What Are You Going to Do With All That Money??!!

With the Kentucky mega million lotteries reaching its all-time high in the last month it has made me start thinking a lot about this country’s priorities.   While I am sure that we all know someone who is wasting money on some frivolous object that we can’t understand, I have seen what the consequence of frivolous money spending can be.
At some point in my career, I cared for a patient who had lost a lot of money.  The patient had a lot of exciting stories of their life and the many things they were able to do.  However, when they came to the hospital, they had nothing.  There was not a home, car, and only one pair of clothes to this patient’s name.  As I was talking to this patient, I learned all about the things you can do with millions of dollars.  You can buy a multi-million dollar house in a gated community.  However if you don’t pay your dues to that community you may lose that house…all because you didn’t pay $150,000 of dues (this may seem like a lot of money to us, but for this patient it was just pocket change at the time).  You may also buy all the fast sports cars you want.  I do believe that at one time this patient had 10 different sport cars…now please tell me why you need 10 when last time I checked you can still only drive one at a time.
 Oh but the most important thing you can do with that money…is of course buy DRUGS!!!!  And have a great time at all the crazy wild parties you want. 
Eventually it was the drugs, which claimed all the money of this patient and left the patient with nothing.  This patient went from a normal everyday life, to one day waking up and having everything they could possibly think of.  I can’t even imagine what that would be like…although believe me it would be a great thing to figure out what it would be like.   I felt bad for this patient because they had their whole life settled and made for them and then all because of a few bad choices they were even worse off than they had been before they won the money.  But then at the same time…I felt a little like… “Man…you had it made…what in the world were you thinking!”

With What???!!! That Small Thing???!!!

While nursing is of course always about caring for patients and doing your best to ensure they stay free from physical harm, every now and then I will have a patient who makes me so mad, all I want to do is cause some physical harm to them.  However, I need to control myself and act professional in every way which was not very easy with this one patient I cared for.

This particular patient was admitted for acute respiratory failure secondary to methadone overdose.  He was stabilized in the ICU and sent to the acute care floor.  Now this patient was a big man…morbidly obese weighing close to 500 pounds.  This made it really hard for the patient to ambulate and perform his basic activities of daily living.

Not only was it difficult for this patient to do basic simple activities, he was extremely stubborn and refused to do the things that he needed to do to become healthy enough for discharge such as: wearing a C-Pap machine and sleeping in the bed instead of the recliner.  One of the most annoying things this patient refused to do however was use the urinal or bedside commode!  Instead he chose to be incontinent and wanted help with cleaning up.  (I hate it when patients do this…because not only do I have to help…but it really only hurts them in the long one).

I had already taken care of this patient for a few nights in a row and was beginning to get tired of his rude comments and constant need for help. (Now I am one who will help anyone with anything…but when it comes to situations where I know that the patient can do it for himself…it becomes incredibly hard to continue being nice).

One night as I was helping to clean him up I noticed that he had some fungus growing in his folds.  As I was scrubbing his folds, he leaned forward and said “You have been a bad girl.  You need a spanking.  I am going to spank you.”  WITW!!!  I very quickly stopped cleaning him and stepped back…of course I was so mad I left the room and sent the tech in to finish.  For the rest of that night I only went into the room when I needed to.

The next night of course I had this patient again. (Believe me when I say I was a little mad at my co-worker for making me have him again, but oh well).  I took him his medications and began to assess him.  He stopped me and asked me to scrub his testicles because they were itching.   I told him that I would get him a washcloth so he could do it himself.  He then proceeded to throw a huge fit about how he couldn’t do it because he couldn’t reach it.  I very quickly went and found my guy tech and sent him to help.  (Neither the patient or the tech was happy about this move).  

This patient was really starting to get on my nerves yet again and the night had just begun….I was managing to stay professional until…it happened.

Before I left that morning I went in to do his dressing changes.  I was almost done when he grabbed my arm and said “I’m going to bend you over the bed and take you right here.  I’m going to have you right now.”  I quickly shook off his grip, looked at him and said “Excuse me…You are going to do what? With what???!!! That small thing you can’t even reach???!!!”  (Yes, it is possible I have grown into my mouth a little and do have moments where I may not exactly filter what comes out). 

