You always remember your first. He was in his sixties and I was 22. As a nurse, dealing with death and dying is inevitable. It is an ever present possibility. Sometimes, it is a peaceful, uplifting experience that reminds you why you do what you do. A doting husband holding his deceased wife's hand, crying softly while telling you what a wonderful life they shared, and how happy he is that she is at peace. Children and grandchildren sharing stories, laughing, singing, and even praying by the sides of their loved ones. These are the good ones.

My first time losing a patient was slightly different. For some reason it has been on my mind today and I find that writing about it is cathartic in a way, so bear with me.

It was my first month off of orientation working in the ICU. In those early days I was terrified of making a mistake. You know on some level as a nursing student that you are responsible for keeping people alive. Mistakes on your part can lead to patient injury, and in some extreme circumstances, death. But when you actually have your own patient assignment, knowing you are solely responsible...well, it is a tad overwhelming as a new grad. That night I was working in the step down part of our unit. My patient was transferred from the critical care side to step down right as I came on shift. I even helped move his bed over; the distance from one unit to the other is only a couple of feet, with an open doorway in between. I received report, he was recovering from a brain tumor resection and had a pretty good prognosis. I met his son, who was very worried and anxious and had not been home the entire time his father was in the hospital. He was using a hotel room to shower and change, taking all of his meals at the hospital and sleeping in a recliner at his bedside. I reassured him over and over again in that first hour. His father was doing great! He was being downgraded to a less critical area, his speech was improving and his vitals were stable. I joked around with both the patient and the son. At some point in the night, I told the son to go home. Get some rest. Sleep in a real bed. He was very hesitant, and felt that if he left something would happen. I told him not to worry; I would personally guarantee his father's well being and if anything were to happen, I would call him right away. Reluctantly, he left. But not before giving his dad a kiss on the forehead and triple checking I had the right contact information.

You already know where this is going. His father did not survive that night. Without going into too many details, he went into respiratory failure and eventually cardiac arrest. In my heart I know the events that led to his death were out of my control. His death was unpreventable. But I sent his son away on the one night he wanted to be there. I wasn't even able to call him when he started to become unstable, it was that fast. We coded him for 40 minutes. If you work in healthcare, you know that's a long time to be doing CPR. When we finally called it and I was able to think straight, my heart broke as I realized the phone call that I needed to make. It was the single most difficult conversation I have ever had with a patient's family member. I felt responsible. I felt guilty. And his son was in no mood to assuage my guilt. He screamed. He cried. In the end, he didn't even come to see his father's body. His brother called me soon after we hung up (or rather, he hung up on me) and told me he would make the arrangements but to please not call his brother anymore.

I have had many patients die since that night 5 years ago. Some were expected, some were not. I can't even say that my first experience of patient death was the most unexpected; there have been worse cases. But it was the one that had the most impact on me as a nurse. It made me more humble and compassionate, I think. You never know what can happen, life is not a given. I have never again promised with certainty the health of a patient. I have never again pushed for family to leave the bedside to get rest. I love my job, I love the feeling of accomplishment and sense of purpose that comes with being a nurse. But it can also be very difficult.

There really is no point to this entry, except to put my thoughts into writing. I hope my career continues as it has, with the good experiences outweighing the bad. And I certainly hope that somewhere, a son can forgive the well meaning nurse who sent him home on the night his father died.

Birth Story: Ellie Rose

So I guess I should really do better keeping my blog updated, and what better way to get back into it than to share my experience of the birth of my first baby, Ellie.

It all started nine months ago...jk!! Seriously though, from the moment you find out you are expecting until that moment you are holding the baby in your arms, there is such a roller coaster of emotions. After the 20 week mark, I started really delving into any information I could get my hands on regarding birth, caring for newborns, breastfeeding, diapering, post partum care, etc. If it had something to do with pregnancy and/or babies, I was reading it. I thought I was prepared.

First off, I was going to have a regular, vaginal delivery with as little medical intervention possible. If I could focus and breathe through the pain, I wouldn't even need an epidural, but I was not against getting one. Then, after minimal pain (because I would labor at home for hours, coming in to the hospital only when the pain was unbearable or when contractions were less than 5 min apart) I would give birth to a beautiful baby girl, breastfeed with no issues (because I would be vigilant about getting the perfect latch) and go home after 48 hrs with my new little family. That was my imagined scenario.

