Two in One Night...Oh Come On!!!!

There are bad nights in the hospital, and then there are really bad nights.  Last night was a really bad night.  As I walked into the hospital and made it to the floor I work on, I heard over the loud speaker “Code Blue, Code Blue”.  This is not a good thing at all.  In fact it means that a patient is coding somewhere.  As I rounded the corner I found the excitement.  I jumped in with chest compressions and helping out wherever I could.  Unfortunately, the patient was too far gone and was not able to be saved.  Not a great way to start a shift.  This was going to be a very long night. 

As I was making my rounds, one of the nurses informed me of one of her patients that was not doing very well.  In the few minutes we had been there she had started to take a turn for the worse.  Her oxygen requirement had increased and she had to be placed on supplemental oxygen.  Her breathing had also increased and she was having trouble catching her breath.  We paged the doctor who ordered a chest X-ray and some medication, Lasix, to help pull any fluid off of her lungs.  However, he was not extremely worried about the patient’s condition. 

However as the night progressed, the patient respiratory status continued to decrease.  Her oxygen was increased again and again until she was requiring the highest amount of oxygen therapy we were able to provide on the floor.  She was still having trouble catching her breath, and after every breath she was having a weak cough.  In fact just by looking at the patient it was obvious she was exhausted and her energy to even take a breath was wearing out quickly. 

We re-paged the doctor, who came to the bedside to assess the patient.  He continued in his assumption that there was nothing wrong with the patient and he did not want to do anything at this time.  We paged Rapid Response and they came to access the patient and immediately knew something was wrong.  They managed to push the order through to get the patient moved to progressive care, however as our luck would have it there was no beds available at the time and it would be awhile before the patient could be transferred.  This turned out to be a very dangerous situation, because the patient was quickly approaching a point where she was not going to be able to breath at all on her own, which means we would have to call a code and the likelihood of reviving the patient would be slim.  However, if we could find a progressive bed for her they could move her and intubate her before it reached the point of a code.  Two hours later, a bed finally became available.  As Rapid Response began to move the bed to transfer the patient, she stopped breathing and they ended up taking her to the progressive floor doing chest compressions.  When they reached the new bed, they intubated the patient and she was able to get the oxygen her body demanded.  This was one work night I wished I would have called in for. 

What in the World is Going on With This Patient?

Sometimes one of the hardest things about nursing is knowing what is actually going on with a patient…especially in the middle of a patient decline.  During a decline, it is the responsibility of the nurse to inform other members of the healthcare team (doctors, rapid response, and respiratory therapists, etc.) what is happening with the patient.  The information obtained from the nurse helps set the treatment plan. 

However, many times when a patient is declining, there are a million reasons why the patient may not be doing well.  In fact many times, it is impossible to tell right away because so many different declines may have similar signs and symptoms, which may prolong diagnosis and treatment.

 
The other night was a regular, ordinary night with not much action occurring.  In fact we had all gotten into the mindset that this was going to be a good night, and this was our mistake number 1 (Never ever as a nurse or healthcare professional even entertain this idea, because as soon as you do, you will have jinxed yourself 
every time).

 As we were basking in our quiet night, one of the nursing techs came and informed us that one of the patients was acting a “little funny”.  She was definitely more confused and more agitated then she had been for the last few nights we had been there.  We went and checked on her, but found nothing to be alarmed about, our mistake number 2 (Never assume just because some patients get confused over night in the hospital, that this is normal for all patients).

 Twenty minutes after checking on this patient, I was giving some medications to another patient, when I heard patient number 1, start yelling at the top of her lungs.  “Help!!! Help me!!! I need you to help me right now!!!”  I went running into the room with the other nurse and we found the patient laying in the bed with a crazed look in her eyes and tossing herself all over the bed while still screaming at the top of her lungs.  Her next words got us springing into action.  “I think I am having another stroke!!! Help, Help me please.  I don’t want to die!!!”

