so no compassion for you, then?

i have a lot of empathy.  and it works for me.  sometimes i feel so ridiculously sorry for someone that the only way to make me feel better is to make them feel better.  so i fluff fluff fluff the pillows, wash some hair, obsessively organize the room...whatever it may be to make the patient feel well taken care of and like they're getting "extras".

so that's what i've been doing for my new 'lifer' who will sadly be in the hospital for probably almost ever.  according to trauma, the guy was practically dead upon arrival.  he's a hot mess: trached, tubes all over, multiple broken bones, required more than one -ectomy, just SICK.  his bowels will. not. move.  will not.  after so many surgeries, his belly is a tangle of adhesions, and somewhere one of them is obstructing his small bowel.  we feed him in one tube, it comes out the other.  and, while he is getting nutrition, every day he seems to get skinnier and skinnier.  

so he sits in his bed, looking like some sort of large frail bird.  he's trached, so he can't really talk.  he can't eat.  he's clearly bored out of his mind.  and every time i walk in his room to see him holding a picture of a family member and just staring at it, it breaks my heart.  

how sad, to be in the hospital for months and to have every day be the same as the one before.

to not get to do the things you love.

to not be able to do the things that once came so easily.

to feel so isolated, and so hopeless.  

like i said, it breaks my heart.

or, i should say, broke.  

because low and behold, who shows up today?  the police.  and wouldn't you know it, the story wasn't quite the same coming from them.  turns out the patient was drag racing drunk with some of his other drug selling felon buddies and ended up crashing his car.  the police recovered thousands of dollars and some stolen electronics.  there was also some sort of bribery involving the patient's mother who's silence could be bought for something like $10,000.

you have GOT to be kidding me.

i guess this stuff shouldn't surprise me anymore.  it also shouldn't matter.  and in a way, it doesn't.  i'll still treat the patient the way i always have.  and i still feel bad for his situation, bad for the fact that it will take months for him to get back to even a halfway decent life...that is if he doesn't die of complications first.

but for some reason, it still really bothers me.  i feel like i was lied to.  i've been treating the patient like a victim.

the only thing this man is a victim of is his own lifestyle.

i have a rule, and it is however you treat me, that is how you will be treated.  you can be a murderer or a thief or an abuser and we will not have a problem if you are polite and respectful.  i'm not sure why this situation feels so different, but it does.

so what do you do?  is compassion a resource?  does it go to those most deserving of it?  or is it kind of like triage...given to those who need it the most, despite of why they arrive on our doorstep?  can the feelings be taken out of it altogether?  is it possible to provide compassionate care to people you think kind of deserve what they got?

i think it can be done.  but we shall see.

   

active shooter

today, i feared for my life.

we were in the middle of a mass casualty situation.  the hospital was on high alert.  we were discharging people to open up beds, and the ICU was dumping out to make room for the criticals.  at this point, we didn't know much.  there was an active shooter at an outside location.  7-10 injured, all coming to us.  suspect still at large.

i saw my patients and was settling my ICU transfer when the call came out over the loud speaker.  they named off the code for 'dangerous situation', followed by the very urgent "THIS IS NOT A DRILL.  REPEAT, THIS IS NOT A DRILL".

and all at once, it was my nightmare come true.

the shooter was in the hospital.

as luck would have it, i sat through an active shooter class a month ago.  "active shooters are like water", the instructor said, "they take the path of least resistance".

they showed us this.  it gave me goosebumps.  they played a video reenactment of the columbine shooting.  i almost had to get up and walk out.

at the time, i made my plan in my head.  of all the choices (run, hide, engage) i knew that i would hide.  and it's true what they say: what you practice is what you remember.  so i did what i did all those times in my head.  pick a patient to stay with.  make sure the shooter can't get in.

i went into the room of my ICU transfer.  i shoved a chair underneath the door handle, then proceeded to push all of the furniture in the room against the chair.  i closed the blinds.  and i waited.

i waited for the gunshots and the screaming that would tell me the shooter was on our floor.

and i expected them to come, but they didn't.  i busied myself around the room, first assessing, then charting.  i called a coworker, she was watching the hallway with several others.

you couldn't have paid me enough to stand and wait for a man with a machine gun to come around the corner.

but after 20 minutes with still no gunshots and no screaming, i felt guilty about my other patients.  slowly i moved the furniture from the door.  i peeked out into the hall.  i quickly moved to my other rooms, hugging the walls and looking over my shoulder for a man with a gun.

