It's very easy to get attached to some of our patients. When I think about this topic, I hear all sorts of scenarios from my psychiatric nursing class, where we talked about why we like some patients more than others.
Some of them remind us of someone we liked, didn't like, was our neighbor, relative, or friend.
It's not confined to patients, either. Sometimes, we nurses, meet some incredible physicians and other staff in the hospital.
Our docs in the Hotel, while often quirky, are our doctors. So when one wins a major prize, we celebrate. She has been with the Hotel for almost her entire career. Other doctors just visit us, and while we're nice to them, we're not nearly as fond of them as we are of our own.
However, since I have been roaming around on behalf of the Hotel at our sister unit, I've met a lot of doctors I first learned about while reading notes. One of those docs was Dr. M.
Dr. M. was a surgeon at the Washington. We waited for him for a long time. The first specialist retired, they hired someone, then the other never showed up (got a better offer while awaiting information from our HR--the specialty is in demand). We had one doctor (on loan) but PrivateU called him back to work in their hospital (when he wasn't sitting outside the US awaiting his Green Card.)
After years of waiting (literally), Dr. M. came on board from oceans away. He was a jovial fellow for a surgeon. The patients really liked him. He was kind and down-to-earth. Many of our doctors liked him, because he had a phone number and answered the phone whenever possible when he was at his desk. He was also happy to answer any questions they had when they saw him (the infamous hallway consults). I got to help Dr. M. occasionally when he was on the sister unit, visiting folks after surgery. Dr. M. always seemed to be smiling. Eventually, Dr. M. had a real department with another surgeon and a nurse practitioner.
However, our happiness was short-lived. We got the news that Dr. M. died at home over the weekend. Arthur Schopenhauer said “Mostly it is loss which teaches us about the worth of things.”
The happy, smiling surgeon left us physically, but we'll never forget him or the good work he did for our rehab folks.
More later...
Showing posts with label consults. Show all posts
Showing posts with label consults. Show all posts
Wednesday, November 18, 2015
Wednesday, October 15, 2014
Hit the nail on the head
This could have easily been the theme of my week this week.
1. Yes, slacker coworker, when you sit in our weekly meeting and chart, instead of participating, you look like an idiot. When a patient with a LOS of 25 days and you really know NOTHING about him or her and they are your assigned patient, I only have one question. Why in Hades didn't you read THE CHART?!
I know, rocket science...
2. The boss finally decides that the hallway consults are causing issues with continuity of care. Yes! That only took a year to convince him/her. We shall see what happens...
3. Thank you jo at Head Nurse for the link to this Suzanne Gordon article. Yes, communication is vital, and lack of it is deadly.
So far no Ebola in the Hotel Rehab and our specialty docs like it that way. We will keep praying it gets contained.
It's one souvenir from Dallas I'd prefer not to get on my next connecting flight.
Stay tuned...
1. Yes, slacker coworker, when you sit in our weekly meeting and chart, instead of participating, you look like an idiot. When a patient with a LOS of 25 days and you really know NOTHING about him or her and they are your assigned patient, I only have one question. Why in Hades didn't you read THE CHART?!
I know, rocket science...
2. The boss finally decides that the hallway consults are causing issues with continuity of care. Yes! That only took a year to convince him/her. We shall see what happens...
3. Thank you jo at Head Nurse for the link to this Suzanne Gordon article. Yes, communication is vital, and lack of it is deadly.
So far no Ebola in the Hotel Rehab and our specialty docs like it that way. We will keep praying it gets contained.
It's one souvenir from Dallas I'd prefer not to get on my next connecting flight.
Stay tuned...
Saturday, April 20, 2013
Peeling back the layers
While I'm not the one who waits to admit patients to the Hotel anymore, I have assessments to do for folks who end up in the SU, so I still visit. I knew this particular patient would be trouble from the start.
Mr. I. had a history from faraway. He was a complex character. I had fun trying to find his records but when I did, they told me two big things: mental illness and intractable pain. Many nurses, when they see this think of two words: drug seeker. Mr. I. had a life of ill repute, so certainly he must be addicted to those painkillers, one staff member told me matter of factly one day. He was also mentally ill.
I did my required assessment and found him pleasant and with his sister when I came to call. Mr. I was fine doing his assessment with the sister there. "Sure, she can be here. I tell her everything." I did my work and was on my way, thanking both of them. Mr. I had been estranged from his family for a long time due to the distance and his illness.
The course of his stay was usual. Patient caused trouble, psych was called, meds were changed, and the Caffeine free Diet Mountain Dew cans were thrown at staff. Empty, Mr. I told the security staff, when they called a surliness code one day. "I know a full can might hurt someone, so I'd never do that, but she (Nurse Suzy) made me mad." Nurse Suzy made him mad when his pain meds were late and he was in pain. Mr. I told everyone that he was in pain all the time and nothing worked. Mr. I also said he had pain for years. "I probably have terminal cancer." he told another nurse. "I've been reading about it on the internet."
Day after day, Mr. I still complained about this and that, and was finally consulted to the pain management doc, and he/she said to leave his pain meds alone. He/she didn't see any changes coming anytime soon, so it was best to leave them alone.
