April, 2007 Archive

i know he has AIDS. i know, for a fact, that he is dying.

i also know this sounds totally cold, but you know what, i just don’t care anymore. i treated him with respect. i looked past the truth that he got the virus out of abusing IV drugs. he was my patient, and he needed my help. he didn’t have a long time to live, but i was optimistic i can make a difference, even a tiny one.

well, me and my grand ideas!

for the past three weeks or so, every nurse who has taken care of him warned me about his attitude. they used every sort of word to prepare me. obnoxious, stubborn, hard headed, manipulative, condescending. hard as it was, i tried to erase all the images and started on a clean slate.

he has every right to be angry, i told myself. of course he hates life and everything in it. i mean, why wouldn’t he? he is only in his 30s. he is supposed to be at a point in his life when he is starting to enjoy it, but he’s not. instead, he is starting to lose it. it may have been because of some stupid mistakes with those infected needles, but still, who doesn’t make stupid mistakes?

when i went to meet him for the first time, i was planning on making his life less miserable. his last weeks or months shouldn’t be the worst time. i will try, and with my so called warmth, i will make him smile, or at least, i will make him more cooperative.

surprise, surprise! i failed. and i failed big time.
he refused or took meds depending on his moods. he changed his IVF rate, turned it off just because he knew better, and because he knew how to deactivate the lockout system. 
he argued about the time of his pain medication and denied i have given him any.
he called often, to remind me i was lying to him about his pain meds. he criticized me for not knowing how to do even the simplest things like taping his IV tubings.
he was not happy with this, he was dissatisfied with that. 
nothing was right. 

to him, everything i did was wrong. every nurse he met was either lazy or stupid. to him, all the doctors were against him and do not have any idea what they were doing. he is dying because we are not doing what we were supposed to do. on and on and on, it dragged for two nights, and yes, i admit, it unnerved me. it pushed me to the edge.

after three nights off, i went back to work expecting he was transferred, but he was still there. and as luck would have it, not only was he still there, he was my patient again. he just had a bronchoscopy and it was quite difficult to wake him up after they have given him some serious sedatives. i hoped the power of versed combined with dilaudid would last the whole night, but it didn’t.

after about two hours, he was half awake. when i got to his room, he was tyring to put his shoes on. with the calmest voice i can muster, i explained why he shouldn’t go off the unit. not only that he was being monitored, and was hypotensive, but he was obviously still very unsteady. “you are clueless about what i want to eat, so you can’t stop me from going to the cafeteria”, he said. it would have been easier if that was the truth, but the truth was, he wanted to sneak out to smoke, as he had been doing in the past, despite every imaginable reason why he shouldn’t be sneaking out.

“i know i can’t force you to stay, but i hope you realize that what you want to do is unsafe and i do not want you to go”, i told him.

“well, i am going anyway. watch me.”

he was a little wobbly with his first steps, but i didn’t help him, and i didn’t flinch. not only that i didn’t approve of him going off the unit, i was hoping he will listen when he found out he was not that ready to walk alone yet. he was determined, and smugly showed it. i could have repeated my explanations for the nth time, so he will stay, but i didn’t. instead, i walked away. then, i sort of washed my hands and told the charge nurse i’ve had enough. fortunately, she handled it very professionally, and ended up sending our very busy patient care assistant to go with him off the unit after negotiating that he go in a wheelchair.

after that, all my resolves to make a difference flew out of the window. for the next hours, and the night after that, i was so disgusted with him i offered him nothing. no empathy. not even sympathy. not even when he was crying.

i was helping him put his legs up the bed and he started crying about his swollen body being “full of toxins, and all the doctors doing nothing about it.” in between sobs, he was still bashing the doctors and the nurses, it was unbvelievable. without making eye contact i asked him if there was still something i can do to help him. he was a llittle short of breath, but it didn’t stop him from being opinionated. when he started again, he picked up from how the doctors are never doing what they were supposed to do, to how the AM RN didn’t pay any attention to him. apathetically, i left the room while he was still going on and on and on blaming everyone about his miserable life. well, everyone else except himself anyway.

i left him crying, and i offered him nothing. no little touch on the shoulder to let him know i feel his pain. no look of understanding to let him know someone was there for him. none of those. all i offered him was a meaningless stare, which i selfishly thought he fully deserved. i was so cold, i could have left him frozen.

i didn’t plan it, but it turned out, it was not that hard to act like a robot. you know, i was there giving him water, emptying his urinal, changing his sweaty gown, cleaning up his vomit. i was there, but was not really there. listening to him complain about everything made me realize it was impossible to make a difference in his life, and he made me sick. 

