Daily Archives: July 7, 2013

Angels All Around Me

Angel guiding childrenThree a.m. My beeper goes off.  Again.  Ever since I got that beeper, I suspected it was bugged with a gyroscope that sensed whenever my body was horizontal.   Then the damn thing would go off, jolting me out of whatever delirious sleep-like state I had managed to achieve.

“Doctor, these orders need to be signed.”  Good grief, can’t they wait till 5 a.m. when I’m due back on the ward?  No, not worth getting written up for cracking wise with a nurse.

“Doctor, the patient in 36-G needs an I.V. restart.”

“Doctor, the patient in 26-G has a fever.”

It wasn’t long before I had one thing figured out: “Doctor” is not a title of honor: it’s a generic substitute for “Hey You.”  So I rolled off the hard call-room cot and went to do my duty.

But that particular morning at three a.m. it was a different kind of page.  I had actually fallen asleep, all my scut work being done (scut work is what low-on-the-totem-pole doctor chores are called: drawing blood, collecting specimens of  various body fluids, starting I.V.s, etc.).  The pager went off and I peeled myself off the ceiling, cursing and grumbling as I felt the walls for the light switch, knocking the old black phone off its stand in the process.  I called the nurses’ station, wondering what trivial chore they could have thought up this time.  Maybe like last night: “Doctor, the patient in 37-D has Tylenol ordered for fever over 38.5.  Is it all right to give it?”   AAAAGHHH!  Yes, please give the Tylenol as ordered.  Yes ma’am.

But this call was different.

“Doctor, Nadine is asking to speak with you.  Can you please come now?  She’s a bit agitated.”

I threw on my white coat, bulging with tools and books, and hurried down the hall to the School Age Ward.

Nadine was a very special child.  She was 11 years old, and had end-stage Cystic Fibrosis (CF).  In those days, children with CF didn’t grow up to be adults with CF, like they do today.  In those days, they didn’t grow up at all.  The oldest known CF survivor in those days had made it to 18.  But most died in early childhood of raging lung infections.

CF affects the whole body, but especially the lungs and pancreas.  It’s a genetic disorder that causes the body to produce a thick, sticky mucus that gums up the airways and makes a wonderful home for bacteria.  It fills up the ducts in the pancreas so that the organ cannot make digestive enzymes, and the food that’s eaten just goes right on out the other end, and the child slowly wastes away from malnutrition.

Nadine was born with CF.  She got sick very soon after she was born.  She required a lot of care, and soon her father couldn’t stand it and moved out.  Before her first birthday, her mother couldn’t stand the stress of round-the-clock care either, so Nadine was left with an older aunt, who was a very good person but had not bargained for having a child at her stage in life, let alone an extremely high maintenance one.  Nadine required special breathing treatments every four hours, followed by chest physiotherapy.  That entails turning the child into all sorts of awkward positions while banging on the chest to loosen the stuck mucus and encourage the child to cough it out.  Every four hours around the clock.

So even though Auntie was very good and had the disposition of an angel, she really couldn’t do it all on her own.

Nadine came down with pneumonia several times that first year, and had to be hospitalized, given antibiotics and oxygen and chest physiotherapy from the respiratory therapists, who were merciless and very effective.  She would come into the hospital, stay for two or three weeks till she was over the infection, and go back to her aunt.  It started feeling like a pendulum, swinging back and forth, back and forth.

In order to absorb her food, she had to take enzymes extracted from pigs’ pancreases, sprinkled on applesauce before her meals.  (Pigs are biologically the most similar to humans of all animals.)  She didn’t like the applesauce, and would just spit it out.  Her aunt had to fight with her at every meal.

Soon poor Auntie just gave out.  She had no help.  There was no such thing as a home health aide that could be paid for by public assistance.  So Nadine came to live in the hospital when she was three.  Public assistance did pay for that, and she had everything she needed there, even school.  When she was well enough, she could go outside with a volunteer.  The hospital became her home, and the nurses and doctors her family.

She bonded with the nurses especially, because the nurses were more steady than the doctors, who changed wards every two or three months.  But for some reason, she bonded with me, and I with her.  If I had an odd moment that wasn’t spoken for elsewhere, I would go and sit with Nadine and read her a book, or sing with her.  She loved to sing, even though she could only get two or three words out before she ran out of breath.  But we had a good time, laughing and joking, until my beeper would go off.  ”Bye, Doctor Doctor,” she would grin.  That was her name for me:  Doctor Doctor.  It was our secret joke.

As time went by Nadine got sicker and sicker.  She suffered terribly from air hunger.  If you want to know what air hunger is, just hold your breath until you can’t hold it any more, and then hold it five seconds longer. That is air hunger.  It’s suffocation in slow motion.

