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!

You Will Thank Me!

Sometimes my patients just amaze me.  Some amaze me because of their stories, some because of their attitude and some (what am I saying, most of my patients) because of their stupidity and ingratitude.  I always say I’ve seen it all, and then I’ll have a patient who makes me realize there is more for me to see and experience. 

This patient came in drunk.  His blood alcohol was 0.28.  This is four times the normal level and very drunk.  Not only was he drunk but he was older, in his 60-70s…old enough that he should know better and not be doing this kind of stuff anymore.  Of course in his drunken state, he had taken a little trip and ended up with a broken elbow, hip and smashed face. 

Now let me say drunken patients are not fun to care for.  I always think that with that much alcohol in their system they should pass out and sleep but that never seems to be the case.  It was a long night with a tough patient.  It was his first night in the hospital with no alcohol; actually it was only three hours since his last drink.  This was not even enough time for the alcohol to be out of his system, in fact he was still very drunk, however, he was convinced he was detoxing. 

“Hey, you nurse, I think I’m detoxing…I’m shaking and need something to help. How about some medicine right now!”  “You’re not detoxing…in fact you are still quite drunk, but I promise to let you know when you are!” 

He was ringing out on his call bell all night long, every 5-10 minutes.  It was quite frustrating and it was getting on all of our nerves.  My co-workers were even threatening me to “do something with that patient before we all go off on him.  How about you give him some Ativan, Haldol, or valium?”.  This on top of the patient “Can’t you do something for these shakes? Can’t you give me something for pain? Can’t you give me something for nausea? Isn’t there a doctor you can call?”  I got tired of saying the word NO that night.  In fact there was a doctor I could call, but I knew there was nothing they were going to do so I didn’t even bother.  I just had to wait it out and it was turning into a long night.

Finally the morning arrived and with it the surgeon.  The patient was very upset and refused the procedure with not so nice, colorful language.  (Now really!!! The refusal of this patient was going to result in a loss of movement in his arm).    The arm would end up with some big wound, infection, and then amputation due to the basic neglect this patient had for his health.

I went in plopped down into the bedside chair and stared at the patient until his swearing was finished.  Just me and the patient.  Then came the talk.  “You need to have this surgery.  If you do not you won’t be able to eat, drink, shake hands or work with that arm again?”  Of course the only word he heard out of that whole tyrant was the word drink.  We talked for what seemed hours but finally the patient consented to the procedure and signed the paperwork. 

The next time I worked (four days later) I see the patient sitting in the bed complaining and yelling.  I go in to check on the patient. “Hey you’re the one that convinced me to have surgery! I wish I hadn’t listened to you! I’m in so much pain.  I want to rip my arm off!!!!” Yep, I’m the one that convinced you to have that surgery.  You’ll thank me in a few years when you’re holding a grand baby in that arm, when you’re hugging your daughter after her diagnosis of cancer, and when you are at death’s gate holding the hand of your nurse.  Of if not in any of those moments, you will surely thank me the next time you are holding your next drink.  Yes You will thank me.  

Quello che sarà sarà

While I am at work I try to maintain a laid back attitude.  It seems to make my night better if I start it off in a good mood.  If I go into the shift upset or angry, it makes for a very long night and I tend to have a bad night. 

Usually when I first arrive to work, I hear the day nurses ranting on and on about how bad their day was, how busy it was, and how bad the night is going to be.  I try really hard to tune their voices out and just focus on the upcoming shift.  I try not to judge my patients based on day shift reports.  There are many times I hear “Oh this patient is a pain in the butt, or this patient is doing so bad you will be in there all night, or OMG, this patient sucks and I won’t take them back next time”.  I have found that there are many times when day shift will say how terrible the patient is, and yet when I go into meet the patient they are sweet as can be and we don’t have any problems all shift. 

It’s tough to raise above the negativity and there are some days that I am not successful, especially if it is like three or four nights in a row, or if I had a bad night the night before.  However, I still try to keep one of my favorite work mottos in mind.  Quello che sarà sarà (what will be will be).  

This saying usually manages to pull me back into my calm space and I'm ready for the next big disaster to head my way.