I have one more day left to spend in the hospital, but I am essentially done with classroom learning in the main nursing skills class so I figured I could write about it. I've been putting off writing about the "spirituality" and "alternative treatments" chapters, which is strange because this blog is titled Atheist Nurse. I dislike confrontation with most people (except for my mom - Hi, Mom!) so I didn't really want to write about this until now. It's not like I have anything profound or interesting to say about it; mainly I'd just like to get some crap off my back about the ignorance and magical thinking some people (and college book writers) possess.
I'll start with the Spirituality chapter. I don't have any particular problem with learning about different types of spirituality in nursing school; I look at spirituality as something I don't have, but for a majority of people there is a physiological basis for their belief in god/gods. Some peoples' brains are incapable of not believing in god/gods. Therefore, if they are in spiritual distress or are depressed because they think their god dislikes them, I need to treat them with the same care and compassion that I would treat someone with a broken leg. This is especially important because the psychological health of a person is directly correlated (in most cases) to how well their bodies can heal physical wounds they may have.
So, disclaimer aside, I hate this book. It says that the definition of an atheist is "a person who denies the existence of a God." Um... what? Atheists do not deny the existence of a god with a capital G. All the atheists I know have concluded that there is no evidence to support the existence of any god or gods - not just the Judeo-Christian god they seem to favor. They even have this as a question at the end of the chapter to make sure the people understand what an atheist by the book's definition is. I have a test tomorrow over some of this material, and I'm unsure of what I'll do if the teacher (who happens to be the wife of a minister and a youth minister herself) has a similarly misleading question on the exam. In class, when teaching this material, the teacher insisted "Everyone needs spiritual care - even the atheist - because we all have a spirit, and they all need care!" ...Right. And there is also only one atheist in her world, evidently.
The chapter also has several ready-made prayers available for the student nurse to use in his/her practice. One general prayer in case we aren't used to praying, and one specially created nurses' prayer. I find this all wildly inappropriate, mainly because the only acknowledgment of the non-religious people is the single-lined definition of an atheist and agnostic with the admonishment that "They deserve respect for what they choose to believe." Beyond that, it's 25 pages of how to care for religious folks and how to become friendly with your own spirituality. Oh, and also some Critical Thinking story about how if a kid is diabetic and his parents won't take him to the doctor because they're Christian Scientists, you should put off calling CPS until you consult with the family, the family's church and your nursing organization. This is because the nurse in the story believes in the "power of prayer." Hmm.
I wanted to go on about the Complimentary and Alternative Medicine chapter, but I'll just mention some of the things they "teach" us about. Like the value of chiropractic "medicine," homeopathy, fixing your Qi, Therapeutic Touch (a horrifyingly ridiculous nursing practice that the book touts as scientifically valid), the scientifically proven positive affects of intercessory prayer (I'd love to see the studies they're referring to - because all the ones I've read show that is has negative affects), and how to feel your own energy by holding your arms out and then pulling them slowly in to feel when something "pushes back." Wow! Sounds like valuable educational material.
Like I said, I hate this book.
Sunday, April 20, 2008
Sunday, April 6, 2008
The Real ER
(Cheesy title, I know. Forgive me. P.S. I'm going to put in some links here in case anyone wants more information, and also to give a better idea of what I'm talking about.)
Last week I spent the morning in the cardiac catheterization lab, and watched a cardioversion and cardiac catheterization. We had to wear lead outfits (which weighed about 20 pounds I would guess?) and got to look inside a man's body, starting in his femoral artery and vein and snaking up to his heart. The craziest part was that he was awake the whole time! And let me tell you, when you see blood squirting a foot upward out of someone's artery on TV, it might not be that unrealistic - it really happens! I wouldn't want to work in that place though; they said that some people are so fragile when they go in for the procedure that they just die on the little table because their hearts can't handle the stress. Everyone we saw came out well though, thankfully.
After lunch, I spent 4 hours in the trauma section of the ER. The ER has one area for colds, sniffles, asthma, and other non-emergency basic care - most of the people who use it are those without insurance. The other part of the ER is divided into a trauma side and then other emergencies - those having heart attacks, reaction to chemo, or just plain... dying. I was following a nurse who had several different kinds of patients. I will just talk about one woman who made an impact on my day. Sadly, this was not necessarily a positive, happy impact.
