I read a statistic this morning that said that ~94% of all blogs haven’t been updated in the past 6 months.  Or something funny along those lines.

I’m writing mostly just to write.  It’s 3 a.m., I’m awake.  I don’t have a specific story to tell this time.  I don’t have any patients that have truly been absorbing my thoughts.

Now that I write that, I think of all of the ones that have, recently, but only briefly.

A middle-aged man with just terrible, terrible luck — infection after infection, a fall, gastrointestinal problems, now very ill and debilitated and tired, looking much, much older than someone in his 50’s should.  He was so depressed Thursday.  I kept teasing him, cracking jokes in his room, and he was trying so hard to smile.  He wanted to, but his whole face, his whole body just struggled to remain afloat.  It’s hard to smile when you just want to die instead of continuing to fight the battle.  Every time he smiles I feel like I’ve won another round.

We moved a 585-pound woman on Thursday.  I don’t know why she was admitted to our floor, I’d been off work for a few days prior to that.  But there she was, and we had to order a special bed for her, one that can fit through our (very narrow) doors (the hospital itself is quite old), and then expand width-wise to accommodate her girth.  Problem with these beds is that if the patient in the bed should code, or suddenly need to be transferred to the ICU, the fastest way to do that would be to wheel them out of the room in the bed itself.  But if the bed can’t fit back through the door once it’s been expanded, because the patient is too large, you actually can’t get them out of the room.

How do we know this?  Yes, that’s right — it’s happened before.  A huge guy coded and we had to get the code team up to stabilize and tube him in the room, and then fight to get him out of the room and up to the ICU.  Needless to say, we strongly prefer not to attempt that stunt again.

So we bring up a specialty bariatric transport cart, designed to move patients that weight almost 600 pounds, and set it up next to her bed.  And then SEVEN staff members work together to slide her off her bed and onto the cart, and then she’s transported (using the cart’s special power drive, so we don’t get a hernia pushing it) down to the 2nd floor, where the bariatric beds and rooms are — wide beds and wide doors.

She was admitted to the hospital for massive macerating ulcers on her butt, back and legs.  I don’t know the whole story, but another nurse said that family at home was trying to care for her, but just couldn’t.  She was urinating and defecating on newspapers for a while, but they couldn’t keep her clean, and the moisture, bacteria, and weight of her body started to cause all the skin she lay on every day to start to rot.  She was rotting underneath herself.  It’s a horrifying thought.

And she was maybe 50 years old.  Probably younger.  And anyone who reads this knows my opinion on people who allow themselves to balloon out to almost 600 pounds.  But she sobbed.  When we pushed, pulled, and shoved her body from that bed to that cart, she lay there on her back and sobbed, in excruciating pain, humiliated beyond belief.  There’s a person in there, buried in 400 extra pounds of illness and an early grave, and it’s so sad to see it when it finally falls apart.

Someone mentioned that she might get bariatric surgery down on the 2nd floor, which might be the only chance left to save her life, but I saw the flip side the other week.  A really tall, large gentleman, probably 300 lbs, was admitted to our floor for depression.  And abdominal pain.  They tacked that last part on there to get him admitted to a med/surg floor, because we don’t accept patients with a diagnosis of depression.  That’s what a psych floor does.  But for some reason, his MD was insistent that we admit him.  To our floor.  So they made up a medical diagnosis.

He arrives on the floor, and he can hardly even look at me.  He sits at the edge of the bed with his head hanging down, and looks furious.  I was seriously intimidated.  This is a big motherfuckin’ dude, and he’s pissed.  I usually start my admissions by sitting by someone’s bed and going through an extensive interview with them to get their medical history, but this guy just didn’t want to talk.  Change of plans.  I told him I was there for him, asked him if he needed anything, and left.  I wasn’t going to push him, wasn’t going to force him to talk with me.  He was too far gone for that.

What happened eventually is that he came out of his room to the kitchen to get some juice.  And he started talking to me in the kitchen, and I started listening.  And we meandered back down the hall, and I listened.  And he sat on the bed in his room and I sat on the table in there and listened.  And he talked and talked and talked.  And cried, and talked.  I was so fortunate that night that it was quiet among my patients; I was able to spend about two hours with this guy in one-hour chunks, letting him talk.

There were many, many, many issues in his life, all coming together at once, which is why he was so paralyzed by this depression, and so angry at the circumstances in which he found himself.  But one of the major issues was the fact that he’d had bariatric surgery at the beginning of the year, an act of desperation to get a orthopod to agree to perform a knee replacement, because the cartilage in that knee was gone and he was in constant, excruciating pain.

It worked — he dropped over 100 pounds in six months, and had the knee surgery done.  But he didn’t realize what he’d lost until it was too late.  A huge part of his identity was wrapped up in food.  He loved food.  He loved to cook food, to grill out, to BBQ, to create meals for family and friends.  He loved to eat food, to try new foods, to go out and celebrate at restaurants and cookouts.  He would go on dates and cook meals for his dates, or take them out to his favorite restaurants.

Then he had the surgery, and he couldn’t eat anymore.  Literally.  After they staple your stomach into a tiny pouch, you can barely eat.  And you have no appetite.  Food isn’t interesting anymore, and it certainly isn’t tasty.  There’s no joy in it.  He’d lost over 100 pounds, and in doing so he’d lost himself.  He was a happy, content person at 450 lbs, who could function in his life.  And now, at 300 lbs, he couldn’t stand to even see himself in the mirror.  He saw a ghost.

Life is much too complicated for my brain.  People are too complicated.

I’ve accepted a job in the Emergency Room on the other campus.  They offered it to me on Thursday, a week after I interviewed with their director.  Part-time, second shift.  I can pick up my extra hours anywhere in the house, including my med/surg unit.  I don’t know yet when I’ll transition over.  I ought to be thrilled, energized, ready to go.  Instead, from the moment I accepted the offer, I’ve been…reflective.  Quiet, almost pensive, but not terribly negative.  Just….thinking about it.  Processing….