Frustrating Part of Being a Nurse

I’m going to admit to something that really is not a good thing at all.  There are times when my patients get me so frustrated I just stop caring and really don’t want to help them at all anymore.  I get into this mode where if they don’t care if they get better then why should I and what difference does it make if I go out of my way.  Like I said not a good thing at all…and I’m working on it…but hey I never said I was perfect ;)  I have two patients in general this last month that has gotten me feeling this way.

One is a patient with Cystic fibrosis.  This diagnosis means that she is in fact a frequent flyer and in the hospital every few months or so.  That in itself is sad because it’s not an easy disease to live with.  Anyway…this patient is very familiar with the healthcare system and because of this they have become a drug seeker.  This patient knows the words to say and the manipulations to get what they think they need.  It is very exhausting…mentally…to care for this patient…because you have to constantly be on your toes and be one step ahead of them so that they don’t manipulate you into giving them what you want. 

Anywho…this patient is also a smoker…not a very good combination with the chronic lung disease they have…but hey what do I know…I’m only a nurse…The patient consistently asks to leave the floor to go down for a smoke.  No normally we can’t really push the situation that far and refuse to let patients leave…but because of the patient’s past history of going down and shooting up Benadryl in the PICC line…we do have cause to tell this patient no…Usually the nurses just do not want to deal with it and so they let the patient go…but when a nurse does say no…boy does the patient ever get upset…even to the point of unhooking the IV fluids by themselves and going down anyway…and of course coming back high and strung out.  This patient is in fact only doing herself a great injustice and speeding up the progress of the diagnosis…but they can not be argued with.  It is frustrating on so many levels.

Patient number 2 has endocarditis from using IV drugs.  The drug of choice is Percocet which of course has that layer of fungi on it which does not mix so well with the heart.  The endocarditis required heavy duty IV antibiotics and because of the past history of drug abuse the patient had to stay in the hospital for 2-3 months to finish the antibiotic therapy.  At first the patient was talking big dreams of staying clean and “I gave up that lifestyle…I won’t ever do drugs again, I came too close to death this time.”  (Now this patient had had a mitral valve replacement 6 months earlier and had already ruined it with this new trip to the hospital).  The patient seemed sincere and many of the nurses choose to believe what was said…that was until we started to notice that the patient was high and strung out for a good three or four day stretch.  A family member had come to visit him and our conclusion was had brought a little extra to add to the party.  The doctors were a little mad and did a urine drug test (of course we didn’t tell him what it was for…instead making some excuse about the antibiotics and how it’s routine).  The drug test came back positive for a drug that we were not giving him.  The patient was required to sign a drug- free contract…basically saying that if it happened again the doctors would be forced to discharge the patient even though the antibiotic treatment would not be finished. 

Everything was good for about a week…I happened to be off and when I came back I heard that the patient was doing very well with no back slides to the drugs.  However, that first night back, I became very suspicious of the patient’s behaviors.  One of buddies of the patient ended up being in the hospital around the same time and so they began to spend a lot of time together.  Now this other patient was on a PCA pump where he was getting 0.2mg dilaudid.  I began to suspect the reason they were spending so much time together was to share the dilaudid.  Turns out the patients were unhooking the PCA and then hooking it back into the IV access of the other and in fact sharing the pain meds.  When I found this out…let me tell you that I was very upset.  At that moment, I wanted nothing to do with either patient…and didn’t really care anymore…but I had to put that behind me and care for them both.

The caring of healthcare professionals are not enough.  The patient has to want to get better and improve, or there is no chance anything will ever change.  All the nurses and doctors can do is try to help the patients see what is best and what they should do…but many times while we are saying and teaching it…we know that it will not change and they will just be back in the hospital a few months later for the same self-destructive habits.  It has to be one of the most depressing things about the job…knowing that you can’t help everyone. 

Hardest Thing

This week I’ve had a patient who may be the first patient that I actually have cried over a patient and his situation.  I’ve had this patient for a couple of weeks.  He has a terminal form of cancer and has a bad prognosis.  In the last couple of weeks, I’ve helped the patient work through his diagnosis, progress through the stages of grief and became a reassuring listening ear.  Nursing school prepared me for all of these things…however nursing school did not prepare me for what I was/am feeling about the situation.  I wasn’t prepared that I would also experience the stages of grief…not as prominently as the patient and family but it is still there.

In the beginning I believed there was something that could be done to help this man.  I wasn’t sure what but I was sure that the doctors would be able to do something…after all modern medicine has a lot of miracles.

After the denial I began to become upset at the situation.  The patient was in the hospital, and had been for many weeks.  He had only seen his wife twice since then and his kids not at all.  His wife seemed to not want to deal with the problem and because of this she kept the kids away from the hospital and their father.  At first I was upset and couldn’t understand and then realized that this may be the wife’s way of dealing with the grief. 

