"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"

Wednesday, November 23, 2011

Drowning Alive

So these past couple nights I had a pretty interesting round of patients. My one though, was probably my first patient who scared me. She has chronic COPD and emphysema. Now, we learned about these two evils in class...In clinincals and as an RN I've had patients with "a history" of COPD/EMP and occaisonally they ask for an inhaler...And I guess in my mind thats all I thought it was. I guess I knew it got worse but so far I had never encountered it. Until last night.

She was extremely nice. Elderly woman. But the simple act of going to the commode which was right next to the bedside, was the equivalent of you or me running two miles with no break. Audible wheezing, gasping for air. On top of all this, she was admitted with extreme back pain and was going for surgery the next day, which was giving her extreme anxiety on top of it all.

So, luckily she slept through the night for me. I checked on her every hour (theres that hourly rounding for ya) and was thankful to see her breathing normally with no problems and she didnt appear to be in any pain.

But then comes time to wake up. First what happened was she needed to take her pills, but I had to have her sit up so she wouldn't choke. So she leaned forward in the bed, and she's now the color purple, and shaking violently. However she manages to get down the pills and falls back into bed but she's in excrutiating pain. Now, ( in comparision to the twenty something I had the shift prior who was making up reasons why she needed Dilaudid), this lady was truly in 10/10 pain. This was the first time I was actually watching the clock waiting to see when the next time I could give her Dilaudid. She even told me she hates painkillers, but the pain is so severe that she needed to take them. I believed every word.

So after I got her less purple and breathing a little better (just from the simple act of leaning forward in bed), she got a breathing treatment. After that, she wanted to seize the golden window to get on the commode. Nursing is the art of timing everything just so, so that maybe, if you're lucky, you can avoid emergencies and your patient ending up blue on the floor. So me and her timed it right so that she would get up to use the commode right after her breathing treatments and I would time it so that she would get her pain medicine about 30 minutes before we made the move.

Even so, its always an epic adventure/risk but a needed one. I always try and time it so that I can spend *at least* 30-45 minutes with her on one of these trips to the bathroom (oh the beauty of having time on nightshift!). She told me, "you know you have a loss of dignity when you can't even have a normal trip to the bathroom and peeing all over the floor." It broke my heart, to feel for what it must be like in her shoes. For those of you that don't have asthma, COPD, or emphysema, imagine when you've had a bad cold in your life, that tight feeling you get in your chest that you just aren't breathing right.  You just can't seem to take a full breath. You get short of breath faster. The simple act of brushing your teeth makes you exhausted and gasping for air. Now imagine that feeling being 10X worse. Now imagine suffering through this for 20 years, until your death. You are on your death bed, gasping for air, feeling like you are slowly drowning alive. In her case, add on 10/10 excrutiating nerve back pain and you've got yourself hell.

After I got her back into bed and *somewhat* comfortable, I had some time to really sit with her and talk to her. I knew she was having extreme anxiety about the surgery and that certainly wasn't helping her breathing. So I stayed with her for an hour, sitting at her bedside, even holding her hand. I let her talk and talk because thats what she truly needed. I listened. She needed someone to listen. We all do.

As my first week flying solo (meaning I have left the comfort of having a preceptor to guide my decisions), I feel extremely unconfident. As I teach my COPDer breathing exercises to calm her down, am I even doing any good? Should I be doing more? When she says, "I can't breathe", do I freak out? If it were any patient, she'd be a CAT call or possibily even a code. But this is her baseline. So I have to think around the problem. The best we can do is breathing treatments, repositioning, inhalers and breathing exercises. But with me being so new and her being so sick, I was so nervous I wasn't doing enough. I prayed that she'd just make it through my shift, just keep breathing, please.

However I am beginning to really see whats important and whats not in nursing. I'm slowly beginning to see the bigger picture. Even though she is admitted for back pain, has baseline horrible COPD, a big big problem was beggining to be her bowels. On my second shift, she hadn't gone in over 6 days. I offered her prune juice and her prescribed laxatives but she kept refusing. Eventually I got it out of her that she is afraid to take any laxatives because she's afraid of having to rush to the bathroom and not being able to breathe. So I'm beginning to recognize that as almost an equally significant problem as both of her admitting diagnoses.

Apparently I did a good enough job, because when I got her settled in the morning, I gave report to the day nurse and we both went in to meet her. After that I finished some charting, and by 8am I walked by one more time and stopped by to say goodbye. She confided in me and told me she was really going to miss having me as her nurse. She then began to beat around the bush and was indirectly trying to ask about the day shift nurse. Eventually I had to ask, "What is your question?"  to see what she actually wanted to know, because I didn't want to give the wrong answer. She then said, "is the day nurse going to be as good as you? Is she going to.....you know, know how to take me to the bathroom like you have been?"

I was........astounded. She felt that comfortable with me? Me? A three day old solo nurse? (of course she didnt know that, but still). After I got over the initial shock, I reassured her that her day nurse was one of our best and is the nurse that even trained me. That helped her anxiety some. But I was truly astounded. After three nights of literally just *praying* she would make it.

I keep waiting for the day I can complete a 12 hour shift and feel like I *truly* did a great job. I knew how to do everything, I made all the right decisions.....but will that ever even come? probably not. At least not for a long time....

Well, goodbye for now folks, thanks for reading through!

~A Writer in a Nurses Body

1 comment:

Jessica said...

Aw, snaz, that's such a great compliment :) Looks like you're making an impression even if you are not as confident as you'd like to be. <2
(ps I giggled when I read "preceptor"