Finishing the Race

My patient died on my watch. I knew it was possible…I just didn’t think he would. He was on comfort care – basically hospice in the hospital. I have 5 patients each night and he was the only one on comfort care. He was breathing like he was running a marathon all night. His breathing was so loud I could hear him down the hall. 

Fortunately it wasn’t a crazy night – no alcohol withdrawals, active seizures or patients jumping out of bed - so I was able to spend a good amount of time with him. I have only had one other patient die and she had family and many visitors around when she died. With this patient, his family left around 10 that night to get some rest with assurances from me that I would call if there were any changes. But there weren’t any changes…until he was gone.

His life story isn’t mine to tell. I didn’t know him. When I took him as a patient he was no longer responsive. I don’t know what his personality was like, what he did for a living or if he had a good sense of humor. I just know his medical history. His heart was in really bad shape – kidney’s weren’t so great either. He then had a pretty significant stroke and his body and his mind just couldn’t recover.

I tried to make him as comfortable as possible – after all, it is called “comfort” care but I just couldn’t seem to change his breathing no matter what I tried. It was almost like he was racing to the end. I asked the more experienced nurses that night for advice. I didn’t feel like I was providing him much relief. When all the medications didn’t seem to be changing anything…I just spent time with him….did my extra charting in his room, put chapstick on his lips and swabbed his very dry mouth. He was working so hard. From my experience with running, there isn’t anything better (other than finishing) than having a cheering section along your route. If I couldn’t give him a more comfortable pair of shoes, at least I could provide encouragement along the way.

My shift was just about done. The day nurse was there and I was giving her a report on the night. I had just finished telling her how hard this patient was working all night when we walked in his room. It was silent. His race was over. We listened for a heartbeat and it was still there…barely. We stood in his room in silence as he died.

Being with someone when they die is mostly beautiful with just a smidge of terrifying thrown in. He seemed peaceful…the most peaceful he had been all night. But, in the back of my mind I am wondering, is he scared? Is he comfortable? Did I do all I could do for him? I will be left to wonder. His heart came to a stop and his soul was gone. 

I knew my patient would die soon. I just didn’t expect it to be on my shift. Maybe he took pity on this poor new nurse who was trying desperately to provide some measure of comfort and wanted to show me how comfortable and peaceful he could be. Maybe his heart just said enough. I hope that as I encounter more death in the hospital I never get used to it. If I never see it as normal or routine, I am hopeful I can hold on to the sense that the experience of a physical life ending and a soul going on to find rest with God is sacred.

Keep the Gown On

I have to believe that nurses see more people naked than most legal professions. I see a lot of naked people. When I was a student I found this embarrassing. Now, I have come to expect it. There really isn’t a chance that if I am your nurse I am not going to see some skin. It is my job to perform an assessment of you when you become my patient. The assessment includes looking at your skin. I will be discreet but I do need to see a good portion of you. Now, if you have wounds, I am going to have to look even more thoroughly. After the initial assessment you might be able to keep your gown intact the rest of the evening unless you spring a new leak or have any complications.

That being said, I can’t get some of my patients to keep their gown on no matter how hard I try. Just because you are in the hospital, you don’t have to be naked. I know those hospital gowns don’t provide good coverage but you shouldn’t take that as a license for indecency. I had a patient recently who was going through alcohol withdrawals and having a bit of a break from reality. Every time I came into his room – which was about every 20 minutes because he kept trying to leap out of bed – he had disrobed. The whole situation was a bit unnerving but the nakedness made it even more so. I would get him back to bed and reattach his gown…each time…even though I knew my efforts were probably pointless considering we would repeat the entire scenario shortly. Don’t misunderstand me, I really think most people in the hospital are half naked without even realizing it. They are out of their environment and their routine. They are put in a strange place and given a nightgown with a big gaping hole in the back. Many are in pain and have much more pressing issues than whether or not they are clothed. We don’t hand out tickets or fine you if we come into your room and you are naked. But, we also don’t charge you extra for the gown. Go ahead and use it.

All this skin has become part of the job. It doesn’t rattle me much anymore and if you find yourself in this situation, you shouldn’t feel too embarrassed about it. Know we have seen A LOT of people before you. For what it’s worth, let me offer you some advice for the next time you are in the hospital. If, on a daily basis you wear clothes at home and work, do the same in the hospital. We have hospital pants. If nobody offers you them, ask for them. Ask for an extra nightgown and tie it on backwards. That way your backside is no longer hanging out for the world to see when you walk in the hallway. Bring your pajamas from home and we may let you wear them as long as we can still access the iv sites and hook up the heart monitor if necessary. If you feel less inhibited and freer half clothed, go for it. You will be in good company.

