Wednesday, April 12, 2006

Up & Down week

I had a good week at work overall (I love how it's only Wednesday & I can call it a, but it is nearly 40 hours of work when you do 3 nights in a row!).  I worked Sun, Mon & Tuesday nights. 

On Sunday I started out with 4 patients & knew I'd be getting a new admit sometime in the night.  I don't mind having 5 patients IF there is also a patient care tech on the floor.  Yet there was not...big shock...NOT.  We are not very well staffed at night when it comes to PCT's & unit secretaries...which I think is unfair.  It's not that we can't get people to work, they simply aren't hiring or at least making no effort to hire people...not fair.  We are expected to be nurses, PCT's &'d think we'd get some type of bonus when we have to do these other job roles, but nope.  Nothing.  Not fair!  Luckily, I had a good group of guys as patients that night.  Other than medications & snacks, they really didn't need me for anything.

My first patient was an older man who came in with a dx of DVT (blood clot) in his left leg.  While he was at the hosp, they decided he needed a cholecystectomy also.  When they took him to the OR, he went from sinus rhythm to A-fib with RVR.  Needless to say, surgery was postponed.  He was a sweet man...the type you want to go above & beyond to take care of because he's unable to do it for himself & grateful that you are willing to help him out.

My second patient was in with "near syncope"...he felt dizzy but didn't pass out.  Cardiology did a work up on him & the primary doctor wanted him discharged on Saturday.  He didn't get discharged though because his cardiologist wasn't on call over the weekend & the on call dr. didn't feel comfortable discharging him until his cardiac meds had been the discharge was to be postponed until Monday.  This guy was a walkie talkie...another sweet man.

My third patient had back surgery & while he was on the med/surg floor, physical therapy got him up to start ambulating him & he passed out cold.  So they transferred him to PCU for a cardiology work-up...but that was postponed because they were thinking that perhaps the Morphine PCA was the culprit.  They discontinued that, started him on Lortab PO instead (as if that is any comparison to IV Morphine).  It was enough to take the edge off the pain though, so he wasn't complaining.  Very, very nice of those that you just kind of instantly connect with, can joke around & you both know that you're on the same wavelength. 

My fourth patient was/is probably the first patient since I've actually been a nurse that I could get teary-eyed about.  I haven't actually cried because I can tell I am blocking some feelings out related to his condition, but he's been on my mind a lot. 

The only time I've ever cried related to a patient is when I was in nursing school & during clinicals I had a woman in her late 30's/early 40's & she came in with nausea & vomiting & right sided pain.  They were thinking that maybe she had gallstones.  She asked me numerous questions regarding gallbladder surgery.  I'm pretty familiar with it as I have had my gallbladder removed about 10 yrs ago.  Anyways, the nurse told me in confidence that this patient's test results came back & it wasn't her was a tumor on her liver...cancer...terminal cancer.  The nurse told me the doctor would be in around 6:30 pm to tell her, so don't say a word to the patient regarding this.  Ok, no problem.  I went back into the room later & her family was there & now they were asking me questions related to the gallbladder & such.  It was so hard answering those questions fully knowing that this wasn't the patient's problem.  I felt like I was misleading them by answering their questions.  I would have rather not known the real problem.  What brought me to tears was later that night...around 6:30 or 7 when I was at home, it dawned on me that my patient was probably getting the devastating news right about now.  I can't even imagine what it's like to know you have a limited amount of time left to live. 

Since then I've beenable to distance myself emotionally from stuff like that. It's not that I distance myself from the patients...because I really do take care of them the best I can & try to make an emotional connection in those first 30 seconds of introducing myself.  I just don't dwell on how impacting their diagnoses are...if that makes sense. 

Anyways, my fourth patient was a man in his late 50's that came in because he was feeling tightness in the chest.  He had no health problems in the past, yet the news he got is pretty much the worst you can get.  It turns out he has lung & liver cancer.  I was told that even the doctors that broke this news to him got tears in their eyes.  They wanted to do a colonoscopy to try to find the source of the cancer. 

