The Lost Art of Patient Care

I recently read something a friend of mine wrote about an experience she had with her husband’s surgeon. Reading through her words and imaging the pain and anger she felt hit me to my core. Her husband having had a complex heart surgery had complications post operatively. The surgeon never came to check on him as he struggled and nearly died in the intensive care unit. As I was reading her words I wondered to myself when did we start to lose the love and devotion for our jobs? When did taking care of patients become a burden? When did we lose the art of patient care? 

I say 'we' because it spans over the whole of medical professionals.

I remember the first time I was shocked by a physician leaving a patient situation. I was a Labor and Delivery nurse at the time, and the General Medical Education board had just changed the duty hours of resident physicians. We were in the middle of an emergency cesarean section (baby was out and doing ok) when the resident looked at the attending and from behind his surgical mask informed her that he was now over his duty hours for the week. He scrubbed out and left the operating room. I was shocked. Everyone in the operating room just kind of stood there for a second and I am sure we were all thinking the same thing, what in world?! 

I say that it spans the whole of medical professionals because I also had an experience several years later when I then was a nurse in the Cardiovascular Intensive Care (CVICU). I was assigned a student nurse for my shift. Glad to have some extra hands I got into teaching mode. When it was time for our patient to have a glucose check the student looked at me and said, "oh I have already been signed off on those, so I don't need to do them anymore."  When those words came out of his mouth all I saw was red. And the conversation went something like this.... I’m sorry what? I don't think I heard you. Your badge says student, correct?! That means you are here to learn! I don't care how many blood sugar checks are left in this shift, you will do every single one of them and if you tell me again that you won't, we will be having a conference with your instructor! 

I was a student once and I soaked in every single moment I could from my preceptors. They all had something to teach and I was hungry to learn. I could never have imagined saying that to one of my preceptors. Not ever. And here I was standing in front of the next batch of nurses who thought they didn't need to take a blood sugar.

Another experience I had in CVICU was with a physical therapist. Her and her aide were working with a patient on out of bed transfers using a lift. At some point while they were working with the patient the patient experienced an accident. Instead of pushing the call light to notify us we needed to come to the room, they laid the patient back in the bed in the soiled linens and went to the computer to chart and left. Moments later the patient called me to the room to tell me what happened. Again, I saw red. Why would you ever treat someone like that! I notified my charge nurse who called the house supervisor to report the incident so that they could call their supervisors. These things shouldn't happen. 

I go back to thinking about the surgeon my friend dealt with and the resident. I know that they have lives. I know that they are tired. I know that they are under a lot of stress, I see it. I live it every day. I myself get frustrated at times when birthdays are missed, trips out of town are canceled, the kids go weeks without seeing their dad, but I have to remember someone else's child needs him. He has never once to this day not answered a page, a call, an email from a nurse, another attending or even a patient family member. He goes back when they ask or even if they don't. He never misses a lab draw or a change in status. He often sits at his patient’s bedside watching, waiting. If he is home, he is attached to his phone watching the lab values as they are resulted. I am not saying he is perfect. Lord knows we are still trying to figure out how to balance life on the edge of the scalpel. But he is a throwback to a generation that served their patients. In my years in the medical profession I have worked with so many outstanding professionals, but I can't deny that the things I saw concern me for the future. If we become detached, lose our compassion, our pride in our work and our servants heart then what is left?

The Long Road

When I first started this blog a few years ago it was because I felt like sharing what it was like being married to a surgeon. Everyone and their dog watches Grey's Anatomy (ok, so do I) however that is not what our life is like. It is not one hour blocks of amazing, life saving intense scenes. It is a struggle. It is a huge amount of sacrifice and a lot of ups and downs. It is real.

I met my husband eleven years ago when he was a second year family medicine resident. Two years later he started general surgery residency. Five years after that he started adult cardiothoracic surgery residency. Two years after that he started his fellowship for congenital cardiac surgery. All of those years. All of those moments. All of those sacrifices and today was the culmination of all of it. He got word that he passed his congenital cardiac surgery boards. He is now, one of the very few (if not only) quadruple boarded physicians in the United States. 

