Time of Death

(FYI: this post is graphic.)

I rushed down the stairs from the 4th floor as soon as I heard the code called overhead.

Nurses, doctors, and respiratory therapists were all running toward one room. I knew who was inside.

It was my patient who had been mostly unresponsive since I met him. Whose grandchildren–and possibly great-grandchildren–had colored pictures and made cards that were displayed in the windowsill and on the bulletin board. Who didn’t even flinch when I drew his ABG yesterday morning.

My patient whose son has an alcohol problem and had yet to come to the hospital to sign the DNR/DNI we kept talking about.

The senior resident had already started compressions when I walked in. My patient had no pulse and he wasn’t breathing. He had been pale all along, but now he was exceptionally white. Nurses were giving epinephrine and eventually vasopressin through his IV. Anesthesia was working to secure an airway.

It was my turn to take over compressions. Hard, fast, deep. You’re the only thing keeping his blood circulating right now, Erin. Focus. Just like you’ve been taught; just like you’ve practiced hundreds of times.

I was sweating. My stethoscope, draped around my neck, thumped rhythmically against me with each push. The nurse across the room grimaced as my patient’s ribs cracked and grinded with each compression of his chest. “I’ll never get used to that sound,” she admitted.

Hard, fast, deep, Erin. Make each one count. His head and neck bobbed limply as I continued to beat on his chest, forcing his heart to squeeze. His ghost-like skin was turning purple. Harder. Faster.

The patient was intubated. Nurses called both phone numbers his son had given them: one was disconnected, and he didn’t answer the other. They kept trying to call, praying he would make it to say goodbye, hoping he didn’t come in drunk. Respiratory therapists pumped oxygen into his lungs. A few of us rotated through compressions.

The monitor indicated slow, weak electrical activity of his heart. Dopplers confirmed what our fingertips had told us all along: his heart wasn’t beating. Pulseless electrical activity.

We stopped moving. Twenty minutes had passed.

The senior resident called time of death.

Nothing prepares you for that moment when you first start compressions. I’ve been certified in CPR since I took the American Red Cross babysitting course as an 11-year-old. I was recertified a few times as a lifeguard, then got BLS and ACLS certified during PA school. I’ve practiced on dummies and memorized algorithms. I’ve taken countless exams. I watched patients die and performed post-mortem care when I worked as a nurse assistant during college. But nothing–nothing–prepares you to crush another’s chest in an attempt to keep him alive.

I looked back into the room as I closed the door behind me. The handmade cards were still neatly lined up along the windowsill, untouched by the earlier chaos: Get Well Soon, Papa!

My patient’s son never came. No one said goodbye.

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Time of Death

Times

Sometimes God rattles and shakes and transforms my little world with one sermon, Scripture, song.

Sometimes I’m not ready to listen.

Other times, God pokes and prods and transforms my little world calmly, quietly with conversations, questions, and early Spring days.

Sometimes–those times–I get it. I listen.

Don’t allow life to interfere with living.
Life is the time we’re given on this earth. Living is what we do with it. Many of you, I hope, have heard about Ben. His story is one that literally tears my heart to shreds and forces me to my knees, pleading with God to do the medically impossible. It’s also one that has made me question God about His purposes and plans and made me question myself about my purposes and plans.

What am I doing with my life? How am I living? Am I living or am I just getting through life one day to the next? If I had no financial, physical, or emotional limits, what would living for God look like?–and why, why, why am I stuck in this mindset that those limits have more power over my living than God does?

It’s easier to trust Jesus when you’re living thankfulness.
Momma gave me a book for Christmas called One Thousand Gifts. At the same time, my Bible study leader gave me Jesus Calling. Both speak of the idea that when you are grateful for every moment–the delightful and the devastating–trusting God is the result. Trusting God, then, is the opposite of worry, fear, doubt.

Refuse to worry! In this world there will always be something enticing you to worry. That is the nature of a fallen, fractured planet: Things are not as they should be. So the temptation to be anxious is constantly with you, trying to worm its way into your mind. The best defense is continual communication with Me, richly seasoned with thanksgiving.
–Sarah Young, Jesus Calling

After reading only a few chapters of One Thousand Gifts, I bought a small notebook and began what I call my Thankful List. Admittedly, I haven’t been good at writing things down–part of the whole life-interfering-with-living thing–but my attitude has slowly begun to change. I have a long, long, long journey ahead of me still. For example, my attitude toward my current clinical rotation for PA school has stunk. There has been no evidence of Jesus in my life when I talk about it, when I go on rounds with the rest of the teaching team, and when I study. I have been bitter and self-absorbed and ungrateful and miserable.

That being said, I had 50 degree sunshine to run in yesterday. The warm wind blew through my hair and my legs peeked out from my favorite pink shorts.

Be still.

Be still and know that I am God.

