Japan's Tsunami Survivors - Nurse's Blog

"Do not cry": a nurse's blog brings comfort to Japan's tsunami survivors article at The Guardian, 8th May, 2011.

The original blog in Japanese, JKTS.
The blog translated into English, "JKTS: A Japanese medical aid worker's diary".

Story's End by Meghan O'Rourke in The New Yorker, March 7, 2011.

Last day at main place

Tuesday, my last day, turned out to be a pretty good day from the point of view of experience related to nursing. I started out doing assorted tasks: making sure gowns, gloves, etc., were in plentiful supply in their various locations. I then moved on to collecting breakfast trays. I went into PT SS's room to get his tray and ended up sitting with him talking (listening to him) for around an hour or so. He talked about his business - he was a furrier. He'd had a factory and had employed a number of people in the past. He'd had a partner, but he'd left the business - he'd been in poor health. Slowly over the years, PT SS had let the business get smaller. Now he was alone and outsourced everything. He kept at it because he enjoyed it so much. He no longer dealt with stores, such as Niemann Marcus, etc., as he had in the past. Now he had personal relationships with individual customers. He particularly liked this since you got immediate feed-back and got paid right away! He talked about the rehab options his daughter (he had two daughters) was investigating for him. He'd require about a week of rehab once he was done with the hospital. He was anticipating perhaps another week in the hospital. His skin had improved visibly in the short time since he'd had the chemo and he expected this to continue to the point of his condition being manageable at home. He did want to go home, of course, as one would, but he was particularly keen to get back to his wife who was missing him very much. She had COPD and was not very mobile. He took care of her. He also said that this (he'd previously been on the rehab floor for 3 weeks prior to the oncology floor) was the longest he'd been away from his wife throughout their 55 year marriage. This was hard on her. Their younger daughter's boyfriend - they lived in the building next door to theirs - was taking good care of her every day during his absence but it wasn't the same as having him with her all the time.

NH came in to give him meds and to talk to him about changing his dressings. She returned after a little while with his pain meds (to facilitate dressing change). Since the summer intern nursing student was assisting another nurse with a task I ended up assisting NH with the dressing change. I gowned, gloved, and masked up. Probably around 70% of his body was covered with medically impregnated yellow bandages. PT SS joked about being a mummy! He took it very well. This process required him to stand up for a long period of time while NH removed the old bandages, slowly and gently. Meanwhile, I started unwrapping the new bandages. These are individually wrapped in foil packets. They're very messy and smelly (sort of carbolic smell); they're approximately 3 x 5 inches). Once she'd removed all the previous day's bandages (now changed once a day, previously were changed twice a day), NH applied bacitracin ointment to the wounded skin and carefully placed one of the new bandages over each area, covering the wounds. Over the bandages she applied white petrolatum ointment. She slowly worked her way over his entire posterior body. Once posterior was complete, PT SS sat on a covered chair. NH then removed the dressings from the legs, arms, etc. and carefully repeated the same routine.
Meanwhile the PCAs had come and changed his bed, including placing a new cover over the sheet (anti-exudate cover, usually used for bone marrow PTs). PT SS carefully placed himself on the bed, seated, and with a little help as we held his feet and helped him move them, he got himself back onto the bed. We put a clean gown on him.
Now all clean, redressed and back in a clean bed, PT SS seemed very happy. He felt there was a distinct improvement; he certainly seemed in far better spirits.
Subsequently, I paid a brief visit to PT K. We talked about his lunch. He wondered if he could eat American Cheese. He has to avoid foods containing tyramine.
A PT's family had bought us pizza, so I had a great, tasty, HOT piece. There were also donuts, but I didn't take one. After lunch I spent the afternoon doing various maintenance tasks, refilling gloves, gowns, etc., then left for the last time at 2.30pm. Perhaps I'll be back on this floor at some point, we'll see.

