Tag: trauma

Categories
medicine

What Medicine Is Doing to Fat People

“Doctors are supposed to be trusted authorities, a patient’s primary gateway to healing. But for fat people, they are a source of unique and persistent trauma. No matter what you go in for or how much you’re hurting, the first thing you will be told is that it would all get better if you could just put down the Cheetos.”

–Read the full article “Everything You Know About Obesity Is Wrong” at Highline (Huffington Post)

Do you want to know what the medical director of my unit says about “obese” patients, often unconscious and critically ill in the ICU– he says to calorie restrict them to 1,200kc a day and that at least they’ll lose weight in the hospital. I don’t even think I can fully explain how cruel this is. The patients are critically ill and it is hard to even get 1,200 calories into an unconscious person via tube feedings. The tubes can be tricky to get in the right place, the bowels often are not properly functioning so we don’t know what is even being absorbed, and tube feed is notorious for causing copious diarrhea. Which takes all the nutrients and additionally much of the water out of your body. Conscious patients who are able to eat often are so exhausted that they just can’t, not to even mention the frequent periods when patients can’t eat before tests or procedures. Even food brought from home, which I highly encourage, is often left untouched.

But fat shaming, per se, doesn’t happen as much in the inpatient hospital setting. It’s at the doctor’s office, the lab, the radiology department. Its at the OB-GYN’s office when you’re told that maybe if you had weight loss surgery, the heavy menstrual bleeding you’ve been experiencing continuously for over 6 months might get better. Or at the neurologist’s office when you’re told that a brain condition nobody understands might be caused by being fat but that, again, nobody understands why. Or at your primary care physician’s office, when you go in with your first ever joint problem (a sprained knee, it turns out, basically nothing, fine in a week), you are first (FIRST) even before the physical exam of your knee, told that if you weighed less, you’d hurt yourself less. And then the same doctor says later in the appointment, “I don’t want to be the asshole doctor that weight shames you.” Too late, doc, too fucking late.

If you hadn’t noticed, I am the fat person here. I am one of us, a person traumatized and triggered by the very industry that I work in. I have more to say about this, but the words evade me now.

Categories
intensivecare

I dreamt I died

Work has been shit lately. Covid is still surging in my ICU, and we’re busy with other things too.

Last week was an especially difficult week for our heart failure service, as every patient on service was deemed “not a candidate” for advanced heart failure treatment. Bottom line: this is end-stage heart failure and hospice is the next step. For many patients, this means removing a piece of equipment that’s been helping their heart do it’s job (like an intra-aortic balloon pump, or an Impella). This can mean almost immediate death, but many patients do go home from the ICU to die there. It’s emotionally exhausting but incredibly important work.

And it’s so important to spend some quality time with these patients. Last week, I helped a gentleman who was just days away from getting his Impella out to go home on hospice. He was itchy from laying in bed. I washed his back with real soap and water and washcloths. The put on lotion with a little massage. 20 minutes including gathering supplies. And it made his day! We chatted about traveling and life’s simple pleasures. These are the important moments at the end of life, and I was so happy to be there for him.

But despite that part of my job being so meaningful, there are other parts that are nearly unbearable. There is a day shift charge nurse who is mad at me no matter what I do, and who demands a ridiculous amount of report on our patients. She wants a full head to toe but the 90 second version. Do you know how long it takes me to prepare a cohesive and comprehensive 90 second head to toe report that also includes the plan and updates from when she was last on shift??? It takes about 5 hours to do it for 30-36 patients. And when I don’t give her all the info she wants, she asks for it in aggressive tones. If I don’t know the answers, she will eye roll, sigh and slam turn the pages of her printout. Actually, she does that sometimes anyways if she’s annoyed by something, anything.

I find this to create a workplace so toxic that it gives me panic attacks. I dread giving her report. I get short of breath talking to her. I often cry after interactions with her.

So what do I do when I tell my managers about this and nothing changes? That is the million dollar question facing me right now.

Oh, I almost forgot my dream. I had a left ventricular assist device (LVAD) in my dream, but it became dislodged internally. FYI, I’ve never ever seen this happen in real life… I was bleeding to death, surrounded by work mates. They could do nothing. And finally, as I was about to die, one of the help pressure on the bleeding spot as the warm feeling spread through my chest and I lost consciousness.

Whoa. Is that symbolic? I hope not.

