Working in the field!

I finally got to carry out one of my lifelong nursing dreams... do a service trek and serve rural communities! Of course, I did it in Nepal, where I speak the language, and so had the added experience of being a translator, which I loved. Now I'm hoping to lead a group every year to the clinic we worked at, and start to make a little progress in the area. I loved it there, the community of Sherpas was wonderful. Nursing there was more like being a doctor, though. I diagnosed and treated just using my own brain and the rest of my team. I was terrified at the thought, at first, but after a while I got kind of used to it.

We had some severe cases, like an infant suffering from hydrocephaly, looked like it was going to die soon. We had a guy with a GI obstruction, most likely, a woman who swallowed something sharp when she was drunk, and a woman coughing up blood with TB-like symptoms. But mostly we saw a lot of GERD, aches and pains, babies with diarrhea, dehydrated adults, and wounds and skin infections. The clinic could use a lot of training with the workers, more reference books and drug books, and some programs on ergonomic lifting, hygiene, and birth control.

I'm excited to really be a leader and take group after group. It's totally my niche in life!

In other work-related news, my love affair with cardio-thoracic surgical tele unit is over. I no longer click with management or my co-workers, and I'm a little bit bored with the patients, too. I think it's time to move on, and re-stimulate my brain again. I applied to the baby NICU, L&D, and visiting nurses. I haven't heard anything back, so we'll see what happens. I want more experiences so that I can be a better clinic nurse in Nepal!

reconfiguration

I nearly lost my position in the "unit reconfiguration" that is taking place. They are taking beds from our unit, the cardio-thoracic surgical stepdown, and beds from next-door neurosurgery, and creating a middle unit for otolaryngology and plastics. The positions on all floors were bid on by seniority, and by the hair of my chinny-chin-chin I managed to grab the very last day/eves spot! I would've cried. Not a single cardio-thoracic nurse volunteered to become a plastics/oto nurse. No thank YOU. This whole split cause us to lose some fantastic nurses, and was just unfair and unpopular all around. Everyone had a stomachache, for weeks.

So it is back to business on my unit of choice. I'm ecstatic even if it means being lowest in seniority. But hey- I wanted to work Christmas anyway. Triple time here I come!

patient stalkers

I took care of a very difficult patient, or should I say a patient with a very difficult family, for two 12 hour days. I bent over backwards to keep the family from going over the edge, and to keep from calling security (as the night shift had done). I went out of my way to deliver on all kinds of bizarre requests, and tiptoed around their ever-changing moods. I was exhausted by the end of those two days, but I was also tired because the family stalked me around floor, trying to convince me to join a Jewish group and go to Israel. I told them several times that I wasn't Jewish, but they didn't believe me. The stalking got out of control, to the point where if I left the conference room they would be standing outside of it, waiting for me.

I spent the next two days at work under an alias, at the opposite side and end of the hall, because they were looking for me. I think I did really good work with them, considering how hostile they were to the rest of the hospital staff, and I'm glad that they liked and trusted me. I also got much closer to the PAs on the cardiac surgery team, and one even gave me a hug at the end of the day and told me I did good work. Still, I'm more than relieved that they'll be gone the next time I go back!

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.