#ManicMonday

It is not even noon on Monday and the other nurse and I have already managed to send 4 people to the emergency room and 2 for other assessments and testing… and probable hospital admissions. #manicmonday There is no other explanation for it. Our phone lines are blowing up and every patient walking through the door seems to have a whole slew of problems. It is like every sentence coming out of their mouths is one of those statements that you are taught in school to immediately have sirens going off in your head. Before I even left for work I had dumped half a bottle of cumin into the chili had in the crock pot for a dinner tonight and my dog was refusing to go to the bathroom.

 

I’m a nurse… which in turn often means I’m an adrenaline junky. I thrive in environments that are high demand and high stress, but when I crash, I really crash. But I have also come to learn that I handle these situations best when I take time for myself. This means not booking up every week night and not overbooking the weekend. But some weekends life just explodes… and this was one of those such weekends.

So how do I plan to recover from this manic Monday and overpacked weekend?

1. I take it one moment at a time. I’ve learned in the last year that sometimes just don’t look ahead. Be prepared, but don’t focus on the next moments. Take it one moment at a time.

2. I pray and ask others to prayer. Whether its prayer or meditation or whatever it is that calms you down… make a conscious effort to do it.

3. I make sure I get at least a walk in. Exercise calms me down and helps me to process. So when I get home you best be betting I’ll be circling the neighborhood with my dog.

4. I hug. Research is coming out how much hugs help you in so many aspects but also in feeling loved and in reducing stress.

5. I step back and take perspective. I’m given perspective every day because of the population I work with. I’m not minimizing the amount of stress I feel but I am putting it in perspective. Yes, I’m stressed but at this moment I’m not dying, nor is a loved one dying, and I’m considered “healthy”. I’m not worrying about a possible GI bleed or heart attack. I’m just dealing with the every day comings and going of life and by perspective my stress level can quickly change.

So how do you deal with stress?

Until next time I’ll be singing it is just another Manic Monday….

I have a problem with the medical world..and I’m part of it

In the last week I have dropped more money on doctors appointments and prescriptions than the last 3 years combined. I always go to a yearly physical and dermatology appointment (and you should too), but this year there was much more going on. I have had migraines, asthma, and IBS for years, and recently they have gotten out of hand. No longer was my albuterol inhaler only needed once every couple of weeks, but it was being used daily. No longer was ibuprofen taking care of my migraines. No longer were my intestines being controlled by diet and exercise.

I don’t like taking medications unless absolutely necessary.  I would much rather change my lifestyle than take medications, however I also recognize when medications are needed.

I researched for weeks, read multiple doctors reviews,  and tentatively picked a new primary care in the suburbs. I had everything including my allergies, history, current medications, family history, and present complaints typed out for this new doctor so we could dig deep into my problems. She walks in the room, glances at my thoroughly typed out sheet, and promptly gives me 2 medications, tells me there is nothing really to do about my IBS, listens to my lungs, looks in ONE of my eyes, and walks out of the room.

I’m a nurse, nutritionist, and personal trainer. I know there are things to do. I know many are lifestyle issues. But my main issue? After I told her I had had all these horrible GI symptoms she didn’t even look at my stomach let alone press on it.  And I had absolutely no ease that nothing else is going on in my abdomen outside of IBS.

I am a part of the medical world and I left my doctors appointment beyond frustrated even though I talk the language. I left my appointment feeling like I should have never come. I left and I had a greater understanding of why so many of my patients waited years to see the doctor OR saw the doctor and their cancers took years to diagnose.

So this is my plea and my cry to the medical world from one who is in the medical world. Can we PLEASE slow down and listen as much as we can. I know demands are high. I know stress is high. But maybe, just maybe a few of us slowing down and showing that higher patient volume in small time frames is doing more harm than good.

So my medical friends out there… who is with me? Who will slow down and truly listen with me?

 

Every hug was a victory dance… A goodbye story

I am an oncology nurse. Saying goodbye and grief comes with the job. However, no matter how accustomed I am to this, it is never easy. And no matter how experienced I get with this there are patients who will always leave such a mark on my life that saying goodbye to them will be like losing a part of myself. Today, I said goodbye to one of those patients.
 
