today was quintessential trauma drama. for the entire shift, i found myself scowling and holding back tears. now that i am home and halfway through a glass of wine, however, i can see the hilarity in many of the situations that made me think that i was (finally) going to lose my mind. here's the rundown.
1400: pick up patient named after pop icon. said patient insists on doing dances with his IV pole, repeatedly running into walls and nearly falling over. patient gets 8 beers a day. insists on calling my nursing student "the apprentice". immediately love said patient.
1700: patient's wife complains that bathroom is "filthy". bite back comments about not being able to control explosive diarrhea. scrub poopy bathroom with bleach wipes. try to smile like i mean it. rue the day i became a nurse.
1845: receive patient from ED. no report given. patient is 305 pounds and 5'6''. cannot get patient off cart. call more staff, almost drop patient on floor. call ED and ask if report was recorded. talk to developmentally delayed ED nurse who allegedly recorded report and yet can tell me nothing about patient. hold back angry rant against ED nurse and hang up.
2045: go into favorite pop icon patient's room and notice epidural is leaking. must have been from the dancing. call doctor, stop pump. answer 234235 million call lights. call different doctor for new pain meds. call doctor again for benadryl for another patient. stalk doctor in halls and get cough syrup for a third patient. take phone call from yet another doctor and am warned of the dangers of epidural hematoma with displaced epidural line. talk to pop icon about dangers, then feed him more beer. call yet ANOTHER doctor about new admission, as patient was admitted with weakness and all admitting orders say constipation. cry.
2100: go into chart of new admission and read note from ED RN. RN has written that i called for report and that it was clearly recorded in the system. complain to nurse manager. receive apology from ED. plot revenge.
2115: respond to screaming match from patient's room. listen to patient's gf yell "YOU WAS TRYIN TO KILL THE MOTHER OF YO BABY". watch security remove gf from room. observe as patient attempts to go after gf and then hits security with crutches as they try to hold him back. police arrive, listen to patient swear the whole thing never happened. go into room of patient next door and assure her she is not in danger.
2130: remember i am supposed to be holding a meeting for night shift nurses. have no time for meeting. feed nurses instead and continue to run around floor.
2200: pass meds. console crying patient that i have neglected for hours. drop meds on floor, and have to order new ones. hold down elderly woman for straight cath. try not to get bitten. listen to patient threaten nurse for taking away his crutches.
2300: finally begin to chart.
2330: listen to report from ED patient. incorrectly recorded. feel vindicated.
2345: punch out. contemplate self harm. consider winding up as patient on floor and reconsider. decide to drink wine and sob myself to sleep instead.
so here we are.
Friday, March 11, 2011
Thursday, March 10, 2011
today i get to eat my words. yum.
sadly, i am not as nice as i used to be. somehow after almost 3 years of trauma drama, i've gotten cynical. nursing is a frustrating job. you watch the same types of people make the same types of bad choices and you aren't supposed to be angry. you have to deal with patients manipulating you and dish out drugs like candy and you're just supposed to smile as you get walked all over. it's hard, and it makes me mad, and as a result i can be judgmental and snotty.
but really. excuses get me nowhere. today i was wrong and here is why:
i was sitting up at the nurse's station with a couple of coworkers working on charting. the tele monitor was alarming, as it had been all night. we have a patient on the floor who is constantly pacing the halls. she's always out to smoke, or otherwise disposed and her tele is either too far away to give off a signal or her leads are bouncing around and the monitor thinks she's in v-tach. at this point, the monitor was saying that her heart rate was in the 140s. one of the nurses asked why, to which i replied "she's probably out smoking or doing whatever she does". well (surprise surprise) the patient is actually NOT out smoking, but right outside the nurse's station, overhears everything i say, and proceeds to tell me so and then yell at me. enter me. dying inside. because, unfortunately, she's right.
yes, i said it.
this patient is a drug addict. she manipulates the system. she has a history of doing naughty things in bus shelters. but that doesn't mean that i am judge and jury of the trauma unit. that doesn't mean that she gets treated with any less respect, or that i get to say whatever i want about her. because, really, she is none of my business. i (thankfully) am not her nurse and her antics are not my responsibility, so i don't get to have an opinion.
