February, 2006 Archive

i started the morphine continuous drip through the PCA at about 8 pm.

i questioned the debate about physician assisted suicide.

really, what is the issue all about?

all you need is to have a terminal illness. tell the doctor and your family that you are in severe pain. tell them you wish to be comfortable. and comfort is a big thing. actually, it’s the only thing.

you will be referred to palliative care. they will order either a drip of morphine, or ridiculously high doses of pain relievers at ridiculous frequencies.

you start saying thank you to the doctors, to the nurses, to your family and friends, then you start to fall asleep.

and never wake up.

is that physician assisted suicide? definitely sounds and looks like it to me.

the palliative care team however, calls it comfort care.

we are all professionals of course, and we agree to disagree. after all, we are here for the patient, and it’s not about us and what we really think. the only thing that makes me uncomfortable is the fact that it is MY job to hook up and start the morphine drip, or push that versed. it doesn’t seem fair. or you know, something just doesn’t seem right somewhere.

ten hours passed…all sorts of tears have been shed. the morphine continued to drip, yet the patient continued to breathe, the heart continued to pump.

and the family wanted to know. …”how long…?”, they reluctantly asked.

i had no answer.

aside from the fact that i didn’t really know, the question made me uncomfortable.

i remember my past experiences with this same situations.

the first one had the morphine drip for more than 24 hours, but still, she kept moaning. palliative care decided i should give versed. 5 mg quieted her, but they think she was still uncomfortable. another 5 mg of versed was ordered. that quited her. for good. in a few minutes.

the second one breathed his last after approximately 5 minutes of getting 5 mg of morphine.

it seemed like every person has his own time table. why? i have no clue. when is that time? i don’t know.

anyway, the question made me feel uncomfortable because it sounded like the family was dying for the patient to die. i’m sure that was not what they meant, but it still sounded depressing.

when i came back the next night, the body was awaiting to be brought to the morgue. 19 hours of temporary comfort…then the final, total absence of pain.

i cannot totally psyche myself up to believe that i did the right thing. i know by law, i am covered, but there is this blunt, nagging thought that haunts me. i am a nurse. i’m supposed to prolong life. what did i do? i cannot escape guilt, even though i know patients die eventually, and by giving them comfort, i am being a good advocate.

i need to convince myself that in situations like these, death is a good thing. a really good thing.

how do you do that?

my back hurts. my arms are sore.

three nights of repositioning two patients whose one leg appears to be bigger than my waist (and believe me, my waist IS large!) is taking its toll on me. we don’t have a lift team, and even if we do, i don’t think they should be called every 30 minutes to lift one leg or one arm.

i have nothing against morbidly obese patients. i believe they deserve the same medical care and attention that everybody else does. i know i shouldn’t feel sorry for them, but i will be lying if i say i don’t feel sorry for them.

how humiliating is it to call the nurse for things that other people just take for granted?

i can’t count the number of times W called to help him move his leg a few inches to the right or to the left. it usually takes two people to lift his leg, usually, i get impatient waiting for other nurses to be free, so i just go ahead and do it myself. my bones cracked.

a little over 500 pounds, W is too weak to even hold a plastic cup with juice, but God knows he wanted to try. on the process of trying to be independent, he spilled his juice twice. and we ended up changing his gown twice.

lifting his arms actually made one nurse fart. to maintain our professional aura, we all pretended it was the patient in bed 2.

the other patient is T. he is a little over 400 pounds. he kept telling me his arms and legs are really really swollen, and he is concerned. he said the doctors looked at it in the morning but didn’t really tell him anything. i told him i’ll check his chart, because the truth is, it was really really hard for me to tell the difference.

working as a break RN for two nights, and then having T on my list on the third night was physically draining. i would go home and just refuse to carry my 18 month old boy. he weighs 27 pounds, and probably weighs less than W’s arm, but i had no strength left.

at home, i lied on the floor for hours, thinking about a lot of things.

i knew i felt sorry for the patients. it pained me to see them struggle with their independence because it was just not possible for them to reach their back to get rid of that itch. it must be frustrating to go to MRI, and find out MRI can’t be done because you can’t fit in the close MRI thingy. it must be embarassing to be a full grown man and not be able to lift your legs, or hold up a cup of juice, or turn to your side. it must be degrading to get every nurse in the room just so you can face this way instead of that way. it must be utterly humiliating to know that you need two nurses to insert your foley catheter. one with the catheter, and one who will locate where to insert the catheter. once, it was a symbol of their manhood. now invisible, it must make them feel the same. unseen. unheard.