I have no words for how proud I am of him. He has dedicated the majority of his life (he is 35 years young) to his training. He has a story that still amazes me and I love to share it. Graduating high school at 15, undergraduate by 17, MD by 21 and then 11 years of residencies that followed. He gives as much to his patients as he did to his training. His drive and ambition, immeasurable. More things are to come in our lives as we continue to balance life on the edge of the scalpel.

Oh Boomer 🐹

The first time Boomer went on a late night adventure we scoured the internet looking for ways to entice him to come back to his home after having spent hours looking for him. There were plenty of suggestions because apparently it is not uncommon for these furry friends to make jail breaks. The most popular suggestion was to place his home on the ground with fresh food and treats and he will likely return. And they were right. By the next morning he was happily snuggled back into his little house in his habitat. Kids were happy, mom was especially happy, and all was well in the world again. I was grateful we survived our hamster adventure and took extra care to make sure that would not happen again. But it did. Several times in fact. I believe Boomer to be some kind of escape artist. He most times would stay in the upstairs bathroom, nestled in until we found him in his favorite corner of the linen closet. Occasionally he would venture out and be found under our oldest son's bed. And of course the one time he paid me a nice visit in the downstairs hallway bathroom.
The first night he was gone this time we tried the same tactic that worked the first time. Knowing he was no longer in the upstairs bathroom we placed his home in the upstairs hallway with a fresh bowl of food and treats. The next morning we woke and everything was as we had left it. Boomer had obviously made the dangerous trek down the 15 stairs and had made it to the main floor as I had thought. So we spent a lot of yesterday pulling out furniture, appliances etc again but he continued to evade us. So last night I decided to put his home in the middle of the living room floor. I knew if I were to find our little friend it would likely be in the middle of the night and so at 320am when I found myself awake I decided to check his cage. Yep he'd been in there. But he wasn't anymore. His treats gone, his food bowl moved, the evidence obvious. But no Boomer. And so off I went. It took me all of about five minutes to go into the kitchen to make a cup of tea when I saw his furry self scurry across the floor trying to find a new hiding spot. Caught ya! And so off we went on our struggle, him trying to remain a free man (we think he's a he) and I trying to wrangle the furry creature like trying to catch a pig in slop. Eventually the reality hit him that I was not giving up until he was secured in his home, either that or he just got too tired from running and he let me catch him. He was safely placed back in his home, at which time he went to his water container and drank like a kid in the sun on a summer day. And so his adventure ended at 430 this morning. Until next time Boomer.....

Blog Résurrection: The Missing Hamster

It is hard to imagine it has been over a year and a half since my last blog post. As I sit here tonight, with a million other things I could be doing, I felt compelled to resurrect my blog.
A laundry basket sits in the corner with nice clean clothes waiting to be folded.
My text book sitting next to me with two more chapters to read by Friday.
My computer screen with my school browser open in another tab waiting for discussion dialog to take place with my classmates.
My Windows program open with my half finished assignment that is also due on Friday.
Oh and Boomer, where is that guy?!
The kids and I have spent the better part of today on a hamster search and rescue mission. His last known whereabouts were around 8pm yesterday evening when the kids fed him his carrots and seeds. My youngest, having gone back in at some point before he went to bed, opened the cage door enticing him on another late night adventure.
This is not the first time our furry friend has escaped and went roaming around. Often times we locate him fairly quickly. There was one early morning several months ago he paid me a surprise visit in the hallway bathroom. I did not have my glasses on at the time but as I walked in and turned on the light a furry blob entered my visual field and sat by my feet. Well, good morning to you too Boomer. The part that perplexed me the most was how in the world he had gotten so far. Normally he stays in the kid's upstairs bathroom. The convenience of tile flooring and away from the general public made the placement of his home there practical. He had to travel down 15 stairs that are longer than the length of his body and still continue on his adventure through the house to find his way to that bathroom. When he did have his previous escapee adventures he would mostly stay in the bathroom, hanging out in there waiting for us to find him, offer him a treat and place him back in his home. This adventure however has lasted a little longer than I am comfortable with. We have looked in every corner, under every single piece of furniture in this house. There seems to be no place we have not looked and yet he continues to evade us. And so we go to sleep tonight wondering where is our friend Boomer and a reminder to everyone to make sure they turn the lights on when they get up to use the bathroom in the middle of the night.

