This is what I do.

So, yellow man died of alveolar hemorrhage at another hospital. I just found out at work today. Wife and kids. Young kids. Acute myelogenous leukemia. This is what leukemia does. It steals your life. That man was my first real patient. I shaved his head when chemo hit. I guess he's dead now.

I can't tell you how strange it all is. I can try, though. He was young (late thirties/early forties), really good looking, in good shape. Competent and strong-willed like a man should be.

The numbers become people. I talked about numbers earlier. But the trouble is, when I think about each of these room numbers, I remember a person in that room who died. 2 is yellow man. 6 is the woman who died when we turned her. That happens sometimes. When you turn a patient, sometimes it quickens death. 7 is yellower man whose room smelled like mint. We put mint menthol in the room, because his necrotic tissue was really strong smelling. 14 is beautiful man, the one that looked sicker than anyone I'd seen yet. His dog came to visit here. And he said that he had a lifetime high after showering with a nurse. Then there was Candy. She died recently, too, and her face is ever etched in my mind. She made me think about the Father's love for us. Because she was so helpless. She was a mess. And we cleaned her up over and over and over. And you just had to love her. You had compassion on her so easily. It wasn't hard to take good care of her.

A man had "exploratory surgery" today. That means they can't figure out what's going on, so they open you up to try to find out. He had a bowel obstruction; couldn't poop. It wouldn't resolve. When they opened him up, they found cancer. He was full of cancer. So they closed him back up again. Six months to live.

There's some sort of comfort about people grieving and everyone knowing why. I can't describe it. People are crying, and it's normal. Nobody's telling you that you shouldn't cry. They're just letting you grieve. They're just being there when you're grieving. They're hanging out and getting you what you need, no matter what it is. Even if it's your dog. That's what nurses here do. That's what I do. I take care of the things they forget to take care of. I watch out for their bodies. I watch out for their families. I touch their hands or their feet. I clean them up. I help them fall asleep. I help them breathe.

death

Three people died on my floor this weekend. I took care of all of them.

One was even yellower than yellow man. He was mustard colored. His liver stopped working completely. And his fingertips were black and hard - necrotic tissue. And they smelled awful. He was unresponsive, but was breathing through a trach on his own. His family took him off curative cares. It's called comfort cares. And he lived for five or six days after that. They had begun to wonder if they had made the right choice. He died on his wife's birthday just after my shift was over and before my next one started.

The other man was one I talked about before - the sickest man I ever met. You know, if you're in the medical field, you hear people say, "I could just tell when I saw him; it was cancer." or "I knew he wasn't going to make it. He had that look about him."

I get it now.

He made it home before he died. That was what they all wanted.

I didn't get attached to the other lady. It's a good thing, too, because hers was the first and only body I saw dead. I was in the room when she died. She was on comfort cares, too, but her family wasn't around when she died. They had gone out to eat. And didn't come back for a few hours after her death and didn't answer their phones. She had been seizing all day long, the nurses think. Her eyes were rolling back and forth, back and forth, slowly, slowly, all day long. She appeared to be in a lot of pain. And we went to clean her up, and it all happened so fast. Body processes I won't tell you about. I was amazed at the nurses I was working with. They were incredible. It happened at six pm, just before my shift's end at 7:30.

That morning, I had been teary-eyed. Everything I was doing was making me cry. So I took a minute. I thought that's all it would take, but when I got in the bathroom, I couldn't stop crying. I was beyond the point where I could wash my face and look normal. So this girl opened the bathroom door - she didn't know I was in there. And she was totally cool with the fact that I was crying so hard that I was hiccuping. And we talked about death. Cause she's a nursing aid on that floor. Has been for like...three years or something. And I was a little more composed until I went in the room of mustard man with my preceptor to clean him up. And we talked about death more. Death process. Death paperwork. Family coping. Personal coping. Still wanting to come to work, even though there are hard things. And how getting through this and coping with this job says a lot about a person. "If you can do this, you can do anything," she said.

I'm okay, really. Yeah, I think I'm okay.

PS: Sushi fell through.

discovery

Here is an unorganized something.

I had a root canal. The whole experience made me feel like a little kid who had just pooped his pants. I had this huge rubber thing attached to my face exposing one tooth. And I couldn't suck in my spit, so I was drooling all over. And I couldn't talk. I kind of grunted to the dentist lady so she could suction out my spit. On the ceiling, which I stared at for a good majority of the 90 minute visit, there appeared a chart about the acidity and sugar content of various beverages. "Sip All Day - Get Tooth Decay". Crafty. It was interesting for about seven minutes. Then I wished there was some kind of art up there.

As I was feeling exposed, awkward and abused, I started thinking about going home to bed. And how ugly I felt. And then I started thinking about my roommates. They were going to go to the cities and help out their youth group. And I could ride along if I found a place to stay. Earlier, I had called my friend Matt, whom I barely know. "If I happened to come to the cities tomorrow, would I have a place to stay?" He figured he could work something out. But by this time, I was thinking, "I don't want to go. I want to go to bed."

