We have a patient on the floor, a social admit. Adorable. She’s completely independent, mobility-wise, and wanders the floor constantly, asking that her ever-present Styrofoam cup of prune juice to be reheated. She flirts with all the men, telling them they’re the spitting image of Clark Gable, sugar lips and all.
From the desk, I see her make her revolution around the unit. She pauses next to the room with the moaning confused man with a hip fracture. I see her raise her hand to the doorframe. She makes no move to go in or even peek. But her hand trembles and she’s obviously affected.
She continues on to the end of the hall, looks out the window at the pitiful view, then returns to the desk and asks me to heat up her prune juice. As far as I can tell, she doesn’t actually drink the stuff but promise her a new fresh cup and she beams.
She makes several rounds, pausing outside noisy rooms and staring out the windows at the end of the corridor. This time of year, the trees are naked and the sky is grumpy. She’s riveted though. She always comes back to the desk and chats with me. It’s the same short conversation throughout the night. She doesn’t feel like doing the dishes. Can they wait until the morning? She’s tired and wants to go to bed.
Despite her fatigue, she makes another rotation. Whenever one of our staff passes in her in the hall, they call out her name with a bright hello. She beams and tells them that they’re the spitting image of someone famous. I look like Ann Margaret. Preeti looks like Pocohantas and Aimee’s Linda Blair.
We talk about patients and quality of their life. This lovely special little old lady has been able to affect the quality of life of everyone on this unit. Talk about giving back. We’re blessed to be a way station on her journey.
Showing posts with label nursing. Show all posts
Showing posts with label nursing. Show all posts
Wednesday, March 14, 2012
Thursday, February 2, 2012
'Tis the Season
We are awash with new fractures, new nursing students and bad weather in this neck of the woods. My work days are long and busy.
There was a call in tonight so busy became frenetic. There were the usual culprits of laziness but I was amazed with one of the nurses.
Airyeal* is one of the younger staff members and has always given the impression of someone who doesn't really care about anything outside the scope of her own comfort/pleasure. Tonight though, she was incredible with one of the students. She spent her entire break showing the student the ins and outs of charting, how to find information in the computer and in the chart, and what particulars are important to know as a nurse.
It was awesome and set a really good example for the rest of the preceptors. Watching their interactions totally made my night.
There was a call in tonight so busy became frenetic. There were the usual culprits of laziness but I was amazed with one of the nurses.
Airyeal* is one of the younger staff members and has always given the impression of someone who doesn't really care about anything outside the scope of her own comfort/pleasure. Tonight though, she was incredible with one of the students. She spent her entire break showing the student the ins and outs of charting, how to find information in the computer and in the chart, and what particulars are important to know as a nurse.
It was awesome and set a really good example for the rest of the preceptors. Watching their interactions totally made my night.
Friday, January 13, 2012
Laziness and Loneliness
I'm lonely.
When I moved back from the west coast to my itty-bitty industrial town, my life changed completely. During the subsequent two years when my time was consumed with caring for my mother, my smart, stimulating and worldly friends across the continent dropped away. I just hadn't the time to nurture our relationships.
I'm trying to create new stimulating relationships but apparently I'm weird.
My nursing coworkers, the pinnacle of education in this working class town, are consumed entirely with creating and raising families, getting married or engaged. We're friendly enough at work but I so miss talking with people about things beyond our immediate sphere of family and work.
Those who read, read Twilight and the Hunger Games. They tease (not maliciously) me about the books that I bring in and I can't find any interest in the antics of Belle or Edward.
Growing up here, I was the lonely little girl in the tree with a book fantasizing about evading the trolls below. When I left at eighteen, I discovered a wonderful world full of fascinating curious people who read, traveled, explored cultures, food and art, fought for environmental preservation and human rights. They celebrated their own uniqueness and seemed to appreciate mine. I swore that I'd never return to this area.
Then dad got sick and mom got sick and I again was tethered.
I know that the end is in sight; I'll be leaving in a few months and re-entering a world of more curious people.
This last year has been brutal though. Those who have applied to medical school probably remember how demoralizing the process is. You basically rip your life and history apart, present the pieces to anonymous adcoms and wait for them to decide that you're lacking. With the deaths of my parents and my relocation thousands of miles and several time zones away from my friends, I lost all of my social and emotional support.
Every time that someone I work with asked why my applications were failing, I withered away a little more. Trying to explain the immense competition involved came across as just defensive and it showed in their expressions.
Emotionally, I'm hibernating now. The acceptance that I received validated me in a way that I could have never predicted. My intellectual loneliness isn't so severe now that I know that it's finite.
I don't feel defensive anymore when people insinuate that I'm lazy because I don't plan on working through medical school. I can just wait a few short, yet impossibly long, months and I'll be with folks who'll understand that I'm not lazy.
I'm grinning now in anticipation. I know that I'm leaving an intellectual desert to conquer an ocean of knowledge. It'll be hard, I know, but it'll never be as hard as the last few years of dehydration. It can't be.
When I moved back from the west coast to my itty-bitty industrial town, my life changed completely. During the subsequent two years when my time was consumed with caring for my mother, my smart, stimulating and worldly friends across the continent dropped away. I just hadn't the time to nurture our relationships.
I'm trying to create new stimulating relationships but apparently I'm weird.
My nursing coworkers, the pinnacle of education in this working class town, are consumed entirely with creating and raising families, getting married or engaged. We're friendly enough at work but I so miss talking with people about things beyond our immediate sphere of family and work.
Those who read, read Twilight and the Hunger Games. They tease (not maliciously) me about the books that I bring in and I can't find any interest in the antics of Belle or Edward.
Growing up here, I was the lonely little girl in the tree with a book fantasizing about evading the trolls below. When I left at eighteen, I discovered a wonderful world full of fascinating curious people who read, traveled, explored cultures, food and art, fought for environmental preservation and human rights. They celebrated their own uniqueness and seemed to appreciate mine. I swore that I'd never return to this area.
Then dad got sick and mom got sick and I again was tethered.
I know that the end is in sight; I'll be leaving in a few months and re-entering a world of more curious people.
This last year has been brutal though. Those who have applied to medical school probably remember how demoralizing the process is. You basically rip your life and history apart, present the pieces to anonymous adcoms and wait for them to decide that you're lacking. With the deaths of my parents and my relocation thousands of miles and several time zones away from my friends, I lost all of my social and emotional support.
