The Many Faces of AIDS, part 1

Notice: this series of posts will highlight the personal side of one of our country's major health problems. Please note that these are in NO way portraying real people, but are a combination of my experiences. If you think you recognize someone, you are wrong, these are not real stories.

She was wasted, emaciated, almost nothing on the stretcher. Friends, family members all piled at the bedside, all concerned about her. They had pictures from a month, a year, several years ago. All these portrayed quite a different picture: laughing, dancing, normal weight, friends and family all around.
Today, she was crying, covered in sores, odd lumps present here and there. She said that her family had brought her in "because they are all worried about me". History was hard, if not impossible to obtain with all of them around. The family painted a picture of declining appetite, declining weight, declining energy, "she just seems sick all the time".
I asked for a little privacy so I could get a urine sample. The family willingly filed out to the waiting room while making it clear that they would be back, they weren't abandoning her. Once gone, she dissolved into tears.
In bits and pieces the story came out, she was born in poverty in the inner city. While attempting to earn a college education she had run out of money. Her minimum wage job wasn't paying enough to allow her to finish school. There just weren't enough hours in the day for her to work enough to pay for school. So, she turned to what she knew would make her a little more money. She stated it started out slowly, but quickly it trapped her. Selling her body became more and more easy, and made more money. She finally made enough money to finish those last 2 years of school. She graduated top of her class, with a degree that ensured she would never have to stoop that low again.
She left that city, went to another one, got a good, well-paying job. She never turned to the streets again, thought she was done with that shameful period in her life. But, the deed had been done, and there was no avoiding the consequences. After a time, she moved back to her hometown and continued to work at her new profession. She had money, friends, influence, and even a new boyfriend.
But then, the weight loss started, the frequent infections. She knew that her old life was coming back to bite her, but didn't know how to tell her family and friends. She was scared of what they would think of her stooping so low for those 2 years. So, she avoided the issue. She told them she was getting back into shape, that the cross-country move was to blame for her frequently being sick, anything to get the attention off of her increasing sickness.
Now, she was lying on our gurney, sick, scared, and broken hearted. She told me she knew it was AIDS, she said "I just know I caught it in those 2 years, but I don't know how to tell them". I stayed with her until the sobs quieted, and tried to offer reassurance. But deep down, there wasn't much reassurance to offer. The signs were all too obvious, and the stigma all too deep.
We ran a few blood tests to confirm what was already obvious. We arranged for her to be admitted to the hospital for the first round of medications. We helped her break the news to her family, who solemnly shook their heads and filed out of her room. We answered questions, and tried to reconcile them. Hoping, hoping that she would have someone left to support her through the ugly days ahead.
I sent her upstairs, and sent her family after her. I sent the chaplain up after them, hoping to break the cycle of social stigma. I didn't see her again for awhile.
4 weeks later, a familiar name flashes across my screen. I quickly ask to have her again, to follow up on what I had started. This time, the scene was so different. She was even sicker, but alone in the room. A small heap under the bedclothes was all that was left. She sobbed again as she told the story. The tests were indeed positive, and confirmed her worst fears. Her family and all her friends had immediately abandoned her, even her roommate had moved out while she was at work one day. She had lost her job due to being unable to work from the illness. Her boyfriend had left town and wouldn't return her calls. She was facing the horrible truth, all alone.
We saw her fairly frequently for the next few months as we tried to curb the spread of her illness, stop the insidious slide toward the grave. She was always alone, scared, trying to find her footing alone in the world.
About 8 months after that first day, we got an EMS call. "Unknown female, unresponsive, initially pulseless, revived after one round of CPR and a defibrillation. Now unresponsive, pulse of 100, BP 60/40, ET tube in place, 2 min ETA, blood glucose 200". For some reason, my mind flashed to her as soon as I read the report. As I readied the room and summoned the other personnel needed, I mentally reviewed her case. Sure enough, when the Paramedics rolled in, it was her. She was down to less than 70 lbs, and had obviously not been able to care for herself in sometime. EMS reported a very dirty house, and indications she had not moved from bed for some days. Nobody knew who called 911, but she was alone when EMS arrived.
We tried our best, but her fate was sealed long before she arrived. She died soon after arriving despite our best attempts. She didn't die alone, but she died without any family or friends by her bedside. The horrible grip of the viscous disease finally won.
We attempted to contact family and friends, but no one would come, no one was willing to be associated with her. We finally sent her body to the morgue, alone. The disease had won again, and social stigma had taken another victim.

LOA Reasons

Hi to my few readers :). I just wanted to drop a quick post to explain my lengthy absence. I have been very busy, I am preparing to move clear across the country. I have moved twice since May to short-term rentals in anticipation of this job opening up. Now, I'm preparing for a 3000 + mile move, and a major job change. So, in a nutshell, I've been simply to busy to post for awhile :). I haven't gone anywhere, and will be back!

Life Lessons, Number 1

This is the first of a series, titled Life Lessons; although perhaps it should be titled "things my patients taught me never to do".

