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Things I’ve Learned in Quarantine- A Personal Retreat (part 1)

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  1. Staying positive doesn’t mean you have to be happy all of the time. It means that on hard days, you know that there are better ones coming.
  2. Take every day to count your blessings. I have a healthy family, a paying job, a home, etc.. Social isolation began about 3 weeks after the Nashville tornadoes. There were families who lost everything and now had to remain inside a stranger’s home until it was safe to rebuild. 340 employees were furloughed at my hospital, I am very fortunate.
  3. Being alone with my thoughts sucks. My anxiety exacerbates when I am isolated. This led to phone calls, video conferencing, among other activities to stay connected without complete social distancing.
  4. Joy and tragedy can coincide. When I run through the neighborhood, I see positive quotes from children written in chalk. Countless videos have been posted about people placing thank you signs around the hospitals for front-line staff. One of the most memorable videos is from a city in Georgia who stood on their balconies and congratulated nurses as they changed shifts at a highly populated hospital. Volunteers have made masks and donated food to essential workers and those in need.
  5. I love Yoga! A friend introduced me to online Yoga videos and I do at least one every day I am off work. It’s a relaxing work out, forces me to stretch, and allows me to be present in the moment.
  6. I love community. Before all of the forced social distancing, I willingly social distanced myself. It is easy to want to stay home and relax alone without having to worry about the schedules of other people. It is easy to text, call, or FaceTime a friend for social interaction. It is easy to choose to be virtually present for a race, meeting, etc rather than physically being present. But now that virtual interaction is the only safe means of connection, I realize that relationships and community are so important for a healthy soul. Being engaged in the lives of your friends, coworkers, church, group hobbies, and family creates a sense of self-worth. I may not be fully willing to go out of my comfort zone and seek connection, however when I do, I always feel so much better after. The conversations that can be had with people with common interests and those in my daily circles improve my life. Connections and experiences are what is remembered for years to come, not what I gift or create myself.
  7. The rise of telemedicine.
  8. Homemade peanut butter cups are easy and delicious. Not to mention they are great with afternoon coffee!
  9. I have grown more in love. This “staycation” with my fiancé has allowed us to do all of the things we enjoy for multiple days in a row.. morning coffee while reading on the couch, yoga, running, netflix marathons, cooking, and just being in each other’s presence. I was worried about our October wedding (we have been planning for 2 years) not happening, but just going on a big adventure together wouldn’t be so bad.
  10. I have revamped my acting career.. more info to come.
  11. I am the 2020 nursing preceptor of the year.
  12. I ran my first half marathon in 2 hours, 14 minutes, and 32 seconds.
  13. I enrolled in a clinical trial to test the use of plaquenil for COVID prevention.

To Quarantine or not to Quarantine? This is Corona.

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I have debated on posting about this topic for several reasons. First, I am already tired about hearing about the coronavirus. Second, the world is in a state of panic over this pandemic and I do not want to add to the chaos. However, I am now writing because some facts and concerns need to be clarified using reputable sources.

What is the coronavirus?

There are many different strains of the coronavirus, of which 7 cause human illness. The one in concern today is the COVID-19 (coronavirus disease 2019), previously known as SARS-CoV-2.

What are signs and symptoms?

The most typical signs and symptoms in order of prevalence are fever, cough, and shortness of breath. The incubation period (time in which the disease creates symptoms) is anywhere from 2 days to 2 weeks. A majority of cases are mild and DO NOT require hospitalization. 1 in 5 people develop serious illness and around 2% of the cases have been fatal.

How do we test for the COVID-19?

Testing is increasingly becoming more available locally using respiratory specimens. Most testing is done officially by the CDC, taking 3-5 days for final results. If other respiratory pathogens are positive (influenza), then the COVID-19 is ruled out.

How is it treated?

There is no specific medication, cure, or vaccine approved for the COVID-19. Antibiotics are not effective because this is a virus, not a bacteria. Treatment is supportive- Tylenol, decongestants, rest, hydration, etc. People are advised to call the doctor’s office and if not severe, to remain home. Anyone who exhibits symptoms, but would not normally see medical care should remain home, even if they suspect the virus. Serious cases are those that require breathing tubes or assistance, and need trained hospitalized care.

Let me reiterate. Patients who present to the ED with mild symptoms are sent back home. Patients who cannot breathe are admitted into the hospital. These patients are placed on airborne and contact isolation in a negative pressure room. Health care professionals are required to wear a gown, gloves, N95 mask, and face shield when performing medical care.

Though no current medication has been specifically approved for the COVID-19, China has trialed the medication chloroquine phosphate (an anti-malarial) which was successful for SARS.

Who is at risk?

Currently, the risk for transmission is still low for the general population. High-risk populations include older adults, males, hypertension, diabetes, obesity, lung disease, and an elevated D-dimer (lab shown to be elevated in blood clotting disorders).

How to prevent the spread?

Handwashing and sanitization are the most important… why are we out of toilet paper and paper towels?

If you are sick and do not need hospitalization, stay home. The closures of schools and businesses is a way to “flatten the curve” of transmission. Large, crowded areas allow the reparatory droplets to spread through the air and infect multiple people. That is why avoiding crowds is important.