I was led into one of the rooms, and briefly introduced to my nurse. Immediately I was hit with probably the most awful smell I've ever experienced, and I'm not exaggerating. On the small stretcher in the center of the room was an elderly African-American woman. The nurse assessed her, and her Glasgow Coma Scale rating was 4, which means that she didn't open her eyes to even painful stimuli, she made no physical motor movements, and she made only incomprehensible sounds when she was moved. This indicated she was in a deep coma. Her body was in decorticate posturing, which indicates some type of brain damage, tumor, brain hemorrhage, or stroke (above link is a picture; decorticate is the bottom image.) The picture doesn't show this, but when in decorticate posture, the arms and legs are also extremely rigid and tight to the body, so she was nearly impossible to move to start an IV, catheter, or clean her. The nurse believed that she was septic, because her blood pressure was about 60/40 (normal is 120/80) she had a fever, and obviously was in a coma of some sort.
I asked the nurse where she had come from, expecting her to say "the streets." Instead, I was surprised to find she had come from a nursing home. She said this was a common occurrence - many nursing homes take awful care of their residents, such as only changing their diapers once or twice a day, not cleaning them at all, and basically providing little to no care while charging the family several thousand dollars a month. Two patient care techs (PCTs) came in to help the nurse wash the patient, change her diaper, and start a urinary catheter. When they lifted her gown and removed the diaper, we discovered was the horrible smell was. A diaper full of feces and urine, most likely not having been changed for 8 or so hours, as it had soaked through the diaper itself, 2 very absorbent hospital bed pads, and the sheet. The real base of the odor was worse, however. What we were smelling was essentially rotting, raw human skin and muscle. She had bed sores all down her bottom, on her thighs, and on her knees from never being repositioned or cleaned properly. It was sad, depressing, and revolting that she had been treated this way, and that there are probably hundreds (thousands?) of others being taken care of this way as well.
The family came in about a half hour later - the patient's daughter and two grandchildren. It's awful and embarrassing to say, but I immediately judged them, particularly the grandson. He was in his 20s and dressed in stereotypical "gangster" clothes, with long baggy shorts, big tshirt, and baseball hat. I thought "Why are they here? Don't they know how she's been treated? Why do they even care?" One by one, each family member walked up to the patient and petted her face and hair and spoke soothingly to her, trying to get her to respond. After a few moments, they were all quietly crying, even the grandson - even me. It was heartbreaking to watch them see their family member in this state, and I silently berated myself for ever thinking that the way they appeared outwardly had anything to do with the emotions they were feeling inside. Worst of all though was the way the nurse treated them - she completely ignored them, not saying a single word to them while they spoke to the patient and cried. Thinking back, I feel terrible for not saying something to them sooner. I can only imagine how I would feel if I went to see an extremely ill family member and the nurses and doctors ignored me - I would be outraged. Once the nurse left though, I went over to the granddaughter and spoke with her and told her some basic information about her grandmother's condition. There are rules about divulging patient information, so I couldn't tell her much, but I'd like to think I comforted her at least a little. I also spoke with the patient's daughter, who told me that her elderly father was also in the ER just down the hall, so she had even more to be worried about.
My nurse had two other patients who she also basically ignored. One was Spanish-speaking only, and the other was an African-American man. I could see the judgment in her eyes when she spoke with them, and it was sad, upsetting, and disturbing. I could go on and on about those few hours I spent in the ER, but what I really hope to remember is to NOT BE LIKE THAT NURSE. She could have easily said to the septic patient's family "I'm sorry that I can't talk with you for very long, but let me tell you a few things about your grandmother/mother." There was just no excuse for the way she acted towards her patients and their relatives. Part of me is scared that I'll become desensitized to others' pain, but I hope that experiences like this will keep me from ever forgetting that inside those sick and silent bodies, a person lives and needs emotional support, too.
