Wife From Hell

Sometimes I wonder what in the world I was thinking when i decided that having a job in the public sector was best for me.  I mean I'm not even a major people person.  I am much more content most of the time to be a loner and lost in a good book or watching a movie then being around a group of people.  And after last night I know exactly why that is!
When I arrived on the unit, I was informed that I was getting a new patient.  No one likes to get new admits just because its more work and you don't know the baseline of the patient so if anything starts to go wrong, you may not always know right away.  Anyway, I was getting report and the patient sounded pretty straight forward.  He was being admitted for a pulmonary embolism but was stable. Sounded pretty good.  And then they started to tell me about his wife.
The names that this other nurse called the wife were names that I am not going to repeat but they were pretty vulgar.  And I knew instantly I was not going to have much fun with this patient.
The patient arrived on the floor and before they even made it into the room, the wife was carrying on about how "It must be time for your pain meds....I wonder why they haven't given you any yet...They need to hurry up and do their da*n jobs and get you your meds".  Oh so much fun!!!!
I went into the room and introduced myself.  The patient seemed pleasant and began to assess him.  He denied having any pain at the moment.  Of course with no pain, I was not going to give him his pain meds that were not scheduled but instead only as needed.  I began to ask questions and before the patient could even get his answers out, the wife kept interfering.  "No he does not want that.  I don't know why you think he would.  He does not want an advanced directive, he wants to be a full code...he is not going home...I don't care what you say".  Okay...thanks for the peanut gallery but I'm pretty sure I was talking to the patient.
About an hour after being on the floor he was complaining of pain, so I went ahead and gave him 4mg of dilaudid.  He began to rest.  Within 30 minutes, his wife came storming out of his room.  When I asked her what I could do for her, she demanded. "He needs to be moved right now!!!  I want to speak to your manager."  I was a little confused, and asked her what was going on.  "The patient in the other room, has hepatitis and he's coughing and my husband has been getting radiation and is not supposed to be around that.  And you need to get him moved now!!!"  I told her I would do what I could.  (Little side note...the patient on the other side of the room DID NOT have hepatitis and he was not coughing, he was snoring and sleeping like a baby).
I called and found him a private room but it was going to be 1 in the morning before we could get him moved.  The wife was not happy with that and I swear I really thought about slapping her when she rolled her eyes at me...but I was very pleasant and polite.
Another hour passed and his wife came flying out of the room and demanded I go check on him.  When I entered the patient was sleeping, I listened to his lungs and noticed a little bit of wheezing so I got a breathing treatment ordered.  As I was listening to him, he told me he was hurting, so I got him 2 mg more of dilaudid.
After the breathing treatment the patient went back to sleep, and started to have upper respiratory sounding wheezing and loud snoring.  Now this was because of the pain meds and the relaxation of the throat, but the wife was convinced that I was trying to kill him.  Needless to say 1:00 could not come fast enough for me.
At 0230 I was finally able to move the patient to a different floor, but let me tell you that wife wore me out to the point, I was not sure I was going to survive the last 5 hours of my shift.

Um...You know...It's Not...That Bad??

One thing that more expierenced nurses are constantly telling me is that it will get easier to take care of patients who have received bad news.  However, I find this a little bit sad.  I hope that it doesn't get easier for me...because I don't want to be that calloused or hard. 
This past week I cared for a young man who had been admitted for meningitis signs and symptoms.  He was treated with antibiotics and he started to get better.  Then he began to get worse and none of the doctors could figure out why.   He was just not responding the way he should to the treatment.  So of course, the MDs ordered a ton of blood work and other tests. 
The patient was anxious as he waited for the results.  He said he had an idea of what the result would be, but he was hoping it wasn't going to come back as HIV.  Two days later, the results came back and it was indeed HIV.  The MD went into tell the patient just as I arrived for my shift.  The MD came out of the room to find some tissues and it was clear that it was hard on her too, as she was crying. 
It was a tough night caring for this patient, because 1) what do you say when one hears this news 2) how do you help him accept the results. 
He was very depressed and sad throughout the night, but it was clear that he was definately working through the five stages of grief and by morning, he was well onto his way to acceptance.  He was even telling his family members and friends. 
It was difficult working with him and not knowing what to say, because it's easy for me to say all the right things, but it means nothing since I don't really know what its like. 
Although I may have lots of occasions where patients receive bad news, I hope that it will always bother me a little bit.  I hope that I never become so hard and calloused that I can not feel empathy for my patients. 

Vacation!!!! Or Not!!!

So for the last two weeks I have been on vacation from the hospital.  (Well actually, I'm pretty sure I'm going to just start calling my vacation time, sick leave, since the last two vacations, I have gotten sick).  It has been nice to catch up on sleep and not really HAVE to do anything.  But I was thinking about it and even though I was not in the hospital...I really didn't stop nursing.  Yes, the technical hands on skills part, but overall I guess it's true when they say: "Once a nurse, always a nurse".  Looking back on the two weeks, I see that most of my everyday activities could be defined or seen as part of nursing, especially since nursing isn't only a profession but really more of a way of life. 
On my days off, it was nothing for me to answer medical questions for family members, friends, and yes even those complete strangers who happened to notice I was a nurse.  (It kills me how often I can be out in public on my days off, and people will ask me "Are you a nurse?"  It especially cracks me up when this question comes when people watch me wash my hands and they say "I can always tell just by how you wash your hands".) 
The things I do everything can often be described as "nurse" things: giving advice to a new mother about nutrition, care seats, and baby behavior, letting others go first in line, actively listening to friends or family members, volunteering my time, and of course just thinking like a nurse, whether hanging with friends or making my bed at home (got to love those sheet corners). 
It is amazing to me how for the first time, I really realized that nursing is not just a 12 hour job, or even a job that can be left at work and not taken with us where ever we go.  Nursing isn't only a job at all, but rather a life time commitment of changing people's attitudes and lives, if only in the little everyday things that we do.  So while I may have gotten a break from the hospital, there was no break from nursing. 

