prelude to a break
a long, boring, account of the night i when i thought i should have been a professional dancer instead.
of course, some stuff are not accurate. the exact times, the documented BPs, the lab results. not only because of confidentiality issues, but also because i do not have that photographic memory. anyway, the numbers are pretty close to the real ones.
1830: only two patients on the list. A, a male in his 70s who had massive fungal infection of his sinuses. isolated for MRSA (a bug that will make nurses and everybody else wear that very fashionable isolation gown and gloves everytime they touch the patient or anything that might have come in contact with him). he was oriented and proud, but pretty weak to do things on his own. B, a female in her late 80s who had severe dysphagia (swallowing even a tiny bite of pudding was extremely excruciating). she was paralyzed from the hip down, due to multiple sclerosis. also, she was supposed to be a VIP (son was the president of a hospital in another city, and colleague of a lot of our doctors). what has that fact got to do with my job? i guess they want me to be extra nice to her. why? i have no idea!
1850: answered call of B, who wanted me to talk to a doctor on the phone. nice doctor on the phone, who was practicing at the hospital the patient’s son was the president, wanted to know the name of the GI doctors who did the endoscopy earlier, because he was wondering what their plans were, why were they not sending the patient home yet if they had no plans for tomorrow. told doctor will get back to him later. assessed patient B. charge RN said third patient was coming. looked at the info paper and found out it was another MRSA isolation patient. what happened to the agreement that we were not supposed to have two isolation patients at a time? i guess nothing.
1905: assessed A, who was sitting on the side of his bed, with his underpants on his ankle. offered assistance, but he looked at me like i was from outerspace, because yeah, what do i think of him, invalid? stood at bedside and observed him. decided i cannot let him do things on his own when he almost fell on the floor while reaching for the urinal. ignored his protests and claims that he was superman and helped him with the urinal anyway.
1925: talked to charge RN about the doctor of A and asked her to handle the situation. charge RN said just tell him to call in the morning when A’s attending will be available. charted, checked schedule of meds, checked if meds were complete. got C’s bed ready. took report on C.
1935: tried very best to sound professional to the nice doctor on the phone who was adamant in getting GI doctors’ names so he can discuss what the results of the endoscopy was and why it was done twice and why was the patient still in our hospital when she was supposed to be home as they were not doing anything to her anyway. first of all, the GI doctors do not decide the discharge orders. second of all, i don’t know where the GI doctors are at this time. third of all, i don’t think i’m allowed to give out their pager numbers. man, sometimes, it is very hard to reason with some doctors!
2000: C, a male on his 40s who was very jaundiced (skin as yellow as the very fashionable isolation gown) arrived from basic unit. gasping for air, but initial vital signs appeared okay. needed to watch his BP, as he was transferred to our unit for hypotension. they just finished giving him a bolus of 250 ml saline.
2045: charted. prepared meds for three patients, gave meds to two patients.
2100: at B’s room, giving her crushed meds exactly 2100 as scheduled. it might mean trouble if VIPs don’t get their meds at exact times you see.
2120: came out of B’s room. felt like i knew her for years, and was told it was really nice to talk to me. an immigrant from portugal, her family moved here when she was 2. her husband of 48 years passed away last october. it was an arranged marriage, and he courted her for 13 years, after which she agreed to go on a chaperoned date. two years into the arranged marriage, she was diagnosed with MS, and she thought that for sure he would leave her. the guy stayed with the sickly woman, and showed her unconditional compassion. on the fourth year of their marriage, she realized he must love her, and decided she will love him in return. those 48 years were good, happy years, she said. they had three kids. the first son a medical doctor, the second a dentist, the daughter, a medical doctor. all three were adopted. the two boys, who never knew their bilogical parents, were from an orphanage in india, and the third one, was the ninth child of a relative in india. she disagreed when i told her that those kids were blessed. she said she was the one who was blessed. the note on the chart was right. she was a VIP. very interesting person.
2130: charted. told by charge RN that fourth patient was coming. got report. D, female in her 80s, filipina, with alzheimer’s, restrained, had been spitting blood for a couple of days. suspected of TB, but was ruled out after a scan showed pulmonary embolism (that little clot that can kill you any minute). will have a filter placed in the morning. got D’s bed ready.
2145: checked all ordered morning labs. asked secretary to enter missed orders in the computer.
2200: D arrived. got lucky, ducked on time when she aimed her bloody spit at her son and missed him too. reoriented her about the catheter when she screamed she needed to go to the restroom to pee. initial vitals okay. if only we can do something about the spitting!