I got my fifth patient around 3 am.....a woman in with chest pain.  I don't mind getting patients after midnight...because they usually just want to finally get some sleep after being in the ER for hours. 

On Monday I got my four guys back.  My fifth patient was being discharged & we had enough nurses that I wouldn't be getting anymore than four.  I like, like, like having patients that I had the night before...because you're already familiar with their history & they already know who you are when you walk in the room.  I did my rounds, eventually transferred the patient with back surgery down to med/surg as it turns out it was the morphine that caused him to pass out (so they think).  I was expecting to get a new admit to fill the bed of the patient I transferred, but I lucked out.  The housekeeper was so busy that night, she didn't have time to clean the room until 5:30 am.  It didn't bother me one

My patient with near syncope who was supposed to be discharged on Saturday......well, the primary doctor came in & was yelling about why wasn't this patient discharged...I wrote orders...blah, blah, blah.  The nurse explained to him about the cardiac meds needing adjustment before the patient went home (the current ones he was on were dropping his heart rate to the low 40's).  Turns out the results for his CT of the brain were back & he has a brain tumor.  Needless to say, he wasn't about to be discharged anywhere.  More tests needed to be run.  So it was a blessing that this discharge never took place on Saturday.


There was a code blue called that night on the other wing.  While going to the bathroom, a male patient had an acute MI (heart attack). 

Gina & I were in the cafeteria when they called it, so we went up & they were saying he was on the bathroom floor & needed help getting him to bed to fully perform the code.  Well, this guy was over 300 lbs.  There was no way I'd be able to lift him without killing my back, plus my shoulder is already really sore from pulling a muscle while working out.  So I knew I wasn't going to be much help.  It was a mess.......all these people trying to run the code & get him into bed.  They did manage to save him & off to ICU he went.  Hopefully he'll recover...time will tell.

Tuesday night I had my 3 guys back plus an ICU transfer.  When I arrived at work, my older patient was in PACU...he had his gallbladder removed in the afternoon & was in recovery.  My patient with lung & liver cancer had his colonoscopy that afternoon...they found a large mass & the doctor accidentally perforated his bowel during the he was in emergency surgery.  The poor guy...all he wanted was to go home.  He was looking soooo forward to going home after being in the hospital for the last week.  Instead, he ends up in ICU.  :(

My patient with the brain tumor was now med-surg status as his cardiac meds were adjusted & no longer needed cardiac monitoring.  We transferred him pretty quickly as our ER was overfilled (as usual - why don't the majority of these people go see their primary doctors instead of going to the ER???). was overfilled & I knew there were patients waiting to come to our floor.  That left me with one ICU transfer.  The guy was a little quirky, but mostly slept.

I got news that my patient with the colonoscopy was officially being transferred to ICU, so we had to pack up his stuff & move it over there so that another patient could take his place in PCU.

I got my older man back from surgery....he was doing quite well.  It still amazes me that they can make incisions in your abdomen & the only dressing you need is a simple band-aid.  Needless to say, he was sleepy from the anesthesia & he also slept most of the night. 

That left me open for two new admits.  I lucked out...both were walkie talkies in with chest pain.  Labs looked really good, no complaints of chest pain since they got to the hospital...both arrived after midnight & wanted to get some sleep.  Just the way I like them! 

So my week at work was overall good for me, but sad for my patients who got bad news regarding cancer & a brain tumor.  It made me stop & think about how many other people around the world are getting such devastating news.  So, so sad.

I would have gone back for a fourth night, but my nephew was playing baseball against a team that is "supposed" to be one of the best in the state.  Well, by the fourth inning, my nephew's team had scored 10 runs, the other team had zeroooooooo.  So after 5 innings the game was over....something called "a mercy rule."  If you're winning by 10 or more after 5 innings, they call the game.  So yay....they win again.  Two games left in the regular season...then it's playoff time...woo hoo.

Time for me to catch up on some tv...take it easy y'all!!!


1 comment:

hadonfield78 said...

cONGRATS on being a Guest editors Pick this week.............
I just discovered your journal...
I am really enjoying reading it....