Now I know that the professionalism disappeared and I probably shouldn’t have said what I said, but I was very angry…it’s one thing to have patients say things when they don’t know better…but this man was 100% cognitive and knew what he was doing.  I have learned that many times people who are rude and crude, only respond and actually hear what you are saying when you are rude and crude right back to them.  The worst part is that I have to continue to care for him for the next several weeks…while they find placement for him…it’s going to be a long month.

O My Goodness...What in the World Do You think I Am...A Progressive Care Nurse???

Let me say right here before I even get started with this post…so that no one can misunderstand...I LOVE MY JOB!!!!  However if there was one thing I would change it would be the acuity of the patients.  Now for those of you who don’t know, I work on an acute care medicine floor.  In simple lay man’s terms it is the floor where the liver, kidney confused, dementia, drug abusers, cystic fibrosis and psychiatric patients end up…that is as long as they are stable.  Acute care means that I do not have the same training as a progressive and critical care nurse…normally this would be fine…but we have a huge problem.

We are CONSTANTLY getting patients admitted to the floor that need a higher level of care who should be at least progressive and sometimes critical care.  It is aggravating because not only do they not belong on the floor in the first place, it becomes a patient safety issue when patients begin to decline and we are not trained to handle it as well as critical care nurses…and of course I have a nice fun example of this ;)

I can pretty much tell what kind of night it is going to be within the first few minutes of being on the floor.  This particular night I knew it was going to be a long busy night and it was going to be a rough one.  We only had three patients admitted to the floor which left seven empty rooms and admits for during the night.  I began to get ready for report from the day nurses when the phones begin to ring off the hook.  Of course it was the ER trying to call report on two new patients.  Now it is really annoying when other floors try to call report during our report because there is just way too much going on and it leads to important information being missed.  But we can’t refuse report so, the nurse I was working with and I sucked it up and took report.  We then got report on our patients on the floor.

This left us with three patients already on the floor and the two coming from the ER…plus two other patients coming up from the ER the day nurses had taken report on…this meant four new patients coming to the floor all at once…with us trying to see our three patients before the new ones arrived.  Within five minutes the ER had sent up all four patients and chaos erupted.

As I was trying to get my new patients settled and assessed, another floor called to give report on a patient.  This one was coming from a progressive floor.  I asked the nurse working with me to ask the nurse calling report to give me five minutes and I would call her back since I was in the middle of helping a patient ambulate to the bathroom and couldn’t just leave to go to the phone. 

Within five to ten minutes I called the nurse back and received report.  Before I even hung up the phone, the patient had arrived on the floor.  This was my third new admit in twenty minutes and I was drowning a little.  As I headed into the new patient’s room I noticed right away he had a unit of blood hanging.  A patient is usually not transferred while receiving blood due to the monitoring and everything that has the potential to go wrong (and of course I was not told about the blood transfusion in report).  I was a little upset about this.  As I walked closer to the bed, I saw the patient had a trach (this would have been fine except this was left out of report also). 

The next thing I noticed was that the patient had a massive amount of blood pouring out of his trach.  There was blood everywhere!!!  If I didn’t know better I would have thought there was a serial killing in the room.  I quickly called for help and went to the patient.  There’s not really much you can do when a patient is bleeding from the trach…there’s not really anywhere to hold pressure.  I quickly turned off the blood infusing and waited for rapid and the doctors to arrive.  The patient was still breathing, had a heart beat and was semi-conscious. 

As I was dealing with this mess, my co-worker came in to tell me the ER was on the phone trying to give report.  As she saw what was going on, she quickly jumped into help and the phone call was forgotten (apparently this was not appreciated by the nurse on the phone).  I left the room to grab some towels and ran into the HOA. She started to yell at me about refusing report and how that was not acceptable.  I quickly ran past her into the patient’s room.  When she saw what was going on she quickly forgot about yelling and began to call the doctors and rapid since they had still not shown up.  Within ten minutes the room was packed and the doctors updated. I left the room and let rapid response take over the care of the patient.

It was crazy to say the least.  But thank goodness the patient was ok, because I felt like I was out of my expertise and really had no idea of what to do…so I just did the basics and prayed that would be enough till rapid response showed up.  Thankfully it was…and needless to say I sent that patient right back to the floor where they came from.  The nurse was not too happy about getting him back, but he was better prepared for that mess then I was.   And the crazy night continued because as I hung up the phone, the ER called back to give me my two new patients.

I Got Played!!!

