Semester Four, Week Thirteen

Completed two more practicum shifts this week; one more to go next Friday, the 29th.

Sunday, my preceptor and I were on short stay procedural/cardiology, and the patient load was light enough that I was able to assume total patient care for our four patients. At the onset, it was admittedly a bit difficult getting together everyone's medications for the morning (we're talking 15-20 meds each!) As well as doing assessments, but, I prioritized care and got everything done. It was a great day, and true to how it always works out, I cared for a Jehovah's Witness patient with a GI bleed/anemia, and while a blood transfusion was what she "needed" she was able to have her volume replaced, and was later discharged. 

I also had a patient who was in alcohol withdrawal, and her CIWA score was 2, in regards to confusion on date, even when looking at the white board in her room signifying the date, she couldn't clearly identify what day it was. Anyway, her ammonia levels were elevated at 38, and she told her physician that she would refuse lactulose, because she did not enjoy the diarrhea that comes with it. (Side note: I was really excited when I heard the physician discussing lactulose, and I immediately knew I needed to check her ammonia levels).

My preceptor suggested I go in and talk with the patient, so I pulled up a chair next to her bed, and utilizing the information I learned in med-surg (woo hoo!) I held a theraputic conversation, specifically regarding AA, but also how lactulose works and how it will help her elevated annomia levels. I did not attempt to convince her of the need to take the drug, and I informed her that taking the medication was her decision, and she could refuse it, as that was within her rights. However, at the end of our discussion, she stated that she would like to take the medication after all. Both the physician and my preceptor were impressed!

During our second shift, we were assigned to the ICU, and it was admittedly a very hard day. Our assigned patients were stable, but in the room down the hall was a dying 22 year old patient, diagnosed with leukemia two weeks ago, and that morning, it was determine that she was not responding to dialysis, and despite best efforts, her pH was 6.8. As a direct result, comfort care measures were initiated.

Throughout the day, multiple family members and friends came in to say their goodbyes, and the sound of crying was heard nonstop throughout the day. The staff was clearly overwhelmed, as both this patient was dying as well as one across the hall; another young individual, diagnosed with interstitial lung disease.

Near the end of the clinical day, she died. After her family and friends had cleared out, preparations went underway to prepare her body for the morgue. I felt the need to help, and asked how I could do so. In addition to disposing of all the IV medications and fluids that had been administered, we prepared her body. 

While I have helped with the aftercare of the deceased a few times in my life, this situation felt different. For one, the patient was so young, and I was taken aback by the tragedy and destruction that cancer causes. She had presented to her physician two weeks prior with a sore throat, and diagnosed with cancer. Treatments failed, she developed ARDS and respiratory failure. It was a downward spiral, and as we cleaned her body, I couldn't help but think of all the life events she would never get to experience; 22 is far too young to die.

While placing her in the body bag, her nose began to pour blood. Her skin was jaundiced, edema all throughout. She looked peaceful; I kept looking at her hair; it was evident that she had just had it colored. She had a fairy tattoo on her right forearm, and the long dark eyelashes, and I wondered who and what she was like when she was well. It was an honor to aid in preparing her body for the morgue, but incredibly sad, and an excellent reminder of how precious life is. In that moment, it didn't matter that I had just put in over 12 hours, didn't matter that I had homework to catch up on, that I was exhausted and sleep deprived. What did matter is that a young life had been lost; someone who was clearly loved.

We spend so much time not saying the words that need to be said to people, not investing in friendships and relationships; letting people exit our lives because of conflict or strife. The loss of this young woman's life was, and will continue to be a solid reminder to strive for consistency, love, integrity and honor, in my professional practice as well as my personal life.