Not in My World

So this post is about an issue that has come up recently in my little nursing world. Very recently, only over the past week have I noticed it but it's happened 5-6 times in separate instances...


So in case you don't know my nursing history, I was an aide for five years until I graduated nursing school and was hired, at the same hospital as an R.N. For awhile I struggled accepting the differences between being a nurse aide and a registered nurse. I couldn't grasp the fact that now I had to delegate tasks to my coworkers that used to be the same position as me, but now they were beneath me. I knew how busy they were because I had been in their exact shoes. So I became determined to always try and do everything myself and only ask for help from the aides when my patients safety depends on it.

Then this year I came over to a new hospital, where it was a little easier to accept the boundaries between being an RN and the aide. I respect my new aides very much and still always try to help them out, even with patients that are not my own. I try and only ask for help when either I cannot do it or another patient needs me more or I just need an extra hand in the room.

 But recently, my patients (like I said, 5-6 different patients within the past week) have done something peculiar.

I go into the room to do my nursing assessment, or perhaps give them a medication of some kind. This one patient asked me the other day, "Do you have CNAs (nurse aides) or something?" I said "Yes, we do." She said, "Can you please send one in when you have a chance, I need some ice water." I looked perplexed, I  said back- "well I can certainly get you some ice water, I'll be right back." and she quickly said, "No no, you're the RN, you have much more important things to do. Send a CNA in." This was the first time I had ever heard something like this. I assured her I had the time to do it and I wanted to get her ice water and that I did.

A couple of other patients have done the same thing, and its only been recently. A male patient I had last night spilled a drink of water and needed a new set of napkins, and a towel to clean up the water. I said "sure, I'll be right back" and when I got back, he said, "you didn't have to do that, that is dirty work, i know you have more important things to do."

I looked up at him , almost incredulously- as this was the 5th or 6th this same instance had happened with other patients, and I assured him that helping him and making him feel better in any way was just as important to me as anything else. I don't mind doing anything, that is my job-regardless or not if it can also be the aides job. In fact I think I think it's even in my hospitals nursing policy that we do not leave any room without making sure the patient has everything they need and they are happy. If they aren't happy, we need to find a person with different capabilities that can make them happy. I don't know why my patients have gotten it in their head that the RNs are "better" than the aides. We aren't better. We just can do different things for our patients. Just like I don't necessarily consider doctors "better" than RNs, they just do different things. Sure, I respect the doctors I work with and they are obviously a vital part of health care. But so are nurses. And so are aides. Ok I've gone off on a tangent.

Anyway, my boyfriend has puppy eyes and is staring at me over top my computer screen waiting for me to finish, so I'm wrapping this up. Sorry for the short blog, I just wanted to write about it since its happened so many times recently....and it just doesn't fly in my world.


With Love, WNB



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Gingerale is a Soda, Too

Hey everyone!

So I wanted to do a little piece on patient education, something that has been irking me a little lately while on the job.

When I was in school, patient education used to scare me. I used to think, how can I teach a patient about their health condition when I barely know anything about it myself? Sure, I can research it and tell them what I learn, but what if they ask me questions? What if they find out I know absolutely nothing and am therefore incapable of being responsible for their lives during my shift??!

Okay, maybe thats an exaggeration . But regardless, I still got scared about the thought of effective patient education one day. I never dreamed that one day it would actually come naturally and I would find myself automatically in a "patient teaching" moment that I didn't even have to prepare for. Which has happened many times already, so awesome!

I always used to think I would enjoy teaching patients about something I knew a lot about, because obviously its easier to teach. Well, I was wrong. About it being easier to teach.

Every single time, it baffles me to no end how much the general public does not know about health and medicine. Granted, I don't expect you to know a single thing about a condition we just diagnosed you with. But a chronic condition you've had for years....Is it so wrong that I expect you, as the patient, to know a little bit about your disease/condition? At least a little?

For example, very recently I have had a patient of mine for about 11 days, in with migraines. Elderly lady. Used to suffer migraines years ago, they went away, but all the sudden they returned with a vengeance, which-naturally-worried her, being in her elder years. Brain tumor? Stroke? Brain bleed? Heart attack?

So she comes in and we run all these tests, basically to rule out a stroke. All negative. Not finding anything. So now we are left with the epic neverending pain management for migraines.

