No, really, back off!

Me: frantically trying to figure out the mismatch between a patient and a case booking last weekend. Same patient name, just reversed, same birthday.

You: standing very very close to my left shoulder pointing out the obvious ‘This is not our patient’

Me: on phone with ED, trying to solve the problem ‘I’m working on it’

You:  who knows NOTHING about how to schedule cases or where to find patients in the computer ‘Why is this wrong?’

Me: ‘I’m working on it’

You: leaning closer, pointing your finger at the top of the screen. ‘look the sex is even wrong’

Me: leaning away from you, still frantically typing, aware of the patient, their mom, their dad, the anesthesiologist, the trainee nurse all staring at the confrontation ‘I’m working on it’

Me: what I didn’t say, at this company we do not point out what seems to be obvious differences in sex listing in the computer, didn’t you pay attention to the lgbtq presentations that have been going on for the last six months. Maybe they are in transition and don’t need to have it pointed out to a room of strangers. Oh, that’s right, you’re a bigot.

You: edging closer yet. ‘Is it fixed yet?’

Me: turning my head and whispering, sotto voce, ‘Please back away. I would like room to work.’

Me: looking at anesthesiologist, ‘Dr, I’m afraid I’ve had to repost the case and you have to re do your pre-op note.’

You: tsking ‘You’re always so disrespectful. You always have been.’ Loudly, so the family and the patient and the rest of the whole room can hear.

Me: hunching my shoulders, finally getting the case reposted and beginning the pre-op checklist.

You: FINALLY backing away so I can work. Sorting out the lines so you can whisk the patient away to the operating room. Without waiting for me to tell you that I have completed the check list and they are ready to go back.

You: Finally acknowledging the patient and doing the time out without me.

Me: what I do not say, ‘My God, really! In front of the patients and the rest of the staff.’

You: taking the patient through to the OR.

Me: smiling at the mom and telling her to come with me.

I walk her to the waiting room, explain the phones on the desk, explain that she will need to answer the phone when it rings, explain that we will take excellent care of her child and to expect a call soon. I explain to her, briefly, that the problem with the computer was that the case had been booked under another patient, who had a very similar name but that our focus was on her child and fixing the problem so the child could go home.

Me: not speaking to the CRNA for the rest of the night.

Me: rejoicing that the CRNA’s last day in my OR will be ten days from now. I can do anything for ten days.

Me: mentally planning the Ding Dong, Thank God She’s Gone party I will be throwing after her last day.

Haunted? Not really. Patients I carry.

I’ve been thinking and haunted isn’t the correct word. Haunted denotes that the memories are unpleasant and something to get rid of

A better phrase is the patients I carry. This is a less negative connotation.

The next patient I carry is a patient whose name I no longer remember. Which is an odd thing to think of.

She was mentally disabled, blind and deaf and lived in a local state hospital. She was near my age in numbers only, her mental age had been gauged to that of an infant. While we were caring for her she couldn’t interact with us. I imagine to her we were just hands out of the darkness. Although we tried to be gentle, how much did she understand?

She was so, so ill. No one knew exactly what was wrong? Just that she kept bleeding. There was no interaction, no this makes me feel bad, why is it happening? She was utterly passive.

She had no family that visited. Ever. But she was a full code.

I remember that all she was able of doing was laying in bed, her eyes closed.

I know that I was in nursing school at this time, so it was in the 90s. I was working as a telemetry tech/CNA in an rural community hospital. I was new to the hospital, new to patients who were less than 60 years old.

One night she arrested. There was a lot of blood. To me there was a lot of confusion. The code was called and the code team responded. I was hovering, waiting to be of assistance. The ED doc snapped at me to begin compressions. Why me, I have no idea. Apparently I took too long to step forward, an ICU nurse, who he may have been barking at, gave me a dirty look and began compressions.

I felt horrible. But I still stayed to be the fetch and carry portion of the code. But she still died.

It was my first code.

It was not a happy code. Are they ever?

After it was all done I was left with the body. I was to clean her and prepare her for the funeral home. I’m not sure if she was a coroner case. Even then I knew that an autopsy had to be done in the person had been in the hospital less than a day. But she’d been there a week.

