Serendipity

It can't exactly be summed up in one word. When I read this article, I thought of my own experiences on subway trains all over the place.

Consequently, I find the same thing happening as I do my job. Sometimes, when I was on the floor, I'd have those moments with those super-needy patients where I felt as if every ounce of caring was sucked out of me. I was spent.

Before I knew it, someone would come and change everything, in that very moment. One particular moment I remember was working on Mother's Day. My coworkers swore our weekend always encompassed the holidays, like Mother's Day. I finally got everything done for my patients and headed for the nurses' station to chart (since we don't do bedside, nosirree!). One of our chaplains came to the desk and gave all the mothers a rose. It was sweet. He has moved to a different area, so I smile when I see him and think of that day.

That same article made me think of one of those super needy patients. Partly because he lived in New York City for a while. I think of some of our folks, like him, even more this time of year, because he died not long before Christmas. His sister, an old nurse, liked to bring donuts.

We may not be in a subway car, but in our little unit at the Hotel, we find fortunate happenstance in places we never expected. I hope you do, too, wherever you are tonight.

My Monday midweek

Yes, when I start rotating my shift, I always feel like it's Monday. I work several days in a row, and then, eventually it's over, but it never fails that the first day is momentous.

First fun item: one patient gets taken off the floor after much nurse cajoling of MD because his oxygen sats wouldn't go up. Diagnosis in the ER: PE. So glad he didn't get to code on us!

Second fun item: the dualling trach patients. Who would have to be suctioned the most...patient #1 at one end of the hall who swore he didn't need to be suctioned, then asked as you left the room or patient #2 who would get turned, then need suction or would need suction at the most inopportune times?

Third fun item: Mr. C. got rejected  for his colonoscopy that day, so let's just prep one more day and have him drink a gallon of GoLytely again to clean him all out. Yes, he got cleaned out, but it was fun changing linens all freaking shift. Clean, clean, clean to keep him from breaking down. Heavens!

Fourth fun item: Mr. Needy. Move this, move that, lift me up, 'cause I can't see my computer, etc., etc. I  would have killed him if it wouldn't have made a mess. (I really like our housekeeper Bob, and  he'd probably run away if I made a big mess like that.) Mr. Needy just made my shoulder pain turn into back pain very quickly.

Thankfully, one of my menagerie of patients, Mr. S. was so sweet. He's been training to do some of his care I'd normally do, so he was ready to fly solo. I was so happy. (One less thing I had to do.) I made sure he got his snacks and whatever else he  needed on rounds. He was the highlight of the night.

Is it psycho Thursday again?

That was my question this morning. Oh, why, oh, why do some people insist on being complete idiots?!

Psycho #1: The crazy patient who threatened everyone earlier in his stay was getting antsy when his pain meds were wearing off. So he asked for Tylenol. Which I didn't have an order for. Which required pulling (or finding) a doctor who was rounding willing to give me a verbal.

Got that, so all is good, right? Until...

Psycho #2: One of my coworkers made a mistake and started cleaning up one of my people. All this right after I had told him, "Go back to sleep and we'll get you cleaned up at 1030ish."

For some odd reason, the Slug decided she needed to yell at me and demand that I clean up another patient of mistaken employee. "No, I'm busy. (since I was still working on the order for Psycho #1 and I had my own other patient, in addition to med delivery). You're not the charge nurse. Go tell him/her if you have a problem." The Slug just kept getting in the way. Somehow, I managed to get everything done.

Psycho #3: The dreaded patient came in, and thankfully, left without issue. Said patient provokes PTSD in some of our nurses from the abuse on his/her last visit. Many people were really, really happy they didn't have to deal with that admission at this time.

To top it all off, we got the news that JC folks are on the prowl and should be visiting our hospital soon. If I wasn't having nightmares before, I'm sure they'll start now.

Less psychosis and more fun to come...stay tuned!

Still going...

I had the colonoscopy patient again today. I had to try to sell the GoLytely gallon again, and I fell short of my quota (only 3/4 of a gallon went down). I did have plenty of help from the other nurses on the unit to get Mr. Colo turned and cleaned up each time.