So we try morphine. Doesn't work. Try imitrex. Worked, but they came back. Tried DHE, a special migraine treatment. Didn't work. Tried dilaudid, which works but the headaches come back. We tried IV Thorazine, a powerful anti-psychotic also known to treat headaches. Nothing. The headaches would go away and then come back with a startling vengeance.

So, on her eleventh day in the hospital, she was having this return pain problem and wasn't getting any sleep for me. I knew her well at this point (that tends to happen when you have her for eleven days), so I pulled up a chair and had a serious talk with her about migraines, at 4:30 am. Now, this was about a week ago so I'm going to paraphrase a wee bit, but this is a little bit how our conversation went:

Me: miss migraine, I was thinking. You've been getting these headaches and were giving you some pretty powerful pain medications. Then they go away, but they come back. So that leads me to believe that there has got to be some sort of trigger every time that causes them to keep coming back. So we have to find this trigger and delete it.

Miss migraine: okay.

Me: okay. Problem is, migraines are very tricky. There could be many triggers. First of all, let's start at the beginning. When these headaches came back again after all these years, had you just started any new medications?

MM: no.

Me: how about any new foods? Start using any new products, any new restaurants?

MM: *she thinks * no.

Me: okay. I'm going to go over some common food allergens that are known to cause migraines. Do you eat a lot of dairy?

MM: no, not really. I have a lot of stomach issues so I don't drink milk or eat cheese. Every once in awhile I eat yogurt.

Me: okay. How about alcohol use? Any red wines?

MM: no, I never drink.

Me: okay. How about chocolate?

MM: yeah, I like chocolate. My friend brought me a bag of M & Ms to eat while I'm here.

Me: okay well chocolate has been known to cause migraines. Maybe we should lay low on the chocolate for right now, and see how you feel.

MM: well actually I haven't eaten any in about a week, and headaches keep returning, so what else?

Me: okay, how about pig products? Pork, bacon? Ham?

MM: every once in awhile, not really. I cook a sunday dinner, sometimes with pork but rarely.
Me: okay, so besides the chocolate, you don't eat a lot of the big triggers.I also want to talk about dehydration. Do you feel like you stay hydrated?

MM: I always feel dehydrated- I can feel it in my skin. I try and drink lots of fluids though but none of it works I guess.

Me: okay. What kinds of fluids?

MM: well I like Sierra mist. So my son brought me a case of it to drink here.

Me: okay. How about water?

MM: yeah I drink water. But I like Sierra mist better, so I drink more of it.

Me: okay well, actually, the carbonation in soda can actually cause severe migraines in some people believe it or not. So I want you to try and stay away from the sodas for a day or two and see how you feel.

MM: oh, really? I had no idea. Okay,  I'll ask for a gingerale next time, I hear ginger is good for you too.

Me: ginger is good for you, but gingerale also has the carbonation and will generate the same bad effects the Sierra mist does. So how about we stick to water for a couple days?

MM: okay, I can do that.

Me: okay. I also want you to think about allergies. Consider seeing an allergist when you go home, they can help you pinpoint something specific that we talked about that you could actually be allergic too, and your manifesting it as a migraine symptom. I also want you , from now on, to look for patterns. Every time you get a headache again, I want you to think about what you were doing for the entire hour before hand. What you ate, drank, did, smelled, etc. it's helpful to write it down, look for repeats.

MM: interesting. No one has ever told me any of this before. I'm interested to try these things.

And thats basically how the conversation went. Yet another baffling case of a patient that suffered from chronic migraines, and yet didn't know the basics of what caused them. I figured out the basics of migraines before I ever stepped foot in nursing school, because it was something that mattered to my own health significantly.  There are many things that could be causing her migraines that I can think of, including :

- Food allergen (dairy, chocolate, pork, soda, etc).
- Environmental allergen (dust, mold, mildew, trees, pollen, etc.)
- dehydration (drinking too much sugar, carbonated beverages, not enough clear fluids (water).
- ineffective caffeine balance (too much caffeine or too little)
- possible gluten intolerance
- something more serious (chiropractic issue, osteopathic issue, brain issue, etc).

So All of this made me realize that I so desperately want two things.

1) I want to readdress my previous desire to go into a career of a Nurse Practitioner, specializing specifically in holistic practice and nutritional therapy.
2) I want to go back to school for a degree specializing in holistic therapy AND/ OR  getting my nutritionist certificate.

