Tuesday, June 30, 2009

Post of the Day Award!!

Thank you very much AuthorBlog!! I am very honored that you choose my blog for your Post of The Day (POTD) today!!

If you have not been to see AuthorBlog, please click on the link and go for a visit. His blog is very intersting, funny, and overall a great read! Also go visit the other blogs he chose for POTD.


What Lies Beneath

Keeping to the nursing home theme from yesterdays post, I would like to share yet another tale of nursing home days long ago.

I had just started picking up some night shifts for overtime. I loved working with the night shift girls. It is no secret in nursing that night shift is a breed all its own. The girls began to tell me of the "ghost stories" of this facility. How they would see things, hear things, call light going off in rooms that had no one living in them, etc. This in turned totally freaked me out. Everyone knew if there was a call light going off, we were going to work in tandum. I hated going into rooms alone, just because I never knew what I was going to find. I sure didn't want to come face to face with that black figure they had all seen lurking around.
On one particular night, I was working with some of my best friends. We were all pretty tired because we were all on overtime. It was the middle of a bed check and we were at the far end of a long long hall. All of the sudden we hear a call light going off. I told the girl I was with that I would go and get it. I didn't really want to but I was trying really hard to overcome the fear, and be a big girl. In essence it was high time I "put my big girl panties" on. I needed to prove to them that I wasn't the "scaredy cat" they all thought I was.

I went down the long hallway that was poorly lit (we turned the hall lights down at night), and turned the corner to the short hallway that finished off this unit. There it was, the call light that needed answered. I found it a little odd that the call light was on in this particular room. The lady living in that room was very old, bed ridden, deaf, and demented. She had no idea what the call light was let alone how to use it. I kept trying to tell myself that maybe she accidently hit the call button or something. I was determined not to be afraid. There was no one really close so no one would know that I turned on the room light just to walk in and turn the call light off. The reset button was right next to this lady's bed. I turned off the call light then I reached over and pulled this sweet lady's cover back over her, she had kicked most of them off. Just as I was reaching into her bed to grab the covers. . . . .
something grabbed my ankles!!!!! There was a tight grip on BOTH of my ankles. I couldn't move. All I could do was scream at the top of my lungs and before I knew it I was standing in a nice warm puddle.
Thank goodness this lady was deaf. She had no idea what was going on around her! The hands that gripped my ankles let loose, I am sure because they were now quiet wet. And all I could hear was giggling coming from below the bed.

Two of my "dear friends" who knew my fears, had planned this all night. They had been the ones to push that call button. What was so funny is that one of them was sure I wouldn't be able to scream. We had talked about fearful times before and every time I had been in a situation where I should have been scared enough to scream, my mouth would come open but nothing would come out. So they felt it pretty safe that no noise would come from me.

It was terrible!! However now it makes for a great story when we are reminiscing of days gone by. Everyone remembers the day I had to borrow a pair of sweat pants from the unclaimed clothes in the laundry department.

Let me assure you that pay back for those people was OH SO SWEET!!!

(that is a tale for another time . . . .)


Monday, June 29, 2009

She called on, Jesus, Mary AND Joseph. . .

Catherine was quiet a feisty lady. She was at least 80 yrs old and I was somewhere in my 20's when I was her Aide at the nursing home she lived in. She had raised many children, lived on and worked a farm with her husband, until they were no longer physically able. She knew the meaning of tired to the bone.
She had dementia. Her husband had already passed on several years before this, and her children had important lives to lead. They would come visit at Christmas and Thanksgiving and sometimes even on Mother's Day. But I am not sure at this point Catherine really even noticed. We had become her family, and she had become "Grandma". That is what she answered to, so that is what we all called her.

She was no longer able to walk, however she couldn't seem to remember that. She was in a wheelchair with a "lap buddy" or a tray. It really depended on the day and how feisty she was at that moment. She was able to stand but only long enough to move her from the bed to wheelchair or from the wheelchair to the toilet. Her bed was 6" from the floor with a soft mat laying on the floor beside it. She was forever trying to get out of bed, forgetting she wasn't able to walk, and then would fall. So to help prevent her from breaking anything (like a hip), her bed was lowered as low as it would go.

"Grandma" taught me how to think fast, and move fast. She hated to get out of bed. She hated to get a bath, she hated to get dressed, and she never wanted to give up her teeth for the night so they could get cleaned and soak. I learned real fast, that if I was going to make it out of her room without bleeding I had to hurry and get her dressed and bathed just as fast as I could. See, Grandma I am sure was a street fighter in her younger days. She had a great right hook!! She would hit, yell, curse, bite, pull hair. Whatever it took to get you to leave her alone. But once you were done that was the end of the battle. It was like she totally forgot you just lost 5 pounds of sweat just trying to dress her for breakfast. Once in her chair she was happy as a lark.

I learned one night while putting her to bed that if you talked real sweet to her, she would be nice just long enough to get her teeth before she bit you. See, no one was able to get those teeth out of her mouth without getting bit. She just wasn't giving them up. I would get her laughing and before she even knew what happened I could do a one finger sweep and get the bottom plate right out of there. As soon as she realized it though, she would be mad as a hornet!! But once the bottoms were out I was less afraid of being bit. See, if you can hold the bottom jaw down long enough to get the top plate out, you are home free. Just watch out for her hands because she would be swinging by this point. I could have this whole tooth thing done in a matter of less than 2 minutes.

"Grandma" was my favorite nursing home resident. I think it didn't bother me that she beat me up everyday when getting dressed and undressed because I knew she didn't know what she was doing. After her teeth were out it wasn't as hard to deal with. I would be changing her clothes while she was knawing on my arm. Her teeth were already out so she was just "gumming" me to death. That didn't bother me in the least and it kept her busy and satisfied until I got her clothes changed.

However, keeping her nails trimmed was quiet a chore. You let those babies grow too long and you were in trouble. I have scars on my arms to this day from sweet little "Grandma". I think of them as my way to never forget her!

I remember one morning I went to get her up. It was early probably 5am, but I had alot of people to get up and dressed before breakfast and I knew she was going to put up a fight no matter what time I did it, so I just as soon get her done. I went in and knelt down by her bed, rubbed her forehead and talked real sweet to her, trying to wake her up in a good mood. She looked at me with utter disgust and said, "Well, Jesus, Mary and Joseph, but especially Joseph!" I think this was her way of saying. . . 'I have been up with the chickens my whole life, can you not just let me be for one cotton-pickin' day?'

Grandma wasn't always combative, sometimes she could be so sweet. She would tell us she loved us and give us a sweet little kiss on our cheeks. And if you weren't careful when you walked by her wheelchair, she might just give you a little swat on your behind, and chuckle like a mischevious child.

The nursing home was awfully quiet after "Grandma" passed on. Of course her family showed up just in time for that, even though they had not been there much of the other time. "Grandma" had us with her too. She left this world only after making an impact on many lives of those who cared for her. Most of us in our 20's to early 30's thought we had it all figured out. "Grandma" helped us remember what is important about life. Loving someone even though, even if and even when.

She loved her family even though they didn't visit, even if she was mean to them too, and even when she couldn't remember who they were.

And we (her caregivers) love "Grandma", even though she yelled and hit, even if she pulled our hair and bit us, and even when she would slap our behinds and give us those sweet kisses.
One can not have too many Grandmas!!!


Inflammation. . . . damaging the sheath

She was 37 years old, with complaints of progressive weaking in her lower extremeties over a couple of weeks. It really started with slight neck pain, then to the lower back. Then all of the sudden her left leg was really weak, then the right. By the end of the two weeks, her husband was calling 911 because she could not move any part of her body from her belly button down. She was unable to urinate, unable to have a bowel movement, unable to wiggle her toes, unable to lift her feet or legs off the bed. She could feel them if you touched them but she could not move anything! She kept complaining that her legs were tingling like they were asleep, and that they were so heavy she couldn't lift them. She really wasn't having alot of pain other than a headache and some "muscle pain" in her shoulders.

After several tests including x-rays, MRI's, a lumbar puncture, and blood work up they diagnosed her with Transverse Myelitis. What is Transverse Myelitis you ask? I am going to give you the short version since I have also left you with a very informative website. The website is where I am getting all my information for this post as well.