Number 1: Never, ever let your dog chew on your tracheostomy tube. If by some chance your dog does, please discard it immediately. Do not, and I repeat; DO NOT continue to use the tube anyway. Especially do not continue to allow your dog to chew on it, and continue to use it.

This patient came in with a tracheostomy tube that was approx 1/3 the length it had been, the end of it was jagged and sharp. She had a tracheoesphageal fistula from continuing to use the sharp tube. That fistula was discovered when the patient attempted to drink liquid potassium supplement, and then coughed it all over the night shift nurse! Now, you really don't want anything down in your lungs, but especially not liquid potassium!
The patient had been living with a family member who made no attempts to help her, get her medications, or even feed her properly. She was diagnosed with aspiration pneumonia (no surprise!) and eventually sent to a nursing home, under care of Adult Protective Services.

94 years old

She was 94, frail, but still mobile with the assistance of a walker. She had called us with a nosebleed that she couldn't get stopped. She lived in a large, 2-story farmhouse that stood on what was obviously previously a working farm, but was now a housing development.
When we arrived, it looked like a small massacre had happened in her home, with blood all over the floor, the walker, the bed, even across the room. She removed the tissue for a moment, and the blood squirted across the room. I was the preceptor on this call, a situation that doesn't happen too often. The probate member rightly decided that this lady needed the hospital yesterday, and started making preparations to hustle her down the hill to the waiting ambulance. While he was moving furniture, I took a moment to look around the room. It was the living room, but obviously had been transformed into an all-purpose room at some point. There was a bed, a couch, a desk, a table, everything she needed was in that one room.
The patient interrupted my musing, stating nicely "you know, I really don't want to leave, do you think all this fuss is really worth it?" The probate member immediately starting listing all the reasons why she could bleed to death if she decided to stay. After politely listening to him, she turned to me and stated "I just don't want to leave this place, for I'm afraid I'll never come back". She turned to survey the room, and look out the window at the mountains visible. "I was born in this house, I raised my 6 kids here, I had 2 kids die here, I lost my husband here. I just want to come back here, and die peacefully here one day. Sorry, you all are nice, but I don't want you to come banging in as I'm in the business of dying".
The probate was lost at this spiel, and started trying to quickly load the patient onto the stretcher. She paused for a moment, "wait a minute, young man, I need to grab my pocketbook." He was impatient, found the pocketbook quickly, and then hustled her onto the stretcher. By now the bleeding had finally slowed, so the urgency was less, but still the probate hurried her. I held up my hand for a second, and he paused. She was crying now, and softly told me "I love it her, all my kids live in the neighborhood, they don't farm like I used to, but they all have good jobs. Can I come back?" I held her hand for a moment, and reassured her that most likely she would be home before dark.
At that moment a massive figure appeared in the doorway. I instinctively ducked, for he had come in silently and I had no idea who he was. "MOM! How are you?" he gently called out, as he moved in to hold her hand. She turned to me, "this is my oldest son, and he comes over and cooks and cleans for me, allowing me to live her". He was gentle and carefully with her, and even tried to help us carry her out of the house. He reassured her that he would be at the hospital to pick her up "just as soon as I get some decent clothes on". We locked the door behind us, and gave her the key. When I climbed in the ambulance she was crying again. She caught my hand, pulled me close, and whispered around the tissues "Thank you for listening to me dear, I really do go on a bit about the house, but I'm getting older and if something kills me, let it kill me there". She patted my arm, smiled, and sat back.
Later in the day, I heard the ER got the bleeding to stop and sent her home in the care of her son. They commented on the care he takes of her, and her love for her family and her house.

He said "Uh Oh"