The COVID-19 is an airborne virus, so surgical masks are not effective. Surgical masks are only useful for very large particles, such as to prevent a surgeon from sneezing or coughing directly into an open wound.

Warm weather has not been proven to halt this virus.

What is the current situation?

As of March 14, 2020… Globally, there are 142,539 confirmed cases and 5393 deaths.

Final thoughts…

Yes, this is a serious pandemic. No, we do not need to panic. No, we do not need to stock up on unnecessary items like toilet paper and paper towels.

It is important to respond, not to react. Wash your hands, avoid large crowds, stay home if you are sick, and have peace over panic.

Resources

https://reference.medscape.com/slideshow/2019-novel-coronavirus-6012559

https://www.who.int/health-topics/coronavirus

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Until next shift,

Shania

A day in the life of a nurse

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Here is a “typical” hour by hour breakdown of a 12-hour shift with 5-6 patients:

0645-0730: Huddle and report

0730-1000: Gather medications, pass medications, shift assessments, review MD orders, get everyone into chair for breakfast

1000-1200: Document assessments, care round, answer call lights, call family member, clarify orders, d/c patients

1200-1230: lunch?

1230-1400: d/c and admit patients, code?, care round

1400-1600: pass medications

1600-1800: update report cards, care round

1800-1845: Make sure pain medications are given, IVF are infusing, all orders are completed and reordered, MD responses documented, I/O, care plans updated

1845-1930: Night shift report

The patient with the black fingers

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**Note: Any patient identification has been substituted to maintain confidentiality.

I had a patient last week who was found to have necrosis due to an extended infection. Her fingers were black and necrotic, however she still c/o severe pain in her hand. That morning, we had pleasant rapport and she was able to get up to the chair. Labs and VS remained stable until after lunch. Her BP started to drop with the systolic in the 70s and 80s and was resistant to fluid resuscitation. The pt was asymptomatic minus mild lethargy.

Family came to the room and quickly notified staff of a change in her condition. She was found to be slumped in the chair, however still response to commands. She was placed in the bed and MD notified.

By the end of the shift and transitioning to night shift, the pt skipped dinner and just wished to sleep in the bed. I went home.

The first thing I did when I logged in the next morning was to check on her BP overnight and review her progress. An alert came up stating that I was accessing a deceased patient. My BP immediately dropped.

The pt continued to get worse overnight and refused treatment. Her wish was to go home to Jesus and that is exactly what she did. Regardless of her wishes, I am still in shock of the events that took place that day and night.

It is so scary to realize how quickly a “stable” patient can decline. The previous morning she was up in her chair and talking to me as I am dressing her wounds. Today, she is sitting alongside Jesus’ throne.

Until next shift,

Shania

The patient that confirmed my specialty

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**Note: All names have been changed to protect patient confidentiality. This post contains graphic content and portrays the events of the shift without disclosing any patient specifics.

I originally started on a medical-surgical floor to utilize and master all of the nursing skills that were practiced in the skills lab. The first year on my own, I had an oncology patient that decided my specialty.

Oncology has always fascinated me, both biologically and emotionally. Each cancer patient I cared for were always so humble and gracious to receive the care that was provided for them in the hospital. I had one family that I will never forget.

This family came in and out of the unit every few weeks to either receive chemotherapy or to receive treatment from the complications that the chemo had caused.

This day was the beginning of the end for the Smiths. Sean could not stay awake and was increasingly disoriented. He would have brief episodes of lucid behavior and his wife would cling to these moments with all of her hope. She had a faith that could move mountains. She believed in miracles and frequently voiced how God would turn this around. I would sit with her and pray for strength and healing regardless of the outcome.

Sean’s H/H continuously decreased. He was passing clots through his rectum. I have never seen anything like it before and still have yet to witness such a horrifying event. Bright red blood passed like a fountain through his rectum whenever he stood up. It covered the floor and looked like a bucket of red paint was knocked off of the table. Luckily, his wife was not there to witness this. We safely got the patient back to bed and bleached the floor. You could still smell the scent of the massive GI bleed that had just occurred.

He had a critical hemoglobin, hematocrit, and platelet level. The oncologist had ordered 2 units of platelets, 1 unit of plasma, and 2 units of PRBCs. I remained in this room until late that afternoon. Due to the massive influx of IV fluids, Sean went into fluid overload. He was prescribed lasix in an attempt to counteract the extra fluids, and then we waited to see what his labs looked like the next morning.

Long story short, He died that night. I remember that I cried the next time I came back to the hospital and heard this news. I knew deep down that this was probably for the best as he was suffering, but I could not help thinking about the beautiful conversations of hope and healing I had with this family… and all the prayers that were not answered as we had hoped.

I sent a condolence card to the funeral home, but did not attend the funeral. The city was over two hours from my house, and I decided not to go. Now, two years later, I wish that I had.

I got a recognition letter from my manager the day after this shift to recognize the hard work I had put in to keep this family comfortable. Oncology continues to be a specialty that I will pursue whenever an opportunity arises.

Until next shift,

Shania

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