work – Page 3 – Barrelhaven

Well at least I found out

It turns out that I may not be as ready to go back to regular work as I thought I was. Tuesday night was fine, I felt a bit more tired than usual but it was also my first full night shift in several weeks. Wednesday I felt like I’d been put through a wringer and I most certainly didn’t feel like I could go back and do it again. My new proposal is going to be working on the unit, say, Tuesday and Thursday, and in employee health on Wednesday and Friday. I think that might work. Once again, though, the only real way to find out is to try it and see what happens.

To be perfectly honest, part of the reason I felt so drained on Wednesday was that I spent a couple hours of it fighting with Verizon about phones. Our phones are old enough that ~~Apple has started throttling their data speed and battery function~~ their performance has really started to suffer, so we decided it was time to get new ones. Verizon, as I’m sure most carriers do, has a deal to turn in your old phone and get an upgrade (with an extra two year contract to stay with Verizon of course) so we did. Ordered two phones, one for Shannon’s number and one for mine. This was maybe the first week of October. For a couple weeks everything looked fine, then I got an email from Verizon saying that one of the phone orders was cancelled because it had been “confirmed as fraudulent”. This was news to me. I don’t recall anyone actually asking me if the order was fraudulent and the other order had gone through without a hitch.

I called Verizon’s customer service line and, after slightly more than the usual frustration navigating through their automated system, and after spending 75 minutes on the phone with three different people, the “fraudulent” order was cancelled and a new order put in. Good. This was late Wednesday morning.

That afternoon I got another email from Verizon saying that a recent order had been flagged as fraudulent and that I needed to contact the fraud prevention department.

So after considerably more than the usual frustration navigating through their automated system, and after spending 45 minutes on the phone with two different people, the “fraudulent” order was cancelled and a new order was put in.

I did give serious consideration to cancelling everything and switching carriers but after making some inquiries it seems like all the carriers are approximately equally awful.

First world problems…

Updates

Updates are called for;

House:
- The basement floor project is still in a holding pattern. Last word was that everything should be in place to have it done by the end of the month
- The new plumbing leak is also in a holding pattern. There is slightly better news than I expected here. Not good news, but not as bad as it could be. The leak was from the seal on the toilet in the bathroom upstairs. It was fast and (relatively) inexpensive to fix. We are waiting on hearing back from the people who are going to come and fix the floor and/or ceiling to find out exactly what is required there.
Work:
- I’m going back to work on the unit starting next week. With the most recent covid surge settling down, Employee Health isn’t as busy as they have been and don’t need as much help. There are certainly other things I could do for light duty but the fact is I’m probably recovered enough to just go back to work. I’m never going to feel ready and the only way to find out if I can do it is to do it.
Health
- Health is also in a holding pattern. No news has been good news.
- Mental health is honestly as good as it can be under the circumstances. The previous post announcing the bathroom leak is typical of how I’ve been reacting to new difficulties recently. I’ve been feeling very brittle; when something hits I kind of break into a thousand little pieces and can’t see anything but crisis and my brain does everything it can to persuade me that things are as bad as they can possibly be and they will never be fixed. This is a known issue. I haven’t had much luck moderating my initial, disproportionately negative, response but I have been getting better at pulling myself together again.

The fact is, in spite of everything I, right now, today, I feel pretty good both physically and mentally. There is still a lot on my plate and I’ve been ready for all this shit to be done for about 6 months or so, but the struggle can continue.

Oh right. That.

I suppose people might be curious about the outcome of my visit to the urologist today.

The news is not bad. Dr. Urologist was happy with how everything looked right now and wants to wait another three months for the inflammation from round 1 to really get gone before starting round 2. There are still some cytology results that we’re waiting for but Dr. Urologist is not really expecting anything to show up.

This is pretty good news under the circumstances. The fact that he is willing to wait three months before more treatment is reassuring. The only down-side is that I will probably have to go back to my real job for at least a while until round 2 starts.

Nothing is perfect.

I can’t even with this

This popped up on one of the nursing forums I lurk on so I can’t absolutely vouch for its authenticity, but it seems unfortunately plausible. Someone wants to put themselves on extracorporeal membrane oxygenation at home rather than get vaccinated.

As a point of information, this is what someone on ECMO looks like:

I assure you there is a patient under all that equipment

And just for further fun, this is what happens when a component on the ECMO circuit fails and you have to swap it out for a new one:

That was a real patient (I was filming) and once my two colleagues there put the clamps on the circuit the patient was, by some quite reasonable definitions, dead and wasn’t really alive again until they took the clamps off.

So yeah, go ahead and do this at home. Good plan. WAY better than getting vaccinated.

Edited to add – Looking at the picture and video above, I am almost positive they are the same patient. I remember when we were getting set up to change the oxygenator there was a great deal of unease because the patient was entirely dependent on the pump to keep his blood circulating. His heart was not actually beating at all.