This is an MRI of the thoracic spine (the part between your neck and your lower back). The grey solid area in the middle is your spinal cord. The white area where there is an arrow (very difficult to see) in the spinal cord is the area of inflammation. The really white areas that kinda outline the solid grey spinal cord is CSF (cereberal spinal fluid).

Transverse Myelitis is not limited to age, sex or race. There does not have to be any family history of this for you to have it. Most cases occur however, at the ages of 10-19 and 30-39.

It is a neurological disorder that is caused by inflammation across the spinal cord. Inflammation can actually damage or destroy myelin, which is the fatty substance that insulates and covers nerve cell fibers. This ends up causing scaring on the nervous system that interrupt communication betweent he nerves it the spinal cord and other parts of the body.

There are many things that can cause Transverse Myelitis, such as viral infections, insufficient blood flow in the spinal cord, complications from syphilis, measles, lyme disease, certain vaccinations (ex: chickenpox and rabies). It often developes following viral infections such as varicella zoster, herpes simples, cytomegalovirs, Epstein-Barr, influenza, echovirus, HIV, Hep A, and rubella.

Because some affected individuals also have autoimmune diseases such as systemic lupus erythematosus, Sjogren’s syndrome, and sarcoidosis, some scientists suggest that transverse myelitis may also be an autoimmune disorder. In addition, some cancers may trigger an abnormal immune response that may lead to transverse myelitis.

An acute, rapidly progressing form of transverse myelitis sometimes signals the first attack of multiple sclerosis (MS), however, studies indicate that most people who develop transverse myelitis do not go on to develop MS. Patients with transverse myelitis should nonetheless be screened for MS because patients with this diagnosis will require different treatments.

Symptoms may develope over several hours to several days/weeks. Usually starting with lower back pain and/or sudden burning, tickling, prickling or tingling in the legs, as well as partial paralysis of the legs. This paralysis usually progressed from the legs to the lower part of the trunk. Bladder and bowel dysfunction is very common. The patient will likely feel general discomfort, headache, maybe a fever, loss of appetite and muscle spasms. Depending on the area of the inflammation on the spinal cord, some may even experience respiratory problems.

There is currently no effective cure for Transverse Myelitis. Treatment is meant for managing the symptoms and really depends on the severity. Steroids to degrease the inflammation, they also reduce the immune system activity since there is also suspected autoimmune involvement. Then there is pain control. The goal is early treatment and keeping the boy functioning, while waiting and hoping for some kind of spontaneous recovery of the nervous system. Physical therapy place a huge role in this, with range of motion and keeping those muscles moving.

Recovery typically begins within 2 to 12 weeks of the onset of symptoms and may continue for up to 2 years. However, if there is no improvement within the first 3 to 6 months, significant recovery is unlikely. About one-third of people affected with transverse myelitis experience good or full recovery from their symptoms; they regain the ability to walk normally and experience minimal urinary or bowel effects and paresthesias. Research shows that a rapid onset of symptoms generally results in poorer recovery outcomes.

Many people with Transverse Myelitis only have one episode, however there is always a chance it can rare it's ugly head again. When/if it does return there will likely be more workups for underlying causes such as MS or systemic lupus erythematosus. Most people who have more than one episode have some kind of underlying disorder.

Now that you have had some education, let me tell you that I have seen this many times in my years of nursing. It is very scary for the patient and family. One day you have control over your own body and the next day, you can't move! People think they are just tired, been doing too much, and pretty much let it go. Thinking they just need some much needed rest.

This particular patient I cared for after she had already spent over a week inpatient. She was scheduled to go to an inpatient rehab hospital for intensive Physical and Occupational Therapies. She was diabetic, had been on 1000mg of Solumedrol for 5 days. That is ALOT!!! Her blood sugars had been hard to control because of all the steroids, so she was having to deal with that aspect as well. They also had her on Baclofen to help with the muscle spasms, as well as low doses of Vicodin for pain. While in the hospital she was also receiving therapies. She had a foley catheter, because she was unable to urinate, and she was having trouble with her bowels. They just didn't want to work.

Her husband was amazing! He never left her side. He was right there caring for her and doing whatever it was she needed at that moment. Her spirits were good. When she was admitted to the hospital, as I stated before, she could not move ANYTHING from her belly button down. The day I had her, the day prior to her discharge, she was able to lift her left leg (the first leg to be affected) off the bed. Now, she was not able to lift it far, but she did get it off the bed. She also couldn't hold it for long and was unable to hold it against pressure. But she was making progress.

Her attitude was amazing. He kept me in stitches all night. She and her husband both should have been stand up comedians. Most patients of this age would have found themselves in a heap of tears and doom. Looking only at the possibility of never being able to move again. Not this young lady. She knew she was going to recover fully and have a full normal life.

I have not heard of her or seen her back at my hospital since that night. My prayer is that she did recover. That she is home with her husband, living life to the fullest!


Friday, June 26, 2009

To ICU or Not?

I had a 47 year old patient several months ago that was admitted from an outside hospital because he had a ruptured appendix that ended up causing a MAJOR infection. He had been in our hospital for about 4 weeks and had just been transferred from ICU that morning.

He was extubated the day before, had been in a vest restraint as well as soft wrist restraints in ICU because he has pulled out a total of:

* 3 IVs
* 1 PICC Line
* 2 Small bowel feeding tubes
* 1 Foley catheter
* 1 Rectal tube
* 2 Chest tube
*Rectal Tube - the large blue end in the bottom left
of the picture is what is inserted into the rectum.
It is then inflated like the picture above to secure placement.
The other end of the long tubing is connected to a collection bag.

*Small Bowel Feeding Tube - Inserted into the nose down the back of the throat through the esophagus and stomach to the small bowel. Can be used to give liquid feedings and medications for patients that can't swallow well and are at risk for choking.
This was all included in my shift report at the beginning of my shift. The day shift nurse also told me he had been "pretty good" that day. He was no longer in restraints. He did however have a sitter, and his mother stayed in the room with him. But he wasn't pulling at anything. Well, HELLO??? Was there anything left to pull out??? He did have PICC Line but that was all that was left. He was only really oriented to his name. He had no idea where he was or why he was there. He could not tell me the year or who the president was. He was very confused and most of what he said didn't make sense. His mother was off the chain!!! You could tell she was so worried about him and she just wanted to do whatever she could to make him better, but really she couldn't do anything but sit there and listen to him talk crazy and drop the "F" bomb about every 45 seconds.
On first assessment he complained he couldn't breath. He thought his lung was collapsing again. His assessment was negative, however I did call the doctor just to inform her of how he was feeling, even though his lungs sounded great. He was pretty anxious so I ended up giving him oxygen just to make him feel better. I actually worked. It gave him something to play with. He didn't keep it on however. But since his O2 sats were 98% on room air, I wasn't really concerned too much.

As the night progressed, he became more and more confused. He was increasingly agitated and began hallucinating. He was seeing birds in the room, he thought there was a fire in the room. He also told the doctor how beautiful her ears were, they looked just like those of a baby deer. He was so sweet when he said it, he was sure he was giving her the grandest compliment.

I had been giving him, per her orders, Fentanyl 50-100 Mcg IV for pain. He could have it every 3 hours. Normally it would have made other patients sleep for a while. He was not sleeping. He was crawling out of bed, yelling, and requiring me to be in his room ALOT. I had 3 other patients so this was not that easy. She had me begin using Ativan to see if that would calm him. Two mg would calm him, but only for a short time. She decided to put a request in for a med psych bed and we were going to transfer him once there was a bed available. Well in the middle of the night this is not a quick task.
He kept complaining about his breathing and I kept talking to the doctor about it. Finally we got a chest x-ray, ABG's and some other labs. His x-ray didn't come back too bad but his ABG's were all jacked up. The doctor stated to me that if he was in ICU she would be intubating him right now. Then she said she was calling the ICU resident and they would probably intubate him and take him to ICU. She wanted to intubate him on the floor, without having the rapid response team or code team there.
While she was on her way to the room I called my house supervisor who also came because she was not going to allow anyone to be intubated on the floor without the team there. Well, short version, the ICU doctor wouldn't take him in ICU. They had 9 admits already that night and he and the other doctor that I was dealing with collaborated back and forth on what to do.

