October, 2006 Archive

i shouldn’t really write about this anymore. things like these are getting really boring.

but R is my friend. i knew exactly how she felt. except i’m thinking, i probably wouldn’t have cried the way she did, in front of the patient, and later, in front of every living being in the unit. i usually run to the restroom. i know, i’m such a loser.

R was taking care of K, a patient with end stage renal disease. an african american who is on three times a week hemodialysis schedule. in his mid 30s, he lives in a skilled nursing facility with people much much older than him, because his family cannot really take care of him and his regular hospitallization situations. we have a joke in our unit that he really loves spending time with us, because he is admitted for two to three weeks at a time on average, he is home for an avergae of ten days, then he is back at the ER, then, to us. with chest pain and shortness of breath, the hospital cannot really say no to him.

there are only two things that upset K. first is when the doctors wean him off the IV pain medication. second is when his IV pain medication is late. he wants his dilaudid 1 mg IV every two hours, on the hour. when the doctors decrease either his dose or frequency, or you come five minutes late, things will get ugly.

as expected, as the doctors anticipated K’s discharge, they decreased his dilaudid to every 4 hours instead of every 2 hours. R was the unfortunate nurse to break this news to K. as expected, he was NOT happy. he started saying rude things about the doctors. R, bless her heart tried to stay with him to calm him down. that was the idea at least, but things didn’t really worked out as planned.

his voice escalated. and he went on and on and on about a lot of things. about the hospital, the doctors, the nurses, and later, about R, and the fact that she is obviously a filipino, not american, but is working in america. R, concerned about the possible commotion his really loud voice might cause, closed the door.

“GET OUT OF HERE! YOU DO NOT BELONG HERE! GO BACK TO ASIA WHERE YOU REALLY BELONG!”

well, in summary, according to R, that’s what he said. unable to control her offended spirit, she went to the corner and sobbed. just in time for the charge RN, who is from india to come and check what the yelling was all about. the attending MD, who happened be a filipino, intervened, and patient relations was called.

the whole incident concluded with an apology from K, which  R sealed with a handshake. the patient relations people told K that this is never going to happen again…or else, he will be blacklisted.

i do understand why K is frustrated. i know it is important for him to get his IV medications as he wishes. all i’m saying is, is it really more satisfying to express one’s frustration by yelling, racial slurs included?

this is not really news, except that it still gets on my nerves how people can imply being racist even when they are too sick to take care of themselves.

on a totally different issue, let me ask you guys something. is it wrong for me to feel irritated with a co-worker who, everytime i give report to, expresses her extreme disgust that she works as a nurse, in our unit. these are her lines, verbatim: “i hate this freaking place. i go off for three days, and when i come back, i get this same list of crazy patients. i can’t wait to get out of here. i hate this place.”

what boggles me is that she has been telling me this for a year now, and she has not really done anything to resolve her issues. this is my point: i know she has her reasons for hating her job, and that is really none of my business, but is it really necessary to lash it out on me like it is all my fault she hates her life? i have tried seriously recommending that she consider transferring to another unit or hospital, and she said she will, but that was, as i said, a year ago.

if she really hates her job, do i really need to hear about it everytime i give her report? frankly, i do not have the skill to sort of give her the therapy she badly needs. i dread giving report to her, and i wonder if she actually feels relieved after expressing her negative feelings in such colorful language. if it does make her feel better, am i doing the right thing by being quiet when she starts her litany, when deep inside, i really want to tell her: “do me and yourself a favor, get out of here, get a better job, and enjoy your life!”

what is getting on your nerves at work? let’s talk about it… 

patient C has that familiar face, familiar look. he has Down’s syndrome. admitted for respiratory distress, he had this episodes of really bad cough, i felt sorry for him. everytime i suctioned his secretions, it felt like his tracheostomy tube will come out. to make matters worse, i just increased the rate of his tube feeding and although he seemed to tolerate it, he was slightly nauseated at the beginning of the shift.

he kept me busy, but he was “very cute”, i ignored my aching legs. in his early 30s, he still looked like an angel. and if there was something he knew best, it was to smile. his face lighted up everytime i entered the room. his smiles were only interrupted by the coughing. he made my difficult night a lot easier. his smiles so innocent it made me feel so appreciated.

five rooms away from him were two of my other patients. both in their mid 80s, both depressingly loosing their marbles, i felt sorry for them.

patient A would scream for the cops, “GET THE POLICE! NOW! YOU ARE TRYING TO KILL ME WHILE CORPSES ARE ON THE FLOOR? WHAT RIGHT DO YOU HAVE TO KEEP THE CORPSES ALIVE, AND YOU WANT ME DEAD?”

what?

patient B would call every five minutes and say: “i had a heart surgery, and i understand the doctor left a list of instructions on a paper so i will not bleed. are you following his instructions closely? am i bleeding?”

what?

patient A calls and asks: “WHAT IS THAT DEAD BODY DOING IN THAT BED?”

to which patient B responds: “i am not dead, i just had heart surgery.”

