Last week, I had the honor of taking care of the sweetest young lady. Her symptoms were straight forward: congestion, productive cough, feeling unwell x 5 days. She wasn't sleeping well, she wasn't able to pay attention in her classes, and so she came to be seen. Straight forward, like I said. She would benefit from an antibiotic, plus some day time and night time cough suppressants. Her scenario was so much like most of the young people I care for on a daily basis. Except for one thing. This young lady is blind. Since birth, actually, she has lived with four senses only. I think that our appointment together was more beneficial for me than her, to be completely honest. It made me realize how much I take my eyesight for granted. Also, it made me realize that the visually impaired must be an incredibly challenged population in the field of health care. We had to make some medication changes for her, because our cough syrup measure spoons did not have a raised marker of the dose. I gave her two or three different pills that she had to feel first to remember which was which. But, this girl was truly amazing and inspiring. She was funny, to boot. She was not phased at all by her handicap, because this was her; it was all that she knew. She's studying zoology, and she wants to be a horse veterinarian. After learning this, I tried to think about my job, and if I could care for others without my sense of sight. Gosh, it sure would be a challenge.
I live for these moments, though. These moments that make me realize that the world is so much bigger than my piece of it. These moments that show me no matter how difficult my day might be, there is someone achieving greatness despite bigger odds against them. And in health care, I am so fortunate to have this unique opportunity to be a person that someone trusts with their life. Literally. Sure, I may have treated this young lady's bronchitis, but, in truth, she was the one who held my heart, if only for a brief fifteen minutes.
Monday, April 23, 2012
Tuesday, June 21, 2011
what if i don't believe in miracles?
Two weeks ago, my 46-year old uncle lost his battle with Stage IV bladder cancer. He lived approximately 18 months past his initial diagnosis, enduring chemotherapy and radiation for multiple metastases to his spine. Ultimately, after a hospitalization for hypercalcemia, he died due to aspiration related respiratory failure. He was strong, and he fought hard. That's all I can really say, because there's no way to justify his death or paint it in a good light. It's just unfair and that's that.
There are numerous aspects of his cancer care and his death that keep me thinking about the importance of the patient-provider relationship and above all, honest and effective communication. When he was first diagnosed, he was given a prognosis of 'being lucky to live for 2 years.' After that prognosis, he did well! He went through chemo, and began cyber-knife radiation for the few metastases that had crept up on the spine. And the cyber-knife worked! It shrunk many mets and halted their growth. After tackling one met, though, another would crop up. So regardless of the 'successful' procedures, the bottom line was that this cancer was a bitch.
His sudden decline came as a surprise to some, since he was getting around okay one week, then walking with a walker the next, then not ambulating at all the next. On top of that, he had been constipated for at least a week. And on top of all that, he had some mental status changes and was therefore hospitalized for cancer-induced hypercalcemia. His problems were then addressed and somewhat controlled, and they had even spoken about plans to move him to a rehab center and to begin another chemo course.
My mom and I visited him on a relatively good day, when he was alert, his pain was well controlled, and they were talking about short term rehab plans. Leaving for a trip to Europe within days, my mom and I were nervous, to say the least. When we left the hospital, I finally said what we both were thinking: there's a good chance that he would die while we were away. We both knew and felt that, unfortunately, he would not survive through the summer.
When my dad called my hotel room on the second morning of our trip, all he had to say was "Well," before I completed his sentence. Uncle had died. The news I had been waiting for had actually happened, and we were 3000 miles away. I couldn't cry much, and what tore me apart most was knowing that I couldn't be there for my family in their time of greatest need. What I feel strange about is the fact that I was not shocked, I was not hysterical, I had time to prepare and say my internal goodbyes. He was no longer suffering. The fact was that he had Stage IV cancer with distant mets that were uncontrolled. He was going to die, it was just a matter of when and how. How could I be so rational? So level headed? So factual? I felt and still feel guilty about this. But I digress...
When my mom spoke to my aunt over the phone (which, by the way, is a horrible means of comfort), she spoke to console her saying, "He fought hard, and he was strong." And my aunts response was, through her tears, "I know! Which is why I thought he was going to beat it!" This, right here, is the crucial moment. Had somebody along the way given my aunt false hope? Is it part of the communication process with terminal patients to perpetuate the idea that there's this chance that the cancer might just give up? Am I cynical for not believing that there could have been a miracle in this situation?
It was this moment that got me thinking about how to communicate effectively to patients and families regarding terminal and severe illness. Maybe there's a thin line between optimism and fallacy. Had someone actually delivered the piece of false hope, or had my aunt created it in the absence of pessimism? I wonder what the statistical definitions are of 'likely,' and 'probably,' and 'maybe.' Because don't we say those words all the time to cover the possibility of us being wrong, or to lighten the blow of what we know to be true?
