We recently had an experience in the hospital where a 25 year old man went down at home, he was revived by paramedics, and brought to the hospital. After a few days on life support, he was declared brain dead. His fiancee, whom he had been with for several years, wanted to withdraw care and let him go, as she knew that this was the decision he would have wanted to make. However, he did not have an advanced directive to appoint a power of attorney or living will, so the decision legally went to his mother whom he was not close with. His mother couldn’t bear the thought of her son passing away, so she refused to let the hospital withdraw the life support. He laid in the bed for several days before physicians stepped in and told her that it was not ethical to keep his body going with the ventilator and other supportive equipment.

We, as nurses, had several conversations with his fiancee and she confided with us her frustration. Her and her fiance had actually had the conversation about “being a vegetable” after seeing a story on the news. They both vowed that they never wanted to lay in a hospital bed in that exact condition. But, because they never filled out an advanced directive (and weren’t legally married), she had no say on this decision. With just a few signatures, this situation could have become slightly less stressful on the fiancee.

Below you will find links to the PDFs provided by the State of Arizona to easily fill out your living will and healthcare power of attorney forms (at absolutely no cost to you). The living will is a document that discusses only “deathbed” decisions, while the healthcare power of attorney appoints one person to make all medical decisions for you, limited by decisions you made in your living will.

So, take a few minutes to print out the attached forms, take some time talking with your loved ones, and fill out the forms. Each form requires a notary to verify the signature, and most banks offer a free notary service when you use their company for banking. Many libraries also offer notary service, so make a quick phone call to find out.  After you have filled out your forms, you can choose to file them with the State of Arizona’s Advanced Directive Registry (the pdf with instructions is below). This registry keeps your forms online, easily assessable to anyone you choose to give your password to. You can also choose to give copies of your advanced directives to your loved ones in case your find yourself in an unthinkable situation.

Living Will Form
Healthcare Power of Attorney Form
AZ Advanced Directives Registry Instructions

The Boston Globe recently published an article titled “Gene experiment may offer hope for those with cardiac failure“. In this article, the author discusses how scientists in San Francisco have discovered that they are able to take fibroblasts, which are connective tissue cells that make up about half of the heart, and regenerate them back into working heart cells. This new ability gives them hope that they can use this as a new way to treat heart failure by repairing the damaged tissue.

“After a heart attack, the blood supply to the organ is cut off, leaving sections without the oxygen they need. Cells in the oxygen-starved areas die, form scar tissue, and no longer contract properly, impairing the heart’s pumping. Patients with this kind of damage, known as heart failure, can become exhausted by walking or climbing stairs.”

They’re hoping that clinical trials will begin in the next 5 years. I’m hopeful for any advances in heart failure as I can see the intense effect it has on peoples’ lives after their cardiac function begins to decline. Here’s to hoping for a cure.

I was the team leader (aka relief charge) for the ICU a couple days during our craziness and I can’t even begin to explain what a difference it makes to have such a wonderful coworkers at the hospital. I’m lucky to work alongside a group of people who are truly a team. If one person is getting their butt handed to them by their patient load, you’ll always see another staff member in the room. You’ll rarely see someone sitting down to chart if someone else needs a hand.

Just throwing that out there…. thanks to all my coworkers for being so great. I can only hope that most hospitals can retain this kind of staff. :)

One of my favorite examples of inspiration in the medical field was from several years ago, Dr Nicholas Yphantides was extremely overweight at 467 pounds and teaching his patients “do as I say and not as I do” and feeling badly about it. So, he kicked his life into gear and lost over 250 pounds without the help of surgery or medications….and has kept it off. He can now teach his patients to “do as I say AND as I do”.

Or, back in March, when Methodist Healthcare System in Texas encouraged it’s employees to be more health with a “100 Day Live Healthy Challenge” where employees form teams and compete on the amount of aerobic activity per week or weight lost. If every hospital developed a program like this, especially with incentives, I think our workplaces would be quite a bit healthier. Maybe we’d stop seeing boxes of Krispy Kreme or oversized bagels and cream cheese sitting in the nurses’ lounge?

