Vegetables at Home

The other night at work, I was taking care of an elderly man in his 80s. Like it so often happens, I often end up having heartfelt conversations with patients around 3-4 AM. Some people may think that just because I work nightshift, I never see my patients, because they sleep the whole time. Not true. They sleep 25% of the time, lol. In reality, I spend a lot of time with them before they go to bed, from when I come on at 7pm to 11pm (about). I get to put them to bed, which can be quite a personal thing- I am involved in their routine on a nightly basis. Then, once they go to bed, I see the average patient even 3-4 times after that. Either they need pain medication, need...anything, they need their vitals attended to because they are out of whack, or they need assistance to the bathroom.

So this patient was having a lot of gastrointestinal problems, so I was in with him a lot helping him to the bathroom. After one of his trips, he was feeling sentimental and we got to talking. He got to telling me his life profession, about his wife whom he's still happily married to, his friends, what he does per daily basis in his retirement. He was telling me how upset he was that he's never been sick his entire life, and then now in his retirement- the time he's always envisioned being able to enjoy- he's sick now. But then he got to telling me something, something that he probably didn't even realize made me think so much.

I've heard this a lot from patients, especially my elderly crew. They are worried more about their home life, more so than the fact that they are sick at the moment and in the hospital. They are usually worried about their dog, cat, etc., or worried about their spouse, or the mail, etc. But for some reason, this guys stressor made me so sad.

He was so worried about his vegetables. He was telling me he has been working on a full garden at home for years now, and how his wife was now alone at home. He said she wouldn't be able to drive his truck down to the garden and pick his vegetables, and they would go to waste- Even though she told him she would try. He didn't even want her to try, because he didn't want her to hurt herself.

Now you may think, why is this such a big deal? But the look on his face, the sorrow....he was so incredibly upset, to the point of almost tears, as he said "those tomatoes were just about grown too, they were going to be perfect....and now I'm in here. You know, I try to feed all my friends? Some of my neighbors and friends, I give them my vegetables because I have so many, and they are so poor that they rely on my garden. And now I'm here and can't be in my garden."

These kinds of things are hard for me to hear because as a nurse, I can't help them on these problems, whats making them so sad. I can treat pain, I can treat upset stomachs, I can treat mental conditions, I can treat infections, I can treat electrolyte imbalances, I can treat chemotherapy side effects, etc. But I can't go to my patients home and pick their vegetables or feed their pet, or make sure their spouse is OK. It breaks my heart. I am the type of personality where I want to fix everything, not just in nursing. When I'm in a relationship, I want to make that person completely happy. I can't  stand for my boyfriend to ever be upset- I do everything possible to turn the frown upside down, if I can't help it. And it kills me if I am ever the cause of someone else's sorrow.

I had a patient tell me a story a couple of weeks ago. There was a time where my patient that I was taking care of at that moment, her husband was in a nursing home while she was still at home, by herself. I guess conditions warranted that either family wasn't close by, didn't care, or family didn't exist, so it was the two of them. Well she went and visited her husband every day in the nursing home. Well one day she didn't come visit. The husband knew something was wrong, he told a nurse. The nurse shrugged it off, figured he was getting confused or the wife was just busy at home that day. The next day, she didn't come again, he told another nurse. She did the same thing. He began telling some of the other residents, and they backed him up- telling the nurses that the wife does exist and she hadn't been there in a couple of days. Eventually, one nurse decided to go above and beyond her call of duty. She remembered seeing the wife at one point. She found the patients home phone number and called the house, there was no answer. She called again later in the day and there was still no answer. She decided to call the police, and asked if they could please go check it out. Turns out they found the wife in the basement on the floor, she had went to get something and tripped. She was alive but had spent 3 days on the basement floor with a broken hip...Obviously the police saved her and sent her to the hospital, but ultimately, that nurse saved her. That nurse went above and beyond her call of duty to help her patient, the husband that she was taking care of. She saw the whole holistic picture, what was making him so upset. She fixed it and I think that's amazing.

So my patient was that wife, a couple years later and she was telling me that story. She told me how she survived by crawling to where she knew she had saved food down there, and fought through the pain, and some other....unpleasant survival techniques- being that humans have body systems that need to be relieved. It was so sad, but inspiring.


Well that's it for today folks. To all my other nurses, just remember- there will be things you can't fix sometimes. But what you can do is be there to listen. Sometimes that's all that your patient needs. So often does the nurse treat the body system that needs attention, and then they leave. Sometimes we have to leave because another patient is critically ill....but other times....not so much. Just always remember the psychosocial aspect of your care plans. See the whole picture. It will make you so much better of a nurse...



