No Worries, I'm Still Alive

Hello all!


First off, my apologies for not being as diligent in my blog writing as I was in the first couple weeks! I have been fairly busy with my full time job at Mayo and volunteering at my church! Many of you have been emailing, and asking for a little inside look on what I do everyday...


My day starts out, bright and early, at 5:30 AM. Not a fan of that early morning stuff, but once I get my first cup of coffee, I'm good to hit the road. 



The shift starts out at a little before 7 AM, where I find my patient assignments for the day. I look over their histories, medications, lab values, and past assessments to paint a picture of what my plan of care will be for the day. I then receive report from the night nurse with my preceptor (the nurse I assist all day) and we go in the rooms to introduce ourselves. 


The morning is usually a blur or doing full body assessments, lots of computer charting, answering call lights, and passing medications. A huge change for me (but something I really appreciate) is the in-depth patient care that Mayo incorporates. There are many people who provide direct patient care for a specific patient. Each patient on the Hematology/Oncology/Bone Marrow Transplant floor has a nurse, nurse practitioner or physician assistant, social worker, dietitian, pharmacist, and attending physician. All of these people get together in a conference room for "rounds" every morning, and discuss the plan of care for the patient, and to best help them to recovery. So, every morning at about 10:00, it is my job to go into the conference room and give report to these providers. I sometimes still get very nervous, as it's super intimidating to speak to these well-educated people. BUT what I love is that ALL of these people are looking out for the best interest of the patients.
After rounds, I am usually finishing up on my charting and answering more call lights. Yesterday, I was able to sneak off the floor and attend a post-bone marrow transplant caregiver class that one of the nurses on the floor teaches. 


When looking at the population of our patients, I would say that most of our patients come in with some kind of leukemia, and are in need of a bone marrow transplant (BMT). In order to prep our patients for the BMT, they come in a few days before to receive their prep-chemo regimen. The type of chemo depends on the type of cancer the patient has, and what the provider feels will be the best form of "attack" for their specific cancer. Basically, we give them chemo, which completely wipes out their immune system, and cleans out their bone marrow. Therefore, we all have to be very careful that we prevent any type of infection. These patients are in positive-pressure rooms, on neutropenic diets (no fresh fruits or veggies), and we are constantly preaching proper hygiene (washing hands, daily showers, wearing a mask when going outside the room, etc). 

Excuse the science geek part of me...

So, after they receive their high doses of chemo and their marrow is cleaned out, we are able to do the transplant. Patients are either "auto" (receive their own cells back) or "allo" (someone else's cells). When it is transplant day, the medical team calls this "Day 0," and we also say it is their NEW birthday! Many people buy birthday cakes and throw the patient a little party. 


I helped with a transplant yesterday, and it truly is such an emotional experience. I think of the journey this patient and their family has been on, how much hurt and struggle they have gone through. This transplant day is a day of new beginnings for them. Most often, the hospital chaplain comes in right before the transplant to bless the cells, and lead the patient, family, and medical team in a blessing and prayer. I may or may not have teared up a few times (: I get so excited for the patient that this is their chance for a NEW life, and while the road/journey is far from over, this is one of the happiest days of their life. 


The BMT process takes a few hours, and basically looks like a blood transfusion. In the days to follow, many patients start to feel the effects of the chemotherapy they had a few days before, and start exhibiting flu-like symptoms. Let's just say they feel pretty crappy. 12-16 days after "Day 0" we will start to notice the patient's white blood cell counts to come up (we need white blood cells to fight infection) and we call this "engraftment." This means that the transplant cells have started multiplying in the marrow, and the patient is on their way to recovery. This is a huge victory for the patient, because this means that we can start planning for discharge. They will need a 24 hour care provider when they go home, as they are unable to do household chores, provide food, etc as this could cause infection. These patients will continue to have daily outpatient appointments for 2-3 weeks after discharge from the hospital, and will follow up with their regular provider on a regular basis. 


Some patients have a much longer road ahead of them. I have seen patients spend many months in the hospital due to Graft Vs Host Disease (GVHD). This occurs when patients are "allo" transplants, and their body rejects the cells that have been donated. This can cause organ shutdown and many more complications. 


But, anyways, in continuing on with my day, the afternoon is spent eating lunch (YUM-the cafeteria is too delish for it's own good), checking on patients, giving medications, changing dressings, and assisting other nurses. On some shifts we will have to discharge or admit patients, which is always a long process. On my downtime, my preceptor is great at educating me and encouraging me about the BMT process. She is so great! She is always looking for new ways to push me to excel, and I've learned more from her than I can say. When I first started on the Hematology/Oncology/BMT floor...I can literally say that I felt like I was in a different country where I didn't speak the language at all. Having no experience in this area stressed me out a little, but my preceptor has been so patient in teaching me! One of the things she is currently challenging me with is carrying our little phone. Let me preface this by saying I HATE talking on the phone at the hospital. I'm always terrified I'm going to mess up and look like an idiot, or not have the right answers that the providers, lab, radiology, dietary, etc is looking for! But, so far, so good! I'm still terrified of the stupid thing, but it's going better every day (:


Once it gets closer to 7 pm, we are all scrambling to finish our charting, and we give report to the night nurses! It is my personal job to do all charting (except for medication administration and provider notifications) and give updates/report to the night nurse. 


PHEW! Are you still with me? I know that was like medical-information-overload for some of you. 

Phoenix is GORGEOUS!

I know that was a lot to take in, but I felt bad that I hadn't given ya'll an update on my time here in Arizona. I truly think that this floor is such a beautiful place, and I really love it a lot! When I'm not at the hospital, I love sitting by the pool, running, skype dates, watching old movies at night, helping out at Harvest Bible Chapel North Phoenix, and getting invested in my small group here! Let me side note to HBC North Phoenix...these people are AWESOME! So warm and welcoming, and always making sure that I have company and something to do! I love working with fellow believers!


With all that being said, I feel that the lyrics to a camp song are a proper closing to this post. 


"Go now in peace, may the love of God surround you, everywhere, everywhere, you may go."


Until next time, cheers!


Jenn