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!

1024x768_bestfit - Copy (72)

The Mediterranean Sea when it is calm.

Advertisements

From Dialysis to Home Care

November, 1991

I have now worked in the new dialysis center in the suburbs for about three months. It is going fairly well, although the 13 hour shifts three times weekly are so long and exhausting. I’m having trouble recovering on my days off and am feeling about as badly as when I used to work night shift. I started looking for a job with daytime hours. I was able to find a good home for my dog, Sandy, with a single man at church who has his own business and takes Sandy with him in his van. My condo seems rather empty without Sandy, but I enjoy visiting him some weekends at his new home in the country. He just about wags his tail off when I visit, but he seems to enjoy his new owner.

The fellowship with the believers at church has been very precious and refreshing. I feel like I’m growing in the Lord and being encouraged to know God better through the Bible messages. I thank God for a good job in a poor economy and trust in Him for strength to keep going.

God is my strength and power; and He maketh my way perfect. II Samuel 22:33

July, 1992

But my God shall supply ALL your need according to His riches in glory by Christ Jesus.  Philippians 4:19

The Lord has been marvelous to me and continues to teach me so much about how wonderful He is! In December, I became a member of the Bible church I am attending,  and joined the choir in January. It has been such a blessing to sing with a group again, and lift up my heart to praise God. I was also able to play my violin with an ensemble at a children’s program.

I was thrilled to go cross country skiing three times in the mountains of Vermont and New Hampshire! I also spent a long weekend in Washington DC with a couple ladies from church. In June, the Career Group from church had fun touring the quirky Gillette Castle overlooking the Connecticut River. Quite different from the castles in Europe!

Skiing in Vermont 1992

Skiing in Vermont 1992

Skied at the Balsams grand resort in New Hampshire 1992

Skied at the Balsams Grand Resort in New Hampshire – 1992

Toured the White House in DC with some ladies from church 1992

Toured the White House in DC with some ladies from church – 1992

Quirky Gillette Castle overlooks the Connecticut River

Quirky Gillette Castle overlooks the Connecticut River

The 1880 colonial home God let me buy in 1992.

The 1880 colonial home God let me buy in 1992.

The long hours in dialysis continued to be a trial. Praise God that He gave me a new job in home care last month! I took quite a pay cut, so I have a second job doing home care with a different agency two evenings a week. I love driving around the pretty green countryside and being able to eat my sack lunch at a different place daily. I discovered the town library and town hall have clean restrooms, as well as most fast food restaurants.

A favorite library, lake, and orchards in my district

A favorite library, lake, and orchards in my district for lunch stops.

Lake Beseck 3 Lymans view 3

I feel like I am using my brain again to autonomously solve the problems of my patients. I can understand why the agency requires every home care nurse to have at least one year of hospital experience. When I am all alone with the patient, I must be confident in my assessment skills, know when the patient can remain at home, and when I need to call the ambulance to send the person to the hospital. Most of my patients are elderly and very kind, so it is nice to have time to chat with them instead of rushing off like I did in the hospital. Many of my patients have wounds that I assess and then change the dressing. I do extensive teaching with each patient on how to manage his condition, and when he needs to call the doctor or the nurse after hours.

The most difficult part of the job is finding the patient’s house the first time. The admission nurse writes directions in the chart, and then I study my maps every morning before I leave the office to try and remember the route visually. I usually can locate the home, but I have trouble finding my way back to the main road. I also have trouble backing out of long driveways, so sometimes I just park at the end and walk to the house. Perhaps I have poor depth perception?

I write the name, address, and phone of each patient on an index card and then place the cards in order of my visits on my desk at work. If my supervisor needs to contact me, she calls each patient until she locates me. Occasionally, I have to make an urgent visit or see a patient a day earlier than I had planned. After I finish my visits, I return to my home to finish charting so I only go into the office in the morning, which is conveniently located one mile from my new home.

My car trunk is full of chart file boxes, extra supplies, and my large nursing bag. I write down my mileage every day and turn in my total mileage every two weeks to pay roll. They reimburse me 28 cents for each mile I put on my personal car to cover the gas and maintenance.

