

If there ever comes a time that I have no quality of life, only a pulse and a ventilator....LET ME GO!! I know you love me! Please know that I love you too! Please know that it is OK to let go of me! I know my Lord and I am not afraid to die. Please don't be selfish and let me linger here to become a burden and NEVER EVER let releasing me to go home to Jesus burden your heart! Please donate every viable piece of me to help someone else live to their potential! These are my wishes.

I know this is a depressing morbid blog post but it is real life!!

Thursday, February 14, 2013

I'm proud of you!

I have heard that a lot the last two days. "I'm proud of you!"

It sounds so strange to me. I did my job. I did not save a life. My uncle Garland is gone. But everyone is PROUD of ME.  They tell me they couldn't have done it. They tell me I was so brave, courageous. I do not feel brave or courageous. I am not disappointed in myself, there is not reason to be. It was God's timing. I do not feel "proud" of myself in this situation, though. I have a weird "numbness" that goes along with my sadness. Maybe I don't know how to feel yet.

Do you want to know how I did it? I can't tell you. I don't know. I sort of felt like I was in a bubble? I felt like I had tunnel vision when doing compressions. All I remember about doing the actual compressions, is seeing my hands on his chest and feeling the burning in my arms and back as I compressed his chest with everything I had in me. I could hear my compressions on the monitor. When I was not doing compressions I watched everything, but it was almost like I wasn't really there and it wasn't really him.

How are you doing? Are you ok?

I hear these questions too. I just say I'm ok. I'm fine. I'm good.  Am I?  Am I ok? Am I fine? I don't know. I think so. I know that I will be. Am I right now? Kinda.  I feel sort of numb. I get upset and I cry. I think about things. I try not to think about things.  I try to stay busy. I have a little trouble concentrating if it is quiet. I feel a sadness inside. I feel like I know some secret that no one knows. I feel like I had a really bad dream. Time will help, I WILL be ok!


I have had so much on my mind, that I really haven't thought much about Valentine's Day. So, Happy Valentine's Day. I hope it was a great one! LYTYBF

Tuesday, February 12, 2013

Worst clinical day ever!

Hello, out there.....I know I started this blog a while back and never updated it. I think it might be a good idea to try it out again. So here goes...

I have been sick with a VERY bad cold for the last week. I missed 2 days of school last week and ended up missing my clinicals yesterday.  Well, I am feeling better, I went to clinicals today and this is what happened.

I got up and went to the hospital, checked in and was assigned to Samantha and Buffy (my preceptors). We went up to the 3rd floor and got started on morning rounds. I did my assessment on a lady who coughed so much that I couldn't count her respirations because when she wasn't coughing, she was holding her breath to try and keep from coughing.  I gave her a nebulizer treatment, did a post assessment and headed down the hall to my next patient.

My next patient was a nice old man. He had old navy tattoos and it made me think of my granddaddy. He told me it was nice to meet me, but he was ready to meet some food because he was hungry! lol  I did his assessment and gave him his nebulizer treatment. While I was getting his treatment ready, he told me not to get into his stash because he would need some of his muchies if they didn't bring breakfast soon! He was watching the news and there was a story about a girl killing her boyfriend. The old man shook is head and then told me that when he was in Turkey, if you committed a crime like that, they marched you out in the street and just "Kablwow" they shot you right there! He said he ducked and run the first time he saw it because he wasn't sure what was going on! I just said "Oh, my!" He says we should do the same here and we wouldn't have so much crime. I think he is a wise old man! Anyway, he finished his treatment and I did his post assessment.  I told him to hold tight and breakfast would be there soon!