 We quickly asked the tech to get a set of vital signs (temperature, heart rate, blood pressure, respiration and oxygen saturation).  While he was doing this, I quickly did a stroke assessment trying to ascertain whether she really was having a stroke.  My assessment came up inconclusive because there were some signs and symptoms of a stroke, but not enough to warrant a stroke alert.  The tech informed me he was not able to get a temperature on the patient.  I asked him if he would mind getting a blood glucose level.  Sometimes when a patient’s glucose level is low they tend to have signs and symptoms of a stroke.  As soon as the tech informed me of the glucose level of 15, I knew we had found the reason the patient was declining.

 I quickly ran out of the room to grab some D50, which is a concentrated form of sugar that is pushed into a patient’s IV to raise the glucose level in the blood.  However, as I ran back into the room with the D50, the other nurse, the patient’s nurse, informed me, “Oh shoot she doesn’t even have an IV.”

 Because of the no IV access, the treatment options had become very limited.  I quickly grabbed a glucose gel tube and some glucagon.  As the other nurse put the glucose gel under the patient’s tongue, hoping the sugar would absorb into her blood, I quickly mixed up the glucagon and administered it as a shot in her leg.  When we rechecked her glucose level again, it was 14.  Our mistake number 3.  (When you arrive for your shift and you learn that one of your patients does not have an IV, it may be a good idea to ensure an IV is placed BEFORE the patient actually begins to decline and every minute counts).

 While we were starting the IV and administering meds to help the patient, the patient was yelling the whole time.  She was saying she was dying, she knew it.  She was having a stroke and we needed to help her.  Finally I grabbed her hand and was able to calm her down with a quiet voice.  Within seconds of placing an IV we were able to administer the D50, and within minutes she was more responsive and aware of her surroundings.  Thankfully all the pieces of the puzzle fell into piece relatively easily for this particular patient decline and we were able to quickly provide treatment with no harm to the patient.  

I HATE these caps!!!!!

Many times the supplies or equipments we use in the hospital may change based on availability or cost.  The newest change to hit us has been our IV connectors and IV caps.  Now usually I don't notice a difference in most things, however, I am going to be completely honest and say I HATE these new connectors and caps.
I was in the middle of starting a ridiculously hard IV when I attached the cap (we didn't have any connectors at this time).  The IV was drawing blood beautifully, however when I went to flush it, it would not flush at all.  No matter what I did, I was not able to flush the IV, which meant that I had to take the IV out.  It frustrated me a little since I knew the IV was good since it was returning blood.  Anyway I found a new spot and put in a new IV.  This time when I placed the cap on it flushed and drew beautifully.  YAY!!!  I taped it all down and hooked up the fluids.  Of course as soon as the fluids were attached and turned on, it decided it didn't want to work (I was not happy about this, thinking I was going to have to change the whole IV yet again).  I retaped the IV and did everything I could think of to make the IV work, with no success.  I finally went to a different unit and found an IV connector.  After connecting the connector and starting the fluid, it again did not want to flush.  At this point I was beyond frustrated.  A task that should have taken 15 minutes was turning into a 45 minute job.  Finally I got the bright idea to replace the cap on the end of the connector.  As soon as this was done, the IV worked like it should have.  I was so happy that I did not have to change out the IV again, especially since the patient was needing some blood pressure meds for her BP of 220/113.  

I Kill You!!!!

