...are the ones that make the biggest difference


Happy Thanksgiving?

I work Monday through Friday nights and this week was no exception. And about the first thing I heard upon coming to work last night was that one of my favorite patients, a gentle old man who always said "thank you" for the least act of kindness, had died. Mr. S had had an x-ray earlier in the week that showed cancer had spread throughout his body and that he was beyond any hope of remission or treatment. So the decision was made to remove him from the vent and he died within a few minutes. My first duty last night was to clean up his body and take him down to the morgue where he would await transport to a funeral home.

There have been several deaths since I began working there, but this was only the second that happened on my shift and the first I was solo on taking care of. And that is the way I wanted it. I loved Mr. S - it was always a pleasure to help him. The first night I had him, I discovered that he had the disconcerting habit of sleeping with his eyes open. Thanks to the risk of aspiration he could not have anything by mouth, so it would get very dry. Everytime I went in to turn him or perform some other service, he would ask me to swab his mouth out with water with a little stick-sponge we have for that purpose. I would dip it in some nice cold water and let him suck on it a few times and he always asked for just one more. He was just so grateful for anything you did - a cool cloth on his forehead, adjusting his pillows, making sure he was getting his pain meds - it didn't matter. Every act was greeted with simple gratitude. And for a relatively small man, he had some giant feet!

I found his death to be an affront, and not just because he died but where he died. He died in a hollow place, a harsh place. It is a place that truly denies our humanity and stubbornly refuses to let us leave our mark. Every room identical and no matter how hard patients or families try to personalize them, the austere, hard formality pushes itself on your awareness. And once the superficial glaze of pictures, balloons and get-well cards are removed, it is as if that person had never been there. Had never been at all. I fight a war there every night, trying to turn the tide of inhumanity, trying to leave a mark if only for those people who will die there. To let them know that they will be remembered, that their presence lingers in a fond heart and that this place is not their end.

God's speed, Mr. S.


Not all that encouraging

It certainly isn't very encouraging that Iraqi leaders would adopt language, no matter how carefully crafted or restrictively endorsed, that legitimizes armed resistance against US forces who are, in fact, the only thing keeping that fledgling government from being felled by said "resistance". Either they're just plain dumb (which, given the state of politics in this country is certainly a possibility) or they're stuck in such a difficult place that they are forced to side with the insurgents against the US for fear of what will happen in the future.

Which actually raises an interesting question in my mind. Last night, as I was driving home from class I listened briefly to the Sean Hannity show and a caller made the dubious statement (paraphrase) "when will those darn Democrats learn that if they would just shut up and support the mission it would be successful and everyone would get home much faster." At the time I thought this was just more of the same drivel one hears on conservative talk radio. I mean, is the success of US forces really dependent on the size & team spirit of their cheering section in Congress? Maybe if we all got together and started yelling at the insurgents "We've got spirit! Yes we do! We've got spirit, how 'bout you?!" with an exaggerated pointing gesture accompanying the last beat, then we'd finally be able to get 'em licked. But I didn't think about the flip side of the coin - what about the effect talks of immediate withdrawal have on the nascent Iraqi government? All the highly believable positive statements by the Bush administration about the readiness of the Iraqi army & police forces notwithstanding, if I were a member of the new government I'd be wetting myself at the prospect of US forces leaving. So where do we draw the line on healthy political debate? We can't forsake our right to discuss these issues but we have to find the balance.

Lock up the women and children, finals are a'comin'!

Finals are fast approaching and man oh man do I have a lot of studying to do. I've got a semi-research-paper-thing due for my psych class (about 75% done, thankfully), a large-ish anatomy test & lab practical prior to the anatomy final, a research paper for my communications class and good ole chemistry. On top of that, we're moving into our new apartment on Saturday. And the cherry on top is that I need to retake the nursing school entrance exam by the 2nd. I did well the first time I took it - 91%, which is much better than the school's average of 79% - but I need all the points I can get. I bought a study guide and figure I can squeeze a few more points out in a few of the areas, like punctuation rules - I haven't looked at the rules regarding comma use in, oh, say, 10, years. Hopefully the book will help.