Every time that someone I work with asked why my applications were failing, I withered away a little more. Trying to explain the immense competition involved came across as just defensive and it showed in their expressions.
Emotionally, I'm hibernating now. The acceptance that I received validated me in a way that I could have never predicted. My intellectual loneliness isn't so severe now that I know that it's finite.
I don't feel defensive anymore when people insinuate that I'm lazy because I don't plan on working through medical school. I can just wait a few short, yet impossibly long, months and I'll be with folks who'll understand that I'm not lazy.
I'm grinning now in anticipation. I know that I'm leaving an intellectual desert to conquer an ocean of knowledge. It'll be hard, I know, but it'll never be as hard as the last few years of dehydration. It can't be.
Sunday, January 8, 2012
Outrage
It was a busy crazy day at work. I’m usually the only one on the desk on evening shifts; the charge nurse takes a group of patients. This week, the patient who will not be named was here again so I worked with Charge in that room and managed the desk.
We’re implementing a new rounding system next month and so I was also responsible for logging all patient call bell requests in preparation for the new protocol.
There was a water line rupture in the unit next to ours and the shut-off affected some of our patient rooms, public bathrooms and other facilities. I needed to contact Engineering, itemize the affected plumbing, and make other arrangements for patients and staff.
We also had a stroke response on one of our post-ops. I had to monitor the call, STAT orders, arrange for CT, and, afterwards, restock the crash cart. The house staff was going to send the patient to telemetry and I arranged the transfer between the units.
In the meantime, we received 2 contact precaution admissions from the ED and, with no available isolation rooms, I had to rearrange the already admitted patients, inform the nursing staff, direct the aides, contact housekeeping to clean the rooms and then admissions to confirm the computer transfers.
While the stroke response was occurring, the nursing supervisor arranged for a transfer of someone already downgraded to medical from telemetry to make room for our unfortunate patient.
It soon became apparent that our patient belonged in intensive care and not tele. I began those arrangements.
Despite the alleviation of urgency, the other unit decided to send up the transfer, walking! before we were ready. I scrambled to find somewhere for her while her room was prepared. Argh! Her meds hadn’t been hung and she was due for pain medicine so she complained the entire time while I tried to juggle everything. Her new nurse was still dealing with the stroke situation.
Finally things settled a bit and, ten minutes before shift change, the supervisor called about a non-urgent transfer from intensive care. “ICU only has two patients, can this wait until morning?” “No, this patient needs to start PT first thing in the am.” “Sigh, alright.” I HATE moving patients around at 11 pm. I think it’s hard enough for them to get sleep without the jostling and noise from rolling squeaking beds and housekeeping carts. But I took down the details, another iso-room needed! and began rearranging our patients.
The aides grumbled but they moved the patients. The call bell system erupted from all the newly awake patients. “I have to use the bathroom.” “Am I due for pain medicine?” “Will you call my family to let them know about the change?” etc..
11:10 One of the nurses from ICU called to give report. I told her that we weren’t ready yet. Our nurses were just starting report themselves.
“NO! I need to give report NOW.”
“Um. No you don’t. It’s a non-urgent transfer and I know that your shift isn’t over until 0700”
“We’re just starting an in-service. I want to give report before it starts. I won’t send the patient up for a while.” Sigh.
“Jackie would you mind taking report now? She’s insisting.” I rolled my eyes and handed the phone to an incredibly patient nurse. Jackie gets report and says that the patient’ll be up between 12 and 12:30.
11:15pm. I track down the housekeeper just before he finishes his shift and beg him to clean the room for our transfer.
11:17 ICU nurse calls with update on the transfer patient. I tell her that the nurses are in report and that Jackie will call back when she’s ready.
11:19 Housekeeping is still in the room cleaning. The elevator door opens and our patient steps off, white knuckles grasping his walker and the aide carrying his belongings. !!!!
“The room’s not ready! Why are you here!”
“Oh. I just came on. They told me to bring him up.”
“You have to go back down. We’re not ready.”
“I can’t go back down; They already stripped his bed, we don’t have anywhere to put him”
Seriously? I lead them down to the room and pull a chair out into the hall for the patient.
Following the aide back, I laid into her.
“We told you folks several times that we weren’t ready! This is inexcusable. You didn’t even bring him up in a wheelchair!”
“I’m sorry, I just came on. I’m just doing what they told me to.”
Sigh.
“I know that it’s not your fault but this is ridiculous!” Grumble Grumble.
The aide leaves and I go back to the room to get the patient settled in. When I come out, the nurse from ICU is yelling at Jackie.
“How dare you yell at my aide! Blah blah blah, miscommunication that’s all your fault.. blah blah blah..”
I could feel the hackles grow across my shoulders like the hump of a grizzly bear. I’m outraged and start to jump in but a nurse grabs my arm and I pause. Jackie diffuses the confrontation by apologizing and the ICU nurse righteously storms off.
I’m told that the ICU nurse is something of a barracuda, is always right and never lets things go. After she leaves, the nurses gather and complain about her unjustified behavior and how awful she is.
It’s now five days later and I’m still stewing over the situation. It makes me so mad when people like that ICU nurse get away with laziness, superiority, inconsideration and recklessness because people are afraid to call them on their crap.
In hindsight, I know that if I had gotten involved, the confrontation would have escalated. It wouldn’t have been fair to the night crew to spark it and then leave when my shift was over.
But I HATE that someone else gave an apology for my behavior. If my behavior calls for an apology, I want, I NEED, to be the one to offer it.
In this situation, though I cognitively recognize Jackie’s motivation to diffuse the situation, her apology stabs me viscerally. I know that I should just let it go but I’m so outraged.
We’re implementing a new rounding system next month and so I was also responsible for logging all patient call bell requests in preparation for the new protocol.
There was a water line rupture in the unit next to ours and the shut-off affected some of our patient rooms, public bathrooms and other facilities. I needed to contact Engineering, itemize the affected plumbing, and make other arrangements for patients and staff.
We also had a stroke response on one of our post-ops. I had to monitor the call, STAT orders, arrange for CT, and, afterwards, restock the crash cart. The house staff was going to send the patient to telemetry and I arranged the transfer between the units.
