January, 2006 Archive

people talked about it last night.

that K was, and still is speechless after a little encounter with me last week.

K is an RN who minds everything. even things that are totally none of her business. i admit sometimes it could be a good thing, but most of the times, we just want to put a duct tape over her big mouth, and end the misery we all suffer in the middle of a supposedly quiet night.

i have observed a lot of human beings in my 36 years of life. one thing very common among us is that there are certain people that just test our patience, whether they do something legitimately irritating or not. just human nature.

i felt that way towards K. i felt like she just opens her mouth too much. i believe in the wisdom of king solomon. you know, “there is a time for everything…a time to yak your lungs out, a time to keep your mouth shut” or something like that. for a guy with a lot of wives, he sounds pretty sensible to me. anyway, i kept up my professionalism, and stayed away from K as much as possible.

my professional facade turned into real animosity when K started leaving the unit to smoke. she will keep one RN responsible for her patients by saying: “you’re watching my patients for 5 minutes, okay? i’ll be back in 5 minutes. nobody will call, they are all okay.” then she is gone before you can even say “no, i am up in my butt with stuff to do here.” for the record, it doesn’t bother me that she smokes, or that she takes her break. what bothers me is the fact that she thinks she can take it at anytime convenient to her, even if others are really busy.

at first i took this request (can you call it that? because it sounds more like a demand to me!) in stride, thinking: it’s okay, smoking is an addiction and if i were a smoker, for sure i will do worse things than that. only, as time goes by, the 5 minutes became 6, then 7, then…she is out for a whole 10 minutes now, although she always says she’ll be back in 5 minutes. other nurses started complaining, but only behind her back. we all knew we can’t deprive her of her two 10 minute breaks, because it is not her fault if we all don’t go off the unit to take ours. that is her break, she has the right to spend it any way she wants. if we choose to catch up with our paper works instead of actually going out for a break, that is not K’s fault. we unconsciously started a support group to go through the irritation and stress that K’s break cause us. that’s how we thrived.

after a year of this nonexistent relationship, i have learned to deal with K in a more productive way. when she starts yakking about how stupid an intern was for not ordering this and that, i try to imagine i was deaf. if i had the luxury of time, i slowly close my eyes and turn her endless complaints into a sound of a splashing, calming tiny waves. the thought would carry me to the bahamas, and i would frolick in the sand, wearing an itsy bitsy teeny weeny yellow polka dot bikini. i looked so hot ! K’s never ending opinions are free, but so is dreaming, and i would rather dream, thank you very much.

last year, one RN yelled for help. when i got into the room, her patient’s paper white face, and the fact that she was grabbing the ambubag made me go straight to the carotid pulse to check. no pulse. i just started CPR when K and another nurse came. K looked at the monitor, and said: “May, stop CPR, it’s not asystole!” i calmly told her the patient had no pulse. she then pointed her lip to the monitor, nonverbally saying: “duh, she has a rhythm.” D, the other nurse who arrived with her said: “just keep doing CPR May, don’t listen to her!”

the code team arrived in less than 3 minutes. the patient was transferred to ICU. since then, K hardly “requested” me to watch her patients on her smoke break. i wondered why.

last week, my quadriplegic patient, who was all nice and sweet at the beginning of the shift, calling me Ma’am and saying thank you for every little thing, all of a sudden woke up at 10 pm, and started screaming. he emphasized each statement with the F word before and after a sentence, and he was calling anybody to take the f@#%$g NGT out!

as expected, since K has a sense that she is in charge of the whole unit (or the universe for that matter!), she was in the room even before i got there. i asked my patient what the problem was. to me, he looked like somebody who woke up from a bad dream, and didn’t know where he was, or what the heck was going on. you think K would let the patient answer in peace? no, she is too much of an advocate to just let the patient speak for himself.

“you should just pull out his NGT and call the doctor May” she demanded.

i feared being unprofessional by using the restraint to shut her mouth up, so i kept quiet. the patient got more agitated, screamed about the f#$#%*g NGT and used every foul language availabe to mankind. i slowly went out of the room, to check the chart if there was something i can give to calm him down.

K, who as i said was the recipient of the annual patient advocate award (the trophy she buys herself, i must say), was already one step ahead of me. she looked up the on call doctor’s pager number and told everybody she is calling the doctor. just before she picks up the phone, she sensed a little responsibility to ask me. after all, i am the patient’s nurse, right? and the last time i checked, i still had my fingers, and was totally capable of calling the doctor myself. if i want to. or if i need to.

“you know, just because he is quadriplegic and cannot take out the NGT himself, he should be left to suffer like that. he has the right to refuse the NGT you know. are you calling the doctor?”

“no. i’m not” i said.

“fine, i’m calling her then. that NGT should be pulled out. let me just get something from the cafeteria before it closes, and i will call her when i come back.”

