There is nothing as amazing to me as the eyes of someone that is vented- where you know that the person is there- ready to enter back into life and take over their own breathing. There are some patients that just grab you with their eyes, pulling you closer and asking the hardest question of all-why?
Those patients are the ones that I take with me when I leave. I have never been a person that things about prayer as a way, often resorting to the COTHism of jingles. For these patients, the ones that stay in my vision, these are the ones that I think about during my days off.
I think that being able to be an active part in these patients lives will be one of the best parts of being a PA....
Monday, August 18, 2014
A few that touched my heart
(disclaimer- Clive knows he is in this blog and was very excited about it!)
This is Clive', or CJ as his friends and family know him. CJ is one of those very special patients that will not be forgotten, and deserve serious mention.
He came to our unit (CICU) and is being worked up for a few issues. CJ is legally blind... and very VERY shy. He is 19 years old. To say that the past several years of his life have been hard would really be an understatement.
But look at this smile. That smile only peeked out a few times, but with this smile, CJ could move mountains. I really hope that he one day sees himself in the same sort of lovely light that we saw in him. He was very worried about pain, and felt scared. I was there when he got his PICC and thereby was able to see just what a lovely young man he is.
Yesterday was Easter. CJ had no family to visit him. I had some easter candy I was going to offer up for the night shift, I decided (knowing that I might be in trouble, but oh well...) to make him an Easter Basket. I was lucky enough to find a basket that suited in our cabinets, and proceeded to fill it with as many goodies as I could find. I carried it over to CVC and presented it to CJ. Now, imagine that smile with the light of lots of candy...chocolate...jelly beans....! That hug he gave me made up for all those exhausting nights working, those back to backs that made my head pound. Thank you CJ...for making my last day as a Tech one of my best days.
So, I will look at CJ's picture in the coming months, and this will help me remember why I am walking down my path. Because it's this smile that makes everything worth it.
A thank you to those that mentor
to all that were kind enough to mentor me during this process. I realize that this was an invasion of your work day, time away from getting your job done efficiently. I realize that with each patient that came in the door, you realized, as did I, that my being there was an invasion of their lives- their most private lives. In this, I must also that the patients that accepted me and allowed me to eavesdrop into their visit.
By allowing someone to shadow, to experience what the real word of being a PA, you have given a gift both to the future PA but also to the profession. It is not surprising that it's a requirement to shadow a PA for acceptance into most programs. The day to day life of each PA and their particular area of practice is vastly different from each other. By looking at each particular PA I shadowed and what their careers entailed, I was able to see the possibilities for my own career, and honestly, give me some "oomph" in the rather tedious process of pre-reqs.
I had wonderful PA's to shadow. I sat in on morning rounds, grand rounds, the weekly trauma meetings, and cardio-thoracic meetings. I was in the hospital, in clinics, in private offices and in the Student Health center. I saw a lot- stitches, a very interesting I & D, burns, a freshy pregnant woman, a first pelvic, numerous UTI's, skeletal issues, and things I just had never thought of- how does someone get something stuck in their ear? Especially if they are over the age of six?
So, thank you. Thank you for your time, your advice, your support. Thank you for offering an ear and saying "if you need anything, just drop on email!" Thanks for the tips on surviving school, for the copies of notes taken, for the books passed on. Thanks for taking your time, both for and with me, but for the profession itself.
By allowing someone to shadow, to experience what the real word of being a PA, you have given a gift both to the future PA but also to the profession. It is not surprising that it's a requirement to shadow a PA for acceptance into most programs. The day to day life of each PA and their particular area of practice is vastly different from each other. By looking at each particular PA I shadowed and what their careers entailed, I was able to see the possibilities for my own career, and honestly, give me some "oomph" in the rather tedious process of pre-reqs.
I had wonderful PA's to shadow. I sat in on morning rounds, grand rounds, the weekly trauma meetings, and cardio-thoracic meetings. I was in the hospital, in clinics, in private offices and in the Student Health center. I saw a lot- stitches, a very interesting I & D, burns, a freshy pregnant woman, a first pelvic, numerous UTI's, skeletal issues, and things I just had never thought of- how does someone get something stuck in their ear? Especially if they are over the age of six?