A normal person with even a minimally functioning heart will produce a tracing on an arterial blood pressure line that looks similar to this;

The red line there measures the pressure changes in an artery (usually the radial artery in the wrist, the same place you feel for someone’s pulse) with every beat of the heart.

If you look closely at the two monitors in the picture above that have an art-line tracing on them, you will see this;

Those lines are, in fact, flat. This is not all that unusual for people with bad hearts that have a pump doing all the work for them but what it does mean is that if something stops the pump, like someone clamping the circuit so they can change the oxygenator, all the patient’s blood pressure goes away. Not “low blood pressure” but “no blood pressure”.

So again, go ahead. Do this at home. What could possibly go wrong?

If you want to learn more about extracorporeal membrane oxygenation, check your local library!

Or just ask and I’ll talk about it for as long as you’ll let me.

Two days until round 2

Time for some brief updates on everything.

I had previously decided that I was going to take a short break from school during the month of October and that has gone through, been approved and is all taken care of. I’ll be back to working on my degree in November. I’m not terribly excited about the delay, but I think it will allow me to get enough other fires put out that when I do go back I will have a much easier time focusing on schoolwork, so I think this will be a good thing.

The basement is frustratingly close to being done. We have been wrestling with the people who are going to replace the bits of the floor that are missing since the second week of August with almost nothing to show for it. Supposedly they’ll have all the flooring tiles, adhesive, baseboards, etc. this week and the installers are tentatively scheduled for Thursday. If everything goes well. Maybe. It’s not certain.

I’m trying to remain optimistic that the floor will be done by the second week of October and then The Great Unpacking will commence. The Great Unpacking should only take a few days, a week at most, and then the basement will be done.

Side effects; the fatigue is way better. I’m still not 100%, maybe more like 75-80%. Just in time to get scoped in two days and start round two of treatment. Round two will not necessarily kick off right away, but this is what is going to set the schedule. I am hoping that with only three treatments instead of six, maybe I’ll only be half as fatigued afterwards. Time will tell.

Work; I will confess to being somewhat anxious about work, likely for no good reason at all. As previously mentioned, My doctor wrote me a note authorizing essentially indefinite light duty and I plan to take advantage of that. I don’t think there is anything that my employer can legally do to pressure me to return to my usual job but I also have to wonder what kind of reception I’m going to get after slacking off for 2-3 months. Time will tell.

Events may be aligning such that I will only have to deal with work and treatment during the month of October which will almost be like a vacation compared to the last six months. Of course the last time I said something like that we ended up having a global pandemic, the country elected one of the top three worst presidents in the history of the United States, the basement flooded (again) and I changed jobs three times.

I’m keeping my mouth shut this time.

Okay, fine…

If you run into an asshole in the morning, you ran into an asshole. If you run into assholes all day, you’re the asshole.
Raylan Givens; Justified

Not saying I’m the asshole (not meaning to imply that I’m not the asshole either) but when different people are all independently telling you the same thing, you may want to pay attention to what they’re saying.

As mentioned in the previous post, nearly every person of significance in my life that I talked to about the question of whether or not to come off light duty said the same thing with surprisingly little variation. The common theme seemed to be a general concern that I was going to scramble my brain if I didn’t ease up on things a little.

I will certainly admit to having felt overwhelmed and overcommitted for most of the last three years or so, but I always assumed that was because my life was a disorganized mess and I couldn’t get my shit together. It is possible that I have been feeling overwhelmed and overcommitted because I actually have been overwhelmed and overcommitted. And then I got cancer.

The point to all this is that my primary care doctor gave me a note that appears to authorize light duty for me indefinitely and I may take advantage of that to stay on light duty until I actually feel better. As one particularly insightful person pointed out to me, I have obligations to my family that should carry at least as much weight as my obligation to work. It has been altogether too easy for me to forget that and I needed the reminder.

I’m still not sure what needs to happen before I feel like I’m ready to go back to work but I’m going to make an effort to find out rather than just going back whenever.

To return, or not to return…

As previously mentioned, I went and saw my primary care doctor on Friday. He didn’t really have any concrete ideas about the fatigue. He ordered a few basic blood tests to see if I’m anemic (I’m not), or hypothyroid (I’m not), or have any kind of unusual muscle damage (I don’t). In spite of that, he was somewhat equivocal on whether or not I should go back to work in the unit. He felt that I probably could go back to work but it would also be understandable if I stayed on light duty for a while longer, without a great deal of specificity on what “a while longer” might mean.

Being that I appear to be almost completely incapable of making this decision, and have been required to do so more times than I care to think about for school, I decided to make thing as complicated as possible and create an evidence table for whether or not I should go back to work. I’m leaving out any judgement on the quality of the evidence because I don’t think anyone I interact with on even a semi-regular basis has much to show in the way of an impact factor.

