Tuesday, September 23, 2008

The meeting and a story

Thanks to everyone that leaves me a comment or writes me an email. I really do appreciate your feedback! I went to the meeting today - it was more like a training session. It was mostly centered around our upcoming Joint Commission survey. They are the ones that give our hospital accreditation. I am sooooo thankful they don't visit at night...lol. Not that it really matters because we know the right answers to anything they ask - but none of us like being interrogated about our patients or their care. I'm glad I got the meeting over with. Now I have the next 2 days to take it easy.

I read this story on another web site and wanted to share it. It touched me and I'm sure it will touch others. I hope it's ok to post it here...

The Patient I Failed

She knew what she wanted.

She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself.

So, she wrote a living will, had it notarized, gave it to her personal physician, told all her friends and family what she did not want. She wasn't eligible for a DNR, as she was a healthy 89-year-old, but she knew what she wanted.

"I do not wish my heart to be restarted through usage of any chemical, mechanical or physical intervention..."

Of her 6 children, one fought against her mother's decision, and it was this child, this one desenting voice, who found her mother collapsed on the kitchen floor.

"I do not want any external device to be used to maintain my respiration if my body is incapable of sustaining it on its own."

The daughter told EMS her mother was a full code, and they intubated her on the floor of her kitchen. Once at the ER, her heart stopped, CPR was performed, and her heart was shocked back into a beat. Under the hands of those trying to follow the daughter's wishes, the woman's ribs cracked and broke.

"I wish to die a peaceful, natural death."

She was then sent to ICU, where her heart tried to stop 3 more times. Each time, the broken ribs jabbed and ripped into the fragile muscle and skin as CPR was performed. Electricity coursed across her body and her frail heart was restarted a 4th time. By this time, the other children were there, but the act had been done, over and over. No DNR was written, and the Living Will fluttered impotently at the front of the chart.

"I do not wish artificial means of nutrition to be used, such as nasogastric tubes or a PEG tube."

Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat.

"I wish nature to take its course, with only medication to prevent pain and suffering."

The daughter who wanted the mother to remain a full code also refused to allow narcotics to be given, stating she did not want her mother sedated, since she would "wake up" when the correct medical procedures were performed. Her nurses begged the doctor to write a DNR, and he said, "the family can't get it together, and I'm not getting into the middle of it."

"Allow me the dignity we give to beloved pets. Let me die in peace."

I met her one Tuesday night, and spent that night pouring Jevity into her tube, only to suction it back out. Her legs were cool and mottled, her bowel sounds were non-existant, and her blue eyes stared blindly at a ceiling she could no longer see. The MD refused to terminate feedings, but I held them since there was no digestion taking place. The woman was turned and repositioned every 2 hours, and each time, she moaned and gurgled as her lungs slowly filled with fluid. I whispered my apologies as I did the very things to her she tried so hard to prevent.

Suctioning improved her lung function, but would make her body tremble. Over the next 2 nights, she slowly died, all while the daughter demanded more interventions, and maintained that her mother wanted to be a full code. We had read the Living Will. We knew better.

"Thank you in advance for helping me in the last moments of my life to have a gentle, peaceful passing."

She had another stroke, and went back to the ICU, where she was coded until there was not enough surviving heart tissue to maintain a beat. Finally her heart was broken.

And so was mine.

Saturday, September 20, 2008

Snake Bites and Pizza

Well, the flood situation is over at my hospital. We still have a lot of water, but none of it is on the roads. Hopefully this will never happen again. As if it wasn't enough that we had a monster tropical storm and flooding...that same week AHCA made a surprise visit. AHCA is the Agency for Health Care Administration. As a result - we have a mandatory nursing meeting type thing to review what we are doing wrong. It's a 4-hour meeting...ugh. I'm going to try to go tomorrow afternoon just to get it over with.

The patients that stand out this week for me are the ones that got bitten by snakes. One of them for some reason decided to adopt a rattlesnake he found during the recent flooding. Not only did he decide to adopt it, but he considered it his pet & would play with it. Huh??? Who plays with a rattlesnake??? With their bare hands??? This guy did & sure enough - he was bitten. Luckily he responded well to the treatment and was discharged home a few days after getting bit. I asked him if he planned on keeping the snake...........nope.

The second guy that was bitten....well, let's just say the only people I've seen bitten by snakes have been males. Hmmmm. This guy's children found the snake and this guy decided to try to pick it up. Apparently he did not know what kind of snake it was. The snake bit him on the left hand. What does he decide to do? Call 911? Seek help??? Nope, he tries to pick the snake up with his right hand. Guess what...bitten again. Sigh! Turns out it was a pygmy rattlesnake. He ended up killing it & bringing it to the hospital with him. Apparently he's going to be ok & hopefully he's learned to stop trying to pick up snakes with his bare hands.

On a different note, I had female patient the other night that asked me something no one has ever asked me before at the hospital. She rang her call light & asked to see her nurse immediately....me. It was 1 am and I had already spent the majority of my time in the room with her that evening as she was a very needy type patient. I had given her a sleeping pill earlier and was fully expecting her to get some sleep any time now. So I go in the room & she's sitting up in bed & says "I need pizza now." Ummm, excuse me? She says "I am craving pizza and I need some right now. Can you help me?" Huh??? I looked at the clock & it's 1 am. I told her I didn't think any pizza place would be open this late on a week day. She asked me if I could please call around and find out. I told her I really did not have the time to be calling restaurants, but she was welcome to call or look them up on the internet (she had her own laptop computer in the room). She was ready to start crying...not from pain, but from possibly not getting pizza when she wanted it. I really didn't think she'd find any place still open....but I was wrong. Domino's was open until 1:30 & sure enough - she ordered a pizza. I asked my charge nurse if that was ok...because I've never had a patient order pizza or any other delivery type food while they were in the hospital. She said "We can't stop her." I just had to laugh because of the situation. She got her pizza and was a happy camper after that. Yay!

I'm trying to like the other hospital I work at, but it's tough. There are a lot of similarities as far as charting, but the flow of the place is just very different than my usual hospital. The staff is much different too. I feel disorganized & I don't like that feeling. The team nursing is not really being done even though it's supposed to be. I don't like the team nursing. I prefer to have my own 4 or 5 patients and not have to worry about anyone or anything else. After 5 patients, I find that it's hard to retain any more info. For them to think we can take up to 12 patients and do quality nursing care...well, it's impossible. So the night shift nurses have been splitting the teams/assignments. We're not supposed to, but the charge nurse doesn't seem to mind. I'm sure it's only a matter of time before administration figures it out and either gets stricter or listens to the nursing staff and changes things.

I'm debating about trying another hospital. The downside is that the other hospitals are further away and more traffic which means I'd have to leave earlier to get there and take longer to get home. Plus I don't want to burn any bridges. For now I'll try to give this other hospital more of a chance. I've only been there 3 times...so I will make more of an effort to be comfortable there. All I can do is see what happens. I would like to get into a bigger hospital and get into an ICU training program. Perhaps I'll do that at the beginning of next year.

I'm off until Friday...unless I pick up some shifts. Well, I do have that meeting tomorrow. I think I'll enjoy having the rest of the week off.

Have a good weekend everyone!