Do I or Don't I?

My work week is over - at least for a couple of days.  I go back on Sunday night & will probably work the entire week if everything goes well.  This week wasn't too bad...physically it was pretty simple, but emotionally...not so simple. 

I continued to have both patients who had been diagnosed with terminal cancer.  The lady with the spinal cancer - it came down to whether she wanted to go to a skilled nursing facility & try an experimental chemo type drug or go home with Hospice care & no medical treatment other than pain relief.  She obviously would have more time with medical treatment as without, but she has 3 dogs at home that love her unconditionally & she felt that she would be abandoning them if she wasn't there.  Her family was discussing putting the dogs to sleep, which I thought was totally wrong...not just for the dogs, but for the emotional toll it was taking on my patient just thinking of that happening.  She kept saying how she just needed someone to let her dogs out once during the day while her husband was at work.  I advised her to call her vet's office, that they may be able to refer her to someone that does that type of stuff because I know I've heard of dog walkers & dog sitters.  I'm not really sure what her decision was - I forgot to ask the day nurse that discharged her.  I'm pretty sure she chose the skilled nursing facility with the hopes of going home in a week or two.  She thanked me for understanding in regards to her dogs.  I totally understood because I do think dogs are more than just pets - they are part of the family.  My dog is nearly 14 yrs old & I am having a tough time making the decision to put him down...even though it seems like he's getting worse week by week. 

My other patient - the one with the brain tumors.  They were still arranging to do a lung biopsy & a cystoscopy to see if he had lung &/or bladder cancer.  He has been so cheerful all week long.  Emotionally he got to me more than my other patient.  I don't really know why.  Maybe because of his attitude or how kind he was...I don't know.  No matter when I woke him up (for vital signs or to take medications), he was always so happy.  He has a big family and a lot of support, for that I'm glad.

My other patients were easy to care for.  I had one in with COPD exacerbation.  The doctors were ready to send him home & he said "Nope, I'm not ready."  Shocking - most patients want to leave as soon as they get admitted.  He was weak on his feet & didn't want to go home like that because he'd just end up back at the hospital in a week or two if he couldn't ambulate very well.  I ended up moving him to the med-surg floor because there was no need for cardiac monitoring anymore.

I had another gentleman that came in with chest pain.  He has chronic renal failure & gets dialysis 3 times a week.  Whenever they start dialysis, his blood pressure skyrockets & he develops chest pain.  So they are thinking his tessio cath in his chest that they use for dialysis was infected.  He had an AV graft in his right arm, but it wasn't working properly.  I am told by the day nurse on Wednesday during report that the surgeon was in & told her that we needed cardiac clearance to proceed with a revision of the AV graft.  She tells me the cardiologist will be rounding late, but be sure to get cardiac clearance.  As the night goes on, I don't see the cardiologist...so at about 10:45, I call his answering service.  I get a call back from the on call doctor that night who wasn't the doctor consulted for this patient.  I inform him of what the surgeon is requesting & just wanted to let him know that no one from their office has been in to see the patient.  I wasn't expecting him to rush over to the hospital at that time to do what I needed - I just wanted to make him aware so something could be done in the morning.  I would get in trouble if I simply ignored the surgeon's request & dumped it on the day nurse.  Needless to say, the doctor on the phone was not very receptive to my information & gave me a long lecture about how he doesn't care what this patient needs, that it's not his patient, that he doesn't care what surgery does & that he doesn't appreciate being called regarding this matter.  Grrr...not nice at all.  I have found that there is no talking sense into someone acting like that, so I let him ramble on & ended the conversation with "ok."  Oh how I would have liked to write out the order word for word as to what he said, but I knew that wouldn't really fly...can you see it...."I don't care what this patient needs, it's not my patient, I don't care what surgery does & that I don't appreciate being called regarding this matter."  I just narrowed it down & wrote the order to call the consulted cardiologist directly the next morning at 8 am at his office, not the answering service.

I did receive a call from the consulted cardiologist at 7:15 that morning, so at least the jerk informed the cardiologist that I had called & needed cardiac clearance from him.  After all that was said & done, the surgeon came in around 10 am & said "I don't need cardiac clearance, I'm doing this surgery anyways."  Ahhhhh...to be lectured for nothing...so not fair.  My patient had the procedure done & came back to me around 9 pm Thursday night.  He was in some pain, but otherwise doing well.  The cardiologist never did get to see him because by the time he came around, the patient was already in surgery.  Oh well, I'm not going to worry about it.

I had another patient that was downgraded from ICU with congestive heart failure.  He is also a dialysis patient...but a non-compliant dialysis patient.  He skips his appointments for dialysis & ends up in the hospital with CHF because he's not getting the fluid (urine) out of his body.  He's an older man & I somehow doubt that this will be the last time he's non-compliant. 

My final patient for the week was a middle-aged guy in with chest pain rule out MI (heart attack).  I've said it before & I'll say it again...those are my favorite type of patients.  It's pretty routine what to do with them, what medications to give them, what tests will be ordered & I'd say about 90% are negative for heart attacks.  He was scheduled for a stress test & had no chest pain after being admitted to the hospital.

I think the next time I start looking for a job at a different hospital, it will be in some type of cardiac type unit.  I am comfortable taking care of those type of patients.  These other ones with respiratory issues or GI issues or even surgery...I'm always uneasy because they seem so unstable to me.  Not sure if I'm making sense - I just remember the cardiac information I've been taught a lot better than other stuff. 

I'm still debating about whether to go back for a Bachelor's Degree in Nursing.  I know it's a good thing to have, but I'm not sure I want to get back into school mode.  The main advantage of having one is the idea of being able to work in a Veteran's Hospital.  I don't think they accept nurses with anything less than a Bachelor's degree.  They have the best pay & benefits - especially their retirement plan & they are building one here in Orlando that is supposed to be state of the art in the next 3 to 5 years.  I'll have to think about it a little more & investigate whether my hospital will reimburse me for it...I believe they do...which would make the decision easier.  Why not get it if it won't cost me very much?  I'd be dumb not to, right?  I've already been accepted to a local school & the courses are all online. I wouldn't even have to do any clinicals since I'm already an RN.  Do I or Don't I???  Any advice would be appreciated.  ;)

I enjoyed this week...the people I work with are fun to be around & my patients were enjoyable also.  It's one of those weeks where I can say I enjoy what I do for a living.  Hopefully next week I'll still feel the same way...lol.  Have a great weekend everyone!!!