Dialysis Nurse on the High Seas

January 1, 1991 – Caribbean Sea

10-9-8-7-6-5-4-3-2-1-  HAPPY NEW YEAR!!! blared the loudspeaker.

Dialysis Cruise Ship 1991

Cruise Ship 1991

I shot out of bed and stood in the middle of the pitch black room with my heart racing. Where was I? What was happening? Oh yes. I signed up to work as a dialysis nurse on this nine story cruise ship for the week, and my payment was a free cruise. I went to bed early because I took a Dramamine tablet for my motion sickness. I drowsily climbed back into bed to sleep until my alarm clock awoke me at 5:30 a.m.

At 6 a.m. I joined my cabin mate, Laura, and Tess, two other dialysis nurses, in the dialysis room in the lowest level of the ship. The dialysis company had rolled on three dialysis recliners and three ancient dialysis machines along with gallons of dialysis fluid. In addition to the fee for their cruise, nine patients had each paid the company $1200 to dialyze them three times during this week-long cruise so they could see some places outside the USA. Once they left the USA, Medicare no longer paid for their life saving treatments. People with End Stage Renal Disease (ESRD) whose kidneys no longer cleaned their blood of toxins or removed fluids from their body needed 3-4 hours of dialysis three times weekly.

Our charge nurse, Ellen, divided us into two teams and assigned us to patients and times so we dialyzed only while cruising at sea. Therefore when we were in ports, patients and nurses were free to go ashore and sight see. The ship left Fort Lauderdale, Florida, then cruised to Key West, Jamaica, Grand Cayman, Cancun, Mexico and then returned to Florida on the seventh day.  I met the qualifications since I had now worked for three years on a large dialysis unit in the Midwest.

This is my first cruise. The seas are rolling, so I am suffering from motion sickness. I was blessed in reading Psalm 107:28-31: He makes the storm a calm, so that the waves thereof are still. Then are they glad because they are quiet; so He brings them unto their desired haven. Oh, that men would praise the Lord for His goodness, and for His wonderful works to the children of men!” Yes, the Lord is in charge of the seas and this ship. I thank Him for this opportunity to meet new people,  see new places, and relax in between dialysis sessions. Laura was on the ship last week also for Christmas and said it was so rough she had to go to the ship’s clinic to get a shot to stop her vomiting. She appears to have her sea legs now. Terra firma felt fantastic when Laura and I went ashore at the different ports! !

Key West Florida houses

Key West Florida houses

I climbed the rocks of Ocho Rios Falls in Jamaica in bare feet!

I climbed the rocks of Ocho Rios Falls in bare feet!

Parasailing in Grand Cayman

Parasailing in Grand Cayman

Pam with one of her patients using the old dialysis machine

Pam with one of her patients using the old dialysis machine

Laura showed me how to prime the old machines with saline and enter the amount of fluid to remove for each patient during their prescribed length of dialysis. They did not use the new computerized machines that I was familiar with because the rolling motion of the ship made the alarms go off too often. Our three patients arrived at 6:30 a.m. Our supervising dialysis doctor for this week was also a dialysis patient. I am not sure how ethical this was since he gave me his own orders for dialysis, but it was too late now to do anything about it. Dr. C. was a kind gentleman who also brought his wife and young children with him on the cruise. After he weighed in and we calculated the amount of fluid to remove over the next 3.5 hours, he asked me to take an extra half pound off so he could eat and drink more! I reluctantly entered the amount as he ordered me to do. I took a deep breath as the ship rolled and inserted two large needles into his fistula in his arm. We checked each patient’s blood pressure every 15 minutes and recorded it. Patients and staff chatted together in the small room as three hours slowly passed.

I checked Dr. C’s blood pressure, but it was too low at 70/50! I quickly put his recliner back so he was flat and stopped the machine from removing any more fluid from his body. “Dr C, I know you wanted to get extra fluid off, but I really want you to be with us on this cruise the entire week, so I am giving you 100 cc of intravenous fluid now (about 1/2 cup) to raise your blood pressure.” His face was pale. He didn’t argue with me. He completed the treatment and left with his blood pressure back up to his baseline of 110/80.

I snorkeled in Cozumel, Mexico.

I snorkeled in Cozumel, Mexico.

