Friday, March 28, 2008

Feelin' the Love

Spring break was great! Here is a brief recap. Drove to Austin to see Richard Dawkins at UT - an incredible, incredible experience. Busted my nuts working on the house every single day of spring break (aside from Dawkins Day). And make roughly 5 trips to Lowe's to buy paint, rollers, color cards, swirl sticks, 3 kinds of primer, drywall mud, sand paper, drill bits, and so on. It was great! I got a ridiculous amount of work done and I pat myself on the back for it.

Consequently, I got way out of my previous school schedule and patterns, and so this past week has been a little rough. Going into the hospital on Wednesday morning, I realized I'd left my stethoscope at home and my money for lunch in the car in the parking garage. I then went up to the floor and waited in the lobby for my instructor before going into the actual patient area. Evidently I'd missed the memo on being told not to do that any more, so I was promptly chastised by my teacher who repeatedly told me I missed report. Another point for me!

After getting the customary glares from the nurses on the floor (most of them are barely able to mask their immense dislike of students), I went to my patient's room and asked if it was alright if I was her student nurse for the day. She was a little gruff, but said she didn't mind. A few minutes later, she let me know she needed her pain pills for the morning so I got to work on finding her nurse. Luckily for me, all the nurses on the floor were in what would become an hour long meeting - fantastic! During that time, my patient's husband repeatedly came to me and was near-frantically trying to get the pain medication his wife desperately needed. I finally was able to get ahold of my patient's nurse to get the hydrocodone. However, I was so nervous at that point for making my patient wait so long for her medicine that I forgot to ask her her name and date of birth (a hospital necessity for every patient/health care provider encounter - especially narcotics administration!) My patient then snipped at me for forgetting. Wonderful! Could the day get any better?

Surprisingly, yes. I spent the entire 9 hour day with that woman, and she was wonderful. Once she had her medicine - her "hydrocozone" and "valian" (Valium) she was much happier - and I don't blame her for being cranky. She'd had a hip replacement surgery a few days earlier, but because of recently healed broken bones, she had chronic pain issues on top of her fresh surgical pain. Don't get me wrong, this lady was smart! She looked 15 years younger than her 70 years, her mind was sharp, and she wanted like hell to get strong again and get out of the hospital. I went to all her physical therapy appointments with her (4 hours every day) and by the last appointment, I was pushing her wheelchair down and taking her back to her room even though there are people paid to escort patients from their floor to the rehab facility. She talked about her life and all the things she'd done, and how the last few years have been tragedy after tragedy for her. She kept asking me to make sure I got her next hydrocodone pills to her on time, and I felt good knowing that I could do that for her - even if the next day, the nurses would "forget" or become "too busy" with other patients to listen to her requests for medicine, at least today she would have her pain managed. Her chronic and acute pain had been the reason she was in the hospital for a few days extra, because she nearly always was at a pain level 10 out of 10 - described as the worst possible pain you can imagine, and at an unbearable level. No wonder she was having problems! No one had been helping her out properly. She had a few setbacks during the day - a few accidents that embarrassed her, needing someone to assist her with the most intimate tasks. I was so happy that I was the one to help her out and make her feel comfortable.

When I dropped her off at her last physical therapy appointment, I wanted to hug her but wasn't sure if it was appropriate or not. She wouldn't have minded, I don't think. Her eyes were misty when she looked up at me and said "How did I get so lucky as to have you with me today? Thank you so much for picking me as your patient. You made my day today. You tell your momma and daddy that I said thank you for having you!" I got up to her room and quickly wrote her a note that she could read when she got back to her room, letting her know how wonderful she was and that I knew she'd be getting out soon with all the hard work she was doing, and that I wished her the best. She made my day too, and I wanted her to know it.

These types of patients, these types of days ... they are the reasons I want to be a nurse.

Wednesday, March 5, 2008

Week 8 and Still Alive

I haven't posted in quite a few weeks, but it's for good reasons - not getting my ass in trouble. I've been somewhat conflicted about whether or not I'm "allowed" (from a HIPAA/legal standpoint) to post about patients and specific stuff that I experience while in the hospital. Of course I'd never use a patient's name or even initials or any possibly identifying information, but who knows. I'm sure I will post about other things that don't directly pertain to being with patients, but right now it's probably the most interesting thing I'm doing. But anyway, I wanted to post about what's been going on anyhow. I talk far too much to be quiet now!