Last week I spent the morning in the cardiac catheterization lab, and watched a cardioversion and cardiac catheterization. We had to wear lead outfits (which weighed about 20 pounds I would guess?) and got to look inside a man's body, starting in his femoral artery and vein and snaking up to his heart. The craziest part was that he was awake the whole time! And let me tell you, when you see blood squirting a foot upward out of someone's artery on TV, it might not be that unrealistic - it really happens! I wouldn't want to work in that place though; they said that some people are so fragile when they go in for the procedure that they just die on the little table because their hearts can't handle the stress. Everyone we saw came out well though, thankfully.
After lunch, I spent 4 hours in the trauma section of the ER. The ER has one area for colds, sniffles, asthma, and other non-emergency basic care - most of the people who use it are those without insurance. The other part of the ER is divided into a trauma side and then other emergencies - those having heart attacks, reaction to chemo, or just plain... dying. I was following a nurse who had several different kinds of patients. I will just talk about one woman who made an impact on my day. Sadly, this was not necessarily a positive, happy impact.
I was led into one of the rooms, and briefly introduced to my nurse. Immediately I was hit with probably the most awful smell I've ever experienced, and I'm not exaggerating. On the small stretcher in the center of the room was an elderly African-American woman. The nurse assessed her, and her Glasgow Coma Scale rating was 4, which means that she didn't open her eyes to even painful stimuli, she made no physical motor movements, and she made only incomprehensible sounds when she was moved. This indicated she was in a deep coma. Her body was in decorticate posturing, which indicates some type of brain damage, tumor, brain hemorrhage, or stroke (above link is a picture; decorticate is the bottom image.) The picture doesn't show this, but when in decorticate posture, the arms and legs are also extremely rigid and tight to the body, so she was nearly impossible to move to start an IV, catheter, or clean her. The nurse believed that she was septic, because her blood pressure was about 60/40 (normal is 120/80) she had a fever, and obviously was in a coma of some sort.
I asked the nurse where she had come from, expecting her to say "the streets." Instead, I was surprised to find she had come from a nursing home. She said this was a common occurrence - many nursing homes take awful care of their residents, such as only changing their diapers once or twice a day, not cleaning them at all, and basically providing little to no care while charging the family several thousand dollars a month. Two patient care techs (PCTs) came in to help the nurse wash the patient, change her diaper, and start a urinary catheter. When they lifted her gown and removed the diaper, we discovered was the horrible smell was. A diaper full of feces and urine, most likely not having been changed for 8 or so hours, as it had soaked through the diaper itself, 2 very absorbent hospital bed pads, and the sheet. The real base of the odor was worse, however. What we were smelling was essentially rotting, raw human skin and muscle. She had bed sores all down her bottom, on her thighs, and on her knees from never being repositioned or cleaned properly. It was sad, depressing, and revolting that she had been treated this way, and that there are probably hundreds (thousands?) of others being taken care of this way as well.
The family came in about a half hour later - the patient's daughter and two grandchildren. It's awful and embarrassing to say, but I immediately judged them, particularly the grandson. He was in his 20s and dressed in stereotypical "gangster" clothes, with long baggy shorts, big tshirt, and baseball hat. I thought "Why are they here? Don't they know how she's been treated? Why do they even care?" One by one, each family member walked up to the patient and petted her face and hair and spoke soothingly to her, trying to get her to respond. After a few moments, they were all quietly crying, even the grandson - even me. It was heartbreaking to watch them see their family member in this state, and I silently berated myself for ever thinking that the way they appeared outwardly had anything to do with the emotions they were feeling inside. Worst of all though was the way the nurse treated them - she completely ignored them, not saying a single word to them while they spoke to the patient and cried. Thinking back, I feel terrible for not saying something to them sooner. I can only imagine how I would feel if I went to see an extremely ill family member and the nurses and doctors ignored me - I would be outraged. Once the nurse left though, I went over to the granddaughter and spoke with her and told her some basic information about her grandmother's condition. There are rules about divulging patient information, so I couldn't tell her much, but I'd like to think I comforted her at least a little. I also spoke with the patient's daughter, who told me that her elderly father was also in the ER just down the hall, so she had even more to be worried about.