- A Writer in a Nurse's Body



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Week Two as an RN: Getting my Legs

Would you believe I have seven blogs in draft mode that I've thought of in past week, and this is the first *spare moment* I've had to sit down and even start the first one? (This one). It's been absolutely insane!
Well, I survived week number two as an RN, and boy..........have I learned and done a lot. Tomorrow it starts all over again, three more days. This past week I've had a very interesting set of patients, as well as having practiced continuity of care. I started the week with two patients and kept one of those two for the whole three days.


I ran into a lot of problems, but was able to solve them. I'm running head first into a lot of "oh my god I can't handle this!" type moments, but the important thing is learning that they ARE going to happen everyday no matter what and no matter how experienced you are. The important thing is to take a deep breath, close your eyes, reprioritize, and get right back to it. As long as you constantly reprioritize and act with the best intentions, you can't go too wrong.


So that was my second week. I missed things, yes. Things fell through the cracks. But as the week went on I learned from those fallbacks and made sure the next day to not let it happen again. As much as I hate making mistakes, in my opinion-bring on the mistakes now while I have a preceptor (rar!) who can teach me the right way, rather than in a month when I'm on my own on nightshift. The worst thing you can do, and something I am faulty of, is trying to figure out something on your own. The hardest (and easiest, sorta) lesson to learn is knowing when to ask for help. To put aside your own pride and dignity for your patients sake and safety.


Its funny, those frazzled moments....You start off your day with everything calm. You get there, get report, organize all your papers, make to-do lists, draw up your AM meds, do assessments....and for the most part its pretty calm. But then, then the frazzle moment happens. Its been a different time of day each day so far for me. Sometimes its 10am med pass, sometimes its a random point in the day at 2pm, or sometimes its right before we leave, in the evening. The frazzle moment is when you HAD a plan, but somehow that plan was thrown out the window, and replaced with four new plans, and everyone needs you to do something. But not only do they need you to do something, but they ALL need you to do it right away. And its hard to prioritize when they all want you at the same time, and you have to figure out who to make wait and who can't wait.

But, talking with my staff development educator after one of these frazzle moments helped me learn something else: Knowing when to delegate!  I explained to her that I was having a hard time with that, because the aides on the floor are my friends, and its hard going from working with them to now telling them what to do. She noticed I was having a problem because I was trying to do everything myself for my patients. Things aides can do, and my own nurse work, and thats where everything was getting to be too much. So, have to work on that.


But, I'm really excelling in my skills. The hardest part so far has (still) been communicating with doctors, and prioritization. But, that will come. Every day I learn something new! :)


So, exciting news?? I got in my first IV!! on the FIRST TRY!! WOOT!!! It was pretty amazing, and I really had to restrain myself from literally jumping and doing a dance in front of the patient, but I refrained because I didn't want to further help clarify that it was my first time. I think she was already nervous enough as it was. But yay! But despite having done one once, I'm still nervous for # 2....Is that normal? :\


Needless to say, There has been a LOT of prayers coming from me this week. I have levels of prayer...some are just mere wishes, like, "I hope the cafeteria has chicken sandwiches today".....and some are level 1 prayers, like: "please let me have a good day today." Level 2 would be, "please let work, please let this work!"  and the ultimate......Level 3: WHen you hear the beginning sound of a code when you're on your lunch break, "For the love of GOD, PLEASE don't let that be my patient!"


Lets just say a lot of Level 3's have been entering the prayer (center? Receiving area?) from me.



But eventually they will fade. In a couple years, I won't need prayers answered, because I will know how to do things myself rather than rely on chance and fate.


Also, I got to use my "therapeutic communication" skills (or lack thereof, I really don't know). I was sitting at one of our more secluded nurses stations, by my section of patient rooms, and a woman (visitor) came outside of a room.  I looked her way, we made eye contact, I smiled, and went back to charting. But then I registered that she was crying. I looked back and asked if she was alright. She nodded, but clearly wasn't. So, even though she wasn't in my patient section, I'm not about to just continue sitting there while she cries in the hallway. So I closed my charting, walked over next to her and told her that although her loved one was not on my patient section (and therefore I couldn't answer any questions) I'd be more than willing to sit and talk with her if she wanted. She agreed, and explained to me why she was crying (it was a really sad story :( ) and so....with all this sadness..I didn't know what to say, but who does? I tried to remember all the things we learn, that silence is golden, and people like hugs....So I tried to just stand there with her and not say anything, and when it was time to say something, I just tried to say encouraging words and encouraged her to talk more. Hopefully it helped some and I wasn't an intrusion.