While I was in nursing school doing clinicals, I could never understand how older, experienced nurses could be so cynical and cold towards their patients…especially concerning drug seekers.  When I did my synthesis in the emergency room, the nurses would flippantly say “Oh they are just here for pain meds…they don’t really hurt!!!”  It made me mad and I couldn’t quite understand it.  The nurses would tell me that I would understand one day…
For many weeks I was caring for a patient who was in spinal precautions.  He was experiencing a lot of pain and discomfort.  Because he was in the hospital for a long time, I established a relationship with him and his wife.  I was happy to see that he was getting better and it was getting closer to the time for them to be discharged. 
The patient and his wife were so sweet and were a joy to care for.  However, I got played big time.  One day I came into work and did not have this patient.  However, I was helping my co-worker care for them.  As I and my co-worker went into the room to roll the patient over, the nurse gave him his pain meds.  The patient then did something really weird.  He took his sheet up over his head.   Then we saw his hand go up to his mouth under the blanket.   My co-worker and I looked at each other and decided we needed to figure out what was going on.  The other nurse said she was going to do her assessment.  She pulled the sheet down from his head.  The patient kept his hand closed tight.  She assessed the patient but didn’t find anything.  We rolled the patient and left the room.  As we left I realized that I had forgotten my stethoscope in the room.  I turned around and headed back into the room.  As I entered I saw the patient hand something to his wife and the wife put it in her mouth and swallowed.  When they saw me they got a really guilty look on their face.  Apparently this patient had been cheeking his pain meds and his Xanax and given them to his wife. 
I felt so mad and betrayed.  I had been played the whole entire time.  It was at that moment that I knew how nurses can become so cynical towards their patients and how they have no trust for when a patient says they are in pain.  It was a sad lesson to learn for a naïve innocent new nurse.  Time to wake up to reality I guess.

Slap that Patient!!!

Sometimes there are patients, that I would just like to slap.  They are lucky that I possess some form of self-control (even if it's only a little).
This one patient in particular came very close to getting slapped or something.  She started out nice and sweet but as the night progressed the evil side of her began to surface.  She became more and more demanding and wanted things when she wanted and not a moment later.  This of course is an unrealistic goal when you are in the hospital.  We try our best but sometimes, our superpowers of being people pleasers just give out from pure exhaustion. 
She was becoming more and more hateful and was asking for some pain meds.  Unfortunately her pain meds were not due for another few hours.  She became irate.  She then proceeded to rant and rave about how "You are here to be at my beck and call...You do what I say when I say...I don't care if my meds aren't due...I want them now...and you will go get them!"  Goodness, at this point I was very upset...but at the same time...i was fighting an uncontrollable urge to laugh my head off in her face. 
I managed to use my self-control to not slap her nor laugh in her face...but i sure mumbled under my breath as I left her room...Needless to say it made for a long rest of the night of dealing with this patient. 

Does the Patient Have Feet?

When I first started working on my unit, I was a little overwhelmed with five patients and everything that I had to do, however as the months have went on, I have become more comfortable with it.  Nevertheless sometimes I still manage to get my charting switched up, which can lead to some funny incidents. 
One night was particularly busy and it seemed that none of the patients wanted to sleep; instead it was if they had all plotted to ring the call bells all at the same time, for the entire night.  This makes charting very difficult, because as soon as you sit down and chart one thing, you have to hop right back up to go see what the patients want and when you return your train of thought is pretty much ruined. 
I had been trying to chart for the last couple hours and wasn’t accomplishing much, when finally the call bells grew quiet for a few minutes.  I decided to take advantage of the quiet.  I managed to completely finish charting on three of my patients.  I then realized that I may have forgotten to mark on the charting that my patient had bilateral above the knee amputations. 
I clicked on the patient’s name and discovered that I had mistakenly documented that the patient’s dosalis pedis as being 2+ palpated.  Now that meant that I felt the patient’s feet pulses and they were normal…however the problem is this patient did not have feet due to the amputations.  I fixed the charting and finished the rest of my other charting. 
I then called report to another floor on one of my patients.  This patient was moving to a private room due to cognitive behaviors and there was none available on the floor.  I called report and then transferred the patient to his new room. 
I returned to my floor and went into another patient’s room to do trach care.  As I was doing trach care, the nurse I had given report called for me, my co-worker told her I would call back.  When I was finished I called the other nurse back. 
When she came to the phone she started to laugh.  She said that she had a question.  “Does this patient have feet?”  I very quickly tried to figure out what in the world she was talking about.  “Um...Of course, he has…”  The nurse was laughing hysterically at this point and I joined in because I realized what she was talking about.  I had accidentally charted the amputations on the wrong patient!!!  It was quite funny because the nurse who had gotten my patient, said she had done her assessment and then went to chart and just happened to glance over my charting and had to go back to the room, just to make sure the patient had feet!  I guess charting was not my forte that night!