My hope is to continue to write on my blog as I find I have missed this outlet and writing over the last 19 months. Hopefully I can catch up on all of the things that have happened and the shenanigans that continue to happen in our house as we continue to balance life on the edge of the scalpel.....To be continued

Pregnancy and Infant Loss Awareness Month: A Mother's Story

When you look at the statistics of pregnancy and infant loss it can be surprising. Most people do not know that 1 in 4 women will experience pregnancy and/or infant loss in their childbearing years. I know that until I experienced it I was unaware of the statistics. The reason why most people don't know is because it is a sensitive subject that often is not talked about, or at least it wasn't until recent years. Due to the lack of discussion a lot of families feel alone in their grief. I know I did.
In November of 2012 I experienced my first pregnancy loss. I had, I thought, made it safely into my second trimester and so we decided to announce the news of a new addition to our families. We were so excited to have a new addition and news quickly spread. Not too long after that I had experienced a little spotting and thankfully was scheduled for my next appointment the following day. My husband normally didn't make it to appointments because of his schedule but said if his surgery case finished early he would drive over for it. As soon as I went to check in I notified the front desk that I did have some spotting the night before but hadn't had any since. They notified the doctor and she requested that they take me back to preform an ultrasound before my appointment. The ultrasound tech called me to the back and we began the scan. I requested that she turn the screen so I could see as well, and she reluctantly did so. As she placed the wand on my belly my eyes were already on the screen and I watched as she found the baby's heart and silent tears began to fill my eyes as I lay there alone looking at my precious little one laying so still with it's little heart just as quiet. The tech grabbed my hand because she knew that I knew and she started to talk but I didn't hear a word she was saying. The questions began in my head. The baby was fine on the last ultrasound, how did this happen? Why is this happening to me? What's next? The tech was gracious enough to let me sit in the ultrasound room until my husband arrived. As soon as he did I didn't even have to tell him as he saw my red tear stained face and hugged me and said it will be ok. We went next for my appointment. Because I was starting to get a low grade fever the doctor was concerned that I shouldn't wait too for my body to do things naturally but because I had eaten that day I wasn't able to get booked on her afternoon surgery schedule. And so she sent me home and I was scheduled for two days later. Those two days were some very emotionally difficult days. The next day I woke up in normal form of morning sickness with a quick run to the bathroom. As I sat there on the floor thoughts of why kept circling my brain. I decided we needed to get out of the house, so my son and I went to Target. As we were getting in the check out line the lady in front of me was giddy with excitement about the upcoming birth of her baby as she was buying some last minute items. I stood there, still pregnant myself, with my baby that was no longer alive and it became too much. I moved lines, quickly paid for our items and back home we went. Why were these constant reminders still there of me being pregnant when my baby would never get to come home with me? Those two days were two of the longest days of my life.
After my surgery I had to return to work after a week off. I thought I would be ok, however, working in the maternal child area of the hospital proved to be a struggle as well. Constantly surrounded by babies, mother's having babies, and taking care of them proved to be a difficult reminder of what I had just gone through.
We lost another baby in April of 2013 right before we moved to Seattle. Again I had to have another surgery. The grief and the darkness were very difficult. I found myself not wanting to talk to people, withdrawing more more. It was a very challenging time in my life. I had to move on, push forward for our son and our family but there were the days when my heart felt heavy.
We decided we were ready to try again and we were blessed with our daughter in November 2014. Every single day of that pregnancy it was in the back of my mind, would this one survive,  would we get to bring this baby home, will our son finally getting the sibling he so desperately asked for? Finally she arrived and it was the second best day of my life.
We lost one more baby in February of this year. It was a very different experience. Since we lived so close to my family at that time, my mom left work early the day I found out our little one's heart had stopped beating and though I had already miscarried the baby by the time she got to our apartment nothing felt better than a hug from her. It was a hard thing to deal with being home by myself with our two kids but the beautiful thing about that was that I did in fact still have them.
People say funny things when they find out you are miscarrying. Trying to be supportive and find something to say they pick words that unfortunately can still be hurtful. It used to make me so sad when after our first pregnancy loss someone would say well at least you have your son be thankful for that. As if I was in fact not aware how blessed I was to have him. I would get angry because it was as if the baby I carried for four months didn't matter. Another difficult thing is being pregnant with people at the same time and losing your baby. I was pregnant with one of my oldest friends one time with just a week separating our due dates. Two days after I lost my baby she had texted that she had her appointment and baby had a good strong heart beat and was doing well. I was so happy for her but a part of me felt like I had been stabbed in the heart. It's never easy being the one who loses the baby. It has made me more sensitive about sharing my own pregnancies when they are successful because I know what it's like to be on the other end.
I did a lot better after the third baby we lost. I clung to my faith and my family leaning on both for support. I know that though we cannot always understand the things that happen to us and the trials we face in this life, there is a bigger plan. I still think about those babies we lost. I remember the exact day I found out each of them had died and their due dates. Those dates pass every year and though no one else remembers, I do. I say a quiet prayer for them and keep them in my heart. They were real. They existed. They are a part of my story. And they always will be.

