Monday, August 03, 2015

So I have this patient.

She's young. Way younger than me, like thirty.

And she's got two kids. One about to start preschool, one just born.

And the other day, her arm quit working. And it hurt a lot. Enough that she thought it would be a good idea to go to the ED.

Where they found a tumor.

On her spine. Actually, three.

And one on her pelvic crest, and then another, right next to it. So, two more. That makes five.

And then they did another scan and found that her belly is full of tumor.

After three biopsies, all of which have been sent to places like MD Anderson and Harvard and Brigham and Women's and Johns Hopkins, nobody knows what the fuck is going on. The tumor slices aren't staining right, or are staining funny, or something. All anybody knows is that they're not ovarian cancer, or breast cancer. They're probably some sort of sarcoma; whether it's osteosarcoma or one of the more obscure soft-tissue cancers is yet to be determined.

Any way you slice it, she's an outlier.

An outlier who became my buddy while I took care of her, running steroids through her brand-new central line, in an attempt to get the inflammation around her cervical spine to calm down enough that her arm worked again.

Her arm is working fine. She's actually doing, from the view of any medical person, really well. She does her incentive spirometry faithfully, she's not constipated from her hydromorphone drip, she walks four times a day in the halls. So far, so good.

Except that she's got a couple of cervical vertebrae that the neurosurgeons are planning on cementing this week, provided nothing more goes wrong, because the bone has been totally eaten up with tumor.

And, of course, she has a belly full of tumor.

And two kids. One about to start preschool, and one who just quit breastfeeding.

And she's fifteen years younger than me.

Ask any nurse: the benchmark for disturbing cases changes as you get older. At first, the disturbing people are fifty. Then they're forty. Then they're younger than you are.

This one is enough younger than me that I could've competently changed her diapers when she was a newborn.

I'm not judging the world by my age or experience. . .but this person is my peer, yet enough younger than me that I cannot, under any circumstances, feel peaceful about her diagnosis or disease process or outcome.

Because, again, no matter how you slice it, her projected course fucking sucks.

Sarcomas in adults have some of the toughest treatment regimens out there.

I refuse to lie about it to her. When her grandmother, who's my mother's age, shows up and says "You'll beat this!" I nod. When her mother, who's barely a decade older than me, says "You'll beat this!" I nod again. And then they leave and we look at each other across the length of the bed and I say, "Well, fuck." And she nods.

I do not know what to do.

The best I can do at this point is send her links to "Poldark" and "Being Human," because Aidan Turner is just that worth watching. I post links to Foamy The Squirrel and Cute Overload on her Facebook page. I bring croissants and nail polish to work.

That is the best I can do, to be the person for whom she does not have to be Cancery McCancersons. We do nails when I can take a break, or we talk about the kids, or I show her new videos of drag queens she may not ever have seen before. And I promise that when she gets out of the hospital, we can go do non-cancery stuff, because she lives ten minutes away from me.

I hope she gets out of the hospital. I kind of doubt she will.

This is a person who, in all likelihood, will die. She is my friend. She is young, and good, and has children she ought to be able to watch grow up. And all I can do is post videos of baby otters learning to swim, and it is not enough.

It is not enough.

It's the hope that someday it will be enough that keeps us going back to work.


IMQTPI said...

Wow. That just sucks.

Silliyak said...

no words, just sorrow

RehabRN said...

Coming to work and being you is the reason why. Because there will be another, no matter what they do.

And it's sad, but who else will be there for them, if not you?

If you don't do what you do, who will?

That's how I go to work. I feel for you.

Dr. Alice said...

I'm sorry. Really, really sorry.
And you are exactly what she needs right now. Keep that in mind. Tell her she's got the good wishes of a lot of people she doesn't know.

Anonymous said...

I hope you never leave nursing, you are great!

Jennifer Thorson said...

Well, fuck.

salsabike said...

All of those things that you are doing---they're what you have (in addition to what you do professionally); they're ALL you have. They're what we all have when the big things go to shit---the little things that you can control. Bless you for doing them. They don't change the outcome but they damn well change the journey for her, in a better way. So thank you.

bobbie said...

Hugs for you and your friend ~

Can-suh sux.

JEN said...

I have no problems.

Anonymous said...

“… for that is what redeems us, that is what makes our pain and sorrow bearable—this giving of love to others, this sharing of the heart.”

–Alexander McCall Smith
In the Company of Cheerful Ladies

Jen ♥ said...

Jennifer Thorson: My thoughts exactly.

Back Porch Writer said...

So sad. Offering her comfort and peace as a nurse and a friend is all you can do except pray.

Jamey said...

Jesus, that's horrible. At least when I was working hospice, it was 99% very old men who'd lived long full lives. I'm glad she at least has you to be there for her with drag queen and baby otter videos.

clairesmum said...

You are doing exactly what you can do - making life keep going in the ways it can occur in a hospital room. You know the picture is going to deteriorate rapidly..making the hospital room her 'safe place' for at least part of the time is a gift - gives her some space and energy to sort out what is happening to her.
and well, fuck...that sums it up.

she - and you - are in my prayers. once it is over, refer her family to whatever local hospice does good grief work with kids..

Anonymous said...

I understand the age thing. I sit in the ED scanning the tracker to see how many patients are younger than me and how many are older. It is disturbing to see someone younger in with chest pain or a stroke, but some people just draw the short straws. Life is funny that way, or maybe just cruel that way.

Sorry to read about your friend!

Bee said...

What salsabike said. Being there with something that recognises her as herself and not a patient is a big, big bonus and really important.

Anonymous said...

I am glad she has you.

Tracy Timmerman said...

I feel sorrow for this mother as I am also a mother of four boys; leaving my children early is one of my biggest fears as a mother. I couldn't imagine the emotion turmoil she goes through in her own mind. If I was in her 'shoes' I would be so fortunate to have you as my nurse. You are great and no doubt make a huge difference in what little bit of life she may have left.

Anonymous said...

Honesty combined with kindness is the best a medical professional can offer. I speak from experience as a patient.

Penny Mitchell said... nothing. I am so, so sorry.

Just My 2¢ said...

Well, shit.

Sarcomas suck because they are slow to be investigated; or in my case, misidentified by a small-town pathologist.

On Wednesday, I'll be driving 400 miles for my 4th year surveillance checkup.

Vocabulary word for the day: Dermatofibrosarcoma protuberans

Anonymous said...

I have a friend, 36 years old, 2 kids, with stage 4 pancreatic cansuh. We all just live for today, in the now, cuz it's all we got and, right now,it's ok there.