Never Work a Full Moon

You'd think that by now I may have learned my lesson, but alas, that is false. When self scheduling as a nurse, I always forget to check when the next full moon is and almost always find myself working over the full moons. Not just one shift, or two, but three fabulous shifts all in the spree of the full moon. And this past one was extra special, being the lunar eclipse last night. Patients were lining up outside the hospital 5 days ago for this full moon.

Now I'm pretty sure everyone knows that full moons make patients go crazy in hospitals. But it's not just that. Normal patients start acting crazy, and the crazy ones just get even crazier. It's like they all gang up and conspire with each other on how they can plan the most eventful full moon shift ever. And that's not even it. Equipment acts up. You'll hear the strangest noises come out of your machines and equipment, or all of the sudden it stops working, or all the sudden your hospital phone won't work anymore. And things come alive and get lost and walk away. You'll be looking for your bladder scanner and turns out its 4 floors down and they have no idea how it got there. And then there's other just weird stuff, like your patient comes in with one thing and you're dealing with a completely different, extremely time consuming issue. Great fun.


So, within the past couple shifts I worked over the full moon, these are the top 15 reasons  that I hate working full moons.

1) I asked my patient if she could tell me her full name. She tells me, "I'm Italian! Do you think I know not my name!?"

2) A patient on the floor tried to convince me he was legit abducted from aliens, I wasn't good enough to have been abducted, and he was looking to speak with a scientist. But I was definitely not the scientist.

3) Same guy as said above proceeded to injure staff and scream down the hall, wrestle people in the hallways, despite 5 doses of Ativan, 2 geodon, and 1 haldol.

4) My patient tells me when I get on shift, "I just had diarrhea." Me, "Ok.....thank you....for....letting me know..."   patient,-"yeah...its still in the toilet. I need you to look at it."   Me,-"why?"  patient, "I think I swallowed something. Can you tell me what those colored things are?"

5) one of my IV poles presented with "ERROR" on the screen. Despite me being tech-savvy and familiar with the IVs, I have not only never seen this error message, (or the horrifying beeping eradicating from the machine), but I couldn't get it to turn off, either. The best part is it wasn't even on in the first place.

6) Call light goes on, about 330am.  Me, "Hi, how can I help you?"  Patient-"The music! I turned on the music box and it kept ringing, and ringing, and I couldn't get it to stop, but then it stopped. Do you hear the music now?"

7) my (previously normal) patient tried to pull out her NG tube and foley. At the same time.

8) same patient, turns out her NG tube was draining poop. Because, why not?  For my fellow nurses out there, you know how rare this is, but it definitely happens. lots of fun.

9) The giving nurse tells you, "the patient came from home taking ThisWeirdDrugIveNeverHeardOF but were not giving it to him here because you can only get it from canada. WTF.

10) I take a chest pain admission and the patient speaks ONLY (literally) Italian. So does the wife. And the son is trying to order pizza to the hospital room, and only speaks Italian and is trying to ask me (In Italian) how to order pizza. I only know this because he's shouting PIZZA and the 8 year old grandson is translating into English for me. Turns out the patient has no chest pain, he's severely constipated. So you know, pizza should be good for that.

11) Same patient as above was angry that we could not get his Italian drugs imported from Italy for him to take during his stay with us. Because that is extremely unreasonable.

12) I had to explain to said patient that I had to give him a laxative suppository. Since I don't speak Italian, I tried to do this through gestures. That Involved a lot of gestures I hope to never have to use again.

13) One of my dementia patients told me he wanted his Easter bread. If he didn't get his Easter bread, God would strike me with zebras and the patient was going to leave and go to the hotel next door ( room # 745 specifically) so he could get his Easter bread.

14) Patient asks me for Morphine. I told patient she doesn't have an IV, how am I supposed to give her morphine? She told me I can inject it into her brain.

15)  Patient asks me for food at 3:30 AM. I offer crackers. He asks for an egg sandwich. I tell him kitchen is closed. He says OK how about Cornbread? Ummmm, no. I don't have cornbread. He then asks for fresh fruit. I tell him again kitchen is closed but I can give him crackers. He said he's not hungry enough for crackers but what about a Milkshake?

16) The nurse before you tells you she charted she gave medicine but really didn't and can I please call the doctor to see if he really needs it? Um no. No I cannot do that.

17) My 93 year old patient asks me what a Hookah is.

18) My 36 year old female patient tells me she hasn't urinated in the past 14 hours because she doesn't like to use public bathrooms and asks me what I can do for her.



I can't make this stuff up you guys. Seriously.

