A woman's work

**Side Note: First of all, I must apologize, because while I'm filled with emotions and thoughts when I watch this video, my thoughts are not translating well into this blog...so please keep in mind that words cannot describe much of my emotions and feelings, and thoughts on this dance routine....**

This is why I love So you Think you can Dance so much. (And still have many more episodes to watch, so please do not ruin that for me. Do not comment on any episodes past when the top 8 perform....pretty pretty please!! :D I love DVR...)

I'm so touched by this routine. Melissa and Ade danced it beautifully, and put their souls behind their movement...when I watch it I don't see a dance, I see a story. I don't think you need a description of the story behind this routine, but just in case you don't see it....

It is simply a story of one woman who has breast cancer. But the movement translates further than that. For me, she has "cancer" not specifically any cancer, it could be breast, sarcoma, colon, lung etc. I feel like "she" could be a "he", as the emotions are very similar for either sex. The journey, and the experience is very different. For example, men can fit in with a bald head, while women tend to stand out. (Hair loss, however, is not necessarily an easy side effect to deal with for men, but in general it is not as devastating for men. Again, it is different). Of course, since the dance is to "A woman's work" the story is obviously more centered around a female's experience of cancer.

The emotions hit me like a slap in the face. Hope. Love. Support. Strength. Trust. Beauty. Grace. But also Anger. Fear. Loss. Grief. Uncertainty. I see all of these in the video.

I have watched the routine over 5 times now, and I still cry when I watch it. At work I see this too. We give chemotherapy on my floor, and I love my chemo patients. But, they do have cancer, and they do have good and bad days. Some of them don't make it through their chemo (they receive several cycles before "finishing" chemo). Some of them make it through, only to come in to the hospital to pass on. Some of them live longer than "expected." Some of them don't.

But most of them hope. Most of them live (as in be present for the moments that they have left.) Most of them survive, even if their "survival" is only a few years after diagnosis.

Unfortunately, though, sarcomas are usually found later on, and are therefore harder to recover from. This is difficult to remember when I am talking with a living, breathing, hairless patient, who aside from the tumor and the chemotherapy is otherwise healthy, happy, and full of life. My coworkers will mention things like "it's too bad" or "it's sad" but while I agree that cancer sucks, I don't necessarily feel like all is lost. Not until they are actually on their deathbed can I picture them there.

Maybe I'm naive. But I like to think of myself as hopeful. I think my coworkers think about the worst, to help to detach from the patient. To prepare themselves for the worst, because "the worst" has happened a lot on our floor. If they aren't as attached, and the patient loses their fight, the grieving process is easier. I think that is the theory at least. I don't feel like I'm hurting myself to form bonds with people who might end up of dying from cancer. Besides, it's not about me, it's about that person, who happens to have cancer. If I'm hopeful, they can sense it. At least that is what I believe. I prefer to think positively, and I think my patients appreciate that.

On my way to being Chemo certified!

Well today was the last day of a 2 day course on chemotherapy. The course was rough: we trucked through a 1 inch thick (at least) book in less than 12 hours. And then, to make matters more stressful, in order to become certified, you must take a test at the end of the second day.

Fortunately it was open book, but if you don't know the book very well, it would be difficult to find the answers in 90 minutes. 50 questions total, and you can only miss 10!

I was nervous in anticipation, but I had faith that I would pass it.

Oddly enough I was reminded of college. And how much stress it was to prepare for tests. How I often felt nervous before the test, only to have relief directly after the test. Most of the time I did well. Better than I felt I would do before the test.

And today was no different. Last night I went over all my notes in my book, and reorganized. They gave post-its that were the small ones, but bigger than a simple skinny tab. And it was a mess. I couldnt read anything because they overlapped. So I used my skinny tabs, made sure they didn't overlap, and went crazy. Mostly I did it so I would know the book, and would know where to find things.

It paid off. I missed 2 questions. One of which was obvious afterwards, it was one of the first questions and had I gone over it before turning it in, I would have caught it. But since i looked up pretty much every answer, I didn't want to go over the questions again.

What a sigh of relief!

Now, all I have left is a "skills day" on december 5th where we will go over the how-to's and have a more hands on day for chemo administration.

That means I have a good two weeks before I actually start giving chemotherapy on the floor. Which gives me time to absorb and review the information and get used to the idea of administering toxins to people...