The local priest came to bless the body. Last rites were of no use to her, as they are done with an alive person who can confess their sins, and receive communion and absolution.

He and I had a much needed conversation about her and about faith’s role in the hospital. He had not known this particular patient but he knew me from church. He asked me to say the rosary for her with him. I told him my rosary was at home, he offered me his own, a wooden well used one, and pulled out a plastic one for himself.

We said the rosary over my patient and he blessed the body. He told me that my presence was one of comfort for the patient, even though she had died. It was good that I cared enough to participate in the rosary for her soul with him.

And then he had to go back to the parish house and I had to go to my other ten patients.

He wouldn’t take his rosary back. I still have it, over twenty years later. The priest has himself died. I hope that the nurse who attended him at the end of his life was a comfort to him.

The lesson is there is room for faith at the hospital, but not as a leading force, but as a comforting one. Regardless of faith, my own or that of a different religion. All people deserve comfort.

 

What are you? 5?

This week some very disturbing information fell into my lap.

I was working at the desk when two techs started talking about their favorite nurses. Which is okay. It wasn’t me, but who cares.

And then the conversation drifted off into how they “punish” the circulators they don’t like.

What, now?

You punish a circulator you don’t like by not having all of the supplies you know you are going to need for the case. So you can make them run for supplies.

Oh, hell, no ladies.

In actuality you are punishing the surgeon because they have to wait for the supplies.

But most of all, you are punishing the patient. The patient who has given themselves over to our care and are TRUSTING us.

The circulators are there for the patients. They are not there to dance on your strings.

If I hear of this again, I will be going to management. This isn’t a step I take lightly but no.

Just. No.

This is why we can’t have nice things

Today was hard.

Today was busy.

From the moment I stepped into the OR core I was running.

Within two hours I had given two scrub breaks, a circulator break, and fetched a patient from the ED for an emergent case. It was 1520 and if we could get the patient over and prepped and the surgeon there we might make the 1700 cut off.

When the patient and her daughter and I rolled into the prep area the nurses looked at me with quiet desperation. I asked them if they wanted me to prep her.

They agreed and so I popped back into the prep room and told her that I was now her prep nurse, as I was wearing a different hat. She and her daughter laughed.

She and I did her pre-op checklist and she signed her consent. The surgeon came to talk to her and I took the opportunity to duck out and inform the CRNA that she was prepped and nearly ready to go back. She agreed and went to her room to do her interview. I checked in with the room and they were prepared for her.

I went back to prep to check on the CRNA’s progress and almost ran into her as she was entering the core, looking for me to do the pre-procedure time out.

Long story short, the patient was in the OR at 1600, antibiotics on board, H&P done.

And her case was completed at 1630.

Yay!

This was one of the only things that went my way tonight.

At the end of our last case, I was doing my usual end of case chores. Nothing on the floor, suction coiled up and discarded, keeping an eye on the field as I busied myself.

There was a clunk.

It’s an unmistakable sound, the noise a camera head makes when it falls to the floor.

The resident has dropped the camera, and was holding the middle of the cord.

I looked him in the face and said simply, “Don’t do that.”

With that I put gloves on and picked up the camera head, coiling the cords neatly, not looking at him.

People!

That’s why we can’t have nice things.

Haunting patients 2

After I hurt my shoulder, had surgery, lost my scholarship, and I had to leave school, I had to rehab my shoulder and go through a second operation when the first didn’t do the job, I had to get back into nursing. It was what I wanted to do.

I considered all sorts of foolish options. I had heard the LPN test could be challenged but I had little practical experience. I considered become a housekeeper at the local hospital but they never returned my calls.

I took the exam to become a certified nursing assistant and I passed. The only job I could find was as a night CNA at a nursing home.

That is where the next two patients became my shades.

The first was a right amputation below the knee. She was not unlike the first haunting patient in that she was jolly and wanted her caregivers to smile. After four months she became very sick and I became aware that she was a DNR, a do  not resuscitate. This was foreign to me, and after research, I found out that of the four halls in the nursing home, three were filled with DNR patients. The other, the blue hall, were patients who were in the nursing home for rehab.

