March, 2007 Archive

March 29, 2007, 8:36 pm

dry walls

just when i thought it can’t get worse, it did.
i’m talking about our staffing condition.

the change that was implemented last week caught us by surprise, but we are flexible, so yeah, we are still alive. now, if our patient census is 17 and below, we do not have a resource RN, no PCA (patient care assistant), no unit secretary. “what doesn’t kill you only makes you stronger”, right?

i won’t bore you with the details of how i find this new staffing guideline extremely revolting and unbelievably inconsiderate (both to the staff and the patients) but when i say this sucks BIG TIME, you better take my word for it and just believe me.

the other night, i was going to take my patient off the bedpan when i saw G, the other patient in bed 1, naked. she was calling out different names of people who i assume are important people in her life. confused and incontinent of urine, her soaked diaper was left open, a new set of linen, diaper and gown were at her feet. lying in bed diagonally, she was trying to get out, but was too weak to succeed. it looked like somebody started cleaning her up, but was unable to finish the task.

like a real pro in staffing shortage issues, i did the smartest thing to do in situations like these: i looked the other way. ”i have MY own patients, and i need to take care of MY patients first”, i rationalized. you know, to sugar coat the guilt. i went straight to the restroom to wet the washcloths…and what did i see?

an awkward, uncomfortable sight.

G’s nurse, (let’s call her Anna) was standing on the corner of the shower area, crying her lungs out. she covered her face with the washcloths, not much out of an attempt to conceal her identity, but to save her face from the implied humiliation.

i didn’t have to ask her what was wrong, because i already knew. i only asked because i didn’t know what else to say. since my supposed concern made her more tearful, it made me feel bad. i tapped her shoulder a couple of times and told her to wait till i’m done, and i will help her. now, helping another nurse is not in the “how to survive stupid staffing rules handbook”, but there is something about a fellow wounded soldier that strikes a chord.

while we were cleaning G, Anna was fighting back tears. “please don’t tell anyone that i cried, or i mean, that i’m crying… it’s just that…and i don’t want others to make a big deal out of it…”

i nodded. i know, it was not a big deal. G being over 200 pounds, Anna being under 100 pounds. honestly, cleaning a patient twice your weight is not a big deal. the real big deal is: you need help and there was NO ONE who can help! taking care of four total care patients is no big deal. the real big deal is: there are no extra hands and feet when you can’t lift and run in four places all at once. “promise me you’re not telling anyone…”

i told her i’m pretty sure no one will notice it. everybody was just selfishly concerned about their OWN patients. anyway, “it wouldn’t hurt if you wash your face with cold water” i said. while she was drying her eyes, i assured her she was not alone, that like her, everybody else was overwhelmed. images of myself and nurses on the verge of breaking down, and some eventually crying in the middle of countless responsibilities, flashed in front of me. all of a sudden i realized how this whole thing doesn’t make any sense.

this whole situation doesn’t make a lot of sense. it probably doesn’t make sense to others, and it certainly doesn’t make sense to me. it doesn’t make sense to me that a lot of good and caring nurses feel inadequate and drained. it doesn’t make sense to me that many genuinely helpful nurses do not feel rewarded and fulfilled in helping the sick anymore.

it doesn’t make sense to me that a number of usually composed and confident nurses who think straight even under tremendous amount of pressures are found crying inside patients’ restrooms, frustrated and overwhelmed, helpless and embarassed.

it doesn’t make sense.
but it doesn’t mean it’s not happening.

March 23, 2007, 8:06 pm

time of death

are you a believer of “time”?

you know, the argument or idea that we all die, when it is our “time”. it doesn’t matter where we are, or what we are doing, if it is our “time”, we will go. nothing, or no one, can stop us from passing. that somehow, in some unexplainable nature of things, there is something or someone beyond ourselves that allows death to happen at the intended “time”.

or do you advocate the thought that there are deaths that are simply caused by others’ stupidity, carelessness, and thoughtlessness?

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i have been a bedside nurse for a total of 9 years now. i know that is a short time compared to a lot of nurses, but just like the veteran bedside nurses, i have seen, touched, smelled, and faced death so many times, it almost seems ordinary. in those 9 years, i have witnessed deaths of different kinds.

there are patients who come in with very simple problems. silently, we often question why they are wasting their time in a creepy hospital room when they could have just rested in the comfort of their homes and get better without medical intervention. a few days later, in some unbelievable twist of fate, these very same relatively healthy people die. they die unexpectedly. usually, there would be all kinds of scientific medical explanations. these explanations sometimes make their deaths reasonable, but it doesn’t always make it acceptable.

there are patients who come in with very complicated health problems. silently, we often question why they are wasting their time in a creepy hospital room when they could have rested in the comfort of their homes and peacefully pass without the intrusions and invasions of medical hands all over their fragile bodies. yet, these very same dying patients, in some unbelievable twist of fate, miraculously get better and go home. they go home cured, without any kind of logical medical explanations. their healing would always be acceptable, but it doesn’t always make it medically explainable.

