17 February 2007

Didja screen 'em, yet??

I just hate this question, my being a research coordinator and all. If you think you found a patient for a study, then, you must be part of the study team. As said member of the team, I have not only put together consenting packets, but have also posted study inclusion/exclusion as well as the most current version of the consent form on the transplant server (you remember the computer??) in the nicely organized study folder. Why don't you screen and consent them? You just saw the potential participant. Not to mention the fact that you just paged me away from the bedside of a patient I'm consenting in pre-op....Hello??

10 February 2007

Memories of Amy...

Well, here it goes. I'm not sure what I'm doing, but I guess I'll take a stab at the blogosphere. Welcome to my world where the sky is cerulean blue....

I read oncRN's blog and started thinking about some of the folks that have come into my life that left an indelible mark. Her name was Amy and she was ~19 years old when she came into the chemo room the first time. She was beautiful and courageous, and was about to start the fight of her life. I remember talking to her about the chemo (we treated her with ABVD/MOPP) and reassuring her that we (the docs and the rns) would be there to take good care of her .

Amy fought her battle with Hodgkin's Disease and went into remission...briefly. When she recurred, I was there to start another round of treatment and support her. We used up her veins and she got a central line. She became septic and we treated her with triple abx and a trip to the hospital. She developed a fistula between her trachea and esophagus that was patched with a gortex graft. That was the beginning of the end.

Several months went by and I left the hem/onc office to take a new job as the night charge nurse at the hospital in town where we usually admitted our patients from the office. I went to work on the oncology floor and was there for Amy's last trip to the hospital. As she and I had gone through so much already, I came on and quickly assigned her to me for the night. It was so good to see her, again. The fistula had been patched, but it seemed to be giving her problems. She still had a productive cough, but was bringing up old blood (ie: drk red).

Around 0200, I was making my usual rounds to check my patients. I poked my head into Amy's room where the light was still on and Amy lay awake. She wasn't sleeping. I looked on her bedside table and noticed the bright red clots in her specimen jar. "When did you start coughing up this," I said, pointing to the cherry red blobs? "Just a little bit ago. It's nothing." That's what I wanted to believe while I started to panic on the inside. "Amy, the change in color concerns me a little; so, I'm going to check your bp and stuff." The stuff being a head to toe assessment. Amy was young and everything looked and sounded good. VSS with clear breath sounds, no dyspnea and her sats were >90%. I reassured her and told her to call me if she started coughing up more blood.

Once I was outside the room, I went to call Dr. G to let him know of her change as she was a full code. "Keep an eye on her and if you need me, call me back," was Dr. G's calm reply. Really, other than the change in her expectorate, Amy looked and sounded ok. I discussed with Amy calling her mom to come in and be with Amy. Amy answered, "Do you think we should? I'd hate to wake her up." I hoped that Amy couldn't tell I was uber super duper concerned, "Yeah, Aim, if you were my daughter, I'd want to be here just in case."

Call it a nurse's sixth sense, but Amy wasn't ok and I was starting to worry. Every time I went back into her room, I was met with more and larger clots. Although her pulse went up slightly and her bp barely dipped, I called Dr. G, again. "Hey RG it's AZ, again....I know, I can't put my finger on it, but she just doesn't look good and I'm getting worried." Just the words Dr. G didn't want to hear. "Ok, AZ, I'll come in. It's almost time for rounds anyway."

"Hey, AZ good thing you called, let's get her transferred to the ICU, now," Dr. G said coming out of Amy's room. My team helped get the transfer going while I finished charting and calling report. Amy's mom arrived before the transfer and went in to keep Amy company. My friend and I transfered Amy to the ICU.

After my shift, I went up to the unit to see Amy. There she was in the bed, intubated with her eyes closed. Dr. A, her primary oncologist was in talking to Amy's mom. "Amy, it's AZ." Amy's eyes flickered open as she raised her head to look at me, briefly. It looked like it took all her effort. "I'm heading home, but I'll be back tonight. I'll come see you before my shift."

That was the last time I saw Amy. When I went in that evening, the ICU staff told me she had died?! My Amy!! I was stunned. Down on my unit, my friend Dave asked, "Hey, AZ, I heard you transferred Amy to the unit. How's she doing?" I looked at him and started to cry....

Amy, I miss you. Thank you for allowing me to take the journey with you.