2215: gave A’s every 2 hours eye drops. answered call light of B, who wanted a sleeping pill. was asked if i was single. told her no. was asked if i had kids, and who’s watching them when i’m at work. told her i have two boys, a 3 year old and a 21 month old. told her that my husband, who 7 weeks ago was watching the boys. was asked if he works in the morning. told her he decided to quit working as a nurse because he felt burnt out, took his retirement savings out, decided to work at home on what he thinks is his perfect dream job, an internet business of sorts. was aksed how i liked the new set up. told her that i enjoy the fact that he is home all the time, but i sometimes worry because yeah, just liken everybody else, we have mortgage, car payments, insurance, etc. etc. was told not to worry because all men go through a phase like that. was told that i should look at it from a different angle and think that it is good that my husband is having an early midlife crisis, because at least it will be over earlier than the normal. hhmmm…now THAT is what i call a brilliant advice!
2230: rechecked C’s BP. 89/50. not that bad but i’m concerned. D was screaming in the background. A’s call light was on.
2245: after helping A with his futile attempt to change his gown after spilling his urine on it, somebody yelled that D was in between the rails, screaming. how she was able to sit up and slide on the side of the bed with wrist restraints on was totally beyond me. restraints must have some magical powers.
2300: did vitals of all four patients. C’s BP 74/48. started the bolus of 250 ml saline after talking to the on call MD. D was up again, screaming she wanted to pee. was promised a piece of land if i only take her to the restroom. reoriented her about the catheter, was ignored and was promised with a big amount of money this time, if only i take her out of bed.
2330: C’s BP 76/49. started another bolus of 250 ml saline after calling on call MD. checked availability of Ambisome (an antifungal that takes a lot of time to administer) for B. called pharmacy to verify the whole thing and was told that this was how this drug should be given: prehydrate with 1 liter saline; flush line only with D5W or sterile water; give 300 ml Ambisome over 3 hours; flush IV line with only D5W or sterile water, posthydrate with 1 liter saline. also, the drug should be ordered 1-2 hours prior to administration. whew! i need to pee!
0000: B was asleep. time for A’s eye drops, every 4 hours ear drops, and every 4 hours nasal wash (which, to my relief, he refused!) started his prehydration of 1 liter saline. ordered Ambisome and charted.
0015: C’s BP 85/50. alpha-paged on call MD. okay with it, just watch it. D’s gown and top sheet changed. was promised more money if i let her out of bed. meds given to her after a long discussion that she has not taken it yet because it just came from pharmacy.
0040: A wanted pain med. B wanted to go to the commode. C wanted help with his urinal, and needed convincing that the oxygen will help him a little bit. D’s bloody spit was on her gown again, but had no time to change it. had to think about everybody’s suggestion of vest restraint as the haldol didn’t touch her obviously. no, she looked so tiny, it just didn’t seem right.
0115: called pharmacy for the Ambisome. was told it will be sent before 0200. gave patient D’s IV antibiotic. rechecked C’s BP. 83/50. alpha-paged MD, no response. i need to pee! whose leftover french fries are these? okay, where’s the ketchup?
0140: A was still sitting on the commode, but the floor was wet with his urine. he was trying a new underpants, and was adamant about putting it on himself. covered the floor with towels while asking somebody to call housekeeping. watched him put the new one on, fighting the urge to just do it. reassessed B’s pain.
0200: A finally back in bed with a dry underwear. flushed his line with sterile water. gave his eye drops. called pharmacy for the Ambisome. was told it will be sent in a few minutes. D was screaming, wanting to pee, one leg in between the rail. thought of changing her gown, but had no time. rechecked C’s BP. 85/48. thought of alpha-paging MD, but decided against it. i need to pee!
0220: tried hard to sound professional while talking to the pharmacy person. the Ambisome is still unavailable! told that the courier just left. charted. cleaned D’s her face with warm washcloth. was promised more money as i was the most caring grandkid she ever had.
0240: finally started the Ambisome of A! finally went to the restroom! ahhh! sweet relief!
0300: checked vitals of all four patients. D’s BP 159/70. C’s BP 76/45. paged MD. checked total IV intake of all four. made sure all foley catheters were emptied.
0325: rechecked BP of C (75/48) and D (147/80). paged MD again. checked if Ambisome going okay.
0335: tried hard to sound professional while talking to MD, implied that it won’t hurt if he will come and see the patient, and maybe consider referring him to ICU, since the boluses are not really helping. started bolus of 250 ml saline anyway.
0355: gave A’s eye and ear drops. offered his nasal wash, which, thankfully, he refused! told D to keep still. (like it was going to happen!) gave charge RN a quick report before the break.