Since I work in a big hospital, there are occasions when the patients we care for are prisoners from the surrounding areas.  Many times, people are scared to enter their rooms because they are afraid they will get hurt, however, I always think these are the safest patients because there are always at least one guard stationed in the room.  The patients that always make me a little paranoid are the patients who have a mental health issue.  There are no guards in their room, and many times, it is impossible to tell what they are thinking or about to do. 
One patient in particular this week has managed to make most of the staff members wish we did not have to enter his room at all.  He was admitted for osteomylitis in his spine secondary to a past gunshot wound.  From the minute he was admitted he was telling stories of his time in prison.  While making conversation he would expand that it was because he had killed his first man when he was 10 years old.  As he continued to talk his stories became more and more violent and graphic, until he reached the point he was threatening every person who entered into his room. 
Well of course I was the lucky person who got sent into draw some labs.  While I was doing this, he was screaming at me and threatening to throw me through the window.  It was quite fun.  Honestly, I got the impression he threatened everyone but would never really act on his threats.  He said he was going to bring a gun in and shoot everyone, he threatened to kill his doctors because they didn't know what they were doing, he threatened to kill the cleaning ladies because his room was never clean enough.  In fact I didn't really pay attention to most of the the threats.  However, that changed really fast. 
When I returned the next day, I was met with serious faces.  The day nurses informed me that the patient had physically threatened one of the staff members and was now a candidate for having a security officer stationed in the room with him.  However the patient could still go down to smoke unsupervised because of course we do not want to invade on his privacy (really! Honestly...how does this make any sense!!!!????).  During one of these trips down to smoke, we received a call from another security officer informing us that they were going to return the patient to us, and he was no longer allowed to leave the floor. Apparently this patient had physically grabbed a doctor in the hallway and was beating him when the officers showed up.  The reason "I don't like those foreign doctors." 

Acceptable Hair

Every now and then one of my patients or their family members just make me speechless.  I have no idea what to say or even how to respond to something that they do or say.  It's quite frustrating at times. 
One of the nurses asked me to draw some labs on her patient.  I gathered my supplies and entered the room.  First I introduced myself and explain what I'm there for.  The wife instantly jumps in with all sort of questions, "Why are they doing more lab work now...they just did it four hours ago?"  I explained to her I was not their nurse and was just asked to draw the blood.  "Did they get the results back yet...have you seen them?" Once again I politely explained to her that I was not her husband's nurse but I would have his nurse come in and talk with them if she would like. She huffed and hawed for a few minutes and then gave her okay to attempt the blood stick.  
I told them that I was going to try to get the blood out of his IV so I would not have to stick him.  The wife was not happy with this and demanded that I stick his left arm.  I shrugged my shoulders and prepared to draw the blood.  The wife grabbed his hand and said, "I hold his hand because he jerks anytime he gets stuck by a needle".  I assured her this was fine.  As I barely stuck the needle into the vein the patient jerked and the needle came out.  Instead of re-using the needle that had barely broke the skin, I closed the needle and once again suggested drawing from the IV since the patient was still really dehydrated.  
The wife was still not happy with this and lost it.  "The nurses today said you can not do that! I think you are incompetent if you think that's a good idea!"  I explained to her that we draw blood from IVs all the time and this was an acceptable way to get the blood and it was easier for the patient since he would not need to be poked a second time.  I finally convinced her to let me prepare to draw out of the IV.
Of course, as it goes sometimes, the IV was a little sluggish in the beginning and this freaked the wife out.  "Why is it not drawing?  Does this mean it is not a good IV?  Are you sure you know what you are doing?"  I explained to her that sometimes the IV starts out drawing slow but improves in a few seconds.  
I was able to waste my 4 millimeters of blood and as I switched syringes to draw the lab work, she stopped me with "How long does it take before it clots in the syringe?  I think you are taking too long and you don't really know what you are doing."  I finished getting the blood and cleaned up my supplies.  
As I was walking out of the room, the wife said, "I don't want you to come back in here."  I smiled and said okay and left the room.  
The patient's nurse went into the room, and spent some time in there.  When she came out she was laughing and said "His wife really does not like you.  She doesn't want you to have anything to do with the patient or her for the rest of the night".  I shrugged it off and went about my way remembering there are just some people you can't please no matter what you do for them (and besides I really did not want to go in there anymore either).   I was fine and it was forgotten until, I walked past their room (their door was open) and saw the wife staring straight at me and saying, "Her hair is so unprofessional.  I can't believe they let her wear her hair like that!  Maybe if her hair was done differently I wouldn't have a problem with her!"  
You have no idea how badly I wanted to step into that room and take the wife out with some form of bodily injury, however, I just kept my head high and continued walking on down the hall away from her.  I didn't realize that the way I wear my hair determines the type of care that I give to your husband or the way I look make me able to do my job better.  
At 0200 AM the patient had some more labs that needed to be drawn.  Since I was not allowed to enter the room, the nurse asked another resource nurse to try and explained to him that the wife would rather have the patient stuck.  He grabbed his supplies, gowned up (pt was in isolation), and went about his way.  After about 10 seconds the nurse exited the room and began to grab the supplies to draw blood from the IV.  He told us that the wife did not want him stuck, but wanted him to use the IV.  I was a little speechless and upset.  REALLY!!!!!  I guess this nurse must have had acceptable hair. ;)

