silveryscrape (silveryscrape) wrote,
silveryscrape
silveryscrape

I'm this close to putting my head down on the desk right now, although god knows this nat'l geographic special on bats with those weird kratt brothers is riveting. But I wanted to talk about my patients from today before I pass out.



She had been feeling kind of tired lately, she told me. So she went and had bloodwork done at her doc's on Tuesday. By Thursday she was in the hospital getting chemo through a brand new surgically placed tube in her chest, learning more about leukemia than she ever wanted to know. Today, she got to experience the start of her nausea and diarrhea and the first strands of her hair coming out, and she asked me how long this would go on and I told her what I always tell them. You'll probably go into remission after the first round of chemo. I didn't tell her that not everyone does, and that she's gonna get pretty sick before she gets better. She'll probably be in the hospital for at least a month this time. If they give her stem cells she'll be in even longer, getting blood and platelet infusions and antibiotics for the fevers, and the diarrhea and nausea she'll experience will make today's seem like a fond dream of the past. Maybe I should have been straight with her. I don't know. But it seemed to me that right now what she has to learn is that her life has changed. It's the first lesson cancer teaches you.




But sometimes it's not as sad. I took care of a lady last week, a sweetheart, who put her hand on my head as I knelt before her arranging her plastic diaper and told me "bless you my child" and then cackled when I snorted and rolled my eyes. Her daughter is the one I mentioned a few days ago who offered me a hospice job in *shiver* New York State. Well, this lady had a fractured tail bone, lots of pain, so we put her on a morphine machine. She got a base amount all the time, plus she could push a button to get more. Within a day she was confused, weak, confined to the bed, and her blood pressure had bottomed out. So, too much morphine. We took her off the base amount of morphine and her blood pressure got better, but then she got more confused and weaker and her lungs filled up with fluid, and suddenly she had pneumonia and bacteria in her blood and she was a very sick little old lady indeed.

At one point she asked me and her daughter, "is this it?" Her daughter said "do you think you're dying?" and she said yes. She was hearing the music, she said. Her daughter the hospice nurse thought she was dying, too. I asked her if she really thought so, or if this was her getting used to the idea of her own mom's death. She said "maybe" but seemed doubtful. It was a pretty scary few days.

And can I just tell you that maybe I almost felt like a nurse for a minute there. Her temp went up a little bit, but was still normal, but I got a weird feeling and called the doc and he said "well, what do you think is going on?" and I told him "she's septic." He ordered the antibiotics and the blood tests on the strength of my word, a freaky feeling, let me tell you, and? She was septic. But we saved her.

Today she toodled down the hall with the cute physical therapist, smiling at everyone, and when she saw me she said "how are you, dear!" which made me laugh.
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