He was young, way to young. 19 year olds are not supposed to be dead. Instead, he was supposed to be healthy, innocent, free, dreaming, imagining himself invincible. Now, he was tangled in a web of poor choices, poor decisions, bad rearing, inner-city crime, and violence that I couldn’t even begin to wrap my head around.
It was a horrible tragedy, never should have even begun. He had plans, dreams; he was going to escape the web that bound his entire family. He had scholarships, colleges, roommates, all lined up. An escape route planned, now thwarted by someone else’s twisted self.
I couldn't even begin to imagine the blasé attitude of those on the scene. To stand there and watch him get shot like that, by someone who was laughing. I couldn’t even begin to wrap my brain around it. Mom, siblings, girlfriend, friends; never stopped the other guy. In fact, they all initially helped make up a story about him shooting himself
EMS was called for “a guy not acting right”. Initially, he acted like he was drunk and high. Everybody else there was, so why not him? Except he didn’t smell like alcohol. Toxicity screens later proved, and 1 friend onscene said; he was totally sober. He had shown up at his childhood home, simply attempting to get in touch with his family, keep connected to his roots. They couldn’t stand the thought of him bettering himself, and shot him in the head. The poor EMS providers, they initially began trying to treat him as a drunk/high patient. Then, someone noticed the bullet hole in his head. Police were not even on the scene at the time. Then, the gunman scared them all by showing up and telling them what he had done while brandishing the gun. EMS quickly removed the patient and fled to the ambulance, while having to listen to the jeers and callous remarks of those who had stood there and watched the whole thing. PD soon arrived and dispersed the crowd so they could pull out and leave.
He was initially awake, but slightly confused. During the twelve minute transport, he quickly became unresponsive. I was the trauma nurse, me and me alone. Supposedly there were to be 2 of us, due to his condition. However, due to staffing, it was only me. Plus I had 4 other beds with sick, sick patients. Stressed already, my heart rate accelerated when I saw him; pale, thrashing, confused, mumbling. By the time we got him on our stretcher, be began posturing with his arms. He looked up, looked in my eyes and said “Uh oh”. Those were the last words he ever said, and I was the only one who heard them. Heard his last words as that bright, beautiful life was snuffed out in a senseless act of violence.
His eyes slowly rolled back as his limbs stiffened and then curled into posturing. Soon, they straightened out into even more ominous posturing. His BP sky rocketed, and his heart rate plummeted.
We worked as hard as we could, using all the resources we could. A second nurse stuck her head in, and was soon sucked into the activity.
We ran him to the CT scanner; while the neurosurgeon started scrubbing for the OR. I stood at his side, in a lead apron, and pushed Mannitol in as fast as I could while they scanned his head. Quickly, quickly we worked.
He briefly started to improved, then crashed again. Before we could get him to the OR (8 minutes door to OR), his heart rate plummeted again as his brain herniated.
The OR team was standing ready as we crashed through the doors. They were joking as they attempted to remove his skull fast enough to save him. It was all to no avail, he died on that table. He was spared the horror of a code due to the bullet in his brain. His CT looked like “brain mush” as one CT tech put it. Saving his heart wasn’t going to fix his brain problem. The OR team continued laughing, joking, as they cleaned up the mess.
I wanted to stop them, tell them of his last words, his dreams and aspirations, and the abrupt end of them. This was a talented, bright young man destined for brilliant success killed in senseless inner-city violence.
We called his Mom, who had watched him get shot. She said “another one dead?” totally apathetic. She never came to see him, and nobody else did either. We were the only spectators of the end of that bright, young life. We wheeled him down to the morgue, and left him there, alone, dead dreams crashing down around him. I was certain that if I stayed and listened, I could hear them slowly falling and crashing around his stretcher. Hear the cries and echoes of those who would never know of his brilliance, his friendship, his healing touch. For he had planned to be a doctor, he was headed to medical school. He had scholarships for all the way through.
Meanwhile, we went back to attempting to save those who did not want to be saved; leaving him, alone, dead-the one who wanted to live was gone.
It felt like such a failure, although we couldn’t have changed anything. Those words echoed and reechoed for days: “Uh oh,” “Uh oh,” “Uh oh,” words of desperation, words of hopelessness, words of one caught in a tangled web.

NREMT-P Coming to your town!!!

I did it! I am officially an NREMT-Paramedic, and I have the card and patch to prove it!

I passed every one of my practical stations on the first try. I was still sick with mono, but I made it to the exam and passed every single station! I was proud of myself :)

I took the written exam 3 days later, and passed it with 82 questions in 45 minutes! The National Registry posted the results about 5 hours later on their web site. I wasn't expecting the results for several days, so it was a pleasant surprise to see it that day.

I received my card in the mail about 10 days later. I spent awhile jumping up and down and showing off my patch like an excited little kid :)

Now, I have sent off the stuff required to receive my state certification and am awaiting the card. I can't wait to start precepting at the rescue squad. I get so tired of sitting in the back and being unable to do the things I can do in the hospital. Last night, we joked about raiding the post office and grabbing the card so I could work a cardiac arrest that we were headed to. There were only 2 of us, and both were EMT-Basics, so it would have helped to be able to use my ACLS skills. Fortunately for the patient, the PD arrived before we did and found him merely intoxicated. He went to jail, and we were cancelled before we got to the scene.

Just for Laughs

Today I went in to work for a few hours, the first time I had been back since the mono started. Lets just say it didn't go to well, and I won't be trying that again for awhile. I need to recover a bit more before I try that again!
However, while at work today I saw something that made me laugh. I work at a large academic center and frequently bump into, consult with, and care for patients of prestigious doctors. Today, I happened to look up and see on of our world renowned neurosurgeons and one of his fellows (also fairly well known) walking down the hall together. Actually, they weren't exactly walking, they were both quacking like ducks, flapping their arms, and chasing each other down the ER hallway. In front of patients, staff, and visitors! I turned to the nurse next to me and asked "is that Dr. S0-and-So quacking like a duck? She quickly assured me that it was indeed the prestigious neurosurgeon on his way to see another brain-injured patient. After a good, long laugh at the situation we both had to admit that he is one of the most cool doctors either one of us has ever been privileged to work with. His sense of humor never fades, and while he tolerates nothing less the than absolute best for his patients, he is always willing to go the extra mile and explain something or help out in any way. And yes, even willing to quack like a duck to make the work day less tedious!