In the meantime, we received 2 contact precaution admissions from the ED and, with no available isolation rooms, I had to rearrange the already admitted patients, inform the nursing staff, direct the aides, contact housekeeping to clean the rooms and then admissions to confirm the computer transfers.
While the stroke response was occurring, the nursing supervisor arranged for a transfer of someone already downgraded to medical from telemetry to make room for our unfortunate patient.
It soon became apparent that our patient belonged in intensive care and not tele. I began those arrangements.
Despite the alleviation of urgency, the other unit decided to send up the transfer, walking! before we were ready. I scrambled to find somewhere for her while her room was prepared. Argh! Her meds hadn’t been hung and she was due for pain medicine so she complained the entire time while I tried to juggle everything. Her new nurse was still dealing with the stroke situation.
Finally things settled a bit and, ten minutes before shift change, the supervisor called about a non-urgent transfer from intensive care. “ICU only has two patients, can this wait until morning?” “No, this patient needs to start PT first thing in the am.” “Sigh, alright.” I HATE moving patients around at 11 pm. I think it’s hard enough for them to get sleep without the jostling and noise from rolling squeaking beds and housekeeping carts. But I took down the details, another iso-room needed! and began rearranging our patients.
The aides grumbled but they moved the patients. The call bell system erupted from all the newly awake patients. “I have to use the bathroom.” “Am I due for pain medicine?” “Will you call my family to let them know about the change?” etc..
11:10 One of the nurses from ICU called to give report. I told her that we weren’t ready yet. Our nurses were just starting report themselves.
“NO! I need to give report NOW.”
“Um. No you don’t. It’s a non-urgent transfer and I know that your shift isn’t over until 0700”
“We’re just starting an in-service. I want to give report before it starts. I won’t send the patient up for a while.” Sigh.
“Jackie would you mind taking report now? She’s insisting.” I rolled my eyes and handed the phone to an incredibly patient nurse. Jackie gets report and says that the patient’ll be up between 12 and 12:30.
11:15pm. I track down the housekeeper just before he finishes his shift and beg him to clean the room for our transfer.
11:17 ICU nurse calls with update on the transfer patient. I tell her that the nurses are in report and that Jackie will call back when she’s ready.
11:19 Housekeeping is still in the room cleaning. The elevator door opens and our patient steps off, white knuckles grasping his walker and the aide carrying his belongings. !!!!
“The room’s not ready! Why are you here!”
“Oh. I just came on. They told me to bring him up.”
“You have to go back down. We’re not ready.”
“I can’t go back down; They already stripped his bed, we don’t have anywhere to put him”
Seriously? I lead them down to the room and pull a chair out into the hall for the patient.
Following the aide back, I laid into her.
“We told you folks several times that we weren’t ready! This is inexcusable. You didn’t even bring him up in a wheelchair!”
“I’m sorry, I just came on. I’m just doing what they told me to.”
Sigh.
“I know that it’s not your fault but this is ridiculous!” Grumble Grumble.
The aide leaves and I go back to the room to get the patient settled in. When I come out, the nurse from ICU is yelling at Jackie.
“How dare you yell at my aide! Blah blah blah, miscommunication that’s all your fault.. blah blah blah..”
I could feel the hackles grow across my shoulders like the hump of a grizzly bear. I’m outraged and start to jump in but a nurse grabs my arm and I pause. Jackie diffuses the confrontation by apologizing and the ICU nurse righteously storms off.
I’m told that the ICU nurse is something of a barracuda, is always right and never lets things go. After she leaves, the nurses gather and complain about her unjustified behavior and how awful she is.
It’s now five days later and I’m still stewing over the situation. It makes me so mad when people like that ICU nurse get away with laziness, superiority, inconsideration and recklessness because people are afraid to call them on their crap.
In hindsight, I know that if I had gotten involved, the confrontation would have escalated. It wouldn’t have been fair to the night crew to spark it and then leave when my shift was over.
But I HATE that someone else gave an apology for my behavior. If my behavior calls for an apology, I want, I NEED, to be the one to offer it.
In this situation, though I cognitively recognize Jackie’s motivation to diffuse the situation, her apology stabs me viscerally. I know that I should just let it go but I’m so outraged.
Friday, November 25, 2011
Faces
Last night, one of our lovely confused LOLs grasped my cheeks with her hands and told me that seeing my face made her feel better.
Aw. Shucks.
Then she tried to bite my arm.
Aw. Shucks.
Then she tried to bite my arm.
Wednesday, November 16, 2011
The Catheter Interrogation
First thing this morning, a urologist came to place a supra pubic catheter bedside. The patient had been retaining crazy amounts of urine and neither his nurses nor his orthopedic surgeon could place a foley in him. So urology was consulted.
The doctor had called in a list of supplies that he'd need bedside by 0530. Apparently he was rather rude to the evening secretary about it, saying 'everything better be ready", in a 'you people always mess up' sort of way. But I know the evening secretary is something of a sensitive whiner, so I took her report with a grain of salt.
He arrived examined the patient and then decided to try his hand at placing the foley first, giving me and the patient's nurse a new list of supplies. We have coude catheters in different sizes and foley kits stocked on the floor so much of his list was immediately manageable. But he wanted Urojet (lidocaine) syringes too. We don't have them in our McKessen so it was a short process to get them up to the floor. He needed to write an order, I faxed it to pharmacy and then immediately ran down to pick them up.
He was NOT HAPPY.
Though it took 10 minutes tops to get them (5 of which were taken by him arguing about writing the stupid order), he was incredibly put out. I heard about how ridiculous we were, how he doesn't have time for this stupid delay.. etc, eye rolls and disdain galore.
Fortunately for the patient, he was able to successfully place the foley. Whew.
A few minutes later, I stopped in the room to check on the patient and I noticed that his collection bag had over a 1200 cc in it.
I remembered reading somewhere that draining the bladder too quickly can cause the patient major discomfort so I pointed it out to his nurse. She was busy doing her end of shift med pass and instructed me to ask the urologist if she should clamp the catheter.
So I did.
I thought he would attack me.
He completely lost his temper and flayed into me.
"That's the stupidest thing I've ever heard! Why do you think to clamp the catheter? Why?" and then he waited. It took me a moment to realize that it wasn't a rhetorical questions but that he actually wanted a response.
I tried told him that I had read somewhere that it could hurt the patient if the bladder emptied too quickly but as soon as I started talking he restarted his rampage.
