The Lion and Hippocrates

I get this email in my inbox everyday about praying to God about the names he calls Himself in the Bible. Yesterday, I prayed to the Lion of Judah who protects His people and acts fiercely for His own name. I asked Him to protect me at work. It was the last day in a string of a couple weeks scattered with overtime. I was pretty tired.

Our floor is super heavy right now. A lot of our patients are very complicated. It seems like the supervisors in our hospital send us the patients who are borderline ICU patients, but only give us normal floor staffing. Our floor feels heavy. A woman came for palliative chemotherapy from an outside hospital. She had been with me for a couple of hours when severe, sudden pain had her lying in a fetal position, moaning. She had been in pain for all of our time together, and I had given a few doses of pain medication and initiated a pain pump with some relief. But right now, her pain was suddenly much more severe than before.

When something like this happens, we're wondering if it's happened before. It could be a very serious situation like a heart attack or pulmonary embolism, or it could be the pain they always feel after they eat a spicy chicken burrito. On our floor, it could also be the cancer pain they consistently feel. For example, another guy that day was complaining of chest pain. The CNA came to me and said, "He's complaining of chest pain, and I can't find his primary nurse!"

So I went in and took some vitals as the investigation began: "Has this happened to you before?" Everyone in the room was ambiguous and kept speaking another language. I tried again: "When did this pain begin?" More ambiguity. "Hey people, when...did this pain begin?"

"Ten days ago."

Oh.

Inside chuckle. He's not having a heart attack.

Just like him, my patient came in with severe pain. When the ambulance dropped her off, she was sort of sprayed on the bed all perpendicular. I know the ambulance guys don't just leave patients like that. She wanted pain medication before she moved. She had been on a dilaudid pain pump at the hospital from which she came.

"Talk to me about what you're feeling. Is this pain usual for you?"
"It's the cramping feeling I always get before I throw up."
Puke bucket, check. Phenergan (an anti-emetic), check. Another dilaudid, check. 

After that, she was pretty sedated. Actually, I chose phenergan because it has a sedating effect, but she was a little too sedated. I didn't like it. She was arousable by tactile stimulation for one or two seconds. I grabbed a set of vitals. BP was fine, afebrile, but her pulse was in the 150's, and her saturation was a hair low 88-90%.

A high pulse is sometimes just an asymptomatic sinus tachycardia. Recently, the people who monitor our patients' heart rhythms called me for a pulse in the 130's. When I checked on the patient, she said quite regally, "I'm having a bowel movement."

A high pulse, however, in a sedated patient is a little unusual. I palpated her pulse. Definitely not sinus tachy, very irregular. I called the charge nurse in to be an extra set of eyes while I grabbed oxygen tubing.
"Should I call a rapid?"
"You might have to." Her sats were 84-90%. I waited another moment to see how she'd respond to oxygen. She didn't right away, so I called it. By the time the team got there, she was satting 100% on 4-6L. We had set her up on the heart monitor. That's when we found out she was in atrial fibrillation. A-fib occurs when the top chambers of the heart pump so quickly that they become ineffective. The electrical signal that makes an effective heartbeat possible only randomly, irregularly gets to ventricles, the portion of the heart that sends blood to the body and lungs. It's why her pulse was irregular when I felt it.

The resident ordered 10mg IV lopressor in doses of 5mg. The patient continued in a-fib. The next step was to transfer her to a unit where a cardizem drip could be managed. It just so happens to be a floor that does not have chemo-certified nurses, so her chemo is on hold for now.

The biggest question in my mind was my decision to give phenergan and dilaudid at nearly same time. When I mentioned the timing of my administration to my charge nurse, she said, "I don't think that was a bad call. We give those together all of the time." It's not the first time I've done it. On the other hand, it was the first time I had administered phenergan to her - which is to say that it may have been the first time she'd ever received phenergan. Next time, I'll give a half dose and wait a little longer before giving anything else. However, phenergan has no a-fib side effects. And dilaudid - well, if dilaudid was going to throw her into a-fib, it probably would've happened a long time ago. Even the ICU nurse alluded that she was probably in a-fib before I gave anything. Her puke pain may have been that severe, because it was coupled with angina.