this is hard for me. i see injustice and i want to stamp it out. i would like things to be fair and right, and people like this DRIVE ME OUT OF MY MIND. i don't get to go around and do anything i want without consequences. i don't demand things and have people fall all over themselves to grant my requests. i don't manipulate the system. but once again, it doesn't matter. because i am not the drug addict, i am the professional. and because of that, and also because i was wrong, i got to go and apologize.
can i just say that i thought i was going to get beat down? she actually said to me "if we were out on the street it wouldn't have gone like that". but despite the threats of bodily harm, i apologized. i told her that i was wrong and that my comments were uncalled for. that it was inappropriate and none of my business. and that i was sorry. and she accepted my apology. and then ranted about me to anyone who would listen for the next 2 hours.
frankly i am horrified by the whole incident. do you know what is not fun? taking care of shallow selfish people. do you know what is even more not fun? stooping to their level. so tonight i ate my own words and i deserved every bite. and tomorrow? i may need a disguise.
but really. excuses get me nowhere. today i was wrong and here is why:
i was sitting up at the nurse's station with a couple of coworkers working on charting. the tele monitor was alarming, as it had been all night. we have a patient on the floor who is constantly pacing the halls. she's always out to smoke, or otherwise disposed and her tele is either too far away to give off a signal or her leads are bouncing around and the monitor thinks she's in v-tach. at this point, the monitor was saying that her heart rate was in the 140s. one of the nurses asked why, to which i replied "she's probably out smoking or doing whatever she does". well (surprise surprise) the patient is actually NOT out smoking, but right outside the nurse's station, overhears everything i say, and proceeds to tell me so and then yell at me. enter me. dying inside. because, unfortunately, she's right.
yes, i said it.
this patient is a drug addict. she manipulates the system. she has a history of doing naughty things in bus shelters. but that doesn't mean that i am judge and jury of the trauma unit. that doesn't mean that she gets treated with any less respect, or that i get to say whatever i want about her. because, really, she is none of my business. i (thankfully) am not her nurse and her antics are not my responsibility, so i don't get to have an opinion.
this is hard for me. i see injustice and i want to stamp it out. i would like things to be fair and right, and people like this DRIVE ME OUT OF MY MIND. i don't get to go around and do anything i want without consequences. i don't demand things and have people fall all over themselves to grant my requests. i don't manipulate the system. but once again, it doesn't matter. because i am not the drug addict, i am the professional. and because of that, and also because i was wrong, i got to go and apologize.
can i just say that i thought i was going to get beat down? she actually said to me "if we were out on the street it wouldn't have gone like that". but despite the threats of bodily harm, i apologized. i told her that i was wrong and that my comments were uncalled for. that it was inappropriate and none of my business. and that i was sorry. and she accepted my apology. and then ranted about me to anyone who would listen for the next 2 hours.
frankly i am horrified by the whole incident. do you know what is not fun? taking care of shallow selfish people. do you know what is even more not fun? stooping to their level. so tonight i ate my own words and i deserved every bite. and tomorrow? i may need a disguise.
Thursday, February 10, 2011
patient advocacy, yet another joy of nursing.
i am trying to think of a way to say this diplomatically. nope, can't do it. SURGEONS TOTALLY SUCK. ok, so today it was just one in particular. let me explain.
i have a 91 year old post-op patient. this in itself is actually very bad. 91 year olds shouldn't have surgery. please, if i am ever that old and someone wants to cut me open, slap a DNR bracelet on me, cover me with a palliative care quilt and call the harpist to play me into the light. i want this on the record!! unfortunately, this lady wasn't so lucky. she had surgery, then had complications, then her extremities filled with fluid, her lungs went to crap, and she got a couple of infections. Now she has so much fluid in her legs that my handprint stays on her when i touch her. and her lungs are so wet that you can hear her rattling from the doorway. and as all this fluid is in inappropriate places, she is actually dehydrated and has had only a small amount of urine output in 24 hours.
enter me. i came to work today feeling the need to right wrongs. i had the patient the night before, and was concerned about her fluid status and urine output. the on-call doctor that night didn't want to do much because he didn't know the patient. so when i got to work today, i was anxious to find out what was being done.
enter the surgeons. what was being done? ABSOLUTELY NOTHING. now on some level i understand this. we can't give her fluid because it's not going to the right places. we can't pump her full of diuretics because her kidneys can't handle it. we can't cure her because she is 91 and she's probably going to die. but we CAN do something, namely making her a palliative care patient and getting her comfortable.
enter me talking to the surgeons. i really did try. i sat down with the chief resident of the surgical service, the nurse practitioner, the intern, and the med student. i explained my concerns. i went through her edema, her lungs, her urine output, etc. and when i was done, i waited for the chief resident to respond. and what did he say?