I was mortified. I tried to explain that I was just an aide and the messenger for the nurse but he kept at me. I can't remember everything that he said; I was flustered and just trying to escape. I remember him saying that they don't teach nurses to be doctors and thrusting a new order at me, written in block letters as though I were in grade school, DO NOT CLAMP CATHETER. It was the only completely legible order he'd written thus far.
He ended up staying to yell at me for longer than it took him to place the foley.
So much for his valuable time....
I'm totally re-writing one of my evil book characters in his honor and he's (the character) is going to suffer.
.
The doctor had called in a list of supplies that he'd need bedside by 0530. Apparently he was rather rude to the evening secretary about it, saying 'everything better be ready", in a 'you people always mess up' sort of way. But I know the evening secretary is something of a sensitive whiner, so I took her report with a grain of salt.
He arrived examined the patient and then decided to try his hand at placing the foley first, giving me and the patient's nurse a new list of supplies. We have coude catheters in different sizes and foley kits stocked on the floor so much of his list was immediately manageable. But he wanted Urojet (lidocaine) syringes too. We don't have them in our McKessen so it was a short process to get them up to the floor. He needed to write an order, I faxed it to pharmacy and then immediately ran down to pick them up.
He was NOT HAPPY.
Though it took 10 minutes tops to get them (5 of which were taken by him arguing about writing the stupid order), he was incredibly put out. I heard about how ridiculous we were, how he doesn't have time for this stupid delay.. etc, eye rolls and disdain galore.
Fortunately for the patient, he was able to successfully place the foley. Whew.
A few minutes later, I stopped in the room to check on the patient and I noticed that his collection bag had over a 1200 cc in it.
I remembered reading somewhere that draining the bladder too quickly can cause the patient major discomfort so I pointed it out to his nurse. She was busy doing her end of shift med pass and instructed me to ask the urologist if she should clamp the catheter.
So I did.
I thought he would attack me.
He completely lost his temper and flayed into me.
"That's the stupidest thing I've ever heard! Why do you think to clamp the catheter? Why?" and then he waited. It took me a moment to realize that it wasn't a rhetorical questions but that he actually wanted a response.
I tried told him that I had read somewhere that it could hurt the patient if the bladder emptied too quickly but as soon as I started talking he restarted his rampage.
I was mortified. I tried to explain that I was just an aide and the messenger for the nurse but he kept at me. I can't remember everything that he said; I was flustered and just trying to escape. I remember him saying that they don't teach nurses to be doctors and thrusting a new order at me, written in block letters as though I were in grade school, DO NOT CLAMP CATHETER. It was the only completely legible order he'd written thus far.
He ended up staying to yell at me for longer than it took him to place the foley.
So much for his valuable time....
I'm totally re-writing one of my evil book characters in his honor and he's (the character) is going to suffer.
.
Monday, November 14, 2011
Book
I spent hours and hours writing my med school applications. Now that they're done, I'm at loose ends and am trying very hard not to obsess over my statuses. Watched pot and all that...
So I've spent the last few weeks maintaining that creative momentum and focusing it into a story.
I am writing an FBI/armed forces thriller. Ha ha ha ha! It's absolutely ridiculous but I'm having so much fun. I've done a lot of research and am surprised at how much I've learned.
I was never really interested in military history before. Now I have a new appreciation for what my grandfather must have experienced as a ranger in the 6th Battalion during WW2. How I wish now that I had the knowledge/interest to talk to him about his experiences before he died. I didn't even realize before the significance of his being a ranger, a member of the special forces. It's thrilling to have have a personal connection to something that is so romanticized now. I'm trying to balance the romance with reality in my story.
I've fleshed out the plot and have composed about 60 pages but the more I research, the more I have to add to my story. I know that I'll probably never finish it but the process is, so far, fantastic.
So I've spent the last few weeks maintaining that creative momentum and focusing it into a story.
I am writing an FBI/armed forces thriller. Ha ha ha ha! It's absolutely ridiculous but I'm having so much fun. I've done a lot of research and am surprised at how much I've learned.
I was never really interested in military history before. Now I have a new appreciation for what my grandfather must have experienced as a ranger in the 6th Battalion during WW2. How I wish now that I had the knowledge/interest to talk to him about his experiences before he died. I didn't even realize before the significance of his being a ranger, a member of the special forces. It's thrilling to have have a personal connection to something that is so romanticized now. I'm trying to balance the romance with reality in my story.
I've fleshed out the plot and have composed about 60 pages but the more I research, the more I have to add to my story. I know that I'll probably never finish it but the process is, so far, fantastic.
Wednesday, November 9, 2011
Impatience.
There's a nurse on our unit who come in nightly to regale us with tales of how awful her husband is. She dyes her hair only because he prefers blondes. She can't eat this or that because he thinks she's fat. He won't help her at all. He expects her to support them with her night shift and then take care of everything like chores, shopping, all aspects of child care while he sits on his duff and watches television during the day. She's always so tired blah blah blah.
Tonight's tale was about how he controls all of the money including her wages using direct deposit into in accounts that she has no access to. If he's feeling generous, he allots her a $5 weekly allowance. If she ¡misbehaves!, he'll take the money back.
First, I think she's totally full of crap. I don't doubt that the husband is a total jackass, but I'm pretty sure she stretches the truth unrecognizably.
She comes in with her stories and everyone fawns over her.. "oh he's awful!" "He should be shot for or " "You should kick his ass to the curb" and she preens under the attention.
I usually try to avoid engaging with the more manipulative staff but she put me on the spot and directly asked me what I thought in front of the rest of the crew. I tried to prevaricate but she was a bloodhound, asking me over and over.
I finally turned and told her that I thought she was spineless, that if she had such an issue with his money control to deposit her paycheck into her own damn account. He didn't hold a gun to her head when she signed up for direct deposit.
After that, she answered every phone call with "U8, Spineless speaking." Seriously, how old is she?
I would love to be a fly on the wall when she goes home and regales her husband to all of the stretched stories of how awful everyone is toward her at work.
On a more positive note, tonight was hellishly busy but I was working with my two all time favorite nurses and we totally rocked it. I love how efficient, sensitive and cool they are with the patients. Over the last year, I've learned so much from them about how to work with even the craziest, most difficult patients calmly and effectively.