I’m not sure I ever entered the bargaining stage, but I was able to witness my patient endure that stage.  He bargained with God for many days, before he moved on to the harder to handle “What if…” moments.  “What if…I had done this differently?  What if…I had been a better father/husband?  What if I had spent more time with the family”?  This was a tough stage for the patient because the more “what ifs…”  the more and more depressed he got.  It is hard to see your patient become depressed to the point of giving up and not seeing the point anymore…especially in this particular situation…because the hope of life isn’t there anymore.  It’s hard to know that there isn’t much you can say or do at this point to help.  It’s especially hard to know the patient is facing the hardest moment of his life…with no support and no one to be there with him. 

The patient finally agreed to sign a DNR and consider the option of hospice and the return home.  With this option he began to become less and less depressed.  He had something to look forward to…returning home to spend his last days with his family. 

As a nurse, I wanted to help him and make him less depressed but at the same time…I know that there’s not much that can be said or done.   Although I know this…it does not make it easier to face the feelings that are forced upon you…I don’t think there is any way to prepare yourself for that.  

Scardey Cat

The other day at work, a co-worker told me that she didn’t believe I ever got mad…since in a year’s time she has never seen me mad or angry.  I quickly disagreed with her and told her that I do get mad, and in fact she had just missed the opportunity to see me very upset…in fact I was upset enough to want to physically harm someone (this time I not only wanted to but was very tempted to just reach out and punch some common sense in the guy).

I had switched to day shift for a few days to help out with the shortage our unit is experiencing.  Because of this switch I had to interact with a lot more people: family members, doctors, social workers, teachers, guards and patients.  One of my patients was a prisoner and did have a guard at the bedtime.  As I received report on the patient, I quickly learned that the patient’s ammonia levels were critically high.  This caused the patient to go crazy and act irrational and crazy.  The night before he had laid on the floor and crawled on it like a dog, got on the footboard of the bed and stood on it and tried to fly off of it…of course leading to him falling flat on his butt.  The patient was quickly restrained and given some Ativan to help calm him down. 

When I arrived he was sleeping due to the medication and had one hand and foot cuffed to the bed.  When I entered the room to draw some labs, the guards were changing shifts.  This meant that I got to listen to the conversation.  The night guard told me to be careful and to keep my eyes peeled.  I agreed and assured him I would.  The new guard coming on decided to get a smart mouth right from the beginning and stated: “I want to use my gun today…maybe I’ll get to use my gun on him…because I guarantee I will not hesitate to shot”.  This statement in itself upset me and did not start the day off right between this guard and myself. 

As I was finishing up the lab draws, the new guard was asking me a million and one questions about the care of the patient.  I kept telling him that I was not able to tell him anything.  He insisted that he needed to know so he could tell the facility.  I told him to have the facility call me and I would talk to them about the patient and only them…he then mumbled that he was not a guard at this particular facility but was only assigned to the patient because his location was closer to the hospital then the facilities guards.  This did not make me any happier with the guard.

The rest of the morning the patient slept off the medications and was fine.  About 1400 the patient began to awaken.  He was very sweet and apologized for what had happened the night before.  He was very compliant and followed all of my prompting.  However as I was walking out of the room, the guard asked me, “would you knock him back out…he’s getting mouthy”.  I looked at the patient who of course overheard the guard.  He quickly reassured me he was not getting mouthy.  I nodded at him and walked out of the room. 

The guard continued to be mean to the patient for the rest of the day.  The patient was beginning to get upset and edgy but remained calm and polite.  The patient and I could not wait for guard shift…it could not come fast enough for us. 

Seriously, the guard is there to protect if anything happens with the patient…however, I found myself more afraid of the guard, because I could totally see him pulling his gun and shooting one of the health care members in his ambition to shoot the patient.  It was just setting up to be a bad situation if something did happen.  Fortunately nothing occurred and the guards finally switched out…but if I ever have another patient with that particular guard…I will remember the type of man he is…a sacredy cat who is probably more dangerous with the gun then the patient would be.

The Best Patient Ever

I know that usually I write about negative things or just rant and rave about things…but this post I want to write about a patient who was possibly the best, most perfect patient ever. 

She had broken her femur and had a rod placed to fix it.  When I got report I was told she was elderly…I automatically thought…”Oh no…she’s going to be confused and a difficult patient”.  I couldn’t have been farther from the truth. 

