Wednesday, March 14, 2018

I Remember Martin

This was an essay I wrote many years ago, about a patient who stayed with me throughout my career.  

I remember Martin. I was 20 years old, barely a nurse. He was 53 and about to die.

While I was studying nursing in the late 1970s and early 80s, there wasn’t much emphasis placed on dying. We were focused on saving patients, teaching them how live with chronic diseases, or helping them heal from various medical procedures. Patients did die of course, but that was when we failed to keep them alive. Palliative and hospice care had been introduced, but were not yet mainstream. We were taught that nurses helped save people, and this is what I believed. Until the day I met Martin.
Martin was admitted to our medical unit to die – to 514, a private room across from the nurses’ station. He had been living with cancer for a few years now and had come to the point that his chemotherapy was no longer providing him with a good quality of life. He had stopped all treatment, including kidney dialysis. On his admission papers, we were told that he would likely die within three days – four days at the most.
I was next in line for admissions that day, so Martin became my patient. I watched as he came out from the elevator. He walked slowly, deliberately towards the unit. I noticed that he wasn’t much taller than I was. He had piercing blue eyes in a round, creased face, and fading blond hair. He was so polite, so nice, so alive. I was told to complete the admission like all others – take a nursing history, ask the questions, fill out the forms. In other words, I was to act as if he was like every other patient on our floor. But he wasn’t. At least he wasn’t to me.
Other than a few patients who had died while I was on duty, and grandparents who I barely knew and who had died in country on another continent, I had little experience with death. But I knew that Martin wasn’t just another patient.
For the first few hours, I didn’t know what to say to him. I went in and out of his room more than I normally would have. I was looking for a way to connect with him. But I didn’t know how. What to say? What to do? I had no guidance, no map.
His daughters came. They were my age, another thing to think about. Martin wasn’t just a patient. He wasn’t just a dying patient. He was a father of two young women who would soon be losing their father. His wife came. She quietly cried in the hall for a few minutes before composing herself. She would be a widow in a few days.
I had been warned that Martin would start to lose mental function as toxins built up in his blood – he would become confused, disoriented. I wanted to connect with him before this happened. But I had no idea how. What I didn’t know was that Martin did.
During one of my visits in his room, he said, “Can I talk to you? Do you have a moment?” I had more than a few. I had cleared away all my other work so I could have time for him. He asked me to sit. I did.
I don’t recall all that Martin talked about, but I do remember him saying how he was afraid that he might start not making sense. How he might say one thing but mean another. He told me that certain things just didn’t matter any more. He explained it by comparing shapes and colors – triangles and circles, red and green. He said, does it really matter that the shapes or colors aren’t the same? Does it really matter that we aren’t all the same?
For the rest of that afternoon, I took care of Martin’s physical needs as he talked about his life, what he had done, and his love for his wife and his daughters. He talked about his regrets and the things he wouldn’t get to do. And he talked about dying. How he was afraid, but he knew it was time.
I went off shift at 4 pm. I didn’t want to go to work the next day. I didn’t want to witness Martin’s decline. I didn’t want to see him die. But I did, because that is what nurses do.
The next morning, I listened to our change-of-shift report and the nurse described Martin’s night. It hadn’t been an easy one. The team leader had thoughtfully given me a lighter patient load so I could spend time caring for Martin. As I entered his room that morning, it was obvious that the man I knew the day before was already gone. He barely opened his eyes, barely responded to my questions.
I tended to him, talking to him every step of the way. I talked about some of the things he had mentioned just the day before. And sometimes there was just silence.
The rest of the day, there was always a family member in Martin’s room and I didn’t want to intrude. I popped in to do what needed to be done, and then left the family to themselves. I left at 4 pm again, after saying my good-byes to the family. I wasn’t scheduled to work the next day. I would likely never see them again. I had no idea what to say.
I thought a lot about Martin that night and all the next day. When I returned to work for my next shift, there was a new patient in 514 – someone with hopes of recovering and going home. Martin was gone.
Twenty-five years later, I began working in hospice The time, the place, and the situations were all very different from that first experience with an expected death. I knew what to do. But I never forgot Martin. When I think about him from time to time, I don’t see him as he lay dying, but as the 53-year-old man who walked onto our floor. And those piercing blue eyes.

Friday, February 9, 2018

Over 90,000 Page Views for a Post I Wrote in 2008

Wow. Just wow.