i know this may sound inhuman or something, but really, while i was taking care of him, i was in such a state of mind or emotion wherein if he dropped dead right there in front of me, i probably wouldn’t care. i lost even the slightest ability to care, and the whole thing just saddens me, that realizing it made me sick of myself.

why can’t i be more compassionate? what does it take to be more patient? what do i do to be more understanding?

should i just shrug my shoulders and say “well, he wants to be miserable, that’s his choice, not mine” and look away? is it justifiable to be cold and unfeeling towards a person who seemingly gloats in the idea of demeaning other people because they are helpless about their own situation?

i don’t know. i just know that’s what i did. at that time, nothing else felt more appropriate. i rationalized over and over that i was only giving him what he was asking for, and that it was right. yet, after everything has been left unsaid and undone, why does everything feel so wrong?

maybe because it is.
maybe because being coldhearted is always wrong.
and i was coldhearted, and i was wrong.

the result of last year’s surveys is in and it is not good.

the patient satisfaction survey:

we scored high on loyalty, but low on satisfaction. according to Nurse Manager (NM), the Gallup poll finds this result very unique in our hospital. usually, this two are directly proportional. why is it that our patients (at least this particular group of population polled) are not happy with our service, but they will keep or have kept coming back to us?

we don’t know, so it is a waste of time to discuss why the contradiction. for all we know, they might be a group of masochistic people who thrive on being unhappy. the list of possible explanations are endless, but they are all assumptions, because the truth is, we don’t really know.

we moved on and focused on something we know: why they are unhappy. well, guess what? it’s OUR fault. by “our” i mean the staff nurses. you see, ”we don’t take time to dialogue with them. they know that the unit is busy, they know that we are always busy, and they don’t expect us to hold their hands and sit on their beds for 20 minutes, they just want to know what is going on and not feel ignored. it is not that we lack the staff, it is the fact that we don’t manage our time wisely so we can spend quality time with our patients.”

i completely agree. so i packed my big mouth with cotton balls and kept quiet.

the employee satisfaction survey:

our lowest score is the “my opinion counts” item. this means that most of the employees answered “strongly disagree” to this statement. “do you have anything to say about this, so we can improve in this area?”, NM asked.

surprisingly, everybody seemed to have lost any sense of opinion after hearing this question. like me, you must either be wondering why, or you must have known why all along.

anyway, this is why it took a lot of energy for me not to speak out. there were a lot of other stuff that sort of irked me, especially all those tidbits related to our JCAHO (which by the way, wants to be called THE Joint Commission now) preparations, but i don’t really want this post to be THAT boringly long, so i just ranted on the main issues. believe me, i didn’t mean to be sarcastic (well, maybe i did. a little bit), but do we really have to own all of the blame?

i mean i do agree with NM about spending quality time with our patients and keeping them informed about everything so they won’t feel left out with their plan of care, thus, decreasing their anxiety of the unknown. i totally get that, but to completely negate the issue that we lack the manpower to deliver the goods is just plain unfair. after all, the patients also feel ignored, and therefore unhappy and therefore unsatisfied when they press the call light and nobody comes to ask them why the light is on in a matter of seconds or minutes.

one staff attempted to voice out an example by describing a very common situation:
if you have patient A that needs to be helped to a bedpan, and she pressed the call light while you are in a middle of cleaning patient B, who just threw up all over himself; you hear the call light go off, but you don’t answer it right away because you are in the middle of something. you finally finish cleaning patient B, and went to get him a cup of ice water and extra blanket he requested, all the while, patient A’s bladder is busting.

will patient A be satisfied with your service? well, you guessed right, because an unhappy bursting bladder is an unhappy patient. will patient B be happy? i assume he will. the point is, we can’t satisfy just one patient and dissatisfy another. the thing is, to satisfy them both would have been a breeze if there was an extra pair of hands who would have helped patient A to the bedpan. plain and simple. this is not the exact example, but you get the drift.

i said attempted because this whole scenario was not really laid out, as most of the staff knew (as the poll so well revealed), “my opinion does not count”. so we ended up hearing a starting line, (”the problem is, when we are in the middle of something and another patient needs something…”) then a pause, then a sigh, then silence. 

then, in the middle of deafening silence, we heard  NM say “we have to step up and do the little things, our patients deserve to be satisfied or we will lose them, and we will end up suffering the repercussions if we have a low patient census.” the staff looked at each other with a sense of defeat. end of discussion.