“CALL THE POLICE! NOW! DON’T JUST STAND THERE AND LOOK, MOVE! NOW!”

they both needed my attention every so often, i eventually ended up just grabbing a chair, and sitting outside their room to make sure they didn’t “kill” each other with their words and confusion.

when both ladies finally fell into the slow but short effect of the sleeping pillls, i was exhausted. i was not only physically drained, but i was terrified at the thought of my future.  i wondered if reaching the ripe age of 80 is worth it. these ladies’ condition made me sad and weary. i didn’t want to turn 80. alive, yet unaware of the joys i am supposed to enjoy. but then again, it boggled me. how do i do that?

it was a tiring night to say the least. the only thing that kept me going was patient C’s smile. the smile of innocence that made me realize that balance makes sense. i smiled back at him.

i know it must be a heartbreaking thing for parents to find out that their child has Down’s syndrome, but they must be thrilled to find out later that these kids’ warm and loving nature is like a sip of ice cold lemonade on a really hot summer day.

well, maybe even better than lemonade really. besides, summer’s just a memory. except, i can’t think of another form of simile. but, you know what i mean.

she was my patient three months ago. back then, she was very depressed. in her early 60s, she was dying of lung cancer. i cannot relate, but i can imagine the looming sense of panic when one is facing the end.

she told me she started smoking when she was around 12. it was a typical peer pressure story. only, most of her friends who told her it was cool to smoke, eventually stopped doing it. she, however, got hooked. for more than 30 years. one new year’s eve party, she  was admitted in the ICU for nine days, for severe pneumonia. not her choice, but the fact that she was on a ventilator those nine long days without a cigarette made her realize she can actually live without it.

she was discharged after about three weeks in the hospital. she decided to quit. cold turkey. she was cigarette free for more than 18 years when the coughing and shortness of breath started. COPD, lung cancer, certain death. she had every reason to feel sad, but imminent death was not the reason she was depressed.

“May, my daughter smokes. she has been smoking for years now, and there is nothing in the world i won’t do to help her stop. she has kids and she goes to my house everyday to help me with things i can’t do. we have a great relationship, but when i start talking to her about quitting, she gets very defensive. i do not know what else to do. i mean, is it not enough that she sees me dying? is that not enough motivation for her to quit?”

when i saw her two nights ago, she obviously looked worse. worse, but composed. she had that look that says she is ready. when i asked her about her daughter, she was quiet. “she still hasn’t quit?”, i asked. she nodded.

“i’m sorry.” i squeezed her hand and left.

it must be overwhelmingly painful to see your child choosing the same path you walked on. especially if you know first hand, that the path you chose could possibly lead to her early death.

the guilt must be unbearable.

she didn’t have to tell me every word. i know she blames herself. she told me her daughter started smoking because she saw her mom doing it, and no matter how hard she tells herself she cannot change the past, she still wishes she can.

i don’t know which is more difficult, the fact that she is gasping for air to live a little longer, or the fact that she is struggling to forgive herself, to heal, before she breathes her last.

he was teary eyed when i handed him his clean dentures. i just smiled and handed him the mouthwash, holding the basin for him to spit on. “you are the best nurse i ever had”, he said.

he kept repeating his thanks, i had to leave. honestly, it was getting a little embarassing. it was just a clean set dentures after all. it was not like all of a sudden i discovered some cure for some really terrible diseases, his lung cancer for instance.

it used to be that cleaning a patient’s dentures was a part of oral care, a routine nursing care. now, patients seem to find it unreal or even shocking that a nurse would offer to clean their dentures, and they really make a big deal out of it. the way he asked me a few times if i was really sure i wanted to do it, you woud think i was telling him i can make his cancer go away in a second. he was still in a state of utter disbelief when i was done, he was really exagerrating his words of thanks.

believe me, it was beginning to be uncomfortable. for what its worth, he was really thanking me beyond what was necessary. if somebody heard him, repeatedly expressing his gratitude, they might have thought i really did something as grand like telling him he was now cancer free.

anyway, if you want to know the truth,  before it got really uncomfortable, it made me feel really happy. it was very heartwarming to say the least. i know, i’m shallow. but the thing is, a smile and that look of thanks are worth more than a thousand words, and that sense of making somebody feel better, even in the smallest way, is really beyond any price.

i may not be the smartest nurse, but i suppose it didn’t really matter to him. his mouth felt fresh, he thought that having clean dentures will spare him some embarassment when he goes for his scheduled bronchoscopy, and he was happy. a clean fresh mouth may not really lessen the chance of him finding out that the cancer has spread, but for a fleeting  moment there, he found it really significant that he had fresh smelling breath, and it was all that mattered, even for a really brief moment.

i am not really the best nurse he ever had, i know that. but hey, when your dentures have not been cleaned in the past three days that you were in the hospital, and you are getting really self conscious about the whole thing, call me. i’m your gal.