Reflection

With the invention of  GPS and cell phones, it is much easier for a home care nurse to find her patients and for her supervisor to find her in the field. Unfortunately, the volumes of charting in home care have increased over the years even though it is done electronically now on laptops. The pressure has increased to see more patients each day and bring more income to the agency since the reimbursement rates from Medicare and insurance companies have decreased. By the way, the 2016 Federal rate of reimbursement is 54 cents per mile!

It was great to be a home care nurse on days when the weather was gorgeous, but not so much during snow storms, freezing temperatures, or sweltering heat.  I enjoyed the daytime work schedule which allowed me to participate in evening activities at church. I only had to work one weekend a month and could sit in the balcony for a portion of the morning worship during my lunch break since the church was within my territory. There are pros and cons to every type of nursing!

Culture Shock in New England, USA

June, 1991

The huge moving van drove up the hill to my new condo and parked on the roadside. The men carried my 100+ boxes and furniture over the grass, through the sliding glass doors, and piled the boxes floor to ceiling in the living room. “Lady, you sure have a lot of books. Will they all fit in here?” I smiled and replied, “God willing!” I treasure all my Bible commentaries and missionary biographies.

After filling up my water bed with the hose, I put on the bed sheets, drove down the street to a fast food place for dinner, and came back home. I began unpacking the bathroom things, but quickly discovered I was too exhausted, so I fell into bed. The next morning, three ladies from church came to help me unpack, so I made good progress. Thankfully, all my books fit!

The following day, I drove down the street to the grocery store, but couldn’t find it. Nearly in tears of frustration, I went back home and called the assistant Pastor to ask for directions. He gently told me I had turned the wrong way, so I got back in my car and tried again. I’m finding I need to leave 15-30 minutes early before I go anywhere new to allow myself time to find it. I have a county map that usually helps me when I become totally confused!

September, 1991

It has been quite a summer for me. I absolutely love the new Bible church I am attending. The Bible teaching and music are wonderful, causing me to  dig deeper in the scriptures and grow in God’s grace. I have been richly blessed by the fellowship in the career group with about 20 single adults my age. I also attend a single ladies’ group of all ages that meets every Monday night in a retired lady’s home for dinner and Bible study. The church picnics, volleyball, and water skiing have also been great fun and times of sweet fellowship in the Lord.

I have been able to see quite a bit of New England including the mountains of Vermont, the elegant mansions in Newport, Rhode Island, and Acadia National Park. I survived my first hurricane on the way to Acadia. I have never seen rain blowing so hard totally horizontal! I was wondering why it was so difficult to keep the car on the road. When I pulled into a gas station, the owner said, “Ladies, they are shutting down the roads so you have to find a place to stay.” At the next highway exit, we checked into a room at a nice inn and watched in amazement the torrential rain and wind as we swam in the cozy heated indoor pool. I’m used to seeing tornadoes in the Midwest where I grew up, but not hurricanes!

Acadia view 1991

Misty Acadia National Park after Hurricane Bob

Cornwall CT covered bridge 1991

Cornwall Connecticut covered bridge

Vermont 1991

Pretty view in Vermont mountains.

The people at church are so friendly, but in general, the public is cool and distant. It’s difficult to get the grocery store cashier to even make eye contact with me or say hello unless I greet him first. Then he usually just grunts in reply. People are rude on the phone also. The traffic is congested on the highways and the drivers are terrible! They zoom in and out across all the lanes, never use their turn signal, and never seem to get caught by the police.

I’m trying to learn their terminology. Pop is called soda, a submarine sandwich is called a grinder, and I never heard of a calzone before! I discovered that it is an Italian stuffed pizza sandwich that you dip into tomato sauce. Very filling and quite good. I miss the German food of the Midwest. There are mostly Italian immigrants here, so there is an abundance of Italian restaurants.

One guy in the career group teases me about my Midwest accent. They say um-BRELL-a, but I say UM-brell-a. They say in-SUR-ance, but I say IN-sur-ance. I was talking with a lady at church whose young grandson was standing next to her listening. He turned to her and said, “Grandma, why does she talk so funny?” The Pastor grew up in Boston, so at times I have trouble understanding his accent. Some people leave out the “r” sound as in “quawtah” for “quarter”.

