February, 2008 Archive

the intent of this post is to whine. big time.
if whining is not your kind of thing, you’ve been warned. 
if you think i am whining because i hate my job, you are wrong.
i don’t whine everyday. 
i just have to get it off my chest.
sometimes.

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the other night, i worked my butt off to the point where i was so tired, the idea of lying on the hospital floor to sleep, crossed my mind about a hundred times.

it wasn’t the kind of tired where i huffed or puffed here and there because my patients were getting sicker, but it was the kind of tired that physically and emotionally drained me. i maybe criticized for being really honest here, but there were a lot of instances when i thought and felt like i was faking being a professional, because the better word to describe what i was doing was being a SLAVE. i wound be emptying a bedpan, and inside the restroom, i would see my reflection on the mirror and feel so sorry for myself, i felt like a major loser.

i am perfectly aware that my job is to make my patients feel comfortable. i am not complaining because i am this stupid girl who didn’t know what i got into when i got into it. at work, there is nothing i want more but to make my patients feel that they are being cared for. it may sound so cliche, but i do want to make a diference in my patient’s lives by making their hospital stay least distressful.

but sometimes, certain unpredictable situations blur my ideals. the other night was one of those blurry nights. i felt used and abused. believe me, to set the record, i don’t take any of it against the patients at all. it was just a case of an imperfect list combination. i had to tell the charge nurse to break my list for the next shift because i could not bear to picture the AM nurse going through what i went through that night.

patient A was our 589 pounds male who had multiple wounds on his buttocks and was having severe diarrhea. i started the shift cleaning him. since everybody was busy, and i can’t wait to clean him, i tried the routine of pushing his leg to the other side to help him turn. i felt or maybe imagined my lower back made that little crackly sound when it is strained. he pooped four times, making me change his dressing twice, which each time, takes about 20-30 minutes.

patient B was a 400 plus pounds lady who was having asthma exacerbation, and for some reason, had the urge to pee every two hours or so. both her feet were bothering her, and she was not very stable. i would help her to the commode, clean her, and help her back to bed.

patient C was a two post C-section young woman who developed DVT and just had a filter placed. scared to move and just about everything going on, she was calling every 15 minutes, literally. i had to assist her pump her very uncomfortable engorged breast every 3 hours, i had to put her on a bed pan very often. her temperature was off the roof and she would be very cold one minute and be very warm the next. a number of times, i was called to either add or take off a blanket, change her gown, wipe her sweat, chnage her sheets.

the whole night, i was practically helping one of my patients, that the only time i get to catch my breath was when i would chart and get pain medications that they all want on a regular basis.

on the verge of tears, relieved that the shift was over, i talked to the morning charge nurse that i cannot have the same list when i go back the next night. i told him that it was not because it was a hard list, it was just a bad combination. what i didn’t tell him was that on top of being so exhausted, i have also worn myself out emotionally, by getting very invoved with my patients’ specific situations.

while dressing patient’s A’s wound, i would stop and feel so bad about how his young life is almost nonexistent because of his weight. just barely out of his teens, but confined to a bed like that, unable to even reach his own penis to put it in the urinal because of the size of his thighs. i was disheartened to see him eating a hamburger obviously sneaked in by his mom even when they were strictly instructed he was not allowed to eat food from outside. as a person who is struggling to lose a tiny fraction of the weight he needs to lose, i can only imagine his desperation and i know exactly why he is almost giving up. but as a mother, i feel for his mom too. i mean, his poor mother was understandably unable to bear the fact that he was getting weak, since he didn’t like any of the hospital food and was just trying to survive on liquids. i knew she meant well. the whole thing was just so sad.

when patient C would start wheezing, i had to shake my head off to erase the scene i see in my head. i have asthma, and when i say i know exactly how scary and uncomfortable it is to have that attack that might be your last, i know exactly what i am talking about.

numerous times, patient C cried about the possiblity of dying, and her fear that her kids would grow up without their mom. sobbing, she would often talk about ” my little girl is lucky you know, at least she hasn’t really known me yet. how about my three year old? he has been asking…” since i have my own 5 and 3 year old boys, and also having experienced C-section twice, it is a given why i totally feel patient C’s fears and pains.

