Saturday, September 11, 2010

At Least I Know What Unit I Don't Want To Work On

I stood in the hallway outside the room, nervously looking on at my first CRT (Critical Response Team) incident. Before the CRT was called, the woman was on a bedside commode, slumped over and moaning softly. “Clara,” her nurse, shook her shoulder and put the woman’s head between her hands, trying to get her to open her eyes. “Mrs. Jones, open your eyes! Can you hear me, Mrs. Jones? Try to look at me.” The woman was virtually unresponsive. The nurse I was working with ran into the room and asked if Clara needed help. “Call a CRT. Now.” Within minutes, the small room was swarming with help and the woman was whisked off to ICU. The relief Clara felt after the patient was stabilized and off our unit was palpable.

CRTs are sort of a pre-code blue; they are called by the nurse in the hopes that help will arrive and the patient will be stabilized before they lose consciousness and stop breathing. They are not called frequently, particularly on the unit where I work, so it was several months into my training before I experienced the one above. The charge nurse will show up quickly, as will all nearby nurses on the floor, and the ICU charge nurse and another ICU nurse will come down to assist as “another pair of eyes” to help assess the situation. The room fills almost instantly with helpful (and sometimes just curiously nosy) bodies.

Since ending my orientation on the unit and beginning to work on my own, I had a list of three (albeit irrational and somewhat ridiculous) fears that I had successfully avoided dealing with on my own. A month or so ago, I conquered all three of them in a single 3-day workweek, from 3rd most feared to the number one most feared, strangely enough. #3: Changing a PICC-line dressing on my own. (For those other nurses out there, I know this is bizarre. But I’m always afraid they’ll slip out!) #2: Putting a Foley catheter in. (I somehow managed to not put one in since nursing school.) #1: Transfusing blood/blood products. (Legitimate to fear, but still not worthy of months of avoidance.) In any case, I thought I had conquered the worst if it and have been feeling, for the most part, pretty competent at work. The last lurking fear I had that occasionally stressed me out was walking into a patient’s room and finding them unresponsive (or worse) and having to call a CRT or code.

The other day I squelched that one and made it through my first CRT. The man was a diabetic in renal failure who had been evading his nephrologist for some time who wanted to start him on dialysis. He came in for an unrelated surgery and when his labs came back the morning after, a slew of doctors convinced him to stay in the hospital and have a dialysis catheter (Permcath) placed and hemodialysis started. For this surgery, he needed to be NPO (nothing to eat or drink) for at least 8 hours, which can be tricky for a diabetic. Toward the end of my 12 hour shift, I was in the room with him and noticed a slight alteration in his mental status and also that he was profusely sweating. My suspicions proved correct when I checked his blood sugar and it was 30. This is quite low, and can be very serious – the normal accepted low is at least 70, but normal blood sugar is closer to 100. I began to follow our hospital’s protocol for hypoglycemia but despite two attempts, we couldn’t get his blood sugar higher than 60, which is still too low. I notified the MD and implemented the orders. He was started on what is essentially a sugar-water IV drip and I thought everything would turn out alright.

An hour later, I was in the room with him explaining his surgical consent, and within minutes before my eyes he began to decline; he was sweating worse than before and was extremely drowsy, mumbling, and tremulous. I checked his blood sugar immediately and was shaking as I waited for the results, knowing they would be awful. His sugar was 26. I ran into the hall calling for help and snagged a bottle of D50 (very concentrated sugar water) and told someone to call a CRT. In under a minute I had half a dozen nurses in the room assisting me, and within 2 minutes the full critical response team had arrived. My hands were shaking so badly I couldn’t draw up the D50, but someone graciously took over that task. The patient eventually stabilized and after a maddening amount of arguing with the internist, we transferred the patient off the unit.

I will still have lingering worries about worst-case scenarios and crashing patients, but at least I feel like I’ve had a little taste of the worst things this unit has to offer. One this is for sure – with those embarrassingly shaky hands, I sure as hell know the ICU isn’t for me!

Wednesday, June 30, 2010

Dementia; Or, the First Time I've Felt the Need to Post Since Graduating

“Do my daughters know I’m here? I need to see my babies, they need me to tuck them in at night. I always tuck them in.”

“Your daughters are all grown. They brought you here a few hours ago. They’re doing very well.”

“Do they know I love them? I need to tell them I love them. I love them so much. I’m so lonesome for them.”

“I know you are, but I’m here for you right now. They do know. You told them over the phone a few minutes ago, and they love you very much too. They told you so, and they’ll be back in the morning.”

“Why are you spying on me? I want to go home to the lake. I should’ve never fallen down that manhole. Why did they leave the cover off that manhole? Do my daughters know I’m here? They need me to tuck them in.”

“Your daughters are all grown up and they know you’re here. They love you very much. They’ll be back in the morning.”