In spite of my own advice, I imagine if I ever find myself as a patient in the hospital one day I will probably be the delirious one disrobed at the end of the hall. If you see me, please give me a gown...wait, make that two.

Miss Congeniality

Not all my patients like me. As something of a people pleaser, this is hard to come to terms with. Some just don’t seem to buy that I am capable and compassionate. There are the patients that don’t like anybody so I am working on not taking their disdain personally. On the other hand, sometimes it is personal. It is just ME they don’t like.

I had one patient this week that wasn’t a big fan of mine. I am quite certain she won’t be writing a letter about the remarkable care and service I provided during her stay at the hospital. She had back surgery a couple of months ago and returned to the hospital with complications. I have no doubt that she was in a lot of pain. Despite trying to meet her needs during the night, about halfway through she told me that I might as well go home since I wasn’t doing her any good. I thought she might be on to something. It was 2 a.m. and I was tired. I shared with my charge nurse the patient’s suggestion but she told me I had to stay. My other 4 patients hadn’t excused me and I was still stuck with #5 even if she didn’t want me around.

You can imagine her dismay when I was her nurse again the next night. I was hopeful. It was a new night. Maybe she would take to my sparkling personality. She and I….we were going to be friends – or at least friendly. Well, I thought we were until about 20 minutes later when she accused me of lying about giving her any pain medication. In addition to hostile, she seemed to be forgetful. It didn’t help that I had to take her lighter and matches away when I came into the room and realized she had been smoking. Ummm….they have rules about smoking in your hospital room. YOU CAN’T DO IT. I won’t bend on that one. I would prefer we didn’t start a fire considering at least half the patients are not very mobile. She told me she quit smoking the week before and was just seeing if her lighter still worked. Uh huh. It SMELLS like she quit smoking about 60 seconds ago. 

If you are looking for a really extra sweet nurse, I am probably not your girl. I may be a bit more no nonsense than some. Just ask my kids. If they have a runny nose I hand them a Kleenex and send them to school. If they want a Band-Aid, I make them show me the blood. I like to think I am compassionate and I try to advocate for my patients but I also think it is important that they continue to do the things that they are able to for themselves. Many of them are in bad shape and I know being in the hospital, with me, is not where they want to be. I TRY to make their experience as pleasant as possible. My patient this week, she wasn’t buying it.

This dislike is something that I am going to have to come to terms with. I am not going to be everyone’s favorite nurse. Heck, I hope that I am at least one person’s favorite some day. I think I am on my way to becoming a good nurse and I try to meet my patient’s needs but there will always be someone more considerate and more knowledgeable. Good thing I am not running for Miss America. I know I wouldn’t do well in the swimsuit competition but I would think in the interview portion or congeniality, I might do okay. After this week, I am not so sure.

Moves Not Quite Like Jaggar

Contrary to the title of my blog, I will not always talk about nursing. Sometimes I will just be wordy AND some weeks just don’t lend themselves to nursing reflections. So far this week, many of my patients had abscesses. This is one of those topics that is probably better left untouched – possibly figuratively and literally. So, I will keep my thoughts on abscesses - although I DO have some -  to myself but now you are left to random ramblings.

I am a jogger. I like the simplicity of the sport. All I need is a pair of shoes and some motivation. When I run I feel like Steve Prefontaine. I FEEL fast, strong and confident – at least for the first ½ mile. I am always surprised when I get home and see a disheveled, red-faced, possibly middle-aged woman looking back. That’s not how I picture myself when I run. So, even though I may be kidding myself about the grace and strength I embody when I run, I still like it. The night shift job has made finding time to run more challenging. I decided that I might need to find an alternative exercise that accommodates this schedule better – something for the rainy nights when I am finally not tired but don’t want to go out in the darkness.

I have always thought Zumba sounded intriguing. Just like I fancy myself an elite track star when I am running, I like to imagine that I could be an amazing Latin dancer with some effort. When my very cool 70-year-old father-in-law told me that he does Zumba for seniors at the gym I decided it was time to give it a try. I am not totally delusional so I got Zumba for the Wii rather than sign up for a class. Last I checked, I don’t actually have ANY South American heritage so even though I fancy myself fairly coordinated, I knew the first experience might not quite be worthy of a public forum. 