Around 0300, "Dr. Armstrong" was paged to U7, one of the more dangerous pysch floors. We then heard thumping and shouts in the south stairwell. Unperturbed, Jackie, not taking her eyes off the IV line she was priming, strolls over and flips the lock on the door knob. A "Dr. Armstrong" is the hospital code for a combative patient. Moments after she locked the door, we heard a thud and more yelling.
Later, we discovered from the nursing supervisor, that one of the patients actually kicked in the door of the secured ward and escaped into the stairwell. I only caught some of the details in passing. Apparently, the patient had enough time to defecate on the stairs before pushing past the security guards to escape downtown. He assaulted one of the police officers chasing him and is now in jail. It capped the already crazy night.
Tonight's tale was about how he controls all of the money including her wages using direct deposit into in accounts that she has no access to. If he's feeling generous, he allots her a $5 weekly allowance. If she ¡misbehaves!, he'll take the money back.
First, I think she's totally full of crap. I don't doubt that the husband is a total jackass, but I'm pretty sure she stretches the truth unrecognizably.
She comes in with her stories and everyone fawns over her.. "oh he's awful!" "He should be shot for
I usually try to avoid engaging with the more manipulative staff but she put me on the spot and directly asked me what I thought in front of the rest of the crew. I tried to prevaricate but she was a bloodhound, asking me over and over.
I finally turned and told her that I thought she was spineless, that if she had such an issue with his money control to deposit her paycheck into her own damn account. He didn't hold a gun to her head when she signed up for direct deposit.
After that, she answered every phone call with "U8, Spineless speaking." Seriously, how old is she?
I would love to be a fly on the wall when she goes home and regales her husband to all of the stretched stories of how awful everyone is toward her at work.
On a more positive note, tonight was hellishly busy but I was working with my two all time favorite nurses and we totally rocked it. I love how efficient, sensitive and cool they are with the patients. Over the last year, I've learned so much from them about how to work with even the craziest, most difficult patients calmly and effectively.
Around 0300, "Dr. Armstrong" was paged to U7, one of the more dangerous pysch floors. We then heard thumping and shouts in the south stairwell. Unperturbed, Jackie, not taking her eyes off the IV line she was priming, strolls over and flips the lock on the door knob. A "Dr. Armstrong" is the hospital code for a combative patient. Moments after she locked the door, we heard a thud and more yelling.
Later, we discovered from the nursing supervisor, that one of the patients actually kicked in the door of the secured ward and escaped into the stairwell. I only caught some of the details in passing. Apparently, the patient had enough time to defecate on the stairs before pushing past the security guards to escape downtown. He assaulted one of the police officers chasing him and is now in jail. It capped the already crazy night.
Friday, November 4, 2011
Wednesday, October 19, 2011
New Digs
I'm settling into my new apartment. It's a tiny studio in an old Victorian house with ceilings higher than the room is wide...
I'm using an old refurbished library study table for dining. I last rented a mother-in-law basement apartment, draped in grapevines and filled with books, that I christened the li-burrow. I haven't yet thought of a clever name for this new place. I'll post some more photos when I finally organize the living/bedroom. It's filled with boxes now and not very inspirational.
We have a patient at work. I'm not able to express the turmoil that this patient throws the hospital into when (s)he is here. I've been on the unit for over a year an this is the second visit. It's an incredibly stressful time for nursing staff, manager and hospital administration. This patient only comes to our floor for reasons that I can't go into without violating HIPAA. I can only say that they're unique and awful. I'm not experienced or clever enough to adequately change the details and still portray the magnitude of this person's effect on us. We get extra staff and the nursing supervisor relocates her center of command to our floor for the duration of the patient's stay. It doesn't help with the stress levels of the nursing staff. My manager hand selects the staff assigned to the room. Though he picks his most reliable, most patient and most experienced, it's not an honor.
The last time, the patient stayed 2 months. I'm not looking forward to another two months of complete anxiety before every shift. Bah.
I received my first med school interview offer. I'm thrilled but my loneliness yesterday was amplified in my hunt for someone to share my excitement. I mentioned it to my coworkers but they were more concerned that this means I may not be there next year. My brother disapproves of my ambition (I'm too old) and my west coast friends couldn't talk last night.
I'm still excited though!!
Saturday, September 10, 2011
Disaster
My area is under a state of emergency right now. I worked a 20 hour shift at the hospital yesterday and am looking into another long shift today. The region is devastated, without drinkable water and many homes without electricity. Emergency command centers and shelters have been set up throughout the county.
I'm amazed at how well everyone worked together these last couple of days. The folks who actually made it, driving hours in convoluted directions, without complaint buckled down to work and spirits were remarkably high. We didn't know how long we would be the only ones who would be able to work and so my manager set up a rotating schedule partway through the day so that we could get some sleep.
A rep whose presentation was canceled, dropped the food off on our floor and so we dined. Because we couldn't use the municipal water, our coffee dispenser was shut off (it is connected directly to the water line.) A neighbor of the hospital dropped off a couple of percolators so that we could refuel.
Another aide came in to relieve me around 4:00 this morning and I began my journey home. Only one bridge in the area is functional and so I have to drive 2 hours on a winding path in the opposite direction to get on the right side of the hill/river in order to get home.
I was the only car in the middle of nowhere when a red sports car wheeled in front of me and then over-corrected to go flying into the tree in someone's front yard.
Immediately stopped, I put my hazards on and called 9 1 1. Describing what happened to the operator, I got out of my car to approach the accident. As I'm walking up, the boy who had been driving, stumbled into the yard, turned to look at the car, said "oh shit!" and took off across the road into the woods.
And so I told the operator. She said someone would be out as soon as they can. Considering the area was in a state of emergency, that 'as soon as they can' was 2 hours and 15 minutes. After giving my statement, they let me go and I began the long trek home.
I'm amazed at how well everyone worked together these last couple of days. The folks who actually made it, driving hours in convoluted directions, without complaint buckled down to work and spirits were remarkably high. We didn't know how long we would be the only ones who would be able to work and so my manager set up a rotating schedule partway through the day so that we could get some sleep.
A rep whose presentation was canceled, dropped the food off on our floor and so we dined. Because we couldn't use the municipal water, our coffee dispenser was shut off (it is connected directly to the water line.) A neighbor of the hospital dropped off a couple of percolators so that we could refuel.