Ultimately he ended up with a 50% venti mask and alot more drugs. She said pretty much he was hyperventilating. He wouldn't slow down to breath well enough to get good air exchange. So she wanted him as sedated as I could get him without sending him to the ICU so he would breath slower and more calmly.

He ended up with the Fentanyl every 3 hours; 2 mg of Ativan every hour, and 5 mg of Haldol every 3 hours. I calling her before I gave any of it because he really wasn't going to sleep. He was calming down some but it was really hard to keept he mask on him. He kept taking it off. I was so afraid all the meds were going to catch up with him and eventually knock him on his butt! The doctor was calling me about every hour (when I wasn't calling her) checking on him. There was so much charting to do just to keep up with what we were doing with him. And then there were my three other patients.
He ended up sleeping about 45 minutes out of my 12 hours shift. Med Psych never had a bed, the meds never caught up with him.
I reported off to the day shift and apologized because he was going to be so much to handle. I recommended her getting him off the floor as soon as she could because he was really a 1 on 1 patient and this floor doesn't staff that way.
I went back to that floor 3 days later. . . . .
He was being discharged to home as I was coming on to my shift. He was a new man!!! Evidentally that day shift after I left him last, he was quiet. He didn't cause them any trouble at all. And by that next evening shift he was off all oxygen and totally alert and oriented and no longer hallucinating.

Now you tell me what causes someone to change mental status so quickly!!! I worried about him and the day shift nurse the whole time I was off that day. And within less than 24 hours he is totally a different man!!!
AMAZING, what a body goes through!! How much it can handle and how quickly it will recover sometimes. I was glad to see him going home. Not because I didn't want to take care of him again (although, it did make for a really rough night!!!), but because he was becoming more himself. He had a young daughter to go home to. He had a life. He was not an ill person before all of this. He was hallucinating and acting crazy before the doctor had me giving him all the meds, so it wasn't the meds causing him to be acting crazy. But whatever it was, it was better. He was going to be ok. He would be back to work in a few weeks after his surgical incision healed and hopefully he would have little memory of his bizzare behavior in the hospital.
Thank God for selective memory!!
Today, I wish him well as he should be fully recovered and living a full and happy life with his family, what mattered most to him!!!

Thursday, June 25, 2009

Is it wrong to need people to be sick. . . .?

"When you're a nurse you know that
every day you will touch a life
or a life will touch yours.
-- Anonymous
Ok, so this is going to be quickie! It was jut running through my mind how a census can change so quickly at a hospital. I heard this past week that a major hospital in our city was on diversion. We received alot of admits because of this. Our census went way way up. Which for me is a great thing because I get to work. Then this week, census is way, way, way low. I have been scheduled for three shifts so far and only worked one of them. I was cancelled the other two! This is not good when you are nonbenefited!
So is it bad to want people to be sick? Because my job and lively hood depends on it?
Or maybe I should just pray that the people who are already sick and at home and refusing to get medical attention for whatever reason, FINALLY decide to show up so we can make them well!!!
THERE! That is better. I don't want people to be sick so I can do my job!!! Just want the sick people to use their heads and get help.
Good grief, I hope I don't get cancelled tonight. This is certainly messing up my sleep pattern!!! I sleep all day then try to go to work then get cancelled then up all night!
Gotta run!!! Got to get ready for work!!!


MRSA & C-Diff

Have you ever smelled MRSA. . . . .what about C-Diff. If you haven't you probably have no idea what I am talking about. If you have, it is a smell you remember for life. One that goes with you in your nostils after you leave your place of employment. And the only way to rid that smell is to immediately take a shower and try to drown yourself with the water spraying from the hot-as-you-can-stand-it shower.

I walked into a patient room, knowing the patient was there because of cellulitis of her foot and diabetic foot ulcers. Also by this time it was known that she had osteomylitis. What she didn't know at this point was that she would most definatley be losing part of her foot before this hospital stay was over.
Anyway, as I was saying. . . I walked into her room and immediately smelled it. MRSA!! She wasn't in isolation yet, I guess they were waiting to get the wound cultures back to confirm what we already knew. It was MRSA in that foot! I backed out of the room and went ahead and called for an isolation cart for the room. Once it arrived I gowned, and gloved and went in to see what the smell was all about. The closer I got to her bed the stronger the odor was. I thought I was going to lose my lunch! I could see blood stains on her sheets around her feet. I uncovered them and the odor just about knocked me on the floor. There were two large wounds on her right foot. Her big toe was about twice the size it should be, and very red and the reddness was halfway down her foot. On the back side of the toe it was all black and oozing clear/pink drainage (serosangous). There was no dressing on this wound just left open.

There was another wound just below the toe on the bottom of the foot. This was about the size of a dime and I could see bone inside it. If you picture it like a bullseye, it would look like this: immediately around the opening is a thin, hard black ring, then a hard white ring, then the rest of the foot is red and hot. This wound had thick, yellowish, puss draining from it (purulent). It did however have a dressing over it. It had a dry 4x4 gauze that was STUCK to it. I took that off and cleaned it all.

I asked her what she used at home as a dressing and she said usually she got out of the shower and would dry it off and put toilet paper on the bottom one. She didn't know about the one on her toe. She didn't know it was there and had not seen it. She just knew her toe was red and hurting. So, I guess that explained why I was digging toilet paper out of that wound huh? GROSS!!!!

I put a wet to dry dressing on it because there weren't really dressing orders and I knew the podiatrist was doing to be seeing her in the morning and hopefully telling her what the plan was. She was really wanting to get home. She had no clue how serious this was. The xray showed definate osteomylitis. She was on 2 different antiboitics and she was going to leave the hospital, minus one toe.

I felt bad for her because she was in such deniel. She was non compliant with her diabetes. She didn't take her medicines at home, she didn't eat right, she had poor hygeine. All of this leading to the condition her foot was in now. AND. . . she was in her mid 50's!!!

About two hours after I did all the work on her foot, I went to help her to the bathroom and low and behold. . . . C-DIFF!!!! She had been on antibiotics evidentally just long enough to cause her to have C-Diff. Now not only did I have to smell the wound infection in the room. . . . I could smell the C-diff all the way to the hallway.
At the end of this shift. I was wishing we had a staff shower that we could use. I so didn't even want to get into my car or come into my house I was feeling so grimey! Poor lady, had to live in that room with that smell! And she was still going to lose her toe! AND. . .ALL cultures came back positive. She did in fact have C-Diff and MRSA!

Moral of this story~~~~

If you are diabetic, take care of yourself. Keep your sugars in control, take your medicine and pay attention to your skin. And for goodness sakes DON'T DRESS A WOUND USING TOILET PAPER!!!

**If you dont' know what C-Diff and MRSA are let me know. I will do a little more education in another post!


Monday, June 22, 2009

Defying Gravity!!!

I recently went to see the musical Wicked.

I have to say I absolutely loved, loved, LOVED it!!! There are a couple of songs in it that have brought me to tears at times and also made me think back in my life of different times.

This particular song, "Defying Gravity" makes me think about my time in nursing school. See, many of you who read this really don't know me. Not the real me! So let me tell you a little.

I was an "OK" student in high school. Really? I did just enough to graduate, nothing more! I had a high school counselor who actually told me after I took the SAT's that I wouldn't even be able to get into a community college because my scores were so low and my grades were not good enough in school. So I might as well decide now to try something else. That was a real downer!! Actually, I don't ever remember in all my high school years ANY school counselor, acedemic advisor, teacher, or any other adult leader, telling me what classes to take or advising me on things to do to actually make it to college. No one telling me that I should take the harder courses not just the easy ones.

I decided to try college anyway. My grandmother was an elemetary school teacher and the job I had as a high school student was working in a day care. So, how hard could it be to become a teacher. I liked kids. So I thought I would try that. Maybe kindergarten, since the older kids really just mostly made me angry with their attitudes. Well, short version, I did get into the local college. I again didn't have much help putting my class schedule together and ended up with a crazy schedule of pretty in depth classes the first semester. Needless to say, I didn't do so good. I hated it actually. So I guess I proved that high school counselor right when I decided to quit school after a semester and a half!!!