Good Intentions Lead To...Overdose???

Nurses and doctors do everything they can to make the stay of patients to be a good experience.  This includes providing pain control…or at least trying to help with pain control…however sometimes good intentions do not always have good outcomes. 
One of the important lessons nurses are taught in pharmacology class is that many times doses of medications may need to be adjusted for patients.  Yet, sometimes this may be forgotten.
I was caring for an elderly patient one night.   He was complaining of pain in his lumbar back area.  He had fallen earlier that day, so the doctors came up and assessed him and did the battery of tests to make sure there was no injury.  When all the tests were done, the doctors ordered 2 tablets of Percocet to be given every 4 hours. 
I went ahead and gave him the 2 Percocet.  At exactly four hours later he was complaining of pain again.  It was time for some more pain medications, but I was a little hesitant to give more due to a history of chronic renal failure.  I text paged the doctor just to verify the dose and suggested maybe decreasing the dose or increasing the hours between the doses but the doctors did not seem interested in my concern.  I was very careful during the night to make sure the pain meds was not building up in his system.  He seemed to be fine, and in the morning I left for a four day break. 
The next night I was at work, I noticed I was getting this patient back.  I received report and checked his pain meds.  They were the same as when I left before so I didn’t think another thing about it.  I went in to assess the patient and found him to be very lethargic and only responsive to aggressive stimuli (sternal rub) and would only keep his eyes open for a few seconds after being aroused.
Great!!!!  Just what I needed to start my night!
I did a double check to see when his last pain medication was administered.  It had been 15 hours since his last dose.  His vital signs were stable and everything was fine except for his lethargic state. 
I called the doctor, he came up to assess the patient and ordered Narcan to be administered.  Narcan was given and the patient came to.  He was fine, and the doctors left with orders to move the patient to progressive care and a Narcan drip.  The patient was fine and transferred to the other floor.
While doctors and nurses have good intentions, we do not always get good outcomes, but thankfully this patient had a good outcome with just a minor speed bump in his recovery.

Come Here...!!!!

*****Disclaimer!!!! may contain some swear words******
One of my favorite parts of my job is getting to interact with patients.  This is a very good thing, since that is the majority of my job ;)  Anyway it never ceases to amaze me the things my patients do or say to make my night.  Many times, I deal with difficult patients.  However, it is much easier to deal with difficult patients when I know that they can’t really help it because it is related to the disease process.  Some example of this would include: older patients suffering from dementia, patients who are in genuine pain and patients who may have just heard bad news about their health and the rest of their life.  For these patients it is a lot easier to have understanding, compassion and sensitivity when they are being difficult.
One patient in particular made my night. He was an older gentleman and was suffering not only from dementia but a form called sundowners.  Now sundowner means that the patient is more confused and out of touch with reality after the sun goes down (night time).  He had no family with him and he was very confused.
He arrived on the floor, and I oriented him to his room as best as I could.  I gave him the call bell and yet knew that he probably would not be able to use it correctly since he was blind in both eyes.  I decided to leave his door open so we could keep a close eye on him.  This was a big mistake!!!!!!!  One that I was going to regret!!!!
As the night progressed, the patient became even more confused.  He started to panic and began to call out.  The tech went into take his vital signs and didn’t take the precaution of announcing herself before grabbing his arm.  He freaked out and threw up a punch with his right fist that caught the tech in the chest, knocking the wind out of her.  And that was only the beginning.
We managed to calm the patient down and went on with our tasks.  I thought the patient would get some sleep, but I am beginning to learn that patients never sleep at night, unless they are the patients that are pretty much self-sufficient (which doesn’t really make an easy night for the nurses and techs).
Every time someone would walk past the patient’s door, he would holler out for them to come in.  After the first few times, we realized the patient didn’t really need anything other than some good old fashioned attention.
As I was walking past the door at one point, I heard the patient yell something that I hadn’t heard him say yet.  He was very upset and was starting to freak out again.  “Come here b****s and whores!!!  I say come here.”  I was shocked to hear him say that.  I went in the room and began to talk to the patient.  He calmed down and I left the room.  But I obviously had set a precedent for the rest of the night because any time someone walked past the room we heard “Hey, come here b****s and whores!!! B****s and whores come here right now!!!!!”  While I’m not usually one that tolerates that language from my patients, like i said earlier sometimes patients with dementia may be allowed to say some things that normal patients would not be able to and it was kind of funny in an ironic way to hear this patient yelling it out.  Made for a very interesting night.