So, thank you. Thank you for your time, your advice, your support. Thank you for offering an ear and saying "if you need anything, just drop on email!" Thanks for the tips on surviving school, for the copies of notes taken, for the books passed on. Thanks for taking your time, both for and with me, but for the profession itself.
What the patient says means a lot
So I did indeed say I wanted to write more in the blog. I have evidence that this is a good thing -The Academic Life in Emergency Medicine Blog- which has reference to blogging as being good for medical education and promoting self awareness, increasing compassion...which everyone needs more of, but I seem to have in abundance and actually gets in my way at times (how's that for a sentence!). The ED rotation work has shown me that I had best pick up the speed....but I care if they are anxious about their kids and their work and their...I digress again Argh!
Obviously I have not done this better blogging thing. But I have thought about it. That road to hell is indeed paved with good intentions. So, here I am. And I have over 100 pts to log, a garden to ready, and a week of grandkids, kids, graduation, parties, and...more. But the strange thing is I have been thinking about a few patients -a lot.
What has stuck is the patients that stick. Yeah, I know-terrible prose. But I have experienced a few patients with stories that have really stayed with me over the years-the ones that wake me and I think- what went wrong? Or right? or what could I have done now that might have made the outcome better? And so, I'll mention them again, maybe some for the first time but...and hopefully, when I have some time, I will expand on their stories as I remember them. But for now....
There was the man who came in the the unit late one night- he was youngish, 50's? Had a hx of cardiac issues. He came in with his with his family- all were scared. As the medics wheeled him past, he looked at me, and said...I am really scared I am going to die.
Anyone that knows and heard this statement knows it's not one that you want to hear. Especially in this sort of pt. You'd think he'd be fine- he should be fine. But that sense of forebearing makes me nervous- always evokes that "thump" in the pit of my stomach. I was hooking him up and looked him right in the eye and said "we are going to do everything we can to make sure that does not happen." Dangerous statement- because while we can do everything, some things can't get fixed.
So without details, he did indeed die. I, of course, felt I had let him down. But the strange thing was this: He was still there. I mean it. Still in the room, still felt totally alive. His heart pumped nothing, his lungs exchanged no O2, his brain had not one discernible electrical wave. I have wrapped many a body, and some I believe were long gone in spirit before we readied them for the family and the final visit. This man was very much there, as confused as the other humans in the room when the code was called. This is a man that was not ready to die. Wanted to live. Wanted to see his kids grow, marry, and carry his grandkids. He wanted to do what most get to do, and don't even appreciate. His body died long before his soul was ready.
Often when wrapping a body, there is light talk, and sometimes laughter- it's a horrible task, really. That last zip as we close them inside the bag- it is so horribly finite. So, laughter can ease the time and stress of the task. There are some realities that happen at the end of everyones life that have to be taken care of. Some are not so nice, and really rather smelly. So, yes, while it seems terrible, there are some very bad jokes told- some bad situations that we've gotten into that do cause giggles to escape when it seems quite wrong.
For this gentleman, there was no talk, just whispers, and then, a soft prayer-for the transition he so badly did not want to take to go smoothly, because he was kicking and fighting the entire way. I spoke to him when doing my work- and I admit, tears were there. Because I really had let him down- a promise made that I could not keep...medical science had let him down. But finally, it was his body that had really let him down- while there are some things that can be fixed, so many can't. He could not be fixed.
He I will never forget.
Obviously I have not done this better blogging thing. But I have thought about it. That road to hell is indeed paved with good intentions. So, here I am. And I have over 100 pts to log, a garden to ready, and a week of grandkids, kids, graduation, parties, and...more. But the strange thing is I have been thinking about a few patients -a lot.
What has stuck is the patients that stick. Yeah, I know-terrible prose. But I have experienced a few patients with stories that have really stayed with me over the years-the ones that wake me and I think- what went wrong? Or right? or what could I have done now that might have made the outcome better? And so, I'll mention them again, maybe some for the first time but...and hopefully, when I have some time, I will expand on their stories as I remember them. But for now....