Another aide came in to relieve me around 4:00 this morning and I began my journey home. Only one bridge in the area is functional and so I have to drive 2 hours on a winding path in the opposite direction to get on the right side of the hill/river in order to get home.
I was the only car in the middle of nowhere when a red sports car wheeled in front of me and then over-corrected to go flying into the tree in someone's front yard.
Immediately stopped, I put my hazards on and called 9 1 1. Describing what happened to the operator, I got out of my car to approach the accident. As I'm walking up, the boy who had been driving, stumbled into the yard, turned to look at the car, said "oh shit!" and took off across the road into the woods.
And so I told the operator. She said someone would be out as soon as they can. Considering the area was in a state of emergency, that 'as soon as they can' was 2 hours and 15 minutes. After giving my statement, they let me go and I began the long trek home.
Tuesday, September 6, 2011
Changes (and cleaning)
I know that I've been subtle about my frustrations with the folks at work. (tongue in cheek) A UA on the third shift has given her notice and I volunteered to step in. My manager is very thankful that I'm helping out and I'm really thankful that I get to work permanently with a stronger team.
I'm going to miss the greater opportunity to talk with patients during 2nd shift. I've found, though, the last few months I've been scrambling so much to do both the secretary's and aide's work I didn't have time to spend with patients anyway. I'll be glad to wear just one hat on this new shift.
On the cleaning note, I was out of town this weekend. I spent Saturday and Sunday up at my family's cabin. Coming home, I found my cat sitting on the window sill behind the kitchen sink watching the squirrels on the deck. Like she did all last winter...
As I turned to make a cup of tea, a mouse, A MOUSE!, ran across the stove and down into one of the burners. UGH! What's the point in having a pain-in-the-ass-she's-lucky-she's-so-cute cat if she doesn't mind roommates of the rodent extraction? I HATE rodents. Always have. I barely tolerate chipmunks and squirrels outside and the thought of them in my house makes my skin crawl. Their sharp pointy teeth that never stop growing are creepy. Besides, all of my work in Yellowstone has made me uber-aware of awful diseases (hantavirus, LCM etc) spread by little pointy toothed vermin.
I immediately pulled the stove out from the wall and, using a bottle of bleach, began scrubbing every surface I could reach. In my entire kitchen. For 3 hours. Then I went down to the 24hour drug store and bought a couple of traps. So far, I've only caught one and let it go across the street in the woods. My uncle mocks me for not killing them. He says that they'll just come back. But I can't rationalize killing something just because I hate them. Otherwise, all old drivers who go half the speed limit and don't use their turn signals...
I'm going to miss the greater opportunity to talk with patients during 2nd shift. I've found, though, the last few months I've been scrambling so much to do both the secretary's and aide's work I didn't have time to spend with patients anyway. I'll be glad to wear just one hat on this new shift.
On the cleaning note, I was out of town this weekend. I spent Saturday and Sunday up at my family's cabin. Coming home, I found my cat sitting on the window sill behind the kitchen sink watching the squirrels on the deck. Like she did all last winter...
As I turned to make a cup of tea, a mouse, A MOUSE!, ran across the stove and down into one of the burners. UGH! What's the point in having a pain-in-the-ass-she's-lucky-she's-so-cute cat if she doesn't mind roommates of the rodent extraction? I HATE rodents. Always have. I barely tolerate chipmunks and squirrels outside and the thought of them in my house makes my skin crawl. Their sharp pointy teeth that never stop growing are creepy. Besides, all of my work in Yellowstone has made me uber-aware of awful diseases (hantavirus, LCM etc) spread by little pointy toothed vermin.
I immediately pulled the stove out from the wall and, using a bottle of bleach, began scrubbing every surface I could reach. In my entire kitchen. For 3 hours. Then I went down to the 24hour drug store and bought a couple of traps. So far, I've only caught one and let it go across the street in the woods. My uncle mocks me for not killing them. He says that they'll just come back. But I can't rationalize killing something just because I hate them. Otherwise, all old drivers who go half the speed limit and don't use their turn signals...
Friday, August 12, 2011
Choices
Finishing my stint on third shift this morning, I stepped into the clear cool air and watched the beautiful blushing sunrise. It was a serene moment after a long night and a tense early morning.
One of our patients had left AMA just after morning labs. Last week, high on cocaine, Russell** started a bar fight and injured his shoulder. Dr. Joe told him that the surgery would be delayed for several days to allow his body to metabolize the cocaine. Russ was not happy to be stuck in the hospital for a week and recompensed by abusing the nursing staff: dumping his urinal over his sheets and the floor, barking at us when we walked by and spitting at anyone who came into the room.
We, of course, avoided him as much as possible. Well, Dr. Joe neglected to mention to Russ that he would have to have another drug screen before the surgery. Apparently his visiting friends had decided to bring him more drugs instead of flowers. When the lab tech went in to draw his blood, he went a little nutso, pulled out his IV and, blood dripping down his elbow, stormed out of the room toward the nurses' station screaming about bovine stool and ordering us to procreate with ourselves. Thinking he was going to attack us, we called a security code.
After the grey coats wrestled him back to his room, Dr. Joe came up and told him that the surgery was, yet again, delayed. Russ decided that he didn't want the surgery and demanded to be allowed to leave. Dr. Joe, quite angry and quite willing, retrieved the AMA paperwork and Russ left.
I stopped by the grocery store for cat food on my way home. I settled in the express line as a heavyset young woman unloaded her cart of items with the corresponding WIC vouchers on the counter. I had the rest of the day off and so buried my natural impatience with a magazine.
I soon found myself eavesdropping on the transaction ahead of me. The woman, refusing to pay the 58c difference for a bunch of grapes, told the cashier to take some grapes out of the bunch. I watched as the scan was voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided and then grapes added one by one until the weight matched the amount allowed by the WIC voucher. *sigh*.. "day off.. day off.. day off.. breathe.."
The cheese came next without issue. The juice wasn't juice but punch and not allowed under the rules of the program. Argument. Huffing. Return with Lemonade. Argument. Huffing. Apple Juice.
Finally, the cashier began scanning the non WIC items: HungryMan dinners, bagels, jars of baby food and beer. Total $21.53. Oh, only have $18.37.. Big eyes look at the cashier then move to me. I bury my face in the magazine. Hummm... Ok, take the baby food off.