stay in your rooms, i told them.  just to be safe.

the hospital was swept floor by floor, room by room.

no shooter.

the news was all over the place.  they kept repeating the name of the hospital, reminding everyone that there was a possibility he would come to find the victims.  repeating the phrase "lockdown".  no one in, no one out.  one channel said that he had possibly been seen in the cafeteria.

the sweep continued.  nothing.  then the news: the shooter was dead.  found at the primary scene, a suicide.

the shooter had never been in the hospital at all.

so many feelings.  relief.  embarrassment for being so scared.  resentment towards the system that allowed us to think that our lives were in jeopardy, a system that has no way to differentiate between a possible active shooter and sure threat.

and what i did, i think that i would do again.  i'm not ashamed for feeling a legitimate fear, for trying to survive when i thought that i was truly in danger.    

the hospital is usually my safe and familiar place, and today it wasn't.  it's a harsh reality, and sad to come to terms with the fact that you really aren't safe anywhere.  at church, at the grocery store, getting your nails done...people living their everyday lives are perfect targets for this type of sick violence.

and it's going to take me a while to stop thinking of myself as a sitting duck.



 

timing is everything

the floor is ridiculous lately...everyone on the bed alarm, sitters galore, super sick 1:1 ICUesque patients with plasmapheresis and chemo that have some how ended up with us, etc etc etc.  today we were down 2 nurses at shift change and running our asses off when the ICU called up a patient to our only open bed.  i had the nurse on one phone, our unit secretary on the other, and three other people in line waiting for things from me.

"i just got the page, i don't know who's going to be taking the patient, can i call you back?"

the ICU nurse was fine, told me she'd call back after lunch.  half hour later the secretary called and told me the transfer was cancelled.  why?

the patient coded.

crisis averted.  narrowly.

stay home and die

so i'm pretty much over people who like to be sick.

you don't want to take care of yourself?  fine.  don't.  but don't come to the hospital and make your problems mine.

seriously, i'm done bending over backwards for people who just don't give a damn.  from now on, i'm telling you what you need to do and why, and if you don't want to put forth any effort to, i don't know, LIVE, i'm not going to put any effort into you.

oh, so you're in the hospital for DKA and find it necessary to try and order about 20 carbs on your tray?  and you just happen to be 38 years old and up ad lib, yet somehow have a stage 3 pressure ulcer on your butt?  this completely baffles me.  and sure enough, despite the fact that this patient was unwilling to do a single thing to try and not die, she somehow wheedled her way into staying an entire weekend beyond when she should have been discharged.  and then, five minutes before she was set to go home she got "sudden" "10/10" "stabbing" chest pain.  that was "radiating down her left arm".  ok miss negative cardiac workup, you're gonna have to try again.  and after numerous sessions with the diabetes team, an hour going over discharge med instructions, and basically free insulin, guess who couldn't be bothered to go fill her insulin prescription?  that's right.

and do you know who couldn't be bothered to care?  me.  because if this lady wants to go home and suck down mountain dew all day until she's in a coma, who am i to stop her?

another patient, in for constipation but refusing meds.  refusing to get up and walk.  refusing to follow her diet.  intermittently refusing dialysis.  because "i know my body" and "you all are trying to keep me sick".

here's a thought: if you don't want to follow medical advice, DON'T BOTHER COMING TO A HOSPITAL.  if you think that we are trying to kill you at this hospital, go elsewhere.  PLEASE.

and despite the fact that we are all horrible people who treat this woman badly and are trying to make sure she doesn't get better so we can make money, she continues to return to our facility.  she comes in, refuses to do a thing we say, and then refuses to go home.  yes, that's right, she's on the phone with everyone from her sister to patient relations claiming that we are "unlawfully discharging her", despite the fact that she's not doing a single thing here that she couldn't be doing at home, namely ABSOLUTELY NOTHING.  oh, and then when she finally did agree to leave, she walked herself down to the ER and checked herself in, because "they did nothing to fix my pain".

listen here bia.  you want to shoot up IV pain meds all day then sit like a lump in your bed and refuse laxatives and wonder why you look 5 months pregnant, do it on your own time.  i'll spend my time with people who would actually like to get better.

i'm going to start a new public service ad campaign, and it's going to be called 'stay home and die'.

bottom line:  do what it takes to get better in the hospital.  work with therapy.  take your meds.  follow your diet.  get better, go home, don't come back.  if you don't want to do any sort of work, or follow the advice of medical professionals, or you would just prefer to come to the hospital and make a sport of terrorizing the nursing staff and wallowing in learned helplessness STAY HOME AND DIE, and spare me the trouble of watching you ride the slow train to suicide.