“Why am I in prison like this? I just want to go back to the lake with my daughters. Please can I go?”

That is how the entire second half of my twelve hour shift went. She had dementia and was incredibly sweet, pleasant, and cooperative, but she couldn’t remember anything that I told her and was surprised every time I repeated my stock answers to her litany of questions. I’ve never dealt with someone whose mind was more like a sieve. She was, of course, a fall risk, and I had the bed alarm turned on so that a blaring noise went off whenever she tried to get out of bed without one of us there. For 6 hours, this went off almost every 10 minutes. I do tend to exaggerate at times for comedic effect, but I only wish I was exaggerating about the previous sentence. I repeated the same thing every time I went in and reset the alarm. I sat with her for a solid hour and a half, but she was insatiably lonely and immediately tried to get out of bed as soon as I left. I distracted her with magazines, foods and drinks to nibble, tried to find a show for her to watch, and even asked her to “help” me fold towels and washcloths to keep her hands busy. None worked for more than a few minutes, ten at best.

I can’t imagine being the caretaker for someone with a disease this severe. It’s unfathomable and devastating. When I finally caved and called her daughter after several hours of repeated pleading, I could hear the tension in her child’s voice over the phone. She apologized to me, saying that she wished she could be there, but she needed a break. Just a little break and some rest. I couldn’t blame her for failing to warn me what my time alone with her mother would be like. I had to hang up the phone even though she wanted to tell her daughter that she loved her one more time.

I cried on my drive home, my first time crying because of work since I started in February at my first real career. I’ve been so proud of myself when the other nurses ask how many times the job has made me cry. “None!” I’ve said, and they’ve been surprised. I’ve been emotionally drained from patients before, but never like this. Everything I did for her and said to her was pointless. Hopeless. Irrelevant. She couldn’t remember all the times I’d repeated myself over the past hours, but somehow, her frustration was building and all she could recall was that I was keeping her hostage. “This is America, you know. The United States. I’m not a prisoner. I’ve had my picture taken with the Statue of Liberty. I’m free.” No matter how much I soothed her, hugged her, held her hand, stroked her face, and reassured her that both she and her daughters were safe and loved, she forgot it within 5 minutes. I kept my voice calm and gentle with her, but as soon as I left her room I would lose it. Over and over.

I’m not entirely sure what to make of this day, or this post. It’s cathartic. And depressing. And terrifying that it may happen to someone I love. Terrifying to think I might have to do this for more than a day, way more than a day. I don’t think I’d want to live if I was that way. At what point do you just give up?

Saturday, January 30, 2010

New Town, New Job, New Life

It's official (and it has been for some time now) - I've graduated school and passed all the necessary requirements to practice nursing in Texas! In this state, in addition to the NCLEX, there is also the Jurisprudence Test that must be taken to be registered as a nurse. It's extremely easy though, and it's essentially open book (or open browser - it's online and any resources can be used.) It's also official that my husband, The Pug and I are moving! This is a big deal to me - I dislike almost everything about Texas, particularly the conservative rat hole devoid of any concept of social justice where we currently reside. Texas does have its redeeming qualities though, most notably the generally friendly and endearing "Howdy y'all!" populace and the liberal progressive oasis of Austin. We'll still be in Texas, only in an exponentially better location.

I also have a job! As a graduate RN in Texas, many people mistakenly assumed that finding a job would be easy. Unfortunately, at the time of graduation in December, more than one third of my 100+ person class was still jobless, and that included myself. Several hospitals around here even have a hiring freeze, as do several of the places in our new city. When even the job outlook for nurses in Texas is bleak, something must be seriously wrong with the economy.

I tried to sell myself as best I could, and even with the magna cum laude on my diploma and volunteer work on my resume, I only got one bite at one hospital. And holy crap, was that a nerve wracking job interview. I practiced for hours before hand and am pretty sure that I bombed several questions, and then had to wait over 3 weeks for a callback. Luckily I got the job for the only position I was even considered for. There were only 3 positions even available, even on a 64-bed Med-Surg floor. Apparently budgets are pretty tight right now.

Anyway, the hospital is, unsurprisingly, religiously oriented. It does a metric ton of charity work in the area though and is not-for-profit, and that's something that I'll be proud to be a part of. (I don't want to get into politics at this moment, but let's just say that I don't think health care should be a for-profit venture and everyone should have access to quality healthcare.) It'll be interesting to see if there are any signs of the hospital's religious background in my day-to-day nursing experience. Obviously there are crosses on every wall and a point is made to notify visitors and patients of the hospital's mission, but hopefully it ends when it comes to employees. Overall, I think it will be a great place for me to start out and is full of opportunities.

I am excited to be able to continue on relating stories of the amazing people I come across and how they change my thoughts and views. I can't wait to grow as a person and care for my future patients. Next week, I start a new life.