Thursday, January 24, 2008

Because we are Human

I still wonder how I ended up where I am in life. Never as a child did I want to be a nurse. I wanted to be a teacher. For some reason path in life led me into nursing. I'm still trying to figure that out.

I will write more about my last 6 straight nights of working later on. I'm tired & need to get some sleep, but I wanted to post about what happened Tuesday night. Or should I say early Wednesday morning. There was a patient on my floor - he wasn't my patient, but I got to know who he was, what happened to him and ultimately - I was the one to watch him die. I didn't plan on the last part happening, but sometimes things don't go as planned.

The patient was a man in his 70' active man. In fact, he had been doing yardwork as recently as this past Saturday. On Sunday he began feeling some left-sided weakness. Like any of us, he thought it would go away. It didn't. He ended up falling at home because of the weakness. So his wife brought him to the hospital to get him checked out. He was admitted to my floor Sunday night.

He still had left sided weakness, but he was responding to questions and able to move. By the time I got back to work Monday night - things had changed drastically. I overheard the day nurse telling his night nurse that he wasn't expected to make it through the night. Huh??? What??? Why not???

Turns out when he came in, he had what I believe they called an evolving stroke. They had started Mannitol on Sunday night to reduce intracranial swelling. It wasn't helping. The patient's wishes (before this happened) was not to do anything drastic to save his life. He was in his 70's, felt he lived a good life and if/when the time came - let him go peacefully. Hospice had been contacted and they came in Monday night. His nurse and I spent some time with his wife.

She was so full of stories inbetween the tears. I can only imagine how she was feeling - to see the love of your life slowly fading away. We got a private room so she could spend the night, but around 2 am she came out & told me that she simply couldn't sleep in there. The noises were keeping her awake & she needed her rest to provide her with strength for the coming days. I assured her she was doing the right thing - that she did need to get some rest and get something to eat. I told her to call if she needed anything at all and that we would be in touch should something happen while she was not there.

I checked on him a few times that night - he was doing ok. His breathing sounded wet - like he had fluid in his lungs, but his 02 sat was fine. He developed a high fever that morning...I believe it was over 103. His nurse gave him a tylenol suppository, but it wasn't working. His temp wasn't going down. I went home that morning thinking his temperature was going to lead to his death sooner than later.

I went back Tuesday night and his temp ended up being ok. Although at this point his family had withdrawn all medications. He was in hospice care now - but they did not have a bed available at their facility - so he was still in the hospital. He had a different nurse that night - someone that wasn't familiar with him or his family. They had left before I arrived. Regardless, I didn't have a good feeling about the night.

They only did vital signs on him once that evening. We still had him hooked up to the heart monitor and the 02 sat. Amazingly his heart rate & rhythm were ok as well as his 02 sat. It was around 3:25 am that his 02 sat monitor was alarming. Well, it had been alarming on & off all night...but it was at that time that I went in to check on him. I looked at him & immediately questioned whether he was even breathing. I didn't see his chest rising - but I also couldn't understand why his 02 sat was as high as it was = (85% - low, but not bad for someone who didn't look like they were breathing). I touched his hand - he was still warm. The 02 sat monitor was still recording a decent pulse around 100 beats per minute. I stood there for a few minutes watching him - assessing his respiration rate. It wasn't good - maybe 3 respirations a minute. Or more like loud gasps. I could sense the end was near.

I went to inform his nurse - she was sitting at the nurses station. She was a med/surg nurse that had been floated to our unit. I told her "I don't think he's going to make it through the night." She replied "Don't say that." It was then on the monitor his heart rate jumped up to 149 instantly. The rhythm was chaotic. I said to her "Look." Of course she had no idea what she was looking at because she wasn't used to having to deal with heart monitors or rhythm strips. So we went to go look at him & by that time he was already gone. :(

The family was informed and showed up shortly afterwards. This is definitely the hardest part of nursing - having to see the sadness in their eyes as they say goodbye to someone that was so very special. As they were leaving, his wife came over to me to hug me.

I silently wished that she didn't have to go through something this painful. No one should...but yet we do...because we are human.

Friday, January 18, 2008

I hate being sick!