This week...

Tomorrow is my monday, I work two 12-hour shifts on the floor and then on thursday and friday I have chemo class.

**Addendum: I lied, I work one 12 hour shift, and one eight hour shift, then I have class on thursday and friday...***

On my floor, we have sarcoma patients. You might remember this from my first post. Sarcoma is a type of cancer, and can be treated with chemo, radiation, and excision. Usually a combination of treatments is used.

Since I have been on the floor for a year now, I will be going to chemo class, so that I can take care of the chemo patients on our floor. It is going to be a stressful time. But exciting as well, I get to really understand the sarcoma patients, and they are quickly becoming my favorite patients. It is draining emotionally, but since they come to us for both chemotherapy and surgical excisions, we really get to know the patients and become a sort of family. (I've thought about eventually doing pediatric oncology in the future...) Kids with cancer, is what that means.

I'll let you know how it goes...

She has passed.

Today when I went to work a note on the white board stated that the patient that started my urge to blog, passed away. For a reminder go here: The Beginning .

I wasn't in work at the time but I spoke with someone who was and she said that she was admitted late a few nights ago, a transfer from a different hospital, and when she arrived the nurse could tell she was close to dying. She could barely breathe and was working very hard to do so. The nurse welcomed her and said that she was glad she came here because this was her home away from home, and we were glad to be with her. (And as the nurse told me this I saw tears begin to form). The nurse knew that at the end of her shift the patient would not be alive when she came back.

The patient refused for a long time to sign a form that said "Do not Resusitate" and near the end of her life she became non responsive, and so the family was in charge of making her decisions. The form was signed 10 minutes before she passed away.

The patient's family filled the halls. I was told 80 people were there, crying and supporting each other. And they would not leave the hospital. They were in denial up until that moment and could not face the reality of her passing.

I asked the reason why the patient came in to the hospital at all and the nurse said "she got scared."

I think I would be too. When you can feel the end approaching, and you realize that it's over. The pain has won.

But I wish she could have been in the comfort of her own home. Where nurses and doctors don't ask the family to leave so they can care for the body. Where she could be surrounded by everything and everyone that loves her.

And yet I wonder if she needed to say goodbye to us. The unit that cared for her through most of her hospitalization. The people who understood that she was dying, because her family didn't believe it.

My thyroid drama

Last November, my primary care provider (PCP) found that I had an enlarged thyroid during a routine physical exam. She wanted me to get an ultrasound done to examine what was going on with my thyroid. So, after the ultrasound, which I had done in January of this year, I was referred to a thyroid specialist. The thyroid specialist stated that my ultrasound showed some questionable areas, and to make sure that the cells weren't cancer, I needed a biopsy.

The biopsy happened in April, and was actually one of the worst experiences of my life. I'm lying there, awake. A nurse. And the Resident is being instructed by his Attending during the procedure. They performed the biopsy using an ultrasound to guide the needle. At one point the Attending said "You see that? That's her carotid. Don't hit that." And that is a direct quote. I'm sure my heart rate increased, and blood pressure skyrocketed as I tried to focus on not swallowing or breathing too hard. The Attending said other things like "This is very interesting." and "This is a very complicated case." and noted that my blood vessels ran right through where they were trying to insert the needle. And as a nurse, I know that some cancers grow their own sets of blood vessels to help nourish the cancer and help the cells to grow. And I am laying there thinking all of that as she continued to increase my anxiety by noting how difficult this case was. And I forgot to mention that she went through 20cc plus of lidocaine as I could feel them attempting to poke and prod at my neck. I tried my best not to burst into tears while they were doing the biopsy, because I had to hold still. But a few tears leaked out and ran down my face toward my ears (because I was lying on my back). I walked back to the waiting area where my boyfriend was waiting for me, and when I saw him I burst into tears. I cried over the pain, and the fear of it possibly being cancer, and the uncertainty of it all. My anxiety finally had a release at that point. I couldn't move my head without it hurting, and I had to call in sick the next day, because it hurt so bad. A few days later I had severe welts where the needles poked me; it itched and was puffy and miserable, and eventually I went to my PCP who gave me some steroid cream to help it go away.

