Saturday, September 29, 2007

Beauty Fades, Dumb is Forever

For those of you who know me know that I am quite close to my niece.  I've practically been like a second mom to her & my nephew from the time they were toddlers because my brother & sister-in-law were separating & fighting.  I was the one that stepped in & made sure that those little kids didn't have to be in that environment.  While my ex-sis-in-law made a feeble attempt to be a mother to them, she was more focused on partying & picking up men for about 5 years.  I remember her telling my mom shortly after having the kids "When is it going to be time for me to have fun?" about you think about that before you decide to have children.  Anyways - to make a long story short - they divorced & she hooked up with the guy my brother found her cheating with & she had a baby with him.  They are living together, but no marriage & my niece cannot stand this guy cause he is always yelling at her & my nephew.  It frustrates me that out of the 9304802394903214901 men out there, she'd have to pick the one that has a grudge against my brother because my brother beat him up when he discovered his wife was cheating.  Anyways...all of a sudden now, my ex-sis-in-law has decided to be a parent - which is great - she should be making those children a priority.  However, at the same time, she has decided that my brother & my side of the family cannot see them anymore.  Yes, my brother has a court order to see them, but he has gotten himself messed up with a DUI & a probation violation - so he will be spending a little time in jail.  So he can't take her to court to enforce the visitation until he gets his stuff all straightened out.  Who knows how long that will be.  I'm frustrated because it's been about 3 weeks since I've seen the kids & even though my ex-sis-in-law says I can spend time with them - when the time comes, she won't answer the phone or make good on her promises.  I'm not looking for any answers here, I'm just venting.  I know this subject matter definitely doesn't belong in a blog about nursing, but I have to release this frustration.  I know the real reason behind blocking me from seeing the kids is because she is resentful/jealous of the bond I have with them.  If it came down to it, both of those kids would rather be with me than her &she knows this too.  Her loser bf just adds to the drama instead of trying to find ways to resolve it.  I feel for the kids because this is all they know in their world - a revolving world of chaos & instability except when they are with me.  I know they'll be alright, but I worry.  They are 10 & 8 - getting to those crucial years of where they can be tempted down the wrong path.  I guess all I can do is be there if/when they need me.  Ahhhh, so frustrating.  Like Judge Judy fades, but dumb is forever - my ex-sis-in-law is a shining example of that quote. 

My week at work started out good - I was actually glad to be at work on Sunday night because it gave me time to focus on something other than the family drama.  Two of my patients I had had in the past & they were really nice gentlemen.  My group was practically ready for bed by 9 pm.  I was having to wake them up to take medications!  I had the same group on Monday night, but the night didn't go as smooth.  The two patients I had in the past both were having symptoms I couldn't do anything about.

One woke up all shaky & even though he was breathing ok, he didn't feel like he was.  I checked his blood sugar because his doctor had been ordering for him to get 20 units of regular insulin twice a day REGARDLESS of what his blood sugar was as well as 35 units of Humulin (longer lasting) twice a day AND to also cover with sliding scale protocol.  It just did not sound correct to me.  I don't even give that much insulin to someone with an extremely high blood sugar much less someone that is around 150 or 200.  I tried talking to the doctor about it & he looked at me like I was the crazy one.  So I checked his blood sugar figuring he was probably crashing from these screwed up insulin dosages...he had gone from 250 to 106 in a couple of hours.  I thought maybe it was too fast of a drop for him, so I got him some orange juice and graham crackers.  The shaking stopped & eventually he was feeling ok. 

My other patient was in with congestive heart failure although he had been complaining more about feeling dizzy.  He woke up at 2 am with the complaint:  "I just don't feel right."  He couldn't describe it beyond that.  Myself & two other nurses were asking him a 100 questions to try to draw some symptoms out of him, but everything was ok other than "I just don't feel right."  I can't call a doctor & say that..especially at 2 am.  We stood there looking at him - unsure of what else to do.  His vital signs were fine, his vision & speech were fine, he was answering questions appropriately...what do you do?  He had no pain, no discomfort, not nothing except not feeling right.  I advised him to lay down & see if it went away.  He ended up going back to sleep & that was that.