While I was waiting for Samantha and Buffy to finish with thier last patient, a CODE BLUE was called to the ER with an ETA of 5 minutes. They finished quickly and we headed downstairs to the ER to get ready. My classmate, Tucker, was already there and several other respiratory therapist. One of the mangers told Samantha and Buffy that they had enough RTs but to let me stay so that I could observe with Tucker since we are students. We are CPR certified and can help, but I thought today we were just watching. We were told that they weren't sure all the details yet of the patient but that they probably wouldn't make it from what they did know.  Tucker and I stood in the corner and waited. There was suddenly a lot of commotion and they were wheeling in the patient. When you are a student like me and new to the CODE, your hearts starts beating fast and you sort of panic a lil but you are ready to jump into the action. They bring in a large man and all I could see was the top of his hair. I had a funny feeling that I recognized that hair. When the move had been made and he was on our ER bed and the EMT moved out of the way, I realized I knew exactly who it was! My uncle Garland. I told Tucker and he asked if I was ok and said yes. I was kind of horrified and ok at the same time. I don't know how to explain that. The doctor told us to get ready and we were gonna get into the rotation of compressions. He pointed at Tucker and said "Jump in!" and Tucker jumped up on that stool and gave it all he had. The doctor told me to get ready and when he gave the word, I jumped in and gave it all I had. There were nurses doing all kinds of things. As chaotic as it is, it is actually a smooth process. Everyone knows what to do and when and it works like a well oiled machine. When my turn was up, the doctor did compressions, and then another male nurse and then it was Tuckers turn again. The doctor told me to watch the clock and when the second hand got to the 6, tap Tucker and jump in. That is what I did, I jumped up on that stool and gave it all I had until I was told to stop. I was the last of the rotation. I was the last one to do compressions on my uncle before time was called. There was a last effort to find ANY cardiac activity with the ultrasound. It was done. Time was called at 8:06am.  I stood there. I listened as the doctor and the RTs told us a few things, more general than pertaining to him, about some of the equipment. It was almost like it wasn't him laying there. The lead RT told us it was time to go back to the dept and meet back with our assigned preceptors. I asked if I could be excused for a moment and when she asked if I was ok, all I could say was "That's my uncle." . Then the tears came.

She asked me why I didn't tell them. She told me that I could have just said I didn't want to do it. I can't really tell you why I didn't tell her or one of the nurses. I told Tucker. I could have as easily just said it out loud and been excused. I guess with the adrenaline pumping and everyone already jumping into action by the time I could see him, I just wasn't sure of what to do other than my job.  The lead RT told me I was free to go. She signed my paperwork and gave me credit for the day and offered to drive me home which I declined.  I drove myself home, crying, with the sleeves of my lab coat covered in ultrasound jelly.

I cried for a while, I called my momma and my daddy and I cried to them.  I came home and just sat here a while. I needed to process this.  I know that I did not kill him. I know that his death  was in Gods timing and not ours.  I did not cry because I couldn't save him. I believe that he was gone before he got to us and we all put in our best efforts as did the EMTs. I cried because my uncle who has lived next door forever, riding his 4-wheeler on patrol of the neighborhood is gone.

Tucker told me that the RTs were very impressed with how I handled everything through the CODE. That I did a good job and that they had no idea of any problems until it was over and I told them.  We were told to make a good impression at clinicals....this was not how I planned to impress them.

My instructor, Mr King, called to check on me and told me how proud he was of me for jumping in and taking care of business under those circumstances.  He said he would not have faulted me at all if I had of spoken up and excused myself.  He asked me to talk to the class about it and I told him that was fine. I don't mind telling them about it. I hope they don't have to go through it, but we all have to face the reality that it could happen, especially if we work in our hometowns where all of our family and friends live, work and play.

This was not how I had pictured my day.  I thought it would be just another day of doing assessments and nebulizer treatments.

Rest in Peace, Uncle Garland! Love you!

Monday, July 16, 2012

Life Changes

Well, my husband and I are officially separated.  We signed our separation papers yesterday and I filed them at the courthouse today. I don't really know what else to say about that.  I do love him and care about him, but it is not the same as it used to be.I am not IN LOVE with him anymore. We can't seem to get along any more.  Neither of us are happy and I decided that we should just end it. We have been working on it for about 2 yrs now and it has not gotten any better.  I have things I need to work on in my own heart and head and so does he.  It is not easy at all. There is a lot of adjusting to do for us both.  He has moved in with his sister and her family and i am all alone trying to pay the bills with my meager unemployment check and go to school.  We will both be ok. 

On a bit of a more positive note, I went to the school advised them of my situation and gave them a copy of our separation papers.  My fiancial aid forms were revised and I will now receive a full federal pell grant.  Otherwise, I would no longer be able to attend school.  I will now start my Respiratory Therapy classes on August 23.  I am scared to death!

I've got studying to do.

