"Called in"

It's late Tuesday night - I should be at work right now.  Instead I called in "sick."  I'm not exactly technically sick, rather I'm sick of the patient assignment I had.  I can't complain, the patients were stable & quiet most of the night.  In fact, Sunday night was a good night - both Gina & I were on the same floor - which was great.  The night went smooth. 

I had one patient that had been downgraded from ICU.  She was originally admitted with the diagnosis of respiratory failure.  She was fine by the time she got to PCU.  Her main care plan was focusing on her discharge for today.  She was a friendly 81 yr old woman that did not want to go to rehab & a skilled nursing facility.  She wanted to fill out her living will & sign a DNR.  I have to respect that - at 81, I would want a DNR also.  I just don't think there is a high quality of life left when you are reaching that age group.  That's just my personal opinion.  I know there are plenty of 80 & 90 yr olds that have a high quality of life & that's fine.  That's why it usually is your decision as to what you want carried out should that time come.  I just know for me personally...I don't want to live to be 90 or 100 years old.  I think it's great that technology has made that possible, but sometimes you have to wonder when you have these patients that are 85 or 99 years old & they are a full code.  Families should discuss this way in advance of something happening.  Anyways, she was very easy to care for - she was happy just watching tv.

My next patient was a man in his 70's who had C-diff.  It's not a pleasant diagnosis by far.  He was also in for sepsis after a BKA.  He wasn't a man of many words.  Getting him to talk was like pulling teeth.  So once again, a relatively easy patient to care for as he was also content watching tv & sleeping.

My third patient was a 91 yr old man - another full code - in with recurrent syncope (dizziness).  He was somewhat confused & we had him restrained in a Posey vest.  He was a sweetheart - even kissed my hand last night as I was doing my assessment.  Hehad orders to be discharged today from his primary doctor, but as usual....the orders were not complete.  There was no order for social services consult, no order as far as what meds to continue on at home, etc.  Some of these doctors are annoying - especially this one's primary doctor who I will not name.  Funny thing is, earlier that day on Sunday I was filling out my forms to get health insurance & I had to pick a primary doctor.  So I picked this guy - not really knowing all that much about him.  I got to the hospital Sunday evening & he was there - making somewhat negative comments about nurses.  The nurse I was getting report from was questioning an order on another patient - it was regarding testing a patient's intrinsic factor & whether there were any antibodies.  I know all about that stuff because I have pernicious anemia.  This doctor jumped in & started explaining it, which is great - until he made a comment about how nurses do not know this stuff because they don't teach us anything in school.  He went on to say that these days nursing school from start to finish is a year & a half.  It was like an episode from Ally McBeal where I just wanted to reach out & smack him or strangle him, but of course I couldn't.  Needless to say, when it came time the next morning to turn in my insurance paperwork, his name was crossed through & I picked another primary doctor.  I just don't have the patience to put up with b.s.  from an old school doctor that thinks he knows everything & disrespects nurses.  I'm sure he is a smart man with plenty of experience in his lifetime, but it doesn't give him the right to put down nurses. 

My fourth patient was one that really began to test my limits.  She was a confused woman that had been admitted with shortness of breath & chest pain.  She had neither when I did my assessment.  And she was also another confused patient that had to be restrained with a Posey vest so that she wouldn't try to get out of bed & fall on the floor.  I felt like I had to repeat everything I said to her at least 5 times before she would understand what I was saying.  Then I'd leave the room & come back & have to say everything at least 5 times again.  It wasn't so bad Sunday night because she slept through the night.  But Monday night - it was ongoing & of course I had a tech that was nowhere to be found when it came to helping out. 

Between her & my fifth patient - a gentleman admitted with pneumonia & coughing in my face continuously (I know he couldn't help it but that doesn't make it any less gross), they were wearing me down.  Add in the telemetry that would not stay connected because he kept moving around & the pads would come off - I was ready to go home.  I got a couple of hours sleep & then decided I needed a night of rest & relaxation. 

As it turns out, my friend Maria also needed a night like that so we met up & went to Circuit City, Target & saw "A Lot Like Love."  Ashton Kutcher is just adorable.  Anyways, it was just what I needed.  I'm off until Sunday night  - the census is low so I doubt there will be any offers of overtime.  I'm heading to my parents house by the beach & taking a little mini-vacation.  Have a great week everyone!

p.s.  Good Luck to my nephew Eric in his quest for his high school team to win the state championship in baseball.  He hit a homerun the other night with the bases loaded to give his team the victory to move on to the next round.