"no."
that's right, no. just no. ok, excuse me? what part of what i just said did you not understand? so i repeated myself. the conversation went a little something like this.
-i explained that if the patient is not palliative care, we have an obligation to treat her.
"well what do you want me to do about it"
-i explained that i thought we should make her palliative
"no"
-well then we should really have a meeting to discuss what we're doing with this patient, because there's some confusion and not everyone is on the same page
"what do you mean there's confusion. who exactly doesn't understand."
-NURSING! I DON'T UNDERSTAND WHAT WE'RE DOING. AND YOU OBVIOUSLY DON'T UNDERSTAND WHAT I'M SAYING.
"well what can we do to make YOU happy then"
-i explained that we needed to make a decision about the plan of care
"well i don't understand why you're so concerned about putting a label on it"
-i explained that these 'labels' exist so that we're not passively killing people. and if i don't have such labels, i will treat my patient accordingly. thus when she starts circling the drain, i will call my resources and we will do labs and tests and oh i don't know TREAT HER, because i have no reason not to. i believe this is also when i started throwing around phrases like 'failure to rescue' and 'obligation to my patient'. i finished up by saying that i didn't feel comfortable with this grey area of medicine, and with watching her slowly drown to death. if the surgeons want to kill their patients in the OR, that's on them. but when they try to do it on the floor, thats on me. (ok i said that last part a little more politically correctly, but the gist is the same). then i told them that i would let them discuss things and they could get back to me with their decision.
now this should have felt awesome. and actually, it was very satisfying. i said what i needed to, and i stood up for myself and my patient. i didn't get intimidated, and i didn't back down even when it was clear that i wasn't going to get what i wanted. but i don't particularly enjoy eye rolling and snippy comments and tall bald men in white coats talking down to me. so was i mad all shift? yes. and do i harbor revenge fantasies involving me running over said chief resident with my SUV? yes. and will i add him to my list of people that are not to touch me should i ever need surgery? yes. and i will underline his name.
for the record, i didn't get what i asked for. the patient is still hanging out, not being treated but not officially palliative care. but for my trouble, i got 20 mg of lasix by mouth! i like to think of that as my consolation prize. i'm sure that i also got a reputation as a crazy vigilante nurse. but at this point, who cares? i can go to sleep tonight knowing that i advocated for my patient. and that evil chief resident? he'd better watch out in the parking lot.
i have a 91 year old post-op patient. this in itself is actually very bad. 91 year olds shouldn't have surgery. please, if i am ever that old and someone wants to cut me open, slap a DNR bracelet on me, cover me with a palliative care quilt and call the harpist to play me into the light. i want this on the record!! unfortunately, this lady wasn't so lucky. she had surgery, then had complications, then her extremities filled with fluid, her lungs went to crap, and she got a couple of infections. Now she has so much fluid in her legs that my handprint stays on her when i touch her. and her lungs are so wet that you can hear her rattling from the doorway. and as all this fluid is in inappropriate places, she is actually dehydrated and has had only a small amount of urine output in 24 hours.
enter me. i came to work today feeling the need to right wrongs. i had the patient the night before, and was concerned about her fluid status and urine output. the on-call doctor that night didn't want to do much because he didn't know the patient. so when i got to work today, i was anxious to find out what was being done.
enter the surgeons. what was being done? ABSOLUTELY NOTHING. now on some level i understand this. we can't give her fluid because it's not going to the right places. we can't pump her full of diuretics because her kidneys can't handle it. we can't cure her because she is 91 and she's probably going to die. but we CAN do something, namely making her a palliative care patient and getting her comfortable.
enter me talking to the surgeons. i really did try. i sat down with the chief resident of the surgical service, the nurse practitioner, the intern, and the med student. i explained my concerns. i went through her edema, her lungs, her urine output, etc. and when i was done, i waited for the chief resident to respond. and what did he say?
"no."
that's right, no. just no. ok, excuse me? what part of what i just said did you not understand? so i repeated myself. the conversation went a little something like this.