“okay, call her” i said.

“i just feel sorry for the guy you know”.

“i feel sorry for him too” i said. (and i will feel sorry for you too, if i am a violent person. because if i am, i would have pulled all your hair out already!)

i won’t blame you if you think i’m making this whole thing up. the whole scene will put a soap opera to shame.

when K came back after almost 10 minutes in the cafeteria, my patient was calm. i notified the doctor that he had this episode, and already got an order for 1 mg of haldol in case he gets agitated again. as it turned out, K, who was so concerned with all the patients, feeling sorry for them like the real florence nightingale of old, was more concerned about getting her food for the night before the cafeteria closes.

she didn’t call the doctor. as a matter of fact, she barely opened her mouth the rest of the night. it is hard to imagine K being speechless, but she was. and i have witnesses to prove it.

i looked at her, to let her know that i will not tolerate implied messages of me being so heartless as to “just leave a patient suffer like that” ever again, but she didn’t look my way. not even a glance.

so, that was what they were talking about last night.

the ones who witnessed the drama that unfolded last week, buttered the story with some hyperbolic illustrations, and everybody rolled on the germ infested floor laughing their aching asses off at the thought of how K got speechless. and they congratulated me for having the good fortune of not being asked to watch K’s patients on her smoke break again. ever.

if she stops avoiding me, i’m sure i will eventually talk to her. you know, let her know that maybe it’s time she realizes that she’s not the only one who cares about the patients. and also, let her know that being a patient’s advocate does not only mean arguing with the doctors about their “senseless” orders, or complaining about the “unnecessary” orders the interns write, or complaining about the all the “lazy” nurses. maybe, if we have the time, i can also let her know that acting fast is good, but it also does not hurt to observe the patient first, before doing something. especially something like taking an NGT out when it has been putting out 200 ml of very dark green output in the last 12 hours. if i’m in a good mood, i could even remind her that if she can’t feel a carotid pulse, it will not hurt to do CPR. when i have time…

for now, let me enjoy the peace that comes from knowing that for a while, i will not hear any complaints about the doctors’ and the other nurses’ stupidity and laziness.

no more dreams about the ridiculous polka dot bikini.

no more lies about me looking hot in it…

where do you draw the line?

empathy versus being abused?

when you give undivided attention to a patient’s daughter; listen to every complaint she say, and make sure she gets everything you can possibly give her, because like her, you used to have a mom who was in the hospital. you spend time with her to listen to her fears and concerns, because you feel for her, because you know how it is to take care of your sick mother and feel helpless about making her feel better.

then, she starts following you around, standing at your other patients’ room, waiting for you, so she can ask you to look and check her mom because she just tried to move her head to the left (like, what’s wrong with that?). or she will call you to see her comfortably sleeping mom, she’ll wake her up, and ask her if her arm, her neck, her stomach hurts, and she will not stop until she gets a yes from her mom, so that she can ask you to do something about it…

but you still try your best to be nice and polite, letting her stay and visit even if it’s three hours past beyond visiting time, and pulling off a really dramatic monologue to the doctor so he will come and talk to her just to reassure her that her mom will be okay for tonight.

and though she finally left at midnight, she still called you at 2:30 (in the morning!) just to get an assurance that she will be able to talk to the attending on a sunday morning, because she has a lot of ideas on what they (the doctors) should do, so her mom will get better faster…

but you still manage to say nicely that she needs to rest and call it a day because for sure, she will be able to talk to the attending on a sunday morning….

i think it is abuse.

i know, “abuse” is probably an exagerrated way to describe it. it’s just that i feel drained. and i have no one to blame but myself.

i think i allowed my patient’s daughter to use the fact that i empathized with her, to abuse me.

and i am disgusted at myself.

sometimes, empathy is overrated.

sometimes.

she slipped in the bathroom. she said she cannot recall how.

i was thinking. well, it could be because she is 92, and as i observed, that is one thing most people above 90 do. they either slip, or fall. or forget. i did not tell her that.

it is quite a challenge to communicate when one is trying to locate a patient’s hidden urethra. i was on my second try, and her urethra just continued to evade me like some missing needle in a pile of hay. all i could think of was that i do not want to be in her place, so i better get that catheter in, before she cries enough. my second attempt was still a failure. i was very apologetic, and i felt like a failure. i told her i had to get another nurse to try, because i don’t want her to hate me for the rest of her life.

R was all nice about it.

“it could be because i have been a virgin till i was 84″ she said.

now, i don’t hear that kind of thing everyday, so i paid attention to the story which was obviously coming.

R said she married her husband when she was 84, and he was 72.