Back to working at day cares and minimum wage jobs for me!! That was not going to land me anywhere fast. I then ended up in a nursing home working as a CNA for a long long long time. I watched as the nurses would get burned out. I watched as I would get angry at lazy nurses. I watched as the older CNA's would struggle with their job because of their age, yet this is what they had done all their lives and couldn't/wouldn't do anything else. I knew that I didn't want to be a CNA forever! I couldn't live on that kind of money. This is where I also decided that maybe being a nurse was for me. I wanted to be better than those nurses who were just there for the paycheck. I wanted to be a nurse who really cared.

I fianlly decided to go to nursing school. (that decision in itself is a whole other post!) I was 29 years old when I walked into class for the first time. There were many people who thought I was crazy. Many people who thought I didn't have what it took. And some who thought I wouldn't make it at all. There were also moments when I myself thought I was drowning and wouldn't make it through. Being in classes with those young, right out of high school kids who had planned for years to be a nurse and took all the biology and anatomy they could in high school was pretty intimidating! I had alot going against me at different times during my college years. I cared for a grandmother who had Alzheimer's. I also helped care for a mother-in-law, who had Alzheimer's, and I had a family! It was by far the hardest thing I have ever done. AND looking back, I truly feel that I did EXACTLY what I was supposed to do. I am EXACTLY where I am supposed to be in my life. I have no doubt about that at all!!!

I really did DEFY GRAVITY!!!

Below are the lyrics to that song from the musical Wicked. Every time I hear it, I think of how I overcame the odds and made something of myself!

(I did leave off some of the lyrics at the end, but this is the jist of it)


Something has changed within me

Something is not the same

I'm through with playing by the rules

Of someone else's game

Too late for second-guessing

Too late to go back to sleep

It's time to trust my instincts

Close my eyes: and leap!

It's time to try

Defying gravity

I think I'll try

Defying gravity

And you can't pull me down!

I'm through accepting limits

'Cuz someone says they're so

Some things I cannot change

But till I try, I'll never know!

Too long I've been afraid of

Losing love I guess I've lost

Well, if that's love

It comes at much too high a cost!

I'd sooner buy

Defying gravity

Kiss me goodbye

I'm defying gravity

And you can't pull me down


It's got to be hard being the "on-call" doc

James was admitted one day before I was blessed with him on my assignment. He was a 70'ish year old man with a very distended and firm abdomen. He was scheduled for a colonoscopy the next morning so I had the previledge of administering the bowel prep. He was sitting up in a chair with his wife, son, dauhter-in-law, granddaughter and grandson visiting him , when I started my shift. I quickly went in did my assessment and got out, giving them time to visit and giving me time to see my other patients before I would be busy with this bowel prep.

He had been having a little trouble breathing when he was in bed because of the pressure from his belly. So sitting up made him feel better. I explained what the evening was going to consist of and told him I would be back in about an hour to get everything started. He had already been drinking miralax so we were well on our way with the easy part of the prep.

About an hour later I came back and was going to talk to him about the timing of the enemas and how much miralax he still had to drink, but I was incredibly distracted by the wheezing and coughing I heard from him. He had not been doing this when I was in the room an hour earlier. His face was flushed and he was freezing. His wife had 4 blankets on him.

I helped him back to bed, raised the head of the bed up so he could breath better and took his temp. . . 101.9! Great! I asked him about the wheezing and couphing and he said he just started that. I listened to his lungs and they did sound a little wheezy too. He was NPO (nothing by mouth) so all I had for the temp was a tylenol suppository. So we postpone the enema (x2) that was supposed to be the next part of the prep, and go straight for the suppository. I called the doc about the wheezing, as he also had a heart history, and I was a little concerned about fluid overload with the fluids they were giving him. We ended up with a chest xray that came back clear, and respiratory treatments.

I no more got that order written and sent to the pharmacy, that I hear his pulse oximenter beeping. His oxygen had dropped to 82%. . . and he was already on 3L of oxygen. I called the RT (respiratory therapist) to get the neb treatments now, and put him on a 50% venti mask.

Poor guy, stayed on a venti all night long. I can't even begin to tell you how many times I called that doctor. I felt so bad for her, calling in the middle of the night but I really didn't have alot of choice. She was the one on call. However she was not the doc that had been seeing this patient, so we did alot of conversing and putting our heads together to keep this guy comfy through the night.
One of the times I called her was for a critical lab. His INR was way high. So high that I knew they would surely cancel the colonoscopy scheduled for the morning. Then by 6:00am (my shift ends at 7:30) his blood pressure was dropping. I had to call her yet again, because it was below the call orders. I also inform her that this patient has been getting fluids all night and has not urinated. We did the enemas, but had no results, and his belly is bigger than it was when I started my shift, AND his face is a little puffy, and his arms are a little puffy (they weren't this way to begin with). By this time the wife is getting a little freaked out. The on call doc simply said, Dr. Surgeon (who was his admitting doc) will be in in a couple of hours. See what he wants to do.

I go to inform the wife that I am sorry, we will have to wait for Dr. Surgeon to get here. I let her know that the on call doc said Dr. Surgeon should be here early. She thanked me and seemed ok with this information. I however felt terrible, my gut knew something was not right!

What I wanted to do was stop the fluids, sink and NG and get it hooked up to suction, anchor a foley and give the man some lasix. But of course I am just the nurse. . . . I had to trust Dr. OnCall and wait for Dr. Surgeon to get there.
I reported off to the day shift nurse and told her all my concerns. She then informed me that Dr. Surgeon is NEVER there before 10AM and since this is a weekend, it would probably be later. I then asked if there was someone else I could call before I left to try to get something done before I clocked out. She just looked at me with this really dumb look and said, "No, but thanks." She really didn't appear that concerned about anything I had told her.

I worried about this man all the way home. I went to sleep and woke up to get ready for my next shift still with him on my mind. Wondering what was done and was the nurse attentive enough, proactive enough, to take care of him.
I didn't work that same floor that next night. However what I learned was that the colonoscopy was in fact cancelled and Dr. Surgeon didn't come in until around 11 and took him straight to the OR. I am assuming they did a bowel ressection, but I have not heard that. Last I had heard, he was still vented in ICU. As soon as I heard the news, I went to the ICU waiting room to see if his wife was there. She never left his side since the day he admitted so I thought maybe she would be sleeping in the ICU waiting area. She was no where to be found. When my shift was over, I stopped by the ICU waiting area again, and still was unable to find her.
All the way home that morning I prayed for him to recover and for his wife to have her husband back at home with her. I have thought of them several times since then. They were a very sweet couple and I felt so bad for them and what they were enduring that particular night.

I never did fine out what the outcome was with James. This is the part of the job that is hard. I have to care for them and let them go. However there are so many that I can't let go of. They remain with me as a gentle reminder of why I love my job. This is the part of my job where I learn to have faith in God, knowing that He will take care of these people. Either way. . .


Forever Changed . .

Not long ago I was blessed to care for an incredibly brave woman. Not that most of the patients I care for aren't brave but this one was different.

She came to the ER because she was "turning yellow". She was in her 80's had already suffered and mostly recovered from a stroke a few years earlier. She had just a few minor residual effects from that stroke. In the ER they did a scan, admitted her to the general med floor where she stayed for 3-4 days. She learned during this stay that there was a mass on her pancreas. Not only was there a mass, but she had cancer, it had already metastasized to her liver and basically she was told there was nothing they could do for her. She was not a surgical candidate and really it was too far already to start treatment.

The family all gathered around and took shifts staying 24/7 with their mother as the doctors worked to find ways to improved her quality of life. To see if there was anything that could be done. They changed her to a DNR, and were making plans to take her home to die at home.

Issues. . . her INR was off the charts!! I am not sure I have ever seen one this high. We were giving her Vitamin K to help reverse it and decrease the chance of spontaneous bleeding, but it was not working. After several doses of Vit K the INR results were left unchanged. Her liver was not functioning enough to make the clotting factors needed to bring the INR back down. The original plan was to get the INR down and send her home.

