"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?"

Monday, September 24, 2012

That Defining Moment

As your nurse, there are a lot of things we know about you that you may not even realize we know about you. But we do. And that's just your history.

Sometimes (actually a lot of times) we also know your future.

We're just not legally allowed to tell you.

For example, last night at work I had admitted this really nice guy. Middle aged guy. No significant past medical history. Admitted for a UTI (Urinary Tract infection). In the ER he was complaining of some constant pain in the abdomen, they ran a CT scan to find out why, pretty common practice when someone complains of pain.

So I got to know this guy when he came to my floor. Nice, retired, family at home, typical.

Then in the midst of running around at my nurses station, I saw his CT scan report come up.

Now, 92% of the time, I'd say thE CT reports I see are all normal with minor anatomical differences. Doctors just order the scan to cover their license, pretty much. So I wasn't expecting much from the report.

But I found the worst, what we hate to find. Bad, bad news. Not definite bit probable malignant cancer, aggressive. I stood there reading the report, just steps away from this patients room, processing this information. The patient doesn't even know yet, that kept running through my head.

How could I go back in the room and keep my same happy face? I thought back to what I had said earlier, he told me about his abdominal pain and I said "well hopefully the CT scan will give us some answers".... I guess there's just no way to prepare patients for the worst answers.

He never asked me what the CT scan said, and even If he did, we're supposed to play dumb and act like we haven't seen any results yet.

The ridiculous part is that this guys admitting diagnosis is a urinary tract infection, something we can easily fix with an antibiotic, and he will be leaving with cancer. What if we had never run the CT? What if he never came to the hospital?

The sad part is, I have off for a couple days and most likely won't get to see the clinical progression of this patients journey, emotionally and physically, but we as nurses, know what's in store for you depending on what road you choose and its never a pretty road with cancer.

So, it's hard. It's hard to pretend like you don't know information that will soon change your patients life. I think that has got to be one of the hardest parts of being a doctor, telling people they have cancer. I can't even imagine.


Anyway, sorry for the extreme lack of posts. I have a lot stored in my head, life has just been over the top busy...

I'll write soon, with love---



Friday, September 14, 2012

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?