November, 2006 Archive

if the temperature stays where it is right now (50s, thanks for asking), you will see me in one of my patient’s room, but you will not recognize me. i would turn into a pillar of ice, and  i would have no one to blame but myself, for choosing a more comfortable life.

it is hyperbolic. of course. but really, it is so cold when i went to work last night, i had four layers of clothes, and i was still having the chills. i have no idea how people survive the snow.

anyway, the weather is so trivial. there are more important events.

for example, one of my patients last night was a guy in his early 50s who had a stroke after a kyphoplasty. before the surgery, he was fairly healthy. the only thing that was really wrong with him was his kyphosis, so he opted to have it repaired. the stroke happened a few days after the successful surgery. when i got him monday night, he was completely nonverbal, and has been that way for a couple of weeks. pneumonia was slowly dragging him down, and his secretions, if i could sell what i have suctioned from him, would have made me filthy rich.

i didn’t voice it out, but i had the feeling, he did not really have a problem about talking, he just did not want to do it. not the one to easily give up on things like these, i started talking to him everytime i suctioned, which was pretty much every hour. he would fight and take my hands out as i insert the suction catheter through his nose, but i explained it is important, and in the end, he would cave in and relax. i forgot all about my worry that he will be in respiratory distress and will be transferred to ICU, because everytime i suctioned, he was breathing better.

i was determined to make him talk. but he seemed more determined not to. his determination prevailed. tuesday morning, i went home feeling defeated. i felt like i wasted time for nothing.

last night, i was given report that he is better. but talking? that was not mentioned. imagine my surprise when i heard him talk to his wife! his wife told me he has been talking here and there the whole day, but she cannot really understand a thing he was saying.

“does he know his name?” i asked.

“i don’t know, let me ask him.”

slowly, he opened his mouth and said his name. i asked her if he knew her name. the look in her face made me realize she didn’t want to know. she didn’t want to get disappointed, if he didn’t know her name. still, i asked her to ask him. she placed her face close to him, talked to him in spanish, removed his oxygen ask, and waited for him to answer.

“…..Lupe….”

almost a whisper. ever so gentle.

i looked at her to confirm if that was indeed her name. she placed the oxygen mask back, looked at me, and nodded, fighting the tears back. i might have said “great!”,more than i was supposed to, but i was really excited, i didn’t care.

it must have been an amazing feeling. to hear your name being whispered by somebody you love, the one you thought death would snatch. the one you don’t want to let go, but whose life was being threatened to end. it must have been an amazing feeling. it must have rocked her world, must have awaken her passion.

i don’t really know. i left the room to give them time alone. it was a moment just for them.

i may not have a part in my patient’s decision to start talking again, but it sure warmed my heart to witness such a moving event. not the kind of warmth that will stop me from wearing all my winter gear the whole day and night, this early, but still.

it was the kind of warmth i needed to keep driving to work, even if the steering wheel feels like a block of ice.

he threw up big time. he tried to reach the restroom, but he did not quite make it. he apologized endlessly when i asked him if he needed something, when i saw his call light on. i told him there was no need to apologize, i will take care of it.

i was thinking, it couldn’t be that bad. i decided i will just clean it  myself, not bother the housekeeper. i opened the door, and the smell was just too much, i almost gagged. i closed the door, and paged the housekeeper. it made me feel bad i had to pass it on to them, but i just can’t do it. the smell, and the fact that it was all over the floor, made me understand why he was so apologetic.

it took awhile for the housekeeper to come. when she eventually did, i saw she brought another housekeeper with her, and they were doubling their masks. i knew they will go home in the morning, and discuss with whoever it is they eat breakfast with, that their thanksgiving night was terribly messed up. for some incomprehensible reasons, i felt responsible. i felt like i ruined their quiet night.

i know, it is not one of those grandiose reasons for being thankful, but still. i am thankful for the housekeepers. because they made my night a lot easier. if you know any housekeeper, tell him/her i appreciate the way they made otherwise messy job, less messy.

it was a slow night at work on thanksgiving. that should be obvious, with the way i highlighted the night with what i normally consider usual. don’t get me wrong, i am not complaining. on top of everything that i am grateful for, i am grateful that this past thanksgiving was not like my thanksgiving at work last year.

witnessing a scene wherein an RN and a resident are literally yelling at each other is not good. all mouths were open as C, an RN, and Dr. P, a resident shouted at each other like they thought everybody else in the unit was deaf, or blind, or just didn’t care.

to be honest, i don’t think i really cared, i was just a little embarassed. i mean, it was a hospital unit after all, and there were patients. and there were family members visiting the patients. i wanted to disappear, but i couldn’t. so we all stood there, looked the other way, and wished it would be over soon.