Laura shared with me that she was in her twenties, a new widow, and this was her first Christmas and New Year since her husband died. He was one of her dialysis patients who received a kidney transplant. But six weeks after they married, he had a complication and died suddenly. She said she couldn’t face being with her family and being pitied, so she chose to drown her sorrow in work on the cruise ship with total strangers. I prayed that she would know the wonderful comfort of the Lord Jesus Christ, “a man of sorrows, and acquainted with grief.” Isaiah 53:3 

Reflection

That was my first and last cruise due to the severe seasickness which plagued me. Even to this day, when I recall that long week, I still become nauseated! I truly thank God that they now have prescription medicine for severe nausea (Zofran) and also Sea Bands (acupressure bracelets). The Sea Bands work fairly well to prevent motion sickness when I am on a plane or train. But when rough weather is predicted, I take Zofran 30 minutes before my flight as it is much easier to prevent it rather than treat it after it occurs.

When I was in Israel several years ago, I gazed over the calm Mediterranean Sea and recalled the Apostle Paul’s shipwreck from the violent sea (Acts 27:14-44) and Jonah’s tempestuous voyage when he was thrown overboard (Jonah 1:15). God sometimes takes us through great storms in our life to teach us to rest and trust Him in the midst of the storm. In John 16:33 Jesus said, These things I have spoken unto you, that in Me ye might have peace. In the world ye shall have tribulation: but be of good cheer; I have overcome the world.” I pray you will have a blessed New Year of looking unto Jesus and learning more of Him through the storms and the calm places in your life!

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The Mediterranean Sea when it is calm.

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Dirty Needle Stick in Dialysis

Summer, 1989

I have been working in outpatient hemodialysis on evening shift now for about six months, four days a week with every Wednesday and Sunday off. When I work every other Saturday, I also have Thursday off. Wednesdays are a welcome break in the middle of the week to run errands, schedule appointments, and teach afternoon Bible Club on for the neighborhood children, followed by prayer meeting in the evening at church. I’m also getting more sleep since I don’t have to get up at 5 a.m.

Sometimes it is a bit lonely since most of my friends work during the day when I’m available to see them. I’m learning more and more to be content with Christ and Him alone. Philippians 4:11-12 continues to bless and challenge me when I think of how Paul wrote this when he was in prison in Rome. “Not that I speak in respect of want; for I have learned, in whatever state I am, in this to be content. I know both how to be abased, and I know how to abound; everywhere and in all things I am instructed both to be full and to be hungry, both to abound and suffer need.”  I figure if the Apostle Paul had to learn contentment, I can learn to be content also during the lonely times and draw near to the Lord.

I thank the Lord for helping me pass and become certified in ACLS (Advanced Cardiac Life Support). This is a requirement for every dialysis nurse since we are in a separate building from the hospital and do dialysis in the ICU (intensive care unit). I learned how to intubate people when they stop breathing and  to order the correct drugs during a cardiac arrest. It was nerve wracking to run a mock code, but the Lord helped me remember all the correct steps!

I like working with the other nurses and technicians on the evening shift. There are three blocks composed of six patients in each block, so we can dialyze 18 patients at once. There is one RN and one tech assigned to each group. When we start at 2 p.m., we complete the dialysis for patients who were started around 11 a.m. After they are off the machine, we set up each machine for the evening patient with his individual dialyzer, which we can reuse a number of times. We use new tubing each session. Some dialysis units reuse their tubing also, but we don’t. We also give a new life changing medicine called Epogen  at the end of each dialysis session. It helps the patient produce their own red blood cells so they don’t become anemic and need fewer blood transfusions. The patients are starting to feel so much better on this new medication!

Some of the technicians are men who are also firemen/Emergency Medical Technicians (EMT) and work part-time in dialysis on their day off from the fire department. They are a fun bunch of guys who really keep cool in emergencies and are excellent at sticking the needles in the patient’s arm fistula or graft. I’m getting much better, but if I don’t get the needle in first stick, I ask one of the EMT’s to do the second stick. They love telling us stories from their fire runs and how they handle each situation. There is a real sense of team work on this unit which is refreshing!

Inserting dialysis needles is an acquired skill!

Inserting dialysis needles is an acquired skill!

I have enjoyed getting to know the patients on evening shift also. Many of them are young and in school or work during the day. Some are waiting for a kidney transplant. I’ve had several opportunities to share the gospel with them, and pray for each of them to receive Christ. They are all very aware that they will die without dialysis three times a week. If they cheat on their fluid restriction or eat too many high potassium foods, they have a rough dialysis session because we have to take off more fluid.