this message brought to you by a nurse who's sick of your crap.

today.

today nothing nothing went right.

the dynamaps were all missing pieces
the computers weren't working or my rooms didn't have them.
everyone was hypertensive.
no one was oriented.
the bed alarms were constant.
we were short a nurse.
there was always a line for my attention.
my phone never stopped ringing.
i was mean to my coworkers.
my assignment was the hardest.
i resented my patients.

i sucked, pretty much.

maybe tomorrow will be better.
maybe not.
but at least it won't be today.

trouble is a friend

it was a weird morning.  rainy and humid and oddly warm for october.  i was chatting with my nurse friend and drinking coffee.  we were on the way to church.  i was driving.  i don't remember what was on the radio, i don't remember what we were talking about.  i also don't remember seeing the red car in front of us spin out, and i don't know how i managed to slam on my brakes fast enough to avoid hitting anyone.

somehow i ended up on the side of the road.  we went to go see if everyone was alright.  another driver pulled over too, and called 911.  the driver of the red car was gushing blood from his head.  seriously, it was like Carrie.  i grabbed a pair of gloves from the glove compartment of my car.  my first aid kit had a 2x2 gauze in it...which was sad and useless.  i grabbed the only other thing i could find (a blue isolation gown), and held pressure to the driver's head.

for the record, blue isolation gowns are water-repellant and worthless for gushing head wounds.

my nurse friend found some rags in the back of my car, so we switched to that.  much better.  the bleeding slowed.  no LOC, no dizziness, no lightheadedness, and pretty darn calm for someone with blood pouring down his face.  "please tell me you're a nurse", he said.  why as a matter of fact...

we waited for the ambulance.  FOREVER, it felt like, but probably less than 10 minutes.  we were on the highway, an overpass just past a big curve.  not the best spot to be, but definitely could have been worse.

THANK GOD the pouring rain had stopped.  THANK GOD the shoulder was big enough for us to work on.  THANK GOD the car wasn't going faster and didn't go over the cement barricade of the overpass.  THANK GOD i was with one of my nurse friends.

i have never been so relieved to see a fire truck in all my life.    they took over, and our merry band of first responders went on our way.  when we left the driver looked pretty good.  my guess is a few head staples and he'll be on his way.

and i'm a little emotionally scarred, but no worse for wear.  the more i find myself in these kinds of situations, the less shaken i am by them.

that being said, i could go for a quiet weekend every once in awhile.

just saying.

 
 

there are worse ways than this

she was dying, and there was nothing to do about it.  she was septic from complications of a procedure.  she was developmentally delayed, wheelchair bound, and had no family.  her guardian decided it was time for palliative care, and we agreed.

making people comfortable is my favorite.  people like to get all warm fuzzy about nurses having "a touch that never hurts".  my touch hurts all the time.  whether it's the heparin shot in the belly, the painful dressing change, the deep breathing or the ambulation that i insist on...i make people do things that hurt every day.  i do it to make them better.

until we can't make them better.  and then we just do nice things.

i covered her in a handmade quilt and wrapped a prayer shawl around her shoulders.  she held the knitted bear that a volunteer had made.  the people from her facility brought her things, and i read to her from her favorite books.  i lotioned her hands and feet, and put her lip balm on her.  i talked to her, sat with her, and played soothing music for her.  i pushed her pain button for her, and i gave her lots of meds to dry up her ever-increasing secretions and to keep her fever at bay.

i cried for her, but they weren't sad tears.  because where she had looked so uncomfortable before, she was now at peace.

i have seen horrible ways to die.  this?  is not that.

if there is a good way to go, this is it.  in a quiet space, with someone at your side.  surrounded by familiar smells, with familiar things.

there is a time to fight, and there is a time to give in.  to let go.  and she did, at 0320, with the night nurses by her side.

knowing that she was comfortable and well-cared for until the end, i'm at peace.  and so, thankfully, is she.  

curses on me, apparently.

today it took me 4 IV pumps and 2 sets of tubing to set up maintenance fluids.

and it took me 3 dynamaps to get a set of vitals, seeing as how each one is missing a key part.

and then i got electrocuted trying to plug the computer in.  literally electrocuted, like electricity buzzing through my fingers.  it was terrifying.



i fear someone may have a voodoo doll of me somewhere.