I worked Fri, Sat, Sun and Monday nights. I tried to sign up for tonight, but they were overstaffed already - so I'm off. At first I was disappointed, but then I got this critical patient at 5:30 this morning & I'm glad I don't have to go back to that stress. She was a transfer from med-surg whose heart rate was in the 170's. Well, they discovered her heart rate was that night when they did the 4 am vitals, but who knows how long it had been elevated like that since they only do vitals every 8 hours. Anyways, they give her to me without any real orders except to transfer to PCU. The only person on the case was the surgeon that did a laminectomy 6 days ago. I like to think I have the magic touch, but no way was I going to get her heart rate to decrease. I got an order for a cardiologist...it just had to be the one I really don't care for because he's so rude on the phone. I woke him up at about 5:45 and all he ordered was Cardizem 15 mg/hr. No bolus, no digoxin. Her heart rate was still elevated when I left at 7:15. Hopefully they'll get it under control. I don't like transfers like that...where I don't know anything about the patient or their history & they are critical. Not to mention the family members asking me why her heart is doing that. I wish I had the answer, but I don't....and I don't like "not" having the answer. My other 3 patients were luckily ok. Actually better than ok....they were stable & didn't need any meds or anything so I was able to focus on this new transfer & able to get the charting done so I didn't have to stay late.
Two of my patients I have had since Friday night. One has been there a month! She came in with chest pain & shortness of breath. She was supposed to be discharged & as she was waiting for her family members to come pick her up, she had a seizure. Well, they think it was a seizure, but they also think she was faking it. I don't know what has kept her here for a month & I don't really know what their plan is for her. She was a sweet lady...kinda needy - it was more like taking care of a baby than a woman. I probably shouldn't have catered to her as much as I did because she should be doing things more independently for herself, but sometimes I can't help it. Some patients bring out the maternal instinct in me. This one even had a teddy bear that had to be tucked in with her each night. It was cute.
My other patient came in Friday night needing a pacemaker inserted. She had been at the hospital the week before & left...only to be advised that she needed a pacemaker. She was in denial, but finally brought herself back to the hospital to get the operation. The cardiologist spoke to her & she was asking him how many of these operations has he done. He told her "Plenty." She asked "What do you mean by plenty?" He came back with a snappy remark like "What number do I have to tell you in order for you to be alright with me doing the surgery?" She didn't like that answer & refused to let him treat her. I say good for her. It was nice to see a patient not put up with the b.s. that some doctors throw at them. So the cardiologist consulted with our top surgeon & the patient really liked him. He was at her bedside, holding her hand & talking to her about the surgery. She felt much better. I had a good rapport with her. We talked about life & family, about her daughter having to put her dog to sleep recently - I shared with her what I just went through. Last night I noticed her doing one of those Sudoku puzzles. I asked her if it was enjoyable & she said it was. I told her I looked at them a couple of times, but just didn't grasp what was so much fun about it. I told her maybe I'd learn on the plane when I go on my trip since it's such a long flight to Hawaii. It turns out she went on the same cruise I'm going on. What a small world...lol. I wish all my patients were like her. I went in to say good-bye to her this morning & she started crying...telling me how sweet I am and thanked me for taking care of her. Awww! That is what makes all this hard work worth it.
The other night, another nurse had a patient that had a massive stroke. It's scary...one minute he was fine & the next he was unresponsive. The CT scan said he had a blood clot in the brain AND hemorrhaging in 3 to 4 ventricles. We were told there isn't anything we can do for that. The family came in and gave their consent for "do not resuscitate" orders. How sad...I felt bad for them. To leave the hospital earlier saying good-bye to their husband/dad and to get a call a few hours later & find that he's no longer responsive...so sad.
We had another patient that was drinking & driving...saw a snake in the road - so he stopped his car. He got out to pick up the snake so it wouldn't get run over. Turns out it was a cottonmouth (otherwise known as a water moccasin) & it bit him. He went into anaphylactic shock. Amazingly they got him to our ER, administered many doses of anti-venom & he's going to be ok. Bet he'll never pick up another snake again!!!