Family came to church

This morning my in-laws came with us to church. Needless to say, it was quite a change of scenery for them. They didn't really ask too many questions about the architecture, or even the Liturgy, although there was one point when my father-in-law took issue with one of the prayers that entreated the saints to "persuade" God to be present. I tried to explain to him about the poetic liberties sometimes taken in the Liturgy but I'm not sure he found it very convincing. Another point they raised was the repetitive nature of the prayers, both within the Liturgy itself and the fact that its repeated every week, and Jesus' words in Matthew 6:7. I know for my FIL, the main issue was mostly of a pragmatic nature - does the Liturgy do what it should? Does it meet people's needs? My MIL felt the priest's role took on a mediatorial role and that, as believers, we have direct access to the throne so why do we need a priest?

Overall, the experience sparked a lot of questions, probably a few rush-to-judgments on their part, but a good discussion. I tend to doubt that they'll ever be comfortable with Orthodoxy if we decide to convert, but at least they have a better idea where we're coming from.


The End of Life Debate: New Clarity & Confusion

As a little bit of background info, my facility specializes in long-term acute care for patients with significant complications. Many are on ventilators and we try to ween them off the machine because there are no nursing homes in this area that will accept patients on the vent. If they do not redevelop their ability to breathe on their own, they have very few options for continuing care. We have many patients with renal failure, diabetes related amputations or circulation problems and wounds. Wounds are probably the 2nd biggest reason our patients come to us, most developing from simple bedsores. What starts as a small little breakdown in the skin can quickly develop into a complete degradation of the skin.* This opens the person up to some bad infections and can exacerbate other conditions.

Since I started working at the hospital we've had several people die. Some of these deaths were expected; the patient's condition was so severe that their chances of survival were slim. One woman had a horrible wound on her leg that had developed from a bed sore and resulted in a systemic infection that left her in constant agony. Her skin was degrading and every movement was torture, so in many ways, her death was a blessing. There have been at least 2 cases wherein the family decided to "pull the plug." Contrary to what you tend to see in the movies or on TV, these "termainal weans" are generally not very quick. It can take hours, or even days, for the person's breathing to eventually stop. There was even one person who was perfectly conscious who decided to be removed from the vent - they lingered for several days before finally passing. We just had a person die yesterday evening whose death took me by surprise. When last I saw him, he seemed to be improving so it caught me off guard when his room was empty last night when I came in for work.

So far, this experience has brought both new clarity and new confusion for me as I think about end of life issues. In seeing the suffering of that woman with the wound & infection, I can see why people would think that alleviating that suffering through death (even high doses of narcotics did not appear to be helping in this poor woman's case) is a good option to consider, particularly if they have chosen it, either through a conscious decision at the time or through an advanced directive. I can even see where people could think its a good idea to eliminate their suffering even if such a patient has made their intentions clear. No one wants to see another person suffer needlessly and if pain management techniques aren't working, as they frequently don't, then the only remaining option is taking their life. Of course, one could argue that there is a profound difference between eliminating life support and actively euthanizing someone, and I agree that there is. However, I have noticed among some of my coworkers the intent of using terminal weans as euthanization - the person is in pain, there is very little chance of recovery or improvement, so why not just get it over with? They even berate the family, behind their backs of course, for not making the decision any sooner in the process. Case in Point: Last night, we (me and a couple of nurses) were discussing a patient who has been in our facility for a while - he is not only not improving, he's starting to slide a bit. But if this is the beginning of the end, its going to take a long time for him to die. One of the nurses opined that the "best thing for him would be to die." I pointed out that the man is alert & oriented. She basically said "yeah, that's rough." Here she is talking about a man, a human being made in the image of God, as if his life is worth absolutely nothing. Is his life very meaningful right now? No, its clearly not and he is just as clearly being a "drain on society" by gobbling up the resources necessary for his care, but does that mean that he should just die?! I'll grant that her view is not representative of all the nurses on staff, but its not uncommon.

It is precisely this compassionate impulse that makes clear and careful thinking about these end of life issues so incredibly important. When things become frought with emotion, or in some instances, a complete lack thereof, our feelings can easily override good moral thinking. We can lose our path quickly and easily. This is where the new clarity is coming into focus for me; we absolutely have to hold the line on these issues because, quite frankly, most of use aren't equipped for the hard thinking they require. And the confusion is that I know I'm not equipped for that yet and certainly am not in a position where I can influence any policy on this matter. Over the course of my education, I'm sure this is going to be something I need to learn a great deal more about.

* If you have family in the hospital for an extended period, probably one of the best things you can do is to make sure your loved one is getting turned at least every 2 hours.