One of the big guy's images.

Things I'm thankful for this week.

Incredibly warm weather for the past two weeks that made January not just bearable but enjoyable.
My lovely friend Shirley died peacefully with her girls and her husband by her side.
I am truly thankful that she is no longer suffering;  she'd had enough.
It's snowing right now.
I made it through a difficult week at work.
Thankful for my lovely patients.
Thankful that Katie is okay and has suffered no ill effects from her overdose.
Watched a wonderful show about marijuana last night.  "Pot Fiction" by the Fifth Estate.  It makes me very hopeful that the Canadian government will legalize marijuana, soon.

What are you thankful for this week?

My very dear friend Shirley died peacefully yesterday afternoon.  Her family was with her.  She was loved by many and she will be deeply missed.  I am beyond sad.

It's been a week.

The big guy and I picked Katie up this morning for Special Olympics bowling and I noticed she was off.  There was something wrong with her eyes;  I couldn't explain it.  She didn't look right.  I asked, did she sleep okay, how was her behavior.  Everything was okay except she slept in.  Katie doesn't sleep in.  When I got her pills to take with us I looked at the package and the pills were different.  When I looked closer, instead of two five milligram tablets there were two twenty-five milligram tablets, five times her regular dose.  I asked her staff to show me the sleeve of her pills and all of the packages had the

wrong dose pills in them.  We left and headed to bowling.  The big guy bowled the first game with Katie while I phoned the on call pharmacist who recommended we take Katie to see a doctor, on Sunday, which means emergency.  The pharmacist also had a new sleeve of pills delivered to Katie's home with the correct dose. 

The good part about the error was that Katie was so drowsy, emergency wasn't a nightmare.  We had to wait;  it was three hours all together which isn't bad.  They did an ECG on her which was interesting and then we waited to hear from the poison center line people.  Turns out Katie received the maximum daily dose but not an overdose thank goodness.  She will be fine it will just take time for the drug to be metabolized out of her body. 

The agency will go over drug administration guidelines with staff and the pharmacy will be getting another call from me in the morning.  My baby girl is fine, just drowsy, dry and dizzy.  On the upside she got lots of attention today which she always enjoys and got to meet new people.  Everyone at the hospital was so kind to her.  I'm thankful.

My friend Shirley was admitted to the Cross yesterday.  I went up to see her yesterday after I was done work.  She was sleeping or unresponsive.  This morning I went back again and her girls and husband were there, sitting, waiting, trying not to cry.  She woke a little, restless, confused.   Her husband was beside her in an instant, her girls alert for their mom to be present.  I realized then that I no longer have a place there.  These four people love her deeply and need to say goodbye to her.  I told her I loved her, gave her a kiss on the forehead and left.  She's with her family, those her love her best and I couldn't wish for more for my good friend. 

One of the big guy's images.

I visited my girlfriend on Sunday evening.  I made crème brulee and wanted to drop it off for her. Her husband invited me in and I walked into the family room.  I saw an old Chinese man sitting on the coach, except it wasn't an old Chinese man, it was my girlfriend.  I didn't stay long, their dog was sick and my girlfriend wasn't feeling great.  When I got in the car and drove away I couldn't stop crying.  I couldn't believe I didn't recognize my friend. 

I don't know how to let go of someone I love who is not part of my family.  I can't park myself there.  I'm not her family but I want so badly to take care of her, to take care of all of them.  When I was there on Sunday evening her three girls were all sitting in the family room as well, freshly showered, in their bathrobes.  What was so comforting for me was how peaceful it was there.  Three teenage girls, a sick dog, a sick mom and a father who's taking care of everyone and their home still felt peaceful.  I guess I need to find a way to say goodbye that doesn't invade my friend's family's space. 

Tomorrow I have a job interview in Nuclear Medicine.  The job entails organizing and arranging care for a group of patients with neuroendocrine tumors.  The clinic/hospital that I work at is one of only three in North America that provides lutetium therapy to patients with neuroendocrine tumors.  The job would allow me to grow and learn as a nurse.  I've been studying and doing research for a couple of weeks for my interview.  I really hope I get the job.

This smile is what I want most for my daughter.  Katie happy, smiling, relaxed, interacting, signing.  It's not always possible but it is what I want for her.  Two weeks ago I visited old friends that I haven't seen in awhile.  They also have a son who is severely disabled.  Their son is blind and mostly deaf and probably functions about the same level as Katie mentally.  When I first met my friend, she was walking around the block, holding her son's hand.  He was three years old.  Now he's turning thirty this year. 

We talked about our kids and I asked if their son ever slept over night at their house.  They did try they said, awhile back but it didn't work.  Their son likes his home, his bed, his routine.  They see him regularly and he lives close by but it's not the same contact as living with someone.  It's bittersweet.  They love him but can't care for him.