At the last nursing conference I attended in Las Vegas, the brochure said that the price of the conference included a “continental breakfast and lunch” each day. So, we show up at 7am and see this picture… trays of danishes. No fruit, no granola bars, nothing else. Oh, and they had coffee… but no juice, no cold water. Outta luck for this girl who doesn’t like coffee and is trying to eat healthy. From doing some research, one of these small pastries has about 150 calories and 8 grams of fat… and many nurses had 2 or 3 of them on their plate as it was the only thing to sustain us until lunch was served at 12:30pm. I would hope that nursing conferences would be a place to start for a healthy change in our profession.

Already having my CCRN, I didn’t attend any of the review sessions, but the critical care sessions I did attend on the first day were uneventful. Day 1 recap: session on New Cardiovascular Drugs consisted of all medications I was very familiar with; Complications of Critically Ill Patients was basic talking about sepsis, abdominal compartment syndrome, etc; ARDS looked great from the look of the powerpoint slides, but the basic review of the mechanism of breathing took up three-fourths of the allotted time and barely any time on the meat of the presentation. The first day was rough – at the end, I was regretting my decision to drive five hours and spend the money to attend the conference.

Day two started out just as rough, with the keynote leaving me with a bitter taste in my mouth. Laura Gasparis-Vonfrolio gave a speech entitled “Condition Critical” where she spoke of her perceptions of why nurses leave nursing, nurse-patient ratios, and mandatory overtime. While I’m sure these are big issues at some hospitals, they’re not big in my professional life and I felt the talk to be extremely negative and disheartening at 7am. What would have made this talk better were more solutions to the problems. For example, she mentioned that we should all create nursing corporations and market them back to our hospitals, but that was all that was said – no one at our table had any idea what that even means. I can understand frustration in the field of nursing, but I would have liked to see more of a call to action, rather than just discussing the negatives. I’ve listened to Laura Gasparis-Vonfrolio’s CCRN review DVDs in the past and she had been hilarious, knowledgable, and easy to listen to.

During that second day, I went to all four sessions presented by Carol Jacobson; on Pacemakers, ACS, Differentiating Wide QRS Tachycardias, and Cardiovascular Drugs. I loved each one of them. While the sessions on ACS and cardiovascular drugs were more basic (probably geared towards the nurse on a step-down unit), it was still full of great information for the less-experienced nurse. Her sessions on pacemakers and wide QRS tachycardias were the highlights of the conference for me.

I’m really glad that I went to the nursing conference. It was actually my first out of state conference, which was a great experience to talk to other nurses in other parts of the country and learn what they were doing on their units and what issues they were facing. It was also a great break/vacation as Las Vegas is a great place to go for any reason. While we were in bed by 10pm the night before each of the conference days to be awake and attentive, but the night after the conference we had the chance to go out and experience the city. (Photo: That’s me in the middle, Erica on the left and Melissa on the right)

I took her to the vet, where they loaded her up with the camel-hump of saline (they inject saline subcutaneously on dogs and the body absorbs it to rehydrate), an IM shot of steroids, and another of an antibiotic, along with drawing blood work and taking an xray. They gave me some extra-calorie dog food to help her gain back some of the weight she had lost and a prescription for oral antibiotics (and a bill for a few hundred dollars…ha). Turns out, she had a really bad respiratory infection, which I would have never guessed because she looked like she was breathing okay and didn’t have a cough of any sort. But, a few days after the visit to the vet, she was recovering nicely.

I know I’m not a veterinarian and I’m not expected to know how to diagnose or treat an animal, but it seems like the symptoms of a respiratory infection would be universal.

I guess I’m just lucky to have a very accommodating vet office, who snuck us in for an appointment and a dog who loves the heck out of me for taking such good care of her. (Photo credits to the boyfriend, who snuck the shot of me listening her to heart and lungs after I got in from the hospital the night she was really sick. Jinx, our puppy, is a 2 year old Boxer/Pit mix.)