Funny Thought for the Day

So, to check orientation of all of our patients when doing our assessments, we have to ask each patient three main questions: Their name, where they are, and what time/date it is. Well, with my younger middle aged patient with something simple like Cellulitis or an earache, I usually skip over this and assume, from my normal conversational interactions with that patient, that they know who they are, where they are and what day it is. Just a hunch.


So it then becomes a matter of where do you draw the line? Is there an AGE where I should assess or not assess for orientation? Is there a diagnosis?

I really think it just depends, its different for every patient. Granted, the older the patient, the more likely I am to check for orientation right off the bat. Some people fool you pretty easily, they are having a full fledged normal conversation with you and you think they are oriented, until you ask them what month it is and they say its February when really its August. And its 1982.

So the other night, I got a new patient under my care. She was elderly, but with her husband. She seemed to be pretty with it but on the verge pretty forgetful. So I decided to definitely check for assessment. This is how it went down:


Me: "This is going to sound pretty silly, but I have to ask, Can you tell me your name?"

Patient: " Mrs. IKnow MyName"

Me: "Okay good, Can you tell me what day it is?"

Patient: "It was just Thursday, but now its Friday."

Me: Okay good. Can you tell me where you are?


Patient:   "Yes."


Me:  ...........


Patients Husband:  "Dearest, I think she wants you to tell her where you are."

Patient: Oh! I thought you just wanted to know if I knew where I was. I know where I am.

Me:    ...........


Patient: ....... I'm in ThisLovely Hospital........ *looks around at everyone*, Right?




*sigh*


~ WNB

Funny What the Memory Has In Storage...

Yesterday we got notice of an admission coming, "84 year old female, stage 4 Alzheimer's Disease", so I got the room ready. She comes up, we get her all set up. She looks like the "typical" Stage 4 Alzheimer patient...confused, picking at her covers and clothes, trying to take out her IV, rambling jibber jobberish words that don't make sense, ragged hair, no family with her...We took care of her, got her all set up, got her nice and dry and in comfortable clothes (hospital gowns YAY! So comfy....At least they're dry), and she started crying, so I stood with her holding her hand and talked to her for a couple minutes, explaining to her she was in the hospital because she fell at home and we would take good care of her and she was safe, etc etc. I looked at her name and tried to pronounce it and asked her if that was the correct way to say it, and surprisingly, the first real word out of her mouth, she corrected me with the right way to say her name. She wasn't able to answer any other questions about her self, where she came from, if she had family, what happened to her, etc. Her memory was not there with us.

So, that all over and done with, we tuck her in for the night and tell her to get some rest. We turn off the lights and say "Goodnight" as we leave the room, and she shouts something I didn't understand. My co-worker starts cracking up, and I ask her why?  She turns to me and says, "Well, She remembers the Italian word for "Fu** off!"

We learned later from a family member over the phone that she speaks only Italian.

*sigh*

Oh, what funny things the brain so conveniently remembers....

UPDATE:

She Speaks Greek. Not Italian. Not that it matters. I guess. But apparantly she knows curse words in Italian. I really don't know. Or maybe she's an ex-international-translator? Interesting thought.

A Look Into Alzheimer’s: Is Early Diagnoses a Better Diagnoses?

20 years ago, Alzheimer's was an inevitable fear looming in the minds of aging adults reaching their 60s. Everyone knew about it, was afraid for it. People in their late 50s forgot their keys or forgot someone's name that they just met and immediately thought they had Alzheimer's. People with parents or close relatives with the disease thought they were sure to be doomed to have the inevitable disease included in their destiny. The article I choose this week to write about focuses on the benefits of diagnosing Alzheimer's early, but today I also want to talk about my own feelings on Alzheimer's development.

The article, "Early Diagnoses Lets Patients Look Alzheimer's Square In the Face", written by Alexi Friedman, makes a strong point that people that are diagnosed early enough and are put on immediate medications, have a much better chance of slowing down the disease. She brings up a member of her community who was 72 years old and was having difficulty remembering things. Upon learning she definitely had the degenerative disease, she made proactive decisions to join a safe housing structure with support group meetings, make "to-do" lists, and get on the right medications (Aricept or Namenda). Even nursing home and care centers that specialize in Alzheimer's care are noticing the difference, and are expected to start changing their plan of care within the coming 20 years. Quote from vice president of the Alzheimer's Association of NJ, "This type of self advocacy by patients was virtually unheard of 20 years ago, when caregivers were the ones to reach out for information and support. But as more people are diagnosed earlier, they [patients] are increasingly taking control of their own futures and, by doing so, forcing traditional Alzheimer's organizations to rethink their missions." I think its great that these patients are choosing to take control. They want to remain part of their lives and the decision making process. Years ago, all we, and the patients suffering and their caregivers did was hope that the unknown researchers were hopefully making progress on the cure somewhere out there. We sat back and watch the killer disease rip through the brain and create multiple broken hearts. But now the patient can slow it down. Multiple video games even are being released purposefully directed at the aging adults. These games include mind games such as word puzzles, anagrams, and other puzzles that "make you think".