She got sicker and sicker, her abdomen swelling and the abdominal pains coming more and more often. One night, her CNA came to me and told me that she had died. None of us knew what she had died of, none of us knew her diagnosis. That CNA and I were to pull her curtains and prepare the body for the funeral home who would be before dawn.

This was my first patient who I had been close to who had died. She and I used to talk books and Reader’s Digest and she was dead.

She had died in horrible pain, and black blood spilled from her mouth onto her hospital gown. Knowing what I know now I have an inkling to her diagnosis. And also, knowing now what melena smells like, and remembering the blood that spilled from her mouth as we turned her and bathed her one last time, I know that she died of an intestinal process. It could’ve been an  ulcer or cancer that had eroded in her gut. But she had died.

She taught me that a sense of smell was valuable, and once you smell it, you will know. As a young person, (23, a baby!) giving time to the elderly in the form of conversation around what she wanted to talk about, was also beyond worth. To her and to me, as I was beginning my health care career.

The second patient who died while I was a nursing home CNA died suddenly, without warning. Mrs. M was non-verbal, she was mobile, and she was always up at 0400. I imagine that her career was as a baker, or a teacher. I never knew, there wasn’t a lot in her chart and she couldn’t tell me. It was my job to get her out of bed when she got up at 0400, help her to the bathroom, and get her dressed. She would be brought out to the nurse’s station, freshly cleaned glasses on, hair neatly brushed and she would sit and watch us as we made our last rounds before day shift arrived and the nursing home woke up.

One morning, at 0515, she was sitting, as usual, watching us when she began to grunt and rock in her chair. This was not uncommon behavior from her. I was doing what little charting we had to do as CNAs, vital signs I think, and I looked up at her. She saw me looking at her and she smiled and rocked faster. She didn’t seem to be in any pain, and her grunting stopped. Imagining that she just wanted one of us to look at her, I went back to my writing. When I looked up, she was slumped over, glasses askew.

Dead.

Twenty years later, I think she had a heart attack. At the time it was shocking and I was left to wonder if she had been in pain when she began grunting and rocking that morning.

But she smiled at me.

She taught me that life can be over in a finger snap. I wish I had left off my charting and gone to her. But I didn’t know enough  yet to do that.

Between those two deaths I began to form my idea of a good death. I think people should not die alone, that there should be light, and all efforts should be made to make people comfortable.

Death is inevitable, but it should never be in the dark.

To thine own hospital be true

I didn’t mean to become that nurse. That elder nurse who knows everything and everyone.

That isn’t who I am as an introvert. As someone who is more comfortable with a patient under anesthesia and the rest of the team doing their thing.

I’ve been at my current hospital for 10 and a half  years. Yeah, shocks me too.

I’ve been here long enough to understand the building, even though it has been constantly under construction for five years. First room 5, then room 6, now another half of the hospital and a 7th OR planned to open this fall. And the 8th is a gleam in the administrator’s eye.

For example, I know when it has been very cold and we have an unseasonably warm day or two the chillers do not like it. Which makes the humidity in the rooms go up.

I know this, I’ve been through 10 winters here.

The new evening plant engineering guy,  he’s been here less than ten months.

And he looked at me askance when I told him the problem. And I reassured him that the humidity would balance out because I’d turned up the heat in the rooms.

Up goes the temperature, down goes the humidity.

Not sure if this is a thing about Southern hospitals or not.

But it is true.

As evidenced by what happened tonight.

The humidity in the rooms was 64%, too high.

So I raised all the temperatures and down went the humidities.

I love being right.

Haunted

We all have our patients who have never left our hearts, ones that when we remember them we think about our careers.

In his 2014 memoir, Do No Harm, Dr. Henry Marsh, a British neurosurgeon, discusses being haunted. Those patients that have taught us and will never leave us.

Over the next few Sundays I’m going to share a bit about the patients that haunt me.

My first patient, in my first hospital experience in 1994, was one of these patients. She was an older lady who was in rehab following her second AKA. It was with her that I performed my first bed bath, as well as assisting the physical therapist with her therapy. Despite her bilateral AKAs she was in good spirits, laughing with the other nurses and the therapist. She told me that life was too short to feel badly about things and if she could keep a smile on her face, surely I could as well.

First lesson, be positive.