And that's when I realized that if I went to bed, I would feel depressed all day long. And even though I didn't really know what would happen if I went to the cities, I figured it would be better than being depressed, so I hung out with Matt and his grandma in her big, old and wonderful house. And I laughed so hard I peed my pants a little.

In other news, yellow man might have cancer around his liver. He's not really that yellow anymore, though. He looks pretty good actually. Last week, I saw a man sicker than I've ever seen anybody. It was eerie. Cancer sucks. It hit me.

I met someone with what's called pure red cell aplasia (aplasia = no growth) a long time ago. This part has been a long time coming. He said that at the time of his diagnosis, sometime in 2007, I think, there had not existed 100 people diagnosed with his disease. It is that rare, and that poorly researched. And he was in a clinical study in order to test the efficacy of new drugs on his condition. It's a type of anemia (you could say anemia means low/ineffective red blood cells) related to the depletion of erythroblasts (the cells that make the red blood cells). A lot of times, when people have anemia, it's because something is killing their red cells or because their red cells aren't working right. This condition was different, because the problem was up higher, you might say, in the process of the formation of the cells.

I feel like life is coming around again. I catch myself smiling for no reason. And I like that. Also, I find myself telling the same stories over and over again, and asking the people around me, "Did I tell you this?" because I can't remember who I told and who I didn't. In fact, I was just going to write something about already mentioning red cell aplasia. I feel like I did.

After all was said and done, the dentist cost $600. But my tooth doesn't hurt anymore. So I guess someone would say that it was worth it. I haven't decided yet. I think dentistry would be a horrible job. Nurses make people feel better. Dentists make people feel worse. Doctors do too, sometimes, but for the most part, the people aren't awake during the worst stuff. It's not fun to feel your head vibrate as a drill goes into your tooth and feel the spatterings of tooth and smell the drill smell. At one point, my bottom eyelid went numb. That was a weird feeling. I'm glad I'm not a dentist.

I'm going to eat Sushi with a band called Bread of Stone today. Yeah...I'm that cool.

Munificent wrote to me. Did I ever tell these people about Munificent? I guess I'll have to save that for a later post, because at the moment, I'm using someone else's computer in someone else's house as I wash my clothes (and someone else's clothes) in someone else's washer and dryer. My friends let me use their house even though they're not here. I thought that was really nice. And I'm eating their popcorn. Truly, does life get better than this?

By Request

I was just asked today to "post some more cool medical stuff on your blog". I have intended to do this for a while, but tonight offers me the chance to do it. I am staying up late tonight in order to prepare for tomorrow's night shift. I was told that I should try to stay up late tonight, get up early in the morning, then take a long afternoon nap before my night shift. It was one of a couple of different suggestions, and I'm excited about it, because I love afternoon naps. Maybe this night thing will work out for me.

I need to set something straight. I completely messed up on graft vs host disease when I mentioned it earlier. I said that the body launches an attack against the graft. That's not true. It's the other way around, and I can't believe I missed this obvious thing. Stinking faulty memory.

Anyway, the transplant attacks the body. There's a couple of different ways to do bone marrow transplants. Autologous means that the patient donates his own bone marrow. It is freezed. His own bone marrow is destroyed through chemo treatments, and then his preserved bone marrow is re-introduced into his body. This type of transplant poses no risk for graft vs. host disease (GVHD), because the cells in the transplant are already accustomed to the cells in the patient's body. In fact, they are the cells from the patient's body. Allogeneic transplant means that someone else donated their bone marrow for the patient. Often, the donor is a close relative. This type of transplant involves the possibility of developing graft vs. host disease.

I met a woman last week who had just begun to develop GVHD. Instead of having a completely red body from head to toe, she only had slightly reddened fingertips. The soles of her feet were also red. She had not yet complained of any itching or other related complications. The nurses still seemed to react more sympathetically to this sign than the patient could understand. I think it's because the nurses know too well the path down which these symptoms suggest this patient will go.

Also, that one patient that was yellow...they did some liver function tests. His bilirubin was, indeed high, as manifested by yellowish skin. Also, his liver function was at less than optimal which explains his jaundice. I felt pretty good about this predictive observation. My nursing assessment skills are slowly coming around.

I also came across a rare skin disorder called calciphylaxis. It seems as though the process of this disease is poorly understood, but it involves the calcification of the skin. In this patient, as is typical, her condition presented with late stage renal failure, probably related to the kidneys' inability to filter out excess calcium. The significant thing about this disease is the necrosis of the skin. "Νεκρος" is Grecian for "dead". When cells die, that's usually not a good thing. In body tissues, necrotic tissue turns black. This patient had 3-4 inch patches of black tissue on the surface of her skin. This is an ominous sign, because it represents the beginning of calcification on her skin. Spots that had started that way have now progressed to 1-2 inch deep wounds five inches in diameter all around her trunk. I was amazed to find that she had only begun to recognize signs of this disease about a month ago. It has already progressed to form significant necrotic craters on her body. These wounds refuse to heal and will eventually cause her death. The patient was experiencing enormous amounts of pain due to her abundant open sores. Somewhere I read that she has a 45% chance of making it for a year and 35% chance of making it five years.