The other topic I wanted to bring up was something I had a good conversation with my boyfriend about. We got started first when I had mentioned that people were living to be so old nowadays, and how it was so strange to think about back thousands of years ago, my age right now (21) maybe being one of the "elders". How strange is that? I had asked him, how could it be that over the thousands of generations, how in time did it get to be that nowadays a 15-25 year old is seen as somewhat immature, that we are still "so young". If we have a baby, we are looked down upon for it. We shouldn't be married so young…but back then, 12-20 year olds were forced to have babies. They were married at 12. If they were lucky to even make it to 25-30 they were a town "elder"…even though they probably looked like I do right now (body type wise). Did they even know what we today call an "old" person looked like? What happened to a human as it got older? Were there some breakthroughs that made it past 60? He replied with the fact and very interesting thought that maybe human beings aren't and never were supposed to get old…Maybe that was never intended and we are making a mistake by extending our lives so much. Maybe Alzheimer's was never supposed to happen, and it is not a disease per say but a natural reaction to the brain fighting old age? If we all lived long enough and died from no other cause, I'm sure we all would eventually get it. He made the point that the body fights getting older, with arthritis, and heart attacks, etc. Maybe God had never intended for us to live this long (on average) and the fact that we are actually intentionally prolonging life is a huge mistake. I take the stand personally on letting death happen naturally. Sure, It is tragic when someone dies prematurely in a car accident or murder when they were otherwise healthy. Should we fight to keep them alive, if they have a chance? Yes, In most cases. But should we give donor implants and artificial limbs to people above the age of 70 just so they can stay alive artificially? We wonder why our planet is getting so crowded…We wonder why and not ever before we are experiencing Earth's fight back on us for being too harmful to the environment. We were never supposed to be here this long, and we got too smart to figure out how to artificially let us stay here longer.

So should they keep fighting for an Alzheimer's cure? Yes. Why? Because who wants to spend the last 10-30 years of their life in a nursing home or assisted living or even worse stuck in bed, or not knowing who their children are or where they are? Who wants to spend 10-30 years with a spouse or parent that doesn't know who you are? Who would ever want the feeling of not remembering anything or being told they weren't allowed to drive? Although I believe that we shouldn't artificially prolong life, curing Alzheimer's isn't prolonging life. It's making life more enjoyable.

So long readers, til next time…

~A writer in a Nurses Body

A Bit About Dementia.

I have only ever done a small amount of research on Alzheimer's disease...That is, research at the computer and through books. But I have been graced with the *delight* of working with anywhere between 5-15 people each shift who suffer some form of dementia. And that number is out of ~30 patients each shift.

It's not easy.


Some people love working with these patients. Frankly, I hate it. I don't mean to sound like i hate my patients, but the work is hard. I think particular nurses that like doing this are afraid. They are afraid of working with people with 100% of their mind. Maybe they are afraid of normal human contact and would prefer to come to work and not be judged by their patients.
Or maybe they just have a bigger heart than the rest of us and don't mind if their patients aren't able to appreciate or remember it.

I need to be able to build relationships with my patients. Thats just who I am. I need to be able to carry out a normal, civilized conversation without being punched, swatted at, growled at, etc. I understand these people are confused out of their right mind, they have no idea where they are and how they got there. I would probably try to punch a bunch of strange people in white scrubs if i didnt know where I was and they were trying to do things to/with me. Thats understandable....but it's still not my preferred area of work. Is that so bad? That even though i accept my future role as a nurse, I still hate a big portion of it? I just pray, every single night, that one day I will find a job that I love...Truly love. I don't care if it has long hours and I am exhausted...I dont care about any of that if I can look forward to going to work, seeing my patients, seeing my coworkers and not dreading the entire thing. I firmly believe that if you are not *remotely* happy at your job, you have no shot at being happy in the rest of your life. Hopefully I'm wrong. Sure, you could still have a great spouse and wonderful children you love to come to, but a job you hate will eventually tear you apart and bring you down, and there is no way for that to not affect the rest of your life. I accept the fact that it is impossible (nearly) to get a job at 21 that I will love. Ok, i get it, I have to work my way up there. But if the rest of my life is like this...I dont know what to do next. . .