Monday, November 19, 2007

One of those Weeks

It was one of those weeks where the last place I wanted to be was at work. We all feel that way about work sometimes, don't we? Thursday night was the toughest - I found myself thinking negatively and not really treating my patients the very best that I could. It's not to say I mistreated them or ignored them or anything like that - I just didn't make that extra effort that I often do. The night was going by so slowly. Too slowly.

My first patient had been given discharge orders as soon as I got there. So I had to arrange transportation and verify the medication reconciliation form with the doctor and work with the social worker - discharges can be time consuming! This patient had come in with chest pain - she lives in a nursing home. I was starting to get the impression that she did not want to be at the nursing home...but really...who really wants to be at one?

My second patient was in her 90's - in with congestive heart failure. She was able to get up on her own - which still amazes me when someone is in their 90's.

My third patient - she had a blood clot in her leg and for some reason, they decided to remove the vein the clot was in. I didn't get to read much of a history to find out why they went that route, but when they took the tape off of the dressing covering her staples - her skin came off too. That was worse than the actual incision. It was frustrating to see that she was taking the attitude of not wanting to do anything for herself. She didn't want to cooperate with physical therapy so that she could start walking again, she didn't even want to use a bedpan - she'd rather just go in bed & have us clean her up rather than use a bedpan. She had a foley catheter so luckily that part was taken care of - but who willingly would rather lay in their own stool as opposed to asking for a bedpan? It's not that she wasn't capable - she was more than capable - I just don't get it. The next night she was getting where she didn't even wantto make any effort with her medications. She would have preferred I put the pills in her mouth than for her to do it herself. I wasn't having that. I have no problem assisting someone who needs help, but laziness or lack of desire isn't a good enough reason. Needless to say - she remained this way all three nights I had her. No desire to get out of bed, no desire to start doing things for herself.....BUT she was able to put on her own makeup and this bright shade of lipstick. I don't get it (shaking my head)!!!

My fourth patient - this poor man - this man had gotten a colostomy back in May because he had an intestinal blockage. Now he came back in September to have it reversed - he no longer needed the colostomy. So it was an elective procedure & our top surgeon was performing it. What could go wrong? Ummmm....everything!!! This patient has been in our hospital since the beginning of September. Through the last 2 1/2 months he has knocked at death's door a number of times - but luckily he has survived. It's scary thinking of these elective surgeries & how they could easily take your life.

This patient still has a colostomy and he has a drain because he developed some kind of abdominal abscess and he has a huge incision on his abdomen that is also giving him problems. He has had renal failure, respiratory failure...even sepsis & I admire him - because even with all that going on - he wants to get better & go home. He is getting up & out of bed, he is taking walks unlike my third patient. He was also on a ventilator while in ICU & as a result, his throat muscles are very weak so he can't swallow productively. He also has a hard time coughing - so the phlegm and saliva get built up & he starts to gag. That is not my strong point. I don't like respiratory issues, I can't stand the sound of gagging or spitting. I hooked him up so he could suction himself to help get that stuff out. With all he's been thru, I did what I could to make things better for him.

I was finally able to discharge my first patient around 10:30 and I got another one around midnight. A frequent flyer in with chest pain. The patient himself told me he's been there 50 times for the exact same thing. He was complaining of chest pain as soon as he got to the floor & what do you know - he's allergic to morphine - the pain med usually given for chest pain. On top of that - I had no order for any nitro or any pain medication. The ER nurse was agency & had no idea about pathways or what to even ask the doctors when getting admission orders. So I called the doctor around 1 am to get some medication & luckily the doctor was familiar with this patient and didn't seem too worried about the chest pain. I think he needed something for anxiety more than pain - but I gave him what I could.

I only got 4 hours of sleep on Friday, but my attitude was a little better. I was actually thankful that I am healthy, that I am able to get out of bed with no problem, that things are good. My patients were fine - no real emergencies. I did hear some sad news - a patient that was at our hospital quite often had passed away. She was only 40 yrs old, but had a lot of respiratory issues and needed a lung transplant. Even with all of her breathing issues, she continued to smoke - so although I feel sad she passed away, I have to wonder how much of an effort did she make to improve her life? I don't want to judge - perhaps she had the mindset that her days are numbered & turned to smoking for one last pleasure in life. I don't know. She was found dead at home, but for some reason they called 911 and brought her to the hospital where they ran a code and then pronounced her. I think she had just been discharged from our hospital like 5 days earlier. Sad.

My niece & nephew have been over since Saturday. I knew their mother wouldn't last taking care of them on a daily basis. They are here until Wednesday beause it's her year to have them for Thanksgiving. They'll probably be back here on Friday. It's nice having them around again. Expensive! But nice. :)

Have a wonderful Thanksgiving everyone!!!

Wednesday, November 14, 2007

Ahhh I don't wanna

I have been off of work since last Wednesday & I don't wanna go back. I work Thurs, Fri & Sat night this week. It's been a nice break - I finally got to spend some quality time with my niece & nephew. Guess the ex-sis-in-law was told she could go to jail for breaking a court order. I'm not sure if that is true or not - but it seems to have worked. I spent way too much money in the last few days on them, but I'm trying not to think about it too much. Just need to get back to work & find some time to work overtime.

I can't believe Thanksgiving is practically a week away. Time is just flying - seems like I say that all the time, but it's true - where does the time go? I don't feel like I'm having fun, but time is still flying by. Oh well - guess that's what happens as I get older.

My brother is doing better with his spider bite or whatever it was. Shay is getting bigger - not too much, but still growing. She got plenty of time at the dog park over the weekend. It's interesting to watch dogs - they just walk in, sniff each other & start playing. Too bad adults couldn't make friends that quickly, huh?

That's about all that's going on over here. Hope everyone is doing well!!