Monday of my last week at my main place

Monday I spent a while talking with PT K. He seemed down. He explained that he had to rethink his plan. He thought he'd decided not to go for the brain biopsy suggested by his neurosurgeon since he'd understood that it would involve the biopsy, followed by 6 MONTHS of radiation, followed by another 6 months of waiting to see what the result was. He further explained that he'd been told that at best he'd get another 2 years of life. Thus, given the ordeal that the treatment would be along with the waiting for the results, he'd decided that it would not be worth it given how little he stood to gain. However, he'd lately been told that he could possibly have another 5 years and it would only involve 6 WEEKS of radiation. Further considerations were that the kind of tumor he has has a tendency to produce blood clots and there was a 10% risk of life-threatening bleeding during this procedure. He was also concerned as to the potential effect on him as a person, either personality change or some kind of incapacity resulting from the biopsy. His surgeon seemed confident that this would be minimal at most and not something to count against undergoing the procedure. He was pondering all these issues.
He further explained that given the initial description of the procedure's risks, the length of the therapy, and possible outcomes he and his healthcare advocate had decided that this was not the way to go. Now a major rethink was called for. They'd had a conference with the neurosurgeon, his healthcare advocate and PT K himself but not with his oncologist who was on vacation that day (and, apparently, hadn't provided enough notice to allow for a rescheduling). The neurosurgeon also said that there was a time window for doing this procedure (PT K assumed - as did I - that this meant in the next few weeks, and not a decision that could be delayed for months, but not something that had to happen over the next couple of days so, he would have time to meet with his cousins and healthcare advocate and give it due consideration). PT K's cousin had suggested that he talk to his original doctor at the first hospital he was at as to his opinion on the possible negative/positive outcomes of the biopsy procedure. He was nervous that perhaps this would require him to impune the skills and reputation of the surgeon he was currently with (who has done this procedure many, many times and is an expert). He asked my opinion. I said that I didn't think he needed to worry about that since he was not asking about the skills of the surgeon, he would be asking about the procedure in general which, no doubt, is performed in many places around the globe, furthermore, if the doctor did not feel comfortable responding, he didn't have to.  He seemed to decide then that he would ask his first doctor.
The chief point of the biopsy is to find out what kind of tumor it is: apparently it could be one of two (of the three kinds of brain tumor). The location is what makes it particularly problematic - at the pons.
I also visited briefly with PT SS. He'd undergone his chemotherapy around four days prior and did seem improved. Certainly he was in much better spirits so, one assumes, he couldn't be in anything like the discomfort he'd been in before.

Slow day in ER

Usually the RNs etc, have the volunteer take/tube stuff up to the lab or blood bank, not today. That really reduced what I had to do. However, it was a slowish day in general in the ED. There were even a number of empty beds.
Today included:
Male PT, approx 60 yrs with scabies
At least 3 female PTs with ankle sprains (I think they were all wearing flip-flops)
Female PT, approx 25 yrs unconscious then had grand mal seizure on gurney (from ambulance), then back to unconscious state
Deceased elderly male in trauma room - body in bag and tagged, waited for family to arrive. I saw foot end, with wrap.
Family obviously very upset.
Escorted male PT to Detox (Addiction Institute) for admittance.

Things seen

Pemphoid/pemphigus
Ascites - both alcholism related and non-alcoholism related (R/T lupus)
ALL
MDS
Sickle cell crises
Various cancers (brain, breast, intestinal, and others)
Other leukemias
COPD
Asthma
Alcoholic detox
broken foot
child with boils (?)
man infested with bed bugs
kidney stone
diabetics with dehydration
older lady (around 60?) with seizures
post-surgical cardiac PTs
Acute respiratory distress
Acute GI distress
PT reporting melena (no other S/P)
Trauma - car accident (minor, soon discharged)
In trauma room, elderly lady resus'ed and intubated, then placed in bay in ER for admittance upon available bed.
Numerous falls and dehydration PTs (unusually hot summer)
Minor ailments treated: migraine, GERD, stomach ache, amongst others

Charming conversation companion

Fairly busy in the ER today. Usual range of errands, pharmacy, medical records, samples to labs, and so on. I got to spend around a half hour with a lovely little boy whose sister was in the ED and was going to have a procedure. It'd be easier without him there. So, I took him around the ER and showed him the x-ray room and talked about all the stuff. Then we took a walk around the block and we talked about movies and  dinosaurs. He was such a sweet little fellow.
The usual detox guy was back again, asleep and thus completely non-threatening this time. There was one other guy in for detox and a completely drunk couple. The woman in this pair had clearly fallen badly and that's how they'd wound up there. She was on a gurney from an ambulance.
There was an older lady who'd broken her foot and cried out in agony several times while they sorted her out and put a cast on her.