What Excites Us?

Ask several people what they find exciting and you’ll get hundreds of different answers. I would bet that the answers you get from nurses are very different than those from regular people. After all, we can sit around the lunch or dinner table and talk about or listen to lectures on constipation, diarrhea, nausea , vomiting, and even death, and it just seems like every day conversation. But even among nurses, I bet there are different things that excite different ones. What a critical care nurse finds exciting a behavioral health nurse might find frightening and what the behavioral health nurse finds exciting the med surg nurse thinks is just psychotic. That’s why we all do different things and have our specialties. We do what excites us.

I have to admit that since moving from a comprehensive cancer center at a large teaching hospital to the community setting, different things have come to excite me as well. Where at one point giving complicated chemotherapy regimens and treating unusual cancer diagnoses was an every day event, I now look forward to and get excited about the much less frequent “exciting” case. Recently we’ve had quite a few of these. For the staff it’s been challenging and a bit unnerving, but it really has energized me. We had a woman with a sarcoma for which the physician prescribed a quite complicated chemotherapy regimen. Included in this regimen was a dopamine drip. What?! We can’t give dopamine on our unit? I got calls on the weekend and night with all sorts of questions. I had to educate the staff that we could, indeed, give dopamine because it was a renal dose and didn’t need any special monitoring. But still they were a little hesitant. I ended up taking the physician orders and writing them out step by step for each day to make sure the nurses felt comfortable with when each drug was to be administered and when. Admittedly, it helped to organize it in my mind as well. But I was in my element. Figuring out this complicated regimen, making it understandable to the patient and the nurses, seeing the results we were getting with this new therapy and looking forward to the next time the patient returned so that we could do our best to get her through this.

Another patient was admitted recently whom I was asked to come and see. As I was going to her room a rapid response was called on her. Luckily I was the RRT nurse that day so was right there. This was a young woman newly diagnosed with APL. Of course, she was bleeding, pancytopenic, and febrile. I was confident that this was the APL and that what we needed to do was get her chemotherapy started as soon as possible. I pulled aside one of the clinical coordinators who is studying for her OCN exam and asked her what she thought was our priority given we had just reviewed oncology emergencies in her studies. She was quick to respond that if we didn’t treat the underlying disease, we would always be chasing the bleeding, fever and cytopenias. It was so exciting to me to know that she “got it”. Of course the attending physician who was her internist and not so familiar or comfortable with leukemia, felt she’d be better served in the CCU. And although she had a port a cath placed the day before, because she had a fever we were not to use it until CT’s were done to verify that was not the source of infection. Chemo would have to wait. It was frustrating but I understood. She eventually came back to us and chemo was started. Unfortunately she ended up going back to the unit and was intubated due to flash pulmonary edema, most likely from ATRA syndrome. But what an exciting case. Somethng we don’t see here every day.

This week we’ve given arsenic, a new drug that replaces IVIG when it is not effective, and admitted another acute leukemia patient. All of these things are so exciting to me. I feel like I am really using my expertise and have the opportunity to teach the nurses with whom I work to learn so much more. Not that I get excited about people being very sick. But we can learn so much and the next time we see that, maybe people won’t be so unnerved. It’s a strange excitement for sure. Maybe it’s good to not to have those complicated cases every day so that one doesn’t get complacent about what they are doing. Maybe a little bit of nervousness is good to help us be on the mark each and every time. But what an exciting few weeks it has been.