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If your leg hurts, don’t wish to cut it off

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A woman in her 50s was treated in a burn center and brought to our facility for continued medical treatment of her delayed healing leg. It looked like she got her lower leg stuck underneath a lawn mower, when it was actually due to a heating pad. Surgery was done to clean out the wound and remove dead tissue. External fixation was placed to ensure proper placement. After 3 months of hospitalization, the patient decided to get it amputated due to the severe pain. She was also aware that even if the leg healed, it would take extensive rehab to ever walk again.

This scenario justifies the importance of pain management and education. Pain is now seen as the 4th vital sign. We ask everyone if they are in pain and will medicate the said pain if present. Many patients immediately expect narcotics and opioids to be the only relief for their pain. Educating on nonopioid or no nonpharmacological pain management is crucial to effectively treat pain. These modalities include NSAIDS, ice/heat therapy, massage, imagery, and movement among others.

This patient had several moderate dose narcotics available as well as IV ketoralac/ Toradol. The only medication that was actually effectively for a long duration was the Toradol.

Toradol is classified as an NSAID and can only be given up to 5 days to prevent GI bleeding and kidney issues. However, with it being an anti inflammatory, this medication was greatly effective for a recently amputated leg. The patient was aware of that and only requested the Toradol for her pain. Education is key.

Aside from the pain management of this woman, her positive outlook on her situation is also what leads to positive healing. She repeatedly stated how God will bring her through any situation she faces. She was confident that this was in her plan and was determined to do anything it took to heal her body.

We actually developed a good rapport after realizing we both favor a particular pastor and both plan on attending his church after the pandemic.

It is important to not simply treat the patient, but to try and communicate with them as human beings. You never know who is in that bed.

When I was going off shift, she reminded me that if my leg was ever hurting, not to wish to cut it off.. I plan to take that advice to heart.

Until next shift,

Shania

If I could only have half of the faith… angels in disguise

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50 y/o female with multiple myeloma and leukemia presents to the ER for a fever… a medical emergency in one receiving chemotherapy due to myelosuppression.

She has been in and out of hospitals to receive chemo and then be readmitted for the side effects of cancer.

I walk into the room and she is diffusing essential oils, she is riding around the hall and her room in her wheelchair, she is cracking jokes, she is laughing, and has the biggest smile on her face, and she asks about everyone’s personal lives when they walk into the room. I have never met someone with as much hope, faith, joy, and someone who as closely resembles Jesus as this precious woman.

She told me that Jesus will put angels in your path and I was one of hers. I can say that Jesus put her as my angel during my past three, challenging shifts.

Covid has brought a much higher acuity census to the caseload and this week has been stressful, challenging, and draining.

Her joy and optimism brought the just needed light into my week. I fortunately was able to sit with her for quite some time as I administered blood transfusions.

The highlight of my entire nursing career thus far was when she asked to go to the main lobby to play the grand piano. I was able to wheel her down in her wheelchair with her IV pole, mask, and lots of hand sanitizer to go sit and play her joyful noise. I couldn’t help but become teary eyed.

Even through everything that she was facing, she continued to minister to others and bring such joy into their lives. If I have half of the faith of this Godly woman, I will be okay.

It is a reminder that even on the toughest days; take a deep breath and trust that God has your back.

Until next shift,

Shania

A Faith of Thorns

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I recently had a patient encounter with an elderly woman and the conversation is as follows:

“Do you think God is creating this virus to destroy the world like he has done in the past? Like he is wanting us to learn something?”

(Me) “I think God is good and would not create this kind of destruction. He has said after the flood that he would not destroy the earth like that again. He said that he works everything out for good. He did not say that everything will be good. The enemy is present to kill, to steal, and to destroy. I believe this is not God.”

(Patient) “I grew up in the Church of Christ and do love God. I have lived for over 70 years and never in my life has something like this happened. I just can’t wrap my head around why. Where is God in this?”

I didn’t really know what to say at this point, other than to listen and ponder with her. I know God did not send this pandemic, but I will never know why it has occurred in this lifetime. I have tried to focus on only positive thoughts such as having more time to learn a new hobby, catching up on Netflix, spending time at home, and enjoying the presence of immediate family; however, the energy of the world is filled with fear, anxiety, and isolation.