Since I moved here with no nursing job, I was relieved to have several dialysis job interviews within the first two weeks after my arrival. I chose to work in a large inner city hospital dialysis unit. Unfortunately, it turned out to be a disaster. They used three different type of dialysis machines from different eras, and the patients were divided into several small rooms. I felt unsafe walking in the early morning darkness from the employee parking garage a block to the hospital. It was so chaotic, understaffed, unsafe, and mismanaged that I developed severe stomach and back pain from the stress. I gave two weeks notice after working there for just a month.

One of the staff nurses told me about a new dialysis unit in the suburbs that sounded similar to my unit in the Midwest. I called the nurse manager, and she interviewed me. I asked if I could shadow a nurse for a few hours during the busiest time when they took patients off dialysis and then put the next shift on, and she agreed. There were 20 dialysis chairs in the large bright calm room, and the staff seemed happy to work there. They use new Fresenius computerized dialysis machines that are similar to the Cobe 3000 which I know. I can also park right outside the building which is in a safe neighborhood. The downside is that they work 13.5 hour shifts from 6 a.m. to 7:30 p.m. three days per week. There is no cafeteria on site, so each staff member has to carry all three meals with them to eat during the shift. The nurse manager offered me the position, so I accepted. I hope I have the stamina to work the long shifts.

Sadly, I have to find a home for my dog, Sandy. While he is home alone so much, my neighbors complain that he barks nonstop. I have asked about 30 people at church, and gave his photo to the vet and groomer to post, but no takers yet. It’s hard to give him up since he is the only living thing I brought with me from the Midwest.

My expenses have doubled and I took a 30% pay cut from what I made in the Midwest. But all in all, I am happy I made the move. The spiritual blessings and new friends have greatly enriched my life. I’ve been told that a person needs to take at least a year to adjust to a new culture, so I will do that.

Thank You, dear Lord, for bringing me here and for providing my every need. Thank You for encouraging me in my spiritual walk and helping me grow in Your grace. Please help me adjust to the new job and long hours. In Jesus’ Name, Amen.

I can do all things through Christ, who strengtheneth me…But my God shall supply all your need according to His riches in glory by Christ Jesus. Philippians 4:13, 19

Reflection

It seems hard to believe that I have now lived here in New England for 25 years. In the summer, I still miss the miles of cornfields in the Midwest, but overall enjoy the more varied geography of New England. The cost of living has become even more challenging as the years have rolled by, but God continues to provide for me. I was able to purchase an 1880 colonial home one year after I moved here, although it was not as nice as my home in the Midwest. I’m on track to retire at age 62 rather than 57 which is what I would have been able to do in the Midwest. But the eternal spiritual blessings from God have far outweighed the earthly challenges, so I thank Him for leading me here.

 

Time to Move?

Midwest to New England – June, 1991

For some time now I have felt stuck in a rut, and I have been asking the Lord if He would have me move to a new location. I have lived in the Midwest since I was two years old. One wonderful thing about being a nurse is that I can get a job anywhere in the world. I attended a weekend Bible conference last fall in upstate New York which was excellent. I had the privilege of taking the Bible teacher and his wife to the airport after the conference, and I was able to ask their counsel. They suggested I move after they heard that I was the only single lady in a small Bible church with only a handful of people remaining.

I investigated being a missionary in eastern Europe in helping teach women and children the Bible, but the Lord did not give me peace about it nor did He put the pieces together.

By faith, I put my house up for sale in January. People told me this was not a good time to sell a house, because it was the middle of winter, the time of the Gulf War, and during a recession. But I know that if God wanted me to move, He would sell my house. If not, I would stay in the Midwest. I didn’t want to rent out my house and be a long distance land lady. Nor could I afford to pay for a mortgage and rent at the same time.