I was poking around in my blog stats this evening. I began writing this blog almost 11 years ago now, so there are lots of posts. Some years, I'm great about posting often. Other years, well, to be honest I don't think about posting here. For a several years, if you Googled "nurse writer," I was one of the top three hits and often the first one. Now I'm not even on the front page. Ouch.  I get busy with paying work and feel guilty about not posting here. But it is gratifying to know that even whien I'm not posting, people are reading. Some of my posts have been read thousands of times.

I try to write about topics that I think you will find interesting. Sometimes I get it, other times I don't. But I sure struck a chord when I wrote, How Can You Die From Pneumonia? Bernie Mac Did. 
The post has been viewed as, of this evening (11 pm EST, Friday night), 90,415 times. This is a particularly interesting post for many cases, but maybe even more now given the flu season we're having. The runner up post, Broken Hips in Elderly Can Lead to Death, has been read almost 45,000 times.

So stay tuned for more stories. Who knows what I may find.

Tuesday, February 6, 2018

This Is Us took a beloved character, but how?

If you have been following the TV show This Is Us, you've known from the start that a popular character, Jack Pearson, had died. But what the audience didn't know until this past weekend was how Jack died. Now we know. (If you haven't watched this episode yet and you plan on it, there is a spoiler ahead. Stop reading now if you don't want to know.)

The series has been following the lives of a family, three adults (Kevin, Kate, and Randall) and their mother (Rebecca), 20 years after Jack dies. His children are haunted by his death and we're given glimpses of the past throughout the episodes. On Sunday's episode, the family home burns down. Jack rescues everyone in the house, goes back to get the dog and some treasures. He comes out of the fire, but succumbs later in the hospital to a heart attack, what Rebecca was told was a widowmaker. But what is a widowmaker heart attack?

A widowmaker is a term used to describe a massive heart attack usually caused by a total blockage of the largest of the heart's arteries, the left anterior descending artery. It's frequently fatal and it strikes people in their 40s or  50s, although it is much more common among men. In the show's story line, Jack's heart attack was caused by smoke inhalation, but there is usually no one specific cause of a widowmaker. Many of us have heard of seemingly healthy men (usually) going about their day and suddenly having a massive heart attack, often with no advance warning. However, some survivors will tell you that they did have symptoms, but they just didn't put two and two together.

Since February is Heart Month, it's a good time to review the signs and symptoms of a heart attack:

  • A feeling of pressure, squeezing or tightness in your chest 
  • Pressure or pain radiating down one or both arms, your jaw or into your back
  • Nausea, indigestion
  • Sweating
  • Dizziness
  • Feeling of impending doom

Women may have different symptoms. They may not have that typical chest pain but more nausea or indigestion, lasting for long periods.

If you feel that you may be having a heart attack, call 9-1-1 immediately. The 9-1-1 operator may advise you to chew a low-dose aspirin if you have them on hand. Do not try to drive yourself to the emergency room because if you pass out while you are driving, you will cause an accident that could injure others. At the same time, having someone else drive you could cost you valuable time. First responders are trained to assist people who are having heart attacks and may be able to stabilize you before transporting you or during transport.

If you find someone who having or has had a heart attack, call 9-1-1 immediately. If they are unconscious, do not try to give them an aspirin. If the heart has stopped, start CPR.

Not everyone knows how to give CPR, but it is strongly recommended that everyone learn how and also to learn how to use an automatic external defibrillator machine. More public places are placing these AEDs in strategic places so they can be used in case of emergency. To learn more about CPR, even if you've not taken a course, go to the Mayo Clinic site, where they explain the steps.

Heart attacks are frightening. If you have a family history of heart disease or have risk factors for heart disease, consult your doctor about how best to reduce your risk of a heart attack. You can also visit the American Heart Association or the Heart and Stroke Foundation of Canada to learn more.

Sunday, February 4, 2018

Is the flu as scary as media stories make it out to be?

The seasonal flu, influenza, is front page news across North America. Every day we are reading or hearing of someone who has died - and often it is someone young and healthy, the last person you would expect to die from the flu.

So is the flu as scary as the media is making it out to be? Yes - and no.

Millions of people around the world get the flu. They can be very sick for a few days with body soreness and muscle aches, terrible cough, fever, and more. But after a few days of rest and rehydration, they start to recover and gradually return to their daily activities. Some people may feel fatigued or have a lasting, nagging cough for weeks after the flu, but for the most part, they get better and the flu becomes part of the past.