I drove home judging her. I drank my black coffee and judged her. I thought about the choices that she could have made but didn't. I began to reflect on the decisions that I have made that could be better and I felt guilty. I could have had something other than that blueberry muffin this morning. I could have had tea instead of wine last weekend. I make awful decisions all the time: too much cheese, not enough greens, not enough water, reading trashy novels instead of literature, watching True Blood. I have a degree in chemistry and a passion for studying nutrition. I still make crappy lifestyle choices. I think most people do.
Lady, you're doing alright. Keep going to your classes at WIC and keep fighting for every grape. Please just don't do it in the express line. And don't date anyone with a gimpy shoulder; he's bad news.
One of our patients had left AMA just after morning labs. Last week, high on cocaine, Russell** started a bar fight and injured his shoulder. Dr. Joe told him that the surgery would be delayed for several days to allow his body to metabolize the cocaine. Russ was not happy to be stuck in the hospital for a week and recompensed by abusing the nursing staff: dumping his urinal over his sheets and the floor, barking at us when we walked by and spitting at anyone who came into the room.
We, of course, avoided him as much as possible. Well, Dr. Joe neglected to mention to Russ that he would have to have another drug screen before the surgery. Apparently his visiting friends had decided to bring him more drugs instead of flowers. When the lab tech went in to draw his blood, he went a little nutso, pulled out his IV and, blood dripping down his elbow, stormed out of the room toward the nurses' station screaming about bovine stool and ordering us to procreate with ourselves. Thinking he was going to attack us, we called a security code.
After the grey coats wrestled him back to his room, Dr. Joe came up and told him that the surgery was, yet again, delayed. Russ decided that he didn't want the surgery and demanded to be allowed to leave. Dr. Joe, quite angry and quite willing, retrieved the AMA paperwork and Russ left.
I stopped by the grocery store for cat food on my way home. I settled in the express line as a heavyset young woman unloaded her cart of items with the corresponding WIC vouchers on the counter. I had the rest of the day off and so buried my natural impatience with a magazine.
I soon found myself eavesdropping on the transaction ahead of me. The woman, refusing to pay the 58c difference for a bunch of grapes, told the cashier to take some grapes out of the bunch. I watched as the scan was voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided, grapes removed, rescanned, voided and then grapes added one by one until the weight matched the amount allowed by the WIC voucher. *sigh*.. "day off.. day off.. day off.. breathe.."
The cheese came next without issue. The juice wasn't juice but punch and not allowed under the rules of the program. Argument. Huffing. Return with Lemonade. Argument. Huffing. Apple Juice.
Finally, the cashier began scanning the non WIC items: HungryMan dinners, bagels, jars of baby food and beer. Total $21.53. Oh, only have $18.37.. Big eyes look at the cashier then move to me. I bury my face in the magazine. Hummm... Ok, take the baby food off.
I drove home judging her. I drank my black coffee and judged her. I thought about the choices that she could have made but didn't. I began to reflect on the decisions that I have made that could be better and I felt guilty. I could have had something other than that blueberry muffin this morning. I could have had tea instead of wine last weekend. I make awful decisions all the time: too much cheese, not enough greens, not enough water, reading trashy novels instead of literature, watching True Blood. I have a degree in chemistry and a passion for studying nutrition. I still make crappy lifestyle choices. I think most people do.
Lady, you're doing alright. Keep going to your classes at WIC and keep fighting for every grape. Please just don't do it in the express line. And don't date anyone with a gimpy shoulder; he's bad news.
Monday, August 1, 2011
Crying at Work
In Floating, I alluded to the reality that staff on my floor don't always do their jobs thoroughly. It's a major frustration; the onus of work usually falls on the shoulders of only a handful of people.
I get particularly fed up when our manager seems to coddle the biggest transgressors. He does have his favorites. Usually leaving before our shift starts, he's not much of a presence and I've always attributed his lack of enforcing job responsibility to his ignorance of what really happens during the evening.
When I first started, I really liked my manager. He was welcoming and warm and seemed to really try to create a happy work environment. As the first months past, he seemed really receptive to all of my little ideas for the unit, posting bed phone numbers over the information board in each room, changing the location of the linen carts to be more generally accessible etc. I reorganized the way that the medical teams, patients and nurses were listed on our charge board, color coding them to make the information much easier to read. You should have seen the way they did it before, it would take minutes to figure out who the doctor and lead nurse was for each patient! I was allowed to join the unit council (their first aide!) and I thought, despite my lowly status as a grunt, my thoughts, ideas and concerns were being heard. I took on all the training of new PCAs and attended workshops to improve my clinical mentoring skills.
Last month, another aide, ignoring an imminently dangerous situation for the patient, neglected to do something important. I stepped in and performed the required task, then followed the her to the nurses station. I confronted the aide and told her that she could not disregard those types of situations.
Well, she started to cry and complained that she was having a really bad day. Her brother was having oral surgery to have his wisdom teeth removed and she was so anxious about it. She became hysterical,(seriously!) and needed a twenty minute smoke break to regain her composure. Of course, I was rolling my mental eyes the entire time.
The next day, I was called into the NM's office and scolded. He informed me that it was not my place to police my coworkers(!) and that, and I quote, "not everyone has your work ethic". I told him that I was indeed having trouble adjusting to lack of my* work ethic in my coworkers and that my actions stemmed purely from my concern for the patient. He nodded sympathetically and asked me to work on my tolerance.
Of course, I've thought that maybe I was out of line or too harsh with the other aide. I talked it over with one of the nurses who had been present though. She reassured me that it happened as I remembered: 10 seconds of me getting the aide's attention, telling her to do her job and her becoming histrionic. She confessed that she too has been scolded for scolding someone else.
I'm currently looking for a new job** but I'm saddened and frustrated by the entire scenario. I absolutely love the work that my job entails (but not the poop part) and I hate that I'm leaving with such sourness. All that I've read about the evolution of healthcare shows that the culture is one of increasing openness to policing each other in the effort to generate fewer mistakes. To be slapped in the face with the very antithesis was shocking.
*my work ethic being that I actually do my job!
**I did call the 'anonymous' hotline two weeks later for an incident that I wasn't directly involved in. I haven't seen nor heard any outcomes but I hope that someone is looking into the mess that is my unit.