-i explained that if the patient is not palliative care, we have an obligation to treat her.
"well what do you want me to do about it"
-i explained that i thought we should make her palliative
"no"
-well then we should really have a meeting to discuss what we're doing with this patient, because there's some confusion and not everyone is on the same page
"what do you mean there's confusion. who exactly doesn't understand."
-NURSING! I DON'T UNDERSTAND WHAT WE'RE DOING. AND YOU OBVIOUSLY DON'T UNDERSTAND WHAT I'M SAYING.
"well what can we do to make YOU happy then"
-i explained that we needed to make a decision about the plan of care
"well i don't understand why you're so concerned about putting a label on it"
-i explained that these 'labels' exist so that we're not passively killing people. and if i don't have such labels, i will treat my patient accordingly. thus when she starts circling the drain, i will call my resources and we will do labs and tests and oh i don't know TREAT HER, because i have no reason not to. i believe this is also when i started throwing around phrases like 'failure to rescue' and 'obligation to my patient'. i finished up by saying that i didn't feel comfortable with this grey area of medicine, and with watching her slowly drown to death. if the surgeons want to kill their patients in the OR, that's on them. but when they try to do it on the floor, thats on me. (ok i said that last part a little more politically correctly, but the gist is the same). then i told them that i would let them discuss things and they could get back to me with their decision.
now this should have felt awesome. and actually, it was very satisfying. i said what i needed to, and i stood up for myself and my patient. i didn't get intimidated, and i didn't back down even when it was clear that i wasn't going to get what i wanted. but i don't particularly enjoy eye rolling and snippy comments and tall bald men in white coats talking down to me. so was i mad all shift? yes. and do i harbor revenge fantasies involving me running over said chief resident with my SUV? yes. and will i add him to my list of people that are not to touch me should i ever need surgery? yes. and i will underline his name.
for the record, i didn't get what i asked for. the patient is still hanging out, not being treated but not officially palliative care. but for my trouble, i got 20 mg of lasix by mouth! i like to think of that as my consolation prize. i'm sure that i also got a reputation as a crazy vigilante nurse. but at this point, who cares? i can go to sleep tonight knowing that i advocated for my patient. and that evil chief resident? he'd better watch out in the parking lot.
Tuesday, February 1, 2011
rules of trauma
rule: bad things happen to good people. bad things also happen to bad people. however, bad people are invincible, while good people have horrible luck.
case in point: this week i had a normal trauma patient. this in itself is news-worthy. this poor woman is a doctor who was heading home from work. it's 2 in the morning and some drunk idiot is out on the roads in his 3/4 ton pickup and hits her head on. surprisingly, her injuries were relatively minor. or so we thought until we got a scan that showed that she has bilateral carotid dissections. this is very bad, basically a stroke waiting to happen. so we put her on anticoagulants and got a repeat scan after 5 days. i honestly thought that she was going to go home the next day. she was a model patient, up walking and talking, looked great. but the scans were worse. and now she probably needs a stent, which has a good chance of knocking a clot off of her carotid artery and making her have a stroke. or we could leave the artery as is and it could completely occlude and she could have a stroke. see the dilemma?
this is why i am upset:
1. she is a nice normal person just doing her job and she has this horrible accident happen to her. why? because other people are stupid and reckless. you can bet that pickup man is just fine. why? because he is a bad person. and bad people are invincible.
2. she has young kids and they should have a fully functioning mom who is not a ticking time bomb.
3. she might not be able to do her job anymore. she's a doctor. doctors aren't doctors because they want to be, they are doctors because they have to be.
4. i am getting very tired of watching bad things happen to good people. it's just not fair.
counter case in point: another patient, this one not mine. double D from the block. he had the misfortune of getting shot through his liver and still somehow living to drive us all crazy despite having no blood pressure in the field. but have no fear!! gangsters are invincible. double D can continue to manage his drug cartel or do whatever it is that he does from the comfort of the hospital. every night like clockwork, we have what i like to call "D on parade". around 8 pm, all of D's friends and family would show up. the group included 3 baby mamas, various infants and toddlers, aunts, cousins, homeboys...for a grand total of at least a dozen people. despite the fact that D has 2 perfectly good legs, he would sit in his wheelchair and insist on being pushed up and down the hallway for a good hour, obstructing traffic and generally being a pain. as the group walked (at a snail's pace) up our very narrow halls, they would stop at various rooms along the way and pick up other members of the community. note: when you are in the hospital and coincidentally know 2 other people on the same floor who also happened to get shot at the same time as you IT IS TIME TO MOVE. and on it went, sloooooow up the front hall, slooooooow up the back hall. back down to the room. repeat. then someone had the bright idea of wedging a couple of kids in a second wheelchair just to make sure that the entourage really took up all available hall space. this literally happened EVERY NIGHT.