A funny thing happens in people whose lungs stop working.  Normal people’s brains tell them that they need to breath based on the blood’s level of carbon dioxide (CO2).  We’re not even aware of it, but the reason we take our next breath usually is because the level of CO2 rises to a threshold level, and a switch in our brain sets off the next breath.  We breathe out CO2, and we breathe in oxygen (O2).

If a person has severely damaged lungs, the brain gets used to having high levels of CO2, so it uses an alternate method of knowing when to breathe: low O2.  So the brain switches from “CO2 drive,” which is driven by rising levels of CO2, to “O2 drive,” which is driven by falling levels of O2.

This can lead to a dangerous situation: if a person is operating from O2 drive, then the brain triggers the next breath when the oxygen level falls below the brain’s preset threshold.  That means that if you give someone who’s in O2 drive too much oxygen, they will stop breathing!  But what do you do for a person who is in O2 drive, but is nevertheless starving for air because their lungs are so damaged?

Nowadays there are lung transplants.  And nowadays there are much better treatments for CF, and people are living into their 50′s and even 60′s with the disease, even without a transplant.  But Nadine unfortunately lived in the “bad old days,” where the best we could do was to try our best to keep ahead of the disease, and when our resources ran out, they ran out.

But here we had this precious little 11 year old girl, and she was suffering, and starving for oxygen, and we couldn’t give her any more because that would turn off her breathing center in her brain and she would die!

The unit director called a conference with the ward residents, the ward attending physician, and Nadine’s nurses (her night nurse even came in) and the respiratory therapists.  We tried to get hold of Nadine’s auntie, but she had moved and the phone was disconnected.

The director asked me to summarize Nadine’s condition.  It was bad.  She only had about 10% of her total lung capacity to breathe with.  It’s impossible to survive with that, and the fact that she was doing it was a testament to her fierce will to live.  She had chronic pancreatitis, which meant that she lived in excruciating pain. She could not be given pain-killers, because that would shut down her breathing.  And then there was the terrible air hunger.  She begged us to please turn up her oxygen, but that would mean instant, although painless, death for her.

The director looked me straight in the eye.

“Doctor,” he said softly yet firmly, “You are the one Nadine trusts the most.  If she gives you any indication that she is ready to go, you call me, day or night.”  I nodded, through my tears.

That next morning at three a.m. my beeper went off, and the nurse told me that Nadine asked to see me.  This time there was no grumbling: I rushed to her bedside.

The little pale face with its ever-blue lips turned up to me with an unearthly glow.  I shuddered involuntarily.

“Hi, Nadine, they told me you wanted to see me.”

“Hi, Doctor Doctor,” came the wheezy little voice.

“Doctor Doctor, do you believe in angels?”

I caught my breath.  ”Well, I don’t know, Nadine.  Do you?”

She began to laugh, and a coughing spell racked her little body.  I sat her up and helped her spit out the sticky mucus.

“Don’t you see them?”  She was beaming.  ”They’re standing all around us!”

That morning, I called the director and told him what she had said.  An hour later, with all of us assembled at her bedside, holding her hands, we turned up her oxygen.  Nadine grew pink as she breathed in the life-giving element, and went home with her angels.

Angel guiding childImage credits: Google Images, public domain

 


Crowded and clouded

The week drained me. Shark week, holiday, socialization. I have been exhausted and grumpy all weekend because every tiny thing seems like a thousand nails on a chalkboard. I do not handle stress with any grace. People, kids, cats, expectations, obligations, it has all snowballed and while I functioned fairly well, I am now having my post break down.

Or at least a cool down. I don’t feel anything but tired.

Which is good, to not feel anything. Not mad, not sad, not happy. Just…Tired. Tired is a simple way to feel. The solution is to rest. Whereas with mood swings there is no solution, no rhyme, no reason. I can handle tired.

Thing is, I have been sleeping, maybe 6, 7 hours a night. I am still drained, my brain still feels clouded. When I say that interacting in the petri dish sucks the life out of me, it’s not a dramatization. It literally leaves me drained because it is just so stressful.

Plus I have now had time to think about the cookout, and things that happened or were said, and OCD scumbag brain has decided to latch onto some of it as a prime example of “why bother trying” to interact. Because nothing I do will ever be right. I will never fit in, I will never feel like I belong, I will never be what others seem to need me to be.

Fortunately, I have been too tired and busy functioning to really truly obsess.