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the other night, i overtook the care of a middle aged Spanish speaking male patient. he started pretty well, meaning he was fairly healthy, generally speaking. he was primarily brought to the hospital for a dvt, and was only staying for another day to be cleared of a tuberculosis suspicion. at the end of the AM shift however, he started having mild chest pain on and off, and was occasionally short of breath. it prompted the doctors to order a few more tests, and caused the family to be very concerned.

when night shift began, he was getting more uncomfortable, and the family more concerned. after about two hours under the care of another nurse, who believed she did everything she can to attend to his and his worried family’s needs, the family demanded another nurse because they believed that their nurse “was extremely rude”.

within the first hour, it was determined that he might be having a pulmonary embolism. for three hours under my care, this patient required almost all of my time. i have done nursing stuff that would have taken care of four other patients in a 12 hour shift. it didn’t help that my other patient’s potassium dropped to 2.0, and her BP to 71/40, but i digress.

this guy needed all of my attention, and i gave it to him. i have gave him blood, reassured his family. bolused him with heparin, reassured his family. started heparin drip, reassured his family. bolused him liters of fluid, reassured his family. given him pain medicine, reassured his family. repositioned him, reassured his family. changed his linens, reassured his family. constantly monitored his vital signs, reassured his family. contacted the doctors countless numbers of times, reassured his family. etc. etc. etc, reassured his family.

finally, the arrangements for his transfer to icu were finalized. with another RN, we transported him. we decided to take the bigger elevator to accomodate his family who were understandably sick with worry. my stomach was turning in anxiety. i was holding on to the ambu bag and was anticipating coding him either in the elevator or just before the elevator door opened.

the freaky elevator took about 10 minutes to open! 10 minutes! that is a lifetime! the idea to go to the elevators in the other end of the building came up and was attempted, but was not pursued because it was not a good idea. this whole time, i can feel my heart racing, my adrenaline shooting up. i was beginning to get shaky in pessimistic fearful anticipation. not so much from fear of not being able to handle the whole situation properly, but the fear of not knowing how to console his family if his “time” did come in front, or inside that gigantic elevator.

the icu staff helped us transfer him to their bed. after losing all that energy, we went back to our unit, relieved. drained, but relieved. an hour later, we found out he coded! 5 minutes after we left the icu! the weary intern told us he was revived and was already in a ventilator when he left the icu. “by far, this is the craziest night of my life!”, the intern exclaimed, and told us how perfect our timing was.

was it really because our timing was perfect that he was still alive? was it really because he was in the hands of trained, intelligent professionals in the icu that he did not die? is that really it? or was it because it was not his time yet?

“to every thing there is a season, and a time to every purpose under the heaven: a time to be born, and a time to die…”

so said the supposed wisest man in the history of the world. what does that mean exactly? does it mean that medical intervention efforts done are pointless because we are powerless against an unknown destiny of death? would it even matter if we don’t pay attention to our health because even if we practice healthy living, when our time comes, it will come even to those who are perfectly healthy? or is this supposed wisdom just a load of nonsense, because we actually have a say in the when and how of our death? do researches that show that people are actually living longer now prove this ancient words wrong?

also, how about this whole idea of premonition? either of the dying person himself, or that of his family? do we, or someone we love really have that sense from nowhere that death is imminent? i still vividly remember my mom saying ” i’m just too tired and i just want to rest. i don’t want this (meaning dialysis, meds, tests) anymore”, an hour before she passed away. did she know her time was coming? did she mean rest as in “rest in peace”?

are these questions just a variation of the presence versus absence of God debates, and therefore impossible to figure out on both equally yet oppositely convinced parties? is there even a point in asking all these questions?

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when someone dies from a bizarre vehicular accident caused by a drunk driver, how do you accept this concept of “time”? you don’t. you don’t just accept something like that. it is very reasonable to blame the mindless drunk driver.

on the second thought, how was it that your loved one was at that exact spot, at that exact moment, when it could have been someone else? or when he could have been somewhere else? and why is it that there are people who have had far worse accident scenarios who come out literally without a scratch?

can medicine really claim credit when a patient’s life is prolonged or saved? can we really say we knew what to do and we did it well, thus preventing death? or can we really blame stupid or slow doctors and nurses, lack of modern technology, lousy lab technicians for losing a loved a one?

these thoughts maybe be totally senseless to others, but these ideas boggle my idle mind. it is never pleasant to contemplate about anything death related, but death is one of those things that won’t go away even if ignored. the gloomy weather seems to magnify gloomy thoughts, but that experience the other night just automatically refreshed these repressed questions.

am i all alone in thinking these thoughts?
do you ever pause and ask these kinds of questions?
if you do, what are YOUR thoughts?…

March 20, 2007, 8:56 am

the happy dance

we looked silly but we did do the happy dance.

our little guy’s renogram turned out okay. he still has hydronephrosis on his left kidney, but hearing the words “he will not need surgery at this time” is more than enough to make us dance, even if we are clueless about dancing. it is a drag that his ultrasound is back to its previous schedule of every six months again, but i’ll  gladly take that than any surgery, at any given day. also, it didn’t matter to me that his urologist is not a people person. yesterday, what mattered to me was that she was the bearer of good news.

to ALL of you who sent good thoughts and prayers…THANK YOU VERY MUCH! we obviously rocked the gates of heaven, and i want you to know i really appreciate your kindness. you may not know me personally, but i feel like i know you all in some way. again, THANK YOU!