Thursday, November 8, 2007

Should have known better

I got a call from one of my brothers on Tuesday. He said he thought he had been bit by a spider. I went to his house & checked it out - there had been some type of bite & for some reason - he squeezed it. After he did that, a lot of pain started. So when I saw it - I could see the redness. It was on his thigh about mid-way between the hip and knee. His big toe was also in a lot of pain, but that ended up to be him stubbing it & as a result had an ingrown toenail that was infected.

So I look up spider bite treatment online & it says to put cold compresses on it and for some reason - take Tylenol but not Advil or aspirin. So I run to the store & get him Tylenol as well as Benadryl, Lanacaine & Neosporin. I went to work Tuesday night & called him to see how he was doing. He said it still hurt and that he was sweating. I wasn't sure what to think, but I gave him my number at work and told him if it got worse, call me. I never heard from him so I called in around 7 am when I was getting off of work. He sounded awful and was still sweating and in pain. So I told him I'd take him to the emergency room.

The big decision was - do I take him to my hospital or to another one nearby. I wasn't crazy about my hospital because I don't think it's the best one around when it comes to ER treatment and I don't like to bring family into where I work. However, they do have this new thing where they promise you will see the ER doctor within an hour of arriving to the hospital. I was kinda curious to see if that would actually happen. Plus I checked the computer to see if there were a lot of people in the ER when I left and it was pretty much empty. So I picked up my brother & told him what all good nurses say - - "Don't tell them I'm a nurse & definitely don't tell them I work there!!!" I work nights so I knew the day staff wouldn't know me and I was just curious to observe the ER from a family member perspective rather than as a nurse. He agrees to comply with my demands. :)

We got there around 8 am & surprisingly enough, I think we were in to see the doctor at about 8:25. Not bad. Luckily we got the better of the two doctors on that day. I had recognized his name, but never met him before. The other ER doctor I recognized because I hear negative things about him from patients as well as other staff. The doctor takes a quick look at my brother's leg and toe and says "We have to open that up & drain it." Eeekk! I didn't think it was that bad, although it was looking more swollen than red at this point. I see the color drain from my brother's face as the doctor talks about numbing up the areas by sticking a needle into the areas that are tender & infected. He then proceeds to tell us how he's going to cut open my brother's thigh and attempt to wash out the infection. I'm thinking COOL!!! I don't think my brother was quite as enthused as I was. He promises he'll medicate my brother before this happens.

In walks the nurse with two Percocet pills. I think "That's it?" Pills? That should take about 30 to 60 minutes to kick in - just how long are we going to be here? About 15 min later the doctor comes back & starts the numbing procedure. My poor brother - he was in a lot of pain & I can't say I blame him. He did well though. I'm sure I wasn't much help as I kept telling him to breathe as he'd clench his jaw in pain.

The doctor waited about another 15 minutes for the medicine to take effect - only it wasn't enough medicine. He had to numb it up some more & that caused my brother some more pain. After that was done, the doctor got out the scapel to cut open his thigh. At this point, I ask "You don't mind if I watch, do you?" I don't think he expected that, but I stood up & moved closer to watch this mini-surgery. Blood gushed out - so cool - lol. The doctor was expecting pus to drain out, but there really wasn't much. He pointed out these little chunks in the blood & said that was part of the infection that was taking place in his thigh. Interesting! He continued to flush it out and then put some packing strips into the incision. He said they would pull that out in two days. Next he went to workon my brother's toe. There wasn't much to that...just cutting part of the nail out. Big deal!

I was expecting my brother to pass out at any moment, but he did well. The nurse came in to cover the wounds and went over the discharge orders. She recognized me - so my cover was blown. She talked about coming back in 2 days to remove the packing strip. I said "Can't I pull it out at home?" She said they would prefer to have him come in so they can be sure the infection is getting better.

My brother had asked the doctor what would have happened if he put off coming in. I was surprised by the answer. He said that it was obvious it was infected and the fact that my brother was shivering and sweating tells him that the infection was starting to spread systemically and that if left untreated would lead to sepsis & possible death. Dang - I should have known better. I thought it was just a minor reaction to a bug bite. Kind of like when you are stung by a bee - it gets red, swollen and tender - but after 24-48 hrs, it's better. Live & learn!

I only worked Mon & Tues night this week. It's hard to get back into being at work when I was off for 5 days. I'm officially off until next Thursday night, but I may pick up some shifts before then - I'll see how I feel later in the week.

I feel a little guilty this week - when I came in Monday night, I recognized a name on our patient board. I cringed when I saw it. I had just had her as a patient like 10 days ago. She's very demanding and needy as well as very critical about everything. The type that constantly puts you down no matter how much you try to help. For some reason she wasn't like that with me, but I have seen her in the past be very nasty to other nurses. I like to think I have some type of calmness that is contagious, but I think with her - she was simply exhausted that night. Anyways - I saw her name & said a silent thank you to God for not seeing my name assigned to her.

I talked to the nurse that did have her & she told me the patient had a stroke and was bleeding in the brain. They couldn't stop it and gave her 30 days to live. I felt sad - partly because of the negative thoughts I had just a few minutes earlier when I saw her name and partly because of her husband. Their kids no longer speak to either of them - I imagine it was because of how critical she can be. Even with her practically on her deathbed, the kids wanted nothing to do with either of them. I felt sad that this man would be all alone having to deal with the fact that he is losing his wife and for him having to see her the way she is right now. It breaks my heart.

I went out with my best friend tonight. We saw the movie "Things we lost in the Fire." It was ok. What was fun about it is that we were the only 2 in the theater - so we could talk out loud thru the movie. It was amusing. I love hanging out with Maria. We've known each other since we were about 13 yrs old & have always been there for one another. Thanks Maria!