I have been battling a cold for about the last 2 to 3 weeks. Just when I think it's gone - it sneaks back up & is even worse than before. Some nights I can barely sleep, other nights anything less than 8 hours is not enough. I've been congested, achy, chills, hot - all this from just a cold! If anyone else is going through this, I sympathize with you. I usually have a pretty good immune system, but I think spending time with my niece & nephew while they were sick is what got to me. Oh well, it was worth it.

It hasn't stopped me from working. Well, it has stopped me from overworking, but I haven't the need to call in sick. I've been off on the nights when I felt my worst. I'm working 60 hours this week. Actually my week is almost over. I work Friday & Saturday night. Should be a piece of

I can't complain about work lately - I've had pretty good patients and we've had a patient care tech all the time too. It just works better when we have proper staffing. Our hospital is full as always as far as patients go. Lots of respiratory problems - pneumonia, respiratory failure, COPD, etc. There also seems to be quite a few people either attempting suicide or taking pills & saying they want to die - but not actually taking something that could kill them. It makes me sad that there are so many people out there that would rather kill themselves than live. We are just a small hospital - I can't imagine how many are showing up in emergency rooms around the country or around the world. I hope their families find them the proper help so they can live a positive life.

Nothing much was going on with my patients this week. I've noticed that I really don't get too rattled anymore by someone claiming chest pain or difficulty breathing. I just do what I need to do to relieve their problem. I did have one patient whose heart rate jumped up & sustained at 150 while he was sleeping. I ended up having to call the doctor at 4:30 in the morning. Doctors love that! I tell him what's going on & he orders "A 500 ml bolus of normal saline and then normal saline at 75 ml/hr." He was ready to hang up. I said "Are you sure you don't want something for his heart rate in the 150's?" I understood his line of thought - that perhaps the patient was dehydrated...but still...lets give a medication that will at least slow the heart rate down a little. He ordered Lopressor 50 mg PO. Again, I asked "Are you sure you don't want something IV?" Nope. I was looking for some quick results & IV is the best for that. I didn't argue....gave the patient the Lopressor & started the bolus. Within a half hour his heart rate was around 100 and by the time I left at 7 am it was in the 80's. Problem solved...pat myself on the

I received a new admission Tuesday night - well, actually he came from our new "Express Admissions Unit." Instead of having a patient wait in the ER for a bed, they transfer them to this unit - another nurse does the whole admission process & then they transfer them to wherever a bed opens up. So I'm getting report on my new patient & I'm told he is a convicted sex offender & no one under 18 is allowed in the room. They had no private rooms that night so he'd have to share a room until a private room opened up. I didn't think it would be a problem as my other patient in the room was in his 80's & the only person that ever visited him was his elderly wife.

Still though - it made me feel a little uneasy. Not that I thought this guy would do anything to me or anyone else...but the fact that here is his roommate - an elderly man having to share a room with a convicted sex offender & not being allowed to know that information. It creeps me out. I never thought about situations like that. You never really know who you are sharing a room with when it comes to these semi-private rooms. Yet another reason all rooms should be private.

In a way I wish I hadn't been told that little tidbit of info about my new patient, but it is important that we are aware since children do come to the hospital to visit their relatives. I didn't want it to cloud my mind or have me treat him differently than any other patient. He was in a lot of pain when he was transferred over to me as well as having a high blood pressure (204/98), a fever of 101.7 and an extreme headache. None of it phased me...I treated the temp with tylenol, the pain & headache with Dilaudid and the blood pressure with some medications that were ordered. I got him a cool wash cloth, plenty to eat & drink and took the time to talk to him - to try to give him some emotional support that soon he would be feeling better.

He ended up surprising me by being very appreciative. He must have said "thank you" to me at least 50 times that night. I did all I could for him - now I just had to wait for the medication to do its job. Within a couple of hours he was feeling much better. By 4 am he was afebrile, blood pressure around 146/78 and the pain and headache was subsided. It's nice to see results. We don't always get to see them in such a short amount of time.

I'm hoping Friday & Saturday night go just as smooth. It's hard to believe I've been a nurse for 3 years. In some ways it seems much longer and other ways it seems like it's flown by. Only 30 more years to go to retirement...haha!

