Thursday, November 02, 2006

I stumbled into work on my last day

...and asked one of the patient care techs if "I'm too sexy for this party" was a valid reason for calling in, or if "I'm itching like a man on a fuzzy tree" would play better.

"Depends" he replied. "Do your friends say you're as white as a bug?"

Another nurse chipped in with, "What would the history look like for something like that?"

Somebody else said, "'I held my nose, I closed my eyes, I took a drink?'"

Then the case manager, going to get coffee, pointed out, "The social history would probably say, 'Mama's got a squeeze-box; Daddy never sleeps at night.'"

We all giggled.

"What about the discharge note from the doc?" Carolita mused.

The Accentless Egyptian Doctor (the AED) looked up from stirring his coffee and said, "'Grampa's done got rhythm; the old man throwed them crutches down.'"

*** *** *** *** *** *** *** *** ***

The AED and I have been working pretty closely on one of those cases you hate working closely with a doctor on: a young person who's perfectly healthy aside from the fact that her frontal lobes are eaten up with glioblastoma.

We took a chunk out of her left frontal lobe about a year ago. Earlier this week, just after her 28th birthday, she started vomiting and losing her balance. So her family, aware that there was a golf-ball-sized tumor in her right frontal lobe despite a year's worth of chemo, took her in for an exam.

She was admitted to us with dehydration and went through the MR scanner.

Which showed that, in just about three weeks, the golf-ball-sized tumor had grown to encompass her entire right frontal lobe, most of her right temporal lobe, and a good portion of her right parietal lobe as well.

Plus she's septic. It's a line infection from a central line put in so she could get chemo.

I spent most of Tuesday doing fun stuff like drawing blood samples, getting chest X-rays done, and talking to her family about what, exactly, septicemia means in the context of somebody who has about two weeks to live anyhow. Her dad, the main mover in terms of her care, is deeply in denial about his daughter's chances of either recovery (none) or survival (ditto) at this point. The attending physician had already told him that he (physician) would not order treatment for the sepsis, nor would he prescribe steroids for the edema in her brain. But Dad wanted serial blood cultures and chest X-rays and the like in hopes that they could find something, anything, to give them hope.

He finally asked me what it would be like if they treated the sepsis and she died from the brain tumor. I had the unenviable job of telling the man that first, his daughter would commence to seizing at odd times throughout the day, regardless of the doses of anti-seizure meds she was on. Then she'd probably (hopefully) lose consciousness, and finally, the edema in her brain would cause her brainstem to get squashed, stopping her breathing.

They're going to get hospice. Eventually. Maybe. Perhaps her husband would rather she stayed at the hospital. Maybe her dad will convince him that she needs to go to another facility for more chemo.

With any luck, she'll die of sepsis before the second set of cultures comes back. It would be kindest.

Sometimes I truly, deeply, madly hate my job.


woolywoman said...

yeah, sometimes it sucks to be us. and I mean that. Hang in there.

Judy said...

Sometimes the job sucks, and sometimes you touch lives in way you'll never know. This sounds like a twofer.