Categories
intensivecare

ICU RN Breakdown

This week’s meme from inside my brain… If you’re old enough to remember the movie Gladiator, you’re welcome lol

Well, I think this week finally broke me. The state of California is removing the stay at home orders in the Bay Area, as they project 25% ICU bed availability in the coming weeks. I just want to know WHAT ICUS HAVE BEDS???? Because its not us. We don’t have any. Any time a patient leave, we replace them immediately with another patient from the emergency department, from another unit on our hospital, from another hospital in our system. Our nurses are getting pulled to go take care of ICU patients in random places all throughout the hospital as we wait for the ICU rooms to be available, but we’re already short staffed. So, we’re basically screwed. Plus, the patients are sick. We’re talking multiple code blue events in the ICU per shift, multiple deaths, overtime in the high single digits. And that’s not great, because research shows that shift workers in the 12th through 16th hours of their shifts have the mental capacities of someone who is legally drunk.

So, the nurses are the equivalent of crabby, sleep deprived, hangry drunks. It is a nasty atmosphere sometimes. A lot depends on the mood of the head doctor (the Intensivist) and the Charge Nurses. The nurses need a lot of emotional support. That leaves a charge nurse like me–who seeks to be supportive emotionally and intellectually as well as an upbeat and positive force in the unit but also suffers from being an empath (as well as her own depression)–in a really hard spot. I can get drained. I have the support of wonderful friends and a great therapist, and it takes me a long time, but I get drained.

And last night, I found myself outside the hospital, sitting on the ground a homeless person has probably slept on, letting the cement cool my legs, crying and smoking a cigarette at 4:45 in the morning. This was not my most glorious nursing moment. It was dark and painful. But those tears needed to come out so I could finish report on well over 30 patients and prepare for what I expected to be the oncoming shift’s foul mood leftover from yesterday’s day shift.

So here I am, after a not-sufficient amount of sleep, trying to process some of last night’s feelings. Being a nurse is exquisitely difficult some days. In addition to all the pressures I’ve already mentioned above, we had a traumatic patient admit that ended after what was essentially a five hour code blue. Another nurse and I pushed ACLS (advanced cardiac life support) drugs regularly, gave units and units of blood products in a massive transfusion, started the patient on CRRT (continuous renal replacement therapy, ie dialysis), maxed him out on ALL the cardiac meds you can imagine. After doing everything we could at least twice, more likely four times, a discussion with the family led us to make the patient comfortable with some morphine. The previous five hours had been filled with such pain and chaos–blinding lights and shouting. I put on some soul music. Don’t ask how I choose what music to pick for patients, but the second “Sitting on the Dock of the Bay” started playing, our patient just seemed more alert but relaxed. I sang to him, held his hand, and told him it was ok now and that we’d take care of his pain. He died while “Ain’t No Sunshine” by Bill Withers played. And that’s not what that song is about at all, but maybe it should be. Maybe its a better song that way.

Here’s a Spotify playlist I started for end of life music. I’ll keep adding to it, but I put this two songs on it for a start, in case you need a listen…

Trauma is something that nurses just accumulate, and its hard to release it. Moments like last night’s sidewalk meltdown are bound to happen for me, as I absorb and process all the emotions of the ICU. Would I change my life if it could be less traumatic? Would I change jobs? I’m not sure. I’m starting to consider the idea that I can’t just continue to accumulate trauma and other people’s emotions. I’m just not sure I would love my job as much if I couldn’t help patients at the end of their lives.

Categories
intensivecare

You have not lived until you have

  1. Pondered your own mortality while rubbing the arm of a man who speaks a different language than you, who is tied to the bed with 2 different kind of restraints and is still trying to hit you, who has survived a brutal car accident that deformed his skull and has now lost more of his brain to cancer, who is on a medicine to make him sleepy and comfortable but still flops restlessly in bed, who somehow manages to fart right in your face as tears come to your eyes, thinking about how you’ll probably die alone.
  2. Received the most vitriolic dressing down from an entitled white woman who no longer wants to be in the ICU but has unfortunately just had her 2nd brain surgery to remove a metastatic tumor. You try to set boundaries by saying “this is not a hotel; it is a hospital” to no avail.
  3. Bonded with your colleagues about all the shitty stuff that’s happened in your night—assignments changed, 2 admits, charge nurse yelled at you, expecting to get yelled at by cardiac surgeon because you didn’t extubate your patient, massive transfusion, and so on. It’s true that working in an an ICU is like going to war. The trauma bonds you.