What really happened:
Friday morning I had a 39 week appointment at my OB office, and was also following up on my blood pressure/protein levels from the previous appointment. My blood pressure was 145/96, not significant by itself, but pretty high for me and it had been steadily increasing since about week 34/35. My protein levels went from trace, to +3 in 4 days. As soon as the doctor walked in, I knew I was being sent to the hospital for induction. At first, I was excited to think that in a couple of hours, if everything went well, I would be finally DONE with pregnancy and holding my baby!! Then I realized that having an induction meant I had no control over my labor. I would be in the hospital from the beginning of the process to the end. On monitors, not being able to eat or walk around, pretty much just waiting for things to kick into gear. That's when I started to think that maybe this whole process was going to take a completely different turn.

We left the office in a little bit of a shock, went home to eat (only Giuliano, I was told no eating for me) and pack our hospital bag. Arrived at the hospital around 1 PM, went into triage and pretty much got rushed in to sit around and wait. The OB on call came to talk to me about my blood work and plan of action around 3 PM. He said, among other things, that I was having a baby and needed to choose induction or C-section. I said I would really like to try induction since it was still important for me to have some elements of my original birth plan. The OB didn't really like that, and kept telling me I was very unfavorable for a successful induction since my cervix was only 1 cm dilated, not very soft, about 60% effaced. Also, he said based on my last ultrasound, baby girl was weighing approximately 8lbs 13 oz. Another reason  should just choose a section from the get go and be done with it. Giuliano and I spoke about it, prayed together, and decided we should just go ahead with the induction. Why not try? I was admitted into labor and delivery, got started with an IV, and connected to all the monitors. Around 5 pm I was given cervidil to soften the cervix, which needed to be in place for 12 hours (2 hours of which I had to stay in bed for) and then in the morning they would do another cervical check before starting pitocin. I was also given one "last" meal before delivery. Lucky me!

I won't go into details, but it was a long night. Every time I moved wrong, the monitor would lose Ellie's heart beat and the nurse had to come back in to fix the positioning. Blood pressure checks at least every hour, and since I was getting a lot of IV fluids I had to pee a lot. Which meant calling the nurse to come in and remove all the monitors. In the morning, they removed the cervidil and checked me: no softer, still 1 cm dilated. Then the pitocin was started, and the nurse told me not to wait for the pain to become unbearable before requesting an epidural. (never happened, I didn't feel the contractions) We settled in again, eagerly awaiting the progress that would signal the much anticipated arrival of my tummy dweller. I would like to point out that during this time, I was not allowed out of the bed at all. So my dear husband had to be my personal nurse and bring me the bedpan every time I had to pee (which, being 9 months pregnant and getting lots of IV fluids, was very often) and empty it since I couldn't wait for the nurses. Such a trooper, he was amazing throughout the entire experience.

At 4 pm I was checked, and despite having contractions every 2-3 minutes, I had made no progress in 8 hrs. I was spent. Exhausted from being in the hospital with very little sleep for more than 24 hrs, mentally and emotionally tired from just the whole ordeal. I would've agreed to anything at that point and my doctor knew it. She recommended a C-section and I practically begged her to schedule it ASAP so I could just be done with the whole process. Looking back now I feel cheated out of a "regular" birthing experience, almost like my body didn't do what it was supposed to.

Off we went to the OR, Giuliano dressed in scrubs and me waddling down the hall knowing the next time I was up and about we would have a new baby in our lives. Pretty surreal. The actual OR experience was not the best, mostly because I am very sensitive to any kind of sedation and the spinal block made me VERY nauseous, resulting in me trying to dry heave for 10 min but unable to bring anything up since I was pretty much numb/paralyzed from the stomach down. Also an odd experience to be unable to take a deep breath or even cough adequately while having the spinal block.

Nothing prepares you for the moment you hear that first cry from your baby. Immediately Giuliano was being told to come and stand to the side, taking pictures and watching them as they cleaned her off and let him cut the cord.

After stitching me back up and sending me to recovery, Giuliano and I were able to go back to our room around 10 pm for some family bonding time. Ellie has been such a joy to take care of. Even her cries are cute to us (which I'm sure won't last, but for right now we are enamored with every little thing she does). I would never have been able to imagine the love you feel for your newborn or the way your love changes towards your husband watching him with your child. It is indescribable.

Recovery from the C-section hasn't been too bad, especially with so many people around willing to help. The biggest difficulties so far have been sleep deprivation (thank goodness for grandmas!!!) and breastfeeding. I have had a really rough time of it, and although I'm told everyone goes through some difficulties, it doesn't change the frustrations I feel. But, then again, if those are my only issues during her first few months of life, I will consider myself extremely lucky. I know for a fact that others have it harder, so I can't complain about my lot. 

For all those who have been bugging me!!

Here are the belly pics for my lovely friends...we are a little more than halfway there!! 

(Slightly terrifying)