As I entered the room, I saw this elderly little lady laying in the bed.  She was so small; the bed seemed to swallow her.  As I introduced myself, and asked her to tell me her name and birthday…she responded. “Young lady, I have told my name and birthday so many times today…if I don’t remember it by now I never will…maybe you should tell me yours so I can use yours.”  I just looked at her not sure how to take her because her face was as straight as a line…but she quickly smiled.  She then proceeded to tell me her name and birth year.  “My name is Betty Boop and my birthdate is 09/18/1929”.  Now I have gotten into the bad habit of not really paying attention to either the name tag or the patient when they say their name…but this one I caught right away…I just laughed and realized that I was going to like this patient very much. 

In the three nights I had her as a patient, I got a glimpse of what the perfect patient would be.  They would be funny and pretty much do what they were supposed to do.  Now this patient did just that…not only did she give me as much jokes back as I gave her…she did everything she was supposed to do.  She was up ambulating less then 24 hours after her surgery (which is no small feat…especially for an older person), she used her flutter valve and incentive spirometer every hour on the hour…she was so on top of this one that she would even stop me in my usual care giving and say “You can just hold on there Blondie…I have to do this before I forget and you get to yell at me.”   I just laughed because it was nice to know someone else cared about their health then the healthcare professionals.  Another thing that impressed me was that she did not take pain medications.  The only time I saw her take a pain medication was the first time she ambulated after the surgery and she did that just because the nurses kept bugging her about taking a pain med before attempting to get up. It was nice to not have a patient that was all about the pain meds. 

I so much enjoyed caring for this patient this week.  In fact I pretty much told her she was not allowed to leave since she made my job so much easier…she proceeded to tell me that I could go home with her so that I could see her have a bad day then I would go running back to the hospital.  She made me laugh and was a dream to care for…if only more patients could be like this…my job would be so much easier.

Healthcare and Politics

*****Caution: May be insulting on some level to some*********

With the election and all the politics making the big news these days, it has made me start thinking some about the healthcare system.  While I’m not one to talk a lot of politics with people because I believe: politics, religion and money are the three subjects that will mess up in one way or another a good day.  I just choose to have my own beliefs on the three subjects and almost never discuss them with others.

However one of my patients has me questioning the way our healthcare system is set up.  And with this comes a personal examination at politics.  For the last year, my unit has been caring for a patient who is a vegetable.  They have very little brain activity left…and can do nothing for themselves and in fact may not even know quite as much of what is happening around them as we want to believe.  This patient has been in the hospital for a year and a half and has been coded multiple times.  One might ask why, if there is that little of brain activity.  That is a very good question and the only answer I can supply is that the patient is a ward of the state.  This means the patient will remain a full code and all efforts will be taken to ensure the patient stays alive.  Now from a nurse’s view this could be seen as a little unnecessary especially when looked at the fact that there is no way this patient will ever make a recovery. 

The patient’s son wants the treatment and care to be stopped and the patient sent home so that the natural process of death can occur, however because the son is still considered a minor he does not have a say at all.  So the care continues. 

Now as one of the patient’s nurses I know the cost that this patient is costing the taxpayers…of course because they are a ward of the state, the state is paying which means you and I are paying for his care.  Instead of accepting the inevitable, politics have deemed that this patient will not stop receiving care until the patient is dead.  This is frustrating to many healthcare providers because it appears there may be a real problem in the system if this patient can have all this care with absolutely no chance of a recovery when there are millions of people who cannot and do not receive any care because they cannot afford it. 

Obviously this seems a little messed up somehow.  And if it doesn’t let me mention another example from my personal experience.  As an acute care nurse, I see many patients who are admitted to the hospital for medical problems that are self-induced: liver failure (from drinking way too much), and endocarditis (from IV drug use).   These particular patients rarely if ever have medical insurance which means the taxpayers are paying for their visit (but this is not the point of my rant).  However, as they are in the hospital receiving care many times, they will revert right back to the self-harming habits that landed them in this position in the first place.  This means that these patients are remaining in the hospital for an extended length of time on the taxpayers dime, with no intention of getting themselves better, while other people who do want to get the chance to get better have no room for them in the hospital. 

Now I am not going to say whether any of the politicians running this year are right or wrong in their stance on Obamacare and the changes that are being proposed and made, however I am going to emphasize the importance of noticing that there is a problem that cannot and should not be ignored anymore.  This is a real problem in our society that is causing a lot of people harm, harm that could be deadly…and for many years NOTHING has been done about it.  In fact many politicians have just swept it under the rug because to them it’s not that big of a problem because they have insurance and can have what they need done.  The issue tonight is not whether anyone is right or wrong but the important thing to remember is that healthcare is important and because of that it is essential that politicians make healthcare important and if they can visualize a change, then maybe, just maybe they may be the one to carry it through for the good of the people.