i lied on the floor for hours, thinking about a lot of things.

i didn’t know i felt sorry for myself, but i did. for being in a situation i can’t control, and i can’t change. i want to complain, but it won’t chnage a thing. all i can do is stretch my back, massage my arms, and feel sorry for myself.

when i gave report to the AM RN, i told her to make sure she has at least three other people to help her turn T. she looked at me with this mocking smile, and asked: “what does he do at home May? his neighbors turn him? if he can’t turn himself, then i guess he stays where he is.”

i know i should have blurted out a smart sounding reply to that one, but i remained speechless. there was silence, and all i could hear was a creaking sound. from my back.

“why do you keep paging me? don’t you know i need some sleep, and i’m really tired?”
- from an on call intern who finally turned on his pager after the resident woke him up because he has not returned a page for a little over two hours.

let me just say this: since he was not even joking when he asked…either this doctor has some really loose screws, or amnesia just washed over his tired body and he completely forgot that it takes some sacrifice and endless sleepless nights before he can add those two letters after his name.

the pager was invented not just to annoy you, but to actually help the patients. sometimes, it’s not just about you.

next time you ask doctor A, i will hypnotize you, so you will remember why you wanted to be a doctor. or, i can also hypnotize you, so you will forget the idea that you are in the hospital to get some rest.

i floated to neurosurgery/trauma stepdown.

the land of empty stares. where the nurses are without faces.

the charge nurse just wanted to know from what unit i came from, and then she told me the room numbers of my patients.

that’s all. no hello. no welcome. not even a fake smile.

okay, so maybe she had a crappy day. you know the kind of day when your kids are sick, your husband is sick, your pets are sick. your unit is full. and the float is 10 minutes late. of course.

well, she didn’t really care to ask if it was my fault that i was late, so i really didn’t bother to tell her.

there were 7 nurses, and i got a quick hello from two of them after midnight. okay.

until last night, i didn’t realize how hungry i am for attention when i float. and also, how ridiculous it is that i was expecting people to just show off their teeth at me like i was the next best thing that happened to their unit. what is up with me and all my ego? what does it matter if all the nurses i work with are stoned face and unfriendly? they are not paid to befriend me, so what’s my complain? nothing really. it’s just that i’m a big insecure invisible thing.

anyway, one of my patients fascinated me. at 19, she had history of breast implants a few years ago. like when? when she was 15? last month, she was in a car accident, and hit her head hard. the incision is almost healed, and the hairs are slowly growing; but apparently, one of her implants popped, and that’s where her pain is coming from. also, her brain is just not ready to work like it did before. she had this empty stare too, but at least she has a reason. a scientific explanation.

what are the nurses’ excuse?

i am digressing.

back to the patient with popped breast. she kept trying to get up, whispering she needed to pee, and would nod when i remind her she had a catheter. apparently, the two weeks that she was in, she barely said a word. well, either the day nurse was lying, or i had this power to pull out words from her once lazy mouth.

most of the times, she would sort of whisper that i f#$%k myself . it made me uncomfortable, but i did not have the strength to keep telling her over and over that i do not understand the obvious obsession with the F word. my fascination with her made me forget that to all the nurses who worked there, i was not officially human, so i don’t need to be seen.

which reminds me. i have seen a lot of confused patients, and the three most common things i notice are: foul language, how they need to get their money from the bank so they can pay bills, or how they need to call their kids about some stuff they need to fix. sometimes it’s just the swearing. at the end of the night, if you literally document the cursing, the patient’s chart will end up to be rated R. as for the money and the kids, patients magically get out of restraints just so they can get that money or that kid. is this a picture of what we all have in our minds when we are not yet confused? then, confusion takes away the inhibitions and we get real? does this mean that people in general are obsessed or preoccupied with cursing, their finances, and their kids?

i totally digressed. again.

just be a little friendly to the nurses who float in your unit. a little smile goes a long way, and if you ask me, it might also determine your chance of getting me to float in your unit again next time. not that i’m indispensible, i’m just too emotionally traumatized to go back there. the scar never heals you know.

i know. i am so shallow.

but it’s not my fault. really.