He and his family had spent two days discussing the options and still were unclear of the path they wanted to take. The patient fell asleep for an afternoon nap and when I went into the room to wake him for dinner he said “no thank you. I don’t want to do this anymore. I’d like to stay in bed and be left alone.” After sitting down next to his bed and asking him what prompted this sudden decision and listening to his thoughts about this being “the end”, I let him sleep awhile longer and I called his son and asked him to come in. His son brought a radio, for him to listen to the Arizona State University Sun Devils in the baseball Super Regionals as the patient played baseball for ASU before the school was ever called ASU. They talked and the family agreed to his wishes and he would go to a hospice facility the next day.

The next morning, the family came in to visit. The first thing out of the patient’s mouth was “Did the SunDevils win? I didn’t get good radio reception.” His son confirmed that they won and that they would be playing in the College World Series the next week, the patient grinned, and then his eyes opened wide, he stopped responding, and the nurse called a Code Blue. Fortunately, the code was cancelled before the patient was revived (due to the fact that he was going to hospice that day, and this was confirmed with the family who were at the bedside).

I had a chance to speak with the son shortly after the event and he commented on how fitting it was for his dad to pass away just seconds after hearing about the SunDevils victory. He would surely be missed in the family, but his wishes were clear and he wanted to go in peace… and he did.

Insanity has been defined as “doing the same thing over and over again while expecting different results.” If you are not seeing the personal outcomes you want, then you need to make some adjustments.

Similar to the ones you may have written for college entrance applications, it might just be time to write an updated personal mission statement. Include aspects of your personal life; In 5 years will you have children? Do more international traveling? Buy your first home?

“To fail to plan is to plan to fail.” If you are not actively planning your life journey, then it is extremely unlikely that you will arrive where you ultimately would like to go. It’s time to start on the next segment of your life.

He was one of those people that I really enjoyed taking care of. I would bring the computer on wheels into the room to do my charting just because I really enjoyed talking to him. He told me everything about his life- from his time in the service, to how he met his first wife… and then his second wife, and how much he had learned about himself between these two women. He had several children and I felt like I knew every single one of them by the time I transferred him to a telemetry room (which was a good sign because it meant he was leaving the ICU) that afternoon.

I stopped by his room every day that I was at the hospital to say hi and would spend a few minutes talking to him and his family. Then, it was the weekend and I was off work (yay!). I came back into the hospital on Monday morning to find his room empty and I was thinking that it was great that he was able to go home, but as I did rounds in the ICU, I saw him… laying in bed, eyes closed, hooked to a ventilator. Oh no… it can’t be…

Turns out, the mix of his chest tubes being removed on Friday and the effectiveness of his blood thinners caused his chest to fill with blood and him to need emergency surgery at 2am.

I now think back to the long conversations we had and the biggest thing that stands out is him telling me not to wait to live my life. He and his wife had put off traveling, waiting for the kids to get older, waiting to have more money, waiting to retire, etc and he went and got lung cancer… and needed major surgery… twice, before they got to follow through with any of their plans. He talked about spending quality time with the ones you love; while you may see your significant other on a day to day basis, remind yourself to cherish the moments – all of them.

So, I’m doing just that. I’m going to Hawaii with the love of my life. I don’t have the proper “emergency fund” set up per Suzie Orman’s standards, but it’s time. At 26 years old, I’ve never seen the ocean and it’s about time to change that with the best company that I could possibly ask for.

So, I’d like to thank D (as I lovingly call him) for the words of wisdom. He was discharged from the hospital a week and a half after his second surgery and I saw him almost every day in between. Who wouldn’t love a patient who’s going through hell, but has a smile and a positive outlook through it all?

From a non-work perspective, we recently took a family vacation out of state and it was so wonderful to get away for awhile (the picture of the pool is at the hotel where we stayed… amazing). But the day after we got home, our living room (aka big) TV stopped working as well as our air conditioning (a necessity in May in the desert). What are the chances? Both in one day? Hmmmm.

I just wanted to check in and say hi since I feel like I haven’t been posting as often over the last few months. I’ll get back on track here I’m sure. :)