tell me, what else can we say to that? nothing. so we gobbled the strawberry shortcake and stuffed our face with more whipped cream.

don’t get me wrong, i don’t consider NM as my enemy. i am just so frustrated about the fact that we don’t have a PCA (patient care assistant) when our patient census is 21 and below, and more frustrated that no matter how everyone agrees to this PCA frustration, our request is simply overruled and ignored. another frustrating thing is the fact that other units in the hospital do not suffer the lack of PCA. for the record, i respect NM because i still want to remain naive and not believe the insinuations, so let’s not even go there.

i just feel like there is nothing i can do to make her realize i am doing my best considering the circumstances. and yes, i feel very strongly about this because i, and most of the RNs in our unit do try our best to provide the best, satisfying nursing care.

i don’t expect her to give me an award for redefining multitasking to my patient’s advantage, and my occasional disadvantage. i just want her to acknowledge the fact that i am trying. i will boldly assume that all the staff shares this sentiment when we all looked at each other like little battered, shivering chicks while NM sort of implied that we simply didn’t care. period. that implication hurts.

at the of the day, after a time of reflection, i can say it all boils down to the bottom line: i am just this needy, attention hungry person who wants to be appreciated for my efforts. i am also this insecure person who analyzes a superior’s unspoken words to further my self depreciation theories. i know that now, and i am embarassed. growth is painful, but i will embrace it.

that’s why i will keep attending staff meetings. it may not mean things are gonna be different, but at least i learn something about myself everytime. who knows, this small self discoveries might lead me to my ultimate goal of self actualization in the future.

and between you and me, being paid overtime rate for 2 hours while practicing self restraint that might eventually lead to better character building is not really a bad thing.

on the side, i get to see coworkers not wearing their usual betty boop scrubs (which is always fascinating), and i get to eat highly fattening delicious foods, (which is always a welcome guilty pleasure).

and, the best thing is, the pay is equivalent to about 4 trips to the nail spa. and, let’s face it, a french pedicure makes every girl’s toes look absolutely gorgeous.
and, for a working mom, a sea salt foot massage is always like a breath of really fresh air.

who doesn’t want all that?

i have an opinion about everything. i know my opinions are not sensical all the time, so there are a lot of times when my opinions are never heard, because  i keep it all inside my big mouth, unspoken.

do you find it easy to keep your mouth shut? you do? you mean i am all alone in this? you mean you don’t find it very hard to keep your mouth shut even if the topic being discussed is something you feel very strongly about?

i better get some training from you guys, because honestly, i find it extremely difficult to keep my mouth shut, especially if i feel very strongly about something. fortunately, no matter how difficult, i also think i do know when to zip it. well, okay, sometimes i don’t.

this is not some magical moment of self discovery, but i am learning. i know that there are times when the smartest thing to do is to keep one’s mouth shut. that being said, i am very proud to announce that yesterday was one of those days for me. it just goes to show that growing older does make one become wiser. how is that for self enlightenment?

how i managed to sit through a 2 hour staff meeting without acting all opinionated was almost unbelievable, but it did happen and i have about 20 witnesses to prove it.

i am going to work again tonight. needless to say, you will be spared the boring details. for now.

however, i don’t call blogging therapeutic for nothing.

tomorrow, you will hear about how i became the smartest woman who ever attended a staff meeting. and more. not that you should be excited, but still. you think you can stop me? well, not technically, but feel free to shut me up.

“nurse managers get incentives for tweaking with the budget. the more money they save, in whatever way, will mean more incentive.”

what does that mean?

“that means they are being rewarded for saving money, and often times, staffing is where they earn the big bucks.”

what does that mean?

“it means it is not always because a unit or a department is losing money that they are cutting on the number of staff.”

you’re kidding, right?

“no, i’m serious. it is a well kept, but well known secret among managers. it is all sorts of different things. bonus, holidays, points, you name it.”

does this happen in all hospitals?

“i don’t have a proof, but everybody knows it is pretty much the truth.”

even in christian hospitals?

“please. what’s the difference? incentives are incentives are incentives.”

you mean, it could even be happening in OUR unit?

“i am pretty sure it is happening. it’s all about the money honey.”

you mean it doesn’t matter that the staff is affected and that patient care is jeopardized….

“sweetie, you are so naive.”

okay, stop.

_________________

any of you know if this is absolutely true in ALL hospitals?
please say it isn’t. please tell me this is just a bad joke.
because it’s not funny.
because i feel like throwing up.

me and my idealistic stupid ideas!