"Um...That Is My Bone"

This week I have witnessed something disturbing and scary with a few of my patients.  However, before I get into my story, let me throw a troubling statistic with you.  In fact it is so unsettling, it may be a little hard to believe.  In an article I read in Health Affairs I found the statement, “We estimate that the annual cost of measurable medical errors that harm patients was $17.1 billion in 2008".

Now there is something very wrong with this statistic…the fact itself is correct, but really what does this say about our medical field.  I am sure that there are many people who have their own stories of errors or possible errors.  Now onto my patient’s story.

 When I arrived at work, I made a list of all the things that I had to do as the resource nurse.  One of the patients had just been admitted and there were a ton of STAT labs that needed collecting.  When I went into the patient’s room and introduced myself, the patient seemed very aggravated about something.  I nonchalantly asked him if there was something wrong.  He started to shake his head, but then stopped and laughed.  “Well yeah there is…I know it’s funny and you will probably laugh and I’m probably making it a bigger deal about it then it should be but something one of the surgeons said left me dumbfounded.”

I laughed…and told him since I was already laughing at him, he should go ahead and tell me.  He laughed.

“The surgeons came in and one started asking me questions.  The other grabbed my left shoulder and started poking and prodding.  He was actually very rough and it hurt a little.  Anyway as I was in the middle of answering a question from the other surgeon…the one with his hands all over me, asked ‘Is this the abscess…gee it’s gotten so much bigger than I thought it was going to be’.”  At this the patient stopped talking and stared at me trying to draw his labs. 

“Well, what did they say after that?” I asked.  

“I looked at him and said, ‘Sir that’s my shoulder bone.  My abscess is actually on my leg!’”  At this I just about died laughing.  The patient stared at me for a minute, and then died laughing with me.

“As the surgeons were leaving they asked me if I had any questions.  ‘Yeah, I do have one.  Please tell me that man is NOT part of my surgery team!’”  With this we both were laughing so hard I just about cried.  I’m just so glad that this patient was paying attention and was able to make sure the surgeons were sure of what they needed to do. 

Servant of Satan

Normally when patients are confused, their conversations are very fragmented and have no specific order.   However this is not always the case.  This particular patient was definately not fragmented at all. 
She was an elderly lady in for a broken hip repair.  (Normally when an elderly patient gets a hip repair/replacement done, they usually end up confused or in even worse health then when they arrived at the hospital).  She was very confused and on top of the confusion she could not hear a peep without her hearing aids, which of course her family had not left with us.  Because she could not hear anything she just continued on in her conversation no matter what we were saying or doing.  
She was receiving blood because during the hip repair she had lost quite a bit and we needed to build her volume back up.  Surprise surprise as the blood transfusion was only about half way complete, she pulled her IV out. There was blood everywhere.  It looked like there had been a massacre in her room.  I went into replace the IV not exactly sure if in her confused state she would let me.  I recruited one of the techs to help me steady her arm and to help me clean her up and change her bed after I was finished.  
As soon as I began prepping my supplies and cleaning her arm, she started to pray.  She continued to pray about how this was the end and it was time.  She then went on to say "Forgive them for they know not what they do.  Forgive this servant of satan (pointing at me) and forgive this rapist.  Make them see the wrong in their ways."  That was the first time I have been called a servant of Satan and was very interesting.  As I finished cleaning her up, she started a narration (complete with all her family, her brother and dead sister in the room).  She was rambling on.  She continued this for 12 straight hours and in those 12 hours she told the longest narration I have ever heard.  And it had a timeline.  Her family and her had went to church (I'm guessing this was during her praying time), drove home, then went to a party up in the hills, then to an after party (at this point she was going on and on about all the alcoholic drinks she was having and how she wanted "just one more beer").  On the way home from the after party, her brother almost ran over a child and they ended up in the creek and almost drowning.  From there they made it home where her sister managed to break her most precious belonging and boy did she get mad.  At this time it was 0600 and I got busy and lost track of her conversation but it left me wondering what kind of interesting life she had led. 