Treatment: pain medications, dressing changes and wound care, dialysis (which is basically a huge kidney; a patient's blood is filtered through a machine).

If you are grossed out easily (Allison), don't read this paragraph. Her wounds are treated with dressings saturated in acetic acid. That's the stuff that makes vinegar smell bad. Another option for treatment of this condition involves maggots - yes, maggots. The maggot larvae eat up all the bad stuff in a wound and leave the living tissue. This patient wasn't undergoing that treatment, which I was glad about.

This patient was, however, being transported to a "hyperbaric chamber" which involves exposure to oxygen at a high pressure, a much more appetizing treatment. I thought at first that "hyperbaric" related to a high amount of fat. "Baryophobia" is a relatively newly defined eating disorder type condition in which a patient is afraid of becoming heavy. Also "bariatric" relates to obese patients. However, the root is Greek again, "βαρο-": weight. It relates more accurately to pressure. So, hyperbaric oxygen therapy relates to exposure to pressurized oxygen.

I had my first reporting off experience sometime last week. At the shift's change, each nurse records significant information on each of her patients for the nurse who will take them. Hearing report everyday is a continual reminder that each profession has its own language. There are so many acronyms on these reports. I've heard a lot of people refer to this phenomenon as B language, but it reminds me of the military. There are also random numbers thrown around like confetti. However, even with my limited knowledge, I'm able to decipher what most things are, and my unlimited M resources help me with the rest.

RMG - something metered glucose, aka: blood sugar
UCI'd - urinary catheter indwelling, aka: patient has a foley

During these reports, I kept hearing the nurses say "rie-ghers". I knew that it was something that happened during a neutropenic fever by context (neutropenic fever is when a patient who is low in neutrophils, a type of white blood cells, gets a fever. This is a big deal, because it is a sign of an infection which the patient is ill-equipped to fight), but other than that, I was a bit puzzled. "Rie-ghers" is spelled rigors. "Oh! 'rhig-ers!" I exclaimed to my nurse. I know what those are - the shake that accompanies a chill.

In other news:
I went to the dentist. They took an x-ray and told me, "Yeah, you definitely have an abscess in there." So I'll need a root canal. I'm scheduled for next Thursday.
I got paid today. Woot.
I signed up for that healthy living place. I did a couple of aerobics type classes. One was called Zumba and I followed an African American trainer in some crazy dance movies. At one point, she said, "Now show me your shimmy. You just move your shoulders and let your accessories follow."
I am self-proclaimed "less than dumb" nowadays at getting around this place I call a city.
I found out that I have some camp friends that live here. I'll probably meet up with them sometime this week.

all the colors of the rainbow.

Last day of the week today, and I'm whipped. My day on the floor was mixed with treasured moments and sleep. I didn't try to sleep, but powerpoints on policies and early mornings add up to sleepy afternoons.

I shaved a man's head today. He had a beautiful head of fine, brown, curly hair that was performing its last act by falling out in huge clumps from his scalp. No more. Crazy how life is, huh? Here is this head hauncho of some big corporation with a bald head and a raging infection in his lungs with no white blood cells to fight it. Struggling to breathe at times.

I guess he was crabby last night, giving the night nurse a rough time of it. I was surprised, because I've enjoyed working with him a lot. The nurse said something like, "You can tell he's in charge of a lot of things outside of here," he's flailing to grab control back. He was being really adamant about having his water by his bedside. Sometimes you have to fight for control, even if it's of your water.

I met a lady today named Tudy, and I thought that was weird. But she was nice.

His eyes were yellow, and I need to find out why. Lab hadn't done a liver function test. The liver takes care of bilirubin which is a byproduct of broken down red blood cells. Let's see... I think the liver "conjugates" it. Don't ask me what that means. I'm not saying that I know or that I don't know. I'm just telling you not to ask me. The liver turns it into bile, the stuff that makes your poop green.

So is he breaking down too many red blood cells due to fever? Does he have some sort of autoimmune thing going on? Is his liver not working? Is he just yellow because there's so little hemoglobin?

Another lady was red. I've never seen somebody so red. Graft versus host, I guess. That's what my nurse said. Sometimes when people get a bone marrow transplant, their body rejects it. They call it graft versus host. I guess it can turn your skin red and leathery. She's dying, but it sounds like she's been dying for a long time. She was just made a DNR today. Do not resuscitate.

In other news, I called the dentist yesterday. He said I have an abscess and will need a root canal or my porcelain cap is detaching and I'll need a new cap. Either way, he said I should just see a dentist here. And today, I met this lady who goes to a place where there's a bunch of dentists in an office. She said I could probably get in this week. Sweet. tooth.

Tooth is a weird word.

My shoulder is peeling. I picked rocks for eight hours in the sun one day, and I wore really good sunscreen. Except I missed a spot, and now that spot is peeling. Just one shoulder, and one spot on my shoulder. There's even a slight pale hand print where the sunscreen went.

I find myself longing so much for someone with whom I can talk about deep things in person. I miss Ruth. I just want to connect with someone, and so often, I think that the Lord isn't enough. How ridiculous. Isn't there a song about "more than enough". How slow I am.