Contact Isolation

Mr. E was one of those patients that you loved to hate. This gentleman made a heartfelt effort, going out of his way to ensure that you had unpleasant encounters with him. He wouldn’t make eye contact with you because he didn’t deem you worthy of his attention. He wouldn’t answer questions, would cut you off in mid-sentence, and refused to listen to any information you gave him regarding his medication regimen, disease process, or plan of care. He’d interrupt you with “I know all that already” and proceed to watch TV. The only value you had to Mr. E was your ability to bring him pain medication, which he asked for every two hours with religious punctuality. Mr. E had graced the unit with his presence numerous times within the past month, all for the same reason: Exacerbated Congestive Heart Failure. It did not help his cause any that he had MRSA of the blood stream, which required all staff to put on a gown and gloves before entering his room for any reason. He was forever on “Contact Isolation”.

After being in the hospital for a week, Mr. E returned after one day of being discharged, for his usual complaint. His simple-minded fiancé, as always, didn’t leave his side for any reason, despite his litany of impolite commands and rude lashings. She wasn’t what anyone would consider a “bright” woman. She quite possibly had some type of learning disability or mild form of retardation. There was an element of codependency between the two that was frankly nauseating. The attraction each found in the other was puzzling. Of course, before the nurse could even get Mr. E settled in the bed, he was already asking for his Dilaudid (which is a potent narcotic that’s eight times stronger than morphine). Never mind that his lungs were full of fluid, his blood pressure barely enough to sustain life, and his level of oxygen in the blood was too low. His pain medication was his priority.

Mr. E was 45 years old and had an ejection fraction of 10% (meaning his heart was barely able to pump blood through his body). He had a crappy heart – literally and figuratively speaking. It was no wonder why he was an angry man. He was angry that his life would soon be coming to an end. He is terrified man. Dying is a very lonely experience. It separates you from others and the world itself. There is true irony in his “Contact Isolation” status. His displaced anger at us did keep him isolated from loving contact with others, creating boundaries that exceeded the gloves and gowns we wore. I wonder if his distancing actions were protective in a way – without having that meaningful connection with others, he wouldn’t have that to lose (thus no grieving) as he died. I felt compassion towards Mr. E, because I understood that no amount of Dilaudid can take away the pain that one feels as years of unlived life slowly slip away, and day by day, you drift further apart from humanity while propelling closer to the unknown.

Stage 6 - Renewal

He lay there, gasping for each breath like he had finished running a marathon at maximum speed. 83 years old, 6’3”, and weighing just barely 130lbs, he was coming to a finish line of sorts. “How are you feeling, Mr. Jones?” I asked, as I routinely do with all my patients. “Fine”, he said in an almost inaudible whisper, as if with every word spoken part of his spirit escaped. My heart sank as the physical assessment continued. His chest was disproportionately large to the rest of his body. His torso resembled a vintage wine barrel, ruddy and aged over decades. In the distance, masked by the gasping, puffing, and panting, his heart tapped softly. His ankles and feet were swollen and soft, like the mush hidden by the wilted skin of a rotten, blue tomato. I gently palpated for a pulse, but to no avail. I could see death creeping upon him inch by inch. It had reached his knees, judging by the mottling of his skin. His throat was raw with thrush, and when it came down to deciding as to whether to use his mouth for nourishment or breathing, his selfish lungs took precedence over his stomach. “I’ve crushed up your antibiotic pill, Mr. Jones. I think with it mixed in jelly, you’ll be able to swallow it and it won’t taste too bad.” “Could you please give it to me through my IV?” He begged breathlessly. “I’m scared to swallow this.” I was scared for him, but he managed to swallow it. He frantically groped for his oxygen mask. I saw panic pour over him. “There’s nothing coming out of it!” He said between gulps. I rushed over to connect the tubing and quietly watched him embrace the mask in a passionate kiss for his life.