My nurse had two other patients who she also basically ignored. One was Spanish-speaking only, and the other was an African-American man. I could see the judgment in her eyes when she spoke with them, and it was sad, upsetting, and disturbing. I could go on and on about those few hours I spent in the ER, but what I really hope to remember is to NOT BE LIKE THAT NURSE. She could have easily said to the septic patient's family "I'm sorry that I can't talk with you for very long, but let me tell you a few things about your grandmother/mother." There was just no excuse for the way she acted towards her patients and their relatives. Part of me is scared that I'll become desensitized to others' pain, but I hope that experiences like this will keep me from ever forgetting that inside those sick and silent bodies, a person lives and needs emotional support, too.
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.
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!
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!
Wednesday, February 6, 2008
Orientation
Beep beep beep! I was up at 5:55 AM. Lovely. I think the last time I was up this early was when I was an infant. At least for regular school days, I only have to get up at 6:30. Next week, I'll be up around 5:00. But enough with my whining.
This hospital campus is huge. Well, maybe not by some standards, like a hospital in LA or New York or something, but it's big to me. Many buildings of many ages hodge-podged together and connected with underground tunnels and hallways and skyways, it reminded me of a combination airport and university. After a long, boring, and relatively useless orientation, we began the tour of the locations we would be during this semester. The cardiac cath lab, the ER, the OR, the dialysis unit, the PACU, MedSurg, and Trauma unit.
We started by touring the cath lab, and the nurses and techs were awesome. They really seemed to love their job. Honestly, most of the people we came across today seemed to really love the unit they were working in. I guess when almost any job that can be done in a hospital setting is available, there's no reason to not love your job. The video footage of what a cardiac catheterization really looks like was incredible! I couldn't believe I was looking at a 20-inch view of someone's left ventricle pumping blood and dye. It was awesome. But the cath lab as a whole? Terrifying. Snaking a wire and catheter inside a femoral artery, through the aorta, and into the tiny arteries of the heart is dangerous. They actually cath some people with the defibrillator pads on them, just in case.
The ER - wow! The director told us this is busy season - they had 380 patients on Monday and 330 yesterday. Not looking forward to fresh car crash victims. At all.
The OR and PACU we couldn't tour, because people are pretty delicate there and they don't need 10 squawking 20-somethings waking them up.
The dialysis unit was the worst. And that's putting it lightly. I've never been in such a miserable place in my life (although I'm sure I'll see worse soon enough.) It was about a 12-bed unit, just one big open room with some curtains between the patients but they weren't pulled. I don't think the patients cared. The room was so quiet, only the whir and beep of the machines and one portable TV in the back corner was noticeable. There was one woman I noticed immediately, in the second bed on the left. Her skin was pale and her head was just a skull with skin pulled tightly over it, and she looked to be in such pain. Her body was so thin it was just a few jutting bones beneath the bed covers. Right when I was thinking "Don't cry. Don't cry." one of my classmates whispered to me "I'm going to cry. Seriously." It was bad. None of the patients were talking, and the nurses were just sitting there monitoring them. Most of them looked like they were running on borrowed time. It was depressing beyond words. I dread the day I'll spend there. The way my instructor behaved was awful - she gave us the guided tour, talking loudly and jovially as if there weren't people dying around her. It was like we were in a zoo and they weren't real people. I was pretty disgusted. Certainly, a nurse has to turn off some emotions some times or else they'd go crazy. But when you've turned yourself off that much... something's wrong with that.
I'll be with a patient on the Trauma unit next week. There are people with head injuries and giant open infected sores and who knows what else. I'm mortified. Nurses' jobs are a lot harder than people give them credit for. I'm beginning to be much more appreciative.
This hospital campus is huge. Well, maybe not by some standards, like a hospital in LA or New York or something, but it's big to me. Many buildings of many ages hodge-podged together and connected with underground tunnels and hallways and skyways, it reminded me of a combination airport and university. After a long, boring, and relatively useless orientation, we began the tour of the locations we would be during this semester. The cardiac cath lab, the ER, the OR, the dialysis unit, the PACU, MedSurg, and Trauma unit.
We started by touring the cath lab, and the nurses and techs were awesome. They really seemed to love their job. Honestly, most of the people we came across today seemed to really love the unit they were working in. I guess when almost any job that can be done in a hospital setting is available, there's no reason to not love your job. The video footage of what a cardiac catheterization really looks like was incredible! I couldn't believe I was looking at a 20-inch view of someone's left ventricle pumping blood and dye. It was awesome. But the cath lab as a whole? Terrifying. Snaking a wire and catheter inside a femoral artery, through the aorta, and into the tiny arteries of the heart is dangerous. They actually cath some people with the defibrillator pads on them, just in case.