The night I cared for her, was crazy. I had the Resident on speed dial and he spent many hours talking to the family, and on the phone with me. The patients IV went bad. We were giving her fluids to help with her blood pressure because it had been so low, she was also receiving antibiotics through the IV. I pulled the bad IV with the intentions of starting a new one, however that didn't work out. When the bad IV was pulled, the bleeding started. I held pressure on that spot for literally one hour! That is not a good thing when you have 3 other patients on your assignment. I called for help from another nurse who tried to start another IV while I held pressure on the bleeder. He tried twice to get the IV and both times the vein would blow then more bleeding. The doctor was called about the IV site problems then came questions from the family. I spent many hours at the bedside of this sweet lady. Comforting her, answering questions and trying to help them make sense of this sudden diagnosis and what to expect. They were a very attentive family. They loved her very much and that was evident. They wanted to make sure we were doing everything possible. They were fine letting go if that was the only option, they just wanted to be sure. They were scared, and I could certainly understand that.

She didn't get much sleep that night. It seemed there was a reason for me to be in that room at least every hour. Then when morning came and it was time to check vitals again, her blood pressure was 70/40. At this point I again called the in house Resident. We both thought there was probably internal bleeding going on. It only made sense. When the patient saw this blood pressure on the Dinamap, she looked at me as serious as could be and said, "I'm dying aren't I?"
HOLY COW!!! What am I supposed to say to that? I sat on the corner of her bed, held her hand and as gently as I could I told her the truth. That is what she wanted. I told her that the blood work was not good. I explained about the INR being high, I explained that the blood pressure wasn't good but that we were going to see if we could get it up. I also told her that as she knew the prognosis wasn't good. This was not new news to her. However I didn't think she was going to die today. Her daughter looked at me with tears and asked if they needed to get her other children in town. Some of them lived out of town and even out of the country. I told her daughter that it would probably be a good idea, however I nor the doctors would be able to tell them when she would die or how long she really had. That was up to someone much bigger than us. The patient squeezed my hand and thanked me for being honest with her. She said she already knew all of this but still felt she needed to ask.

My heart was breaking. She was so sweet and was so brave. She laughed and joked and told stories and treasured the time she had with her children. If she herself was fearful at all she certainly didn't show it. At one point all the family had stepped out of the room for one reason or another and the two of us sat on in the room, just us, and I prayed with her. I prayed that God would give her strength, that He would ease the pain she felt and keep her at peace with what was before her. I prayed for her many children and grandchildren that they would be able to handle this journey as well. That they would hold on to all that was good about their mother. We together prayed for safety for the children that were traveling. I could tell this was difficult for her, however she faced it with such courage. Not letting on that if there was one ounce of fear.

She went to the inpatient hospice unit the very next day. She knew she would never again see the inside of her home. She knew that this was where she would spend her final days with her children and grandchildren by her side. She was resolved that this was what was left of her life here on earth.

She lived about a week longer. Honestly, it was a week longer than I expected. She passed peacefully with her family at her side. She savored all the moments she could with each of them until God decided it was time.

I will never forget her smile. . . her courage.

I go to work thinking that I am there to help my patients, to care for them and hopefully bring some form of healing to their lives, their bodies. What I learn is, that most days, the patients that I care for are really bringing some form of healing to me. I take a piece of them with me at the end of my shift. Whether it be the patient who is dying, the one who has tried my very last ounce of patience, or the one that is a simple post op that will stay 24 hours and go home. I learn something from each of them. And, my heart is forever changed. . . . on a daily basis!


Uninterested. . . .

I have been tagged by Deanna over at Mops and Pops Place.
I am to identify 6 uninteresting things that I love and then pass this task on to 6 others. This is not as easy at it sounds. I think my life overall is pretty uninteresting and how fun is it to share uninteresting things with people who don't know you well, ya know like all 12 of you who actually take time out of your busy day to read this blog.

So I guess here goes. . .

1. I love to people watch - I could go to the mall and sit there for hours on end just watching people. I don't really like to shop so sitting on a bench would suite me just fine! You can learn alot about a person just watching.

2. I do love spreadsheets (not that I like to admit it - so let's just keep this between us ok???) - keeping a list and putting things into a spreadsheet keeps me organized. Sometimes it is the only way to take what is twirling around in my head and make it make sense. I have done a spreadsheet for house cleaning, for how to care for our dogs, for our finances, for vacation planning, for items needed to be purchased (when we were building our house), for my work schedule. . . you name it and I can make a spreadsheet for it. Most people I know think this is pretty "geeky" (is that a real word??), but it works for me!

3. I love to read other blogs - my family thinks it is crazy, and mostly a waste of time, but I love to have that little window into the lives of other people. Maybe because it takes my mind off of mine for a while, maybe because their life is a little more exciting than mine, or maybe because it makes mine look less crazy. Who knows, but I do love it.

4. Crossword Puzzles - this is a new thing for me. But I am starting to like it. . . does that mean I am getting old. I always thought it was older people who did crosswords, but I caught myself searching the hospital giftshop the other day for a crossword puzzle book that I could actually do. You know the easy ones. That is where it all started. They banned facebook from the hospital computers so on my downtime at night when all patients are sleeping and things are quiet (however we never ever ever EVER say that "Q" word outloud!!!!!). I have been working crossword puzzles. Unfortunately for me, my nights have not been "Q" enough lately to even have a chance to pee, so that book is not good and broke in yet.

5. I absolutely love love love musicals!!!!! - We own a ton of DVD's and given the choice I would rather watch a musical than any other kind of movie. And better yet. . . see it in real life! I don't think I have many friends or even family that share this same love for music and theater and I don't get to do it near as often as I would like. I could probably name every song from every Rogers and Hammerstein musical. If there was a trivial pursuit category on musicals, you would definately want me on your team! I love them! My dream (in regards to musicals) is to see a real live Broadway show actually on Broadway!

6. I check the obituaries daily - does that totally make me strange? Many of my friends would say so. However, I have cared for many many people in my career. And sometimes that is the only way to find out what ever happened to them. You can learn alot about a person from their obit. Ok, so don't think I am totally nuts or obsessed with death. I just like to be in the know. . . ya know?

This did take some thinkin' power. But now I am supposed to pass this along to 6 other people, to do the same. Please check out their blogs as I have listen them because I feel they are worth reading. I am choosing blogs I read often but don't comment on alot. I have to admit I am a terrible commenter, even though I love love love it when people comment on my blog. Guess I will have to work on that huh?

the cutest little girl I have seen in a
really really long time.
She also gives her mama
lots and lots to blog about!!
An adoptive mom, Air Force wife, and crockpot cook.
Great recipes, stories about a sweet
brown eyed baby girl, and a woman of great
strength raising a baby while
her husband is deployed.
Our heros are our soliders AND their families!!!
A neurologist who totally cracks me up!
Maybe because I love neurology who knows.
I can totally relate to many of his stories though.
A new blogger who inspires me every day!
She has a great positve outlook on life and can
always find the sun shining even
when there are clouds.
Go check her out and welcome her to blogland!
A fairly new RN working in the Emergecy Department.
She has some great stories to tell and it is so
nice to see and hear from a yet
unjaded, compassionate nurse.
A nursing student and single mom of three children.
This alone makes her my new hero!!
A blog I have been reading but for some reason am
not able to comment on. I click on the comment link
and nothing happens. So I hope she reads this and
knows that I am tagging her and reading her
blog and cheering her on in the wonderful adventrue she is on!
OH. . and don't worry 1/5 IV starts isn't terrible!
You will get the hang of it. It is totally a practice makes perfect thing!
Ok, so go check out those blogs, show them some love and get tagging!! This is a great way to learn more about the people reading your blog and those you read. It is also kinda fun!


Friday, June 19, 2009

My Ministry

No one ever said this job was going to be easy! Some days I wonder why I ever chose a profession that will allow me to be beat up mentally and sometimes physically (by those demented, detoxing, and thoroughly confused patients). That will put me in a workplace where people don't really care about the people they are caring for, they just want the paycheck at the end of the week. That will place me in a world of strange work politics. That will have me working with people who find the petty things to complain and whine about that can't see past the "small stuff" to see what is real.