So after all of that I met with my thyroid doctor again, for the results. She told me that the results showed that it wasn't cancerous now, but could eventually turn into cancer. She told me that I would either have to have yearly biopsies, or get the thyroid removed. She said that since I was young, and since the biopsy was so complicated, that it would be better in the long run to get the thyroid removed.

So I arranged to see the surgeon she recommended, and met with him today. And what he told me was completely different. He basically told me to keep the thyroid in and have yearly ultrasounds to watch the thyroid and see if it changes in size. He said that thyroid cancer is very slow growing and spreads slowly so watching it is much safer than some of the other fast moving cancers. He said I wouldn't have to have biopsies every year, just the ultrasound. He said that it was ultimately my decision, that I could have it surgically removed if I didn't want to have to worry about it. But he would recommend his daughter to have it watched instead of removing it straight away. He said that my biopsy results are actually kind of in the murky area, it isn't definitive either way, it could be cancer, it could be benign (not cancer).

So now I have a big decision to make. I went into that office visit thinking that I would have my thyroid removed. I thought I was going to be making the appointment and going over the nitty gritty details. So I was prepared to have surgery. But I wasn't prepared for him to say that I wouldn't need it.

Part of me is scared to death of surgery and the risks including: bleeding, infection, and possible harm to the laryngeal nerve, causing my voice to be hoarse, either temporarily or permanently. But I'm also thinking about how I'll always have it in the back of my mind that it could be cancerous, and will have to pay for ultrasounds for who knows how long, and eventually might have to have it removed anyway.

I'm still kind of leaning more toward having it removed. But I think I'm still in shock.

Farewell

Today was my last day caring for the patient I talked about in my previous entry. She will be discharged tomorrow and I have the day off. I nearly lost it today when I was in her room. She had music playing, and her husband (of nearly a year) was singing along, and it was a song about love, (If i ever hear the song again, I will remember which one it was...but i can't remember now...). It was heart wrenching. And yet so beautiful at the same time. I wished her luck, and told her it was a pleasure working with her. I hope she can spend the rest of her time at home, comfortable. And won't need to be hospitalized again.

I promise, not all of my posts will be this depressing...

The Beginning

I have had a blog before, but I used it as a distraction from schoolwork when I was in college...and high school maybe? I don't remember...but anyway a friend of mine shared her blog with me and I remembered that I used to enjoy blogging. So I decided to create a new one...



As I was driving home today, I had some intense feelings...but before I describe them, you might need a little background first. I'm a nurse in Seattle, and I have the opportunity to work with many different types of diagnoses. One of which is sarcoma patients. (Patients who have cancer of the connective tissue. ie: bone, muscle, fat etc...for more info go to http://en.wikipedia.org/wiki/Sarcoma.) I also work with hip, knee and shoulder replacements as well as patient's with spine surgeries. And to make it more interesting, we get overflow patients as well, so that means I'm always on my toes...



So as I was saying...today was rough. (To protect confidentiality, I will not get too specific, and I have changed some of the details.) I cared for a young woman about my age who has no more treatment options left, other than providing comfort, because the cancer has spread to pretty much everywhere in her body. She is a mother of one, and recently had a miscarriage.



All I keep thinking about is what if that happens to me? How would I cope? What would I do? Would I feel happy that I was able to reproduce, and send a beautiful child into a world with a loving father? Or would I be distraught over the fact that I sent a child into a world, full of pictures of a lady that was there, but only fleetingly?



I don't think I'm that strong. I'm sure no one truly believes "i'm content to die" at a young age, without some sort of diagnosis that limits the life expectancy...however, there are things that I still want to do. Like be a mother. A wife. A grandparent.



I suppose he will never lose his mother. She will always be his mother. But his memories will be based on his families reports, pictures, videos and notes that she has written in a notebook. Because he is not old enough to form solid long term memories.



Realistically, I'm sure I could make peace with the fact that I was dying and not going to live past the age of 25, but I still cannot imagine doing so. It wouldn't be easy.



I'm sure she's going through this as we speak, grieving for the years she won't be around for, and grieving for her son, who will grow up without a mother. And yet, I don't think she has given up completely. She calls her family and gives them updates, she listens to her mother crying on the phone, and comforts her.



It makes my heart ache. But I enter her room with a smile. I ask her if she needs anything. And listen to her every word. Hoping she won't see how scared I am inside.