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---


-WNB




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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

Ho Hey

I. Am. Totally. Completely. Madly. in. Love. With. this. SONG.


Repeatrepeatrepeatrepeat. LOVE IT. Can we say just adorable!

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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