The ER - wow! The director told us this is busy season - they had 380 patients on Monday and 330 yesterday. Not looking forward to fresh car crash victims. At all.
The OR and PACU we couldn't tour, because people are pretty delicate there and they don't need 10 squawking 20-somethings waking them up.
The dialysis unit was the worst. And that's putting it lightly. I've never been in such a miserable place in my life (although I'm sure I'll see worse soon enough.) It was about a 12-bed unit, just one big open room with some curtains between the patients but they weren't pulled. I don't think the patients cared. The room was so quiet, only the whir and beep of the machines and one portable TV in the back corner was noticeable. There was one woman I noticed immediately, in the second bed on the left. Her skin was pale and her head was just a skull with skin pulled tightly over it, and she looked to be in such pain. Her body was so thin it was just a few jutting bones beneath the bed covers. Right when I was thinking "Don't cry. Don't cry." one of my classmates whispered to me "I'm going to cry. Seriously." It was bad. None of the patients were talking, and the nurses were just sitting there monitoring them. Most of them looked like they were running on borrowed time. It was depressing beyond words. I dread the day I'll spend there. The way my instructor behaved was awful - she gave us the guided tour, talking loudly and jovially as if there weren't people dying around her. It was like we were in a zoo and they weren't real people. I was pretty disgusted. Certainly, a nurse has to turn off some emotions some times or else they'd go crazy. But when you've turned yourself off that much... something's wrong with that.
I'll be with a patient on the Trauma unit next week. There are people with head injuries and giant open infected sores and who knows what else. I'm mortified. Nurses' jobs are a lot harder than people give them credit for. I'm beginning to be much more appreciative.
Wednesday, January 30, 2008
Dive on in there!
You know it's going to be a good day when one of the first things you hear in the morning is "Make sure you really spread the labia open and hold them tight! Sometimes they'll give you a good fight. And remember, that hand is now un-sterile." NO KIDDING! Can't wait to give it a shot on a real person... eesh.
I'll spare anyone reading this details of the stuff we learned today. Catheters, bed baths, changing linens, emptying an ostomy bag, and charting what the results of a Fleet enema were aren't particularly intriguing or appetizing.
Relevant to this blog, however, is the fact that everyone at school is telling us to pray for our teacher and her family. I won't go into details, but one of my lead teacher's young daughter-in-laws is extremely ill. Like on-a-respirator-for-a-week-and-a-half ill. The teacher is the wife of a minister. But we are all being told repeatedly to pray for them? What good are our prayers if a minister's child is getting screwed by life? It's so sad how people fall into these religious voids and can't crawl out. When things get rough, they fall faster and reach even more desperately for answers. I am without a doubt sympathetic and concerned, because the lady is young and with a small child, but I certainly also find it somewhat depressing that I live in a society where you're an outcast if you (silently) refuse to pray for someone.
I'll spare anyone reading this details of the stuff we learned today. Catheters, bed baths, changing linens, emptying an ostomy bag, and charting what the results of a Fleet enema were aren't particularly intriguing or appetizing.
Relevant to this blog, however, is the fact that everyone at school is telling us to pray for our teacher and her family. I won't go into details, but one of my lead teacher's young daughter-in-laws is extremely ill. Like on-a-respirator-for-a-week-and-a-half ill. The teacher is the wife of a minister. But we are all being told repeatedly to pray for them? What good are our prayers if a minister's child is getting screwed by life? It's so sad how people fall into these religious voids and can't crawl out. When things get rough, they fall faster and reach even more desperately for answers. I am without a doubt sympathetic and concerned, because the lady is young and with a small child, but I certainly also find it somewhat depressing that I live in a society where you're an outcast if you (silently) refuse to pray for someone.
Thursday, January 24, 2008
Week 2
Yesterday was my second "lab" day in preparation for clinical, which begins in two weeks. Evidently we will be spending our entire semester in various parts of the trauma unit, including the ICU. I'm still nervous that I'll get sick or make a mistake, but during our lab yesterday we practiced working with "real" patients to help us feel more confident.