Wednesday, June 27, 2012

Bad Day

Today, I am not having a good day.  I an sad, mad, frustrated, confused, just plain restless and irritable.  There are just a lot of things going on in my life right now, some good, some bad.  Here are a few that are worrying me ....

1. Fianacial aid was denied for school on first attempt.  I have had my forms revised and have no idea if I will get any financial aid.  If not, I have to get a student loan. I may just be stupid, but I have no idea how to even go about getting a student loan.  Fianacial aid advisors says she will help, but I have my doubts as she was not very eager to help me revise my forms.

2.  If I find the money, I start my respiratory therapy classes on August 23.  I am scared to death!

3.  My husband and I can't seem to get along for very long at all.  I have no idea what is going to happen at this point.  Neither of us is very happy at this moment, but we have been here before.  Just trying to figure it out.

On days like this, I think.  A lot.  I think about things that are probably a bit nonsensical to everyone else. 

Today i thought of some sayings and truthes......

1. "It has to get worse before it can get better" - What does this mean?  What if you can't handle the worse to make it to the better?  Why does it have to get worse? Why can't it just get better?

2. There is this inevitable truth that people get better before they die.  So what does the previous saying mean to someone who is terminally ill?  Many very sick people take a turn for the better (giving false hope to many) before they die.  If it has to get worse before it gets better, why do they want to endure the worse just for death to follow the better?  I also wonder if these people know that when they take this turn for the better that they will die soon?

3. "When life gives you lemons, make lemonade"  ....  well this is only gonna work if life decides to NOT leave you so broke you cant buy sugar.  I guess life could give you some bees to go with your lemons, but you would probably die from bee stings before the bees even make the honey to sweeten the lemonade.  This saying doesnt really make any sense at all.

ANYWAY....I am going to say good night for now.  I am tired and probably just need to go to bed.

Maybe tomorrow will be better and I can post something a lil less negative.

Tuesday, December 27, 2011

WOW!

So, I hope everyone had a great Christmas!  My Christmas was good, busy but good. There are some really exciting things coming up.

1. My sister in law will deliver another precious baby boy on 1/3/12.  Because of the complications she had before with preeclampsia and c-section, she will have another c-section. His name will be Simon!

2. On Jan 5, I have to go buy all my books for school and tie up any loose ends.  Classes start Jan 9. I am scared to death, but I have some good support and am feeling good about it.

With the new year coming, I have made my resolutions!

1. This is really a resolution from last year. I did not break this resolution, I am just vowing to continue it and kick it up a notch!  I will continue on my journey of health and fitness.  When I lost my job back in September I got a lil lazy and skipped out on my workouts for a month.  During that time, I found a few of my lost pounds. :(  I realized that for me, this is really a lifetime journey. I guess my genetics will not allow me to cheat on my diet and exercise with out reversing my progress.  So I'm kicking it up a notch to shed the extra pounds I found and then continue to a lifetime of health and fitness.

2.  I am tired of being broke. I am tired of my bills being behind. I resolve in the new year to save as much money as I can. I resolve to be sure all bills are caught up and paid on time.  It will help relieve some stress as I start school and need to focus on my studies. 

3. I resolve to be happy. What ever it takes.  I will not be taken advantage of, walked on, lied to, or treated badly by ANYONE. Not myself, not my husband, not my family, not my friends.  I am not saying that any of these people spacifically had done these things. I have had a tough couple of years with relationships with all of these people, some by my own fault, some not.  I love them all and do not want to dissolve any retationships, but I will be happy whatever it takes.

4. I resolve to start my classes at ECC and do the best I can, I will not give up. I will become a Respiratory Therapist no matter what. I will not let anyone or anything get in the way of my education.  I have floated though long enough being broke and working dead end jobs.  I will do that no longer. I will have a career!


Well, I guess that is about all I got for now.  I hope you all have a Happy and Safe New Year!

Monday, November 7, 2011

It's Official!

I am a college student! I went to my New Student Orientation and Pre-Registration at Edgecombe Community College tonight! I was so nervous and still am. It has been so long since I have been in school. Starting college again at 32 is strange to me. I am only taking 2 classes this first semester. Turns out that a lot of the classes I took at Nash Community College years ago are still valid and put me ahead of the game with only 5 classes that I need other than the actual respiratory classes.

Well this was a pretty short blog but I'm sure they will get longer and more exciting as this college adventure begins.