There was the man who came in the the unit late one night- he was youngish, 50's? Had a hx of cardiac issues. He came in with his with his family- all were scared. As the medics wheeled him past, he looked at me, and said...I am really scared I am going to die.
Anyone that knows and heard this statement knows it's not one that you want to hear. Especially in this sort of pt. You'd think he'd be fine- he should be fine. But that sense of forebearing makes me nervous- always evokes that "thump" in the pit of my stomach. I was hooking him up and looked him right in the eye and said "we are going to do everything we can to make sure that does not happen." Dangerous statement- because while we can do everything, some things can't get fixed.
So without details, he did indeed die. I, of course, felt I had let him down. But the strange thing was this: He was still there. I mean it. Still in the room, still felt totally alive. His heart pumped nothing, his lungs exchanged no O2, his brain had not one discernible electrical wave. I have wrapped many a body, and some I believe were long gone in spirit before we readied them for the family and the final visit. This man was very much there, as confused as the other humans in the room when the code was called. This is a man that was not ready to die. Wanted to live. Wanted to see his kids grow, marry, and carry his grandkids. He wanted to do what most get to do, and don't even appreciate. His body died long before his soul was ready.
Often when wrapping a body, there is light talk, and sometimes laughter- it's a horrible task, really. That last zip as we close them inside the bag- it is so horribly finite. So, laughter can ease the time and stress of the task. There are some realities that happen at the end of everyones life that have to be taken care of. Some are not so nice, and really rather smelly. So, yes, while it seems terrible, there are some very bad jokes told- some bad situations that we've gotten into that do cause giggles to escape when it seems quite wrong.
For this gentleman, there was no talk, just whispers, and then, a soft prayer-for the transition he so badly did not want to take to go smoothly, because he was kicking and fighting the entire way. I spoke to him when doing my work- and I admit, tears were there. Because I really had let him down- a promise made that I could not keep...medical science had let him down. But finally, it was his body that had really let him down- while there are some things that can be fixed, so many can't. He could not be fixed.
He I will never forget.
Peds
I am currently in the beginning of my peds rotation in Ann Arbor. I have an amazing preceptor, who loves to teach (there is so much to be said for that!) and the practice is far more varied than I expected in Ann Arbor.
He has been practicing for over 30 years. But, he stays young, and strong, and everyone loves him. They are not dependent, however, on him, and he is busy enough that having people call in, or only RV when needed is the norm. As I said he loves to teach, and takes a lot of moments to teach, which are great and welcome for me.
I've seen 2 mono's (one clear case of mono, and one not-so-clear but both spot tested +) and 2 cases of Pityriasis rosea. Mono, I expected, but pityriasis not so much. I always figured it would be a board question and that's that. But the herald patch was noted in one kid, and the other one not as clear a beginning, but the christmas tree pattern was clear. "Score!"
I think this is my last easy rotation, so I hope that I use the time well. Other than that, things are heading towards Nick leaving, and I am heading towards being an empty nester. Feels kind of good! At least today it does....
He has been practicing for over 30 years. But, he stays young, and strong, and everyone loves him. They are not dependent, however, on him, and he is busy enough that having people call in, or only RV when needed is the norm. As I said he loves to teach, and takes a lot of moments to teach, which are great and welcome for me.
I've seen 2 mono's (one clear case of mono, and one not-so-clear but both spot tested +) and 2 cases of Pityriasis rosea. Mono, I expected, but pityriasis not so much. I always figured it would be a board question and that's that. But the herald patch was noted in one kid, and the other one not as clear a beginning, but the christmas tree pattern was clear. "Score!"
I think this is my last easy rotation, so I hope that I use the time well. Other than that, things are heading towards Nick leaving, and I am heading towards being an empty nester. Feels kind of good! At least today it does....
Mrs A
I had not been back at the U for long, so had not acquired my ICU shoes all that well yet when a pt entered my life in a way that few patients ever will.