In addition to other incredible learning equipment and a Smart Hospital on campus, we also have a setup inside the nursing building with 5 authentic hospital rooms with 2 beds each. In each room were two actors/volunteers playing the same patient (to help everyone get through each room in a timely manner). The subject we were focusing on yesterday was Activity and Ambulation, so each patient needed to be aided in moving or turning. Each patient then filled out an assessment sheet after we left to check off what we did right and what we could do to improve. We haven't received them back yet, and frankly, I'm not sure if I want to know.
In Room 110, we had a grumpy, "pleasantly confused" woman wearing a Posey vest restraint. She needed to be turned over in the Sims position for a Tylenol suppository and then rolled over again on her back. She was a good actor, let me tell you. Yelling things like "Call the police!" and "Can I have some birthday cake? I think it's my birthday. It's Christmas!" and "You two are so nice, why are you hurting me?" was probably pretty realistic.
Room 130 housed a patient who had recently had a CVA and was partially paralyzed on his right side, so he needed assistance with range of motion exercises. Once we were done, we were preparing to raise the head of his bead again, and he handed us a card that said "My blood pressure is 74/52, what are you going to do?" (This was necessary because the patients weren't actually hooked up to any monitors, but some did have IVs taped to them and Foley catheter bags.) Because we were thrown off, I suggested "Why don't we raise the head of your bed?" but then he moaned and said "Nooo I feel worse!" so I ran and got one of the instructors and realized we should've been keeping his head lowered and raising his feet. Then we were supposed to pretend the monitor showed a healthier blood pressure, but apparently I'm no good at pretending anymore. There seemed to be a group member running out of that room frantically looking for an instructor every few minutes, so presumably we weren't the only ones who screwed up.
This isn't a very interesting blog so far, but I can almost promise I'll have many more interesting stories once I'm actually working with real patients. Next week we will be working in the Smart Hospital (which I will talk more about afterwards) and learn how to insert Foley catheters, maintain and clean ostomy pouches, give enemas, change bedclothes with and without a patient in the bed, give bed baths, and more. How exciting!
In addition to other incredible learning equipment and a Smart Hospital on campus, we also have a setup inside the nursing building with 5 authentic hospital rooms with 2 beds each. In each room were two actors/volunteers playing the same patient (to help everyone get through each room in a timely manner). The subject we were focusing on yesterday was Activity and Ambulation, so each patient needed to be aided in moving or turning. Each patient then filled out an assessment sheet after we left to check off what we did right and what we could do to improve. We haven't received them back yet, and frankly, I'm not sure if I want to know.
In Room 110, we had a grumpy, "pleasantly confused" woman wearing a Posey vest restraint. She needed to be turned over in the Sims position for a Tylenol suppository and then rolled over again on her back. She was a good actor, let me tell you. Yelling things like "Call the police!" and "Can I have some birthday cake? I think it's my birthday. It's Christmas!" and "You two are so nice, why are you hurting me?" was probably pretty realistic.
Room 130 housed a patient who had recently had a CVA and was partially paralyzed on his right side, so he needed assistance with range of motion exercises. Once we were done, we were preparing to raise the head of his bead again, and he handed us a card that said "My blood pressure is 74/52, what are you going to do?" (This was necessary because the patients weren't actually hooked up to any monitors, but some did have IVs taped to them and Foley catheter bags.) Because we were thrown off, I suggested "Why don't we raise the head of your bed?" but then he moaned and said "Nooo I feel worse!" so I ran and got one of the instructors and realized we should've been keeping his head lowered and raising his feet. Then we were supposed to pretend the monitor showed a healthier blood pressure, but apparently I'm no good at pretending anymore. There seemed to be a group member running out of that room frantically looking for an instructor every few minutes, so presumably we weren't the only ones who screwed up.
This isn't a very interesting blog so far, but I can almost promise I'll have many more interesting stories once I'm actually working with real patients. Next week we will be working in the Smart Hospital (which I will talk more about afterwards) and learn how to insert Foley catheters, maintain and clean ostomy pouches, give enemas, change bedclothes with and without a patient in the bed, give bed baths, and more. How exciting!
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