Well, change came soon enough. Mr. I complained, complained, and complained some more. The docs decided to give him big workup. We found out his one chronic problem wasn't the only thing causing his pain.
The workup found that Mr. I has cancer. Metastatic cancer, partly related to his chronic condition, but the rest they aren't sure of. The oncologist gently told him that they can't give him a realistic prognosis without one more test (that wouldn't be terribly invasive, but would answer his questions.) Mr. I said he wanted to know, so do the test.
It was a sad day recently when his sister showed up. I asked if she needed anything and she just looked up sadly and said, "I need to get I's things. He's going to hospice, instead of that assisted living place the social worker found." The nurses guided her to the room and one offered to help her. "I'm fine," she said. "I always knew something like this could happen. I just never thought it was true. Now I know."
I waited to see if there would be an emotional response, but she stoically packed his belongings and took the computer and clothes out of the room."I promised to be there for him this time, and now I've got my chance. I never thought it would happen because he was gone for so long."
She turned and with a look of calm said, "I'll take whatever time he's got to help. It's all I can do. I'm his sister after all."
Mr. I. had a history from faraway. He was a complex character. I had fun trying to find his records but when I did, they told me two big things: mental illness and intractable pain. Many nurses, when they see this think of two words: drug seeker. Mr. I. had a life of ill repute, so certainly he must be addicted to those painkillers, one staff member told me matter of factly one day. He was also mentally ill.
I did my required assessment and found him pleasant and with his sister when I came to call. Mr. I was fine doing his assessment with the sister there. "Sure, she can be here. I tell her everything." I did my work and was on my way, thanking both of them. Mr. I had been estranged from his family for a long time due to the distance and his illness.
The course of his stay was usual. Patient caused trouble, psych was called, meds were changed, and the Caffeine free Diet Mountain Dew cans were thrown at staff. Empty, Mr. I told the security staff, when they called a surliness code one day. "I know a full can might hurt someone, so I'd never do that, but she (Nurse Suzy) made me mad." Nurse Suzy made him mad when his pain meds were late and he was in pain. Mr. I told everyone that he was in pain all the time and nothing worked. Mr. I also said he had pain for years. "I probably have terminal cancer." he told another nurse. "I've been reading about it on the internet."
Day after day, Mr. I still complained about this and that, and was finally consulted to the pain management doc, and he/she said to leave his pain meds alone. He/she didn't see any changes coming anytime soon, so it was best to leave them alone.
Well, change came soon enough. Mr. I complained, complained, and complained some more. The docs decided to give him big workup. We found out his one chronic problem wasn't the only thing causing his pain.
The workup found that Mr. I has cancer. Metastatic cancer, partly related to his chronic condition, but the rest they aren't sure of. The oncologist gently told him that they can't give him a realistic prognosis without one more test (that wouldn't be terribly invasive, but would answer his questions.) Mr. I said he wanted to know, so do the test.
It was a sad day recently when his sister showed up. I asked if she needed anything and she just looked up sadly and said, "I need to get I's things. He's going to hospice, instead of that assisted living place the social worker found." The nurses guided her to the room and one offered to help her. "I'm fine," she said. "I always knew something like this could happen. I just never thought it was true. Now I know."
I waited to see if there would be an emotional response, but she stoically packed his belongings and took the computer and clothes out of the room."I promised to be there for him this time, and now I've got my chance. I never thought it would happen because he was gone for so long."
She turned and with a look of calm said, "I'll take whatever time he's got to help. It's all I can do. I'm his sister after all."
Monday, May 14, 2012
In the notes
Since I don't always see everyone in the Hotel in the SU, but I'm still on the team, I have to read the notes to stay current on all the patients we take care of. To do so, I skim the notes.
This was my favorite from one of our consults to audiology (who never tells their patients that they're really in the basement next door and half of them end up in my office...).
"Patient's bilateral ears full of cerumen. Please irrigate and re-consult this service, as testing cannot occur at this time."
Hello?! WT...? Nice. I know the NP who's in charge of ear wax removal, is going to love this one. I'll bet we're not going to send anyone to Ms. Audiology without those Debrox drops first!
Another favorite: we had a patient who needs a urology service consult while he/she is an in-patient. Patient is leaving for the great Rocky Mountain state next week.
RN in charge of this clinic writes in the consult (for the secretary to schedule):
"Please schedule xx urology procedure at earliest date, as patient to discharge by 5/21."
When does the stellar secretary schedule? Consult read: "Patient scheduled at 0930 on 7/30/12 per request". (head plants firmly in desk)
Urology's idea of urgent, surely isn't mine or this patients, either.
I only made it halfway through the patients before I had to get away....stay tuned.
This was my favorite from one of our consults to audiology (who never tells their patients that they're really in the basement next door and half of them end up in my office...).
"Patient's bilateral ears full of cerumen. Please irrigate and re-consult this service, as testing cannot occur at this time."
Hello?! WT...? Nice. I know the NP who's in charge of ear wax removal, is going to love this one. I'll bet we're not going to send anyone to Ms. Audiology without those Debrox drops first!
