What patients teach us

Before I was a registered nurse, before I was an OR nurse, I was a CNA. And I worked in two places: a nursing home and a hospital. In the hospital I floated between two units: the medsurg floor and the skilled nursing floor.

All the while I was rehabbing my shoulder and looking to get back into nursing school.

Always one to look for the next opportunity I jumped at the chance when the medsurg floor was looking for an evening shift teletech. It would mean more structured days, it would mean more learning, it would mean also sometimes stepping into the CNA role.

So I applied and got it. This was in the nascent computer charting phrase. Yes, we had computer charts, but only for narrative nursing  notes. The orders and the MD notes were still done by hand, to be transcribed into the computer ordering system by the teletechs. The nurses validated our work, but we were the ones that inputted them.

Yes, that is one of the reasons I say I read scribble. No, the doctor’s handwriting thing is not a joke.

And while this was going on, the orders, and the CNA work, I monitored the tele machine. That means I watched all the different hearts on monitor and alerted the nurse when there was a problem.

There was one patient, who was still tele, with all the chest pain standing orders, with all the monitoring. However, this patient had a rare DNR order while on tele. Do Not Resuscitate does not mean do not treat. All of his needs were met, including the antibiotics for the pneumonia, but he didn’t want to be shocked, or CPR done to  him. This was his choice.

He was dying and he knew it.

And me, out at the desk, knew that he had a DNR but the nurses still treated his chest pain, and infection.

He had a pacemaker that had a low threshold of 60. That means that if his heart was beating above 60 it wouldn’t fire. But if his heart went below 60, the pacemaker took over.

One night, late, his tracing started to look different. Where before there hadn’t been any paced beats, now it was one out of ten. I alerted the nurse and she went in his room. By this time we all knew that his death was imminent. His family had come and said their last goodbye, his doctor was just waiting for the phone call.

His paced beats became more frequent.

And then the paced beats stopped capturing and all there was was the pacer trying to coax the heart back into beating. With no electrical response from the heart.

I couldn’t turn off just his line on the monitor. I had to get the nurse to disconnect the tele box.

But until she did it was sad, watching that pacer try to restart the man who had died’s heart.

What I learned from that is that technology, as magnificent as it is, doesn’t really hold anything over the body.

 

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