I'm a nurse. I know. News flash, right?
I've been thinking about it all week. It's been one of those "Why am I a nurse?" and "I love being a nurse" week.
I've been thinking of all that transpired this week, and I've been thinking it seems that there should be a blog in there somewhere, but I'm not sure I can convey the angst and beauty I've experienced this week.
Monday night I was on call and we worked on one patient for nearly four hours. Her pain was out of control due to advanced cancer and I gave that woman more medicine than I've ever given one human being. More than I felt was probably safe, but what do you do when your patient is weeping and jerking all over the table during a very delicate procedure and she is crying out to God? You look at your doctor who tells you to give her more medicine and you do it.
I called and checked on her first thing Tuesday morning, then talked to her family on Wednesday. They all said that she had been anxious all Monday night and didn't sleep at all. While that is sad, I was relieved I didn't kill her with the quantity of meds and variety I had been pumping in her trying to get her comfortably through the procedure.
Tuesday we had a patient who has been with us for a while come in. She is dying of liver cancer. Her granddaughter had brought her in for one last drainage of the fluid collection on her abdomen that often results from liver diseases. I was afraid she was going to die before I got her from the wheelchair to the stretcher. I asked "Tiffany" how she was able to get her to the car and then to the wheelchair to come to our department. She confessed she just hugged her and total lifted her. The patient's heart rate was in the 130s-160 and she was not making eye contact. She would answer questions slowly and laboriously. I sat down and asked Tiffany if she wanted me to transfer her grandmother to the ER or take her home to die. She decided to take her home. We sat in the hall and I held her while she cried. Tiffany is about my age and has a beautiful little boy that she takes with her everywhere she takes her grandmother. She kept her grandmother beautifully groomed with lovely hair, and manicured toes and fingers. I told Tiffany that she is one of the bravest women I've ever met. I was proud of what she had chosen to do for her grandmother. I know she'll never regret that decision to care for her grandmother. It has not been easy. But I know it was the right thing for her to do, and you could see the love they had for each other every time my patient would speak of her precious granddaughter.
Later in the day on Tuesday we had an urgent case added. The patient had an obstruction between her kidney and bladder, so her right kidney was not draining urine. Consequently this eighty something year old woman was in pain. The pain medicine had made her very confused and combative. When I got her, the doctor pointed out that the key to this procedure was going to be speed. We had to put her on her belly on a table not much wider than an ironing board and convince her to lie still while the doctor placed a tube through the skin and into the kidney to relieve the pressure. One of my fellow nurses told me, "I don't have a good feeling about this." I was surprised because while I was worried about how we were going to get her settled into position, I wasn't worried worried...Like the "not good feeling" worried.
I did express concern to the doctor that she was going septic, which simply means that there is an infection in her blood, and it goes systemic, and can have very scary results. He said "Okay, but we have to get this tube in to fix it." I agreed.
Well, after we used four staff members to wrestle a 50 kilogram woman onto the table, tied her hands and feet, and I gently medicated her, with the age and weight burdening my brain, she finally settled down. My doctor worked like a fiend and had the tube in within a five minutes.
However, her blood pressure plummeted...
She went unresponsive. We flipped her over onto the stretcher and I gave her reversals for the meds I'd given her, hoping it was a case of skinny frail white woman receiving too much sedation, even though I'd barely given her anything.
Of course her IV went bad. The good news with that was that she had beautiful veins, the kind nurses look on lustfully when they pass by you...And since she was now calm, I got a new IV in no problem. I gave her more reversals. Still no response. I started pumping her full of fluids and called in a "rapid response" which basically gets the Code Team there before a full code actually happens...
She came around a little. She began to answer questions and her pressure recovered a bit. Not enough to relax us, but a bit. We got her placed in the intensive care unit. By the time the rush was over, her son and daughter in law had went to her original room on a medical/surgical unit to get her belongings. I hated that I missed them. I had prayed with them before the procedure and reassured her daughter in law that we would take good care of her. We talked about God being in control and caring about all of our worries. We prayed that they would have peace and that the patient would be calm for the procedure. I don't know how they felt. I'm sure they were scared when they heard the call for assistance over the hospital PA. I wish I had caught up with them Wednesday to chat with them and learn how their loved one was. I wish I had sought them out at the end of the day on Tuesday to hug their necks and tell them I was sorry for their family member's illness.
But I didn't. And there wasn't even any reason not to. I was completely bored on Wednesday. So bored that a fellow nurse and I decided to do the eleven flights of stairs up and down (of course, why would we stay on the roof?) and do ten sets of squats at each landing. Then a few hours later we did it again. All I did to earn my paycheck was audit old charts and stock carts, call patients lined up for the next week, and make sure everything was neat and tidy. And while all of that needed done, it isn't what I really visualize myself doing when I head to work in the morning. I finished off my day with a four hour mandatory class. Again, not what I think of doing when I am at work.
So really there was no reason to not follow up with my little lady. I just didn't. I guess the difference with her was that whatever was wrong with her, I had no control over, yet it was a relatively expected outcome. It was all part of the pathology of her illness. I knew that, and wasn't overly surprised when events panned out like they did. Whereas the first patient had metastatic cancer, but what I was doing to her was way out of my comfort zone.
In each case I was doing what I felt was best and what I knew to do. The difference between the first and the last is back up. In the call case we were there until late in the evening, and I really didn't have a lot of people to bounce off ideas about what to do, and what else I could try to get her pain under control. The second case was during the middle of the day, and two other nurses from my department were right there talking things out with me, discussing what we should try next, and the doctor was able to get on the phone to the patient's attending physician.
I'm a nurse. It's weird. Sometimes I wonder why I do it. I especially wonder what is wrong with me to love doing it. Especially as I'm sitting here typing with a headache that is directly tied to they tension I've been carrying in my neck and shoulders this week.
But I do it. I love doing it, and on some weird level I would love it if my girls did it too. We could have that weird nurse bond that commiserates about annoying, smelly patients and gripey needy doctors. We could swap horror stories of blood squirting and vomit flying...And we could commiserate over each others mistakes, and the wish we had done it different cases...
I'm a nurse.
It's what I do.