now i realize that this sounds judgmental, and i'm certainly not saying that anyone deserves to be shot. but when you still have a house arrest bracelet on your ankle and i watch your 3 different baby mamas rotate shifts, i am inclined to believe that you are living in a gangsta paradise, and may just have played a small part in your fate. and when you refuse to do any of your own cares, snap and clap at the nurses to communicate your needs, and pee/poop the bed out of laziness and entitlement then insist that we clean you up despite the fact that you are perfectly capable of doing these things independently, i am inclined to resent you.
so to recap: we have a productive member of society. kind, polite, participates in own cares and follows medical instruction. then we have a felon. rude. obstinate. unwilling to do even the most basic things despite the fact that he is perfectly capable.
lets take a guess. who walked out (or was wheeled out by an entourage member, most likely) unscathed, and who is facing a very serious diagnosis with a crappy prognosis?
that's right.
case in point: this week i had a normal trauma patient. this in itself is news-worthy. this poor woman is a doctor who was heading home from work. it's 2 in the morning and some drunk idiot is out on the roads in his 3/4 ton pickup and hits her head on. surprisingly, her injuries were relatively minor. or so we thought until we got a scan that showed that she has bilateral carotid dissections. this is very bad, basically a stroke waiting to happen. so we put her on anticoagulants and got a repeat scan after 5 days. i honestly thought that she was going to go home the next day. she was a model patient, up walking and talking, looked great. but the scans were worse. and now she probably needs a stent, which has a good chance of knocking a clot off of her carotid artery and making her have a stroke. or we could leave the artery as is and it could completely occlude and she could have a stroke. see the dilemma?
this is why i am upset:
1. she is a nice normal person just doing her job and she has this horrible accident happen to her. why? because other people are stupid and reckless. you can bet that pickup man is just fine. why? because he is a bad person. and bad people are invincible.
2. she has young kids and they should have a fully functioning mom who is not a ticking time bomb.
3. she might not be able to do her job anymore. she's a doctor. doctors aren't doctors because they want to be, they are doctors because they have to be.
4. i am getting very tired of watching bad things happen to good people. it's just not fair.
counter case in point: another patient, this one not mine. double D from the block. he had the misfortune of getting shot through his liver and still somehow living to drive us all crazy despite having no blood pressure in the field. but have no fear!! gangsters are invincible. double D can continue to manage his drug cartel or do whatever it is that he does from the comfort of the hospital. every night like clockwork, we have what i like to call "D on parade". around 8 pm, all of D's friends and family would show up. the group included 3 baby mamas, various infants and toddlers, aunts, cousins, homeboys...for a grand total of at least a dozen people. despite the fact that D has 2 perfectly good legs, he would sit in his wheelchair and insist on being pushed up and down the hallway for a good hour, obstructing traffic and generally being a pain. as the group walked (at a snail's pace) up our very narrow halls, they would stop at various rooms along the way and pick up other members of the community. note: when you are in the hospital and coincidentally know 2 other people on the same floor who also happened to get shot at the same time as you IT IS TIME TO MOVE. and on it went, sloooooow up the front hall, slooooooow up the back hall. back down to the room. repeat. then someone had the bright idea of wedging a couple of kids in a second wheelchair just to make sure that the entourage really took up all available hall space. this literally happened EVERY NIGHT.
now i realize that this sounds judgmental, and i'm certainly not saying that anyone deserves to be shot. but when you still have a house arrest bracelet on your ankle and i watch your 3 different baby mamas rotate shifts, i am inclined to believe that you are living in a gangsta paradise, and may just have played a small part in your fate. and when you refuse to do any of your own cares, snap and clap at the nurses to communicate your needs, and pee/poop the bed out of laziness and entitlement then insist that we clean you up despite the fact that you are perfectly capable of doing these things independently, i am inclined to resent you.
so to recap: we have a productive member of society. kind, polite, participates in own cares and follows medical instruction. then we have a felon. rude. obstinate. unwilling to do even the most basic things despite the fact that he is perfectly capable.
lets take a guess. who walked out (or was wheeled out by an entourage member, most likely) unscathed, and who is facing a very serious diagnosis with a crappy prognosis?
that's right.