one of C’s patient was refusing a very important procedure. the reason the patient refused was not because she didn’t care about the result of the MRI, it was because she was not in the right state of mind to think things over. she believed she is the current president of the united states, and that every yellow pill was created by the demons to kill her. besides, whatever it was that was bothering her will get better once she takes  a white colored muscle relaxant. plagued with an ethical dilemma, of the procedure that needed to be done as soon as possible, to prevent harm to the patient,  and a mentally unstable, refusing patient, C asked the opinion of our acting nurse manager, who told her to call the nursing supervisor, who told her to call the patient’s attending.

after paging the attending, C’s fiance called. he was on the ground, has excruciating pain on his back, and was unable to get up. panicked, C put her fiance on hold, called 911, and sent the ambulance to their place. i was standing behind C when she got back on the phone with her fiance, (a surgeon) who despite my inability to hear, obviously found the idea of an ambulance on the way, to be ridiculous. C argued about at least having the paramedics check his vitals, and after a few repeats of saying she will NOT cancel the 911 call, said she will now hang up.

this was when she got the phone call from the attending, who wanted to talk to the resident because really, what is going on here? the resident took the phone, and apologized to the attending endlessly, because “i know you should have not been called, but i had no idea about this issue, and i was never told until now”. of course, with escalating emphasis on the “sorry”, and “i was never told”, that made it clear she was both trying to save her behind from trouble, and at the same time trying to indirectly express her frustration that she was placed in a very awkward situation, by C, the RN.

C was furious, took the phone and told the attending that she was told by the supervisor to call her. when C was done talking to the attending, Dr. P reiterated  that she should have been called first, instead of the attending. to which, C, replied: “MY FIANCE IS ON THE GROUND, I DON’T KNOW WHAT HAPPENED TO HIM, YOU DON’T UNDERSTAND ANYTHING!”

P was furious she was yelled at, then the beat went on. i will spare you the details of the ugly exchange. just take my word for it when i say that it was not pretty.

an RN who was trying to save the night explained to Dr. P that it is not really her. that C was upset about  the situation that her fiance is awaiting an ambulance. Dr. P said she understood that, “but if she is unable to deal with things at work right now, because she has personal problems, why didn’t she just go home?”

the whole soap opera episode ended with C crying in the hallway, talking at a relatively loud voice to the outgoing and incoming charge nurses, about how Dr. P did not understand anything. at the other end of the hallway, Dr. P was talking to the other nurses, in a relatively loud voice about how wrong C was, in every account.

let me get the record straight by saying that i believe every person is entitled to react to any stressor in his own unique way. i believe C has the right to panic and get upset, and Dr. P has every right to get upset too. to be stressed out is normal, but is it too much to ask that medical professionals remain professional even at the most stressful of times?

when i try to analyze what happened, i don’t really know what the yelling accomplished. all i know is that most, if not all of the people who witnessed it felt sort of embarassed to be a part of the team. while the exchange of angry voices was going on, everybody pretended not to care, but for the next 11 hours, the discussion was unending.

i was glad that my patients pretended they didn’t care, because if they did ask me what the commotion and the shouting was all about, it would have been easy for me to lie and just say ” i don’t know”.

well, what do you expect me to do? let my patients understand that that’s just the way we are in our unit? that we don’t really mean to be rude and loud, but it just happens when things get out of hand? then what? explain to my patients that professionalism is really overrated, and that by all means, we all should just start yelling when we feel that  things are getting a little out of control?

i don’t know. maybe i’m just too indifferent to care, or too selfish to understand. it’s just that, just like everybody else, i didn’t really believe the elevated voice volume served a purpose.

it started with a hospital policy that out of the blue was printed and posted at the door of the staff restroom. i’m not sure if it was in all the restroom doors all over the hospital, or just in our unit, but it was quite an interesting read.

i know that the charge RN took her time reading it, because i went to the restroom twice, and the door was locked. when she finally came out on my third attempt to use the restroom, she looked all weird. “you read that one yet?” i haven’t, so i took my time in the restroom too.

to make the page long single spaced hospital policy short, it just reminded employees that dating or having a relationship with a patient is not allowed. when you develop intimate feelings towards a patient, you have to wait six months after his hospitalization before you go out and have dinner. it is a totally different story altogether if you two are already dating before the hospitalization. it concluded with the warning that this inappropriate behavior can be a reason for termination.

well, it’s either the administration is watching Grey’s Anatomy and was horrified with what intern Izzy did, or the whole thing was just a coincidence. whatever it is, this thing is not really one of my worries. you see, i don’t really take it seriously when male patients have their TV on the Jazz channel, and they ask if i’d like to dance. i find it very unnerving yes, but never exciting.