"Oh Wait I Understand THAT Word"

Every now and then there will be a patient whose situation completely floors me and makes my heart break.  Every time it happens, it makes it incredibly hard to keep motivated to do my job.  I now understand why nurses tend to get burned out so quickly, because it's a hard thing to deal with when it does occur. 
We received a phone call from the emergency department.  They were sending up a patient who was admitted with seizure disorder.  After they finished telling us all his history and were about to hang up they informed us that he was in four point restraints because he had been a little out of control and attempting to hit staff and escape from the hospital.  This sounded like it was going to be a fun night.  
The patient arrived onto the floor, and instantly we knew we were in trouble.  The patient was a young man who didn't speak a word of English, instead he spoke Spanish.  He had no family or friends with him.  He was in restraints holding his arms and legs down for his and our safety.  
As I was reading through his documents I found out some interesting social history.  He came from a family of six children.  His father was working in two counties over and sending money home to help.  His mom was extremely sick and unable to care for the children.  His older sibling had died, a year ago, from a seizure.  Because the death happened in a hotel, the cops were called in and the family were illegal immigrants so they had to go on the run not only from the police but also from child protective services. The next older sibling became the caregiver for the four younger children.  The patient not only had a seizure disorder, but when he was little it was also discovered that he was always going to have the simple mentality of a 12 yr old.  His younger siblings were worse off with severe mental and physical disabilities. None of the siblings were able to speak any English.  
This was not the surprising facts that I found.  This patient was well known at the hospital.  Apparently this was a frequent flyer who was admitted every couple of months.  The sister who was in charge of making sure he takes his medication would take him off his medication so he would have a seizure and be admitted to the hospital for a few days rest.  It was a rough discovery. 
Anyway when we went into access the patient we discovered he had chewn through all four of his restraints.  As we attempted to replace them one at a time, he became very aggressive.  It took four techs, two nurses, and two security guards to hold him down while we placed one wrist back into the restraint.  It was crazy.  
Throughout the night he managed to chew through six pairs of restraints and had to be wrestled back into new ones every time.  It made for a very long night. 
The  next night when I returned to work, the day nurse told me it was like caring for a completely different patient.  He was out of restraints and behaving.  When I went into take his medication and began to talk to him in Spanish, he was laughing at my pronunciation.  In actuality, it was as if I was caring for a goofy 12 year old patient instead of a 18 year old young man.  The night went well and he was very engaging and cute.
Overall the patient was one I may never forget, but that's a good thing.  And I am sure my college Spanish teacher will be thrilled that in reality while I was able to communicate fairly well with the , patient the only words I am absolutely certain I understand in Spanish are all the curse words. ;)

Remember to Breathe

There are some nights as a nurse that you just want to throw up your hands and quit.  You are pushed to the edge of your emotional cliff, and then just for the fun of it you are pushed off to see if you land on your face.  Guess what, for new orientees and new students we call this harsh training.   Unfortunately it seems all of the people that I preceptor end up getting in crises and finding trouble…what can I say…I guess I’m a good teacher. ;)

One night the new nurse I had taught had a patient that was going to have a liver biopsy done the next morning.  The doctors thought his liver might be destroyed by Hep C.  Since his liver was possibly destroyed, his risk of bleeding was increased.  The doctors had ordered 6 units of fresh frozen plasma and one unit of platelets to be started at 0400, so it would be done before his biopsy at 0800. 