He Has a Crush on You!

One of the reasons I like working on an acute care floor, is most of the time, the patients are alert and oriented enough to develop a therapeutic relationship with them.  I enjoy being able to carry on conversations with the patients and family.  Usually if a patient is giving everyone else a difficult time, I can usually use my charm and charisma to make them like me.  However, sometimes this is not a good thing. 
I had this middle aged man who had an epidural abscess.  This abscess led to paralysis from the waist down. 
The patient was pretty upset about this, because it meant more time spent in the hospital and not only that but the MDs weren't aware if he would fully regain control of his legs.  So of course he was a little depressed. 
I always try to get my patients interested in conversation to help keep their minds off their prognosis if only for a few minutes. This patient had been with us for about a month, when my co-workers began to tell me that he had a crush on me.  I just laughed and brushed it off. 
But then I began to realize that my co-workers were right.  The light hearted joking and conversations with the patient had changed, to talking about my personal life...if i had a boyfriend, if I wanted kids, and other personal information.  Then one night it crossed the line. 
We were talking about everyday things when he asked "Do you like kids?"  I told him of course I did.  He then proceeded to tell me that I could have his, but of course it was a two for one package and he came with them.  I just laughed it off, but could no longer ignore the fact that he did in fact have a crush on me.  It made it a little awkward whenever I had to go into his room...but I just went about my job.  And of course it gave my co-workers even more ammo to tease me with.  :)

Code!!!!

I swear this was the worst week of my life.  Not only were the shifts really busy, and then the glucose patient situation, not to mention the perforated bowel patient last night, but this morning, another situation happened.  We were in the middle of giving report, and the techs went running down the hall yelling for a nurse.  It wasn't my patient, but the other nurses were farther away.  I jumped out of my seat (and apparently over another chair, which the other nurses love to mock me for...my athletic abilities) and ran to the room.  Another nurse was right behind me.  Neither one of us knew anything about the patient.  As we arrived in the room, we noticed the patient was a gray pallor and unresponsive.  We tried the sternal rub with no response...we checked his vitals and glucose levels and everything was normal.  He had a pulse so we called an assistance please.
He had pulled out his IV and so we quickly attempted to get one in before all the MDs, Rapid Response, and everyone else arrived.  Within two minutes, the room was packed with people, and since it wasn't my patient, I stayed in the hallway running for supplies and pretty much doing anything that needed to be done, but staying out of the way at the same time.  They ended up intubating the patient at the bedside on the floor and moving the patient to the ICU.  What a nerve wrecking ending to a work week.  

Perforated Bowel

So I survived the glucose patient last night, only to have another situation the next evening when I arrived.  Once again in the middle of report, the techs yelled for a nurse.  As I ran into the room, I saw the patient laying flat on his back vomiting.  I quickly helped the techs, turn him onto his side, and raised the head of the bed.  When I went to grab the suction, I discovered there was no suction set up.  I quickly had a tech run to get the necessary supplies.  As I was waiting, I noticed the smell of the vomit.  It was stool smelling.  That was not good at all.
  The MD and Rapid Response quickly reappeared (apparently they had just left the patients room, and found him to be stable).   They quickly changed their diagnosis to a perforated bowel in need of emergent surgery.  He quickly left for the OR and the shift returned to it's normal pace.

Where is the Nurse???!!!!

So being the kind person I am, I volunteered to come in early for a fellow nurse who had a family emergency (I don't know what I was thinking, since that put me on a 16 hr shift, but hey you know it could be a little fun).  I got report and settled in to start my shift.  As I was looking over orders, the tech comes running in and tells me that one of the other nurse's patients has a glucose of 10 and she can't wake him up!
Of course, we couldn't find the nurse so I went running into the room.
I tried to wake him up and got no response.  I attempted the sternal rub, nothing.  I ran back to the nurses' station to grab some dextrose.  When I got back into the room, the first thing I noticed was that the patient did not have an IV...well dang it...there goes the dextrose idea.  I quickly ran back and grabbed some glucagon and called the Dr. and rapid response.
I ran back to the room and gave the patient the glucagon.  By this time, the MD and rapid response arrived. They asked a million questions, and I felt very stupid when all I could say was "I have no idea, he's not my patient, I don't know where the other nurse is". They pretty much took over and left me to run to get more glucagon, IV fluids and line, call report to the other floor and stay in contact with the MDs.
They quickly got the patient responsive and back to his baseline.  As they were wheeling him off the unit, the Rapid response nurse came running back and told me to call the MD because the patient was having a heart attack.  I called the doctor and put in the new orders.  About this time, the other nurse reappeared and wanted to know what was going on. She informed me that the patient was supposed to be discharged within the hour.
Since the patient was gone, I went about my very long shift, and just barely survived.