Did I mention that Mr. Colo is big? Not just big, really big. His bariatric bed takes up most of the room. Imagine your favorite football linebacker in bed and you'll have a pretty good idea of his size. Mr. C. has very large legs and he cannot help us turn. As a result, he has the usual pressure sores: on the sacrum and legs. Surprisingly, since we're doing the prep, he's turned a lot. We have to get him clean, and we have to turn him to do it.

Mr. Colo finally got his liquid lunch after I scoured the unit looking for broth and juice. I only found broth, so we got out one of his clear sodas until it arrived. Thankfully, our dietary staff did not include red gelatin on this tray. I'm just hoping he got enough GoLytely that he's cleaned out for the procedure. If not, he gets to do it again next week.

Besides Mr. Colo, I got one of my other patients up in the wheelchair and I got the med wagon on my favorite end. Most of the people on that end are pretty mellow, but they were getting antsy today. It must have had something to do with their special monthly luncheon or something. The volunteers served it early, so they were wigging out when I wasn't down to there rooms by the stroke of 12. Eventually, they calmed down.

Happily, I got the last round of meds passed and I didn't hear a peep out of any of them. There weren't too many pills to deliver and everyone was in a good mood.

One more day...hopefully, Mr. Colo's prep is done by the time I get there tomorrow. More later. The weekend's just a day away!

Sleepy Sunday

Try as I might, I just couldn't go back to sleep this morning. It probably has to do with waking up once and the old sleep button just does not re-engage for me....arrgh!

Last night was busy. I had three patients, two of whom were the same as the night before and two of the three were out on pass at dinnertime, which was nice. I also inherited the med wagon up in the front from J. when she left her 12 hour shift at 2000.

It's only one med run (around 2200) so what should be so hard? The answer: a whole lot of needy patients. If it wasn't one thing, it was another. People would not ask for stuff in advance, they all waited until I got to the room. I doubled back and got everything filled reasonably quickly, but I was still pushing pills at 2355, which really sucks. I just figured I get stuff done before the night shift came on to do their turns.

M. the charge was off last night and P. took over. That team has the neediest patient on the floor--Mr. B. He rang the light over and over and over. Poor P. was never out of the room for more than 5 minutes and the light would go on. Mr. B. is typical of many post-ICU patients: he thinks we only have 1-2 patients and are waiting outside his room for him to call. No dice. Most of the time, we have people assigned to us all over the place on the unit and we are trying to get them turned, bowel routines done, fluffed and buffed and ready for bed all at the same time. Hopefully, he'll get a little more relaxed, but so far, it's not happening. We shall see...

My people were pretty good for the most part and I got everything done by midnight. It was pushing it, though. I'm going to work with a few other things tonight, so hopefully, things will go more smoothly.

More later...

And then there was one...

I started the day with two patients and I ended up with just one, and I'm not even in ICU! Woo hoo!

First, I had to send Mr. R. to a nursing home in a nearby state. It's probably the last time any of us will ever see him. I got his big dressing done and was very careful with it. It was really messy because it was leaking all over the pad he was on when I got to him. Just before that, I had to do a dig stim on him, too, since he didn't get his bowel routine (daily suppository) today. I did this in an attempt to get him cleaned out a little before he left. I cleaned him up, put his theraboots on and a clean gown so he'd be ready to go.

He's not doing well. He was stable, but we don't know how long that will last. He didn't tell us today, but I know he knows he's going home to die. I think it was bittersweet for him and A. was upset that she forgot to say goodbye since she was busy with another patient. I packed all his stuff carefully, put his AM snack in with his lunch and made sure the paramedics knew where everything was. He should see his family today, or so he told me. I hope it all works out for them. We know we did a decent job because he told us he'll miss us. I pray for my patients and he'll be one of the ones on my list. I'll never forget him.

Once I got all Mr. R's paperwork done, Mr. HIJ #1 was my patient for the rest of the day. He was needy as usual, but I got his bath done, his dressing and then I hooked up his IV. He wanted a soda, since none of the volunteers came around today with any, so I went downstairs and bought him one. I even caved in and bought myself one while I was at the machine.

