Category Archives: nursing

If I Should Wake Before I Die

Yes, that title is a bit morbid. But look at it again. It’s not the children’s prayer that says “If I should die before I wake.” This says I have to wake before I die. It’s about living with depression. And how, for most of us, living longer is not necessarily our lifelong goal.

Over the course of my life, I have not been too keen on living for a long time. I don’t mean that I walk in front of trucks, or take drugs to rot my liver on purpose, or anything like that. I just mean, you know, the whole increase the number of days you live your life thing. Add 10 or 20 years to my life? Why? So I can live in a nursing home for twenty years? So I can continue to fight depression every day? Hand me that ice cream cone.

Yes, I quit smoking. The impetus? A radiologist found emphysema on my x-ray. I decided I’d rather breathe.

Yes, I quit drinking. It caused me more problems than it solved, and it made me suicidal. I decided that if I was going to walk that close to the line, and still live, I’d just as soon get rid of it.

Yes, I quit chasing boys. But that was not really voluntary. They stopped chasing me. It’s a good thing, though, as Martha Stewart would say. They weren’t as much fun as they looked.

Now here we are, once again, at the whole diet-and-exercise impasse.

How. Many. Times.

I have lost weight, re-gained it, been a fitness nut, given up sugar and flour, done the whole OA and FA thang, I’ve gotten jiggle with it, the whole nine yards. No that’s not a typo. I jiggle! And I’m NOT INTERESTED. Just hand me the Twinkie and nobody dies.

But I have to admit, after reading a letter from a doctor recently, seeing the words “may become pre-cancerous” made my stomach lurch.

And that’s crazy. Number one, I have had pre-cancerous cells elsewhere before, and there’s lots of cancer in my family. I’m not worried. We all gotta go sometime, right?

Number two, there is no number two.

But maybe it’s the where that is bothering me.

This is in my esophagus, and the worst death I ever witnessed as a nurse was when my patient died from esophageal cancer.

So, let’s go there. Gastro-Esophageal Reflux Disease, also referred to as G.E.R.D., refers to the reflux, or regurgitation, of stomach contents into the esophagus. I’ve had that for a number of years. I’ve been on a whole slew of medications to treat it, and have currently been on Nexium 40 mg daily for about 2 years.

Recently, though, it had stopped working. So I was re-experiencing that back wash, shall we call it, in the middle of the night. Plus, I’d had laryngitis without any respiratory symptoms for about 14 weeks. So I asked my doctor for an endoscopy, a test whereby a scope goes over the river and through the mouth, down the esophagus, and into the stomach. (Some of you may recall that I was supposed to have the colonoscopy as well, but it was deferred). In the meanwhile, she increased my Nexium, and encouraged me to follow through with putting the head of my bed up.

Well, lo and behold, and of no surprise to me, the doctor who did the endoscopy found a small hiatal hernia. WebMD says: “Any time an internal body part pushes into an area where it doesn’t belong, it’s called a hernia. The hiatus is an opening in the diaphragm – the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia), the stomach bulges up into the chest through that opening… Some doctors believe a hiatal hernia may weaken the [lower esophageal sphincter] and increase the risk for gastroesophageal reflux.”

Clear as mud? You can read more about it here.

So. Here I am with this reflux thing, and now a hiatal hernia, that’s fine, I still just have to be careful what I eat, when. Right?

Then I got the letter, on Saturday. The letter said that the “routine biopsies” they had done showed Barrett’s Esophagus, which is “a change in the tissue of the esophagus that occurs due to exposure to acid reflux over many years. In most people, Barrett’s esophagus will never evolve into anything of concern. In a small proportion of people, however, this tissue can transform into a pre-cancerous state.”

According to several resources, this esophageal tissue can then become more like the tissue of the small intestine than that of the esophagus. So it is more than just irritated. It is physically changed. Isn’t that what cancer is? When normal cells undergo a physical change? So it makes sense, then, that this tissue can become pre-cancerous.

credit: Mayo Foundation for Medical Education and Research.

Immediately I flash back to my esophageal cancer patient. She is bleeding profusely from her mouth and throat. She gulps for air, but breathes in copious amounts of blood. She is medicated for pain and anxiety, but there is nothing to insulate her from reality. And there is nothing for her poor husband as he watches helplessly. He will not leave the room. And he will never forget what he has seen.

And here I am, making something so horrible all about me. I am sorry. It was not about me at the time. It was all about her then, trust me. I felt so helpless to do anything for her! It broke my heart!

But now I am at a point where I have to make a decision. And normally I might just shrug and wait until things get more serious, and then decide.

Before now, when I tried to lose the weight, I would tell myself different things to motivate myself. Like, If you lose it, you will breathe easier. You will look better in your clothes. It will be a good witness to others that you have the Lord in your life. You are supposed to be a good steward of what God has given you, and that includes your body. I’ve tried all these rationales to get myself to stop overeating, and stop eating foods that are bad for me. My cholesterol is already too high. My blood pressure, too. Apparently that’s not enough to motivate me, either. And I have prayed, and prayed, and prayed.

Even now I am bargaining: “Let me eat ‘this’ for a little longer.” Or, “‘that’ doesn’t bother me if I don’t eat it too late.”

Then there’s the deal-breaker: Coffee.

NOOOooooooo! Please don’t take my coffee!!!

As to how? God has already provided some of the means. I have a friend who is working on her own weight loss, and she is taking part in a medical program consisting of dieticians, medical monitoring, and exercise. She is more than willing to help me do this, and has built-in support people who will also help me. She also works in a gastrointestinal physician’s office, and knows how to help my primary care doctor to write a referral. Couldn’t be more perfect.

But God has to be part of the equation.

And that is where you all come in. I covet your prayers for me to be motivated, to have the right motivation, and to do this right.

No sweat, right?

Oh dang. I have to do that, too?

YOU’RE a nurse … can you tell me …?

First off, I want to tell you bloggers, the ones I follow, that I love love love you! You make me laugh, think, cringe, and altogether be entertained and informed. Thank you and please keep writing!

Second of all – I was reminded yesterday of something that makes me cringe, awfully.

It’s when someone discovers that I’m a nurse.

They quickly get this gleam in their eye and I swear they make stuff up!

“Hey, will you look at this bump I have in my left armpit/groin/on my buttock?”

Or, even more terror invoking: “I/My aunt/My mother has been suffering this cough/rash/these symptoms …

Now I was a competent nurse in my day. I say “in my day” because I imposed an early retirement upon myself after my last manic episode resulted in my taking care of patients, not knowing I was in a dangerous state of mind. If I didn’t know something, I’d look it up, or consult someone. That’s a sign of genius I think – to know that you don’t know.

Anyway, I knew what I was doing 95% of the time, and I gave good care.

But inevitably, when someone asks me an opinion, it is not my area.

I worked in a lot of fields of nursing.

But not pediatrics. Not clinic nursing. Not maternity. And not “will you look at this thing I have?”

Not rashes.

And not the thing you have decided to ask me out of the blue.

Hence, the terror.

This is why I usually don’t tell people I’m a nurse. People assume I am a library of knowledge.

And it’s just not so.

I have my area of expertise but it’s never what you actually ask me.

So stop it!