i know when my job is really bad, because i honestly consider taking off my stethoscope, turning off my phone, and walking out. this week has been a little like that. ok, a LOT like that. my biggest problem is that the patients have me outnumbered. there are four of them, one of me. this works out ok sometimes, but when everyone decides to be sick at once, we have a problem.
thursday: i had four patients. one was a suicide attempt who's super stable and waiting for placement, one was a brain injured 81 year old who thinks we're on a cruise ship, one was a multiple GSW to the abdomen who has one of the worst infections i have ever seen, and one was a post-op bezoar removal (aka giant food ball stuck in stomach...i swear this stuff exists). so i got my post-op settled and took some vitals. her BP was 78/54. i didn't want that to be right, so i took it again on the opposite arm. 80/53. no no no no no. the woman was white as a sheet and breathing at 12 resps a minute...kind of slow for my liking. to be perfectly honest, she looked like she was dead or well on the way, and it was creeping me out. as i was decided what i was going to do, the door flew open and one of the aides yells that my lady with the brain injury was having chest pain. i HATE chest pain. it almost never means anything on our floor, but you still have to call the doctor and get a bunch of tests and stat labs. so i'm supposed to be 2 places at once, and no one is stable and did i mention that my abdominal infection guy sprang a leak in his belly? poop in open wounds is usually very very bad. so i'm waiting for the OR to call for him and praying he doesn't go septic (that is more septic than he already is) before they do. and i need to fix the ghostly white hypotensive patient. and make sure that my cute grandma isn't having a heart attack. i would like to say that i handled this with grace. in reality, first i had a small freak out, barked orders at my coworkers, then snapped at an aide for asking me for something. then i gave blood pressure lady a fluid bolus, had someone else call the doctor about the chest pain, and made sure vitals were taken on my pre-op abdomen guy. then i apologized for being mean. eventually the blood pressure came up, the chest pain turned out to be rib fracture pain, and OR called for my abdominal infection. but by this point, the night was beyond saving. i punched out an hour late, and STILL managed to leave the hospital feeling like i accomplished nothing at all. so i called up a friend and cried all the way home.
friday: after all that drama i wanted, no NEEDED, a good night. i went in to get my assignment, told the powers that be that i couldn't handle all those people at once, and gave up the bezoar patient to another nurse. my day started out fine, but when i got back from lunch all hell broke loose. i had a discharge, so i was up for the admission. "just an ortho patient" i was told. then i was pressured into giving up my 81 year old who had actually been behaving herself to take back the bezoar patient who wasn't getting along with her new nurse. i didn't like it, but i said yes and went to go check on her. her NG wasn't working, i was supposed to give her 2 enemas, and she burped poop breath (literally) in my face. yay. then i had to meet my new admission. my "just an ortho patient" was really an ortho oncology patient with a white blood cell count of 23,000 (normal 5-10,000) who was bright yellow. he was sick. in the real world, sick means that you have a cold or a headache or want a day off of work. in the hospital world, when you say a patient is sick you mean REALLY sick. so i picked up my second septic patient of the night, and immediately got bombarded with orders for blood cultures and urine samples and a chest xray and abdominal CT. the attending surgeon called me probably 5 times to keep me posted on the plan and give me more verbal orders. in between asking the 234234098 admission questions, i was drawing labs and fielding phone calls. somewhere during the melee, my patient with the bad abdominal infection who had gone to surgery the night before called me to say that his dressing was leaking. i was so busy that i pretty much ran past his room and told him i'd be back in a few minutes. maybe a half hour later i finally remembered him and went to assess the dressing. i had seen the doctors change it earlier, so i knew what i was going to do and grabbed an aide who's in nursing school to come help me. i had been warned that the wound was pretty wet, but i was surprised to see the whole dressing was saturated. as i peeled off layers, i got more and more alarmed. when i pulled the packing out of the wound, bile started running down the patient's belly. bile doesn't belong sloshing around in the abdominal cavity. i calmly asked the aide to go grab the doctor out of my other patient's room and started to soak up the drainage. the on call doctor walked in, looked at the belly, and walked out. then came the chief resident. by this time it was clear the patient was going back to surgery for the second night in a row. over the patient's open belly, the on call doctor told me that he had tried to fix the bezoar patient's NG tube and couldn't...i had to put in a new one. yes. i also had to prep this patient for surgery and make sure that my septic admit wasn't crashing. first i died a little inside. then i called the STAT nurse to put the NG in, finished my preop checklist, and sent my ortho patient to CT. i honestly don't remember the rest of the night too well...just that it ended with me punching out an hour and a half late and cursing the day i decided to become a nurse.
saturday: i got to work and both bezoar lady and abdominal infection man were in the ICU. turns out that's where people are supposed to go for one on one nursing care. who knew.
my brain hurts from so much multitasking. but everyone is still alive. success.
No comments:
Post a Comment