Friday, November 4, 2005

"Let's Make a Deal"

There are some nights that I go into work & feel like I'm in a version of that show "Let's Make a Deal."  Do you want what is behind curtain #1 or curtain #2?  Decisions, decisions.  I worked Monday night, then went into work Tuesday night...fully expecting to get my patients back.  Instead, my name is not even on the schedule...hmmm.  I go talk to the charge nurse & she says "Well, I have a proposition for you.  Would you be willing to work in ICU tonight if we give you one stable patient or we can ask someone else & you can have your patients back?"  Huh?  ICU??  I've never worked a day in my life in the ICU & they want me to float there when they are understaffed?  It wasn't sounding like a good deal to me, plus I wasn't buying the "stable patient" dialogue because I know if the patient were truly stable, they would have been downgraded to PCU status rather than remaining in ICU.  However, the thought of having only ONE patient as opposed to FIVE was a good one.  Hmmm....what do I do?  I ended up saying no, I wasn't comfortable with being in the ICU...I have no training in there whatsoever, not familiar with their equipment nor the drips that might be going for this "stable patient."  Basically I opted for what was behind curtain #2 (my patients back).  It was a good choice as I ended up only having one patient when I took report in PCU.  We had 4 nurses instead of 3 & most of my patients had been discharged throughout the day.  

The patient I did have ended up being an ICU transfer.  His situation is a sad one.  A 49-yr old man that had hip surgery this past August.  Everything was fine, sent home, good to go.  Except....infection set in & took over his body.  He was admitted on Oct 20th with sepsis & renal failure.  He could barely move, skin breakdown on his heels & a stage 2 ulcer on his buttocks.  His heart valves are infected as well as his brain.  He is still with it mentally - to a degree.  At times he hallucinates, other times he reflects back on the life he used to know.  He would start crying & saying "I wish I could have my life back."  Ugh, so heartbreaking.  He has 3 young kids & a wife.  I can't even imagine what they are going through watching him in this condition.  He receives dialysis on Mon, Wed & Fri.  He's in constant pain throughout his body.  Other than giving him his meds & turning him every 2 hours, I found it difficult to really do anything more for him.  I did spend some time talking to him, but didn't really know what to say when he would start crying.  I knew it wasn't appropriate to tell him he would get better because I don't know if he will get any better.  What kind of words of hope do you give when the prognosis is unknown?  I managed to discover that something simple like ginger ale perked him up - so I made sure he had some anytime he wanted it.  It's not much I know.  

I got my second patient about 3 hours later.  A 59-yr old man with chest pain.  He was so cute...he obviously has a wife that is very organized or he has a bag ready to go to the hospital.  He arrived to the floor with a little suitcase type bag which had pajamas, slippers, robe & even a headset to listen to the tv & a radio.  It cracked me up - he was the sharpest dressed patient I've seen in awhile.  He was self-sufficient.  His only real complaint was a migraine headache. 

Needless to say, I had a lot of time on my hands that evening.  I didn't get my third patient until about 4:30 am.  Another chest painer.....a 64 yr old woman.  She was feeling nauseous - which I thought had been from the 6 mg of Morphine given to her in the ER.  She began to have chest pain about an hour later.  I gave her one nitro sub-lingual and 2 more mg of Morphine.  The pain went away but the nausea came back.  I called the doctor & got an order for Reglan...gave her that & it was now change of shift.  I totally expected her to be ok, but when I came back the next evening...she had a heart cath done during the day & was scheduled to be transferred to another hospital that specializes in cardiac surgery.  Three out of four vessels leading to the heart were needing repair.  Of course the hospital she was being transferred to was the hospital I quit from last week.....ahhh, so ironic.  :)  I received a call from the supervisor at that hospital who just happened to be someone I had met while working there.  He often joked around with Gina & I...he was supportive of us being there & also knew the b.s. that we were getting.  So here he is on the phone, giving me a room number for my transfer.  I say to him "Do you know who this is?"  He says "Hmmm, Jennifer, Jennifer......the Jennifer who left here last week?"  I said yep.  He told me I should have asked to be transferred to a different unit.  I told him it didn't feel like we had any options.  He was cool about it all.  Around 10:30 pm, EVAC arrived to transfer my patient. 

I'm skipping around, but basically my week went like this:  Monday night I had 5 patients - all relatively stable with no real difficulties except for one gentleman that had what we thought was a GI bleed.  He had that "GI bleed smell."  Any of you in healthcare know what I mean.  It is one of the worst odors ever.  They assigned him to another nurse on Tuesday night & I was fine with that.  Tuesday night I had a total of 3 patients.  It was a good night.  Wednesday night there were only two nurses on the floor....I started off with 4 patients, the other nurse got 5.  My chest pain lady was transferred around 10:30 pm, so I was down to three patients.  I got my fourth patient around 2:30 am. 

He was kind of strange.  Admitted with abdominal pain, CHF & COPD.  Any time I would ask him a question, he'd laugh this strange little laugh.  I'm thinking "What's so funny?"  His heart rate on the monitor had gone up to 140....good indicator that my patient is probably up to no good.  I go to check on him & he's sitting on the side of the bed attempting to get up.  I ask "What are you doing?"  He said he had to go to the bathroom.  Ummm, sir, you have a catheter - it's there so you don't have to get up.  I manage to get him back in bed & his heart rate goes down.  I tell him to stay in bed, that if he needs help - press the call button. 

I got my fifth patient around 5:30 am.  A 91-yr old man that I would not have believed was a day over 70.  He looked great.....only medical history was both hips were replaced & arthritis.  Only medication he takes at home is a daily vitamin.  He rattled off about all of his family members that were in their 90's or over 100.  His diagnosis was hemorrhagic stroke.  Hopefully he'll be ok.

Practically everyone I ran into at work was asking how it was going at the other hospital.  I told them the truth about what happened & again...they were all supportive.  It was a nice reminder that who you work with is very important.  It makes a real difference.  They put me on the 2nd floor & Gina on the 3rd floor.  That's the only thing that irritates they constantly separate us.  Oh well, what can you do? 

I'm off until Monday...yay!  Actually, Monday is the only day I'm scheduled for the next two weeks.  I may pick up more shifts, but then again, it would be nice to have a break.  We'll see how it plays out.  My niece's 9th birthday is next Friday, so I'm taking her out tonight & tomorrow to celebrate.  Libby Lu's & we  I need to get moving...need to get to Target & buy her some gifts. 

Have I mentioned that I love having my work week done in 3 days?  It's nice having 4 days off (or more) every single really is.  :) 

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