**details have been changed and left out to respect the identity of this patient**
 
I first met this patient last summer. She was coming to us with her second primary cancer. She is a young mom. She was well versed in the cancer and chemo world already. She is gracious, compassionate, has a beautiful smile, is one of the fiercest fighters I have ever met, and has taught me so much in the last months I have gotten to spend with her. Even if I could share all the details of this patient, I could not clearly put into words what an amazing woman she is.
 
This patient is one of the ones who hasn’t handled chemo well at all, in fact, she is absolutely miserable with chemo. We had every medication on board possible and every alternative treatment we could come up with, but no matter what the nausea came like clockwork. Despite the nausea though, we together as a team would battle through the chemo with one goal in sight… to give her just a little more time with her children.  And just a few months ago when she had a clear scan, we danced and hugged and celebrated together.
 
The type of cancer she has though is one where over 60% of patients with this cancer die within a year of diagnosis… and patients diagnosed when this cancer had already metastasized (spread to other parts of the body) are normally given only a max of 6 months. This disease is awful. But this brave patient stared it straight in the face and lived beyond that 6 months. Unfortunately though, because her disease is so bad that clean scan didn’t last long…
 
Last week I saw her for what I now know will be the last time. In my head I knew it would probably be the last time I would see her.. there is a 6th sense you develop after walking with so many people in their last days.. but there is always that twinge of hope… that maybe just maybe things will turn around. But they haven’t and chances are they won’t.
 
Today her mom called into the clinic stating they wanted to give an update. A few minute later before I could realize what was going on there were 3 of us on speaker phone with her as we said our goodbyes. Her body is shutting down and the cancer is winning. And this woman that has taught me so much in the last few months will soon leave this earthly home for her eternal home. I am so beyond thankful for the absolute amazing opportunity to walk with her through her cancer battle. I am so incredibly thankful for the things she has taught me about life. I said it to her and I mean it, I will remember her for the rest of my life. And some of her final words to me will stick with me forever… “Erica every time you gave me a hug at the end of each chemo it was like our victory dance… we did it… we made it through another one…” And as she said those words… I realized just how much a simple hug can mean to someone.
 
It is for this reason  and these moments that I will grieve. I will walk through these awful emotions that go with letting go of someone who has been a part of your life. It is for this that I will allow myself room to heal. It is for moments like this that I will continue to be the best nurse I can… even on the worst of days… even on days where I feel burnt out. I will put my every effort into giving them my all even when, especially when I feel like I have nothing left to give.
 
I will march through every little victory I can with my patients. Because I am their chemo nurse and I want them to know they don’t have to walk this battle alone.

My first septic patient-awareness of UTIs

I’m a cancer nurse… which means I can sense sepsis coming from miles away and can smell an infection long before the signs and symptoms occur. I can’t remember all my patients who have gone septic, but I can remember my first one and always will.

I was in my final weeks of nursing school and enjoying my last few times of just being a quick train ride away from NYC. I was about 5 minutes away from walking out my door to the train station just a few blocks away to ride into NYC for a party when I got the phone call. My best friend from high school had been battling a UTI. She had started an antibiotic but things were not proving… and when she called she sounded like death. I changed clothes, hopped in my car and drove what felt like an eternity (really only 15 minutes) to get to her apartment. I ran up the stairs flew through the door and ripped the covers off when I saw her pulsating stomach and felt her extremely high heart rate. I called a friend because I wasn’t even sure I could get Adel down the stairs. It took a while but I got her to the car and our friend Rachel met us at the entrance to the emergency department.
I quickly parked the car and ran back in. When I saw her vitals it was in that moment that I wished I didn’t know what all the numbers meant. She was quickly rushed back and an IV thrown in her as the fluids started going. 3 liters in and her blood pressure was still well below the low range of normal and her heart rate was super elevated. She wasn’t able to pee and we sat waiting. Friends were cycling in and out and I was keeping her family posted on what was going on as her mom was on her way from a few hours away. It was in this situation I learned the value of hiding my emotions. I didn’t want Adel to know just how critical her situation was.

After 3 liters of fluid and no new signs of improvement the doctors started to talk ICU. It was at this moment that Adel realized the severity of the situation. Thankfully, just a few minutes later she was able to pee and her vital signs started to stabilize a bit. She was admitted and stayed in the hospital for a few days receiving antibiotics and IV fluids.

