A new blog for me

I wanted to post the link for my newest blog here. I started one that is more about my personal life rather than my nursing life. No personal identifying details though so if anyone likes my writing style and it interested in reading it then feel free. You can find it at http://seeingdoublesob.wordpress.com. It's still a work in progress and only has one post but more will come!!

A little push and some perspective

I had an older gentleman two nights in a row recently. He was recovering from a big abdominal surgery and had gotten transferred to my unit after complaints of chest pain. We ruled him out for a heart attack but he had some other problems such as acute renal failure and an early pneumonia so he would be staying with us for a little while.

My first night with him he was surrounded by family members. He had had a rough night the night before including the transfer, a bout of confusion, and not much sleep. When I asked him if he wanted to get cleaned up for the night he refused saying he just wanted to sleep. Fine with me. My preceptor had taught me long ago that in a critical care unit you don't die from a little stink!! Missing one bath isn't too big a deal when the patient is pretty clean anyway and just wants to rest/sleep. We did turn and reposition during the night though.

I come in the second night and he has no visitors. They have all gone home already. He is still feeling pretty icky and again requests to sleep. But he needs some good respiratory toileting and a good lifting of his spirits. So I inform him that sleep isn't an option right now and that he needs to get cleaned up and repositioned. I promise him a back rub and that it will all make him feel lots better. He whispers something that I cannot understand. I ask him to repeat it and when I finally understand it he has said "not worth the trouble". I tell him that YES he is worth the trouble and that, in fact, it is no trouble at all. He just nods.

I take the first washcloth of warm soapy water and rub his shoulder with it and his tense body immediately relaxes and he whispers "that feels good". I tell him that I'm glad. He's been having tons of anxiety the past few days and hyperventilates with any stimulation. We've been between a rock and a hard place on giving him any anti-anxiety meds though as we don't want to further compromise his respiratory status.

I get done with his trunk, arms & legs and get a new cloth for his privates. I tell him that I am going to do them and he immediately tenses again and freaks out while I do that area. As soon as I'm done I reassure him that I'm done with that area and that it was necessary to do it since he has a catheter in. He whispers "I hate you" though I can tell it isn't with much vigor! After a turn, back rub, sheet change and rectal temp I'm done.

A fellow nurse comes in to help pull him up in the bed and get him repositioned on his side. I ask if he is comfortable and notice that he is again relaxed and see that he nods "yes" to being comfortable. Then I ask if he is ready for me to be done torturing him. He whispers "I am so glad you did that for me", claps his hands and has a sparkle in his eyes. I actually almost cried!! Mostly because the night before he was so confused that all night long he was intermittently sitting up and yelling out "help me" and it wasn't easy to calm him down. He was just a confused old man. And the next night he was a sweet old man. Kind of puts it into prospective. Either way, he is an old man who is a human being. I think sometimes it is easy to forget that as we take care of these sick people each shift.

The second night he took a short nap after his bath and then awoke quite confused again similar to the way he was the night before. But tonite I have my perspective back and also my patience. Sometimes I lose that perspective and I'm sad when that happens. Not that it's a great excuse but that first night we had only 1 lucid patient on the entire floor. Makes us all crazy sometimes you know!

Where do they find these docs???

I go out on a MET call the other night (known to some of you also as rapid response teams ) and it is for this older gentleman who is unresponsive. We go through our usual protocols and the nursing super is asked by the floor nurses if we want the hospitalist and she agrees to it since we have done our thing and cannot really do more at this point.

In he walks. Having had prior experience with him I know that I am really no better off except that I have someone who can write orders. We disagree on what is wrong with the patient. The floor nurses found him acutely unresponsive and hypotensive. This doc thinks that it's the klonopin they restarted today despite the fact that he usually takes it at home. I think it's an acute stroke. But either way he's a DNR/DNI and the family doesn't want much major done.

We do do some bloodwork and a CT of his head. He has some irregular neuro respirations and his tongue is falling back into his throat due to his mental status. So my doc asks for anesthesia to be paged to find out how to manage the airway. The nursing super's and my jaws hit the floor!! We remind him that he is a DNR/DNI and that if he gets anesthesia involved they will want to intubate. They really don't like being invited to parties they cannot be involved in anyway. I suggest a nasal trumpet (or nasal airway) for this purpose. This will nicely get his tongue out of the way and help him maintain his airway to the best of his OWN abilities. He agrees. And then asks "can YOU put that in?" Uhhh YUP *eyeroll*!!

The floor nurses then cart the patient off to CT scan and I'm finishing my paperwork and getting ready to go back to the CCU when this doc comes up to me and is asking me tons of questions about the nasal trumpet. Basic questions too! Such as "how do you know when to use those?" "How do you put them in?" "Are they better than an oral airway?" "Do they aspirate less with them?" On and on and on. I'm getting more nervous by the minute as he is a hospitalist who is supposed to be prepared for any situation that happens in a hospital. I could understand if an OB or a dermatologist or even a regular internist who mostly sees patients in the office but occasionally sees them in the hospital doesn't know this stuff. But a hospitalist???