after talking to the morning charge nurse, all was set and i was ready to go, the morning nurse asked for help to set up the breast pump. i had to go to the room for the last time. patient C asked me if i was coming back. i knew where the conversation was going, but i cannot lie to her. she wanted me back.

the truth is, there was a part of me that wanted so badly to refuse her request. i was too drained and just cannot do it for another night. but, i didn’t have the heart to say no. thing was, patient B was her roomate, and if i take her back, i had to take them both. even when i knew it was the right thing, my heart was kind of heavy when i talked to the AM charge nurse again to chnage my request and just give me both patients B and C back. i felt guilty for leaving patient A out, but it was the best i can come up with.

last night was not as tiring because i only got patient C back. i didn’t get to talk to the AM charge nurse about his decision, but i was grateful. the only downside was that it was awkward to hear patient B indirectly making me feel guilty by saying stuff like “last night was better…” every time i was helping patient C.

the dramas of being a nurse!
this is why i have no time to watch soap.
my work makes me experience more drama than i can ever take.

sometimes. just sometimes.

i am mad and i want to blame somebody. or something.

i want to blame her.

why did she do this to herself? why start with something like Percocet and end up with the list of medications, mostly with sedative effects, beyond what is considerably normal? how can she fill up her mouth with doritos, wash it down with soda and eat more cookies and then complain she is extremely nauseated and demand the Phenergan with her Dilaudid?

her total PO doses DAILY: Ativan 4 mg. Dilaudid 48 mg. Zofran 12 mg. Phenergan 50 mg. Meclizine 100 mg. Zanaflex 32 mg. Benadryl 50 mg. she also gets a total of Dilaudid 4.5 mg IV and Zofran 12 mg IV prior to wound dressing changes.

imagine working seven nights straight and on the eighth day, you are not supposed to sleep the whole day because you still have to watch a sick, very irritable baby. that’s how she was everytime she was awake. fogged, drugged, mumbling, redundant. she can hardly keep her eyes open, and was always groggy, that seeing her surrounded with half a cookie hanging out her mouth was not unusual.

still, the few minutes that she was awake, all she talked about was how unfair and inhuman it was of the doctors to decrease the dose of her pain medication, and how stupid it was of them to switch the Dilaudid and the Phenergan to PO.

i want to shake and wake her up. because i think she is in trouble. and because i think her husband needs a wife who is not overtaken by the power of drugs. and because i think it is still the right time, that she can still get that help.
i want to blame the doctors.

why did they allow her to have that power? why didn’t they stand up and say the obvious? was it because it was easier to write that prescription than confront her with the reality that she can officially be called an addict and she needed to face her demons? was it really their concern for the patient’s pain that compelled them to continue increasing her pain meds dose till she got to this point when she constantly desired to live within that fog? or was it the opposite?

i want to blame the availability of resources/money and the system.

first of all, the reason why i have never seen somebody like this in a third world county like the philippines, is basically because nobody can afford it. here, i am so tired or feeling bad for these patients. they test my patience, they push me to the limits, yet, they break my heart. i had one patient burst into tears to me before. she confessed being addicted and without flinching, blamed the system. you know, how easy it is to get away with more more more. so much easier than admitting, or being told, that she needed rehabiliation, not for her constant pain, but for the high she seeked from the pain relievers.

i don’t know. i have thought of everything i can do to fix something like this. i always thought i can change even a little thing. i have seen so many people who never intended to be dependent on something, and i wish i can just take them out of it snap my fingers so they can start anew. it is getting so frustrating. and depressing.

the saddest part is, i know now that i can never help them.
that it’s just me and my wishful thinking.

i can’t even decide on who to blame.
what made me think i have what it takes to make a difference in these people’s lives?
it’s just an unfunny joke.
ALL of it.

they got a fancy looking trophy with their names and the name of the award on it. they got gift certificates to places that were honestly quite fancy. they were all so thrilled, i almost saw tears.

i was beaming with them, and i was happy that some people had the grateful spirit, and actually took it up a notch by taking time to nominate them for this new award our nurse manager decided we should be getting.

the mechanics of “the angel moment award” is quite simple. a person does something you feel is great, great enough to deserve your time, you get that form on top of the snack refrigerator, fill it up and explain why you feel that nominee should get the award. then, our nurse manager gets the form, buys the crystal looking trophy and have your name engraved on it. at the staff meeting, the story will be told, your award and gift certificate will be presented, everybody claps with matching oooohhhs and aaaaahhhhs, and you get to blush and say thank you.