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now, on to something else…your response to my question in my previous post was reassuring. i am relieved to hear that i am not alone in in my thinking. from the patients’ point of view, and from the healthcare team, it is undeniable that the wanted family’s presence is a plus. thank you all for your inputs.

speaking of wanted… like a major coincidence, the wife of my patient the other night freaked me out. i did not meet her, but the notes of the social worker, and the accounts of witnesses were enough to make me think that she was reaidng my blog and was out there to act as exhibit A. you know, the family member who is NOT WANTED at the bedside and should be escorted out of the room ASAP? she was that family! if she was not consciously doing that, what would i make of this harsh words she lashed out on her husband?

“you are f#*ng useless. i don’t even know why i am still married to you! four years of this and you are still alive? why? why are you still alive? you make me sick! why don’t you just die? you used to look good you know, now look at you! you are a f#*ng pain!”

read that in bold, capitalized letters, at the maximum volume a human voice can muster. in a circular unit where everybody can hear everybody, you get the idea. it was ugly. my patient, a really skinny man in his early forties was speechless. i can imagine him holding on to his ileostomy, wobbling on his bony legs, shaking. the effects of chemotherapy seriously overwhelmed his once healthy body. but was it his fault he was diagnosed with rectal cancer? and was it his fault that after four years of what seems like a futile battle, he is still hanging in there?

if i was there when it happened, i would literally drag the big mouthed wife out of my patient’s room. well, not literally, but you know what i mean. she was the epitome of an unwanted family. she should not be allowed at the bedside, at any time. as expected, authorities were called, and the verbally and emotionally abusive woman was indeed escorted out of the unit as soon as possible. not only that, my patient finally decided that he did not want her to make any health care decisions for him anymore. no, not DNR. it could just be in the spirit of revenge, but yes, he wants “EVERYTHING DONE”. chest compressions, tubes all over his already tube congested little body, all that medicine and science can offer, the works.

isn’t it amazing? awakening still happens. even when we are at our sickest state.

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now, on to more things…

i am flattered by the tag/award from dr. anonymous. to be honest, i never thought the popular doctor even reads my blog. it made me wonder: what are his thoughts when he sees my blog?  i hope not this: “what is this woman senselessly blabbing about, what a waste of blogosphere space!” kidding aside, i hope this little blog does make people think good thoughts. after all that is one of the main reasons why i blog. to make sense of things. and also, to find humor from things.

big thank you dr. A!  i apologize if i break the meme, it is not possible for me to pick only five bloggers to give the tag/award to. A LOT of bloggers make me think. it would be unfair to leave someone out, but it would be tacky to break the tagging rules too.

March 16, 2007, 12:17 am

should a patient’s family stay at bedside?

if i am in the hospital as a patient, and i want somebody to stay at my bedside, that somebody should stay because…

…when i am not feeling well, i want somebody who cares about me to be there.
…when i am scared, i want somebody who understands my fears to be there.
…when i feel like everybody’s ignoring me, i want somebody to give me attention.
…when i feel doubtful, i want somebody who really knows me to reassure me.
…when i’m tired and weary, i want somebody to hold my hands.

i am not an attention junkie who behaves like the earth will stop moving if i don’t get noticed, but i do feel very vulnerable and needy when i am sick. anything that threatens my health distracts my sensible thoughts and makes me fearful about the future of the people i love.

i don’t mind being invisible when i am feeling all great and healthy, but…

when i am lying in a hospital bed… 
     throwing my guts out like crazy,
     or after an 8 hour complicated surgery,
     or bleeding,
     or having a heart attack,
     or coughing out my lungs,
     or waiting for major test results…

would it be too much to ask that i have somebody there to let me know i am not alone?

i don’t think it is too much.

that’s why i don’t mind wanted families to stay at bedside. if the patient wants them there, and they want to be there, i want them to be there. if their presence eases the pain, either physical or emotional, that patients commonly experience in the hospital, i want their presence there.

i may be able to do something to help a patient, but let’s get it straight. whatever good i do, pales in comparison to what a needed and wanted family member does to the patient’s spirit. if somebody’s presence positively affects a patient’s condition, how can that person be a nuisance?

the family members who create tension and cause the patient’s anxiety level to shoot up is a different topic altogether. they should be escorted out of the room as soon as they get in.

i could go on and on and on elaborating on the pros of having a wanted family member stay at bedside, but that would eventually get boring, so i’ll stop. i’ll just end this by saying… curmudgeon, your long suffering spouse did an awesome job for being there for you. she, and the likes of her are always welcome at the bedside. always.

i know there are nurses who don’t agree with my opinion. care to share your thoughts? i’m curious…