"Somebody translate please, make me understand, Im I dying?"

Patient comes in because her heart rate dropped to 30 beats per minute causing her to faint (called syncope episode), (average normal heart rate is between 60-100). Now when your heart rate drops, than there is less blood being pumped into your vital organs. The organs that require consistent blood flow and are most important is the heart and the brain. In her case the heart rate decreased, so the heart pumped less blood to the brain, causing her to lose consciousness for a bit. The cause, we were not sure, she was admitted to us for higher level of care. After a strategic assessment, and some diagnostic exams we still didnt find out the cause.  The patient is a sweet 57 years old hispanic mother of 3 siblings. Medical history consist of family history of high blood pressure. Now in her case she was spanish speaking and I was called in to translate. The look in her face, scared, fearful, nobody speaking her language or being compassionate. Not because they dont want to be but more because everyone was fearful of the situation and trying to analyaze possible thoeries that can be the cause and if it were to drop again what would we do next and be prepared for.

The crash cart was wheeled in, respiratory therapist at the bedside giving her oxygen, a lap tech at the bedside drawing labs, six nurses at the bedside, and four doctors. I communicated with the patient, I cannot forget the look of her face of how frighten she was. We than told her in spanish what was going on and that we are going to do everything possible to get everything back to normal. She felt more reassured. I know saying those words sound easy, but body language, tone of voice, sincerity, and being positive has allot to do with it and it comes with passion.

After anaylzing we had to try to stimulate this action again to have more data. We had an external pacemaker attached to her at all times and medication just in case we needed to give her electronic shocks to stimulate her heart. After a week, no symptomes arised, we than decided to implant an internal pacemaker inside her just in case her heart drops again to keep her heart rate above 60 beats per min.

The only thing that really shocked me about this patient care was the look of her face when she saw all these people taking care of her and her not knowing whats going on because nobody speaked her language. The face of fear, not knowing if your life is at jeopardy, at steak, or if there is any hope for survival.

Retired cop gets transplant to live longer but instead dies faster then ever expected

Recent retired police officer of the age of 65 years is now bed rest watching his body rapidly deteriorating. Diagnosis; idiopathic pulmonary fibrosis. Meaning somehow someway his lungs got so deteriorated and caused it to get thicker like scar tissue. Lungs is a type of tissue that requires it to be so thin that allows oxygen and carbon dioxide to exchange so you can breath. The thickening of the tissue delays that action. This cause could have been by genetics, environmental such as pollution, caused by smoking, etc. After diagnostic examination it was found that he would require a bilateral transplant (meaning both lungs replaced) because of the severity of his lungs. Luckily he qualified and passed the qualifications of receiving a transplant, and the surgery was a success. So we thought!

When you receive a transplant of any kind it is considered a foreign body that is inside your body. Your body will automatically try to fight it as if it was an infection by your immune system, which is why many transplant patients are on immune suppressant drugs. But we would think that the transplant would save his life but instead it was the one thing that speed up his death. His body was slowly getting new symptoms. His kidneys were failing and now needed dialysis, his liver levels were elevated (enzymes ALT and AST), the pancreas levels were elevated, he was experiencing rectal bleeding, than required a ostomy bag on his tummy so he can have bowel movements there and allow his rectum to heal. He was on oxygen a lot longer than expected. We figured that this was way out of the expected. Could it be? We did a diagnostic exam to rule out the worst diagnosis he could get "graft vs. host disease". This disease is caused by the transplant. The transplant also has its own immune system from the previous donor. And in this case much more powerful than the patients immune system. So now the whole reason because of all his organs failing (multi-organ failure) was because of the transplant. This is a very rare to happen and its listed as one of the complications. But my God who would have thought. His lungs that were transplanted to give him life is instead killing him. The immune system is your defense system against anything, foreign objects, infections etc. and in this case the lungs immune system was by far more powerful killing than the patients own. Now its now like we can put the old lungs back or retransplant him again because the survival rate is not likely. All we can do is manage is symptoms. He is cognitively intact and totally with it. And I can not imagine how a person like him to can go through such a traggic death, dying slowly, watching your body fail and deteriorate. To know that your body is giving up, and that there is nothing no one can do brings chills and makes my hair stand every time I would take care of the patient. There is nothing no one can possibly do to save him.

His time was near, and to think he just spend all of his life working saving others, protecting the community, risking his life everyday. And when his time came to retire and rest, his life is once again put at risk. He told me he saved his money to buy a pool that his just recently got made in his back yard and a huge playground for the kids. He spent 25 thousand dollars, and now he would never have the opportunity to enjoy it with them. He made it so all his nephews can come over and he could take care of them when his retired.

He was my most difficult patient to have taken care of because he was so sick, so many things were going on and you have to be very particular with his care because he can crash on a nurse at any given night. One night he turned off the lights and then he took off his oxygen to go to sleep, luckily I had a continuous pulse ox to monitor his oxygen at all time, and when I walked in to tell him to keep his oxygen on at all times and pulse ox, he was found passed out, he was not responding, there was a pulse but his lips were blue, skin was pale, and we initiated CPR. We were able to get him back breathing.