Saturday, January 15, 2011
you have GOT to be kidding me.
Yesterday I got a very special patient out of the ICU. I don't mean special as in needs, or a crazy diagnosis. This guy is the stuff that stories are made of. I'm pretty sure that I will never [be able to] forget him, and here's why.
I was getting an ICU transfer and frankly I thought I was pretty lucky. He just had his gallbladder removed, was pretty stable, and just got admitted to the ICU overnight to monitor a preexisting heart condition. This guy is in his late 20s, walking, talking, and sounded like an easy patient. INCORRECT.
The guy rolls in and the first thing he does is strip completely naked in his bed because "I like to sleep naked". Sidenote: this is fine AT HOME IN YOUR OWN BED. Please do not make me see these things. Yes, I am a nurse, but that doesn't mean that I want to see 300+ pounds of what your mama gave you hanging out for 10 hours in a row. Ok. So the naked man now begins to give me orders because "I'm kind of OCD". Whatever. I spent the next half hour feng shui-ing his room and fetching a fan to aim at the wall because "I need circulating air", water, blankets, suction for when "I need to cough and there's this hunk of phlegm way back there and I need to suck it out", pillows, special pillowcases to wrap his legs in because the SCDs make his legs sweat...and so on. At this point I still thought maybe the evening could be redeemed. Maybe once I got him settled he would just leave me alone.
HA.
It is now 1600. At 1615 I go eat my lunch. If I don't go eat my lunch at 1615, I do not have time to eat and that makes me very sad. Needy needy man, of course, chooses now to request his bed bath. First of all, he already got a bath, and I know it. So I hinted around that he already got washed up in the morning, to which he replied "at home I take like 4 showers a day. I like to be clean". Can we say overkill? I could maaaaaaybe understand 2 showers a day, but 4? That's not cleanliness, that's mental illness. Fortunately for me, at 1600 we had no linens on the floor, and I got to postpone bath time until after lunch. So at 1700 I headed in with my big stack of towels and got to work.
Forgive me if I'm wrong. Normal people do not feel comfortable being completely naked and taking a bath in front of their parents and brother. Well, this patient thinks that's A-ok. He spent a good ten minutes lovingly scrubbing his special place while his entire family sat in the room. For the record: NOT OK. This led to a lively discussion about mom, who had back surgery and wasn't allowed to bathe at all for awhile. "Not even your cooter?" asks special patient. No, not even there. This conversation? Also NOT OK.
So I make the guy wash everything he can reach and I helped him with his legs and back. Then, to my horror, he whips out a tube of hydrocortisone cream and proceeds to tell me about his rash. Apparently the hospital soaps don't work well with his delicate skin. He then begins lovingly rubbing cream on his special place. Yes, his family got to see this delight as well. Oh but the fun doesn't stop there. He goes into excruciating detail about the rash on his butt, and asks me to "just lube up a finger and run it all up the crack really good".
Sidenote: this is my life. If I had a dollar for every time a freaky patient with no boundaries asked me to do something repulsive, I could leave this job like 10 times over.
So bath time is done, thank God. But not to worry! The fun is far from over. Unfortunately, this guy had a catheter in that had started to leak. The day nurse took it out, and every hour for the next 6 hours I got to go in and empty a tiny bit of urine from the urinal. This led to a lengthy discussion about diuretics and my patient's peeing habits. For the record, I do not enjoy hearing about your pee unless I ask you. Otherwise you can just keep that to yourself. Thanks. We also had another issue as my patient informed me that he "dribbles". This means that every time I emptied his urinal, I also had to bring him more linens for his "accidents". I'm sorry. 29 years old and haven't quite mastered the art of peeing yet? This may be a life skill that you should be working on.
And this all went on until 2300. Like clockwork, the call light would go off every 20 minutes and I would go down to his room and be presented with a list of four to five items that I would haul back to his room. Once I got down there, he would remember several other "favors" to ask me. It got to the point where I was praying to be fired or just drop dead...ANYTHING to not have to deal with this patient another second.
