December 26, 2013

Boxing Day

It's rather appropriate that the gift for little one #1 that I ordered from the UK arrived today.  And little one #1 loves it.

The surgery is scheduled for January 8.  The first batch of pre-op work looks good, and they are optimistic about both his prognosis and his survival rate.  He is at higher risk of not making it through surgery due to his age and his cardiac conditions--and of course, no surgery is without risk even for the healthiest specimens--but the odds are still overwhelmingly in favor of him getting through it OK.

I was told NOT to come out for it because I would do no good. Dad is going to be in the hospital for at least 3 days, and I will not be able to go to the hospital with little one #2 in tow.  My parents said they will let me know if they need me, and then I and little one #2 will fly out.  I'm thinking I may be needed afterwards when Dad is at home, but we shall see.

So I'm a little frustrated that I can't be there, but I understand.

December 25, 2013

Merry Christmas

If you celebrate Christmas, Merry Christmas.  If not, I hope you're having a merry day anyway.

I just finished talking with my parents via Skype.  It was a little hard not having them here, especially given why they couldn't be here.  But at least we could see them, and them us.  My mom said that she had a difficult morning, but she snapped herself out of it to celebrate the day with my dad.  Tomorrow they go to the surgeon to start planning the tumor removal.  I don't know when that will be...they're hoping to do it soon enough so they can be out here for the February birthdays.  

My better half tried getting me something  He actually did well with two of the three items he picked for me.  He knows I don't wear it often, so subtler pieces are a better choice for me.  One was a blue topaz (my birthstone) earrings and pendant set; the other was a small pendant with my first initial in crystal chips.  The one piece that wasn't subtle...well, he said he thought they'd be perfect stocking stuffers.  And yes, large dangling crystal snowflakes are just that.  I am wearing them right now.

I also got a big haul of yarn, knitting needles and pattern books.  Next year, I'm going to make a Doctor Who scarf.  I'm a classic Who fan:  they kind of lost me after Christopher Eccleston, who was brilliant but didn't want to stay more than a season.
All of the boys were excited about their gifts.  Little one #1 was ecstatic opening gifts; little one #2 was ecstatic eating the wrapping paper.  Two gifts didn't make it in in time:  one for the better half, one for little one #1.  The former's gift is backordered; the latter's gift is coming from the UK.  A little disappointing for me, but what can I do?  

Last night, I caught Midnight Mass from the Vatican on the Vatican's website.  I have to admit, Pope Francis is a Pope I can get behind:  he's not all talk and no action.  He lives his word.  He renews my faith in my Catholicism.  And we share a lot of similar points of view...that reminds me, I seriously have to find a Catholic church around here to start going to.  

Anyhow, for today's entertainment, we've been chilling out, watching religious/Christmas/holiday movies.   The last one we just finished was King of Kings.  I think next may be Ben Hur or The Year Without a Santa Claus.

No work until next week.  Whee!

December 19, 2013

Woo hoo!

The cancer didn't appear to have metastasized.  The PET looked everywhere except the brain and didn't turn up any evidence of growing tumors.  Not sure why they didn't do the brain though, but my sister tells me it's not likely to have spread up there.

So that's pretty great news given that he's still got lung cancer.

They meet with the surgeon on Boxing Day to start pulmonary testing and get the surgery organized.  They're not sure how far the tumor extends down, but going to try to preserve as much lung as possible.  Apparently they can rewire the bronchial tubing if necessary.  Worst case scenario:  the whole lung goes...but that's OK.  Pope Francis only has one lung and look at him:  he's a globe-trotting Pontiff.  He's also the same age as my dad, so even more proof that losing a lung won't be the end of things.

Now I can focus on enjoying the holidays a little bit more.
They are all at the doctors' offices as I type (lab, then pulmonology).   The PET went well yesterday and that's all I know.  Everyone is quietly optimistic.  I'm trying to be as well.

I'm off work today, trying to soothe a cranky little one #2 as I wait...

December 17, 2013


Got a call from my is squamous cell.  I guessed right.

