Thursday, June 12, 2014

what's the matter with you? and you? and you?

No, seriously, you family members of sweet little old ladies who are floor status... what makes you think that it's ok to freak out and yell at nursing for the fact that your mom ordered white bread for her sandwich. She is totally with it, she totally ordered her own dinner. It is also so not ok to get me at the desk every 5 minutes because there is a spot on a pillow, or there is spit in your mom's mouth, or you dropped an ice chip on the bed. You are being obnoxious. You are not the only patient in the ICU, or the hospital, or the world. I'm not here as your personal servant, or your punching bag.

Call me a mean, bitchy nurse. I've given your moms every ounce of my compassion, care, and attention. I've helped them order food, bathed them, and answered all their questions. You may be scared or sad or nervous about them being in the hospital, but they are getting better and going out. The person in the next bed over may be agonizing over withdrawing life support on the parent of their young children... and you complain about this little shit?? Get it together. No one likes you. The patients yes, you, no. You are wasting our time and making it so that staff runs when they see you coming.

Please send in one of your saner siblings.

And yes, that was me, running across 5 lanes of traffic to get the fuck away from you. I hope tomorrow I do better in the patient family lottery.

Sunday, June 8, 2014

when a nurse has to do what a doctor shoulda done

The doctors signed out for the day, a lovely warm Sunday evening with clear blue skies. The attending, who had promised to come back later, decided he wouldn't be returning after all. The cross cover team didn't know the patient, and besides, they were stuck in a room placing a difficult line.

It all fell to me to address the family's concerns and questions regarding the end of their loved one's life, and the removal of his life support. They had made him a full DNR, do-not-escalate care just yesterday. His daughter had panic attacks so bad this morning, when she realized he would not survive the day, that she retched and shook and had to go to the ED herself.

I have often participated in, or even led, these types of discussions. I have never held a family meeting to discuss end-of-life care all by myself. What choice did I have, though? They were ready to let him go, but they didn't know how. They didn't know what to expect or how they would survive it. They didn't know if they could even utter the words that would lead to the push of certain buttons, the end of his life support, the withdrawal of all that kept him alive.

I gave them that permission. I took away that awful choice. I told them that he had lost consciousness days ago, his body had made a decision for all of us. I told them that the doctors had already made the decision that everything that could possibly be done for him had been done. We could keep him going for another day, perhaps, on his current support. Or we could withdraw it and let him slip away peacefully in the next few hours.

I described what would happen to his vital signs. His breathing would quicken, and then slow. His heart rate would go through a variety of rates and rhythms, slow down, and stop. His blood pressure would drop quickly to nothing, as would his oxygen levels. He had already lost consciousness, and he would slip even farther from this world. I described that what we could do to keep him comfortable. They all looked at each other, nodded, and said yes. Let's let him go.

I reported all of this to the cross-cover team. I just needed them to enter the orders. I paged the attending, who still chose not to come in even though he had built a relationship with this family over the last week. I had just met them this morning. Nevertheless, I assured them that their emotions were ok. I said it was ok to cry, or not to cry. It was ok to stay in the room with him, or to leave. There was no right way, and no wrong way.

I was surprised that they chose to say goodbye and to wait outside of the unit. I stayed with him, holding his hand and rubbing his head, representing the Mother that we all call out to in our times of need. I hummed to him and sometimes sang. The family sometimes came in to kiss him and tell him they loved him. Ultimately, they were not there when he passed. I alone was there as his heart beat its final beat. I alone witnessed his exit from this world. And I alone went to the family to express my condolences, and to hug them.

The daughter said to me, through shaky tears, "thank you for being with him when we couldn't be".

This is the greatest work I do, that I've ever done.

Thursday, June 5, 2014

back to school

I got admitted to grad school this fall! I applied for Winter, since I missed the fall application deadline. But they called me and told me they were willing to consider me for Fall if I was interested. And there you have it! I got the acceptance letter from the School of Nursing and I'm just waiting on the actual Graduate School to give me my ID and PIN and whatnot so I can register.
Every ICU nurse I know wants to go to CRNA school... and while I'd love to sedate people for a living (who wouldn't?!) it's just not feasible for me to devote that much time and energy to school while working full-time and raising a child. Plus, I love the elderly, especially dementia patients, and my school offers an NP program with a concentration in Dementia.
Besides the fact that I would love to work exclusively with the elderly, and the pay raise is impressive, I wanted to be an NP so that by the time my daughter is school-age, I'll be working "business" hours as well and can be with her in the evenings and weekends. Even working three 12s a week, I'm going to miss two weekends with her, and be off a lot of days while she's in school all day. It makes no sense to me. I'm always trying to figure out how to be with my little girl MORE. So while she's a baby/toddler it doesn't much matter which days I work, it will later on. I will also be looking for something that's closer to me, as in, not an hour away.
My thoughts prior to school are a mix of excitement (who doesn't love a fresh notebook?) and just a general sense of dread. Dread for the stress and additional work that has to be done on any given day. As it is, I can barely keep my house from looking like a disaster zone, the yard from looking like a jungle, or my kid from eating poison or jumping into bodies of water. It's difficult to manage everything just working three days a week and leaving that work behind me when I leave... not to mention that I miss my daughter and desperately want to be with her every second I can when I'm not working.
So I know this is going to be hard. It's going to require sacrifice (especially of sleep, god help me) but I'm only doing it because I think it will be worth it in the end. I think I will find my career more satisfying, my home-life more satisfying, and my bank account more satisfying in the end.