Is it so wrong that I think that I can help my patients already, with what little I do know, more so than any of these nonconclusive, expensive tests and ineffective pain management? I just think that if powerful pain medications like Dilaudid are only masking the pain until it returns, then obviously there is a bigger issue to address that maybe the doctor's aren't seeing. And do they think to send in a nutritionist? Dietitian? No.

I firmly, firmly, very firmly, believe that all patients need a BALANCE of holistic therapy and modern medicine. I obviously support medicine, being that i'm in the center of it. I participate in it as a patient and as a nurse, I administer modern medicine and practice. However, I believe there is a line to be drawn that hasn't been drawn yet. I believe modern medicine has its place, and is very important in some cases. There are some conditions that can be *helped* by nutritional intervention and herbal remedies, but will never truly be cured without an antibiotic, antiviral, surgery, etc. You can't cure cancer by throwing vitamins at it. I get that. But making a patients life significantly higher quality after surgery/chemotherapy and perhaps extending life with the right nutritional intervention? Yes.

I want to be a holistic practitioner, but more importantly I want to remain on the realistic side of it. I don't want to lose the realism that modern medicine still deserves its place. I feel that many "holistic people" shun modern medicine 100% and it ends up being their downfall. Then, other people blame these people for killing themselves because they stuck with holistic therapy and didn't "go to the doctor". Thats not the right way to do it.

Instead, I feel holistic therapy/ nutritional balance is needed for problem prevention. For maintaining patients at a healthy, happy, normal baseline. To help patients deplete harmful substances, practices and carcinogens before they create the problem that needs modern medicine. Get it? I want to always be smart enough to know when to *give up* so to speak, temporarily, and send my patient immediately to an emergency room. Of course, the nice thing is- once I send my patient to the hospital and they fall into the pool of modern medicine- I don't lose them completely. From what I understand, if I choose to set up a partnership or work for a hospital that tolerates and accepts holistic practitioners, then I can follow my patients into the hospital and still maintain my nutritional and herbal interventions so that I don't have to start at square one, and yet the patient can still have necessary tests run, lab work done, etc. Its a win-win.

I just wish I knew how far down the rabbit-hole was acceptable to go. Lately I have been experimenting with a sugar-free diet and yeast-free diet (thats another blog post completely). But that means I am dairy free, sugar free and yeast free, chocolate free, tomato free, butter free...and the list goes on. But I have strong reasoning behind all my choices, but I get it that other people must think I'm a "crazy health freak".  I wish wish wish I could help my friends and family make the same choices as me, and I often have to restrain myself from taking soda or a glass of milk out of my friends/families hands. I cringe when I see billboards for milk still.

This is all a simple problem mostly dealing with self-restraint, but the true problem arises when I'm at work. Thinking back to my patient described above, how much can I really delve into the world of migraines, when everything I have to say is holistic intervention?  Legally, I canNOT say (but would LIKE to):  " Miss Migraine, we are not doing anything for you here. These tests show nothing, this pain medication is actually hurting you more than it is helping and you need to get out of the hospital. You need to go see an allergist and at least a dietitian."  If I said that, I could and probably would lose my job if that patient then in turn said that exact thing back to the doctor. That wouldn't go over well. So how much is in my official range of practice? How much can I tell patients based solely on my own experience and reading, without backing it up with hospital paperwork that doesn't exist?

What I truly want and need here is a hospital that is solely- holistic based. They treat all patients with nutritionists and dietitians first and foremost. They prescribe herbs and understand them greatly. They prescribe drug medications only when extremely indicated, or holistic interventions not working. I wish I wish I wish....maybe, one day. I just wish doctors believed. The problem is more often than not, modern medicine is at war with holistic therapy. When Patients are curious about turning to holistic therapy, they ask their doctor first. Unfortunately more times than not, thats where it stops. The doctor shoots them down immediately and says that is all "hosh poosh" and never works. Its never backed up by clinical trials. It could kill you.  *slam face against wall now*

What we need is a society where the two realms of practice work together, that is all. A balance, not a war.

My lifestyle practices will never change and will definitely be a part of my future children's lives. I hope to find a husband that either will adopt most of my food choices or at least is willing to work with me and not feed anything to my children that I choose for them not to eat. Is that completely psychotic? I just strongly believe children should never grow up on milk, artificial flavoring, sugar (too much)...I hope that doesn't make me psycho. I hope more people catch on to what I've realized about the American food industry and more people start doing something about it, soon. Because its slowly killing us.