Then there are those days that I remember that God truly placed me in this profession. That if it weren't for Him holding my hand and clearing my mind, I would have never made it through nursing school. That if it weren't for the life experiences I have had, that God allowed me to go through, I would not have the compassion that I have to take care of those difficult patients. If it wasn't for his constant reminder that we are ALL His precious children that keeps me from becoming totally irate with those our of control patients who abuse their nurses verbally and hit and bite and kick and yell, and, and , and. . .

I have been exhausted by work this week. Haven't been able to get enough sleep. Been surrounded by death for the past two weeks and that in itself is exhausting. I have been presented with:

1. A patient who was dying of pancreatic cancer. Who didn't even know it was there until they were admitted to the hospital. Who at one point looked at me with fear in their eyes with one question. . ."I'm dying aren't I?". Who had a 4 day hospital stay then transfered to inpatient hospice. Whose family was amazing and realistic and stayed at their loved ones bedside holding on to every minute they could get.

2. A patient who was admitted with meningitis who has had head trauma in the past and because of that was "just not right". Who insisted on taking pictures of me with her cell phone. Who was laughing hysterically one minute and screaming from a headache the next. Who was impulsive and unsafe. Who refused to bathe and was so incredibly dirty my stomach turned from the smell of the room. Who I am not sure even realized they were dirty or that there was anything wrong with that. Who put their call light on literally every 10 minutes just to make sure somene would come when they called. Who really wanted to get home to their 2 year old daughter. Who I couldn't believe actually had a 2 year old daughter. . . . . who had to have social services intervene due to mental status.

3. A patient who had ischemic bowel who was 95 years old who was dying because surgery was too risky with the other health issues. Who's family along with the patient decided to make themselves a DNR. Who's family decided that along with no CPR they still want every blood draw, every test, every intervention possible done to safe this poor person. Who is having to be stuck with a needle multiple times a day for blood work and IV starts because an IV won't stay good. Who's family doesn't want to put them through getting a central line. Who has a very large family with no less than 5-8 people in the room at one time 24 hours a day. And this nurse doesn't have the heart to tell them to leave. And this nurse sees and sense the fear in the family that this is really the end, as they hold on to everything they can to stay in control. Whose family asks the same questions multiple times during a 12 hour shift, seeking a different answer than they got the first time.

4. A patient who was admitted with venous status ulcers all over their calves. Who lives at home with home health changing the dressings daily, however the dressing were no longer white gauze and kerlex, they were brown from filth. Who, when in the ER had cockroaches crawling out of their clothes, and dead ones their body. Who refuses to go to a nursing home where they can have real help. Who has no family to advocate for them. Who had nurses practically refusing to have them on their assignment because of the cockroach issue. Who was totally alert and oriented just unable to care for themselves physically.

5. A patient who was virtually blind from diabetes, obese, and on dialysis. Who was left in a car while a spouse was shopping in a store. The heat was too much and they were brought by ambulance to the ER because they were unresponsive. Who's blood sugar was 50 in the ER. Who was mentally, not intact. Who was impulsive, out of control, and very difficult to care for. Who had diabetic ulcers on their feet that were dressed in week old dressings. Who didn't notice the stench when the dressings were removed and who couldn't feel their feet when the wounds were being cleaned and redressed. Who has already had most of their toes removed and will probably end up with complete foot amputations before it is over. Who needs to be in a nursing home instead of living at home with a spouse who can't care for even themselves. Who social services is now involved with.

6. A patient who was the sweetest thing I have ever seen. Who thanked me each time I walked into their room. Who is slowly recovering and getting better after several days inpatient. Who will most likely go home with oxygen because they can't seem to keep their O2 levels high enough on their own. Who has an incredibly outlook on life. Who is 88 years old. Who didn't mind that there were labs to be drawn at 4am. Who smiled even when I said, "Your IV just went bad and I need to start a new one." Who made my day by telling me I was a great nurse and they hoped I was back for another shift. Who made my night totally worth it!!!

Nursing is my ministry and I am OK with that. However, what I have learned over the years is sometimes it is the patients who minister to me. Even when it is a bad day, even when the circumstances of my shift may bring tears to my eyes, whether tears of sadness or frustration. Even when I don't agree with the politics. Even when I am among the cliquishness and cattiness of some of the other staff. Even when . . . . .

I know I am in the place God wants me to be. I know this my ministry. I pray that God will use me in whatever way, to bring comfort to the people I care for each night. I pray that God will use me to be an example to those few co-workers who just can't see past themselves.

This is my ministry!


Friday, June 12, 2009

Dealings with the mentally ill. . . .

A patient gets transfered from an outlying hosptial at her request. In report I learn that she is refusing to eat, take medication, answer any questions or even be touched. She will not allow that hospital to treat her at all. She has been inpaitent there for at least a week.

She arrives to her assigned room, I go to greet her with a smiling face hoping she is more happy now that she is in our hospital. After all this is what she wanted. She has a very badly infected surgical wound that I was sure was going to require and I&D. I go through the whole admission process and as I am walking out of the room to go check orders and call our docs to let them know she is here, she informs me that someone has stollen her wallet. She was sure she had it with her when she got here. It only contained her insurance card, pacemaker card and driver's license. So I search her belongings looking for it. It is not there. I called the other hospital, they don't have it, I call the ambulance company and of course since it is after midnight I have to leave a message.

Later, she calls me into her room to let me know that there are two men in a black car that keep circling the parking lot looking into room. I assured her there was no one outside her window. She didn't believe me, she becomes hysterical. I continued to tell her this was not possible as we are on the 6th floor and there is no way possible a car could be driving by her window. I close the curtains and this satisfies her for the time being. The docs have not seen her yet, so I have no orders and no meds to give her to help calm her down.

Later, I am trying to start an IV and her arms are all bruised up. She has terrible veins and after 2 attempts I am unable to get the IV. I apologized and told her that with all the bruising it looked as if they had already used up all the good IV places. She looked at me with angry eyes and said, "If you had been held down by 5 people why they were trying to kill you, you would look like this too. I just knew if I didn't get out of there tonight I would have been dead by morning." I told her I was sorry, she had had such a rough time and we would see what we could do to get her IV started and get her medications going. Another nurse tried and again, no success.

Later, another nurse comes into her room to answer her call light. She proceeds to tell that nurse that her wallet was laying on the table. She said, "that nurse (referring to me) took it and put it there trying to hide it from her." What she was actually seeing was an eraser for the dry erase boards in the rooms. The nurse tried to tell her that wasn't her wallet but she didn't believe her. She actually showed her the eraser and she still didn't believe her. So at this point in the night I became a theif and took her wallet.

I was so upset that my co-workers found out about my secret wish. I had always wanted someone elses pacemaker card. I didn't want anyone to know that I was collecting them and wallpapering my guest room with them. (Please read the sarcasm in this) Really? Why would I want her wallet???

As I was leaving my shift, she was standing in the hallway with her walker. I asked her if she needed something, since she really shouldn't be up walking in her condition. She looked at me and said, "I want to go home!" I told her that she was going to be seeing the doctor today and they were going to take care of her infection. She then looked at me with very angry eyes and said, "How could you treat your mother this way? I have always been good to you and you have no respect for me!" Another nurse was approaching slowly to help me when I told this lady, "I am not your daughter, I am (my name) and I have been your nurse all night. You are at (hospital name) with an infection and are scheduled for surgery today to fix it. Let's go back into your room and we can talk about this." She then said to me, "You and your mother are trying to kill me and are going to put me in the furnace. I heard you talking about it and I am not going to let that happen!" I then looked at the nurse that came to help and told her I thought it would be easier without me. The other nurse was able to get her into her room. I just thought since she was thinking I was someone who was going to hurt her it was probably making her worse for me to even be there.

I went to tell the nurse I had reported off to about this incident, and immediately she said, "I don't have time for this today! If she wants to leave then fine! She can go AMA!" She then called the charge nurse and told her she had a patient that wanted to go AMA and wanted us to call a taxi for her.

