I just returned from a week long vacation to Lake Tahoe, California where we stayed in a condo for two nights, and from there camped in Yosemite National Park, California for three nights. It was amazing. Everything was beautiful, and it was wonderful to get away. While there I discovered something about myself: I think a lot. Sounds weird, right? I found myself starring off into space or at the awesome scenery more than I was having conversations with the four other people I was with.
I do this because I feel peaceful. I am happy with my life, where I am, who I'm with, and where I hope to go. I am blessed with more love in my life than I thought any person could be, and I realized that even more this week. Something being a nurse has taught me is it is far better to listen than to speak. Just by being silent, watching, laying a hand on your patient, you learn so much more than my speaking. Daily I apply what I learned at the hospital to my life at home, and it goes both ways. By listening to what is not being said, by reading a person's expressions, by looking in their eyes to see if the light is present, you learn much more than by having a casual conversation.
When people come to the hospital they become so vulnerable. They are in a new surrounding with people and machines they are unfamiliar with. We bust into their rooms, expect them to undress in front of us, and forget they have insecurities and deserve privacy. I use the term "we" loosely because I try my best to offer as much privacy as possible. I knock and wait before I enter a room, peak around the corner and ask "Are you decent?". As nurses we forget that we are familiar with the surroundings of the hospital, it becomes like a second home to us where we know the location of important items, and we know what each piece of machinery and what each beep and light means. Remember to speak softly, explain each step of each procedure or medication, make sure all questions are addressed and answered, and listen ten times more than you speak.
Sunday, August 30, 2009
Wednesday, August 19, 2009
As hard as I try to never think about work at home, I often find myself daydreaming about things that have happened at work. If I'm lucky, I share my humorous stories with friends, we have a laugh, and we move on. If it's been a particularly difficult day, however, I often have trouble falling asleep or my dreams are filled with events from the day.
Today, for whatever reason, I couldn't stop thinking about one women I took care of over two months ago. I don't remember age, but she was probably in her early forties, and had fallen out of bed at home while her caregiver was asleep. Other than being mentally delayed she had never had significant health problems up to this point.
The previous night I had left work knowing that when I returned the following morning there would be a new admission in the room for me to care for. I arrived to work at 6:45am and started report with the oncoming nurse at 7:10am. As we're standing at the chart and checking medications, I'm listening to what happened to this poor women and it sounds like something that could happen in a third world country, not in North Carolina.
She had fallen out of bed at home five days earlier, been admitted to a small community hospital about an hour north, and upon admission she had a completely broken tibia and fibula. The night nurse giving me report said that upon arriving to the room at our hospital her vitals were elevated, she had an intractable temp of 103, and her left leg was at a ninety degree angle to her knee. Within minutes of her admission our Orthopoedic docs had placed and plastered her leg, and were rightly disgusted at the other hospital's negligence.
Peering into the room I saw a trainwreck. She was on a cardiac monitor, 4 liters of oxygen, continuous pulse oximetry, an IV drip, her heart rate was 130, her respirations were 45 per minute,and suction was set up at her bedside. Her most recent temperature at 0700 was 38.5 C axillary which translates to 39.5 and is lethal if not treated promptly. This poor women had acquired a raging infection from lack of care, and she was now fighing for her life. Her docs were aware of the situation, but all we could do was watch and wait. For the next three hours I spend mere seconds with my other patients, and was in this women's room the rest of the time. I had been administering rectal tylenol and motrin alternately as well as packing her with ice, but nothing would take.
I had notified my charge nurse of the situation, and we were both calling the docs to suggest moving her to the MICU. As I was preparing another Tylenol suppository her sister came out of the room and said " I don't think she's breathing as fast as she was, and this monitor is making a funny noise." At this point I'm thinking that this is good, her heartrate is in the 70's now, she's breathing at about 12 respirations per minute, and when I check her temp, it's 37.0 axillary. Just as I'm starting to have hope, I realize she's not breathing, and now her heartrate is in the 40's. Obviously things were not going well. I called a code blue, everybody rushed to the room, and immediately chest compressions were started.
After coding her for 45 minutes and finding a pulse for a few seconds we sent her to the CCU. When I walked down to the floor she was now on, her room was crowded and they were coding her a second time. She didn't make it.
Why did I choose to post such a long story? Why does it matter? It matters because I could never shake the feeling that this women's life could have been drastically different had the docs at her previous hospital stepped up and taken care of her leg. She should have been in the OR the same day she arrived to their hospital. She shouldn't have suffered, and she shouldn't have died, not like that. I was angry the rest of the day, couldn't focus, and even now as I'm typing this, all the memories come back. I decided that the only way I can have an impact from here on is to learn from the experience, and advocate more for my patients. If one med isn't working, let's try another, and quickly. If a patient is decompensating, let's send her to the MICU now, and not wait. Unfortunately I don't have much pull in those situations. All I can do is keep going down the chain of command until I get someone to listen to me, and more often than not that takes too long, and we've lost precious time.