Homelessness

When I was a few years younger than I am now, I went on a most unusual adventure.  I had previously read a book entitled Under the Overpass: A Journey of Faith on the Streets of America by Mike Yankoski.  Yankoski basically tells of his five month journey living as a “homeless” man.  The book is rather interesting because it tells of not only people’s reaction to Mike and his buddy Sam, but also of the changes that occurred in Mike’s own life.  Well of course after reading this book I was incredibly interested.  Was the experience outlined in this book, the real truth, or was it exaggerated for selling possibilities?  Instead of just contacting Yankoski and talking about the book, I and a few friends got a brilliant idea to try it for ourselves.  Obviously we thought we knew what it was going to be like and that we had the answers to everything (because we were young and stupid!!!!).  Boy, were we ever wrong.
We made our plan…making sure that we informed one person of our plans…kind of as a contact person, even though we wouldn’t have any contact with them for the two weeks that we were going to be “homeless”.  The next step was to put our plan into action.
Naturally, we were all a little nervous, but at the same time, we really did think we knew how it was going to go…so that certainty (well fake certainty) gave us some comfort.  The comfort was very short lived.  Our contact person dropped us off deep in the center of a huge city.  All we had was the clothes on our backs (we wanted this adventure to be real and figured the less stuff we had the more we would blend in).  We left our cell phones, money, clothes, and everything else behind.  As we watched her drive away, it began to sink in that we were really on our own.
The short version is that it was rough to adapt to this particular way of life.  While none of us had come from a privileged, wealthy background, we had never gone without the bare necessities of life either.  The tower of social settings is completely different in this setting, and for the most part, there is a sense of community among the people.  If you have more then you need to survive, you find someone who is worst off then you so you can help.  Now there are definitely some who are only out for themselves and will do anything to get ahead, but for the most part it wasn’t that way.  I learned a lot, and the ideas and thoughts concerning the homeless changed during this journey. Anyway my post isn’t really about my adventure as much as about one of my patients.  The other night, I had a patient who was homeless.  When I received report from the ER, they told me that he had tripped over a railroad tracks and couldn’t get up.  He spent the whole night outside before he was able to crawl to a point where someone was able to help him to the ER.  When he got to the ER, they determined he had bilateral frost bite to his lower legs, ankles, feet, and toes.
He arrived on the unit in only a T-shirt, ratty old blue jeans, and a pair of tennis shoes with more holes then material.  I was shocked that he had only gotten frostbite on the lower extremities and not the whole body.
From the moment he arrived on the floor, the prejudices and judging began.  “OMG, did you know that he’s one of those homeless losers…He’s probably on IV drugs cause you know they all are…He’s just a filthy man”.  And then the classic “I don’t want to take care of him; I hope someone else gets him tonight”.  It was very upsetting to me…because in that moment, they had stripped his humanity from him, and made him less of a human.
As I was talking to the patient and gathering his history…I found out a great deal.  When I was filling out his possession record, all he had was the clothes on his back, and a backpack with a single small book.   He then told me that the book had been his wife’s favorite book.  From there he told me that his wife and son had died a year ago from a drunken driving accident.  From that moment on, he understood that the life he had was not the one he wanted anymore.  He gave up his lawyer job, sold his house, donated the money to a charity, and moved onto the streets.  It was great to hear his story.  He was happy with the life he had chosen, even though no one understood it.
He was not oblivious to the prejudice of the healthcare workers towards him.  He knew that story oh so well. But what was new to me was that it upset me more then it upset him.  He just shrugged and smiled and was nice and sweet to every single person, even if they treated him lower then themselves and gave him less time than the other patients just so that his “situation” didn’t wear off on them.  It made me realize that while we may not understand our patients’ lives or have different opinions then them…we still need to treat them with the respect that they deserve as a human.   Because we don’t do a very good job at hiding it when we don’t, and it may be that our patients become the better people when they give us the respect that we didn't give them and make us feel a little foolish in the process.