I was so not believing my ears!!! That patient NEVER said all of that. And besides she was OBVIOUSLY mentally ill. She had a horrible infection, had not had any medications because she was NPO for surgery and had been having hallucinations through the night. Was she seriously telling the charge nurse to just let this person go???

What are our responsibilities as nurses for taking care of people? She was not really ok at that moment. She needed medication! She needed that infection taken care of before it went systemic! And this nurse was just going to blow her off because she didn't want to deal with her?

Sounds like someone needs a vacation! So I come home and worry about this patient all day. Did she end up leaving or did she go to surgery. Did someone get a psych eval? Did she finally get some medication that would bring her back to reality?
Will I ever know if she was ok or not?

This is the part of nursing I hate. I take care of you one night and then I may never know what happens to you after that.

God, please bring peace to this ladies mind. Please help the staff be patient and tolerant. Please give the doctors the compassion to treat her as a whole person and pull in the extra disciplines needed to treat ALL of her! And. . . . keep her save as she recovers.


Wednesday, June 10, 2009

Optical Rectitis

I was getting report from the day shift nurse on a gentleman who was in his mid 50's. He had colon cancer a few years back went through chemo and all the cancer treatment. He had a bowel resection with a colostomy. . had the colostomy reversed about a year ago and now had been suffering from fistulas with infections. NOT GOOD! He also had a pretty extensive heart history and had dealt with MI's, stents, multiple cardiac caths, etc. He pretty much was a hot mess!! He was scheduled for surgery AGAIN, the next morning. So he was NPO and really because of all the other tests they had done he hadn't eaten in about 48 hours.

When we are reporting off to the next shift, we give report to the oncoming shift in the patients room. That way the patient hears what we are saying, meets the oncoming staff, and can give their input, incase there is something the nurse forgets. This makes the patient feel more like they still have some control over what is going on. It also is a great time to check for incontinence, almost emply IV bags, or other things that seem to ALWAYS get left for the next shift. Those little things that slow you down at the busiest part of your shift.

During this report when the nurse was done telling me everything, she asked if there was anything he wanted to add.

Patient: "She forgot to tell you I also have Optical Rectitis, they found it on the CT scan they did last week."

Me: "Really? (trying hard to go through my memory rolodex searching for that diagnosis)"

Patient: "Have you heard of it?"

Me: (Again, starting to feel a little dumb and not wanting to admit it) "I don't think so, at least that is not one I remember hearing about. They found it on a CT scan?"

Patient: "Well, alot of people have it, but it doesn't get an official diagnosis very often. This is because it is so hard to treat and insurance doesn't like to pay for the treatment."

Me: (still thumbing through that rolodex. . . not finding anything)

Patient: "Basically, what it means is that I have a shity outlook on life."

All of the sudden he and the day shift nurse bust out laughing! I had never heard this before and was so thankful that I couldn't find this diagnosis in my memory bank. I was so starting to feel really stupid!

Truth, he did have a pretty bad outlook on life. However, he was working on it. He had been dealt a pretty bad hand and had kept going through it all. He was really just hoping this last surgery would take care of everything, but because of past experience it was hard to believe that would happen.

By the end of my shift we were both telling jokes to each other and laughing pretty hard. I think his "Optical Rectitis" was starting to go into remission.


Monday, June 8, 2009

Were You Suprised?

A very good friend of mine was working as a CNA about 15 or more years ago. It was one of her first days on orientation and the girl that was working with her sent her into a room of a gentleman that had parkinsons to give him a bed bath.

She went in and did everything by the book. This man was very alert and oriented, and she was very careful to keep his dignaty and keep all parts covered that weren't being washed at that moment. When she pulled the covers back to wash his "parts" she was suprised at what she saw. Her face turned all shades of red as she gently covered him back up and said she would be back to finish in a few minutes.

She left his room and went to find the girl who was training her. When she found her in the hallway she was standing around with a few other CNA's laughing hysterically. My friend simply looked at her preceptor and asked, "Is he always that way or was he just happy to see me?" What the preceptor neglected to tell my friend was that this particular 70'something year old man had a penile implant.

My friend had never seen one before so she had no idea what was going on. After she regained her composure she went back into this mans room and finished the bath with all appropriateness. This story became one frequently told as one of the best moments at this particular nursing home. I think she became a legend that day.


Friday, June 5, 2009

Strong Committment

I love working on the surgery obs unit. Those are the patients who come in to have surgery and then go home within 24-48 hours.

I had a patient who came in for a lap chole (laproscopic gallbladder removal) and ended up in an 8 hour surgery having an open chole. It didn't work laproscopic. He had just came returned from PACU about 10 minutes after my shift started. I had just enough time to get him tucked in and do an assessment before his family started showing up.

He was a Hispanic older gentleman who spoke NO English! I speak no Spanish. So the assessment was somewhat difficult, however we made it though and were able to understand each other JUST ENOUGH. He was scheduled for vitals every 2 hours, and labs every 6 hours, so the tech and myself were in his room alot.

At one point I counted 25 people in his room. Thank God for private rooms. He was so tired from the surgery that I am sure he was not aware there were so many people there. They were all very quiet, children included, and were just standing around staring at him. I kept thinking to myself, I was glad I was not the one in the bed being stared at by my family. They were very attentive and were good to move out of the way whenever we needed to do anything. There were very few of them that spoke English so the conversations between them an myself took a while so someone could translate and keep the whole family informed of what was going on.

It was 10pm and time for vitals and labs to be done. The tech asked me if I would ask some of the family to leave because she was uncomfortable going in a drawing his labs with so many people in the room. I explained to her that I was sure they would be leaving soon as it was getting late they had children. She didn't like this response too well but I just didn't have the heart to tell them to leave.

They were not doing anything wrong, they stayed out of our way and didn't interfere with taking care of him and they were very quiet. I was torn because I know I wouldn't like that many people around right after I had surgery and because I knew he needed his rest. However, he was resting and they were allowing that to happen. I decided that I would not enforce the visiting hours that technically ended at 8pm and I would allow them to stay for a while longer.

I realized that this was their father, grandfather, uncle, brother, . . .relative. . . loved one. This was their culture. I admired their dedication to this gentleman, their concern and love for him. I was saddened by the memories I have of all the patients I have cared for who had no one come see them, no one call, no one to send flowers or a card and no one to go home to when they discharged. I was touched by the committment of this loving family. What if we all this same committment. Would there still be discord among families? Would peopel realize how precious life is and decide to simply love each other instead of holding on to all the past hurts and disappointments that are shared in so many families. Would they hold on to the disfunctions or would they let them go to care for someone who is their blood, who is their family?

This family had it figured out! It wasn't about anything other than being there and showing their care for this gentleman. This is a time when families feel helpless and this family chose to not feel that way, instead they chose to be there, just in case. So he would see them when he woke, so they could offer him a moist cold sponge to wet his mouth when woke and complained of being so dry. So they could offer a hand during his times of pain. This was their way of coping with an ill family member.

How do you cope? Do you stay away because you can't deal with it? Are you able to let go of past hurts and disappointments to be there for your family? Don't wait until there is a reason to "rally". Don't wait until someone is sick to show them how much you care. I could tell from all the love shown in that room that this was a tight nit group and that love ran deep. Show the people you care about that you care. . everyday. Don't let anything get in the way and seperate you from the love of your family. Forgive. . . .move on. . . and let it go. You never know when they won't be there anymore. You never know when you won't have a chance to change your mind and decide that family really IS important.

I thought I was going to work that night to help someone else. I thought my job was to show compassion and care for the patients I had been assigned to. What I learned that night, is that I was there to learn from my patients. I was there to be taught about the compassion of a family, about the comittment of a family and the love of a family.

Don't let another minute go by before you decide how you will treat your family and loved ones. Will you be the committed family or will you let discord stay?


Thursday, June 4, 2009

Drunken fight and snow, not a good mix!


I got report and was told about this guy that had frostbite on his hands and feet. The nurse giving me report explained what had happened then told me to have a good night. . "Oh and by the way, he is on his call light about every 5 minutes. . . see ya tomorrow!", she said giggling as she walked away.