Jesus describes the purpose of parables in Mark 4 by defining three different foundations of faith:

1. Rocky soil= hear the word, accept the word, but have no root and when tribulation comes, the faith falls away.

2. Thorns= hear the word, however the desires of the world overpowers the faith.

3. Good soil= hear the word, accept the word, and spread fruit (joy, faith, success) in multiples.

I would like to think that my faith has a foundation of good soil. I like to think that my optimistic persona will radiate and disperse the fear that is all around me. However, as I write this post, I feel like my faith is grown in thorns. The stresses and worry of current life are drowning my joy and hope I have in Jesus. In the words of my sweet lady, “where is God in this?”

I don’t know, but I do know that I will find out one day. For now, I will hope for the future as I know this too shall pass. I will continue to find joy in the little things. And I will continue to trust that God is with us.

Until next shift,

Shania

“And these are the ones sown on rocky ground: the ones who, when they hear the word, immediately receive it with joy. And they have no root in themselves, but endure for a while; then, when tribulation or persecution arises on account of the word, immediately they fall away. And others are the ones sown among thorns. They are those who hear the word, but the cares of the world and the deceitfulness of riches and the desires for other things enter in and choke the word, and it proves unfruitful. But those that were sown on the good soil are the ones who hear the word and accept it and bear fruit, thirtyfold and sixtyfold and a hundredfold.””
‭‭Mark‬ ‭4:16-20‬ ‭ESV‬‬
https://www.bible.com/59/mrk.4.16-20.esv

Please, do not wish to die

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Our God is a way-maker, miracle-worker, promise-keeper, a light in the darkness. God will put you out of any situation no matter how wide, how deep, how high, or how low it may be. It breaks my heart to see hurting people believing that ending their life is the only solution.

Suicide is the 2nd leading cause of death for ages 10-24 year olds and continues to increase yearly. Speaking with suicide survivors actually reveals that a majority of them regret their decision to take their life and are thankful that their attempt was unsuccessful.

Patients so often state how “they want to die, they are a burden to their families, they are terminal anyway.” Nurses make comments after a long day such as “kill me. Shoot me. etc.” Our language has power, and we may not realize the hurt someone actually feels behind their “joking” words.

Life is so so beautiful. If you don’t see it, be around those who do. Engage yourself within nature and a healthy community. There is breath in your lungs. Joy comes in the morning.

Please, don’t wish to die.

Until next shift,

Shania

Suicide resources:

suicidepreventionlifeline.org

1-800-273-8255

Death: You cannot doubt God

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“What matters is not the meaning of life in general, but rather the specific meaning of a person’s life at a given moment” – Man’s Search for Meaning by Viktor Frankl 

Working with many hospice families on the medical floor, there are so many stories that cannot be explained by science, alone. Each death is different, surprising, and often, beautiful. Supporting a grieving family as they wait and watch their loved one take their last breath brings me to the core of nursing care. No computer, no doctor, no book, and no prayer can comfort like the personal touch of the nurse.

I have seen oxygen saturations in the 70s jump to 100% as a family member walks in to say goodbye. I have seen patients who hang on until they find their last bit of closure whatever that may be before crossing over. I have seen obtunded patients open their eyes and use all of their remaining energy to say a few last words to their family members before closing their eyes for eternity. Death is and can be beautiful.

The first death I experienced was when I was still on orientation. It was a man who battled many years of cancer. He was literally skin on bones. His daughters and wife were at bedside, and it is the family that breaks your heart the most. They sat around his bed and talked about all of the memories that they shared together. They showed me a picture of him, a healthy 180lb man, now a 60lb man laying in the bed. Those are images you can’t forget.

Caring for Hospice patients and families is some of my favorite cases because of how real and genuine the emotions are. At the bedside, nothing else matters except the love and belonging the family has left.

Some families grieve with anger, some with prayer, some with thankfulness, and some with silence. Some patients wait for families to step out of the room before passing, some wait for a bath, some wait for a blessing, and some go suddenly.

It is crucial to maintain the compassion for each of these families. It is easy to appear too busy or even to become insensitive to these life events. The most important thing for palliative care and hospice is to simply be present. Sit down and listen to the family wishes and hopes. It is okay to cry with them, I often do. Cry, and then carry on. Focus on each patent encounter individually. One room at a time.

Death is a beautiful thing.

Until next shift,

Shania

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