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.”