SOURCE	SUMMARY OF EVIDENCE	CONCLUSION
Friends and family	Stay the f*** home, doofus	Stay on light duty
Critical care management	We’d like to have you back but take whatever time you need	Indeterminate, leans return to work
Employee health management	We want you to get better of course, but we really need the help	Indeterminate, leans stay on light duty
Mental health provider	You’ve been through a great deal recently and there is nothing wrong with staying on light duty if you feel like you need to	Stay on light duty
Urologist	Nothing we did should be making you fatigued at this point	Return to work
Primary care provider	You could go back to work, but you really are being treated for a legitimate medical issue so you can certainly stay on light duty if you need to	Indeterminate
My brain	There isn’t anything wrong with you, stop malingering, STFU & GBTW	Return to work

With it laid out like that, the conclusion is pretty clear; I should listen to my brain because it appears to have the loudest and most annoying voice.

Okay, not really. But I reserve the right to feel like a slacker for staying home.

So how am I doing?

Recalling that the original purpose of this blog was to be a platform for updates on my cancer treatment and not really a platform for me to bitch about Covid, and realizing that I hadn’t actually made mention of my condition for a while, I have decided to try and rein this thing in a bit by combining a rant about Covid with a brief update on how I’ve been feeling.

I am still on light duty at work. The fatigue has definitely improved but only to the point that it is limiting instead of debilitating. I asked the urology clinic nurse about this, given that it has now been a bit over a month since my last treatment and I still haven’t bounced all the way back. The urology clinic really had nothing to offer other than to say that it would be unusual for the fatigue caused by BCG treatments to last this long. I have an appointment with my primary care doctor to rule out any other possible cause and after that, who knows? There is also a good chance that part of why my activity tolerance has gone to shit is that I am completely deconditioned from sitting on my ass for the last month plus.

Whatever is causing it, I still don’t feel like I would have the endurance to make it through a 12 hour shift in the ICU, especially under current conditions. Which brings me to my rant about Covid;

The two incidents I posted about below (and there are plenty more stories like those circulating around) made me realize that I simultaneously feel profoundly grateful that I am not working on the unit right now and incredibly guilty because I am not working on the unit right now. Every hospital in the country is desperately short of ICU staff and I am, in my own small way, totally not making that situation even a little bit better. Especially if there isn’t an identifiable physical cause for my continued lack of energy, I am going to have a really hard time justifying sitting things out for much longer.

I’m scheduled on my light duty assignment through next week, which will give me time to see my primary care and make sure there isn’t anything weird or unlikely going on physically and then I have a somewhat difficult decision. I would really prefer to not dive right back in, but things out in the world are not likely to improve much any time soon and I am not going to be able to stay on light duty forever, so a return to the ICU is inevitable. With that being the case, is there any point to putting it off?

More recovery

I continue to feel a little better. I’m on light duty at least through September 10, longer if I still don’t have my energy back. The complication is that on September 30 I go see the urologist for more testing and will likely start another short course of BCG. What this means is that I will likely be ready to come off light duty about the time that I will need to go back on light duty for round two. Awkward.

I felt enough better today that I made an attempt at chipping away on schoolwork. I won’t say that I accomplished much but it’s more than I’ve been able to do for the last few weeks so I’m still counting it as a win.

The basement also continues to make progress. The walls are done and (almost) all painted, as I may have mentioned previously, and the floor may be done as early as Friday which would mean that the only major project left is unpacking. Having the basement finished is going to be a huge weight off my mind and (hopefully) it won’t flood again in December.

Things could be worse.

Light duty

For years, probably since the beginning of my nursing career, I had envisioned a time when, for whatever reason, I would no longer be doing bedside nursing. My dream “retirement job” has always been some form of telephone triage and today I have achieved that goal. The only down side is that it is temporary while I work the BCG fatigue out of my system.

My light duty is to cover the Covid symptom line for employee health. Employees that think they may have been exposed or that are having worrying symptoms call the number and I read down this whole list of questions to determine if they should get tested, if they need to quarantine and for how long, when they can go back to work, etc.

The charting is kind of a pain, but I am sitting at home in a dark, quiet room with my laptop and an algorithm/decision support tool and I don’t have to see another person or even change out of my pajamas. This is as close to a dream job as I am ever likely to get.

Edited to add; I was feeling pretty good today, like almost back to normal. Then I took the trash out (not something I usually struggle with) and am pretty seriously beat down again. When I stopped to think, I realized that probably why I felt good is that I hadn’t really done anything all day. 8 hours of “work” talking to people on the phone while I was lying in bed, leftovers for dinner so I didn’t have to cook anything, then sat around for a few hours generally being a slug.

The light duty is probably a really good idea.