This past week, I was chatting with Jim, one of my older patients, as I took him off the machine. After I took his needle out of his arm, I quickly pressed a wad of gauze on the needle site as Jim placed his finger on top of mine to apply pressure for 5 minutes. As I put the dirty needle in the red bucket for medical waste, somehow the needle  pricked my finger on my other hand through my glove. I pulled the needle out of my finger, put it in the bucket, took off my gloves, and pressed gauze firmly on my finger. I quickly walked to the sink,  vigorously washed my hands with warm soapy water,  and applied a band-aid to my finger. As I scrubbed my hands, I prayed, Dear Lord, Please don’t let me get HIV or hepatitis from this needle stick.

A deadly blood disease was discovered in 1981 among gay men and IV drug users called Human Immunodeficiency Virus (HIV). Some health care workers have also contracted HIV from contact with blood or fluid from HIV infected patients. Some patients have gotten HIV from contaminated blood transfusions and later died from the disease because there is little treatment for it yet.

After washing my hands, I went to my head nurse to report the needle stick. She said we had to go talk with Jim to get his sexual history and obtain permission to draw his blood to check for HIV. Thankfully, he was hepatitis negative at his semiannual blood draw. I was glad that Jim had told me previously that he had been married to his wife for over 50 years and was a farmer before he retired. I nervously approached him and quietly explained the situation. He told me his wife was his only sexual partner, and he signed the release to be checked for HIV. I was so thankful to hear that he was faithful to his wife! I drew his blood and sent the tube off to the lab.

A couple days later, Linda, my nurse manager called me at home. “Pam, we just got Jim’s lab test back and it was negative for HIV! I just informed Jim also.” “Thank you, Linda, for letting me know here at home before I came to work.” I hung up and got down on my knees before the Lord. Dear Lord, Thank You for protecting me from this deadly disease. Thank You that my times are in Your hands. Use me for Your glory and honor.

“When I am afraid, I will trust in Thee. In God I will praise His word, in God I have put my trust; I will not fear what flesh can do unto me.” Psalm 56:3-4

Reflection

Similar to the pink face shield I wore in dialysis

Similar to the pink face shield I wore in dialysis

When I first started my nursing career in 1977, I didn’t even wear gloves to start IVs in patients! In dialysis, I remember they gave me a pink plastic face shield and latex gloves to wear whenever I put needles in or took them out to protect my face and skin from blood. I finally became proficient at feeling the vein through the gloves and applying the tape afterwards.  I later developed a latex allergy from the many years of wearing latex gloves. Now, I only wear nitrile gloves and require a latex free operating room whenever I need surgery.

Ryan White, who fought courageously to educate the public about HIV which he contracted from a contaminated blood transfusion

Ryan White fought courageously to educate the public about HIV which he contracted from a contaminated blood transfusion.

For those of you who are younger, I encourage you to read about Ryan White (1972-1990) who had hemophilia, a bleeding disorder requiring frequent blood transfusions. At age 13, he contracted HIV from a contaminated blood transfusion. He was cruelly ostracized from his school because students and parents were so fearful of catching HIV from him. In those days, a person usually only lived 3 to 6 months with HIV. Here is the link to Ryan’s story: http://hab.hrsa.gov/abouthab/ryanwhite.html

 

Jesus Christ, Born in Bethlehem

“Now when Jesus was born in Bethlehem of Judea in the days of Herod, the king, behold, there came wise men from the east to Jerusalem, Saying, Where is He that is born King of the Jews? For we have seen His star in the east, and are come to worship Him.” Matthew:2:1-2

Bethlehem, Israel – March, 2013

25,000 people now reside in Bethlehem, Israel

Modern day Bethlehem, Israel

Our tour group boarded our bus outside our hotel in Jerusalem and traveled 20 minutes to the city of Bethlehem which now has about 28,000 residents. We drove past the huge cement wall built between Palestinian controlled Bethlehem and Jerusalem to prevent the Arab snipers from shooting them. At the checkpoint, the security guard waved us through after our driver told him we were American tourists. Our day to visit Bethlehem changed since President Obama was scheduled to visit here in three days. We parked in an underground garage and walked several blocks uphill to the Church of the Nativity, the traditional site where Jesus Christ was born in a cave. We passed Muslim women dressed head to toe in black, brown, or gray burkas.

Church of the Nativity

Church of the Nativity

Construction began in 326 A.D. on this oldest church in the Holy Land which is still in use. It is separated into three different sanctuaries of the Franciscan Catholics, Greek Orthodox, and Armenian Orthodox.