She was my first septic patient, but I’ve seen many since then. I write this blog to educate others on the fact that even healthy, vibrant people are susceptible to severe infections. Don’t take any infection or signs of infection too lightly and if something isn’t getting better when you are on an antibiotic let your physician know because the bacteria may very well be resistant to the antibiotic your on. Your life is important :-).

Thankfully, in just a few weeks I get to stand by Adel’s side as she marries the man of her dreams and I’m so beyond thankful that she does have this opportunity :-).

**This story was shared with permission from Adel**

Young Adults with Cancer: the Fiercest Warriors I Have Ever Met

Dear Young Adult Cancer Patient,

I can’t pinpoint the exact moment, but you have captured my heart. Through my 2.5 years of nursing you have taught me far more than I could ever imagine. You have wisdom beyond your years and truly know what it means to live.

I remember the first time I saw an age younger than mine in the chart, it was a harsh reality. Despite being young, vibrant, and healthy you were still diagnosed with cancer. You weren’t even a smoker and you had lung cancer that spread everywhere… they were completely uncertain of how you in your mid twenties had gotten lung cancer.

I remember admitting you for your first round of chemo. You and your husband just a few months prior were talking about starting a family. Now you were faced with the quick reality that you would probably lose your ability to conceive and while figuring out chemo, a stem cell transplant, and dealing with the fact that you have cancer, you had to make decision on preserving your ability to have children. Life really did change for you overnight, but with a brave face you took on this challenge with a smile.

I remember you, not just one of you but two of you, who found out you were pregnant and had cancer. One of you minutes apart, the other of you just a few months apart. You both had a choice… your life or your babies life. You both selflessly chose your child’s life. You both amazed me.

I remember you, many of you, young moms. You faced each day with the determination to have more time with your children and many of you beat the statistics for each of your cancers. You would spend that time with your children. The incredible love between you and your husbands has shown me that true love really does still exist. All of you, are incredibly brave women that I am so beyond blessed to have been able to be your nurse.

The young fathers, how you loved your children and your wives. My heart still breaks thinking of saying goodbye to you as you were discharged to hospice.

And the young singles. You bravely have faced this battle with grace and dignity. I have nothing but utter respect for you as you have faced your battles. Some of you have chosen to face it alone only letting a few people walk with you, others of you let your family and friends rally around you… all of you have left me speechless by your ability to walk through this.

So to all young adult cancer patients and survivors, please know that I think you are incredibly brave, bold, and amazingly beautiful. I’m so beyond blessed to walk with some of you through your cancer battle and will continue fighting for you. Thank you for capturing my heart and allowing me the privilege to walk with you.

With sincere appreciation,

One of your nurses

I could continue writing, but the fact stands… young adults with cancer is a VERY real thing. And it isn’t just one type of cancer, but a widespread variety cancer.  Many of the patients I have come in contact with felt healthy one day and not the next day. Each year 72,000 people ages 15-39 are diagnosed with cancer (1).  There is very little research that has been done on treating cancer in the 15-39 age range. In people 40 and older around 60% of them are in clinical trials while ages 15-39 only about 2% (2). This leaves little room for improvement in treatments.  Cancer is the 4th leading cause of people aged 20-39 only behind suicide, homicide, and accidents (3).

I could continue on with the statistics, but my main goals in writing this post are this.

1. If you have the incredible opportunity to meet a young adult cancer patient or survivor, I encourage you to sit and get to know them. They are pretty incredible.

2. Help the fight by donating specifically to places like Stupid Cancer that specifically go to researching and assisting this specific age group fight against cancer.

3. If you are in this age range, please don’t think you are invincible. Here are the simple things I recommend to help keep an eye on your own health… get a yearly physical, get yearly blood work, get a year skin check… and if you think something is wrong please don’t delay going to the doctor.

Resources:

1. Stupid Cancer

2. National Cancer Institute

3. American Cancer Society

Being Healthy on the Night Shift

This Sunday morning ended my year and a half of being on and off night shift.  I can’t say I’m sad to see it go, but I am incredibly thankful for the things it allowed me to learn.  Until the night shift, I would consistently go to bed at one time and wake up at pretty much the exact same time every day.  Before I worked night shift I had only slept past 1030 AM a very few times in my life.  Until I worked night shift I did not realize how incredibly hard it is to stay healthy on a night shift schedule.