You have to question yourself, though. It's supposed to be a given, to do no harm. But it's a question we're always asking. And it's sometimes a gray question - both at large and at small. Wikipedia told me that the original Hippocratic oath contained a promise to never cause abortion. Somewhere along the lines, we lost the obviousness of that poor decision. 

The truth is, it's not always enough to do no harm. It's not always enough to act for the benefit of the patient. It's not enough to have the best intentions. Sometimes, they'll still be in pain. They'll still go into a-fib and have to go to a floor where we can't give chemo. They'll still die, because it's the world we live in. 

In the end, we still pray to God to protect us everyday. We still look for the day when our intentions will finally meet up with the ability to carry them out. It will happen because of the one who took his intention to love us right to the cross and finished it.  We look for the day when the Lion of Judah rises up and makes His own complete. 

I talked to a friend tonight. He said he was sorry for always making everything about him. It meant a lot to me. See, I've been angry at him for a while now for never seeing me. I was there the whole time, and he saw me better than a lot of people did at that time in my life. But he never really saw me. He only saw himself.

I know we're supposed to forgive people regardless of their position toward us. And I know that forgiveness is not dependent on reconciliation, because forgiveness is one-sided the way covenant is one-sided. Reconciliation's a two-way street. But him acknowledging how he was makes a difference to me. It's forgiveness' catalyst and paves the way for the reconciliation road.

A little truth about the man I love: he has saved me. And I think the truth will flourish in all different colors as time goes on. I only know that there was a time in my life when I was a mess and ran from God, but he thought I was beautiful, and he thought it so hard that he brought it back to me - what it means to face God again, to love God and be loved by Him. T says that maybe someday I'll know how much he loves me.

I know another thing, everyday, he saves me from myself. Seeing him is respite and hope. When he comes home, I sing and dance - usually in fanfare manner. Then we tell Jesus we love Him and share a meal together. And eventually, skin on skin, we go to sleep.

My brother asked me about my job yesterday. I said I don't want to do it forever.

It's because we're short right now. We go home wondering what we missed, and we remember just before we fall asleep. Sometimes it's little, like forgetting to fill somebody's water. Sometimes it's bigger, and we make a phone call. 

Sundays really are good days at work. There aren't a thousand people in the nurse's station, and the patients are just a little bit sleepier and more content than usual. 

And now, I will tell you something big: my feet hurt, and when my husband touches them, I wish he would not stop ever. 

Can you imagine no pain? Can you? And I just wonder about it, because don't you think pain and joy are relative? I know what my feet feel like after work. And they are swollen. I think I am too young to have swollen feet at the end of the day. And so, when Thomas touches my feet, there is a vast difference. The difference is what makes me know anything. Bad/Good; I don't want to move ever/Please don't stop ever. So, what about a place where there's no contrast? There's just good. Do do you think we'll be desensitized to how great it is? I don't think so, because I think there will be different rules. But it makes you think. Maybe we will not forget what was. 

You know, so many things are relative. Like people think it's cold outside. And it is. But they are miserable because of how cold it is. And I don't think they have any right to be miserable at the cold. They don't know what it's like to have your best mittens not be warm enough or feel the wind through snowpants, or not be able to breathe because the wind chokes you. And it's only cold for such a short time here. 

Someone checked my car and said, "You need a new battery, especially for the winter." I thought that was really strange, because it's not cold here. Cars start in the winter. Maybe two days out of the year, you might have trouble. But everything will be cancelled on that day anyway. 

So the moral of the story is: we don't have anything to complain about ever. Only, we don't know it.

Wait

Our church is still meeting in their living room. And it's a problem, because I have people who need to be there. The conversation came about with one of them, because she is a sweet girl, and she feels too old to be single. She's not, though. "I just haven't found the right guy yet." It's because she's just so sweet, and the man ought to be equally as loving as she is. And a man that's fit for her is found in no other place than stuck on God Himself. 

