August, 2005 Archive

my cousin, in his late 30s, just passed away about three hours ago. diagnosed with lung cancer about two weeks ago. biopsy was done after a thoracotomy. thoracotomy was done to get rid of hardened pus from his lungs due to pneumonia, so the doctor said. obviously, it was not that simple.

never touched a cigarette in his lifetime. vegetarian for years. sometimes i stupidly think that makes things easier. it doesn’t. it just makes people sad. but that’s not what saddens me.

what saddens me the most are the kids: two boys and a girl, 7, 5, and 3 years old.

then there’s his wife.

how does one adjust to a sudden loss such as this? you wake up seeing a person’s face for years, seeing him play with the kids, and seeing your kids give out a hearty laugh because of what he does. or in this case, things he did. then just like that, he’s gone. i mean, things like these happen. i see it often enough, it almost seem ordinary. but still, it saddens me.

then….there’s music in the living room.

oblivious to the sad, moving melody of the song that their dad is playing in the piano, my two boys are jumping around, laughing. usually, their laughters lift my spirit. today, it broke my heart.

this is not going to be pretty, but if you are still interested, go ahead, bore yourself and read my two previous posts, if you haven’t yet. just so you get to know the background.

yeah, i’m still talking about P.

she is like a headache that grows larger than life, like fever, that refuses to subside. yes, she is still in our unit.

yesterday, she finally got a hold of our nurse manager (NM). the AM nurse told me that our NM talked to her for two hours! yes, two hours!

after two hours of what i assume was a two way communication (read: P talked, NM listened), NM came up with a full page, single spaced guidelines on caring for P. there was a strict instruction, that at the beginning of the shift, that the nurse assigned to P, needs to read the whole page, very carefully. it was placed in front of P’s chart. why i have the feeling i will end up memorizing the guidelines, is not really clear to me.

let me share with you some of the guidelines, just in case someone out there ends up to be a nurse manager, and you encounter patients like P.

1. make sure you check P regularly to find out if she needs anything. (i say: by regularly, you mean more frequent than every 5-10 minutes?)

2. make sure that when you shampoo P’s hair, air dry it. ( i say: why stop there, can’t the unit afford a blow dryer? or a hairstylist at least? geez.)

3. P wants chocolate ice cream to take with her medicine, so make sure to order it before the nutritional services close. (i say: why not get a personal refrigerator from central service and fill it up with ice cream of different flavors? are we that insensitive to just assume she will like chocolate for the rest of her stay?)

4. when P’s phone rings, let her know that you can only hold the phone for 10 minutes at a time, but that you will be happy to do it again when you are not busy with your other patients. ( i say: how inhuman is that? don’t we know it is therapeutic for her to talk to her family for hours? after all, 10 minutes is such a short time for them to come up with ideas on how to sue the hospital)

5. etc etc etc etc.

i am appalled at the obvious “heartlessness” of our NM. i mean i expect her to be caring, compassionate, and understanding. i am shocked at her utter “lack” of concern.

not that i ever had a dream to be a nurse manager, but if i were one, i will do everything within my power to make P’s stay in our unit, one that she will always remember.

for starters, i will not give her a roomate, i care about her privacy. i understand it is important that other patients hear her when she tortures the nurses, but i believe her privacy gives her the chance to do whatever she wants, anytime.

i will assign two nurses to care for her. yeah, two every shift. i am a great believer in anticipating patient’s needs. i want to make sure a nurse is always there. and by always, i mean 24/7. by her bedside.

i will contact a chef to make sure P gets to eat anything she feels delicious at any time, any day.

a harstylist is out of the question. i will never let P’s self esteem suffer if she has a bad hair day. that would be unthinkable. she will definitely get her own stylist.

and in my break, i will arrange a vacation to europe, ready for the time when P is discharged. i am well aware of the importance of relaxation, and i will not deprive any of my patients the benefits of an expensive european tour. of course, she can take her sisters.

to remind P that she is THE most important person in our unit, i will hang a poster in her room that says:

“rules of patient care:

rule #1: the patient is ALWAYS right.

rule #2: if the patient is wrong, refer to rule #1″

NM’s guidelines depressed me. i felt sick thinking about it. at the end of the shift, i felt used and drained, and i can’t even blame my hormones. what makes me sicker is the fact that i don’t have the heart to refuse taking care of P, because i honestly or stupidly feel she deserves to be treated with kindness, just like every patient.

i go back to work on friday, and i’m sure, P is going to be my patient. it feels weird to be patronized by other nurses, to be asked if i’m okay every time i leave P’s room. they think giving me a little pat on the back frees them from their guilt of refusing to take care of her.

on the other hand, i think i will never be free from the guilt. because sometimes, if not most of the times, i lie to P when i show her i am happy she banged her call light. i am a liar and i’m tired and sick of myself.

it is some weird work of nature.

in my previous post, i talked about P, and sort of vowed i will never ever go near her.

so i said.

i was given report by an obvioiusly worn out AM RN. an asian RN.

she was giving me report on P! it turned out that P was never transferred. i gave her a puzzled look, since everybody knows this patient DOES NOT LIKE ASIAN NURSES.

well, i found out that since she has been in our unit for almost five weeks now, there really is no way the charge nurse can give in to her demand. aside of course from the fact that the handful of non-asian nurses refuse to take care of her. so, for the past week, she has been assigned to asian nurses, and things are at least going smoothly. which means: no further lawsuit threats.

i went into her room in a gloomy mood. but as soon as i saw her face, i let the frustrated actress in me kick in. with a smile, i greeted her.

me: “hi. my name is May, i’m your nurse. how are you tonight?”

P: “your name is May? well May, i am VERY THRISTY. i have been calling the WHOLE day, asking for a drink and NOBODY ever comes and help me. NOBODY. everybody just ignores the call light and walk away, not even caring to ask what i need. can you transfer the channel to cartoons? i can only watch cartoons, because my daughter is watching it at home. yeah, my daughter. i don’t know who put the tv on that channel, because i can only watch nickolodeon”.

(well, of course i know that part of this is not true since i know from report that she had a total of 1500 of fluids taken orally. and also, it is always fishy to hear extremes like “never”, “nobody ever”, “everybody”, etc.)

me: “okay, so what do you want to drink?”

P: “why are they laughing May?”

me: “who’s laughing?”

P: “you know, those nurses. when i call and ask for something, they never ask me what i want. they will come in, laugh, and leave. why is my mouth so dry? is it because i’m thirsty? i can only watch cartoon. my daughter is at home watching this same channel. can i have warm pack May?”

(there is defintiely some flight of ideas here and there, but i am not a psychiatrist, so i won’t even go there.)

me: “okay. here, have some water and tell me if you want some more, or you want other drinks.”

P: ” i need my insulin right now. i don’t want it later May. i know what happens to me when they don’t give it. yesterday, the nurse did not give me my insulin the whole day, and i felt terrible.”

(i do not remember from report that she has insulin, but i was thinking i might just be confused)

me: ” let me check your chart first and i’ll see if i need to check your blood sugar so i can give you insulin if you need it.”

P: “you don’t need to check my blood sugar. just give me my insulin NOW!” do you know what insulin is? it’s that thing with a little needle that they give on my belly. i want it NOW!

(this is definitely getting creepy, so i slowly excused myself and check the chart. no insulin. she never had it before. she had a heparin shot scheduled for 2100 and i assumed she meant that)

me: ” P, i just checked your chart. you don’t have insulin, but you have heparin shot.”