So, here's to a new week ahead! The most important thing is to learn from my mistakes and learn something new every day. :-) I need to invent a portable screeen of some sorts that follows me around and my tasks to do get added to it and things that ive done get added to it on a time schedule, results come up right away, orders.....and so when you do something on the to do list, you can virtually cross it right off and the computer prioritizes for you whats next. We could all be super-nurses! Until the machine breaks....lol.




With much love, WNB.



PS- I have like eight more posts to write, so keep an eye out for them coming up soon!



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Sometimes, You Just Have to Nod & Smile...

So here's how it went down:

patient calls call bell. My coworker answers bell. Patient is normally very nice, alert and oriented to person place and time.
Coworker comes out.
Me: What did he want?
CW: *puzzled look* I don't know...Something about his input and output, and garbage and input again... I don't know.
Me: Hmm. Thats weird.

*an hour later*
Patient calls again. I answer this time.
Me: Hi, Mr. Patient, How can I help you?
Patient (on verge of tears): Everybody thinks my input is my output and my input is garbage and everyone is throwing my output away.
Me: Um,...*silence*...
Patient: *waiting for a response*
Me:  Well, Mr. Patient, what do you mean by input and output?
Patient: I mean my input and my output and everyone thinks it is garbage but its not!
Me: I know its not garbage. No one thinks it is garbage.
*Silence*
Me: Are you concerned about your foley catheter?
Patient: *looks at catheter*...No, you emptied that.
Me: *nods*
Patient: Everyone thinks my input is garbage on my table and is throwing it away. And my output.
Me: *Looks at table* Mr. Patient, I can assure you- No one is going to throw any thing away without your permission. No one thinks any thing of yours is garbage.
Patient: OKay. I Feel better now.
Me: Okay, well- Goodnight. Try and get some rest.
Patient: THank you for listening to me.



Weirdest conversation I have ever had. I guess that just proves that "therapeutic communication" that we learned in Psych really does come in handy, even if you have NO idea what you are talking about with the other person....


~WNB

Suicide: What to say?

Yesterday I spent 4 hours with a patient that wanted to commit suicide. At first I was afraid to go in there because I had heard that once you went in, she wouldnt "let" you leave. But, when I am in the hallway and someone like this is ringing, I cannot not go in to help. Sure enough, she starts telling me about why she has been admitted to the hospital and that she might never walk the same again...and she is normally very athletic. She said more than once to me, that she would rather die then go on one more day like this.

Now, in nursing school, we have had countless lectures in "therapeutic communication" and what to say and what not to say but when put up in front with a patient that is confiding in you all this very personal information about her life, and bawling her eyes out, I am speechless of course.

I am not the type of person to come up with countless corny phrases that these people don't want to hear. "It'll be OK." "This too will pass" "You'll get better soon" "don't lose faith"....they've heard it a thousand times from people like me who are also speechless and come up with the first line in the book and duck out of there. I am also not the person that can just leave people alone that are like this. So here I am in this awkward position where I am sitting there thinking of something to say as she tells me her life story and is crying her eyes out. I hand her a tissue box. I hold her hand...She gives me hugs. She apologizes...I say not to.

What else can I do? I definitely do not feel I am the right person for this...I don't know what to say to people that do not want to continue living there life. I firmly believe that if someone is truly that miserable, then who are we (doctors, nurses, parents, friends, etc.) to stop them? The best we can do is be there as a light at the end and offer our hand in help. But putting them in a psych ward to be babysat so they don't kill themselves? Seriously? I cannot offer words to tell people why life is worth living...Because I don't know why. I am 21 and haven't yet found this reason. I have my own reasons why I continue on, as everyone else. I am not nor ever would be afraid to die, but I know that when I do die, I pray that I will have at least published a novel first...Thats why I live my life...To write...to do photography...to change peoples lives.

I desperately want to be the "hero" nurse that can change peoples lives like my patients yesterday. I want to say the right things...I want them to feel better. But I am petrified that they can see right through me...can they?

I came very close to offering her the number for the suicide Hotline. But I was afraid that would be considered out of line, for someone in my position. Instead I tracked down the Reverend working in hospital and asked if he could speak to her. I also told her nurse who got the therapist. I later went in and she again apologized for breaking down like that, and I again told her not to be sorry...That was what I was here for. She thanked me and I moved on...

I hope I did the right thing. I really do want to learn how to talk to people like this...How to better talk to people in general..I have always had a problem talking closely to people....

I give 1000,0000, 000 props and kudos to the volunteers that work at those suicide hotlines that can stay on the phone with people for 3+ hours and convince them not to kill themselves. They are heroes.

~A Writer in a Nurses Body