"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?"

Sunday, December 11, 2011

In Sickness and in Health

This has been probably the weekend with the most lessons learned in one spree of shifts since working as an RN. My first shift started with a set of all new patients, as I hadn't been there in a couple days. The words "You have a brand new ICU transfer" are never exceedingly happy words to a new graduates ears. And this case was exceedingly unique.

This lady had been in the hospital for weeks before her ICU trip and before she was my patient. Just two days before receiving her as my own, she had a major abdominal surgery, taking out 20 pounds of subcutaneous fat that was touching her knees and therefore creating a pressure ulcer, on her abdomen. Yikes.

So, this lady is still, even minus the 20 pounds, a good 400 pounds. She is 71 years old.  She has four drains coming out of her abdomen that are draining the fluid from the surgery site. Meanwhile, guess how many I'd worked with before these four? You guessed it, none. As an aide I had come from a Medical oriented floor rather than surgical. Anyway, her incision site was 1.5 feet (yes, feet) across her abdomen, and it was leaking. A lot. Can I add here that I have minimal experience in uncovering, cleaning, and redressing surgery sites?

I guess there's nothing like throwing you into the worst of the worst and learning that way. After working with her all weekend, I have a lot better of a handle on surgery drains, and surgery incision care. I even felt that I had a really good way of doing it that was actually working for her, being that they were leaking so much.  Its a hard internal battle with yourself as a new graduate, because you want to desperately trust your instincts on how to do something. You really do think you know what to do. But then theres that part of you that says, questionquestionquestion!!! So you begin to doubt yourself. You lose all faith that you're even doing a remotely good job, because you're so new. How can we even tell the difference? We think we're doing a good job and then it all comes crashing down on us.

So, having this patient before me, (in addition to another ICU transfer, a chemotherapy patient, and another hard case, also in addition to 2 PICC lines, and 1 Port-a-cath), i knew it was not going to be an easy weekend.

Trips to the commode were an extreme hardship with this woman, who was beginning to really have respiratory distress, let alone her size. She needed a special commode, special chair, etc.  Her dressings needed to be changed 2-3 times a shift, which took no less than 30 minutes each time. Her drains needed to be emptied 4-5 times a shift. Basically, my care during my shift was centered primarily around her as I was in there the most, and attending to my other three when ever they needed me.

But theres nothing like that daunting feeling that you really don't think this patient is going to pull through, in the long run, and you just pray they can just survive the night. With her worsening respiratory status, I got a couple of her doctors on the phone, who all advised getting the ICU on board. So In comes the ICU resident, who orders a stronger source of oxygen, (she was already on 5L) and some breathing treatments to help ease her breathing and her wheezing. Her oxygen levels were dropping down into the mid-80s, which is, really not good, particularly with someone with no existing respiratory disease.

Needless to say, this morning, she eventually got sent to the ICU and I can only pray for her from here on out.

What was most unique and heartfelt about her case, besides the fact that she was a very nice and enjoyable lady to talk to and work with, was her husband. Her husband, also in his 70s and very thin,  was by her side every minute. Being that I work nightshift, I can tell you that he slept over both nights on this little tiny recliner, and got up to every unique sound she made or mention of his name. He got her everything she needed. He gave her a massage when she sat on the commode. He didn't just hold her hand, he grasped it. She grasped it back. His eyes, they were so beyond exhausted but also so madly deeply in love. You could just tell she was his everything. Which is, beyond amazing. I'm not implying that all guys leave a relationship when the woman gains excess weight, but most guys don't stick around. But he not only stuck around, he was her caregiver, her nurse, her husband, her best friend. They played around with cute little inside sayings and banter. They had their own way of saying I love you, without even saying it. There were times that she would wake up in the middle of the night and just say her husbands name, making sure he was still there. And even with him being a little hard of hearing, he jumped up and held her hand whenever she did call out.

It got to the point however, that I extended whatever care I could come up with to her husband, because I was seriously concerned over his well being. Not only emotionally but physically. I hadn't been sure of his sleep cycle during the day, but on my shift he was there every minute and only took intermittent naps. He was literally exhausted. I got him all set up on a comfortable recliner and highly encouraged that he needed to get some rest and to eat some food, water, etc.

Thanks for reading everyone. Round three tonight.... more blogs on the way this week. Love you all,



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