So I told her that I want her to meet this guy at my church. I have no idea how old he is. I want to ask him. He might not be right for her at all, but he's a real man. Last week, he told us all about how important it is to forget everything you're not doing and focus on the one thing you have the power to do. "The future you needs all of you to be where you are right now, so future you can be where you need to be then." Basically, spend your time in the place where you are. Be all there. 

Well, I'll tell you the truth: I don't care if they hit if off or not. I just want her to come to church with me and know what the men in her past have been missing. I think that she will love this place - the place that our church is going to be. 

We need a building yesterday. 

There's this woman I know who travels all over the world, and she sends me personalized updates about her adventures. She waits on the heart of God before she moves. I don't know anything about that. So this morning, I was reading about waiting on God. And a lot of it is about hoping that God has the ultimate in Himself, and that He's going to show it to you sometime, and believing it so hard that it doesn't matter when it happens. It just will. Like Hebrews 11.  

¹³ All these people were still living by faith when they died. They did not receive the things promised; they only saw them and welcomed them from a distance, admitting that they were foreigners and strangers on earth. ¹⁴ People who say such things show that they are looking for a country of their own. ¹⁵ If they had been thinking of the country they had left, they would have had opportunity to return. ¹⁶ Instead, they were longing for a better country—a heavenly one. Therefore God is not ashamed to be called their God, for he has prepared a city for them.

It's believing God outside of yourself.

I was talking with one of T's buddies last night. A table full of them, actually. All shaven heads, all ranting. But the funny thing is, they spend a lot of time talking about things that are bigger than they are. One of them said it's all foolishness to wonder what's beyond the universe. "Homosapiens are always looking for the purpose for life," and he went on to say that it shouldn't be necessary. I asked him where he sees himself in that - if he himself can stop looking for purpose. He said he spends a lot of time thinking about that. His mom and dad died before he was twenty. 

Purpose stops there. He can't see Somebody planning it that way. So there can't be Somebody. If there is, he has to hate him.  He said he can't stop looking for the answer, though, and T says that's why he'll get there. He'll find Somebody. 

I think there's another kind of waiting, though, a more daily waiting. Like waiting on God to make my iPod show up. And knowing that it's going to show up at just the perfect time. I guess maybe it's more about letting your relationship with God infiltrate your daily life. Trusting in Him all day long. 

I admit to you, I get itchy with impatience, though. My job is so fast-paced. If I have to wait for something for thirty seconds, it's usually smarter to start something else - even if it means opening a package of crackers so that I can have some calorie intake during the day. It usually means going into the supply closet to get the syringe that I'm going to need to give the med I'm waiting for. Sometimes it means filling up a bucket with ice to make my patient happy. Sometimes it means charting. What I'm saying is that waiting is time wasted at work. So when a nurse is standing behind you at the grocery store, please be gracious to her and have your money ready. 

Only in Dakota

Spent so much time on this one thing, and felt so proud of it. Smiled every time I looked at it knowing she'd like it so much. Continually touching up little things, then wrapped it so carefully in Trader Joe's brown paper. Packed clothes around it in my suitcase.

Puked on the plane. Got to see my mom and my bestie from HS. Took her shopping for her wedding night. Whispered and laughed like women with secrets.

We had a nice time at the wedding. Stayed in my parent's hotel, enjoyed breakfast with them. Then, road trip together across the state. Then together with 8 little blondies, some with brown eyes, some with blue and some with hazel. Ate pizza, played games, wrapped up everybody's gifts, and then...it wasn't there. Panic. Look everywhere, even the hopeless places. Finally hunch defeated. A phone call. No paintings at the hotel. Felt four years old and someone just popped my balloon. Felt like my ice cream just fell off the cone. Felt like someone just ate my new chapstick.

Prayed, "God, you know where my painting is. Will you please let my mom get it?"

Made another phone call, really more of a pathetic plea through tear hiccups. Transferred out of pity to the head housekeeper. Trader Joe's wrapping crinkling in the background. "Is it a painting of two little kids on the beach?"

Are you kidding me? No, actually, there was another painting wrapped in a Trader Joe's paper bag from room 320.