The bottom line is, I guess, that regardless of how or why my aunt had the idea that uncle was going to beat his cancer and grow old with her, no one had recognized it and counseled her. I'm not suggesting that it's important to crush someone with negativity. But, when false hope and denial get in the way of a peaceful, righteous death for a terminal individual, I can't help but think about all the opportunities that must have passed for communication, compassion, therapeutic talk, access to services.
My take-away message from this scenario as a provider is to not be afraid to talk about death and dying. While I will not likely work with terminal patients, I will certainly be caring for people who will one day get old. Why not discuss the important need-to-know things about death while someone is healthy?
I encourage everyone, patients, providers, healthy people with aging family members, to check out the Five Wishes document. Trust me on this, it's a good one.
There are numerous aspects of his cancer care and his death that keep me thinking about the importance of the patient-provider relationship and above all, honest and effective communication. When he was first diagnosed, he was given a prognosis of 'being lucky to live for 2 years.' After that prognosis, he did well! He went through chemo, and began cyber-knife radiation for the few metastases that had crept up on the spine. And the cyber-knife worked! It shrunk many mets and halted their growth. After tackling one met, though, another would crop up. So regardless of the 'successful' procedures, the bottom line was that this cancer was a bitch.
His sudden decline came as a surprise to some, since he was getting around okay one week, then walking with a walker the next, then not ambulating at all the next. On top of that, he had been constipated for at least a week. And on top of all that, he had some mental status changes and was therefore hospitalized for cancer-induced hypercalcemia. His problems were then addressed and somewhat controlled, and they had even spoken about plans to move him to a rehab center and to begin another chemo course.
My mom and I visited him on a relatively good day, when he was alert, his pain was well controlled, and they were talking about short term rehab plans. Leaving for a trip to Europe within days, my mom and I were nervous, to say the least. When we left the hospital, I finally said what we both were thinking: there's a good chance that he would die while we were away. We both knew and felt that, unfortunately, he would not survive through the summer.
When my dad called my hotel room on the second morning of our trip, all he had to say was "Well," before I completed his sentence. Uncle had died. The news I had been waiting for had actually happened, and we were 3000 miles away. I couldn't cry much, and what tore me apart most was knowing that I couldn't be there for my family in their time of greatest need. What I feel strange about is the fact that I was not shocked, I was not hysterical, I had time to prepare and say my internal goodbyes. He was no longer suffering. The fact was that he had Stage IV cancer with distant mets that were uncontrolled. He was going to die, it was just a matter of when and how. How could I be so rational? So level headed? So factual? I felt and still feel guilty about this. But I digress...
When my mom spoke to my aunt over the phone (which, by the way, is a horrible means of comfort), she spoke to console her saying, "He fought hard, and he was strong." And my aunts response was, through her tears, "I know! Which is why I thought he was going to beat it!" This, right here, is the crucial moment. Had somebody along the way given my aunt false hope? Is it part of the communication process with terminal patients to perpetuate the idea that there's this chance that the cancer might just give up? Am I cynical for not believing that there could have been a miracle in this situation?
It was this moment that got me thinking about how to communicate effectively to patients and families regarding terminal and severe illness. Maybe there's a thin line between optimism and fallacy. Had someone actually delivered the piece of false hope, or had my aunt created it in the absence of pessimism? I wonder what the statistical definitions are of 'likely,' and 'probably,' and 'maybe.' Because don't we say those words all the time to cover the possibility of us being wrong, or to lighten the blow of what we know to be true?
The bottom line is, I guess, that regardless of how or why my aunt had the idea that uncle was going to beat his cancer and grow old with her, no one had recognized it and counseled her. I'm not suggesting that it's important to crush someone with negativity. But, when false hope and denial get in the way of a peaceful, righteous death for a terminal individual, I can't help but think about all the opportunities that must have passed for communication, compassion, therapeutic talk, access to services.
My take-away message from this scenario as a provider is to not be afraid to talk about death and dying. While I will not likely work with terminal patients, I will certainly be caring for people who will one day get old. Why not discuss the important need-to-know things about death while someone is healthy?
I encourage everyone, patients, providers, healthy people with aging family members, to check out the Five Wishes document. Trust me on this, it's a good one.
Wednesday, May 25, 2011
Commencement.
Well, here I am. Master's degree in hand times 2 days, patiently awaiting permission to take my nurse practitioner boards, impatiently awaiting a job offer.
Yikes. How did I get here? As the class speaker asked us all on Monday, when did we stop being nursing students and become nurses? When did we stop becoming nurse practitioner students and become nurse practitioners? It feels as though all of a sudden, without warning, the rug has been pulled out from beneath me and I no longer have the cushion of being 'just the student.' At the end of actually being the student, sure, I had moments of feeling like maybe I didn't need that cushion...that there were things I could handle completely on my own, and proudly. But now. But. but...