THanks for reading this abnormally long blog post, and bearing with me. Much needed post to get off my chest!

With love,
_WNB

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

Call Me if You Need Me

Hey Everyone! Its been a pretty insane week, I just pulled through 3 twelve hour's, one night off (last night) and have three more to go starting tonight. Yay! And I just started the inevitable daunting night shift this week, as well... So, I'm tired. But anyway, my hospital is starting a new approach to patient satisfaction, hourly rounding and reducing number of call bells. As many nurses do and all nurses should be doing anyway, hourly rounding is supposedly the key to making patients and nurses happy. As nurses, we naturally are in the room almost hourly anyway, but our new approach is to make it obvious with our wording, and say "Hi, I am doing my hourly rounding, Can I get you anything? I have some time." I think this is great. It does make the patients happier and they don't feel like they are bothering you if they do ask for something, especially with the "I have some time" thrown in there at the end.

At the end of our interaction at hourly rounding, we are supposed to say, "I will be back in a couple of hours to round on you again." We are not supposed to say "Call me if you need me", even if we tack it on to the above said phrase. Supposedly if we say this, it invites patients to call if they need something in the middle of the rounding cycle, and therefore there are more callbells to be answered. Whereas if we don't say it, Patients are more likely to group all their requests together and wait until we come back for rounding to have all their requests completed and questions answered. This is supposed to give nurses more time for attending to more complicated patients, emergencies, charting, etc.

Now, I have been trying really really hard to adapt to these phrases our hospital wants us to use. I try to work them into my interactions with patients without sounding like an automated nurse robot. However, I cannot seem to not say "Call me if you need me." I try, i do try to not say it, but somehow to me It just feels so wrong. Although yes I see the benefits for the nurse, I feel like my patient would feel like they cannot call me, and they must wait for hourly rounds to get something from me. I want patients to feel comfortable and call me if they need anything at all. I think hourly rounding is highly beneficial as well, and I don't want to ONLY say "call me if you need me" because then that dips the patient on the other side of the spectrum and they feel like they are alone and will never see you if they don't call for something. Then they call for every tiny request because they are subconsciously checking to make sure you are even still on the floor with them, especially overnight when not as many people are walking through the halls continuously. No one wants to feel alone while in the hospital.

So basically, I am happy saying to patients, "I will be checking in with you hourly throughout my shift but feel free to call me if you need anything in the meantime". It may not be fitting with my hospital policy, but it is fitting to my personal morals. I feel like the above said phrase lets patients know that I will be checking in hourly, and that they are not alone, but also gives them comfort that I am only a call button away.

There is a high possibility that I am wrong about this. I am a brand new nurse and still have a LOT to learn, not just skill but in communication. Maybe in even just five years I will look back on this post and think, hourly rounding is better without throwing in the "call if you need me part". Maybe I will see the true time saving benefits of doing so. Who knows. Fellow nurses out there, what are your hospital policies for rounding or key phrases? Do you agree or disagree with not saying "Call if you need me?". I just can't seem to not say it!  :-\



Sincerely, a Writer in a Nurses Body


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Ohhhh, the Agony.

Dilaudid. Percocet. Morphine. Fentanyl.

The four most common painkillers I've seen thus far administered to patients in my hospital. I have never taken any of the above, but supposedly, they work pretttttty well. I've seen many reactions, some sleep for hours and hours, some go into la-la land and act like they are 5 years old and don't remember any of it, and I had a patient yesterday who went from being a not-so-social elderly gentleman to a guy that suddenly was talking my ear off, thanks to dilaudid.


In this day and age, hospitals are so drastically focused on their ratings, their scores. With so many hospitals being built in this day, patients now have the ability to choose (if they are lucky and its not an emergency) where they would like to be a patient. Smart patients check the hospitals scores before they choose. How does this hospital score in cleanliness? In nosocomial infection rates? In service? In food? How about pain management. Well, lately hospitals have been noticing a decline in scores because of one thing: Lack of effective pain management.