Pregnancy and Infant Loss Awareness Month: The Nurse's Story

To start this post I think it is important to go back in time to when I was in nursing school. Most of my fellow classmates could attest to the fact that Labor and Delivery was not a place where I wanted to do a rotation. I worked very hard to stay out of that area much to my instructors dismay. On my very last day of  my clinicals I was in the crazy circumstance of delivering a baby by myself in the bathroom (that is a whole other post in itself)! Of course that just solidified that I was NEVER going to EVER set foot in a Labor and Delivery Unit AGAIN!
Fast forward to my first job as a new grad nurse. The hospital that I was to work at didn't have any internships available in any of my desired units (E.R., ICU, or Cardiac Unit) but as luck would have it (well not my luck anyway) they did have an internship in Labor and Delivery. My initial thought was you must be kidding me?! Actually I don't think it was a thought I believe I actually spoke those words out loud to the HR person. And so I began my journey in Labor and Delivery, always telling myself it was temporary until a position opened up in another department. I finished my 9 months of internship successfully (with some VERY interesting stories) and was released by my preceptor to be on my own. Three months later I experienced one of the worst days I had ever had up until that point.
I will never forget that day. We had just changed shifts and the first patient to come up from E.R. was a 21 week pregnant woman with fever of 103 and cramping. I was up for the first admission. After labs were sent, IV was started, formal ultrasound was done and monitoring was taking place it was resulted that the woman was suffering a severe case chorioamnionitis and delivery was imminent. Without getting into the details of that day the woman and I bonded over my 12 hour shift. She was close to delivering when it was getting close to the end of my shift and I could not leave her to go through this situation after I had spent all day talking and consoling her with the impending outcome of her situation. And so I stayed. NICU personnel was present for the delivery on the small hope this baby would be big enough to save but sadly it was not. The doctor wrapped the baby in a blanket and presented it to it's mother and then had to leave for an emergency cesarean. And so I sat and held this mother while she held her baby whispering loving words while silent tears ran down her face and my own. After the baby had passed and when she was ready, I took the baby to take pictures for her, make a footprint sheet and make her one of our memory boxes that we present mothers who have delivered stillborns. It was excruciating. She hugged me for a long time and then it was time to move her to another floor. After having been at the hospital 18 hours I drove home and on the way I called my mom. She listened while I cried. I cried for that poor mother, I cried for the baby and I cried at the cruelty of the situation.
My very last stillborn case was close to the end of my time in Labor and Delivery. It was a woman who had come in that night for an induction of labor being full term and meeting the criteria for induction. As with every mom who comes in I immediately started to attach our contraction monitor and fetal heart rate monitor. As I was searching for a heart beat the seconds turned into minutes. She looked at me and said he likes to hide sometimes and smiled but my heart began to sink. I asked another nurse to try and find heart tones while I called the doctor who ordered a STAT ultrasound. The tech arrived to do the scan and as she was looking the doctor came in the room. The three of us were studying the ultrasound monitor screen as the tech was searching. You could watch the happiness leaving the woman's face as she looked to all of us hoping to see some reassurance. When the doctor had to tell her the baby no longer had a heart beat, the happiest day of this woman's life suddenly became one of the worst.  The crying and pleading with questions of "why" were haunting. It was a horribly heart breaking situation.
In my years as being a Labor and Delivery nurse I had no words for people who would talk about how wonderful it was to work in such a lovely department and never have to experience the kinds of events other nurses did on the other floors and areas in the hospital. And I would just smile but I had no response because working in L&D was such an emotionally taxing area to work in. We either had the best days or we had the worst days. I remember every single mother I took care of who experienced loss. I grieved for them and with them as any person would but it wasn't until I got a small glimpse at what they were going through that I understood the heart break that kind of loss could cause. Seven years later I would experience my first pregnancy loss and go down that dark path of grief as a mother.......