He’d been with him for over 54 years. They were a couple that had been together for so long that they began to look related. Looking at his partner, I wondered if that’s how Mr. Jones looked when he was healthier. He stayed by his bed around the clock. Both of them were so generous and so gracious. When I brought Mr. Jones a warm blanket, he thanked me with such fervor – the kind of passion that’s only possible when it’s likely the last thank-you that you’ll ever say. Even as I was ripping the hairs out of his arm to take off a blood-saturated IV dressing so it could be changed and cleaned, he moaned in agony, but never once complained. When I checked on him for the last time, his partner said to me, “Thank you for taking such good care of him. You’re an angel to us; a true angel.”

He was transferred to hospice that morning, so I’ll never see him again. Though they were appreciative of the care I gave to him, I wish I could have told them how thankful I was for how much they gave me in those twelve hours that I knew them.

Disclaimer: The names and identifying information of those discussed has been changed to protect patient privacy.

the DL on my HDL

This Thursday was the annual Health Fair that my hospital hosts. All employees are encouraged to attend, and as an incentive, all that complete a biometric panel at this fair will receive a $50 gift card. Being painfully frugal as I am, I was set on going - so much so, in fact, I set my alarm for 5:00am so I would miss the Ft. Worth traffic and be one of the first in line.

As usual, the fair was packed with employees, which made me thankful that I chose to wake up early and beat the long lines. First up was the BMI station. I gathered that some lessons had been learned since the last health fair I attended, because a scale was provided for us to stand on for our weight. As far as my height was concerned, they took my word for it. After putting that information into a hand-held device, I had to place the device in both my hands and sqeeze it with my palms. It estimated my body fat percentage. I was flattered by its lies.

Next station: Blood pressure screening. Nothing too exciting about that station, I already knew I had healthy blood pressure.

Now for the moment I had been starving myself for the past 12 hours: Blood Glucose and Cholesterol Station. The girl swabbed the ring finger on my left hand with alcohol, and stuck it with a lancet. A thin tube about the size of a ball point pen's ink cartridge collected maybe three drops of blood. She sent me off to wait for my results. I ventured off to the Nutrition stand to collect a handy-dandy Salad Shaker (what can I say, I'm a sucker for free shit at health fairs).
I came back and eagerly got my results.

Blood sugar was a gorgeous 84mg/dL, something to call home and brag about.
Total Cholesterol was 222 (which was not great, since it should be less than 200), so that kinda ruffled me. HDL (which is the "healthy" cholesterol, or the good type) was 27. 2-effin-7! I nearly died. A "normal" level of HDL is supposed to be greater than 40. Here I am almost at the half-way point. This is where being a Cardiac ICU nurse did not do me any favors. Suddenly my defenses ran wild:

Denial: There's no way that damn test could be right! When we draw cholesterol panels, we have to get 3mL's of blood, not 3 drops! These results are inaccurate.
Anger: I can't believe I drove all the way to freakin Ft. Worth to get some BS blood test results.
Bargaining: (as I was paying for the food I ordered at Taco Bueno) Alright, after today, no more fast food and I'm going to exercise for 45min to an hour tonight.

Of course, I immediately decided to set an appointment with a doctor. However, in the hour or so before the office opened, I decided to be a good nurse and do internet research.

Now, for those that don't know, nurses (and probably doctors for that matter) can't stand patients or family members that research their symptoms or disease online. The inernet is full of lies, misinformation, and myths, and dammit, we went to school to learn about all that so just take our word for it! However, I couldn't resist. Thanks to a wonderful Heart Attack Risk Calculator, I have a 25% chance of having a heart attack in the next 10 years. Delightful news. To top it off, my grandparents on both sides have serious heart disease requiring surgical intervention, and both my parents have slightly high cholesterol. All I can invision is someone with their hand in my groin as I'm having a cardiac catheterization in the near future - or worse, open heart surgery.

So moral of the story, in an effort to get a free $50 gift card, I instead received a weekend full of stress/death-anxiety and Monday I have to pay my $50 co-pay anyhow.

PSA: For everyone 20 years and older, current recommendations are that you have your cholesterol checked at least every 5 years, sooner (like every 1-2 years) is you have family history or pre-existing hyperlipidemia. Get it checked people! Cholesterol is serious business.