i have said this before and will say this again. i am probably the only person who gets embarassed being given an award in public. don’t get me wrong, it made me feel warm all over that people actually nominated me to get the annual “a caring heart award” last year. it would have been more special if it came from the patients, but an award is an award, and if it is a fancy looking plaque with a beautifully written explanation of why i deserve to be acknowledged as someone who has a caring heart, i will gladly take it.

i didn’t attend the award ceremony, but my very sweet nurse manager told me that just like the rest of the awardees, i had a standing ovation. imagine that! i would have fainted right there. i requested her to give the award to me in private when she told me of her plan to present it at the staff meeting. i was so relieved she sensed the anxiety.

anyway, back to the new awards. as stupid as it may seem, after the high fives to the awardees, i started hoping that those people i help at work are those who do not really have time to write and nominate me for that award. i am not against recognition of good works, but i do honestly feel that most of the the times, a genuine word of thanks is more than enough.

i know.
it’s arrogant of me to expect that people will actually notice me for helping.
and it’s plain insecurity that i do not want the award.

what can i say?
if i am not ironic, i definitely am a  hypocrite.

we all rushed to room 5 when the patient’s nurse yelled for help. code was not called, but we were busy anyway. after awhile, she was stabilized. although her blood pressure was barely normal, she was okay.

when everything settled and we were in a contemplative mood, we realized we were all thinking the same thing.

R, the patient in room 5 had been sick for years. all sorts of things, all sorts of surgeries. over 200 hospital admissions that usually lasted a few weeks to a few months, her body had been battered. earlier that night, when the blood transfusion was about to be started, she complained of being “very tired”. not just physically, but about the whole sick-all-the-time thing. very tired, meaning she wanted to rest. in peace. literally.

she used to be DNR (do not resuscitate) but her husband probably convinced her to change that, because just a couple of days ago, her status was changed. we have taken care of R for years now that most of us know her and her husband like old friends. we all know it is him who cannot let go. it is him who is too scared to lose her.

all the nurses i know want to be DNR. some do not even want a day on the ventilator. some want a week to see, and then be unplugged. i am one of those who do not want anything, anytime. just let me go. the sooner, the better. there was a point in my life when i thought differently because i became a mom. i thought i cannot die before my kids grow up, they need me. then i realized how arrogant that thought was, so i am back to being sure i want to be full DNR. and for the record, i want everything usable to be harvested for donation. you are my witnesses, okay?

anyway, the fact that most if not all nurses want to be DNR proves a point. i know you already figured that point out, so i won’t bore you with an explanation.

we kept talking about our wishes. then, we sort of found a dilemma. we were very certain that our spouses, just like R’s husband would not want us to be DNR. we also figured out that we feel the same way about our spouses, that unless they have a terminal illness…”yeah, we want everything done!” and we probably won’t mind all the tubes. not on our kids, on our parents, on our spouses. it’s as if we want them to live forever.

what is it about us? we don’t want to prolong our lives, poked and exposed, surrounded by machines, with tubes in every part of our bodies. but we think differently when it comes to those we love? it’s almost a clear definition of selfishness, but somehow, it also appears like love.

advance directive seems to be the solution, but not so when it is an accident.

advance directive doesn’t really matter when it is an accident because even if i have it, i don’t carry it in my purse, and i’m sure worse comes to worst when my husband is stressed by it all, he might even deny he knows about the directive. and if that happens, i won’t even blame him. i am probably inclined to do the same if the situation is reversed.

and no, giving a parent/sibling the power of attorney is almost pointless when it’s an accident.  for sure, it will be the spouse who will be called first, granted the accident happens during those few times you are not with him/her.

when it comes to a code status, it’s easy to decide for myself, but to say it is extremely difficult to make a decision for those i love is an understatement. in 2001, when my mom coded, revived, and coded again, i was a wreck. i’m pretty sure that if on the second code she was revived again, i will not make her a DNR for a very long time. i probably would have sat there and wait for a miracle while the ventilator breathes for her.

how about you, do you want to be DNR?
if you do, do you feel exactly the same towards your loved ones?
if you feel exactly the same, how hard/easy was it for you to make that decision?
if you want ot be DNR but want your loved one to “live forever”, what is your “excuse”?