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November 5, 2002
Tuesday, November 05, 2002
8 Weeks… not 9!
Well, it looks like my due date is a week later than I suspected it was. Nothing like having a week ADDED to your pregnancy when you aren’t feeling good! UGH. Oh well… no biggie! More on that later…
Halloween
We spent a quiet evening at home for Halloween. Just like last year, we had hardly any trick-or-treaters. I think our doorbell rang maybe 4 or 5 times. We live in a very residential area with lots of kids, but it seems that not many of them are coming out. Can’t say I blame them really. Our heads have been filled with all sorts of scare tactics. It didn’t help that the day before Halloween, there was a huge story on the news about a serial rapist that was hiding out in the woods in our city… they knew he was there but just couldn’t find him. They did end up apprehending him a few days later, but I’m sure it just added to parents’ worries. We watched our Thursday night lineup with our friends, had dessert and just enjoyed one another’s company. It was a nice, quiet evening.
Still Sick
I have still been quite ill this pregnancy. In fact, I called in sick to work on Friday night… something I have really been avoiding like the plague. I need to build up a sick bank, but I just couldn’t do it. I got a GREAT night’s sleep though and that did help tremendously. I felt pretty good on Saturday but bad again on Sunday and had to really, really convince myself to go to work that night. It was not easy. Last night, I was sicker than I ever have been this time around. Mike made me a fabulous dinner and after I ate it, I just got so sick (I don’t think it was from the food… I just think it was a pregnancy thing). Anyway… I have never felt worse this pregnancy… I really thought I was going to vomit. I was heaving and moaning, and breathing weird and just generally feeling like death warmed over. It was so bad. I crawled into bed a little after 7pm and left Mike to do Ethan’s bedtime routine (which he does anyway, he just usually has my help). I am feeling a little better this morning, though I can tell the sickness is right there… one wrong move and I’m in trouble.
The Circle of Life…
Death…
Sunday night I went to work knowing full well that I was next on the list to float. Sure enough, I walk in and the assignment sheet says, “Christina – ICU” . Hey, I can think of about ten worse places to float to, so I was pretty grateful that I was going to the ICU. At least there, the ratio is a maximum of 2 patients to every nurse. Even if they are unstable, at least it’s only two. I also know that they have to give me a decent assignment… I am not officially ICU trained, so they won’t give me patients on ventilators and on certain drips. I got lucky. I got the only two patients on the whole unit that weren’t ventilated. One of them was a DNR (which means they don’t want to be resuscitated if they are dying or their heart stops or they stop breathing) and the other was very stable and ready to transfer out of the ICU.
My DNR patient is the one I want to discuss here… he was a young man of only 48 years. I will call him “John”. John was dying of metastatic cancer (cancer that has spread to other areas/organs). He had had surgery a couple of weeks prior and was sent home on pain medications. His prognosis was grim and I am really not sure why they didn’t do a hospice consult at that time. He was only diagnosed two months prior and I think he thought he had much longer to live. Doctors can only predict so much. Anyway… he had been complaining of increasing pain at home and finally came to the ER on Saturday night. Because he was still a full code at that time (wanted full resuscitation), they admitted him to the ICU… not the wisest of places, but he was pretty unstable and was requiring a lot of care. They had a very difficult time keeping his pain under control.
When I arrived in ICU on Sunday night, he was assigned to me. The nurse that gave me report told me that she thought she had found a good dosage on his pain medication and that he had been made a DNR. (In circumstances such as this, nurses are often given orders for pain medication that state “titrate to comfort”, which means that we can increase the pain medication as much as want to keep the patient comfortable.) She was sure I would have to increase it more as she had been spending a lot of time finding a good dosage.
As a nurse, I often have to put up a wall between my feelings and my work. It’s a hard job and if I get too emotionally attached to my patients, it can make my job more difficult than it already is. However, this man just touched my heart and when I walked into the room and saw him and about 30 of his family members, it took a lot for me not to cry. He never did wake up during my shift. I think the previous nurse found a great level on his pain medication. He was comfortable, sedated, but still had decent vital signs. I never did increase the pain medication on my shift. Throughout the night, I watched his heart rhythm on the monitor change right before my eyes. His electrolytes were totally out of whack his heart rhythm changed exactly as I would have expected it to. He was to have a hospice consult the next morning and transfer out of the ICU.
At about 1am or maybe closer to 2am, I went and woke up his son, who was trying to get a few minutes of shut-eye in the family lounge. It broke my heart but I said to him very calmly and very gently, “Your father’s blood pressure is really dropping and I’m starting to see some pretty significant changes in his heart rhythm and in his breathing. I don’t think it will be a whole lot longer.” He thanked me and closed his eyes again and I promised I would update him again. I walked away and tried not to sob. John’s children were so young… probably in their 20’s. His whole extended family was there, including his own mother. I cannot even imagine. Many of them did not speak English, so I spoke with his son, who had his feelings together and would interpret for the family.
At about 2:30am, I woke up his son again. It had only been a half hour, but I knew his death was imminent. I again explained that his pressure had dropped more and that his heart rhythm had changed even more. He got up and went in the room to be with his family. At just after 3am, this man gave up and died, his whole family around him. I walked into his room and they all looked up at me and said, “Is this it?” I shook my head gently and they all bent down and kissed him and began sobbing, though they handled it remarkably well. I left them alone to say their good-byes. I found myself with a few tears in my eyes. After they had said their good-byes and covered him up with a sheet, they all came out. His son came up and with tears streaming down his face, he gave me a big hug, thanked me and told me that I had been very helpful.