“i am catholic you know, so i never had any sexual relation, since i have never been married. my husband was so surprised when he found out i was a virgin. so on our honeymoon, all he could say was: “oh my, you really are a virgin!” we’ve been married for 8 years now, and i have never been happier.”

i told her i was happy for her too. i didn’t tell her that i was thinking…well, will i still be having…at 84? at 92? never mind.

anyway, the other nurse tried and failed, and did not want to traumatize her again. i was left with no other option but to try again. i had a little high when i saw her urine out of the catheter. i thanked her for being so patient and all nice about it.

R insisted it was not my fault. it was just because she has been a virgin for forever.

the next night, she was my patient again. 6 hours after a hip replacement, i expected her to be in pain. but she said she wasn’t. i told her to call if she needed anything, especially pain medicine.

at 8:30 pm, she started getting restless. she still denied pain, but i knew something was not right. i asked her if everything was okay.

“May, they still can’t find my husband. he left our house at 3 pm to visit me. we live about 2 miles from the hospital. the police already went to the house to check, but he is not there, and the car is not there. i am so worried. where is he? what happened to him? he has dementia.”

at 9 pm, she was on the phone. she said it was her niece, and she was just talking to the police. no news.

my attempt to help find her husband by asking security to look for their car in the parking lot was useless. security said that if he was just missing in the hospital, he could have been found by now.

at 9:15, she was fighting back tears. i felt like i had to do something. i know she won’t be surprised if i asked her if i can pray for her husband. after all, our hospital is a christian hospital. but i asked her anyway. she said yes.

it was a simple prayer. i asked God to keep her husband safe, wherever he was, and that He guide the police so he will be found. she said her thanks, and wiped her tears.

i was giving meds to my other patients, but i can’t stop thinking about R and her husband. what else can i do to help her? prayer was good, but it didn’t seem enough.

it was a little over 10 pm when i saw her put the phone down.

“May, they found him!”

he was in a city about 25 miles away. apparently, instead of turning right from their house, he turned left, and entered the freeway. then he just kept driving. he knew he was lost, but he didn’t know what to do. he finally got hungry, parked at a gas station, bought some chips and cookies, and ate in his car. he has been there for 4 hours when the police spotted his car.

she was on the phone with him afterwards. i overheard her say “there will be no more driving for you again honey.”

she put the phone down. she said she thanked God for answering our prayers. she thanked me.

then, she slept peacefully, like a baby.

R believed our prayer was answered positively. she didn’t want to talk about why it was so. she wanted to keep it simple.

complicated explanations are not for me either. i just believe, it’s easier.

for those who do not believe, prayer is not the reason why R’s husband was found.

it was just a coincidence. everything is.

i get sad in the middle of a loud, happy party, because there are people i wish were in that party, but are thousands of miles away. but i don’t go in the corner and cry uncontrollably getting all severely depressed about it.

i get hyper when everybody is quiet and sort of slow, to brighten up the mood, but i don’t go around thinking i can do anything, even something illegal, just because i am so hyped up.

i guess that makes me a litle weird or a little normal depending on how one looks at things.

i always say i’m manic depressive (bipolar) because i am a nurse.

let me clarify that. when it comes to dealing with illnesses, as far as i know, there are two kinds of nurses.

the first kind are the loony ones. the ones who exagerrate whatever they experience or have, turn them into symptoms, and diagnose themselves, then have fun talking about it with their fellow nurses.

the second kind are the scared loony ones. the ones who would ignore even the legitimate life threatening symptoms they experience, would not see a doctor even if it kills them, and just pretend everything is okay, hoping whatever they have will eventually go away.

sometimes, i am one of those scared loony ones. i say why see the doctor? i don’t want to know what i really have.

most of the times, i fall into the first category. the loony one. i would get thirsty, get hungry, pee, and i’ll say i have diabetes. i feel a little lymph node somewhere and i’ll say have cancer. i’ll have a little pain somewhere and i’ll just say i am having a heart attack. i willl feel sad in the middle of all people having fun because i remember somebody who is not present; or be hyper in the middle of all quiet nurses to change their moods, and i’ll say i’m bipolar. and everybody will start laughing, and i will be symptom free. all for a good laugh. or sometimes, all for a little excuse to worry about something.

i do not take mental illness lightly. i did not intend to make bipolar sound like it is a fun thing to have. but i do say i have it, to have a little laugh when everybody at work has not sat down for six straight hours, to take their minds away from stressful, frustrating thoughts, even for a few minutes.

i honestly appreciate the thoughts, thank you. i also appreciate the fact that you shared your own experince. i cannot agree with you more about seeing a doctor and being medicated. i apologize, if by saying “i am bipolar” i have trivialized this condition. i did not intend to do that. i am not really bipolar, just a little loony. so don’t worry, i will definitely go see a doctor, take medication, once i come up with a legitimate complaint.

again, thanks for your sincere concern.