Now whether this is the "great" option remains to be seen.

In which Meriwhen learns nothing new

Well, not entirely true.  But it sounded good as a title.

So the first round of pathology results are in...and it's definitely cancer.  However, we don't know what type of cancer it is.  It has been narrowed down to three:  adenocarcinoma, squamous cell carcinoma, and some other type carcinoma.  One of these is really slow to grow and spread and if it were this one, it'd be great.  For the other two, not so great.

We won't know until the next appointment on Thursday.  In the meantime, Dad has a PET scheduled for tomorrow to see if it has metastasized.  My sister couldn't understand how they couldn't tell what type it was right away.  I think they want to wait until the PET is done so they have all the info.

I'm going to guess that this is squamous cell, as that one apparently likes to grow in the bronchial tubes and that's where the mass was found.  But who knows?

No one mentioned if it's possible that this is a cancer from elsewhere that spread to the lung.  I guess if they see metastasis, then that means it's very possible.

If we caught this in the early stage, then the 5-year survival rate is decent.  If it's late stage...

So more hurry up and waiting.

On an up note, apparently Dad is a good cancer for surgery, so it must be located in a better spot than they originally thought.  They're optimistic that they could remove it and preserve the lung.  If they can't, his other lung is functioning well enough that it could do the job alone if it had to.

I took a long walk today to clear my head...and to work on losing the next 10 pounds.  Since all of the parents bailed on coming out to visit, there's no excuse for me to not work on it.  So I walked over to the town line and back.  Well, the second town line I came across because I live right on top of a town line:  I go to the corner and I'm out of town and into in unincorporated space.  So I walked until I reached a line into another town, then walked back.

December 16, 2013

I was cancelled at one job today.  I had an opportunity to pick up work today but declined.  I did drop little one #2 off in daycare today.  I need today to get some Christmas stuff done.  I also need a day to myself to unwind, relax, and knit my nephew's Christmas gift.

My parents set up Skype so they can see the boys.  I have Skype but I rarely use it.  The only person I've really used it with is my sister.  My in-laws have Skype but I don't use it with them because what they like to do is wait until they have everyone over and then put me and the boys on display, and I don't really like that...especially as they usually catch me by surprise and not warn me that I'll be talking to people that I hardly know.

But now that my parents have it, I can use it for them too.

So yesterday we all video-chatted.  They got to see the boys.  I got to see them.  My dad looks surprisingly good.  My mother, not so much.  But she's bearing the brunt of all the stress so it's understandable.

I learned that it isn't Tuesday for the results to come in, but Thursday.  More waiting.  Whee.

Moving into lighter topics...I've started working at three new programs.  One is pretty intense, with a patient population that is heavily Axis II and SI.  The other two have patient populations that are more laid back but no less acute.  All are very interesting to work, so I'm enjoying myself.  I have an open order--at least for this month--at the intense program to come in whenever I'm free to help them out.  That's the work I could have picked up today, but declined to.  I'll be there on Wednesday, and I told them if the agency cancelled me on Friday I'll be up there.

The intense program has me honing my suicide risk assessment skills to perfection, since I have to perform a thorough one on nearly every patient that walks into the door.   I've also learned some new techniques to improve my psych assessment skills that I've started using in other programs that I work.

The other programs give me more opportunities for patient education.  Most of my education has been about non-psych (i.e., medical) conditions and care.  Comorbidities run amok in chronic psych patients, and a lot of the time the patient themselves either downplays or ignores them.

I've also had some good shot practice as I administered several depot medications.  They asked me if I would be OK in giving the shots.

"It may take a little getting used to," I replied.

"How so?"

"They're cooperative.  I'm used to a bit of a fight."

Haldol dec is a bastard...thick as Ativan, so it's hard to pull AND push.  I feel sorry for anyone that has to give--or get--it more than q2 weeks.

December 15, 2013


My dad went through the procedure well.  However, it is a tumor.  There's a lot of cells there.  They got the sample and expect the results by Tuesday.  Apparently the surgeon that they had to call in knows what it is but said that we should wait for the diagnosis to be sure.