Another favorite: we had a patient who needs a urology service consult while he/she is an in-patient. Patient is leaving for the great Rocky Mountain state next week.
RN in charge of this clinic writes in the consult (for the secretary to schedule):
"Please schedule xx urology procedure at earliest date, as patient to discharge by 5/21."
When does the stellar secretary schedule? Consult read: "Patient scheduled at 0930 on 7/30/12 per request". (head plants firmly in desk)
Urology's idea of urgent, surely isn't mine or this patients, either.
I only made it halfway through the patients before I had to get away....stay tuned.
Friday, March 2, 2012
The best and worst of the week
What a week it was and I can say I am happy, happy, happy it's over. TGIF!
It wasn't just the weather in RehabLand that got exciting. The mood on the unit was the same tempestuous mix of turbulence that was the weather pattern in our neck of the woods.
One minute, a patient is telling a student that he/she was physically assaulted by a staff member. No signs, symptoms, or witnesses, but some of our staff members got long weekends, courtesy of administrative leave. I am sure our charge nurse is glad this week was over after that reason alone.
On the subject of psychotic patients...one word: ugh! Thank goodness for security support and the folks who mark patient records for illness and non-compliance with little things like psychotic episodes of verbal abuse of staff and then they get them out of the neighborhood when they clearly don't see the sign going into the parking garage that says "No weapons of any kind allowed on this property. (including a nice drawing of a handgun and a big knife)"
Yes, go directly to jail, do not pass go, do not collect $200 if you violate this rule.
It's not really psychosis, but technical difficulties occasionally bring out the weirdos on our staff. I'm so glad our support person got ours sorted out or I would have had my face planted in the wall permanently after trying to keep people from wigging out over really relatively minor items that did have workarounds.
But, despite many of these things that were downright horrible, there were good moments.
One of my favorites was the look of excitement of one of the patients who just got up for the first time after flap surgery. When I showed him the new big screen TV in our lounge in the lobby, you'd would have thought I told him he won the lottery. It was a lot of fun for him to sit in front of a big TV after being sick so long and trapped in a room with a little TV.
Another one of our patients wandered by and was worried that he was getting sick. We got him in a clinic to see our docs, but now he has to have tests. He was worried, but we talked about them, and his strategies for coping with things at home. I even called one of our team to get him a consult for when he comes back for his next visit. He was delighted, and said, "I can't believe you'd do that for me." I just said, "That's my job...keeping us all employed helping you." and smiled. He just laughed. I also got to make sure the transport people picked him up to go home, so I was busy!
And some of my projects I've been working on got rolling this week after, literally months in process. Oh, joy, joy, joy! I may actually get something done this year.
Indeed, it was the best and worst of times, but happily, the best outnumbered the worst today.
More to come...
It wasn't just the weather in RehabLand that got exciting. The mood on the unit was the same tempestuous mix of turbulence that was the weather pattern in our neck of the woods.
One minute, a patient is telling a student that he/she was physically assaulted by a staff member. No signs, symptoms, or witnesses, but some of our staff members got long weekends, courtesy of administrative leave. I am sure our charge nurse is glad this week was over after that reason alone.
On the subject of psychotic patients...one word: ugh! Thank goodness for security support and the folks who mark patient records for illness and non-compliance with little things like psychotic episodes of verbal abuse of staff and then they get them out of the neighborhood when they clearly don't see the sign going into the parking garage that says "No weapons of any kind allowed on this property. (including a nice drawing of a handgun and a big knife)"
Yes, go directly to jail, do not pass go, do not collect $200 if you violate this rule.
It's not really psychosis, but technical difficulties occasionally bring out the weirdos on our staff. I'm so glad our support person got ours sorted out or I would have had my face planted in the wall permanently after trying to keep people from wigging out over really relatively minor items that did have workarounds.
But, despite many of these things that were downright horrible, there were good moments.
One of my favorites was the look of excitement of one of the patients who just got up for the first time after flap surgery. When I showed him the new big screen TV in our lounge in the lobby, you'd would have thought I told him he won the lottery. It was a lot of fun for him to sit in front of a big TV after being sick so long and trapped in a room with a little TV.
Another one of our patients wandered by and was worried that he was getting sick. We got him in a clinic to see our docs, but now he has to have tests. He was worried, but we talked about them, and his strategies for coping with things at home. I even called one of our team to get him a consult for when he comes back for his next visit. He was delighted, and said, "I can't believe you'd do that for me." I just said, "That's my job...keeping us all employed helping you." and smiled. He just laughed. I also got to make sure the transport people picked him up to go home, so I was busy!
And some of my projects I've been working on got rolling this week after, literally months in process. Oh, joy, joy, joy! I may actually get something done this year.
Indeed, it was the best and worst of times, but happily, the best outnumbered the worst today.
More to come...
Saturday, August 8, 2009
Ironies
There are just some things that are very ironic in my job.
First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.
I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).
Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.
Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.
Stay tuned. More merriment to come...
First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.
I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).
Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.
Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.
Stay tuned. More merriment to come...
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