Hold Everything Lightly #9 {Sickle}

Sickle Cell Disease is a cruel, complex, and debilitating disease.
The hemoglobin cells are in the shape of a sickle and look like little  crescent moons. A sickle is used on a farm to fell crops like wheat and is crescent shaped.  Sickled cells do not flow normally and get stuck in vessels and joints causing lack of oxygen and tremendous pain.  This puts patients in "sickle cell crisis." This disease harms organs, muscles, and bones. I took care of these patients for seventeen years.

 Here are two of their stories.

Ruthie

I met Ruthie when I was young and so was she. 

 Ruthie was eighteen to my twenty years. She was in sickle cell crisis, needing IV (intravenous) fluids and IV narcotics. Sickle cell patients often required copious amounts of pain medications. They could be difficult to care for because the pain medicine prescribed did not work fast enough or good enough. When morphine and Demerol on demand pumps came along they helped but we were still constantly adjusting the dosage and calling the Hematologist who cared for these patients. Ruthie was admitted, in crisis, frequently to 5 South and later to 5 North, 3 North, and 5 West. All general medicine units where I was the charge nurse. The hospital became her second home. Her physician, Dr. K was and is truly a  kind and gentle man. He had compassion for his hurting patients. I always marveled that sometimes they fired him because he did not give them more Demerol. Ruthie never fired Dr. K she had too much smarts for that. She had a sense of humor too and smiled often. There develops a kind of rhythm to caring for the same patient over the years and Ruthie and I had that. 

One hot Georgia summer Ruthie was admitted to the corner room of 3 North 

with abdominal pain and kept asking for warm compresses on her tummy. Warm compresses did not exist in our hospital and so we would heat a wet towel in the microwave (this was not a brilliant plan). Ruthie's abdominal pain seemed difficult to access and hard to medicate. She wanted those warm soft compresses. She began to demand them. Then her abdominal skin was burned by one of them (incident report). "First do no harm" was all I could think of at that point.  She did not care. She wanted another one when I said "No" and Dr. K said "No." Dr. K wrote a psychiatric consult. The psychiatrist came the next day to see Ruthie and went to her room and after a minute stepped into the kitchen and heated her a wet towel. 

I was taken aback.

He had not read the consult.

Ruthie died, at home, before age thirty due to sickle cell disease.

Reggie

Reggie, a free spirited guy, was admitted to our 

medicine units over the years in sickle cell crisis many times too.

 He was an older patient for this awful disease.  One time, at age forty, he was admitted to the emergency room in crisis and they tuned him up with IV fluids and IV pain medications. Then they sent him off on his way. Reggie did not go home that day, he had other plans, he told me mysteriously. When the emergency room doctor got his lab results back  he had a shock as Reggie's hemoglobin was 3.0 (should be at least over 8). He could not reach Reggie so he sent the Sheriff to his house and scared Reggie's mama to death. When the Sheriff found Reggie, having fun downtown drinking a few cool ones he confessed later, Reggie was appalled they had scared his mama because Reggie lived with a chronically low hemoglobin his entire life. A low hemoglobin that would be deadly to most of us his body had learned to adjust to because of his disease. He was admitted to my floor that day and I gave him a couple of units of packed red cells. 

Then he was really tuned up.

I do not know what happened to Reggie. 

I hold out hope he is still with us.

"Hold everything in your hands lightly, otherwise it hurts, when God pries your fingers open."

---Corrie Ten Boom 1892-1983 

thank you for reading

Olive