In that instant, I regretted ever having said I have a thankless job. Birth and death… two of the most momentous occasions in life… I was lucky to be able to share this occasion with this beautiful family. Like birth, death is a very private affair… and yet I was privileged enough to help this man die as peacefully and as comfortably as possible.
Birth…
After my patient died and I had said goodbye to his family and sent his body to the morgue and finished up all the paperwork, I sat down and had a strange thought… in just a few hours, I would be going to my first OB appointment. Though I had just been through the sadness of helping a man die, I would be excited to see my new little jellybean on the screen. The circle of life… birth and death… they go on simultaneously all the time.
After my shift ended, I hung out on my unit for a little while and then headed over to my doctor’s office. I checked in and filled out the initial pregnancy paperwork. It was so strange being in that office again. It felt really good. I gave a urine sample and then waited. Shortly thereafter, I was taken to the back where Dr. L’s nurse asked me a ton of questions. She had most of the answers in front of her since I had just gone through this whole ordeal! Mike was a bit late but they showed him and Ethan where I was and they were able to join me. Then we went into the exam room and I got my blood pressure and weight checked. I’m only a few pounds over my pre-pregnancy weight (and still nearly 15 pounds lighter than I was when I conceived Ethan!) My blood pressure was perfect at 116/80. The nurse left and had me undress from the waist down.
Shortly thereafter, Dr. L walked in. My husband, being the goofball that he is, said, “Oh no, it’s you again!” to which Dr. L replied, “Oh no, it’s YOU again!” We started laughing. I just looked at him and said, “We’re back!” He offered his congratulations and seemed genuinely pleased for us. He answered my questions (and since this is my second go around, there weren’t too many!) I did say, “Yes, we’re doing this again, but I think we want to talk about permanent birth control after this!” He was happy to discuss it with us. He said, “If you have a repeat c-section, then that is a perfect time to do it. If you want to try for a vaginal, then we’d have to do it later, but the choice is yours.” I was happy because he was VERY open to the idea of a VBAC… more so than I thought he would be. He said it is totally up to me, but that if I do want a VBAC, he would not consider discussing induction, since rupture rates go up dramatically with that. He said I’d have to let labor start on it’s own, which I had planned on doing this go around anyway. He also said that we would not be able to do any pitocin this time… again, fine by me… it was awful stuff!
I was happy with his responses. I also told him that I am keeping my mind open and he was happy with that too. He said he is more than willing to go for a VBAC. YAY!
Then we proceeded with the ultrasound. I said to him, “Now, Dr. L, last time, we said we thought it would be cool if we saw twins on the screen. This time, I’ll kill myself, so please make sure there is only one!” We both laughed. As he got my uterus up on the screen, his immediate words were, “I only see one baby here!” I was so relieved… don’t get me wrong… if God saw fit to give me twins, of COURSE I would love them and do what I had to do… but this really was a relief. I just can’t imagine having THREE children under age two! We turned the screen so I could see and there was my little jellybean… with a beating little heart, just flickering away! It was “music to my eyes!” He pointed out the uterus, the yolk sac, and the fetus. It was difficult to get a real good view of the whole fetus. My baby is measuring 8 weeks and not 9 weeks but I am not concerned. Although I was pretty sure I knew the dates, I did give myself a week for margin of error. If it had measured any smaller than that, I would have been worried. So, instead of being due June 8, I think we are looking at June 15th instead! My grandmother was born on June 15th, so this is a nice due date. After the ultrasound, I got dressed and went out to have my blood drawn. I then made my next appointment for December 5th! I’ll be twelve weeks then and my mom will be here… maybe she’ll get to hear the heartbeat!
Another Move In the Future??
I know… I’ve talked about moving so often. Let’s see, in nearly four years of marriage, Mike and I have talked about moving numerous times. We’ve considered moving to Phoenix, Hawaii, Japan, Alaska, and hmmm, I am pretty sure there was one other place. Oh well. Anyway, every time we think about it, we end up staying right where we are. Well, we are toying with the idea again!
In my last entry (can’t remember if it was in the diary or Ethan’s baby diary), I talked about how my brother-in-law, sister-in-law, and their three children are moving to Indiana. Well, on Saturday, we spent the entire day with her. We got this crazy idea that it would be cool to move to Chicago (which is about an hour away from where they will be). Lately, Mike has been REALLY unhappy at work and it seems that at least weekly, he tells me he wants a new job. I, too have looking at changing hospitals as the commute is really starting to kill me. We thought this would be the perfect excuse to leave. Mike works in the transportation industry and shouldn’t have trouble finding work in the Chicago area. As a nurse, I can pretty much make a few phone calls and get a job!
Mike is the oldest of ten and his sister, M is his closest sibling. I know he will miss her terribly and so we are just toying with the idea of moving. We’ve looked into it. If we do move, it will probably be next year after this baby is born, but who knows. We would have to sell our house and there are a few things we’d need to get done in order to sell it. Anyway… watch for future updates regarding this!
Keeping Up at iParenting
Bottom line… it’s not happening. I am sorry that I haven’t been answering my TTM posts in a timely manner. I can barely muster up the energy to keep up with my own diary entries, let alone everything else. I do believe I’ve gotten in over my head. Like fellow writer Lara, I realize that my house is suffering and it amazes me just how much I can get done when I am not spending so much time on the internet. I am going to have to curb my time online again. It’s hard to do, but I have got to be disciplined. I think part of the reason it’s hard is because being this sick, it’s WAY easier to just sit at a computer than it is to be up cleaning house and doing other things. At the same time, when I move around more, I tend to think about the illness less. Anyway… if you see less of me around, don’t be surprised!
I think this entry is way too long already. I can’t believe it’s November already and that the holidays are upon us! The next few months are going to be busy for sure!
~~Christina & the Jellybean ;-)
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