Sunday, January 24, 2016

For The Family of Uncle Carlton-Nothing glamorous, just thoughts.

The impact of metal on metal. The unexpected jerk in a different direction. Glass shatters. A driver has disobeyed the laws of the road and collided with your vehicle. Fight or flight. Your body floods with adrenaline. Your mind briefly flashes like a "system reset". Then begins your reaction.

Life is going well. The holidays have wrapped up successfully, and family was together. Then you get the call. That person in your life. One of those beautiful, shining lights that you loved. The one who you could count on to be there and who was a gentle but influential soul. That person has gone to be with Jesus and your time with them on earth is through.

One of the coolest classes I took in High School was Physics. Learning about all of the different forces in the world that would need to be taken into account in order to accomplish something was fascinating. It opened my eyes to things that were out of my control but needed to be considered. The death of a loved one is like a traumatic event. You can never really know how it feels like or how you will react until it happens. As my great-grandmother said, "you are never really ready."

God has been reminding me of some serious "forces" lately. Today I broke down. I heard huge sobs escaping from my normally stoic self. Tears have very little validation when you are crying alone and there is no one to wipe them away. Wipe them away. I've heard that before, something in Revelation about God, Himself will forever wipe away tears someday when He restores His kingdom. Great! But what about us right now??

A very wise person once told me that God uses the valleys and the lowest times in our lives to teach us the biggest lessons. God drops these unexpected things in our lives, then gives us the free-will to react. I've reacted, then reacted again. I've responded and messed things up. Now I'm on my knees and He is teaching me that from the beginning, He was there and ready to help me through the pain and struggling.

My loved one was my Sweet, Uncle Carlton. He has fought long and hard with cancer. He has the "McLarty Spirit", full of adventure-wielding action often involving white-waters. I am certain he had so many more adventures planned, but his body was worn from fighting the forces beyond his control and his reaction was to peacefully embrace his family and prepare for heaven. He left a powerful legacy etched into the world and his family.

Today I got our of work and realized my family would be joined on the other side of the country to remember the life of my uncle and I would not. Not only was I exhausted from work and the recent valleys, but the flooding of emotions brought me to my knees. While down there, my sweet Momma called me. Despite the miles and miles between us, I felt her reach down and pull me up with her words. She wiped away the tears, teased me about my mascara smears, then pointed my eyes toward God. This is the same God that comforted Job in his sorrow. The same God who sacrificed His most precious Son. The same God who is sharing His heaven with my Uncle and myself someday. The same God who was waiting for me to turn towards him with my tears and show me the forces that I could not see.

Carlton is loved by so many and his life will be remembered today and so many days in the future. People all over the US will mourn his passing and smile with his memory.

Stories from the Shadows Part 1

It happens every single day in the ER. Multiple times in a trauma center. Why does it still get me?

Someday I hope to be numb to it. To be calloused to Death while still reaching out and comforting the loved ones in mourning.

He came in by EMS. He was noticeably ill, but nothing we don't see every day. We've had a ton of patients with pneumonia this winter and I've started just drawing blood cultures on everyone with any respiratory complaint.

I helped him transfer over. He looked over at me and smiled. His wife was with him. They'd been married years and she watched with a loving concern as we began to get him settled and ask questions. He could only respond with a "yes" or "no". According to her, he slept much longer than normal and hadn't been the same since she woke him up. He had dealt with a cough for weeks, but today he spiked a fever and after dialysis just wanted to sleep. A terrible sleet storm was raging outside and she thanked the EMS crew for helping them with a ride and being so kind.

My crew was great. It was like the "A" team. My girl from another area jumped in and in about 8 minutes we had him changed, lined and labbed with two sets of blood cultures, fluids hanging, EKG complete, straight cath'd, and charting done. His heart rate was a bit high and he had a slight fever, so we began a septic protocol and sent him to CT to clear the possibility of a problem in his head.

He returned, still smiling and as I rechecked his blood pressure, I noticed him just lean his head back and close his eyes, as if to rest. His wife was seated next to him, still watching with her sweet and loving eyes. I'll never forget the two of them. They both had peaceful, sweet eyes.

They were from up North and would come down every winter to spend it with their children in the Carolinas. Everyone was snowed in apparently and the family they had stayed with were out for the evening. His wife had chatted with me about the snow up North and how thankful they were to not be stuck in it.

He still appeared to be resting his eyes. His BP returned as 60/40. That can't be right. I rechecked. He only had one good arm. His other vitals hadn't changed, but again I got the same reading. The doc had come in to just say hi and we immediately kicked into action. Fluids were grabbed and started. A second IV was established. Respiratory therapy was notified to be on standby. A resuscitation room was reserved. His pressure continued to drop.

A note about blood pressure. You have to have it at a certain level in order to maintain perfusion to your brain. It's just part of life. It needs to be around 110-120/60-80 (people argue about exact numbers but this is a rough estimate).

His heart rate hadn't changed and he still had a pulse. As another nurse and I prep'd vasopressors, his breathing suddenly became more shallow and I noticed him becoming blue. We grabbed the bag and began ventilating him with a bag-valve-mask.

As soon as he had arrived, his wife had been asked about his "code status". Essentially, if something were to happen to where his condition would decline, would they want us to perform CPR and stick a tube in his lungs to breathe for him. She had been on the fence. As his condition declined, one of the Docs pulled her out in the hall and explained that she needed to make a decision. Green light. We were intubating.

He was quickly sedated, paralyzed, and intubated. We got great breath sounds and his blood pressure had begun to improve as a result of the medications. His HR was still fast but had remained unchanged and he still had a pulse. The decision to move him to the trauma bay was made and we began to roll.

As we began moving, suddenly his heart rate began to drop. It dropped so quickly to 60. By the time we were in resus, he was down to 40 and no longer had a pulse. CPR was initiated. Medications were given. We had nothing on the monitor that was sustaining life. His wife was present, watching the entire thing. We do that to make sure the loved ones know we are doing our best and trying everything. Also, we needed her to tell us when to stop. She called it. Time of Death, 2330.

Suddenly, there he lay. Blood coming out of his ET tube. Life slipping away from his body and the color slowly disappearing as rigor mortis set in. His wife muffled her sobs into her kleenex and held his hand closer to her chest as if to grasp some of the life slipping away.

It is heart-wrenching. I don't know how to describe any of the feelings. Mostly we supress them and hope they don't ever come out. Usually we box them up and distract ourselves with our families and friends while secretly begging God that we are never the one making that decision on the other side of the stretcher. Scrubs are like a shield that protect us while we deal with the tragedies of others. Unfortunately a part of caring for people is allowing yourself to empathize with them and to do so you must feel. Hence the obvious difference in scrubs and armor. We do carry a certain part of the pain and suffering of our patients and must figure out what to do with it or we will take it home for our families to deal with.

Nothing more to say. Often I process by writing. There was no happy ending to this story. Only a reminder of life being precious and more "practicing of medicine". One day maybe we will perfect it.