So, I have just two questions for you:

1. Where do they get these docs????

2. Am I asking too much?????

The other side of the bed part 2

For those that were going to follow my other blog on my daughter's surgery sorry you ended up finding nothing.  I attempted to post onto it while I was gone but the children's hospital that we were in had a filter on their wifi blocking "social networking" sites.  So, I attempted to post onto it using google docs but it would only post onto this blog for me.  Despite me changing it to post onto that one it would still only post onto this one.  Grrr!!

Anyway, all went well with her.  And it was actually easy to be a parent instead of the nurse!!  Much easier than I thought it would be.  Possibly that was because everything went so well though!!  I had imagined it would be a rough few days since they were doing surgery on her throat but instead it was a breeze.  The worst part was the 24 hours she was in the PICU and confined to the bed and bored!!!  Boy did she want up and boy was my back sore from holding her so much!!!

I imagine if things had not gone so well it would have been much harder to stay out of the nurses' way.  About the only thing I did that a "normal" parent wouldn't do was hit the silence button on the IV pump when she was asleep so that it wouldn't wake her!!  I didn't think that was too much overstepping bounds though.  My Mom did ask me once if I was being "nice to the nurses" and "staying out of their way"?  Of course, I asked her whatever did she mean???  and she quickly reminded me of when one of my twins was in the NICU and was having a major apnea/bradycardia/desat spell and she was trying to yank me out of the room as I was screaming hysterically.  But, come on, was I really going to leave then???  I think she imagined that as me getting in the way but I was far from it.  I never got in the nurse's way....I just wasn't leaving my son.

Ok, back to happy times.....my daughter came through this with flying colors and is home doing great now.  I'm back to being a nurse rather than patient parent which is how I like it. :)  (though I'm still on medical leave until she gets cleared early next week so I'm liking that too)

The other side of the bed

Unless I find some time and think of some old stories there will be nothing new here for a little while. I'm going to the other side of the bed (or should I say my daughter is) and I will be off for the next 1 1/2 weeks.

My daughter has a laryngel cleft and is going to have it repaired tomorrow (Monday, July 14). I think it is hard to be a nurse and be on the other side of the bed for any reason. Whether it is youself or any family member.

I recently experienced this with my husband as he had an AFib ablation done just prior to Christmas and then his follow up in April. And I have experienced it a ton with my daughter as she has had issues since birth and this will be her 5th hospitalization in her almost 3 years.

I have yet to decide if being a nurse makes it harder because you want to "do it all" or if it is because you just know too much. Or in the case of my daughter I know too much but too little at the same time as I have no real pedi experience. Either way, I'll be away from this blog until I come back to work. But if you want updates on her progress you can still visit me at her blog titled Jenny's Journey.

Good tidings until I'm here again.

Families

It never ceases to amaze me the myraid of family types we get. It is never easy to have a loved one sick or in the hosptial. I do know this first hand as I have a chronically sick child that has been hospitalized 4 times in her almost 3 years of life.

Here is a sampling of the families we had the last shift I worked:

We had a lady who spoke little English and so her family stayed with her for much of her hospitalization. They sacrificied their own home life to help provide for her. They were quite nice to us and helped us in any way they could.

We had a man who was estranged from his family and though he had been in the hospital for over a month we have been unable to get ahold of any family to let them know what he has been through.

We had another family who saw how busy we were with the relvolving door of transfers out to get admits in and felt bad for us so brought us a "snack" which was really a pizza enough to feed us all.

Then we had a family of a man dying. And it was an unexpected death that was going to occur so they were just entering the stages of grief. His first day there everyone was nice and everything was thank you etc. Then it all changed and we could do nothing right in their eyes. It made for a miserable shift. I can understand a family member being upset with me if I've done something wrong to their loved one or made a mistake. But when I have taken care of them like I would my own family member and you are yelling at me just because you need someone to take your grief out on I just don't deal well with that. I know it's not personal but I'm not a punching bad ya know.

Our morning view

There are various reasons I work the night shift most of which I won't get into now but I did want to share this reason. I brought my camera to work a few nights in a row as we marvel at the sunrise each morning. For years I have said that I want to get a picture of it so finally I did. Of course, pictures just don't do it justice but here is our view each morning. I took it a couple of different mornings as it looks so different each day. We overlook a river from my side of the hospital and it is just so pretty each morning. These are taken through the window of a patient room.

The river looks pretty neat with all the lights shining off it each night too. A coworker and I went to the top level of the parking garage and took this:

Like I said, the pictures just don't do it justice but seeing the sun rise each morning that I'm here is a pretty cool thing!!