Okay, so then what? Well, hospital management teams revolutionized their thinking. We know now that a hospital is a business. Patients are the "customers", and as the old saying goes, "the customer is always right". So in our book, the patient is always right. This has been brought down to nursing care so much so now that we are trained to always ask about pain. We ask when we take your vitals. We ask when we stop in on rounds. We ask when we take you to the bathroom. We ask in the middle of the night when we switch your IV bags. We ask so frequently that sometimes I think we plant it in your head that you do in fact have pain!

I'm all for effective pain management.  No one should have to bear unmanageable pain for any length of unreasonable time. But sometimes we as nurses (and doctors) will never truly know if you are having pain. I have had many different types of patients: Those that I think are in true pain but are too proud to admit it and needing a painkiller, those that I doubt the true pain and yet are on the clock the minute they are due for the next dose, and I've had patients that fabricate ailments just to get a pain medication ordered. The other day I had a young gentleman as a patient with a bad case of cellulitis. It really did look painful. He had Morphine and tylenol ordered. He started complaining of pain, and I asked- Do you want your morphine or tylenol? To be honest, given his age, I half expected him to answer Morphine. But he actually said- "I took morphine last night and I don't want to overdue it. So I think I'll go with the Tylenol today." I was pleasantly surprised.

The other week we had a patient on our floor that, in the middle of the night, complained of awful pain in her chest. Being chest pain, of course we have to go through all the steps to diagnose the cause of the chest pain. We need Oxygen, we need chest x-rays, we need respiratory therapists, we need doctors...etc. Well eventually they gave her Morphine and she was as happy as a clam, went to bed, and the pain never appeared again. Now, did she have the pain in the first place? Maybe. Probably. But who is to say?

Recently I had a patient who was addicted to Fentanyl. So addicted in fact, that she overdosed. While in our care, she also came down with severe chest pain, and shortness of breath. Well, her team of doctors were hesitant to give her anything too powerful for the pain because of her history of multiple opiate addictions. However, what if the pain really does exist? We couldn't let her suffer either. So, we found a painkiller that is effective and less addicting (much to her dismay- she was after Dilaudid) and ran a chest x-ray. Turns out she had a pretty bad case of pneumonia, so the pain really did exist.  

I've had patients that are fine all day and then when the doctor comes, suddenly they are keeled over in bed and in agony, asking for pain medication. And then the doctor leaves, and then they are on the phone talking or watching tv.  And the best we can do, as nurses, is to therefore document what we see, what we observe on the patient, all day. The doctors read that. They read when we write, "patient resting comfortably in bed, denies having any pain", or "patient complaining of severe pain in mid-upper back". And its critical that we document that we followed through with that pain, and document we gave them something and what the reduced pain level was after. Its all about documentation.

Just a year ago, when I spent a week in a hospital myself, I was having some severe migraine pain (thanks to lack of sleep, stress, anesthesia recovery, etc). Well, they gave me a medication for the pain called "Toradol", which, is one of the ones that is pretty strong but not addicting. I guess given my age, they went with that because it was less addicting. However, I didn't even know anything about Toradol- all I knew was that I was in pain, and that helped the pain. Did I want the toradol when I wasnt in pain? No. Did toradol make me feel like I was on a cloud? No. It made the pain go away. Thats all I wanted, and thats all I want for my patients.


I've also encountered the situation many-a-times when a patient is dying, like literally on their death bed, and are in a lot of pain. And then the doctors are afraid to give powerful painkillers because they are "addicting". That drives me crazy! So what! They are dying and are in pain! Who gives a flying shit if they will be addicted? It won't matter! Get rid of their pain for crying out loud, no one should die while in pain. They fight over that and yet give Fentanyl to 20 somethings. Go figure.

Just recently I had a patient with a severe leg injury that resulted in a very large hematoma that had formed into a very grotesque blister, bigger than two of my hands together. It looked really painful and I was constantly asking if he needed anything for that. I would have given him something in a heartbeat without question if he asked. And then we have the all to common patient with "invisible pain" (abdominal pain, headache pain, muscle pain, back pain,etc.) And I don't think they are lying, they probably do have pain. But it definitely is a fine game to play. They probably thought when I was in the hospital that since I was a young twenty something, I was making up the migraine and was looking for some painkillers while I was there.

So, just goes to show that there is no way to truly know. We as nurses want to give effective care. So if the patient is in pain, we administer pain medication. It is not up to us to judge whether or not they really do have pain or what their ulterior motives are, if any. We just make them feel better.


With love,

A Writer in A Nurse's Body