After that, my first patient woke up again shaking & not breathing right.  His blood sugar was about 121 - so I didn't think that was the problem.  He also added nausea to his list of complaints.  Ok, I can call a doctor for that - that is something easily treatable.  So I get the order & give him the medication - he is doing better....laying down now...only to get back up an hour later & have the same symptoms all over again.  He originally came in for chest pain, but he wasn't having any of that.  He's actually been coming to our hospital for the last 4 or 5 months with different symptoms & they haven't been able to figure out what was causing him to feel ill.  I told him next time try a different hospital.  I mean why would you keep coming back to a hospital that you are frustrated with because they didn't have any answers?  His doctor usually rounds first thing in the morning - but of course on the morning I needed him there to witness the patient's symptoms - he was nowhere to be found.  He didn't come into the hospital until 5:30 pm.  Figures!  For some reason he wrote an order to transfer him to another hospital to do a pacemaker evaluation.  I don't think the patient needs a pacemaker as much as he needs his medications readjusted.  Oh well, I'm not the doctor.  I was glad to see he would hopefully get some different answers at the other hospital.

Tuesday night was my third night in a row - usually that is the easy night as by then I usually know my patients after having them for a couple of days.  This week it was reversed.  I got a new admission at 8:30 pm.  A 47 yr old with chest pain - I love people with chest pain because they are pretty much easy to treat & for some reason I remember that protocol the best out of anything else.  And when they are young like that - it is usually more related to stress than an actual cardiac problem.  My patient arrives to the floor & the ER nurse says to me "He just said for the first time today that he has been having extreme chest pain all day & night - but didn't want to bother us."  Why do they wait until they are on the floor to speak up about pain?  And wouldn't you know it - no pain meds had been addressed in the ER - I don't know why - he was being admitted with chest PAIN.  So I call the doctor & get some morphine & nitroglycerin sublingual.  I give him 2 mg of morphine IV & nothing changes.  I give him 2 more mg - no relief.  I go with the nitro this time - no relief & now his blood pressure is just over 100.  The patient had a CT scan of the chest to rule out aortic dissection.  I was worried maybe something really was wrong so I called the cardiologist who had already seen him in the ER.  He said there was no way this patient had an aortic dissection.  I said "Ok, what do we do for his unrelieved chest pain?"  His answer: transfer to ICU and start a nitro drip.  Grrrr...all that work just to send him to ICU. 

Later that night I also got another admission with chest pain - he seemed a bit dramatic the first 1/2 hour he was on the floor, but luckily he had a good ER nurse who rather than bring him to the floor as he complained about chest pain right before being transferred to my floor - the nurse pulled the ER doctor in to assess him one more time & got him not only pain medication, but also anti-anxienty medication AND gave it to him before bringing him to the floor.  Just about any other nurse would have dumped him & left me to call the doctor & get the medication & delay treatment by about a 1/2 hour.  So the meds kicked in as I was asking the 984013490130941 admission questions.  He went to sleep after that & the rest of my night went smoothly. 

It looks like we aren't overstaffed at night anymore - easy come, easy  Three of the night nurses opted to go into the ICU training program and another one quit - so hopefully I'll be able to pick up a lot of overtime in the upcoming months.  I really want to pay off my car by the end of the year & put some in savings.  That's the goal.

My puppy Shay is continuing to grow...she's nearly 40 lbs now.  Somehow I don't think she's done growing - so much for the vets saying she'd be petite & about 40 lbs max.  I had her in the car today & she was barking at a motorcycle rider.  She definitely will be a great protector.  Here's another pic of her!




tendernoggle said...

awwwwwwwwww...your little pup is so cute!!! Or should I say your big pup??? lol
You know what...I have a sister just like your sister-in-law! Her kids were cose to me too and she used my love for them against me...when they were little, she would pull them away from me by not letting them come over etc. when she was in a bad mood....Unfortunately, about the only options you have is to wait til they get old enough to come to you on their own or either " suck up " to your x-sis-in-law...for the kids sake.
love ya,

molly146012 said...

What a great entry ...but sorry about the kids :)
Your puppy is so cute.
Hang in there and have a great week .
Your patients are so blessed to have you for their nurse.