Have a good weekend everyone!!!

Tuesday, January 8, 2008


I've been working quite a bit lately. In fact out of the last 7 nights, I will have worked 6 of them. The good news is that after tonight - I'm off until Sunday night. Yay!

I'm not going to go into all of the different patients I had over the last month practically - but there are a few that stand out.

Two of them are related to cancer & we all know that word cancer is not a pleasant one. I had a patient in her early 30's that had come in about 10 days before Christmas. I didn't actually get to meet her until Christmas Eve, but regardless - she came in with the diagnosis of pneumonia. When it wasn't resolving & she began complaining of a sore throat & trouble swallowing her food - they ran more tests. Come to find out she has esophageal cancer...stage 4. She has tumors all over her esophagus. With it being stage 4, there is literally nothing much they can do for her. It is too far gone. We're talking about a mother in her early 30's with 3 kids at home. Sooo heartbreaking! She was going to go ahead with chemo to buy herself a few months. I can't even imagine what it is like for her. You go into the hospital thinking you have pneumonia & get the news that you only have a couple of months left to live. That is so not fair!

My other patient with cancer came in last week. She is in her late 60's & has uterine cancer. She's gone thru 2 rounds of chemo & it's not helping. She started to open up to me about it & I didn't know the right words to say. I told her to try to stay positive - that anything is possible, but I thought to myself how easy that is to say when you're not in her situation. I thought about it a lot the next day & when I had her as a patient again that night, I encouraged her to talk about how she felt. I figured that she felt uneasy doing that with her family as they were very emotional considering the diagnosis and she seemed to want to open up to me. This was also the night in which the doctors informed her that the cancer had spread to her liver....that is really, really bad. She doesn't have much time either. So she told me about how her family was feeling & reacting. I asked her how she was feeling. She told me she was numb. That she's all out of tears. That she doesn't understand why God would take her this way. I told her I didn't understand either. I realized at that moment that she wasn't looking for answers - just someone that could listen without getting upset.

I had another patient - this one didn't have cancer, but boy did she scare me. She had a GI bleed and the GI doctor had found a large stomach ulcer & he cauterized it (to stop the bleeding). My first night with her was began a few hours after she had this done. She was a quiet lady - didn't really ask for much. After a couple of hours, she started vomiting dark colored blood. Not a huge amount, but enough for me to worry. Then she had to go to the bathroom & if anyone is familiar with a GI bleed - you know it has a particular foul scent. This patient definitely had it. So much so...her roommate went running out of the room! I decided it was time to call the doctor because the patient was pale, clammy & cold although her blood pressure and heart rate remained stable. Luckily I had requested another blood count when I started the shift because she had received a unit of blood earlier that day and it was never rechecked. I had the results back by the time I called the doctor. In the meantime, my co-workers were moving the patient to a private room because of that GI bleed odor.

I called the doctor & he was relatively calm. He said he expected her to bleed a bit more and explained to me why he thought this. He asked me if I thought she needed to be transferred to ICU. I told him I wasn't sure - her vital signs were stable, but she was definitely bleeding. He decided she needed something for the nausea/vomiting and another unit of blood. I was worried about her - she was sooooo cold & clammy...yet was complaining she was hot.

I gave her the medication & started the unit of blood rather quickly. Within an hour she had regained her color and now she was freezing instead of hot. I'll take that - much easier to warm someone up than cool them down. I had her the next 2 nights & she did wonderful. What a comeback. I thought for sure she was going to end up coding on me that night. My co-workers are so wonderful - they all helped out in getting her back to feeling better.

Those are the 3 patients of mine that have really stood out and I'll probably never forget those experiences. It's a quick reminder not to take life for granted & whenever I start feeling down about my problems - it shows me that my problems aren't so bad.

Time for me to get some sleep so I can be wide awake tonight. Have a good week everyone!

Saturday, January 5, 2008

Happy New Year!

Happy New Year!!!  I know I'm a few days late, but that's better than never.  I will catch up soon - gotta get some sleep.  Tonight will be my 4th shift in a row. 

Have a great weekend!!!