But some people who get the flu get seriously ill. Some die. Some survive, but leave the hospital weeks and months later, with amputations or other life changing complications. And, because we can't tell ahead of time who may become so sick, this is why the flu is scary. I know of a woman who is 94 and was hospitalized last week with pneumonia following the flu, and she is now fine. Usually, it is seniors or those with chronic diseases who are the most likely to become severely ill from the flu. Yet this year, we have also heard of young children and young adults who were perfectly healthy before they got the flu, and they died.

The most common path to severe illness from the flu is pneumonia. Because influenza is a respiratory illness, it can lead to pneumonia. (There is no such thing as a gastro flu or a tummy flu.) Pneumonia can be very serious and can cause you to develop sepsis, your body's reaction to an infection. This is what can lead to death.

Every year, researchers try to come up with a vaccine for the seasonal flu. Some years, it's fairly effective. Other years, it's barely effective. And the researchers and pharma companies get a lot of flak for this. What many people don't realize is that we can't know 100% what flu virus is going to be the one to hit the hardest from year to year, so the scientists are working on an educated guess. The seasonal flu viruses change and mutate, and because it can take months to produce a vaccine, what may have been effective against a specific virus one month, may no longer be effective months later because the virus mutated and changed.

This begs the question - why bother with a flu vaccine at all then? Because it is somewhat effective. The flu vaccine can help prevent the flu for some people. It can help lessen the severity of the illness in others. But it can't claim to protect you completely - it can only be used as one tool in a toolkit for flu prevention. Compare it to wearing a seat belt. The seat belt helps reduce your risk of injury or death in a car accident - but it can't guarantee it. (When seat belt laws came into force where I live, I knew a woman who would pretend to wear the seat belt, just loop it over her shoulder, because she said that no law would tell her that she should wear her seat belt. Now, 30+ years later, you should see how fanatical she is about making sure her grandchildren are securely fastened in the car.) We know that seat belts save lives. We also know that if you do have the flu vaccine, you've decreased your risk of getting sick.

There are still people who believe that the flu vaccine can make you sick with the flu. It can't. As has been said over and over again, it doesn't contain a live virus, and you need a live virus to cause illness. That's not to say that some people don't get sick after they've been vaccinated. Some people are exposed to the flu before they have their injection - it takes up to two weeks for the vaccination to work. So if you're exposed to the flu just before or just after you have your vaccination, you're still going to get it. Other people report feeling fatigued, feverish, not well overall after getting their vaccine. This isn't the flu, but likely their body's way of coping with a vaccination. It's not comfortable and it would be best not to be sick at all, but it's not the flu.

I've read people saying that more people are dying now of the flu than before precisely because of the vaccines. They say that no one died of the flu before that. To those people, I say Google the Spanish flu. I am pretty sure we didn't have vaccinations back then yet (yes, that is sarcasm). Then Google other flu epidemics. There are others that occurred before we had seasonal flu vaccines.

How can you prevent getting or giving the flu? 

You can reduce your risk by washing your hands frequently. The flu virus can live on solid surfaces like door handles, bank machines, even store counters, for days. Wash your hands as soon as you get home or arrive at work. Clean your hands if you've been out shopping or handling things that others may have. Try to avoid touching your face, especially your hands, nose, and eyes, before you've washed your hands. Cleaning your hands will also reduce the risk of you spreading the virus if you have the flu but don't know it yet.

Get vaccinated. There's still time. Flu season can run up to the end of April, so some protection is still possible. If you don't want to get vaccinated, there's nothing I can say that will convince you, but if you do want to get the vaccine, you still can.

Stay home if you're sick. I know it's not easy. We all have bills to pay and responsibilities to uphold. But going out sick will just make more people sick. And although the chances are very likely that you'll get better and go on, someone else who gets the virus from you may not be so lucky.

Sneeze or cough into your sleeve. Your clothes are washable and less likely to come into contact with a surface that someone else will touch.

What should you do if you get the flu?

Rather than repeating what has already been written, you can go to this information I wrote for Sepsis Alliance: Sepsis and Influenza. There, you'll find not only more information on the flu itself, but the signs and symptoms, as well as when to see a doctor.

Good luck during this flu season. It's a bad one.