To clarify, I don't have a problem helping people, that's my job. I do however have a problem with excessive neediness. Group your requests together so I'm not doing laps up and down the halls. If you can do something for yourself, then JUST DO IT. Don't make me do it, don't make me watch you, I am NOT going home with you so if you can't wipe your own butt we need to figure that out before you go. And for the love of all that is good, HAVE SOME MODESTY. It will not kill you to wear a gown, so leave yours on, please.
So today I go back for more. Maybe he'll get discharged? Oh please oh please oh please.
I was getting an ICU transfer and frankly I thought I was pretty lucky. He just had his gallbladder removed, was pretty stable, and just got admitted to the ICU overnight to monitor a preexisting heart condition. This guy is in his late 20s, walking, talking, and sounded like an easy patient. INCORRECT.
The guy rolls in and the first thing he does is strip completely naked in his bed because "I like to sleep naked". Sidenote: this is fine AT HOME IN YOUR OWN BED. Please do not make me see these things. Yes, I am a nurse, but that doesn't mean that I want to see 300+ pounds of what your mama gave you hanging out for 10 hours in a row. Ok. So the naked man now begins to give me orders because "I'm kind of OCD". Whatever. I spent the next half hour feng shui-ing his room and fetching a fan to aim at the wall because "I need circulating air", water, blankets, suction for when "I need to cough and there's this hunk of phlegm way back there and I need to suck it out", pillows, special pillowcases to wrap his legs in because the SCDs make his legs sweat...and so on. At this point I still thought maybe the evening could be redeemed. Maybe once I got him settled he would just leave me alone.
HA.
It is now 1600. At 1615 I go eat my lunch. If I don't go eat my lunch at 1615, I do not have time to eat and that makes me very sad. Needy needy man, of course, chooses now to request his bed bath. First of all, he already got a bath, and I know it. So I hinted around that he already got washed up in the morning, to which he replied "at home I take like 4 showers a day. I like to be clean". Can we say overkill? I could maaaaaaybe understand 2 showers a day, but 4? That's not cleanliness, that's mental illness. Fortunately for me, at 1600 we had no linens on the floor, and I got to postpone bath time until after lunch. So at 1700 I headed in with my big stack of towels and got to work.
Forgive me if I'm wrong. Normal people do not feel comfortable being completely naked and taking a bath in front of their parents and brother. Well, this patient thinks that's A-ok. He spent a good ten minutes lovingly scrubbing his special place while his entire family sat in the room. For the record: NOT OK. This led to a lively discussion about mom, who had back surgery and wasn't allowed to bathe at all for awhile. "Not even your cooter?" asks special patient. No, not even there. This conversation? Also NOT OK.
So I make the guy wash everything he can reach and I helped him with his legs and back. Then, to my horror, he whips out a tube of hydrocortisone cream and proceeds to tell me about his rash. Apparently the hospital soaps don't work well with his delicate skin. He then begins lovingly rubbing cream on his special place. Yes, his family got to see this delight as well. Oh but the fun doesn't stop there. He goes into excruciating detail about the rash on his butt, and asks me to "just lube up a finger and run it all up the crack really good".
Sidenote: this is my life. If I had a dollar for every time a freaky patient with no boundaries asked me to do something repulsive, I could leave this job like 10 times over.
So bath time is done, thank God. But not to worry! The fun is far from over. Unfortunately, this guy had a catheter in that had started to leak. The day nurse took it out, and every hour for the next 6 hours I got to go in and empty a tiny bit of urine from the urinal. This led to a lengthy discussion about diuretics and my patient's peeing habits. For the record, I do not enjoy hearing about your pee unless I ask you. Otherwise you can just keep that to yourself. Thanks. We also had another issue as my patient informed me that he "dribbles". This means that every time I emptied his urinal, I also had to bring him more linens for his "accidents". I'm sorry. 29 years old and haven't quite mastered the art of peeing yet? This may be a life skill that you should be working on.
And this all went on until 2300. Like clockwork, the call light would go off every 20 minutes and I would go down to his room and be presented with a list of four to five items that I would haul back to his room. Once I got down there, he would remember several other "favors" to ask me. It got to the point where I was praying to be fired or just drop dead...ANYTHING to not have to deal with this patient another second.
