Saturday, February 21, 2009

high times

I had some learning experiences at the beginning of this week. On Tuesday I had a patient who's BP bottomed out. I had to get our Rapid Response team to come, and we had a hell of a time getting the service there. In the end, he went to the unit. The rapid response nurse was awesome, made we want to work in the unit just to get a better handle on things.

I thought no day could've been worse than that, but the next day was. I had a THE patient who developed a leak in her cervical incision, and also threw a fit and refused to cooperate with me when I told her we needed a new IV. Then there was a different patient who appealed her discharge, and I had to get patient relations and social work involved. I requested out of that team and had a calm, relaxing two work days after that. Patient's who are nice, cooperative, and stable. Ahhh.

I'm most excited about getting together on March 7th with my trek nurses. I can't wait to see the group dynamic and get everyone excited about Nepal.

Monday, February 16, 2009

escape artists

On my second twelve in a row, I had a patient with declining mental status and hepatic cirrhosis. He was also a 'code brown-er' (meaning poo, and lots of it!). But just as nice as could be. I'd requested a sitter but no one was available until 3:00. He had yanked out his IV and his Foley bag was full of blood. I would have to keep a close eye on this one. I asked a tech to take him for a walk while I discharged someone else. I came straight back from the discharge to check on him... not in his room. The tech said he'd left him there a half hour ago. His tele monitor wasn't picking up, meaning he'd left the floor. He'd removed his brief (diaper), which meant somewhere in the hospital was a confused 47-year-old in a gown with his bare butt hanging out the back, a walker with a big 'ole 'Property of Hospital' sign on it, and a telemetry monitor to boot.

I called security while the techs searched the floor. I felt like a big dope calling the physicians and saying "I lost the patient". He was found outside of the hospital, starting down the road, in the snow, in his little hospital footies. His feet were like blocks of ice. I felt like a parent saying "Where were you? I was worried SICK!"

Needless to say, I got a sitter.

Ah, adventures!

Monday, February 9, 2009

gift upon gift

I think I would actually like to do home health nursing for a while. My mother did it when I was growing up, and I think I would like it. I will stay where I'm at until the two year mark, I think, but then we'll see. I do know one thing- before I go anywhere else, I'm taking time off and traveling! To Nepal of course, but I will do a few other things, too, while I'm at it. Bangkok, Lhasa, India... I'm in dream world, but I can't help it. I feel so trapped in this nursing job. I can't take time off without pay no matter what I do.

I got a starbucks gift card from a patient I only had for a few hours before sending her to OR. She and her family really liked me, I think because I was in a funny mood that morning. People like to laugh, right?

My french-speaking patient's grandson-in-law wanted me to come over for dinner. But when I got there hours went by and dinner still wasn't ready, and I had to leave. I wanted to do good by this patient as far as lowering his sugar, but I don't want to become too entangled in the family. I've done that before and it's not good for anyone. I am still "the nurse" and I am there for one reason only. I have to keep reminding them and myself of that.

I got several nominations from patients who filled out a form, basically a kudos award. You don't really get anything for it but a certificate, but it looks good in your file. And it makes me feel good.

Monday, February 2, 2009

I believe

I believe I will remember this patient for the rest of my life. I believe that I am doing the right thing, even if I'm breaking the rules.

Today I called the outpatient clinic and scheduled an appointment and interpreter for the French-speaking patient I mentioned in the last post. Then I called the house, without response. After work I drove out to the address listed in the patient's file. It was in the poorest area on the outskirts of a small but diverse university town. The apartment complex was crowded in next to the freeway, and almost every apartment had plywood for windows, except for the patient's. The apartment was being rented by his granddaughter, with whom he is staying, as well as her husband (I assume) and four small children.

I was greeted at the door by a shy but friendly five-year-old and an 18-month-old (by my estimate) wearing a dirty shirt and a diaper. She put her arms up and clamored to be picked up, so I did. The granddaughter, her husband (or who I assume to be her husband), and the patient all came out and hugged me, kissed me, shook my hand, and hugged me some more. I was offered a seat on the couch where the small toddler sat contentedly on my lap and drooled away. I made small talk in my very limited French, and in English with the little girl who told me her name and that she went to kindergarten. There was a basinet set up in the livingroom, where the seven-week-old baby sleeps during the day. The little girl brought me a bottled water.

The patient appeared healthy and well, much to my relief. He told me via the grandson-in-law, the only English speaker in the house, besides the kindergartner. His blood sugars had remained in the mid to upper 200s. A look of worry passed over the young man's face when I said that the patient had an appointment tomorrow afternoon. I then asked, quickly "can I pick him up at 12:30?" He responded with a huge smile and translated for the patient. After a few more minutes, I told them I had to go, but would be back the next day. "Demain!" I said in French, reaching to shake the patient's hand. "Demain!" He exclaimed, and gave me a big hug and a very French pecks on each cheek.

This family is the essence of goodness, I feel. And I wonder what took me so long to realize that this is my calling. These people live in our backyards, people with no one to look after them. People who are sent home from hospitals as lost causes. People who open their doors with complete trust, hoping against hope that in this hard country where everyone lives behind locked doors, and no one speaks to their own neighbors, that a good person will show up and do the right thing.

It's not just me, either. Over the past few days, I found nurses on my own floor who told me stories of dropping by an elderly patient's house a few days after her discharge, to check her wounds. Nurses who invited patients living nearby to come to their apartment to learn how to use their glucometer. I felt extremely proud of them. Going out on a limb, risking your own neck, sweeping aside rules set up by big business and beaurocracy in the name of good, that gives me hope. Our humanity gives me hope.