The nurse called the blood bank at 0400 to request the first unit of plasma.  The blood bank lady told her she needed prior approval from the resident pathologist.  She tried to explain to her that the attending was the one who placed the order and this is common procedure for a liver biopsy but with no luck.  The nurse called the resident pathologist who said she had to speak with her attending about the matter.  The return call to the blood bank to verify that she had spoken with the resident pathologist, resulted in the blood bank technician telling her she couldn’t give her the plasma yet but she could get the platelets.  Ten minutes later the nurse called the blood bank to see if the platelets were ready and the lady told her she needed prior approval for the platelets too and that she had told her that.  But the plasma was now approved and they could release two units and then she would have to redraw his morning INR lab before the rest was released. 

The nurse went up to the blood bank to get the plasma.  She was gone for a while and when she returned, it was obvious she was very upset.  I asked her what was wrong.  She told me that the lady had totally went off on her and called her rude and unprofessional and refused to give her the plasma until after she was done yelling at her. 

After the nurse had calmed down, I spoke with the blood bank and we decided that the nurse would not go back up to the blood bank. 

When that first unit of plasma was done, another nurse went up for the second unit.  While she was up there, the blood bank technicians were discussing the other nurse and about how she didn’t have a clue of what was going on and she had messed it all up.  The nurse just received the plasma and didn’t say anything. 

When I went up and asked for the third unit, the lady sarcastically said “I’m glad you guys have it all figured out now.”  I very nicely looked past her and asked the other lady to help me. 

Unfortunately, there are always going to be moments at work that are tough and they usually happen when everything else isn’t going right, and the stress is already high.  But we just need to remember “All we really have to do is breathe and take life one moment at a time.”

Reality vs Narcotics

There once was a sweet lady, who due to an unfortunate set of circumstances, ended up in the hospital.  She had gone through the ringer.  She was near the end of her rope, and her husband was at the end of his.  She’d had a lousy nurse (yep, they exist) the night before and her day nurse had promised she would have a better night.  Enter into this story: me.

I babied her.  I convinced the doctor to increase her pain medication, I brought her special hot cocoa made with milk, I made sure her favorite TV show was on, and I spent extra time with her. She had great service.  I could tell she was much happier with her care then previously. I worked my butt off to earn that and wanted her to have a better experience than before.  She deserved it.

She hadn’t been sleeping much, even after I gave her a sleep aid.  Around 4am she started getting confused.  I went into chat with her and she said, “This call bell has legs.” Oh dear, Here we go.  She’s going crazy on me.  She reoriented easily, but felt that something was wrong.  She made a few calls, to which I spoke to her family members trying to reassure them I was taking good care of her.  I stopped giving her pain medications and checked her blood sugar, thinking the crankiness was from hypoglycemia.  No such luck.

She refused most care, except from me.  The lab tech was frustrated because she couldn’t draw her blood.  Instead I drew them from her IV site so she didn’t need to be stuck.  As I sat there drawing her labs, she started to cry.  I tried to reassure her.  She looked up at me with tears in her eyes, “I thought you were my friend”.

AND MY HEART BROKE. I started to tear up with her.  

“I AM your friend.  I’ve been trying to do everything I can tonight to help you, comfort you, be with you.” Yet when the brain starts playing tricks on you, anything can happen. I did everything I could to bring her back to the situation, to me, to her surgery.  Anything. I got a little bit back, but not all the way.  She needed time to process all the pain meds she had received in the OR and tonight.  I did all that I could, but still left that morning feeling as if I let her down.  I WAS her friend.  It was a fight between reality and narcotics, and reality usually loses.