So yeah, not good.

I'm remarkably OK.  I thought about why I'm containing it so well on the phone or talking about it with  others, but then I realized that I've had four-plus years of practice in containing it well in front of others.  When you hear patients tell you of unspeakable things that they have done or had done to them, learn of delusions too horrific and fantastic that you shudder to think of the possibility of them being real, and--unfortunately--to have to revive patients who have been found cut or hanging in a homemade noose....well yeah, you get good at keeping the reactions in check.

My sister, on the other hand, is a PhD specializing in cancer research.  She lost it.   Repeatedly.

She decided to fly out to NYC to be there for my parents and to make sure, in her own words, "the right questions get asked on Tuesday."  I had to agree:  I may be the nurse, but cancer is her forte.  If anyone knows what to ask about all of this--and isn't afraid to ask it--it's her.   I fear for the doctor that they will see on Tuesday...between my sister and my mother, he will be thoroughly interrogated.

Also, it may be really hard for the parents if we both came out and left right before Christmas.

So she went out first and will be back before Christmas.  If I have to go out, little one #2 and I will go out after the holidays...or sooner if needed, God forbid.   While I don't have a packed bag on standby just quite yet, I've mentally prepared to drop everything and have little one #2 and I on a plane going East within 24 hours' notice.

It's currently snowing in NYC...that hurts too.  Snow in NYC is magical.  Snow in NYC surrounded by family is even more so.  I miss snow.  It's 75 and gorgeous where I currently live, and there's a lot to be said for this weather, but I miss the snowfall.  The world is so silent when it happens. it's still the waiting game.  Whee.

December 11, 2013

My birthday was nice.  I did very little except relax...try to, anyway.

I was going to write about my trial by fire at work today, but my father's procedure is tomorrow and I'm not really in the mood.  I'll have to type it up when it's all over though, because it was entertaining.  Though you'll probably hear about the procedure before my work adventures.

December 6, 2013

So things are the same

Just finished a long week of work.  I've done enough suicide assessments that I no longer need to read the questions off of the form...and there are a lot of questions.  

Anyhow, the procedure/biopsy is next week so it's all about waiting.  My mother says that my dad is taking all of this very calmly...almost too calmly.  It is the calmness that is unnerving my mother more than anything.  She told me that she's been staying late at work to avoid going home.

Consideing that I found myself booking shifts 6 days in a row to take my own mind off of things, I couldn't throw stones.   My mind wanders down dark roads if I have too much time to think.

The doctor is optimistic given how fast the growth appeared:  he thinks there's a chance it may be a foreign object or cartilage.   Meanwhile, I've done some reading up on bronchial cancer and found that the five-year survival rate is very good.   Of course, as it stands right now, surgery to remove it completely isn't going to be an option, so whatever they can't remove during the procedure will have to be treated with radiation or chemo. 

Maybe one good thing will come of this:  perhaps it will finally scare my parents into finally quitting the cigarette habit.

I did go back and unschedule myself on my birthday.  

December 3, 2013

In which Meriwhen is socked in the stomach

Not literally, though given the specialty of nursing that I work in, I'm sure a few of you were thinking that...

My mother called to tell me that they had to cancel their trip out here for the holidays.  The sock in the stomach is the reason why it was cancelled:  they found a growth in my dad's lungs during a CT scan.  Mind you, this was a follow-up CT scan for something else, and that growth wasn't there it grew in the space of a couple of months.  So how rapidly this growth appeared is what alarmed everyone, plus where it's located.

The doctor himself scheduled an appointment with the specialist for next week.  They're going to go in, take a look-see, grab a sample for testing.  The doctor told my parents it could be anything and that they would not know until they were able to take a look at it.  The doctor also put the kibosh on dad flying:  dad wanted to wait until after the trip, but the doctor said that given how fast this thing sprouted up, who knows what will happen in a few weeks.  They also can't take the risk of the lung collapsing due to the plane ride.