To clarify, I don't have a problem helping people, that's my job. I do however have a problem with excessive neediness. Group your requests together so I'm not doing laps up and down the halls. If you can do something for yourself, then JUST DO IT. Don't make me do it, don't make me watch you, I am NOT going home with you so if you can't wipe your own butt we need to figure that out before you go. And for the love of all that is good, HAVE SOME MODESTY. It will not kill you to wear a gown, so leave yours on, please.
So today I go back for more. Maybe he'll get discharged? Oh please oh please oh please.
Wednesday, January 5, 2011
have i mentioned lately that i love my job?
septic medicine patient from africa? she might have tuberculosis. and considering the fact that i spent about 20 hours with her without a mask, if she has it i've been exposed.
when i go to the doctor there's a question that asks if you've been exposed to any hazardous materials. i usually say yes and write "patients" by way of explanation. this is why.
so now we wait for the results of the bronchoscopy.
when i go to the doctor there's a question that asks if you've been exposed to any hazardous materials. i usually say yes and write "patients" by way of explanation. this is why.
so now we wait for the results of the bronchoscopy.
Thursday, December 30, 2010
eventful PM
when i write notes and have nothing to say, i usually start with "uneventful PM shift". tonight did not apply. a rundown of my special friends
1. a spanish speaking only man who got drunk and fell down. apparently sometime during the festivities, he knocked a tooth loose. i came into his room to answer a call light. he says "mi diente" and hands me his left front tooth. i tell trauma, who go put the tooth back in the socket and make a gauze dressing. when i checked on the patient 15 minutes later, the tooth was on his bedside table. he had taken it out to eat a chocolate chip cookie. needless to say, the tooth will not be getting replaced. when i tried to explain this to the patient in my minimal spanish, he was very understanding. he plans to "just get dentures".
2. a twentysomething in a car accident...not much excitement there.
3. a septic medicine patient from africa who speaks only a rare dialect that we don't have an interpreter for. temp of 103.2. heart rate 127. shaking chills. can't seem to find a source of infection. i have been watching too much House, and therefore am somewhat convinced that she has Dengue fever and so do i. but not to worry!! per the progress note "risk of morbidity: medium". lets all breathe a sigh of relief for that one.
4. and finally, a man who got his arm stuck in a grinding machine. surprise surprise, he too is a spanish speaker!! (in case anyone is keeping track, i'm at a 75% language barrier here). but as it is not enough to simply get your arm almost ripped off, he now is in uncontrolled A-fib. hopefully he doesn't need a doctor for any reason, because he's lucky enough to be a plastics patient, which means that his doctor will not call back, even after you page him 3 times to ask a question.
then on the way out of work, we had to walk through an arrest. security and the police were gathered in the middle of the hall handcuffing and frisking a man. nobody batted and eye and we walked on through. just another day on the trauma floor :)
1. a spanish speaking only man who got drunk and fell down. apparently sometime during the festivities, he knocked a tooth loose. i came into his room to answer a call light. he says "mi diente" and hands me his left front tooth. i tell trauma, who go put the tooth back in the socket and make a gauze dressing. when i checked on the patient 15 minutes later, the tooth was on his bedside table. he had taken it out to eat a chocolate chip cookie. needless to say, the tooth will not be getting replaced. when i tried to explain this to the patient in my minimal spanish, he was very understanding. he plans to "just get dentures".
2. a twentysomething in a car accident...not much excitement there.
3. a septic medicine patient from africa who speaks only a rare dialect that we don't have an interpreter for. temp of 103.2. heart rate 127. shaking chills. can't seem to find a source of infection. i have been watching too much House, and therefore am somewhat convinced that she has Dengue fever and so do i. but not to worry!! per the progress note "risk of morbidity: medium". lets all breathe a sigh of relief for that one.
4. and finally, a man who got his arm stuck in a grinding machine. surprise surprise, he too is a spanish speaker!! (in case anyone is keeping track, i'm at a 75% language barrier here). but as it is not enough to simply get your arm almost ripped off, he now is in uncontrolled A-fib. hopefully he doesn't need a doctor for any reason, because he's lucky enough to be a plastics patient, which means that his doctor will not call back, even after you page him 3 times to ask a question.
then on the way out of work, we had to walk through an arrest. security and the police were gathered in the middle of the hall handcuffing and frisking a man. nobody batted and eye and we walked on through. just another day on the trauma floor :)
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