Boy Crazy

I love it when I have entertaining, funny patients.  It makes the 12 hours go by so much faster and besides it gives me fun stories to share.  I’ve had my share of funny patients, but this one was unique.  In fact, she was downright hilarious. 

She was here for routine surgery.  Everything went great, and she was recovering well.  She was one of those rare patients that did everything we asked (her exercises, using her incentive spirometer, ambulating, and eating well).  But boy did she have a mouth on her.  She was lived in the mountain and had that simple back-woodsy thing going for her (which I loved about her).

Every time I tried to get out of her room to see my other patients, I was drawn back in by something she would say.  She would ask crazy questions or make random off the wall comments about anything.  As if that was not enough, she was boy crazy like a high school girl instead of a lady in her 70’s.  Uh-huh, no joke.  It was bad.  For example:

“Have you seen that physical therapist? Gawd, he is fine?” “What about that guy that brought up my bedside commode? Did you see his blue eyes? OMG they were the bluest eyes ever!” “Oh I gotta watch my show, that Jim guy is on and he is just beautiful.”

One time I made the mistake of asking her what she thought about a certain doctor.

“Oh my gawd, that Dr. McSexy, he is just gorgeous. He can place his hands on me anytime he wants.  Do you think he’s married? If not then I will gladly change that in a heartbeat!”

Yes, that is what I dealt with for three nights in a row.  Her roommate, poor soul, was forced into being her new best friend and talking boy talk while they recovered. On my last morning, I walked into her room with the day nurse.  I introduced the nurse and told her to have a good day.  As I started to say goodbye, she held out her arms for a hug.  I walked up, reached across her for an awkward hug and she kissed me right on the neck! She was so thankful for my care.  I appreciated her gratitude very much.  I can say I haven’t received too many hugs from patients, but this one goes right to the top.  Best funkiest patient ever.

Why I Love My Job

I just love it when I arrive at work, and I realize that I get the privilege of caring for a sweet elderly person.  This week I had the opportunity of caring for a patient that if I could I would totally bring him home with me.  In fact in the last two years of working as a nurse, I have started a “collection” of patients that I would bring home.  It’s really weird but nurses have the uncanny ability to connect with their patients in just a few minutes or upon first introduction.  This is not always the case, since we sometimes have difficult patients that we have to pray for the strength to not kill before the end of our shifts.

This week I cared for one of those patients that just touched my heart.  As the day nurse was telling me about him, I knew we were going to get along great.  This elderly patient was living alone when he passed out and fell at home.  This was due to his sodium level being incredibly low.  His family members did not arrive at his house to find him down for three days.  So for three days the patient was in and out of consciousness and lying on his living room floor.  When the family members found him he had developed many different pressure ulcers all over his body.  He was a hot mess.

The patient had previously had a stroke and the day nurse informed me that he did not speak much and when he did he was incomprehensible.  She informed me that he had not spoken to her on her shift but rather he would just smile at her. 

As we rounded on the patient and I was introduced to him, he gave me the biggest, cutest smile I have ever seen.  He was missing almost all of his teeth, so it was one of those toothless smiles that are just so cute.   I asked him if he needed anything before I came back and he just continued smiling and nodded his head.  He definitely won my heart in that brief moment.

When I returned to his room, his daughter and wife were getting ready to leave.  They had come in to check on him and visit.  He was so happy while they were there.  It was adorable.  After his family left, I did my assessment and was talking to him.  I got the idea that he may have been a little hard of hearing so I raised my voice a little when I was talking to him, and he instantly began talking to me.  He just rambled on and on about everything and nothing at the same time. 

I quickly learned that this older gentlemen was a little flirt and was thoroughly enjoying the attention I was giving to him. I spent a lot of time with this patient that night and he definitely made my night and my week.    By the time I left in the morning I had heard his whole life story, and had been flirted with for the majority of the night.  It made me realize it is for these patients that I became a nurse and why I enjoy my job so much, and why it is so worth it!