that's what it's all about

I made a bond with a patient we shall call T. Patient T came in for an esophagectomy and removal of the stomach. He has been through three J tube placements, and last week, on one of my days with him, he developed a huge leak around the 3rd tube, as he had with the first two. Large amounts of tube-feed BM seeping out and all over his skin. He was miserable. I was miserable. It was a Sunday and the thoracic surgery team was being manned by everyone's LEAST favorite resident. I was upset by their response but I didn't know what to do about it, either.

In the afternoon, the leak progressed to a constant gushing of acidic fluid and BM. I went upstairs to the GI floor and got ostomy supplies, and attached an ostomy bag around his tube's insertion site. For this I was pronounced a hero by his wife. Patient T texted his whole family to tell them that for the first time all day, he wasn't covered in goop. It was a victory for everyone, but it also allowed me to measure the output, which up until now the team had been pooh-poohing. His tube feeds were stopped, a dophoff tube was surgically placed, and he is now being evaluated for a small bowel obstruction. ALL of which I had suggested in the morning!

I have grown close to him and his family during the weeks he's spent here. Even though he wasn't my patient yesterday, I stopped in and did a cervical dressing change for him. I know that this is why I went into nursing- the ability to really play a major role in someone's healthcare, in the way they get through their day.

pulling the plug

Life on my unit has been relatively uneventful. Just the usual requests from constipated patients to just "reach up there and get that piece out" (ewwwww) and cute little old ladies with inguinal hernias that pop out at random times.

The other night, however, I was selected to take care of a patient who has decided to turn off his own LVAD and die naturally. He has been a favorite and a regular on our floor for the last four years, and many nurses were shedding tears over the news. I had not taken care of him much, so I was a good pick because I wasn't sobbing every time I passed by, but it was still very sad. I do enjoy palliative care patients, because I like to think that I had a hand in making their deaths more comfortable and dignifying. I would consider working for Hospice or a palliative care team at some point in my career.

As far as going to grad school, I always thought that I would get a year or two of nursing experience and then immediately go for it, but after just one year of nursing I realize that becoming an NP at this point would only limit me. There is so much out there for nurses, there's L&D, emergency medicine, geriatrics, ICUs... a lot to do and learn and experience. So for now, plans for grad school have been put in the "someday" bracket, to be revisited at a much later time.

good nurse, bad nurse

I got banned from a patient's room, by the patient. She had mental status changes, and was being just goofy... so the service asked me to get a urine sample for a drug screen. She went into the bathroom for a long time, and then I heard her flushing, flushing, flushing. I was getting concerned that she was trying to flush something down the toilet, so I knocked and poked my head in, said "are you ok?" She flipped out, told me I was very rude for opening the door, and that she didn't want to "call the authorities" but she would if she had to.

From then on, she wouldn't let me in the room and I had to have other nurses go in and do her meds. She complained about me to everyone who went in there. The first time she yelled at me I felt like crying. I need some thicker skin, I know. I'm just used to patients really liking me, and not used to dealing with people who aren't at least somewhat polite.

Needless to say, I gave her up to someone else.

the grim reaper

Yesterday I was taking care of a healthy looking 58-year-old man just diagnosed with terminal lung cancer. Supposedly, the service had already told his wife about this. She asked me, suddenly, how many stages to cancer are there? Without thinking, I said "four". She about collapsed into my arms. I held her while she sobbed into my shirt. I had no idea what to say, what to do. I tried my best. She went over to him and hugged him and said she loved him so much. I had to get out of there. Later, the team came in and told her she should take him home, there's nothing more to be done. I had to step out of the room lest I burst into tears, too.

See, I work on a floor where we usually send people home, healthier than they were before. I haven't built up a very thick skin for this kind of stuff.

The charge nurse bought me a cookie. Cookies do help.

houston we have a problem

They are taking some of our beds to form a new unit full of yucky services like oto and plastics. We will go from 48 beds to 36. This is horrible, horrible news because it means our group of nurses will splinter and scatter to the wind. We are a great group that works well together. We are notorious for having the best teamwork in the hospital. Now many of us will be put in a position where we are forced to choose between working on a different unit or finding a job elsewhere, or even switching shifts.

This is terrible. People were in tears. And the kicker is that they are doing it because we complained about having off-services. Actually, we complained that we were taking off-services when cardiac patients were ready to come to the floor. BASTARDS.

good news on the floor!

One of our patients is a fairly young guy (in his 50s) who has been here for 55 days with heart failure, a heartmate (left ventricular assist device), and kidney failure. He was not going to be discharged until he got a kidney and heart transplant. So he was just sitting around every day on top of the transplant list, waiting for a donor to pop up. We took a long walk the other day and he told me all about how he felt perfectly healthy until 10 years ago, and then he was diagnosed with CHF, although he was asymptomatic. He developed a 3rd degree block, and was implanted with a pacemaker, only the small hospital who implanted him put in the wrong kind, which only exacerbated his heart failure. Since then he has had two LVADs and one RVAD and his kidneys have gone into failure.

The day before yesterday his AICD fired several times when he went into sustained VTach. He spent the whole evening scared to death of it happening again.

Yesterday the big news came... a heart and kidneys were on their way! He was wheeled off to OR with this stunned look on his face. I hope he's doing alright. Everyone on the floor is so excited for him!

opportunities for overtime

The nursing world continues on... I have friends now that make work enjoyable, and with whom I can talk about work stuff. Nothing thrilling has happened as far as patient care, nothing noteable, except that I've continued to have nursing students who all seem to like me a lot. It's really gratifying to help others grow in nursing and see how excited they are with what they did at the end of the day. I still remember what it was like to be a nursing student, and I try to be the preceptor I never had but wished for!

The other day was horrible, when three of my patients were off the floor and all came back at the same time. I had a migraine, too. It was a nightmare. I ended up leaving at 7 but made up for it with 16 hours of overtime ever since! In a place where jobs are hard to find for most, I'm really grateful for a job where I can work extra pretty much every week, and get paid nicely for it!