"Mouse hole" entrance to Church of the Nativity!

The tiny entrance to the Church of the Nativity prevented intruders!

We entered through a four foot high door with a foot high wall at the bottom. Our guide told us they built it this short purposely as a deterrent to any enemies! When an enemy entered all bent over, he couldn’t shoot anyone, but the person inside could knock him over or kill him easily. Only one person could enter at a time through the tiny door. It reminds me of the verse in John 10:7 where Jesus said, “I am the door; by Me if any man enter in, he shall be saved.” How I thank Jesus Christ for saving my soul and giving me eternal life!

Then we wandered from one sanctuary to the other. It was quite interesting to compare the different architectural styles, the Armenian one being the most ornate. We waited in line about 20 minutes to see the glass covered hole in the floor that is supposed to be the actual birthplace of Christ.

Traditional birthplace of Christ.

Traditional birthplace of Christ.

Our Hebrew Christian guide, told us that in 1948 when the modern day State of Israel began, Bethlehem had all Christian residents, but now there are only about 40 families remaining. The Muslims won’t hire them, so all the Christian young people are leaving.

We went to a gift shop that an Arab Christian started to support these remaining families. The believers carve nativity scenes out of olive wood which are very intricate. I treasure the one I purchased that portrays Mary and Joseph gazing at the Christ child in the cave. I also learned the typical manger was made of stone, unlike the wooden mangers usually portrayed in America.

My olive wood nativity scene carved by Christians in Bethlehem.

My olive wood nativity scene carved by Christians in Bethlehem.

Reflection

As I recall my days in Labor and Delivery helping those babies into the world on Christmas morning in 1981, I couldn’t help but wonder if anyone assisted Mary during her labor other than Joseph? It simply states in Luke 2:7  And she brought forth her first-born Son, and wrapped Him in swaddling clothes, and laid Him in a manger. This is what the midwife or nurse would typically do who assisted the mother.  Midwives are mentioned in Exodus 1:15-22 who feared God and preserved the Hebrew male babies from Pharaoh’s wrath. “Therefore God dealt well with the midwives; and the people multiplied, and became very mighty.” I do not think God gave any details about Mary’s labor or delivery because He wanted all the emphasis upon Jesus Christ, the Savior of the world.

Shepherds of Bethlehem.

Shepherds of Bethlehem.

The common shepherds were the first ones who learned of the Savior’s birth and came to worship Him, their Creator, who “took upon Him the form of a servant, and was made in the likeness of men; And, being found in fashion as a man, He humbled Himself and became obedient unto death, even the death of the cross.” Philippians 2:7-8. Emmanuel, God with us, who left heaven above, and came to earth to be my Savior. Born to die. Thank You, Lord Jesus, that You love me so much!

Charles Wesley captured this thought beautifully in the fourth verse of “Hark, the Herald Angels Sing”.

Mild He lays His glory by, Born that man no more may die,

Born to raise the sons of earth, Born to give them second birth.

Hark, the herald angels sing, Glory to the newborn King!

I pray you all may have a Christ centered celebration of the birth of our dear Savior!

Christmas Babies!

December 25, 1981 – 2 a.m. Labor & Delivery Staff Nurse

I finished my night shift orientation in September and am feeling much more comfortable in my skills as I don’t have to think so hard about every little thing! Since it is my first Christmas in Labor & Delivery, I am required to work and they designated me as charge nurse since the Assistant Nurse Manager is off tonight.

I glanced at the large white board in the nurse’s station which listed all the patients by name, stage of labor, and doctor. We still had six women in labor with four empty labor rooms. We had already done four deliveries since I was called in early at 9:30 p.m. to help the busy evening shift. I glanced at the fetal monitors which displayed each baby’s heart rate. All of a sudden, I saw one baby’s heart rate go dangerously low to 50 and stay there. The normal full-term baby’s heart rate was 120-160 beats per minute. Cathy, another nurse, stuck her head out the door of the woman’s room and yelled, “Call the doctor and nurse anesthetist, Pam! We have to do a stat C section (surgery). This baby is in trouble!”

The operating room technician, Teresa, ran to the prepared operating room (OR) while I called the two doctors. The nursing assistant helped Cathy wheel the huge bed down the hall to the O.R. Cathy had the mother lie on her left side to try and take the pressure of the baby’s body off her mother’s blood vessels.

Newborn Baby!

Newborn Baby!