Our boss was gone today, so most of the staff scattered from the nurses' station for most of the day. The slackers, including the Slug, never came near the nurses' station, because you might end up doing some work if you hang out there. I don't care. I'd rather do work than spend my whole day hiding just so I can do nothing. Our charge, P., was busy ordering blood and going with the docs on wound rounds this morning. Thankfully, we don't have tons of people to be inspected, so this went quickly.

I ate my lunch in peace around 1130 before the trays came and I set Mr. HIJ up when his lunch arrived. A the NP and I planned our itinerary for our conference in November. It should be fun. We're on the same flight and we plan on getting some sightseeing done near our hotel before the conference starts. We'll have to start out from here really, really, early, but I think it will work out well.

By the afternoon, I even remembered the other stuff I had forgotten earlier, so Mr. HIJ was happy. He was feeling hot (but afebrile) by the end of the day, so I got him all situated with his fan and everything in his room and he got very comfortable and fell asleep. After that, I finished off as many orders in the computer as possible and then I went on my way home.

Back tomorrow...we'll see how many admissions we really get (supposed to be five!).

Not so late

Thankfully, everyone showed up for the night crew. I was warned in advance because as a rule, the charge nurse must stay over if anyone is missing from this shift. Since our charge had already volunteered to work as the fourth person, if someone called in, I'd have to stay. (We have other people who could, but usually they decline or have already left by the end of shift...which is a whole other story). Alas, this did not come to pass.

I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.

I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.

My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.

Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!

More later.

Remnants of Ike...no Tina

Yes, we're getting that rain here in our neck of the Midwest. The yard now has a big lake in it. Three of my five evening shifts are done and the last few days have been interesting enough.

Friday I went to a prescription drug abuse seminar put on by a local psych hospital. They even had free CEs for the RNs and all sorts of goodies. I registered via e-mail and got a confirmation but I forgot to bring the e-mail along. I show up early figuring my name is on the lists there and my name is no where to be found (for CE people and non-CE people). I was very agitated about this, but a lot of other people were, too, (and they actually paid for the CEs and need them this month for their various licenses) so I decided the best course of action was to find the local Starbucks, get a coffee and read my e-mail.

I had plans for lunch, so I found a Starbucks in the neighborhood, so I didn't have to drive around in rush hour traffic. I couldn't get on to the wifi hotspot on my Palm, so I read my Rehabilitation Nursing magazine from cover to cover (it's on polytrauma), which I had meant to do for a couple of weeks. It was a good read and I highly recommend it. I wanted my e-mail, though, so I headed up the street to a local eatery that had accessible wifi and I found a nice booth and newspaper and I read my e-mail and the paper until lunchtime. It was a diversion, but a pleasant one nevertheless.

After my fun surfing and reading, I met my friend C. for lunch. C. was happy I got bumped so she could escape the office a little earlier. We had a great time.

At work, I've been lucky enough again to be pushing the med cart. Supposedly, we get a less taxing assignment when we're giving pills, but it's not necessarily the case. I had the AB boys (that's what I'm calling them because of their bug--acinetobacter) up in the front and it was hellish. The room was so hot. Something is wrong with the HVAC system and these guys have fans, but to go in their room garbed up in an isolation gown makes me sweat like mad. It's a lot of work. They can be needy. Thankfully, C. the charge on Thursday kept them quiet for me while I adjusted to being back at work and on the pill delivery route, which, incidentally is all the way at the other end of the unit. (Our boss is really good at crazy geographical assignments like that!)

Outside of that, our new schedule came out and yes, I did actually get those vacation days I asked for recently. I got lucky and found a couple of blank spots on the calendar and asked my boss if I could take off three days in October and three days in November. I'll actually be away for six whole days, since those days are right before my normal weekend off. My husband Dahey is going to surprise me this year for our anniversary. He's making all the plans. All I have to do is show up. At least that was a good excuse for buying a new dress and some other new clothes recently. Bubba will be hanging out with my friend's boys while we're out, so he should have fun.

More later. Stay tuned.