I get particularly fed up when our manager seems to coddle the biggest transgressors. He does have his favorites. Usually leaving before our shift starts, he's not much of a presence and I've always attributed his lack of enforcing job responsibility to his ignorance of what really happens during the evening.
When I first started, I really liked my manager. He was welcoming and warm and seemed to really try to create a happy work environment. As the first months past, he seemed really receptive to all of my little ideas for the unit, posting bed phone numbers over the information board in each room, changing the location of the linen carts to be more generally accessible etc. I reorganized the way that the medical teams, patients and nurses were listed on our charge board, color coding them to make the information much easier to read. You should have seen the way they did it before, it would take minutes to figure out who the doctor and lead nurse was for each patient! I was allowed to join the unit council (their first aide!) and I thought, despite my lowly status as a grunt, my thoughts, ideas and concerns were being heard. I took on all the training of new PCAs and attended workshops to improve my clinical mentoring skills.
Last month, another aide, ignoring an imminently dangerous situation for the patient, neglected to do something important. I stepped in and performed the required task, then followed the her to the nurses station. I confronted the aide and told her that she could not disregard those types of situations.
Well, she started to cry and complained that she was having a really bad day. Her brother was having oral surgery to have his wisdom teeth removed and she was so anxious about it. She became hysterical,(seriously!) and needed a twenty minute smoke break to regain her composure. Of course, I was rolling my mental eyes the entire time.
The next day, I was called into the NM's office and scolded. He informed me that it was not my place to police my coworkers(!) and that, and I quote, "not everyone has your work ethic". I told him that I was indeed having trouble adjusting to lack of my* work ethic in my coworkers and that my actions stemmed purely from my concern for the patient. He nodded sympathetically and asked me to work on my tolerance.
Of course, I've thought that maybe I was out of line or too harsh with the other aide. I talked it over with one of the nurses who had been present though. She reassured me that it happened as I remembered: 10 seconds of me getting the aide's attention, telling her to do her job and her becoming histrionic. She confessed that she too has been scolded for scolding someone else.
I'm currently looking for a new job** but I'm saddened and frustrated by the entire scenario. I absolutely love the work that my job entails (but not the poop part) and I hate that I'm leaving with such sourness. All that I've read about the evolution of healthcare shows that the culture is one of increasing openness to policing each other in the effort to generate fewer mistakes. To be slapped in the face with the very antithesis was shocking.
*my work ethic being that I actually do my job!
**I did call the 'anonymous' hotline two weeks later for an incident that I wasn't directly involved in. I haven't seen nor heard any outcomes but I hope that someone is looking into the mess that is my unit.
Friday, July 22, 2011
The Fountain
People often ask me at work why I want to go into medicine instead of nursing. I often say in partial jest that I don't like poop. The other, non-jesting half raised it's head last night.
An elderly patient was admitted with a broken hip from a local nursing home yesterday morning. Throughout the day, XRAYs were taken, EKGs performed and Ike* was medically and cardiology cleared for surgery on Monday. It was an arduous exhausting day for the poor, confused man.
As the evening progressed, Ike began to become more confused. Sundowners syndrome is a common phenomenon with some disoriented elderly people. In Ike's case, he became spatially disoriented and lost control of his bowels.
His nurse, Tina and I noticed his incontinence and gathered the supplies needed to clean him up; washcloths and towels, bedclothes, a new gown and Proshield, a skin protectant. We rolled him to his unfractured side and I began the cleaning process.
Afraid that he was going to fall, Ike began howling and let his bowels loose. It was Old Faithful. For several long moments the stool shot up into the air, splattering the sheets, the bed rail and my shoes. I quickly grabbed the clean towel and, in a futile attempt to dike the flow, placed it against his backside.
After the fountain tapered off, I gingerly took the towel away and resumed my wiping. Whoosh, the geyser erupted again spraying the front of my shirt. I snatched the bedpad and all the washcloths and again tried to dampen the flying stool.
This cycled continued for at least 20 minutes, all the while Ike was howling, Tina was trying to reassure him and I was trying to trench the lake of poop. It was awful. Tina was rubbing his back, whispering to him and avoiding my eyes. She snickered a couple of times but for the most part, stalwartly restrained her laughter. I'm sure that I was a sight; covered from shoulder to toes in poop and frantically using anything handy to stop the pool from cascading to the floor.
Later, as I wiped the streak on my cheek away in the staff room shower, I couldn't think of any of my more noble reasons for preferring medicine to nursing.
*all names and details have been changed to protect the identities of anyone who may be totally embarrassed by the occurrences that I described.
An elderly patient was admitted with a broken hip from a local nursing home yesterday morning. Throughout the day, XRAYs were taken, EKGs performed and Ike* was medically and cardiology cleared for surgery on Monday. It was an arduous exhausting day for the poor, confused man.
As the evening progressed, Ike began to become more confused. Sundowners syndrome is a common phenomenon with some disoriented elderly people. In Ike's case, he became spatially disoriented and lost control of his bowels.
His nurse, Tina and I noticed his incontinence and gathered the supplies needed to clean him up; washcloths and towels, bedclothes, a new gown and Proshield, a skin protectant. We rolled him to his unfractured side and I began the cleaning process.
Afraid that he was going to fall, Ike began howling and let his bowels loose. It was Old Faithful. For several long moments the stool shot up into the air, splattering the sheets, the bed rail and my shoes. I quickly grabbed the clean towel and, in a futile attempt to dike the flow, placed it against his backside.
After the fountain tapered off, I gingerly took the towel away and resumed my wiping. Whoosh, the geyser erupted again spraying the front of my shirt. I snatched the bedpad and all the washcloths and again tried to dampen the flying stool.
This cycled continued for at least 20 minutes, all the while Ike was howling, Tina was trying to reassure him and I was trying to trench the lake of poop. It was awful. Tina was rubbing his back, whispering to him and avoiding my eyes. She snickered a couple of times but for the most part, stalwartly restrained her laughter. I'm sure that I was a sight; covered from shoulder to toes in poop and frantically using anything handy to stop the pool from cascading to the floor.
Later, as I wiped the streak on my cheek away in the staff room shower, I couldn't think of any of my more noble reasons for preferring medicine to nursing.
*all names and details have been changed to protect the identities of anyone who may be totally embarrassed by the occurrences that I described.
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