Breath of relief and thank you, and "What's your mom's address?" And blowing my nose. And only in Dakota.

just one psycho

Tomorrow, I am going to change the sheets and make pancakes, and I don't feel bad about it one bit. In fact, I feel really good about it. The last two days, I have barely been able to finish a thought without my phone ringing - someone demanding my attention about some "urgent" matter. "Excuse me," I'm thinking, "12 can't breathe. I'm not worried that 5 wants a shower, thank you." Or, "The doctor is on the phone for you." Really, if they could see what position I am in right now, they would not be calling me. And then physical therapy wants to tell me that they took 4 for a walk and they went this far, and the patient was still breathing. And then lab wants to know why I sent pee and didn't put it in the computer yet. And then blood bank tells me they're sending my blood, and then the ER wants to know if I got a chance to look at the report for the patient that's coming right now. And 2's family wants to know when the CT scan is and when his poor, poor (really obese) father can eat. Some people can really eat, I am telling you. Like, some people can eat 5 portions for one meal. And they still want more. I am telling you, as if you don't already know, there is no holding back for some people. They cannot move, but still, they eat. Denial at its finest.

Sometimes I just want to smack the doctor and tell him to cut me a break. "I'm wondering why the hell eight has strep in her pee! Just please quit acting like that's a stupid question!" Oh, I really wanted to clock him today. Really, it hurt my pride. Let's be honest. I have no idea why she had strep in her pee. Was it really that hard to tell me that strep pneumonia is excreted in the urine? Still foggy. Not to mention that my patient is wondering the same thing. Oh, it makes me angry. I asked him a question, and I'm not kidding you - he didn't even answer me! He must've grown up in Baltimore where that kind of behavior is appropriate. Or else he's just a doctor and thinks he can treat people like they are all idiots because they don't understand the mechanism of respiratory pneumonia being excreted in the urine without causing a urinary tract infection. Really? Don't even know where to start.

2's dying, and the son is putting on his strong face.  5 can't move because cancer broke his bones, but he keeps smiling. 15's daughter yelled at her, and her blood pressure passed 200 systolically, and that was the old fifteen. The new fifteen has Bell's palsy and mets to the liver and bone. 3's not mine, but she's fun to walk by. Short term memory loss secondary to brain cancer. Really funny lady. Her hair is always crazy. I can't remember everyone today. So many people came and went. The hospital was in status E today which means the emergency room is full, and we have to shoo people out to make room for new people. I started with six, went down to three, and came back up to five. It's a mess. My head is a mess, and that's why I took a bath. That's why I'm happy about putting sheets on the bed and making pancakes. And it's why I'm writing now. My head's too messy. I'm going to dream about giving enemas and suppositories tonight, probably to that stupid doc. And I'm going to write for it in his own chart. Hehe...

1. Dulcolax suppository BID PRN for constipation or stupidity. No lubricant, please. Pt is allergic.

2. Fleet's enema whenever pt ignores you. 

3. Encourage proper etiquette for normal human beings. Do not call with results.

4. May discharge to home when pt is nice.

and I didn't mention this, but I don't have any other plans for tomorrow. Just sheets and pancakes. Probably a good idea, eh?

It's that feeling I always have - like something's missing. It was described to me the other days in terms of Chinese medicine. Apparently, these certain people, when their qi is out of balance, they have this overwhelming sensation like something is missing..that, and grief. And when she was describing this phenomena that is so common to Chinese thinking, I felt like I was normal in the world. Only, one thing was different. The feeling was described like something was missing, but there was no ability to determine what it was.

I've always known what was missing. And it's why I've always grieved underneath it all.

From Romans 8: ...We ourselves, who have and enjoy the first-fruits of the Holy Spirit, a foretaste of the blissful things to come, grown inwardly as we wait for the redemption of our bodies from sensuality and the grave, which will reveal our adoption, our manifestation as God's sons. For in this hope, we were saved.

I've always known I was missing Him. My soul groans when I look around. I miss Him. I just miss my Friend.

There's something I've always wanted, and it's just to be lovely forever. Just to be a delight to those around me, nothing awfully self-centered, just a joy-bringer through beauty. And I've wanted it in a place where beauty is safe. Do you think it will be like that when He comes? I don't think it will matter as much what I will be like, but do you think I will be like that? I really just hope so.