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!!!