Today I was on the surgery/operating floor. As a student nurse, there is really nothing I can do in an operating room - there are too many guidelines and rules (as there should be when someone's insides are on their outside) and so it's too risky to have us poking around. But! I got to insert a Foley catheter. And it was glorious! It was on a sedated patient, which is perfect for a first time catheter insertion. I was able to take my time, and the RN I was with even set the whole thing up for me. Let me tell you, urethras do not, at first glance, look like they should have tubing the size of my pinky finger shoved inside them. I could say more about inserting a catheter into a real human being and how real people's undercarriages are different than a mannequins, but I'll spare you all the details. Moving right along...

I had my first ever experience with a true life monster - and it was a CRNA (certified registered nurse anesthetist) of all people! Okay, CRNA's are supposed to be the best of both worlds - a registered nurse (caring, compassionate, understanding of holistic care) and also an anesthetist with the knowledge to skillfully put someone painlessly and safely through a surgery. This woman was truly a nightmare though - but first I'll briefly describe the patient situation. The patient was an older aged woman who spoke only Spanish. However, the CRNA ( I will call her Rudolph [get it.. RUDE-olf? ha... ha..]) was convinced the patient "knew more English than she's letting on." While the patient was being read the consent forms by a translator, the CRNA came to the foot of the patient's bed and said to a doctor, "Jeez, have you seen her belly? A few too many tacos and burritos if you know what I mean!" I ignored her, having been warned by the RN I was with that she was a little rough around the edges. The patient's IV was started and she was given Versed (a sedative and situational amnesia-inducing drug commonly used before the "real" drugs are given for general anesthesia) so she was awake, but not alert by any means. To save time and make a long story short, here's a list of all the crap Rudolph did to the patient.

1. Screamed at her with a god-awful goat voice and her mangled version of Spanish. "Mas! Mas! Andale! Open su boca! No, not su ojos, su BOCA! Can't you hear me?" and so on.

2. Damn near slapped her face to wake her when the surgery was over, and screamed "Réspire! Réspire!" which quite possibly isn't even a proper Spanish word at all.

3. After turning the patient on her side as was necessary for the surgery, the patient's top arm was very awkwardly crumpled and shoved under her body, so I moved it and set it more comfortably. Rudolph snatched the patient's hand and shoved it back where it was, and yelled at me "Trust me, I know what's comfortable for a patient! And wherever the patient puts their hand is where they want it!" How a fully sedated patient knows where they "want" the body parts they aren't even aware of is beyond me.

4. After shouting "Open su boca!" to the woman prior to intubating her, when the patient didn't respond, the CRNA then so forcefully held open her mouth and shoved the tube down the woman's throat that I was sure she hurt her. When the woman was moved to the side position for the surgery, blood trickled out of her mouth and needed to be suctioned. This made me ill, and I bit my cheek to keep from crying seeing the way the patient was being treated. So I asked the CRNA why there was some blood trickling from the patient's mouth. She gruffly said "Oh I don't know! It was probably her dentures.. or something... Who knows with these people!"

5. She also yelled at me unnecessarily a few times, but it's beside the point (yet also says something about the type of person she was.)

I don't mean to be scaring anyone, but I needed to get this crap off of my back, and there's also a part of me that really wants the world to know to be ever so careful in choosing their surgical team (yes, you do have somewhat of a choice in your surgeon and anesthesiologist!) I watched another surgery earlier in the day (an open heart surgery... it was incredible!) and the "heart team" as they're lovingly called were very competent and pleasant (as was the rest of the second surgical team I was with aside from Rudolph.)

Turns out I have plenty to talk about I guess. Next week I'm learning to start IVs and give IV medications. After learning those skills, I'll have all the basics of a real nurse! Hopefully I'll never lose my innate skills (empathy, kindness, etc.) and become jaded and racist like some people I've met - I'm looking at you, Rudolph!