Where it's positioned apparently makes it inoperable:  right lung, in the bronchus, at a fork.  I hope they can debulk it because it's almost closed off the bronchus.  If it were an inch up or down, they apparently could have removed it and put a tube in.

Lung cancer is a very real possibility:  both of my parents are (my dad did cut back drastically in the last several years but never fully stopped) die-hard smokers, so if they weren't smoking the cigarette itself, they were taking in some of that secondhand smoke.   And the Big C is no stranger to our bloodline, unfortunately.  It's appeared throughout the family in many different types.

I realize that my father is no spring chicken.  He's on the downward slope of the 70s and in addition to this, has had cardiac problems all of his life.  To be honest, I'm sometimes surprised he got as far as he did.  On the other hand, we all say that since he sees the doctors so frequently, he'll probably live until 100.  Still...


I'm trying to figure out if I (and little one #2) should fly out to New York and be there for the procedure, or go the following week, or go maybe later in the month.  I couldn't leave any earlier than Sunday.  I could go for a week and come back...I'd have to cancel three days of work, but I think this qualifies as a damn good reason to cancel.  If I waited a week, I wouldn't have to worry about work, but I'd be cutting it close to Christmas.  Or maybe we'll all go at the end of the month once the better half is off.

Better half is in a spot of denial...he's holding out hope that my father will be able to board a plane and fly across the country mere days after this procedure.   I told him several times that the chances of that happening are on par with snowballs in hell.   He continues to be in denial.

In a sad--as in Greek tragedy way--I'm not surprised that they discovered this now.  When I was growing up, his health would always go south around this time of year.  He was usually hospitalized for some part of December because of his heart, though he was always sprung before Christmas.  One year he cut it close though, discharging on the 24th.   For a few years his health perked up and he managed not to have the December hospitalizations.


December 1, 2013

I can't believe it's already December.  Two birthdays this month:  little one #1 and mine.  Then Christmas.  I've scheduled all my work shifts for the first half of the month so after December 15, I am off to enjoy the holidays.

I went to work on Black Friday because you can't pay me to shop on Black Friday.  Seriously, any day of shopping where people are killed in the name of bargain-hunting is not a day for me.  Plus I detest crowds.  So I'm willing to forgo rock-bottom sale prices to both live and not have to deal with parking my truck in a crowded mall parking lot.

Anyone, I went to see a coworker.  It was part work, part break.  I had to update him on a mutual patient (no HIPAAs were violated in the making of this conversation), and then after that, we fell into chatting about random topics.

I told him that as horrible as it sounds, after a patient discharges, I really don't care about them anymore.  I know that it's not the most compassionate, "it's expected of a nurse" response, but the reality is that I can't.  At least, not if I don't want to burn out.

I take the best care of my patients that I can whether they're my patients for five weeks or five minutes.  But when I leave for the day, I put them mentally away.  It's very rare that I let my mind dwell on a patient after I've clocked out...usually it's a very sick one that I hope will be OK in the AM, or one of my frequent flyers who is in the facility so often that when admitting calls to admit them, I can give them the report.

When a patient discharges, I wish them the best (and sincerely mean it), but once they're out that door, they're also out of my mind.  Again, the rare exception may be the frequent flyer that I might hear updates about from coworkers or other patients who've seen said patient in the community.  But once the patient discharges, I have to move on and focus on the patients who well as those who will soon arrive.

Part of it is to avoid my burning out mentally and emotionally by always subjecting myself to the service of others that I forget my own self-care.  I think they call it "compassion fatigue."  I learned from my pediatrics rotation how bad burning out could be...hence why I'll never work peds.  I could never mentally leave those kids at work.

I also think that part of it is because of the patients themselves. After years of dealing with patients who need help and don't want to be there, who go AMA, or who keep coming back because the minute they leave the facility they choose to drink/drug again, or choose not to take their meds anymore, or decide going to follow-up care isn't worth it...well, it's hard not to get a bit jaded.

Not so jaded as to provide the best care that I can, though.  And I do have tremendous compassion for my patients...while they're my patients.  But I have to set limits on that compassion for my own mental and emotional health.