She was on "the list" and had been several times. Each time, you get to "stay on" for a certain amount of time, and then, get taken off, moved out of the ICU (usually at least), have another full work up, and get re-listed. This happens several times for some patients, and it, I am sure, is most frustrating. Our unit remains one of the few that have not been renovated to the degree that being in the 2010+ years seems that it should be- and whomever designed the rooms clearly had never taken care of a patient that was on precautions.
Mrs. A had done the List Dance several times by the time I had really gotten to know her and her family. She had a devoted husband who kept her laughing, and family that cared. She was lucky that way. What she was not so lucky in, however, is exactly how sick she was. Obviously, being on the list meant something was seriously wrong, but also she kept getting those little annoying nosocomial infections. Okay, that is a huge understatement; she never came down with one of the Big Ones (MRSA, VRSA, C-Diff) but the ones that take one off the list but aren't that terrible to actually have.
Her husband had left for the evening, and she called me into her room. I asked her what she wanted and she said "I don't want to be re-listed". It was more than that, really but the end result was she was done. She had had it, and just was tired. At this point, she thought she had been in the hospital for about 6 months. I called in our Fellow (after explaining that I was not the person who needed to know this, but someone that might be able to actually DO something about this needed to hear this from her.) We all cried but clearly, we all understood. One can only take so much. Her reason for staying the path thus far had been for her husband- as I remember it, she said she was really ready months earlier, but she knew he would not want her to make that decision. I was not there the day of the family meeting, but clearly, when one loves as deeply as they loved each other, the decision was made.
Problem was- she had to stay with us. Her meds were not ones that could be stopped quickly and she could not be D/C'd to hospice on the meds. So, weaning began. She did well, and things went as smoothly as can be.
Mrs. A comes back to me a lot during my thoughts of special patients. But this weekend I had a very special Mrs. A moment. Ann Arbor has a lovely thing called Top Of The Park where local musicians play. There is some serious talent in the area. A man named Levi Johnson and his band played this past weekend. As I am wont to do, I began to dance- his was a funky, motown sound that makes even the most tired of feet move. He began (as a black man) to sing "Play That Funky Music White Boy" which brought me back to the last time I saw Mrs. A.
I asked Mrs. A what she wanted most of all and her answer was some good music. Her husband was there- and I asked what that was exactly. I was thinking my Jack Johnson and Michael Fronti might not be it. I was right- They wanted some good soul or funk- 70's type music like- oh- "Play That Funky Music White Boy" So, thank you to iTunes, I downloaded a few songs, we closed the curtains and turned the iPhone up as loud as we could and danced. Well, she moved in her bed and her husband and I danced. I remember that moment, and knew then that this was to be one of those moments I'd never forget- a white woman, in scrubs, in a tiny ICU room, dancing with a black man, and his wife moving as best she could, to the sounds of Motown. I realized then and know now, how absolutely lucky I am to have known them, their love, their courage.
Mrs. A died a week or so later. Her husband was there as were a few of our nurses that went to stay with her at the end. Someone posted a picture of her before she got ill- and she was startling in her beauty. The thing was, I saw that beauty from the inside of her, and it remains one of the most beautiful things I have ever known. My memory of her lives to this day.
She was on "the list" and had been several times. Each time, you get to "stay on" for a certain amount of time, and then, get taken off, moved out of the ICU (usually at least), have another full work up, and get re-listed. This happens several times for some patients, and it, I am sure, is most frustrating. Our unit remains one of the few that have not been renovated to the degree that being in the 2010+ years seems that it should be- and whomever designed the rooms clearly had never taken care of a patient that was on precautions.
Mrs. A had done the List Dance several times by the time I had really gotten to know her and her family. She had a devoted husband who kept her laughing, and family that cared. She was lucky that way. What she was not so lucky in, however, is exactly how sick she was. Obviously, being on the list meant something was seriously wrong, but also she kept getting those little annoying nosocomial infections. Okay, that is a huge understatement; she never came down with one of the Big Ones (MRSA, VRSA, C-Diff) but the ones that take one off the list but aren't that terrible to actually have.