P: “yeah, i know it’s heparin. i want you to give it to me when i’m not looking. i can’t stand it.”

i will not bore myself (and some people who read this) with the details of what happened the whole night. let me just say in summary that i was in her room almost every 5-10 minutes, except when the ambien kicked in and she went into zzzzland for about two hours. the most glorious two hours of my entire night, because yeah, it is physically draining to answer the call light every five minutes, if i have two other patients who are really sick.

i found out stuff about P. she is 34. not 24. she was not a victim of a vehicular accident, but a kind of tumor in her spine caused the paralysis.

in the first hour, i also found out that there are a few loose screws. mentally delayed the doctors said.

it is because of those few loose screws that she waged jihad against asian nurses. it is because of those few loose screws that she says crazy things. and it is because of those few loose screws that she was judged.

in some weird work of nature, i was enlightened without me asking to be enlightened.

i found out some truths about her. and i found out some truths about me.

and it felt terrible.

it didn’t help that through the night, over and over , she said: “May, you are a great nurse, you’re the only one who comes everytime i need you, thank you, thank you. really.”

it didn’t help because i know she didn’t really know that, and also because i know i am everything but great.

i’m not a racist, but i’m a judgmental, asian nurse who jumps into conclusion without knowing all the facts—that’s what i am. and yes, i am ashamed of myself.

she was not my patient. and she never will be.

a red, bold, all capitalized note glared accross her name on the charge nurse’s patient list.

it said:

“DOES NOT LIKE ASIAN NURSES”

honestly, that does not bother me anymore. after taking care of patients who are very vocal about their desire not to be touched by nurses whose skin color they do not like, i got immuned to the so called “racial preference”.

one night, on our white board, where the charge nurse writes the names of nurses and the room numbers of patients we are assigned to, i saw this:

Amy-San
Cathy-San
Roger-San

the non-asian nurses, DO NOT WANT her as a patient. they cleverly thought that the “San” added to their names would make it sound asian. it sounded funny of course, but they still have blond hair, and she wants them.

P is a 24 year old quadriplegic. a victim of a vehicular accident, i assumed she has not fully grasped the life that is ahead of her. two months ago, she was the typical young woman who envisioned life to the fullest. ahead of her was a future limited only by her imagination. in an instant, everything changed. now, her whole life is limited. a tracheostomy to breath, a valve on the tracheostomy to talk, a nod, a shake of the head, and a lot of drool. there is so much she cannot control. the nurses, she can.

she bangs her head on the call light every minute. literally. move the glass of water a little bit to the left. oh, to the right. give me a sip of water. oh, another sip. turn the tv on. oh, turn it off. do this. do that. the call light was constantly on, that the other nurses felt for whoever was assigned to her, and would voluntarily go and see her to relieve the assigned nurse.

when an asian nurse goes to her room to ask what she needs, she goes: “oh, never mind”.

what she doesn’t realize is that most of the times, when we have ten nurses working, 7 or 8 out of the ten are asians. and if the non-asians do not like to take care of her, who will take care of her?

she wants to be turned once, and M, an asian, went to help T, the nurse assigned to her. she demanded that only T turns her. when T told her she can’t do it by herself, she made sure that M was only holding the blankets, and “be sure not to touch me, because i don’t want your hands on me.”

she is lucky we cannot really literally leave her without a nurse, even though the non-asian nurses refuse to take care of her.

i find it mind boggling that somebody can dislike a certain race that much. i had no energy to find out the reason behind it, but i’m sure there is an explanation. i was not allowed to go near her, so i guess i’ll never find out if she was betrayed, molested, or raped by an asian; if her mother was molested, raped, or killed by an asian…

still, i feel for her. and i wonder how am i going to handle a situation like hers.

only, the story, does not end there.

last week, i found out her two sisters threatened to sue because they think her hair was cut too short. the patient requested a haircut, and the nurse was able to arrange one, by requesting the hospital salon to send somebody to do it for free. free. P did not complain outloud, but apparently, she did not like that it was too short.

and yeah, they will sue because the haircut has emotionally disturbed her.

i say: haircut or no haircut, she is already emotionally disturbed. and by the way, even if she drowns in her own drool, i will not, i repeat, i will not go and suction. after all, what if i touch her face on the process. that will definitely ruin her emotionally, right? right. i do not have time for a lawsuit. i have asian kids who need me.

now, I am emotionally disturbed. and unfortunately, i have no one to sue.