Aim Higher

Well, here I am - writing my second entry in an entire year.  I was busy, I moved, I hated my job for a while, I didn't get into a highly-ranked anesthesia school, I was on vacation, I worked too much overtime...  The excuses have an amazing potential to pile up and consume me but I need to aim higher.  And it starts today.

I'm going to begin by confessing that the focus of this blog may have been a road block to, not only my blogging, but my happiness.  Tal Ben-Shahar has a theory of the "arrival fallacy," or the belief that once you arrive at a destination, you'll be happy.  According to Gretchen Rubin in The Happiness Project, "The arrival fallacy is a fallacy because, though you may anticipate great happiness in arrival, arriving rarely makes you as happy as you anticipate."  Nothing could speak more truth to the arrival fallacy than accepting my Transplant ICU job.  Having worked in abdominal transplant for the entirety of my career, I've always had a distant love affair with the TICU.  The patients were sick, the nurses were bossy, and the locked doors to the windowless three-wing trifurcation made it appear such an elitist destination.  My friends, family, and colleagues can attest to my aspirations of working in the TICU since prior to nursing school when I worked as a nursing assistant on a transplant stepdown unit.  It wasn't until I arrived that reality became transparent to me:  this was a scary, depressing, and thankless place.

Arriving at one goal usually presents another.  I was so caught up in the power and attainment of the clinical knowledge I would inevitably absorb that I neglected the emotional consequences and repercussions that came with the territory.  I transcended from an environment of walking, talking, thankful patients with the occasional wound drain to a world of inanimate and swollen shells of people with tubes and lines in their neck, nose, wrist, groin, mouth, ass, and penis.  I wrongly looked toward the older ICU nurses, who so notoriously "eat their young," for guidance.  Having been roughly seasoned with 20+ years of this, it became apparent to me that, in their eyes, these patients were no longer people but instead a casing with no internal substance other than heart, lungs, bowel - and even those things lacked vitality, requiring vasopressors, ventilation, and tube feeds.  After a certain amount of time as an ICU nurse, patients stray from being perceived as individuals with feelings and first kisses and favorite movies toward existing as nothing more than an empty suitcase that shits.  Unfortunately, this hardness is a mere side effect of such a difficult cross to bear:  seeing people die, day in and day out.

I often liken my job to rearranging deck chairs on the Titanic.  It is hard to find purpose and positivity in doing Q2 hour mouth care, administering vitamins and supplements, and hanging blood products for a patient that is going to die, no matter what.  So perhaps I owe more to myself and this blog than telling patients' stories.  I need to also share my story.  After all, I'm the one alive to tell it.   

Some pre-op teaching...

After working at one of the world's top transplant centers for over four years now, I've had to come to the realization that, even though transplantation is mostly associated with life, it involves more death than I could have ever imagined.  Sure, we can think of an eager team of surgeons coming in and harvesting organs from some unfortunate cadaveric donor, snipping and picking kidneys, corneas, lungs, heart, liver, pancreas, skin, and bowel, leaving the OR with coolers and turning their backs on the now worthless corpse, still open and empty.  But, that scene becomes much more palatable and justified when one thinks of the lives that can be saved.  Donate life.  Put it on your drivers license.  And that's where the thinking stops. 

No one thinks of the patient that actually received a liver transplant but his portal vein keeps mysteriously clotting off and his bowel keeps spontaneously perforating, spewing shit all over his insides, requiring him to go back to the OR for surgery after surgery.  His abdomen actually needs to be kept open with only a fine layer of mesh covering his liver and intestines, exposing him to more infection in a body that already has a suppressed immune system.  His loving family that has been at the bedside for weeks with him--puffy, yellow, and sedated on mechanical ventilation--finally agreed yesterday that "comfort measures only" (or "CMO" in the industry) is the way to go.  A perfectly good liver into such a deserving candidate.  Sometimes life and death just aren't fair.  And this is an example of the stories about transplant that no ones knows. 

I am writing this blog because there is value in what a transplant nurse experiences and it indisputably deserves a voice.  While sharing stories at the bar of the grotesque aspect of transplant nursing will probably never cease, there is more to it than that.  There is beauty in being intertwined in the fine line between life and death.  There are inspiring patients and heartbreaking patients and annoying patients and patients that you want to suffocate with a pillow but can't and each and every one of them deserves to have their story told.  There are surgeons that play god and value human life above all else, even to the point where it becomes unethical.  There are nurses that give up on patients too quickly and single-handedly act as the death panel the media blew out of proportion circa 2009.  Truthfully, the possibilities for material are endless.   

Everyone always tells me I should write a blog.  So, here are my stories of transplant nursing, just for you.