Her husband had left for the evening, and she called me into her room. I asked her what she wanted and she said "I don't want to be re-listed". It was more than that, really but the end result was she was done. She had had it, and just was tired. At this point, she thought she had been in the hospital for about 6 months. I called in our Fellow (after explaining that I was not the person who needed to know this, but someone that might be able to actually DO something about this needed to hear this from her.) We all cried but clearly, we all understood. One can only take so much. Her reason for staying the path thus far had been for her husband- as I remember it, she said she was really ready months earlier, but she knew he would not want her to make that decision. I was not there the day of the family meeting, but clearly, when one loves as deeply as they loved each other, the decision was made.
Problem was- she had to stay with us. Her meds were not ones that could be stopped quickly and she could not be D/C'd to hospice on the meds. So, weaning began. She did well, and things went as smoothly as can be.
Mrs. A comes back to me a lot during my thoughts of special patients. But this weekend I had a very special Mrs. A moment. Ann Arbor has a lovely thing called Top Of The Park where local musicians play. There is some serious talent in the area. A man named Levi Johnson and his band played this past weekend. As I am wont to do, I began to dance- his was a funky, motown sound that makes even the most tired of feet move. He began (as a black man) to sing "Play That Funky Music White Boy" which brought me back to the last time I saw Mrs. A.
I asked Mrs. A what she wanted most of all and her answer was some good music. Her husband was there- and I asked what that was exactly. I was thinking my Jack Johnson and Michael Fronti might not be it. I was right- They wanted some good soul or funk- 70's type music like- oh- "Play That Funky Music White Boy" So, thank you to iTunes, I downloaded a few songs, we closed the curtains and turned the iPhone up as loud as we could and danced. Well, she moved in her bed and her husband and I danced. I remember that moment, and knew then that this was to be one of those moments I'd never forget- a white woman, in scrubs, in a tiny ICU room, dancing with a black man, and his wife moving as best she could, to the sounds of Motown. I realized then and know now, how absolutely lucky I am to have known them, their love, their courage.
Mrs. A died a week or so later. Her husband was there as were a few of our nurses that went to stay with her at the end. Someone posted a picture of her before she got ill- and she was startling in her beauty. The thing was, I saw that beauty from the inside of her, and it remains one of the most beautiful things I have ever known. My memory of her lives to this day.
Peds find...
On the "interesting cases" kind of note- Saw an honest to God spontaneous Pneumo ("Large" according to the radiologist...wish I could have seen the films, to correlate PE findings with visual understanding).
Yes, Tall, skinny kid. But No SOB, nor any other serious "OH DEAR GOD" signs. Just an amazing MD who caught it during (yup) a routine PE. I'd bet that the kid was kind of miserable and made the appt. He had not been in for 3 years. I did notice fairly pink (red?) cheeks, which I remember seeing in my CO2 pts before. No ABG or BG to see, I am sure they did that at the ED. I'd also like to have seen that, but honestly, I am hoping it's venous, as this kid was already scared enough. Just writing about it gives me the heeby-geebies. My biggest issue is knowing that he might be in for a world of pain. And, came into the office without family attached to his side. In his car.
Ugh. But nods to an amazing peds MD who A) Caught it, and B) called me in to hear it. Did not say "This is what this is" but let me listen, and think. What I heard was cracking, and "far away" sounds on auscultation. Only way I could describe it.
Yes, Tall, skinny kid. But No SOB, nor any other serious "OH DEAR GOD" signs. Just an amazing MD who caught it during (yup) a routine PE. I'd bet that the kid was kind of miserable and made the appt. He had not been in for 3 years. I did notice fairly pink (red?) cheeks, which I remember seeing in my CO2 pts before. No ABG or BG to see, I am sure they did that at the ED. I'd also like to have seen that, but honestly, I am hoping it's venous, as this kid was already scared enough. Just writing about it gives me the heeby-geebies. My biggest issue is knowing that he might be in for a world of pain. And, came into the office without family attached to his side. In his car.
Ugh. But nods to an amazing peds MD who A) Caught it, and B) called me in to hear it. Did not say "This is what this is" but let me listen, and think. What I heard was cracking, and "far away" sounds on auscultation. Only way I could describe it.
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