I have met several people in New England who have invited me to visit the church they attend, so I decided to take a survey trip in February. I visited New England once on a family vacation and found the region to be beautiful with mountains and ocean, and filled with sites of American history. They also have more snow so hopefully I can go cross country skiing more often. I visited three churches, and was so richly blessed at the second church. They had a choir that sang a beautiful hymn about the Lord’s coming that moved me to tears. It has been so long since I have heard a choir sing. They had a guest speaker in addition to the pastor who had 2 messages Sunday morning and 2 messages Sunday evening all about the rapture! (I Thess. 4:13-18) I felt very well fed spiritually at the end of the day. The people warmly welcomed me.

Then we who are alive and remain shall be caught up together with them in the clouds, to meet the Lord in the air; and so shall we ever be with the Lord. I Thessalonians 4:17

The assistant pastor’s wife kindly drove me around the city so I could look at various neighborhoods where I could possibly live. The cost of living is so much higher here than in the Midwest that I probably will never be able to buy a house again on a nurse’s income.

I interviewed with the head nurse of the dialysis unit at the local hospital, and she seemed excited to meet me. They also just bought new Cobe dialysis machines just like the ones I use in the Midwest unit, so she was thrilled that I would not need much orientation. She offered me a job at the end of the interview! I told her I needed to sell my house in the Midwest first, and I would pray about it. I was also offered dialysis jobs in the other two cities I visited. But I did not feel at home in the churches in those cities.

I returned home and amazingly received a full price offer for my house 40 days after I listed it! This was confirmation from the Lord that He was opening the door for me to move. We set a closing date for the end of April and they asked if I could rent back from them for one month since they had to complete their rental lease. I agreed to this since June 1 would be a nice time of year to move to New England. I gave my notice at the dialysis unit for the end of May. My head nurse and evening staff were sad to see me leave, but understood that I felt the need to move.

I called various moving companies and chose the one with the best price per pound of goods. I will need about a quarter of a cross country moving van. It’s shocking how much stuff I have accumulated in the eight years since I built this house. The goodbyes are so hard to all my family, friends, and coworkers. Many of them think I am crazy to be leaving everything familiar behind. My financial planner is very concerned and said I will never be able to retire at age 57 as we had planned.

Goodbye to my coworkers in dialysis was tough.

Goodbye to my coworkers in dialysis was tough.

 

My dog Sandy and I bid farewell to the house I built 8 years ago.

My dog Sandy and I bid farewell to the house I built 8 years ago.

Three weeks before the move, the phone rang. It was the Director of Nursing from the hospital which promised me a dialysis job. “Pam, I’m sorry but we had to close one of our units and we had to place all the nurses in empty positions in the hospital. One of the nurses chose the dialysis position so we can no longer offer you a job.” I thanked her for calling and hung up. My heart sank as I thought about moving across the country without any friends or a job. I have already paid the deposit to rent a one bedroom condo for a year and have sold my house here, so there is no other direction to go but forward.

Dear Father, Thank You for closing the door to this job and that You have something better. You have promised to provide for me, so I’m trusting You to give me a job when I get to New England. Thank You that You go before me and prepare the way. Thank You for the peace that passes understanding. In Jesus’ Name I pray, Amen.

Be anxious for nothing, but in everything, by prayer and supplication with thanksgiving, let your requests be made known unto God. And the peace of God, which passeth all understanding, shall keep your hearts and minds through Christ Jesus….But my God shall supply all your need according to His riches in glory by Christ Jesus. Philippians 4:6-7, 19

To be continued….

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!

1024x768_bestfit - Copy (72)

The Mediterranean Sea when it is calm.

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

 

Becoming a Dialysis Nurse

Spring, 1989

Ever since returning from the mission trip to Honduras last fall, I have been asking the Lord if it is time to move on to a different type of nursing. After caring for patients in Honduras, it made me realize how much I miss direct patient interaction and bedside nursing. I have now worked in Staff Development for 6 years and have enjoyed teaching other nurses, but am ready for a change. One of my colleagues in Staff Development recently transferred to outpatient dialysis part time on evening shift and is enjoying it. She said there is another opening for a 4 evenings per week nurse. They are closed every Sunday and holidays, and each nurse works every other Saturday. The evening shift extra pay is very good, so my pay would stay the same even though I would be working one less day each week. Each RN is on call one Sunday 4 times per year to cover ICU emergency dialysis.