then…there is this thing about to be implemented next month in our unit. we will not have a PCA (patient care assistant. they are called CNA-certified nurse assistant before, and i agree with the change of name because really, nurses don’t need assistants) if our patient census is lower than 21. we are a 26 bed unit, and at present, we have 1 PCA if we have 21 patients, 2 PCAs if we have more than 21.

to me, this is both good and bad news. good because i do want to see other nurses change their attitudes about the call lights. when we have a PCA, a lot of nurses believe that it is SOLELY the PCA’s job to answer call lights. to these nurses, it doesn’t matter that the PCA is busy and they are not, they will NOT answer the call light. period. they will wait for the PCA, while they gossip away their time, because it is not their jobs to answer the call light. pardon my language, but for me, this is just plain, simple BS. i have gone to nursing school just like everybody else, and i have not heard anything about this rule. as far as i know, when the call light goes off, especially if it is my patient, it is my responsibility to find out what the patient needs. period. when the PCAs are gone, maybe these particular nurses will unlearn this ridiculous belief and start answering their patient’s call light the moment it goes off. that’s really good.

bad news because when you have a total care patient, there are certian things you cannot do by yourself. if all the other RNs are busy with their patients, you are left with no option but to wait till someone is available to help before you can do anything. let’s say i need to turn an immobile 350 pounds patient, i can either wait for two other nurses to be available to help me, or try to be heroic and break my back, or just not turn the patient at all. in the end, it’s the patient’s loss. that’s really bad.

then… a college classmate who has been trying to get pregnant for a few years finally had an IVF that didn’t succeed. just like any stupid person who is eager to comfort a grieving friend, i tried to be helpful. to be honest, i don’t know if that’s what i did.

when she said “maybe God didn’t really mean for me to have children”… i told her that maybe she is right. when she said maybe she “will have kids at 45 just like her aunt who had unsuccessful artificial insemination a few times in the 1980s, then got pregnant when she stopped trying, at 45″… i told her yeah, she’s only 35, so she still has 10 years of possibilities. when she said she doesn’t “want to try again and be in denial about the glaring fact that this ”having children thing” is not really for them”… i told her yeah, you’ve tried the fertility drugs, the shots, now this IVF, maybe you are right. when she said she “could save up again and try another shot at IVF just to make my mother in law happy”… i told her yeah, trying is not a bad idea.

it was a phone call that lasted about 30 minutes, but i felt like it took forever. clearly, i didn’t know what to say, so i should have not said anything. unfortunately, instead of shutting my big mouth up, i kept blabbing along, saying yes, and no, and maybe, till my head hurt. the next day, i emailed her to sort of apologize, and told her i didn’t really know what to say but that i will be praying for her. she emailed me back saying she is completely fine. she said she knows that people expect her to be devastated, but really, she is very practical and takes things as they are without any drama. she said she is honestly okay and does not really need to be comforted.

i take that message to directly mean i am one of the “people” who annoyingly expect her to be devastated when she is not, and that i should take off and leave her alone, now. so i didn’t reply to the email, which i know she will appreciate, but still, that does not stop me from feeling stupid.

then… i had to open my legs to that yearly Pap smear again. it was probably rude of me to tell my OB that i do not really look forward to seeing her, but i was just trying to be honest. if it is not considered immature, i could have kicked her face when she was doing her job, inserting that dreadful looking thing called speculum. as expected of any reasonable adult, all i could do was bite my lip. and when she did that quick rectal thing, i did what was expected of me, which was to bite my lip some more. if you want toknow the truth, what i really wanted to do was scream profanity to her smiling face and to the face of her expressionless assistant. my discomfort aside, my OB is really a very nice person.

then…tomorrow, we are going to a funeral. this guy, a distant relative of my husband, who is in his late 70s, died a few days ago. he was doing his usual morning walk, when he was run over by a car whose driver surely didn’t care enough to stop and see what he/she has done. 

this is the second hit and run case i personally know that happened in this city this year. the first one was early last year. a guy in his 70s, was doing his morning walk with his wife, and they were crossing an intersection when a car run him over. if i remember correctly, he died on the spot.

what is freaky is the fact that this is the same city where my dad lives. it is more freaky because just like the guys who died, my dad is in his 70s, and he walks every morning, everyday. the thought of him being run over is terrifying, but what can i do to stop things like these from happening?

then…

well, you get the picture. the week that started with an interesting read on the restroom door will end at a sad funeral. i can’t really say that’s extraordinary, but you have to throw in the fact that everytime the phone rings, we get a jolt. this is not news to those who have experienced selling their houses, but yeah, there is no way you can walk around your house half naked when any moment, some pairs of scrutinizing eyes are on you, and on your bathroom.

here’s hoping your week was extraordinary, in a good way. or that your weekend will not start with a funeral, because somehow, for some bizarre reasons, it can make the whole weekend a little darker.