Well that is never a good sign. I started doing my rounds seeing all my other patients thinking I should get as much done as I could before he starting calling. When I made it to his room NOTHING could have prepared me for what I was about to see. The nurse did not give me a good report, obviously! In my mind I thought this man had SOME frost bite, we were treating and would be back to normal before ya know it.

What I saw when I walked in was an 50'something year old man that looked about 70'ish. The tip of his nose was completely black, the rest of his skin was dark (kinda like age vs diabetes vs bad circulation) and wrinkly, he had not a tooth in his head, he looked to weigh around 100 pounds on a good day after a huge meal, and his hands and feet were thickly wrapped in kerlex. He was laying in bed mostly uncovered with a T-shirt on and an adult diaper that was totally open. Both of his hands, well his dressings on his hands were covered in BM. When I asked him what had happened he looked at me like I was from another planet. He saw nothing wrong with the way his dressings looked or smelled.

I got him cleaned up from the mess, changed his whole bed, and started to undress his hands. What I found under his dressing made me want to throw up. His hands, BOTH OF THEM, were as black as cole. They were hard as a rock and he obviously had no feeling in them. They looked like if he hit them to hard on something the fingers would simply just break off and crumble. His hands were frozen in such a way that it looked like they had frozed while holding a glass. He was totally unable to move them at all.

I put the new dressings on and asked him what had happened. How did they get this way. He said he was drinking on night with his girlfriend and they started arguing. He went outside to "cool off" and smoke and the next thing he knew he was waking up in the hospital. He had fallen while outside in the snow, with no coat, gloves, OR shoes! His girlfriend was so mad and drunk herself that she left him there and went back to her house. A neighbor had found him and called 911.

He told me they were wanting to amputate his hands and his feet but he didn't want them to. He was going to go home and with all his limbs and live life as normal. I tried to explain to him that his hands and feet were too bad and wouldn't come back, they were not going to heal. He seriously looked at me and asked, "would you let them cut off your hands and feet, or would you just rather die?"

I told him that he cold still have a productive life without his hands and feet and they could get special devices to help him. He still was not interested. So I thought I would go the route of reason. He told me he lived alone. So I went that route. I asked him who was going to fix his meals, feed him, help him bathe, wipe his butt, and clean up after him. He told me he had a friend that he had been friends with for about 20 years that needed a place to live. He had been homeless for some time. "If I let him live with me I am sure he will do all those things", he said. All I can say is that is ONE GOOD FRIEND!!! I am not sure I have a friend that would put up with my attitude (if it was like his), let alone wipe my butt and feed me and be at my beckon call.

I then proceeded to tell him that the hands and feet would not get any better, they would eventually become infected and probably start falling off at home. He was still very determined to go home that way. Not to a rehab or nursing home but to HIS home. Then he said, "all I have to do is find out where this friend is and tell him he can live with me, but I'm not sure where he is."

He did end up going home after about 4 more days in the hospital. I don't know how much help he had at home since I only took care of him that one night. What I do know is that he was back within a week getting both hands and feet amputated. Then he did in fact go to a rehab center of some sort. I have no idea where he is now. Hopefully he is living life, no drinking, and has someone to teach him about assistive devices to help him go about everyday living as best he can. He was so young to be so old. He had made a rough life for himself and I am not sure he knew he could be any better. I am not sure anyone ever told him he could be any better or that he was worth more than that. That his life did matter.

He was a demanding patient, he did make my life crazy that night. AND, I am glad I was able to care for him compassionately and be real with him about his health. I really felt like I had been a nurse that night. Not just someone who comes and checks on you, gives you pills, and does a mound of paperwork. We got to know each other, and spent alot of time talking. I think he was kinda lonely. So it was ok with me that he wanted some kind of snack about every hour and I had to feed it to him. That meant that he got to see a real person, and have a conversation and someone to sit with him for at least 10-15 minutes out of every hour.

I hope my little frostbite man is doing well today!

Lesson in this. . . . don't get drunk, walk out on your girlfriend while there is snow on the ground! Your life may never be the same after that one bad decision. . . .


Tuesday, June 2, 2009

Harold ALWAYS Had the Last Word

Harold was in his 80's had CHF (Congestive Heart Failure), Diabetes, and many other health issues. He was a somewhat grumpy old guy. He liked who he liked and if he didn't like you, you were sure to know it.
He was very bloated, full of fluid to the point of weeping. His legs were huge and fluid would seep from his skin. He didn't want them wrapped because he was always hot. His hands and arms were the same way. He would always sit on his bed and face the window (with his back to the door) watching to see who was coming and going from the nursing home he lived in. He always had magazines and such on his bedside table and a radio in his window sill that would play country music. He usually played it pretty loud, upsetting the other residents who lived in the rooms close to him. However, he was so grumpy that he really didn't care that anyone was upset.
One night I was working night shift. This was many many years before becoming and RN. It was myself and one other CNA (Certified Nurse Aide), as well as an LPN taking care of about 56 people. The other CNA (we will call her Shelly) and I worked together alot. Harold was not doing well. He was in bed but very close to death. His wife had been in and said her goodbyes, but just couldn't stand to stay. So Shelly and I decided we better make a good plan for the evening. We started our first bedcheck on his end of the hall since his room was the last one at the end of the hall. We decided when we got to the middle one of us would go back and check on him then continue down the rest of the hall and then check on him again.
Well, he was hangin' in there so we hurried through our bedcheck, went and checked and then when we knew he was ok (or at least still with us), we finished the bedcheck. As we got to the very last room at the complete other end of the hall, we heard Mr. Johnson yelling out. This was not too unusual. Mr. Johnson lived in the room next to Harold and had an ajoining bathroom. Mr. Johnson had dementia in a bad way, was on a low bed (about 6 inches from the ground) and would usually start yelling out when he had fallen out of bed onto the soft mat that lay beside his bed. So, Shelly and I went to put Mr. Johnson back to bed, except when we got to his room, he wasn't on the floor. He was in the bed. And he didn't quit yelling when we got there. I looked at Shelly and said, "We better go check on Harold."

Sure enough as soon as we got to Harolds room, Mr. Johnson stopped yelling. And Harold had passed. It was as if Mr. Johnson was trying to tell us that Harold had died and we needed to do something about it.
The LPN did her thing, called the family, the doctor, and the funeral home. Is this where I should tell you that this was the VERY FIRST person to die that I had to help take care of. See, in a nursing home (here at least), when someone dies, you clean them up and get them ready for the funeral home to come get them, or for the family to come.
Since Harolds wife wasn't coming, we had to get him ready for the funeral home. So Shelly and I gave him a bath, changed his gown, and cleaned his room, gathering all his belongings and bagging them up. We both loved Harold and he actually liked both of us. We both cried our way all the way through this process. To help make it a little easier, we turned Harolds radio on and up to help drown out some of the emotion.
When we left the room, Shelly turned off the radio and unplugged it letting it remain on the window sill where Harold always kept it. The funeral home came to pick him up and as I saw them coming out of his room I said something I will never forget. I didn't even think and had never seen this before. However, the tears started once again when I looked at the funeral director and said, "Don't cover him up that way, he won't be able to breath!" It was not until those words were out of my mouth that I realized that Harold didn't need to worry about not being able to breath anymore. However it was a good laugh for the funeral director, Shelly and the LPN that was standing right there.
After they left, Shelly and I hurried around to get caught up on the rest of our work. By this time it was time for another bedcheck. We started at the opposite end of the hall from where Harolds room was. When we got the middle we heard music and it was really really loud. We both started walking looking for where it was coming from so we could tell the resident that had it on to turn it down. It was the middle of the night and people were sleeping. When we got the the source of the music, it was Harolds room. His radio was playing! It still sat in the window, still sat unplugged but was playing. Neither one of us could believe it! Shelly checked to see if there were batteries in it, but there wasn't. She tried to turn it off but it wouldn't, it would turn down. Even when it clicked it didn't turn off. So we left it alone and it remained playing softly.

We were both quiet freaked out to say the least! Then we just decided that Harold needed to have the last say. He always needed to have the last say! So this was probably his way of telling us "Goodbye" or maybe his way of saying "F-off!" (as he would put it) to all the residents that got mad when he played his radio.
Who knows what is true. . . What I do know is that Harold will not soon be forgotten!!!