He beckoned me to quiet my heart. I ran to the shore of the tiny lake in the middle of the park, found a giant rock, and sat down. I didn’t say anything. I didn’t need to say anything. God was there. He heard what was  going on my heart. He heard my unspoken gratitude for the sun and the wind and the still-iced-over lake amidst my anger about this clinical rotation. He brought peace and  love and truth to me in that moment of thankfulness, wiping away the self-doubt and God-doubt underlying my anger.

Hoyt Lake

He is God. He gave me life so I could enjoy the beauty and pain and satisfaction and frustration that come from living.

Thankfulness begets trust. Trust begets peace.

And peace cannot be learned…only given by grace.

Times

It’s the little things.

Yesterday, as I turned at the end of my street, I noticed two little kids and their parents building World’s Coolest Snow Fort. Mom was shoveling snow into their recycling bins, Girl and Boy were packing it down, and Dad was hauling the bins and dumping them out to make giant snow bricks.

When I turned back onto my street 45 minutes later, this family was still working hard. World’s Coolest Snow Fort had four walls, a window, a door, and a snow slide. Now, I built some pretty amazing snow forts and tunnels as a kid…but I’d be lying if I said I wasn’t jealous.

I ran past it again today, noticing they had put chairs inside. Looping back on my way home, I noticed that Girl, Boy, and Dad were inside and two handpainted signs were stuck in the snow nearby: Hot cocoa made here.

“Cool fort!” I gasped as I ran by, praying I’d make it the last half mile of my long run.

Girl hollered from inside, “Want some hot cocoa?”

“No thanks!” I said. But that does sound pretty good.

I ran home, dragged myself up the stairs, and found two quarters in my wallet. I headed back outside, ran down the road, and stopped at World’s Coolest Snow Fort.

“Do you still have hot chocolate?” I asked. Boy and Girl were sitting in the fort talking to Dad, who was sipping a beer.

“Yep!” replied Boy. “It’s fifty cents.”

Girl poured my chocolately goodness and Boy declared himself Money Man. Dad and I talked about the weather.

I walked home, sipping a cup of homemade hot cocoa with two giant marshmallows on top.

Sometimes, it’s the little things that bring the most joy.

It’s the little things.

This is what happens when females work in orthopaedics.

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The sales representative peers from behind the sterile table to look at Doctor. “Is this the one?”
“This is the one!” Doctor says as he uses a mallet to pound the trial prosthesis into place.
That’s what all those crazy girls on Say Yes to the Dress say. Hmmm. This whole process is just like that stupid show, actually.

The comparisons begin to form in my brain as I stand on tiptoe to peer into the gaping incision.

On Say Yes to the Dress, a girl goes to the bridal salon and tries on several dresses before she finds one she likes. Once she finds one that she loves (with the help of her maid of honor, of course), the bridal consultant asks, “Is this the one?” After the bride excitedly (and often tearfully) exclaims, “Yes!” they place the order for the dress in her size.
In joint replacement surgery, a surgeon goes to the operating room and tries out several trial prostheses before s/he (usually he, let’s be real here) finds one he likes. Once he finds one that he finds satisfactory (with the help of his first assistant, of course), the sales rep asks, “Is this the one?” After the surgeon calmly (and sometimes dubiously) responds, “Yes,” he tells the sales rep what size is needed and the rep gets it ready.

“Can you prep the cement?” Doctor asks the scrub tech.
I snap back to reality, where we just finished chiseling, snipping, and sawing bones. The room still smells faintly of cautery smoke. Even under our matching sterile surgical garb, we’re all dressed identically. I’m yanking the patient’s muscle out of the way with a metal retractor.
Doctor asks for a screw and screwdriver.
I realize for the first time that I am truly in a man’s world.

And I wouldn’t trade it for anything.

This is what happens when females work in orthopaedics.

Giving Tuesday: Students Without Borders

As many (all?) of you know, I’m in my final year of PA school, which is our clinical year. Since June, I have been able to work in various disciplines including Emergency Medicine, Orthopedic Surgery, Pediatrics, and Psychiatry. I have a few favorites, but none of them compare to my experiences in the Dominican Republic the last few winters.

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My school sends a medical missions team, Students Without Borders, to Hoyo del Toro in the Dominican Republic each January. I have been fortunate to be able to participate in this trip each year of PA school–and I’ve learned so much along the way. Under the supervision of incredible faculty members and other PAs, we set up a clinic in a rural village and provide physical exams, medications, and other necessities such as toothbrushes to a beautiful people who would otherwise go without. Last year we saw over 400 patients! One of my favorite families was a mom and her three children. Not only were we able to diagnose her son’s ear infection and reassure her that her newborn daughter was healthy, but we were able to provide free antibiotics and teach her what to expect when kids are sick. Being able to love this young mom and her children through education and healthcare was one of the highlights of my trip.