What I got from him and the advise he told me was to not work so much, enjoy your family and love ones now, because if not you will be like me, working so hard and in the end never getting at chance to share his love. "Love now, spend time with them now, not later"

Diagnosis; mass between the heart and lung, treatment nothing but heartbreak

39 year old female, comes to the hospital. Has been admitted to several other hospitals for pneumonia, fever and cold. She felt that there has to be something more, because she still feels sick even after all the antibiotics. So she decides to come to our hospital, higher level of care. After doing our exams, and being aggressive with the diagnostics. We found what was possibly causing her symptoms, mass found in between the heart and lung, which could be life threatening.

Now let me tell you a little bit about her. She is a mommy of 3 beautiful children. The youngest who is 2 years old. She has been on and off her so called "boyfriend" over the last 12 years. They anticipated getting married 3 times before but something always comes up, and this is always on his part, which he ends up having to post pone it. It came to the point that he was making excuses not to get marry with her (what she thinks). That she loves him, she does, but, that if he truly loves her, well she and myself even question that. I'm her RN, and after taking care of her and witness the interactions and her sharing her stories and secrets about her relationship I myself sometimes dont know what to say. I sit and listen, sharing my empathy. I mean we all been there, falling stupidly in love. When all the signs are there that you should leave and move on, but you cant, more so your heart can't. And no matter how much you try, you always fall back in the same place, getting hurt.

She knows that "he" doesnt really love her the way "she" loves him. But shes says, I have three of his children, I'm 39 years old, I'm sick, and I have cancer, I'm going to lose my hair, I might die, and well his a good looking guy. Well, that night when she was in the hospital, I was taking care of her. This was the first night she found out that she had that mass, a biopsy was done, and it was found that the mass cannot be surgically removed. The next morning the Medical doctor was going to come by between 7am to 8 am. Not sure what exact time, but he will be here between those time to have a family meeting and discuss the treatment plan and answer any questions. Her anxiety was off the roof, she was crying, was emotional, her hands were shaking tremendously as she wipe her tears off her cheek. She asked her so called "boyfriend" if he can stay the night with her, because she was scared, she felt the world crashing in, she felt her life and the life with her kids was being shorten. I listened on the side well doing my paper work and assessment not really focusing on the conversation. But I kinda felt that her so called "Boyfriend" was trying to give her tough love, saying "were gonna get through this", but he first wanted to go home and take a shower and he will be here in the morning when the doctor comes. She begged and begged for him to stay because she felt so emotional, and alone. He refused and left angry. She was rationalizing, why would he not he stay? The kids are at her moms? I just found out that I have cancer? I myself have not even been able to take a shower? Unless he cant take it or he is having an affair? Just more stress that he was causing, that I see. He has had many affairs in the past, which is why they have been on and off so many years. And she always takes him back only because she has kids with him. But she feels that he comes back because so he wont pay child support because he makes a lot of money. But she does not care for money she just wants her family (nuclear family). But seriously that night, he needed to suck it up, in my opinion, and stay by her side. Stay quite and just be by her side, this one night, a shower was not more important, in my eyes, nothing was more important. After he left, I saw her crying, I couldnt leave her alone, so I decided to do all my paperwork after doing patient care with my other patients and do it at her bedside. Until she fell asleep.

That morning her "boyfriend" came in at 6:30ish, and was insisting to see the doctor to see whats the plan. I was like, you should go spend time with your wife, and the doctor is coming from another hospital and he will be here between 7am to 8 am for a family meeting to answer any questions that you all may have, and possible treatment options. He leaves and goes downstairs at seven fiften in the morning to go get breakfast, I was like, are you freaking kidding me. Knowingly the whole family was in the room he returns with breakfast for only himself. And top it off he walks into the room maybe ten minutes in the family meeting with the doctor. I could only imagine the disappointment in her head and her heart. I was like well, maybe he went downstairs to get the whole family muffins or something that everyone can share. Nope, only eggs and two sausages for himself. What! Is everyone just going to watch you eat, I bet other people havent ate also or are hungry. Shaking my head, not saying a word. Signs are there, careless, not affection or compassion to her needs, etc. And don't do me wrong she is 39 years old, three kids, a strong supportive family, she is beautiful from out and within. There is no excuse for her to not be happy, instead she is living a life that she wont ever know if there is or was someone out there that would love her for her. I looked at the so called boyfriend, and just put my head down showing disappointment, and walked away to give report to the next RN, as my shift just ended.

21 year old has kidney failure because of poor diet.

