A night in the ED

It was a rough week for clinical. I came in on our usual clinical day, Thursday, despite not having to, thinking I could get in a few extra clinical hours before my ED assignment on Friday evening. Thursday was more than I bargained for. Since I wasn’t actually assigned to come in, I thought I might be a floater, and not have any patient assignments, as was done in the past for other students, but I was wrong. OK. Shrug it off. So it’s a little more paperwork. As I was walking down the hall to find my patient, I heard moaning and cries. I looked at the room number, saw it was mine, and my heart froze for a second. I knew it was not going to be an easy assignment, and I was right.

It was manageable right until she was told she was NPO, and then things got hairy. She wanted to go home, threatening to walk right out, despite not even being capable of standing up without 2 person assist. For most of the evening, there were at least two of us in there, trying to keep her calm and in bed. I pulled out every distraction trick I knew, and sometimes it worked, while other times it didn’t. It was horrible. I felt horrible. I wanted to ease her pain and help her find solace, but all I could do was hold her hand and stroke her hair as she oscillated between quiet sobbing and shrieks for the doctor, her mother, her boyfriend. I felt so powerless.

I came home exhausted and my body screamed in pain. And when I woke up the next morning, I had to prepare for a night in the ED. This weekend there was a huge event going on for the local college, and I was thinking it’d be a night sobering up college kids who had partied too enthusiastically, or watching the suturing of lacerations left behind by the cocktail of machismo and youthful impulse. But I wasn’t on that side of the ED last night. Instead, we had more cardiac emergencies, angina, etc. and one particular patient got me thinking.

He was an older gentleman and his wife, who came in because of shortness of breath and chest pain. They were such a pleasant couple, still in love with each other and endearing to watch. And for the rest of the evening, I thought of myself and my husband being in that position. Both of us, a few decades older than we are now, me using a walker to get around, and he with his pleasant ways, despite not feeling well and sitting on a gurney with monitors beeping and buzzing and leads getting tangled with very hand gesture. He relied on her to know his meds and help give the RNs some history. And I wondered to myself how it would be when my husband and I got older.

Would I be able to help us accomplish the basic ADLs without help at that age? Will I be able to help him to and from the toilet? Would I be able to help myself? Would we be able to afford help? It’s a scary proposition getting older, and for the first time, I’m beginning to see myself in the shoes of the patients I come in contact with…

I came home exhausted, physically and emotionally, and I wonder how these nurses do it every day, 12 hour shifts, constantly working because of understaffing, and keeping their families in one piece. These people are strong people, accomplished people, and I admire them more with each passing day.


Latest LLMD Appt and my Future as an RN

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Woke up at about 3:30 this morning with a nasty headache. I’m guessing I should not have stopped my birth control pill (being taken as an attempt to moderate my progesterone levels) so abruptly. Hopefully, I can start on a new pack (and different brand) soon which will even things out again. So, there is an end in sight.

I saw my LLMD yesterday afternoon. Not because I was having symptoms that needed attention, but because my insurance is about to change, and I wanted to get in a visit before my copay more than quadruples. As it turns out, she’s not convinced the antibiotic treatment is benefitting me at this point, so she wants me to discontinue those meds. I can remain on my herbals though, and she gave me a script to keep on hand in case things go south fast, but for a different medication, and I need to look back into my notes to remember the benefit of pulsing that particular med.

We also did some blood work. She hasn’t taken an MSH level in over a year, so it’s time to update that, and see if it’s gotten any better. I still need to educate myself on the implications of MSH and how it applies to my case. I know it can measure immune function, but beyond that I’m clueless. More reading. More researching. Because nursing school doesn’t have me reading enough!

I’m pretty sure (and another LLMD that I see occasionally agrees) the Lyme and co-infections screwed with a few of my endocrine glands, and getting them up and running properly is my next goal. The thyroid meds have definitely had an impact of many of my previous hypothyroid symptoms, like intolerance to cold, fatigue, dry skin, etc. But I remain overweight, and it’s clear that other hormones are at play (like my female hormones) and that the chronic inflammation that has continued for so long has also been a factor.

We also talked about my future as a nurse. Graduation is next May, and I’ll need to get some acute care experience before I can be considered for a Master’s Degree Program, earn my FNP, and settle into a practice aimed at helping others not just with Lyme, but with other chronic illness that doesn’t respond to cookie cutter medicine. (This has been my entire goal from the start.) I think this is partly why I’m so jazzed about nursing. It’s so patient oriented. It’s drilled into us from the first semester: patient advocacy. And that is my drive. Patient focused care. Individualized care. But she knows as well as I do, if I remain stagnated at this level, it may be tricky finding a particular area of nursing that leaves me capable of working within my physical limitations.

But then, what if I make a full recovery by then? Dare I dream that big?

Cycle of Pain and Depression

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Yesterday was excruciating. By the end of the day, I was practically immobile. I was in bed early last night (7ish) after drugging myself with a Flexiril and some prescription strength Alleve. And now I am up early in the am, looking online through my college’s library system, for peer reviewed articles on hormones and pain. Since my pain is cyclic, and it amps up around the time of ovulation and menstruation, I was hoping to find some studies dealing with chronic pain and female hormone imbalances. In addition to my thyroid being off (another factor in chronic pain I am learning), my progesterone is low.

Initially we tried progesterone replacement 2 weeks out of every month, but it made me so dizzy that I couldn’t attend a clinical rotation, for fear of my poor judgement and clumsy actions could put a patient at risk. So for the past few months my Ob/Gyn put me on a birth control pill, but that has been far worse for me pain wise, as my period is so irregular now that my pain can hit horrific levels, and are unpredictable.

Its days like yesterday that bring me down to scary emotional lows. I can get to the point where I tire of the constant battle that is this disease, and question my ability to finish my education. I am tempted to give up the fight altogether, and my mind has indulged that fantasy more in recent months because the pain can get so bad, and interfere so much with my daily life.

And I become far more sensitive to the insensitivity to others. I lost it yesterday, when someone expressed disappointment in my having to change plans, and I screamed, “I am sorry my illness inconveniences you!” I’m not proud of myself, but I am at the end of my rope. The pain is so all encompassing, and so intense, it changes who I am.

This morning I broke down into tears. My husband asked me not to cry as he went to work. He didn’t want to leave me in tears, both of us powerless to really do anything about it. So I pulled it together for his sake, just long enough so he could walk out the door. But even now the tears fall. I’m tired of fighting. So tired. So defeated.