The Lord gave me peace about applying for the position, so I did. The head nurse called me, interviewed me, and gave me a tour of the unit which is a free standing building across the street from the hospital. The new unit is designed for dialysis with large windows and a nice open layout of 18 recliner dialysis chairs. They do 3 shifts of patients a day Monday through Saturday. There is one RN and one technician for 6 patients.  Day shift dialyzes the 6 a.m. group of patients and starts the next group at 11 a.m. Evening shift works 2-10:30 pm and takes the middle group of patients off dialysis, and then starts and finishes the evening group of patients. They end by cleaning all the machines internally with bleach and vinegar.

So the unit dialyzes 54 patients daily. Each patient comes to dialysis 2 or 3 times weekly to have their blood cleaned for 3 to 4 hours by the machine because their kidneys have gone stopped working. Some patients are waiting for kidney transplants. Some patients, especially on evening shift, work all day and then come for dialysis at night. The main causes for kidney failure are diabetes and hypertension (high blood pressure). Without dialysis, the people die within a matter of weeks from kidney failure. Sometimes the patients become weary of dialysis, and choose to take themselves off of it and go on hospice for their final days on earth.

The next day, the dialysis head nurse called me to offer me the evening position 4 days per week. I would keep my full-time benefits. She agreed to give me every Wednesday off. On the weeks that I worked Saturday, she said my day off would also be Thursday so on those weeks I would have 2 days off together in the middle of the week. The orientation is 10 weeks on day shift and the last 2 weeks on evening shift. I would also need to become ACLS (Advanced Cardiac Life Support) certified so I could run a code if a patient had a cardiac arrest while I was dialyzing him in ICU. I told her I would consider it and let her know by the end of the week.

I went home and prayed for a few days and called my friend, MJ, who was working in dialysis, to talk things over with her again. I could move my Bible Club to Wednesday afternoons and attend prayer meeting at church on Wednesday evenings. Since I had every Sunday off, I could continue to teach Sunday School at church. I always enjoyed evening shift when I was a new graduate because I have never been a morning person. By the end of the week, God gave me wonderful peace that this was His open door. I’m looking forward to this new chapter in my life!

Be anxious for nothing, but in everything, by prayer and supplication with thanksgiving, let your requests be made known unto God. And the PEACE of God, which passeth all understanding, shall keep your hearts and minds through Christ Jesus. Philippians 4:6-7

Dialysis Orientation

I gave 4 weeks notice in Staff Development and started on day shift in dialysis for my orientation. I have to be here at 6 a.m., so arise at 4:30 a.m. which is challenging for me. Every day I ask God to keep me awake and help me learn all this new information. (Remember, I’m the one who fell asleep in statistics class in college and during my nursing state boards!)  They have assigned a preceptor to me who is an experienced dialysis nurse. The first week I watched her set up the machine and cannulate (put the needle in) the special fistula that the surgeon created in the arm of each dialysis patient. They connect an artery and a vein together which creates high blood flow. We use large bore needles for dialysis. One goes in the vein to remove the dirty blood, and the other goes in the artery to return their cleaned blood after the dialysis machine removes the impurities. I watch videos to learn about kidney disease and how dialysis works. It is such a complex process. I feel like a new grad all over again and go home totally exhausted daily from information overload. I ask the Lord to help me learn quickly and so I give good dialysis to each patient and do them no harm. This is definitely the most complex and technical nursing I have ever done. I can see why they don’t hire new graduates into dialysis.

Cobe 3000 dialysis machine I learned how to use.

Cobe 3000 dialysis machine I learned how to use.

To make matters more complicated, the unit just bought 12 new computerized Cobe 3000 dialysis machines, but we still have 6 older Fresenius machines where we have to do more calculations. We have a third type of machine in ICU. Thankfully, I won’t have to learn that one for awhile. They don’t make me take call until I’ve worked here 6 months and am totally comfortable with dialyzing someone independently. There is no one around on Sundays to ask questions where the on call nurse is all alone in ICU. So you have to able to do your own troubleshooting when you run into problems. It’s a huge responsibility for these critically ill patients. It’s good to lean hard on the Lord!