We worked quickly. As soon as the anesthesiologist nodded that the mother was asleep, the resident doctor cut her abdomen and lifted the baby out of her womb. He  cut the cord that was wrapped tightly around the baby girl’s neck, and carried her to the warmer. Her own cord had choked her as she came down the birth canal. The baby girl let out a weak whimper.  I suctioned out her mouth and placed the oxygen mask over her small face. I dried her off quickly and she took several gasps of air! I silently prayed, “Dear Lord, Please touch this baby girl’s body that she may live.”  She let out a louder cry and the delivery room staff exhaled a sigh of relief. Her tiny body began to turn pink. The Neonatal ICU nurse wheeled the baby girl down the hallway to keep a close eye on her until she stabilized.

I returned to my other patient, Marie, and checked her progress internally. She was ready to start pushing the baby out. She was totally exhausted after 16 hours of painful labor. After an hour of pushing, I saw a patch of the baby’s black hair peak out! We wheeled Marie in her bed down the hall to the delivery room, helped her transfer to the narrow delivery bed, placed her heels in the steel stirrups, and her hands on the steel handles. I had her husband, John, sit on a stool beside her.

She gave several more pushes, but wasn’t making much progress. Dr. D. instructed, “Pam, give fundal pressure during the next contraction to help her out.”  I looked at Marie over my mask and warned, ” I’m afraid this is going to hurt you.” As I felt her large abdomen harden, I reached across her, grabbed the steel handle with both my hands, and pressed my forearm into her belly with all my strength. She screamed and I felt like screaming as my back went into a muscle spasm. At last the baby’s head popped out and his slippery body slid into Dr. D’s hands.

“Congratulations, Marie and John! You have a nice big healthy boy!” announced Dr. D. I pulled the string on the Apgar clock and wrote down the time — 3:03 a.m. Christmas morning.  Dr. D.  quickly suctioned the mucus out of the baby’s mouth with the blue rubber bulb syringe, and the baby let out a loud strong cry. Dr D placed two clamps on the umbilical cord and laid him on Marie’s abdomen so she could see him. “John, would you like to cut your son’s cord?” “Sure!” grinned John as he took the sterile scissors in his hand and snipped the cord.

Dr. D. carried the baby to the warmer and the Apgar timer buzzed at one minute. I gave him a score of 8 out of 10 which was excellent! His trunk, hands, and feet were still tinged blue. I suctioned the mucus out of his mouth again, wiped off his body with the soft, warm, cotton blanket and put a little hat on his head to keep him warm. The 5 minute Apgar time buzzed and I scored him 9 out of 10. His body was now pink, but his hands and feet were still slightly blue. I wrapped him tightly in another clean warm blanket and greeted him, “Merry Christmas, Timothy! Welcome to the world!” John watched his new son with amazement.

A woman, when she is in travail, hath sorrow, because her hour is come; but as soon as she is delivered of the child, she remembereth no more the anguish, for joy that a man is born into the world. John 16:21

I carried Timothy over to Marie and placed him in her arms. All the fatigue vanished from her face as she gazed at him tenderly and kissed his forehead. After Dr. D. delivered her placenta and stitched her up, I put a warm blanket on her and wheeled mother and son to the recovery room.

The remaining hours flew by as we did two more Caesarian surgeries and two more normal deliveries. Eight babies were born that  Christmas night shift! I sat down twice for ten minutes during my ten hour shift. I was so happy to see the day shift staff walk into the nurse’s station at 7 a.m.! We gave them report, went to the locker room to change out of our blue scrubs into our street clothes, and walked wearily out the door into the bitterly cold Christmas morning sunshine.Christmas morning

Reflection

My severe back pain continued, and I was diagnosed with two injured back muscles. My doctor ordered me to take a month leave of absence while I went to physical therapy to heal and strengthen my muscles. He said I was in poor shape physically and needed to exercise regularly if I wanted to continue to work in labor and delivery. So I joined the local indoor pool and began swimming four times a week. I happily discovered that swimming was also a great stress reliever and helped me sleep better!

The babies that were born that early morning will celebrate their 34th birthday this Christmas and likely have children of their own by now. I wonder what kind of choices they have made in life? They share the same birthday that we celebrate the birth of Jesus Christ, King of Kings and Lord of Lords. I pray that each has chosen to receive Him as his/her personal Savior.

“For unto you is born this day in the city of David a Savior, who is Christ the Lord. And this shall be a sign unto you: Ye shall find the babe wrapped in swaddling clothes, lying in a manger.” Luke 2:11-12