21 year old athlete ends up in renal failure due to poor diet
Today walking into the hospital not know what type of patients I may
encounter. I met a 30 year old healthy individual that is on
hemodialysis because he has kidney failure. Looking at his medical
history I noticed he has none. Only high blood pressure. I than was
curious as I walked into the patient room and leaned on the trash can
to hear his story. This patient was here to have a arterior-venous
fistula repair so that he can continue on having hemodialysis, but his
only 29 years old, I was boggled. Now, hemodialysis is a treatment
that is done to patients that have very poor- to no kidney function.
This treatment is used to filter the blood because the kidney are
unable to do so. If this is not done than the chemicals in your body
accumulate and can cause detrimental effects such as disorientation,
or for example if there is too much potassium your heart will stop
which will result in heart failure.
This patient was a healthy individual, played football, track,
soccer. One thing that he never focused on was his diet because he was
so active and fit. Little that he know that the amount of salt content
that he was consuming was the result of him having high blood
pressure. He would also occasionally drink gallons of water in order
to lose weight. He was just an average adult doing what I think we all
tend to do in that age in order to look good, look fit and look
attractive. Over time, he develop certain type of symptoms. Such as
having numbness and tingling sensation on his fingers and lower legs.
He said he would get those symptoms occasionally but they would go
away. He thought maybe it was diabetes and self diagnosed himself or
was told. He couldn’t remember. But he didn’t want to see a doctor
because the simple fact that he hated needles. One day the numbness
and tingling was so bad that he couldn’t walk. And it was merely his
body slowly shutting down because his kidneys were failing. Now the
reason why his kidneys failed was because of high blood pressure. The
high blood pressure was very damaging to the kidney, which caused them to fail. Now the symptoms that he was developing was his body trying
to reserve his blood to his vital organs, such as his heart, lung,
etc. his arms, legs and face (lips), the vessels get really small to
the point that there is no blood at this locations which is the result
of tingling, results to numbness which will eventually result to pain.
Because where ever there is no oxygen (which is found in blood) will
result to pain if there is pain receptors there. But being that he
hated needles he absolutely waited to the last minute to see the
doctor. High blood pressure that causes this type of damage is usually
found on older adults. Now this patient required to have surgery in
his arm to place a device to allow hemodialysis to take place because
if not he will die. He is now 30 years old and been on this type of
treatment since he was 21 years old. All because of poor diet probably
genetics also but a biopsy was not done because regardless there was
not treatment other than him trying to apply to get a transplant.
Hemodiaysis is a treatment that is usually done Monday, wedensday,
Fridays, and takes about 4 hours each treatment. Now his having
multiple surgeries over the years to keep that device functioning in
order to continue hemodilaysis. A treatment required to maintain life.
Now at the age of 30, 9 years later he will soon have to make a
decision to keep doing what his doing or accept a kidney transplant.
Accepting a transplant also have risk, such as becoming immunosuppress
which might result him having infection, getting sick a lot of the
times, or becoming septic which is a full blown infection that can
kill him. Other risk can be disease such as HIV, which is a blood
virus which the organs do get screened for but there is that saying,
“you never know”, and you have to sign a waiver saying if it does
occur you took that risk and the hospital is not liable. The patient
tells himself as I am talking to him, shaking his head saying “if I
would just have gone to get checked or see a doctor, watch my diet…”.
I empathized with him because this could have been genetics or it
could have been his diet and aggressive abuse that his body took which
by all means a young body can take allot of abuse and can adapt, but
as you get older, well you know the where Im going with this.
Prevention is key and routine yearly exams are so important and I
believe its necessary. Now Im taking care of a patient that is my age
and has dreams of being a fireman so he can save lifes, but the only
tragic thing about this is that right now the only life he can save is
his own, and he may not ever have that opportunity because of what has
happen, leaving him vulnerable. How I wish I can see him as a fireman,
the personality, determination that he has is merely heroic and I’m
just honored to have have the opportunity to have taking care of him.

--
Christopher E. Moreno R.N. B.S.N

My intro

What does the word nursing mean to you? Nursing is one of the most respected professions. As I wake up looking at the sunset (I work night shift) I think about how many people don't get to enjoy that beautiful scenery and only view the walls of their room all day, without any windows, with any scent of fresh air, without the sense of feeling the breeze. Nursing can sound depressing. But it's not. I think nurses are reminded everyday that life is short which is why many of us tend to appreciate life much more. Having the capabilities to make someone's day, or making someone smile, or making someone feel that there is someone that cares for them is extremely rewarding. I know I always pitch it to people that they should be a nurse. I think it's just because of job security, it's good pay, and it feels really good to help others in need. These are the people that need your care, your love, your compassion, and inmost cases your appreciated for it. I think as a perso. It's so hard to go by your day loving your family, your kids, your significant other and not be appreciated for it. But in nursing you are. Maybe not all the time but the majority of the time. And we all love to be appreciated but come on, we all have our own lifes, and sometime we get side tracked. For example your kids my get to busy with school or play, your family maybe to busy with work, your significant other can also be to busy with raising the children, working, etc. what I'm trying to say is that life happens. But we all like the feeling of being appreciated for the hard work that we do. Nursing always or the majority of the time gives you that. As a male, it made me more compassionate, loving, allowing me to put myself in the others persons shoes. Made me learn to communicate, family, gave me an idea of woman's health, maternity, and an idea of child development. This blog that I am creating is to share with you the days in and out that I go through in life, with patients, with struggles, with health, overall as a person. See me as a big brother sharing his experiences and you living thru me so you can have options when making decisions. Or if you think your having a bad day just remember their people out there that are having worst days and some still have the courage and strength to smile and be thankful. Sometimes we complain about the cup being half empty when we should be appreciative that the cup is half full.