August 25th, 2017


August 25--The glioblastoma essay

My students did online modules today, so I was able to stay home. I had some plans to work on my project proposal, but ended up diving deep into my photo archives and posting a bunch of stuff to my Flickr account, which I hardly ever use.

I spent hours and hours digging up stuff and looking at it. I have mentioned it previously, but I can look at almost every photo I have taken and remember something about when it was taken, beyond what the photo itself reveals. I like that connection.


This was taken at the farmer's market on a Sunday morning, near the end of avocado season. According to the online statistics, this is the most shared photograph I have ever posted. An avocado--go figure.

I also found this--an old essay I wrote after a particularly difficult shift in the ICU about 8 or 9 years ago. It really captures what it was like for me as an ICU nurse.

The past couple of days I took care of a young woman who was admitted to the ICU after having a seizure. She stopped breathing after the seizure and had to be intubated and placed on a ventilator. She was pretty much unresponsive when she came to us.

When I began to care for her she was just starting to show signs of coming out of it–some movement of her hands and a furrowing of her brow when I irritated her. I turned off her sedation and waited. 

The night nurse who admitted her told me the story. She had been diagnosed with a brain tumor about 4 years ago, when she was pregnant with her second child. It was a glioblastoma–probably the worst brain tumor you can get. It’s the same thing my best friend Joe died of. It’s a tumor with fingers that spread in all directions. It is invariably fatal.

She had brain surgery after she had the baby, and they removed what they could of the tumor and then started her on courses of chemo. At the time, the surgeon told her husband that, at best, she would have about 4 years. 

She’s been having seizures more frequently lately, and the one that put her in the ICU was the worst so far. I took her down for an MRI scan. It showed tumors on both sides of her brain, with some small hemorrhages throughout. 

Her husband came in and we talked for a while. He is juggling his wife’s illness, his kids, his job, and his wife’s family. He is really trying to hold it all together, but has no illusions about where this is all heading. He knows. After we talked for a while, he had to go back to work. As we said goodbye, I told him that I had gone through something similar. He replied, “So you understand how tough this is." 

"Yes,” I replied. 

The second day I cared for her, she looked better. We put her on a ventilator mode that pretty much allowed her to breathe on her own. She did good, and began to wake up more and more. I got a blood test and talked to the neurosurgeon about taking the tube out. She was for it, but wanted to make sure the critical care doctor was available in case the tube needed to be put back in. 

The critical care doctor felt that it would be futile to put the tube back in, but wouldn’t talk to the neurosurgeon about it, leaving it to me to work it out. A big part of my job is about doing just this–getting doctors to step up and do what they ought to do. It’s frustrating. 

I talked to another doctor–a neurologist, who understood. We talked to the husband and told him what the situation was. He went into the room and talked to his wife for a while. I looked at them through the window. It was heartbreaking–her in the bed, unable to talk because the tumor was pressing on the part of the brain that produces speech, and him leaning over her, still able to talk, asking her what she wanted while they both cried. She is 26 years old, and she is going to die. 

They decided that she wanted the tube out, but if she failed, we wouldn’t put it back in. I called the doctor and got the order. I talked with the respiratory therapist, and we pulled the tube and put her on oxygen. Her husband stayed at the bedside and held her hand. She did fine. 

Her husband had to leave to pick up the kids. After he left, I got my friend Karen to help me clean her up a little. We gave her a bath and changed her linens, so that she would look good when her family and friends came in later. 

I asked her if she felt better. She looked at me and gave me one of the most beautiful smiles I have ever experienced. It was like a brief glimpse of sunlight on a rainy day, and I will never forget it.

Before I went home, I made a referral to hospice for her, so that she could go home and die, surrounded by people who she loved, and who loved her. 

As I drove home, I looked at the clouds reflecting the colors of the sunset. It was so beautiful, and I cried, and was glad to be so fully alive.
  • Current Music
    Steve Earle--To Live is to Fly