Last night, aside from Castiel, the abandoned kitten,  I kicked the cats out and shut my bedroom door because I felt so crowded I was smothering. It has to be extreme for me to kick the cats out. One of the biggest joys in my life is to wake up to the sound of a purring kitty. But dealing with people all week, in the extreme, left me feeling a need for space. Lots of space. My kid was asleep, so I decided to just take the space and enjoy it.

Now I am done running errands for the weekend, I swear. Shopping for this and that, faxing for R, fetching movies from the library for my kid…It wears me down. Plus my car is an absolute piece of shit that runs like shit, so being out in it just proves more frustrating than fun and free.

Like I need one more thing to piss me off.

Which at the moment, I am not. But when I got home from grocery shopping and Damiana was waiting outside the trailer for us, the anger boiled up. The child is a bloody stalker. Who eats our food and leaves and comes back 20 times a day. How is that not going to piss a person off? last night I sent her home and told her not to come back. I just get to the point where if I have to look at her one more second, I am going to gouge my own eyeballs out with barbecue skewers.

It’s not right. I LOVE kids. I just don’t like annoying rude kids. I don’t like kids who use people. I don’t like kids who don’t listen.

And since my own kid doesn’t listen, I sometimes don’t like her. In my dysfunctional mind, like and love are two very different separate things. You don’t have to like someone to love them. (Look up family in the dictionary!) But in all fairness, it’s not my kid I dislike, or well, anyone for that matter. It’s the BEHAVIOR. Behavior is not exclusive to age, race, gender, economic background, sexual orientation. On this I am very black and white, NO shade of gray. If you behave like a jerk, then you are acting like a jerk.

Being a prime example of someone who occasionally acts like a jerk, I feel justified in making this declaration. But I am not my bad behavior. I try daily to improve.

Not easy to do when your every thought is distorted and you question every thing you think and do.

But I try.

Which is a hell of a lot more than a lot of people do.

Now…back to vegetating.

Speaking of…Very twisted joke:

Mrs. Dahmer says to her son Jeffrey, “I don’t think I like your neighbors.”

Jeffrey replies, “It’s okay, Mom, just eat the vegetables.”

(Yes I am a sick and twisted little twonk!)


I’m Not Crazy, I’m Just a Little Unwell

The title of this post is from the song Unwell by Matchbox twenty.  I used that line as the title of the sermon I will be doing at church on the 21st.  I had written most of the sermon when I first listened to this song.  I had heard it many times before, but never really listened.  Now that I have it speaks to me.  I felt compelled to add it to the sermon which required a brief rewrite, but it is so worth it.  I hope you enjoy it as much as I do.

60%

By my calculations, this is 60% of the size it's supposed to be.

By my calculations, this is 60% of the size it’s supposed to be.

I’m fairly new to knitting — I don’t hide this fact. So there’s a lot of cardinal rules that I’ve not picked up on yet. I found out one this week at Stitch ‘n Bitch — gauge ties to thickness of the yarn -and- the needles size. So when a pattern calls for x stitches over y inches, it’s something that should be (mainly) readily determined by both the size of the needles, and the play of the wool. So when I was muttering about gauging for this piece I’m working on and how the needles that matched the wool I had were much bigger than suggested, a friend set me straight.

Armed with new knowledge, I raided the nearest semi-quality shop with yarn and needles...

Armed with new knowledge, I raided the nearest semi-quality shop for yarn and needles…

To be fair, the book didn’t give me anything useful, no ply, not even a brand — it merely mentioned nylon microfiber. Which um… not really enough to go on, mate! So by my calculations, the piece I’m working on is going to come out about 60% of the actual size, or a chest circumference of 17 inches. I wanted to make this for Lilbit, who has a 20-21 inch chest… 17 is a bit too teensy. But the 28 inches that it’s supposed to come out to sounds huge too! Still, now that I had better information, I hit up my usual pit-stop for yarn in town, and managed to find a good deal on both some aran (worsted) and chunky (bulky). I filled in gaps in my needle collection with cheap plastics and metals, which I will eventually replace with proper wooden Knitpro Symphonies (Knitpicks in the States). If this pattern comes out nicely, I’m going to repeat it in the proper wool so that Lilbit can have a nice new cardigan.

Really though, either stockinette stitch is significantly more forgiving than garter stitch, or I’ve improved quite a bit already from the cardigan I was working on last week. I still need to finish sewing it together, and then laughing at all the horrible holes in it. *chuckles* I guess, all in all, I’m having fun and developing a skill, so it’s all to the good.

Now, I might not be around here for the next week — if I’m not, don’t worry. I’m fine. :) I’m just likely to be rather busy, and I’ll catch everyone up on that later.

Hope everyone is doing well!

<3

The post 60% appeared first on The Scarlet B.