That's me and Katie.  I know I can't take care of Katie.  She beats me up, pulls my hair, pinches, scratches, bites and headbutts me.  She requires constant attention and even with constant attention things go sideways. 

But I also know that her behaviors have gotten worse since she moved out and that her anxiety has gone up.  Her caregivers are wonderful people but it's not the same I don't think.  In my perfect world, the one inside my head, Katie would still live at home and she wouldn't beat me up.  I could teach her more sign language.  We could work on skills needed to care for herself like brushing her teeth and bathing herself.  She would eat at a table, with a fork, off a real plate, with her family.  I would tuck her into bed each night and she would not be in a wheelchair.  Sadly, that world doesn't exist.  I can't take care of my daughter and that still makes me sad. 

Katie and her big sister.





 Katie and her big brother.  Both he and Katie thought it was funny for her to push him around in her wheelchair.

I ran into my girlfriend at work today.  When I talked to her yesterday she had mentioned that she was starting a new chemo drug today but I forgot, or rather, I got so busy that I forgot.  And when I went on my break, there she was, sitting near the front door.  Her husband had dropped her off early on his way to work. 

She's so tired.  Tired of appointments.  Tired of having cancer.  Tired of chemo.  Tired of making other people sad.  Tired of feeling tired.  She looks worn out.  The chemo isn't working.  I'm pretty sure this new chemo won't work.  Actually that's not true, I'm very sure the new chemo won't work.  I know the stats, I know her prognosis.  I asked her if she wanted to continue on with her chemo and she said she wasn't sure.  When I asked what her husband said, he said that it was up to her.  Her three girls want her to continue with the chemo.  Her girls are thirteen, fifteen and seventeen.  I don't know if they understand what they're asking of their mother.  Teenagers still believe in immortality. 

I told her to try it if she wants.  She can always change her mind and stop the chemo.  I know I wouldn't continue on with chemo.  I'm a chicken shit.  I hate suffering, physically or mentally.  Palliative chemo involves both mental and physical suffering.  My friend knows she is dying but still can't believe it I don't think.  I don't think I could either.  It's one thing to say, yes, we're all mortal and another to say, this is my last Christmas, my last winter, my last birthday. 

She also knows how much suffering she's causing all of those who love her.  We all know she's dying and we're all grieving.  A part of me would just want to get it over with.  Another part of me would want to hold on to every last day, every last smile, every last hug.  I'm guessing that's how she feels as well.  The worst part would be knowing that the only thing that will ease the suffering of those who love her, is her own death.  We will weep, we will remember her and life will go on, our grief slowing becoming a part of the fabric of our lives.  How do you reconcile all of these contradictory feelings and emotions?  And what do I say to her? 

It's the start of a new year.  I'm off today, have been off for a week and I've had a chance to catch up on odds and ends.  Last year I updated my will.  I've been meaning to write a personal directive but have put it off because well, it makes me think about my own death.  But today, the first day of a new year, I had time.

I've been nurse for a long time.  I've seen many people die, some deaths were good deaths and some were not.  I vote for a good death.  Both of my parents had relatively good deaths.  They were both afraid to die but both died peacefully without medical interference.  When I was a young nurse I had a patient, probably about my age now, who was admitted with advanced metastatic breast cancer.  She hadn't seen a doctor and her family didn't know about her cancer until she was admitted to our unit.  When she came to us her breast was hard and green.  Two days later she coded.  I was there while she died and then while they coded her.  Her family was in shock and I have no idea how they coped with their loss.  All I remember is that the doctor running the code stopped it when she read the patient's chart, but not before the patient had her ribs broken from the chest compressions and a cutdown line put in her arm which left blood all over the bed.  When the code was stopped, the patient continued to have agonal respirations which made it look like she was still alive, even though her heart had stopped.  It was brutal and undignified.  It's also part of the reason I never worked in ICU;  it's the ICU nurses who respond to codes.

When I worked on an end stage dementia unit, virtually all of our patients were no codes.  Patients ate and drank until they either aspirated or stopped.  Aspiration leads to pneumonia.  Not eating or drinking leads to death.  These patients died naturally;  the way people have died for millennia.  When they were no longer able to eat or drink they died, peacefully. 

My girlfriend is dying.  She's three years younger than me.  We talk about her death sometimes.  She's not afraid to die but she doesn't want to suffer.  None of us do I don't think.  So this morning I set out my wishes in writing for my children and the big guy.  I don't want my life to be prolonged.  I want to be independent until I die.  I want to die naturally and peacefully, hopefully in my own garden or at least in my own bed.  I believe that this life is only one stop in my soul's journey and that my death will merely be a transition for me, not the end.