0400: had a dream that my 3 year old son had hypospadia (urethral opening not on tip of penis). was so pissed off with the doctor for not telling us when he was born, and was beginning to cry when the timer went off.
0430: found out that latest BP of C was 89/60. finally changed D’s gown and sheet. checked Ambisome. checked total intakes and outputs of all four aptients. found out that D’s urine output was only 175 ml. decided against paging MD for this and wait till somebody else needed him. checked next day’s medication sheets. pissed off at the new medication sheet program that was started for the first time that night. everything was confusing and needed a lot of manual corrections.
0525: realized that when A will be picked up at 0615 for his hyperbaric treatment, he will still have the post Ambisome hydration, because it was started late. needed a 30 feet extension tubing for the IV line, since pump needed to be outside the door or something like that, of the hyperbaric treatment room. set up the extension tubing.
0545: checked D’s IV site before starting the Clindamycin. pulled her up in bed and started antibiotic after seeing IV site was okay. woke A up to get him ready for his treament. he knew he needed a gown without metal snaps, he insisted of doing it himself, after using the urinal. decided to alpha-page MD about D’s urine output.
0600: talked to the cranky on call MD who was pissed off that i paged him for the urine issue of D, since he stressed it can wait for her primary team of doctors. he kept saying over and over. “let me just ask you something, is this issue something that can wait for the primary team?” and before i get the chance to answer, he will ask the sarcastic question again. it was extremely difficult to sound professional, but i tried.
0605: decided against rechecking C’s BP after seeing he was in deep sleep. back to A’s room, where he was seen still holding the urinal, still in his gown with metal snaps. gave his eye drops and finally convinced him that he needed help in changing his gown.
0620. sent A off on a gurney, with dispatch, for his treatment. checked if D’s Clindamycin was still going. saw her arm swollen. looked exactly like 50 ml of antibiotic under her skin! decided against warm compress because her skin looked so fragile. apologized endlessly and changed her gown while blaming stupid, incompetemt self for not rechecking a least 10 minutes after starting the antibiotic. i’m so stupid, stupid, stupid! still, she wanted to give me the biggest amount of money for being the best among her grandaughters. rechecked C’s BP 87/51.
0640: gathered charts for report. D’s AM nurse was the first who was available. was asked in report if there was a radioactive bin for patient’s soiled/bloody gowns and sheets. realized it totally escaped me that she was radioactive after the VQ scan! interpreted AM nurse’s silence as condemnation upon telling her that patient’s IV site was infiltrated, and the radioactive stuff are in the regular solied linen bin. i’m so stupid, stupid, stupid!
0650: told D’s nurse that there was no available radioactive bin in the utility room, and that the soiled stuff were placed on a regular linen bag, but was labeled radioactive. requested her to call for the bin later. interpreted her bland response of “it’s okay, i’ll do it” as: you’re so stupid, stupid, stupid!
0710: finally finished giving report to all three other nurses. did final check of charts, in the computer and the other papers.
0715: clocked out. said goodbye to all patients. thanked B for sharing her life story, and for listening to mine. thanked D for the promised money and land. apologized for the swollen arm. went to the break room. decided against crying when another nurse came in. stayed in the breakroom for 15 minutes before finally going home, grateful that i did not fall asleep in the car.
the second night was practically the same, if not worse. A was sent home. was replaced by a mentally retarded cerebral palsy patient with restraints. C was transferred to ICU, and was replaced by a patient with episodes of confusion, whose leukemia was back with a vengeance after a few years of remission.
the third night was worse, if not worst. A, the mentally retarded patient was sent back to the skilled nursing facility. was replaced by a patient who was bleeding, with a platelet of 22, and needed lots of transfusions. C, who had leukemia, was transferred to oncology and was replaced by a patient who was about 5 feet 5 inches tall, but only weighed less than 100 pounds. she had severe malabsorption and was very particular with everything.
don’t ask me where the other nurses and the PCAs (patient care asistant) were, all this time. they too, were in a place where sitting was a luxury. everybody was running around like maniacs. one complained aloud that she is so pissed off when her husband expects her to have sex with him at least once a week when she is THIS tired all the time. “how dare him!”, she exclaimed.
it was not even three nights in a row. i worked nights of thursday, sunday, and monday. tuesday morning, i was just ready to forget everything that will remind me of work.
so, if you really want to know, yes, there are perks. one of the perks of having an unemployed husband is that he does not need to ask for days off two months in advance. thus, the spontaneity of out of town decision. as for the disadvantages, i forgot all about that, because i listen to good advice. especially if it comes from a VIP.
now tell me. honestly. you think i deserved that little break?