 

As a nurse, I learned so much in my career by being on night shift.  It allowed me to work more autonomously. I definitely learned the wonderfulness of Ambien.  I transferred far too many patients to the ICU, but not a single one of them coded in my care for which I am thankful. And I got to know some really incredible people and learn how to be a nurse without all the people around.

As a nutritionist I learned that working the night shift means that those regular meals are not going to happen. That when you stay up all night and are stressed, as nursing as a career makes you stressed, you crave those high fat foods.

As a personal trainer I learned just how hard it is to get in a regular work out routine when you walk an average of 6 miles a night at work and you are never actually awake consistently at the same time every day of the week, let alone have the consistency to work out.

As a person, I learned that my body much prefers a day schedule and I’m not the nicest person on night shift.  I learned that there were times I could sleep for almost 24 hours. And I was definitely able to sleep past 10:30 AM.

As a person who constantly likes to learn, I cringed every time I saw another article pop up in an e-mail about the long term health effects of shift work.  But shift work, especially in nursing, will always exist.  There will ALWAYS be sick people, and just because it is healthier for people to sleep at night, it doesn’t mean diseases, especially cancer, will stop causing people to be sick at night.  So since we don’t live in a magical world where suddenly at night everyone is not healthy, we must learn to be the healthiest possible with the schedule we are given.

My advice for evening/night shifters:

1. Don’t fight sleep: your body needs sleep to repair. Staying up for 24 hours multiple times reduces your ability to think clearly.  Especially for people in shift positions, this can be very dangerous.  If you need to revert back to a day schedule, make sure to sleep a couple of hours after getting off of work.

2. Blackout curtains: seriously, especially during the summer, they really help.  It also helps your body to release the proper hormones, like melatonin.

3. Silence your phone: I have a rule that unless there is something I HAVE to hear my phone for, it is on silent while I’m asleep during the day.  My schedule changes every week, so it was hard for my family and friends to keep track of the days I would be sleeping during the day. Your sleep is more important than that text, I promise.

4. Keep the caffeine to a minimum: Caffeine is a drug, a legal one, but still a drug.  In excess doses caffeine can be really dangerous. Don’t keep increasing the amount and set a time to stop drinking caffeine so it doesn’t interfere with your sleep.  On your days off try and stay away from the caffeine so your tolerance doesn’t increase and your rest isn’t interrupted.

5. Have a social life: Make sure that though you’re working a funky schedule you plan ahead to have a social life.  If you’re working shift work, chances are you have to work weekends. Work with those important to you to have time to relax and hang out and feel like more of a “normal” person.

6. Exercise: Try to exercise at least 3 times a week. This could be just taking a walk or doing a 20 minute video.  Exercise will help your body to feel healthier and actually be healthier.  It will also help reduce those stress hormones that shift work increases.

7. Eating schedule: Try and keep your eating schedule as regular as possible.  Try consistently eating when you get up and then every 4-5 hours from there.  There is no research I have behind this, but it seemed to help me.  When I waited to eat until the same hours each day, I would often be up for far too long without eating food. Eat when you’re hungry.  Your body will tell you.  And eat real meals.

8. Stay away from the junk: You can’t always stay away from it, but as much as possible focus on healthy eating. Late nights often make your body crave the worst foods.  Make it an effort to pack healthy and know where at work you can buy the healthy food.

9. Take care of yourself: Keep up with your hair, your laundry, get a massage or mani/pedi, plan fun events you like to do. Often with shift work, because it runs your schedule so much you forget to take care of yourself.  Your job is only part of your life, remember to enjoy the other parts :-).

10. Water and Nutrients: Water, your body needs it.  Make sure you drink enough. Make sure your body has enough of it. Monitor your nutrition and if you think you aren’t getting enough, talk to a healthcare professional who can advise you on supplements.

Chances are on the night shift you are not going to be the healthiest you will ever be in your life, but that doesn’t mean you can’t live at the optimal health for your current life situation. Take care of yourself, your health and happiness are worth it!

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