With the bad comes the good, and I have had so many wonderful experiences since that day. There are always those patients that stay with you, and change your title from caregiver to advocate.
Today, for whatever reason, I couldn't stop thinking about one women I took care of over two months ago. I don't remember age, but she was probably in her early forties, and had fallen out of bed at home while her caregiver was asleep. Other than being mentally delayed she had never had significant health problems up to this point.
The previous night I had left work knowing that when I returned the following morning there would be a new admission in the room for me to care for. I arrived to work at 6:45am and started report with the oncoming nurse at 7:10am. As we're standing at the chart and checking medications, I'm listening to what happened to this poor women and it sounds like something that could happen in a third world country, not in North Carolina.
She had fallen out of bed at home five days earlier, been admitted to a small community hospital about an hour north, and upon admission she had a completely broken tibia and fibula. The night nurse giving me report said that upon arriving to the room at our hospital her vitals were elevated, she had an intractable temp of 103, and her left leg was at a ninety degree angle to her knee. Within minutes of her admission our Orthopoedic docs had placed and plastered her leg, and were rightly disgusted at the other hospital's negligence.
Peering into the room I saw a trainwreck. She was on a cardiac monitor, 4 liters of oxygen, continuous pulse oximetry, an IV drip, her heart rate was 130, her respirations were 45 per minute,and suction was set up at her bedside. Her most recent temperature at 0700 was 38.5 C axillary which translates to 39.5 and is lethal if not treated promptly. This poor women had acquired a raging infection from lack of care, and she was now fighing for her life. Her docs were aware of the situation, but all we could do was watch and wait. For the next three hours I spend mere seconds with my other patients, and was in this women's room the rest of the time. I had been administering rectal tylenol and motrin alternately as well as packing her with ice, but nothing would take.
I had notified my charge nurse of the situation, and we were both calling the docs to suggest moving her to the MICU. As I was preparing another Tylenol suppository her sister came out of the room and said " I don't think she's breathing as fast as she was, and this monitor is making a funny noise." At this point I'm thinking that this is good, her heartrate is in the 70's now, she's breathing at about 12 respirations per minute, and when I check her temp, it's 37.0 axillary. Just as I'm starting to have hope, I realize she's not breathing, and now her heartrate is in the 40's. Obviously things were not going well. I called a code blue, everybody rushed to the room, and immediately chest compressions were started.
After coding her for 45 minutes and finding a pulse for a few seconds we sent her to the CCU. When I walked down to the floor she was now on, her room was crowded and they were coding her a second time. She didn't make it.
Why did I choose to post such a long story? Why does it matter? It matters because I could never shake the feeling that this women's life could have been drastically different had the docs at her previous hospital stepped up and taken care of her leg. She should have been in the OR the same day she arrived to their hospital. She shouldn't have suffered, and she shouldn't have died, not like that. I was angry the rest of the day, couldn't focus, and even now as I'm typing this, all the memories come back. I decided that the only way I can have an impact from here on is to learn from the experience, and advocate more for my patients. If one med isn't working, let's try another, and quickly. If a patient is decompensating, let's send her to the MICU now, and not wait. Unfortunately I don't have much pull in those situations. All I can do is keep going down the chain of command until I get someone to listen to me, and more often than not that takes too long, and we've lost precious time.
With the bad comes the good, and I have had so many wonderful experiences since that day. There are always those patients that stay with you, and change your title from caregiver to advocate.
I'll be taking care of you today.
Becoming a nurse was never truly a choice, but an inborn need to help people return to a normal life, or cope with the new life they must accept. I make it a point to find humor in the most awkward of situations, and to find peace when everything is falling apart. In this blog you will find stories of patients who touched me with their kind words, their acceptance of a terminal illness, humorous moments, and examples of how the human condition unites families.
While some posts may be sad, some frustrating, and some hilarious, others will simply be what the title suggests. They will be tales from the bedside of those people I have cared for. True identities will never be used, but diagnoses, symptoms, treatments, and my role in their care will be honest and factual. My goal for this blog is for readers to enjoy learning and understanding what being an RN is all about. I hope that the reasons I love my job will pour out of the stories, and no person will walk away from their screen feeling empty, but thankful for the life they have.
While some posts may be sad, some frustrating, and some hilarious, others will simply be what the title suggests. They will be tales from the bedside of those people I have cared for. True identities will never be used, but diagnoses, symptoms, treatments, and my role in their care will be honest and factual. My goal for this blog is for readers to enjoy learning and understanding what being an RN is all about. I hope that the reasons I love my job will pour out of the stories, and no person will walk away from their screen feeling empty, but thankful for the life they have.
Subscribe to:
Posts (Atom)