To Be Continued

October Awareness

When most people talk or think about awareness in the month of October the subject that is usually at the forefront of peoples minds is Breast Cancer Awareness. There have been amazing strides in medicine with breast cancer research, treatments, testing, etc. Most people at least know one person who has been affected by breast cancer. I know several strong and beautiful women who have had the misfortune of fighting that battle. As much as I could write a whole blog about Breast Cancer Awareness this post is not intended for that. This post is dedicated to those affected by infant and pregnancy loss.
On October 25, 1988 United States President Ronald Reagan designated the entire month of October as Pregnancy and Infant Loss Awareness month. October 15 Pregnancy and Infant Loss Remembrance Day campaign began in 2002.  By 2016 all 50 American states have yearly proclamations. The significance of this date is to recognize and raise awareness for families who have suffered bereavement due to pregnancy and/or infant loss and to offer resources, information and support. (Wikipedia, 2016)
President Reagan stated "When a child loses his parents, they are called an orphan. When a spouse loses her or his partner, they are called a widow or widower. When parents lose their child, there isn't a word to describe them. This month recognizes the loss so many parents experience across the United States and around the world. It is also meant to inform and provide resources for parents who have lost children due to miscarriage, ectopic pregnancy, molar pregnancy, stillbirths, birth defects, SIDS, and other causes."
This is a subject that until recent years was not often talked about publicly. Families suffered their losses silently. People feel uncomfortable talking to someone going through this emotional time because what can one say? I have become more vocal in the last few years of my experiences. Sometimes it makes people uncomfortable to discuss but you never know who your words can reach and provide comfort to when they are silently going through their own loss. And so as a previous Labor and Delivery nurse and a woman who has suffered three miscarriages herself I will dedicate the rest of my posts in the month of October to opening the conversation of this sensitive subject. Some of my stories may be difficult for some to read but if I can help just one person not feel alone and to help raise awareness about this sensitive subject then my posts have done their job

To Be Continued.........

 On October 15th at 7pm people are invited to help raise awareness by lighting a candle. Whether you have been through this situation, know someone who has or just want to help raise awareness I invite you to light a candle for all of those babies who are no longer with us. Thank You.

For more information please go to WWW.NOWILAYMEDOWNTOSLEEP.ORG