This January, I have the opportunity to return and continue to serve the community of Hoyo del Toro. As a third-year student, I will help to oversee the clinic, teach the first- and second-year students, and provide medical treatment to this underserved population. However, I am unable to do these things without your financial support. I have saved enough money to cover half the cost of my trip, but I am still in need of $700 to be fully funded. Would you consider supporting me as I return to care for the people of Hoyo del Toro?*

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I am incredibly grateful for each one of you, and I ask that you would also pray for me and the rest of the team as we travel in mid-January. We are eagerly anticipating this missions trip!

Thank you in advance for all your love and prayers,
Erin

*All donations are tax-deductible. Checks can be made out to Erin Nichols and sent to my Buffalo address. Thanks! 🙂

Giving Tuesday: Students Without Borders

Of Pediatrics and Parenting

I’ve often heard others say things such as, “Oh, I love kids; it’s the parents I can’t stand!” when discussing pediatrics. I tried to get the notion of difficult parents out of my head as I went into this rotation, especially after one of the nurses told me that most parents give their children vaccines without much (if any) hesitation. From my extremely limited clinical experience, vaccination schedules seemed to be something parents and providers disagreed about most.
If only I had known. The most frustrating thing is not parents who choose to delay vaccinations or who call the office every day because their child developed a new URI symptom. The most frustrating thing is moms and dads who don’t parent their children the way I feel children should be parented.
And what do I know about parenting, you ask? Nothing! Except that kids need discipline. Kids need routine. Kids need to be loved. Little girls need to learn that their personalities should sparkle brighter than their shoes. Little boys need to know that they’re important even if they missed the game-winning goal at Saturday’s soccer game. Teenagers need to be told that their lives have value and purpose. My preceptor, who is a lovely little lady with over 40 years of experience in pediatrics, tells me many stories about her patients and their parents. One mom, she said, told her several years ago, “If I don’t love my kid, who will?!”
There is no doubt in my mind that most people are parenting as best as they can. They’re loving, disciplining, and teaching they way they were loved, disciplined, and taught. As a provider, I need to accept that parents each love their kids in different ways. Children–especially after age 11 or so–often don’t seem to welcome their parents’ words and acts of love, but that doesn’t mean they shouldn’t be told and shown them anyway. To some parents, giving into temper tantrums is their way of loving their children. While I may disagree and explain to them the importance of discipline so that their kids learn proper boundaries (and can become functional members of society someday), I cannot tell them how to raise their kids. I’ve never had a toddler throw himself down on the floor at Target in a fit of rage. I’ve never been responsible for the nutrition of a picky eater. I’ve never dealt with a defiant teenager.
I have also never felt more inadequate as a healthcare professional as I have in pediatrics. I’ve really struggled to find my role in these children’s lives. Behavioral and mental health are vitally important for patients’ overall well-being–patient age doesn’t change that. However, no other population is so dependent on others to influence every single aspect of life.
Friday is my last day in Pediatrics. I have learned so much, but countless questions remain. Regardless of how many answers I feel like I have, I will never have enough. Parents will always challenge my knowledge. As my preceptor always tells me, “Patients don’t read the textbook before they come in to see you!” Likewise, I have heard her tell countless young moms and dads that parenting is the hardest job they’ll ever have. Needless to say, I think I’ll stick to being a PA for a while, regardless of my ineptitude and the struggles I encounter along the way. I mean, treating diabetes in a non-compliant patient seems easier than loving an angry toddler who throws himself down on the floor in the middle of Target….

Of Pediatrics and Parenting

Thankful Thursday: Seasons

Yesterday I compiled a long List of Grievances and allowed it to run through my head continually during the day.
I eventually added The List to the list, but not before it created a selfish mess of me.

Today I determined to have a better day. To keep the petty things from crawling under my skin. To tune out the gossip. To stop focusing on how frustrating and difficult and discouraging this season of my life happens to be.

Seasons change…and life on earth is temporary.

Some clinical rotations have left me incredibly thankful that nothing lasts forever, while I wish others could last forever. All of them have left me emotionally and physically exhausted, terrified by the amount of medicine that I have yet to learn. I have to keep reminding myself that this is exactly why we have a clinical year: we don’t know everything, we never will know everything, and even what we do know from books often means nothing in clinical practice.

I have so much to be thankful for.

1. ‘Tis the season for peppermint mochas.
2. My current rotation is a mile from where my sister lives.
3. New friends. Old friends. Texting friends. Praying friends.
4. Caffeinating with friends.
5. My daily commute gives me ample time to think, pray, and sing (loudly).
6. Occasionally, I’ll earn a toothy grin from a baby.
7. My site visit (essentially an oral exam) is Friday, which means I only have one more sleepless night.
8. I’ve found myself increasingly passionate about and interested in specialties I never imagined I would enjoy.
9. This song:

10. This explanation of the above song (and the fact that they’re playing locally in 2 weeks):

Thankful Thursday: Seasons