It was a big deal in our house when Zumba came home. Audrey laid out the mats and put on her workout clothes. Even Mason was going to give it a try. And then it started. It is HARD. Sadly, I am not a Latin dancer. Turns out, I am really not even that coordinated. Mason threw in the towel early and seemed to be a little embarrassed that his mom was even attempting to move like the lady on t.v. Audrey and I tried to stick it out but pretty soon Audrey discovered that you don't have to actually follow the steps for the Wii to record your effort and for the trainer to say “great work” and “you got it.” So, while I tried madly to master the basic steps, Audrey danced like a crazy woman. At first I snapped at her and told her that we had to do it the right way if we were ever going to learn it but after about 5 more minutes of attempting things that my body will not do, I found myself turning to Audrey and saying, “Audrey, just dance.” 

I guess I need to buy some neon for those rainy nights that I will be out running.

No Trauma Mama

I looked at Michael in a panic after starting this writing project and exclaimed “maybe that was all I had to say!” He looked at me and said, “yeah, maybe.” I may have caught a smirk on his face when he said it…but, he’s good. He has lived with me for almost 18 years and he knows as well as I do that I use more than my allotted 7000 words a day. I am quite sure that Michael doesn’t use his 2000 so often I will borrow some from him. Needless to say, more words came to me.

I had to go to a class this week for work. One of the speakers was a trauma nurse. I love trauma nurses. I could never be one. I am not an adrenaline junkie and I think you have to be one to work in trauma. I don’t want some guy walking in with a knife in his abdomen. He can come see me after the knife is removed but, until then, the trauma nurses are welcome to him.

This trauma nurse, she was no nonsense. The few trauma nurses I have met are all business and seem to have a dry sense of humor. But, think about it…you want your trauma nurse to be no nonsense. If you are in the trauma department you are in BAD SHAPE. You don’t need someone offering you a warm blanket, asking you when your last bowel movement was and offering you a Tylenol. You want someone who doesn’t beat around the bush, is willing to throw the gloves on, get on top of your chest and start pumping like crazy. That’s what I want. I wouldn’t want to see me until about day 10 of my hospital stay. The best advice she gave us “non-trauma” nurses yesterday: “if you don’t remember anything else that I tell you remember this: plug the hole. You see blood, you plug the hole with one hand and you call for help with the other.” Okay trauma lady, I can do that.

Happy Weekend. I hope it is trauma-free.

The Wordy Nurse

Happy New Year. I am not a big fan of New Year’s Resolutions. In everyday life, I am an over analyzer. I am constantly thinking about how to be kinder, more compassionate, a better parent, etc.  I don’t need one particular day to agonize over my long list of shortcomings and write down my resolve to do better. BUT, this year is different. I made one important realization over the past few weeks. 

I am a writer. I like to write. I will never be published or write a memoir or even necessarily write anything particularly newsworthy. But that’s okay…I just need to write.  This has become even clearer to me as I started my new career as a nurse back in September. So far, I LOVE being a nurse. I really do…body fluids and all. I believe that I have finally found my calling and passion. I think this nursing thing and me, we are going to get along just fine. But, here’s the thing: there isn’t any writing in nursing. I chart. I chart A LOT. But, I am limited in my text. Usually I have to make everything one or two words. Even in the free text “progress notes” that mark the highlights of your time with the patient, I am limited to about 75 words. How can I possibly describe my interaction with another human being in 75 words? I feel limited. Apparently nobody wants to know that I think this confused 75 year old man had a nice smile, a crazy daughter, doesn’t sleep and seems particularly anxious about how he will function since having a stroke. Instead, I have to say “yes” he peed, “yes” he walks with a walker and “yes” I removed the staples from his head before my shift was over. There isn’t space to say “Yes, I did indeed remove the staples and that was about the weirdest experience ever. Who knew that the tool you use to remove head staples is pretty much the same one in your office desk? And, it didn’t appear to hurt. How strange is that?” No, those are the things I have to think but not chart.

So, here I am. This year I will try and write. I never fancied myself a blogger. Quite frankly, I don’t even like the word. So, for now I am a wordy nurse. I have things to say…things I need to write down. I am not sure why I decided to try it out in a public forum but let’s give it a whirl. Read me, or don’t…I won’t ask the next time I see you. If you think I am getting to full of myself or I start to think the tiniest detail of my life is of the utmost importance – like what I ate for breakfast – please make me stop.

This is a big year. Here I am…writing. I am a nurse. I am turning 40 this year. Yep, a big year.

Happy New Year.