There's a theory in nursing known as Benner's Novice to Expert model. The idea is that all students begin as true novices, needing rules to navigate the clinical world. Eventually, by graduation, the student may become an advanced beginner, or even competent! I was warned, however, that no matter which stage you reach as a student, once you graduate and begin a professional job, BAM, you are knocked down all the rungs to start once again as a novice. No matter what. So don't expect to be all high and mighty, confidently managing your Type 2 Diabetes and hypertension like you were born doing it. It's time to be humble and proceed as a true novice.
Throughout my nurse practitioner education, we had to have rubric evaluations by our clinical preceptors. I always made a pretty good impression while in clinicals, and I was, for the most part, a chill, low-stress student. My clinical skills were good, but I always needed to run assessments and plans by my preceptors, because there were just some things I didn't know. What I do know, however, is how to connect with an individual. Semester after semester, my evaluations always said the same thing. Amanda commands the respect of her patients; Amanda pays excellent attention to social details; Amanda shows true compassion; etc. I truly believe in the power of relationships and genuine interaction. It's one of my life goals to always treat others as if they are the most important thing on my mind. Most of the time, I am able to truly focus on the individual, and not be concerned about how many others are waiting for my attention.
At first, I struggled immensely to stay within my time constraints, particularly in the community health setting, where they get the shortest time, but have the most to take care of. I couldn't believe that I had to do everything, save their WHOLE LIVES, in just 15 minutes! What torture. As a student, I soon realized that in the 15 minutes, I cannot save anyone's whole lives. Priorities must be made for every person during every visit, which are not always the same for the patient and the provider. But most important is making sure that patient knows that they have your undivided attention, and that the time seems like more than it is. After all, isn't the goal, with most to get them back in 4 months with positive changes?
What I'm trying to say is, sometimes medical and nursing care has to be a fantastic fusion of science and compassion, educating and listing, prescriptions and hugs. That's what will keep them coming back for more. And that fantastic fusion can be more appropriately be coined as...
The Fifteen Minute Relationship.
Yikes. How did I get here? As the class speaker asked us all on Monday, when did we stop being nursing students and become nurses? When did we stop becoming nurse practitioner students and become nurse practitioners? It feels as though all of a sudden, without warning, the rug has been pulled out from beneath me and I no longer have the cushion of being 'just the student.' At the end of actually being the student, sure, I had moments of feeling like maybe I didn't need that cushion...that there were things I could handle completely on my own, and proudly. But now. But. but...
There's a theory in nursing known as Benner's Novice to Expert model. The idea is that all students begin as true novices, needing rules to navigate the clinical world. Eventually, by graduation, the student may become an advanced beginner, or even competent! I was warned, however, that no matter which stage you reach as a student, once you graduate and begin a professional job, BAM, you are knocked down all the rungs to start once again as a novice. No matter what. So don't expect to be all high and mighty, confidently managing your Type 2 Diabetes and hypertension like you were born doing it. It's time to be humble and proceed as a true novice.
Throughout my nurse practitioner education, we had to have rubric evaluations by our clinical preceptors. I always made a pretty good impression while in clinicals, and I was, for the most part, a chill, low-stress student. My clinical skills were good, but I always needed to run assessments and plans by my preceptors, because there were just some things I didn't know. What I do know, however, is how to connect with an individual. Semester after semester, my evaluations always said the same thing. Amanda commands the respect of her patients; Amanda pays excellent attention to social details; Amanda shows true compassion; etc. I truly believe in the power of relationships and genuine interaction. It's one of my life goals to always treat others as if they are the most important thing on my mind. Most of the time, I am able to truly focus on the individual, and not be concerned about how many others are waiting for my attention.
At first, I struggled immensely to stay within my time constraints, particularly in the community health setting, where they get the shortest time, but have the most to take care of. I couldn't believe that I had to do everything, save their WHOLE LIVES, in just 15 minutes! What torture. As a student, I soon realized that in the 15 minutes, I cannot save anyone's whole lives. Priorities must be made for every person during every visit, which are not always the same for the patient and the provider. But most important is making sure that patient knows that they have your undivided attention, and that the time seems like more than it is. After all, isn't the goal, with most to get them back in 4 months with positive changes?
What I'm trying to say is, sometimes medical and nursing care has to be a fantastic fusion of science and compassion, educating and listing, prescriptions and hugs. That's what will keep them coming back for more. And that fantastic fusion can be more appropriately be coined as...
The Fifteen Minute Relationship.
Subscribe to:
Posts (Atom)