I'm not sticking my finger in there!

I am currently enjoying a three day in a row break from work. I think it's the longest I've been off in one stretch since coming home. I love, love, love it. I have been there a lot lately, even curling up on the couch in a meditation room for a night. Then there were a few days with really horrible roads, where it took me two hours to get home.

I have had some interesting, and really sweet patients last week. Patients who hug me and tell their roommates that I'm the best nurse in the hospital. Flattery will get you everywhere with me! I heard another nurse mention that she had to digitally stimulate a colostomy q4 hours. I thought, thank god I don't have that patient, because I am just not going to stick my finger in there! Plus, he kept asking the night nurse to "finger him". And who do you think I ended up with the next morning? Same guy. And the first order of business that day was to explain to him that it was almost time for him to go home, and if he needed to stimulate his colostomy (which was 5 years old by the way, not a new thing!) he could do that himself, with a glove. Then I had to empty his colostomy bag which was full of completely formed stool, and doing it reminded me of squeezing frosting out of a tube. So gross. I hate ostomies, especially colostomies, with a passion.

fate is making all the decisions

After returning from Nepal, I found it very difficult to care for our patient population. Grown-ups who whine and complain about the amount of ice in their cups, the hardness (or softness) of the beds, the kind of foods on their plates, the medicine that's saving their lives is constipating them, the pain from surgery is too much... etc etc. I found myself wishing more and more for intubated, ventilated, sedated patients. I look at these people and think, you came to us for medical help. YOUR choice to have the procedure, to come to this facility. It's not the Hilton. We're not here to make sure you eat delicious food and sleep comfortable and undisturbed. We are going to poke you and prod you and wake you up every hour, we're going to serve mediocre food, the beds might not be top-notch in comfortability, but they do flatten in 3 seconds so we can do CPR and save your ass.

So I applied to every job I could in the hospital, and still haven't heard from anyone. No one. Nada. I guess it's not meant to be, but surely I'm not meant to play waitress for the rest of my life?

Working in the field!

I finally got to carry out one of my lifelong nursing dreams... do a service trek and serve rural communities! Of course, I did it in Nepal, where I speak the language, and so had the added experience of being a translator, which I loved. Now I'm hoping to lead a group every year to the clinic we worked at, and start to make a little progress in the area. I loved it there, the community of Sherpas was wonderful. Nursing there was more like being a doctor, though. I diagnosed and treated just using my own brain and the rest of my team. I was terrified at the thought, at first, but after a while I got kind of used to it.

We had some severe cases, like an infant suffering from hydrocephaly, looked like it was going to die soon. We had a guy with a GI obstruction, most likely, a woman who swallowed something sharp when she was drunk, and a woman coughing up blood with TB-like symptoms. But mostly we saw a lot of GERD, aches and pains, babies with diarrhea, dehydrated adults, and wounds and skin infections. The clinic could use a lot of training with the workers, more reference books and drug books, and some programs on ergonomic lifting, hygiene, and birth control.

I'm excited to really be a leader and take group after group. It's totally my niche in life!

In other work-related news, my love affair with cardio-thoracic surgical tele unit is over. I no longer click with management or my co-workers, and I'm a little bit bored with the patients, too. I think it's time to move on, and re-stimulate my brain again. I applied to the baby NICU, L&D, and visiting nurses. I haven't heard anything back, so we'll see what happens. I want more experiences so that I can be a better clinic nurse in Nepal!

reconfiguration

I nearly lost my position in the "unit reconfiguration" that is taking place. They are taking beds from our unit, the cardio-thoracic surgical stepdown, and beds from next-door neurosurgery, and creating a middle unit for otolaryngology and plastics. The positions on all floors were bid on by seniority, and by the hair of my chinny-chin-chin I managed to grab the very last day/eves spot! I would've cried. Not a single cardio-thoracic nurse volunteered to become a plastics/oto nurse. No thank YOU. This whole split cause us to lose some fantastic nurses, and was just unfair and unpopular all around. Everyone had a stomachache, for weeks.

So it is back to business on my unit of choice. I'm ecstatic even if it means being lowest in seniority. But hey- I wanted to work Christmas anyway. Triple time here I come!

patient stalkers

I took care of a very difficult patient, or should I say a patient with a very difficult family, for two 12 hour days. I bent over backwards to keep the family from going over the edge, and to keep from calling security (as the night shift had done). I went out of my way to deliver on all kinds of bizarre requests, and tiptoed around their ever-changing moods. I was exhausted by the end of those two days, but I was also tired because the family stalked me around floor, trying to convince me to join a Jewish group and go to Israel. I told them several times that I wasn't Jewish, but they didn't believe me. The stalking got out of control, to the point where if I left the conference room they would be standing outside of it, waiting for me.

I spent the next two days at work under an alias, at the opposite side and end of the hall, because they were looking for me. I think I did really good work with them, considering how hostile they were to the rest of the hospital staff, and I'm glad that they liked and trusted me. I also got much closer to the PAs on the cardiac surgery team, and one even gave me a hug at the end of the day and told me I did good work. Still, I'm more than relieved that they'll be gone the next time I go back!

that's what it's all about

I made a bond with a patient we shall call T. Patient T came in for an esophagectomy and removal of the stomach. He has been through three J tube placements, and last week, on one of my days with him, he developed a huge leak around the 3rd tube, as he had with the first two. Large amounts of tube-feed BM seeping out and all over his skin. He was miserable. I was miserable. It was a Sunday and the thoracic surgery team was being manned by everyone's LEAST favorite resident. I was upset by their response but I didn't know what to do about it, either.

In the afternoon, the leak progressed to a constant gushing of acidic fluid and BM. I went upstairs to the GI floor and got ostomy supplies, and attached an ostomy bag around his tube's insertion site. For this I was pronounced a hero by his wife. Patient T texted his whole family to tell them that for the first time all day, he wasn't covered in goop. It was a victory for everyone, but it also allowed me to measure the output, which up until now the team had been pooh-poohing. His tube feeds were stopped, a dophoff tube was surgically placed, and he is now being evaluated for a small bowel obstruction. ALL of which I had suggested in the morning!

I have grown close to him and his family during the weeks he's spent here. Even though he wasn't my patient yesterday, I stopped in and did a cervical dressing change for him. I know that this is why I went into nursing- the ability to really play a major role in someone's healthcare, in the way they get through their day.

pulling the plug

Life on my unit has been relatively uneventful. Just the usual requests from constipated patients to just "reach up there and get that piece out" (ewwwww) and cute little old ladies with inguinal hernias that pop out at random times.

The other night, however, I was selected to take care of a patient who has decided to turn off his own LVAD and die naturally. He has been a favorite and a regular on our floor for the last four years, and many nurses were shedding tears over the news. I had not taken care of him much, so I was a good pick because I wasn't sobbing every time I passed by, but it was still very sad. I do enjoy palliative care patients, because I like to think that I had a hand in making their deaths more comfortable and dignifying. I would consider working for Hospice or a palliative care team at some point in my career.

As far as going to grad school, I always thought that I would get a year or two of nursing experience and then immediately go for it, but after just one year of nursing I realize that becoming an NP at this point would only limit me. There is so much out there for nurses, there's L&D, emergency medicine, geriatrics, ICUs... a lot to do and learn and experience. So for now, plans for grad school have been put in the "someday" bracket, to be revisited at a much later time.