Duckie (affectionately named due to her silk pyjamas with yellow ducks on them) has an infected ankle. The hole is so deep you can see right into the ankle to the shiny metal that was put inside to stabilise it. She has a VAC machine on (a pressure dressing stuffed into the hole, attached to a tubes that sucks out muck while maintaining pressure on the wound base for healing..) and before becoming one of my patients was a very successful solicitor. Her sense of humour is quirky, and we often giggle and laugh at silly little things like my constant sneaking into the educators office to nick minties, the inappropriately timed sucking noise of the VAC that always sounds like someone farting.. or the way I always moonwalk past her room - just to get a smile.
A few weeks ago she was told she may have cancer like growths in her abdomen. She went for tests while the specialist went overseas. Once the results came back.. no one was here to deliver the news. Private hospital politics prevent another surgeon or doctor from reading a report to her and it is not the responsibility nor place of the nursing staff to deliver a diagnosis for fear of litigation if misrepresented. This took my fun loving and well coping patient into a spiral of anger, frustraton and fear. She threatened to rip the dressing off her leg and discharge herself immediately.. the director of nursing was called.. she was crying, swearing and for the first time.. completely and utterly vulnerable.
She had waited days, and suffered invasive testing.. all the while with the fear that she had cancer in the back of her mind and now the results were in.. and everyone was refusing to give them to her. Doctors were called and a massive fuss made. I was completely furious.
She cried, and I rang doctors, my boss called doctors and management and still, no answers.
I didnt know what to do. Sitting on the desk were the results. Clear. No evidence of cancer like tumours.
I did the worst thing possible professionally, but the only thing conceivable morally.
I told her, while explaining that I could be very wrong.. that the test stated there was no evidence of cancer at this stage. At first she just stared at me.. and then she whispered "thankyou". And it was enough to risk serious trouble for, to see her back to normal.
***
Wilma (I call her this because shes partnered with what shes named Fred - her IV machine) swears all the time (and it sounds even funnier because shes british). She had an infected foot and has recently had the metal taken out and the area washed out. She's on very nasty IV antibiotics and is nauseated all the time, so much so shes lost 20ks in 5 weeks. She's still abit tubby, she's jovial.. and rarely rings the bell even when shes got a seriously insane bleeding nose (Which of course results in stern words from me).
Her way of coping with being in hospital is to call it the Jenny Craig institution, burn lavender oil, put tinsel on her monkey bar.. and maintain some sense of ownership over her surroundings.
FRED, as I noted on a small piece of paper yesterday stands for (and this brightened up my day completely)..
F ucking
R idiculous
E lectronic
D evice
Sometimes people tell me that as a nurse, they admire me. That I inspire them.
I find this so weird. I just turn up, do my work and leave.
What I find inspiring is the attitude, the optimism and the sense of humour and creativity that my patients create and possess to pull themselves through the horror it must be, to be stuck in hospital.
In the ED I probably won't have the same opportunity to develop relationships with people like I have in my current job, and as the days creep past and my resignation date comes closer and closer, I can't help but wonder if I've made the right decision.
What will inspire me in the Emergency Department? What will make me smile?
What will keep me going back, day after day?
Thursday, December 14, 2006
Tuesday, November 21, 2006
Dr.W.
"Hi Dr W, I'm calling regaring Mr M - I've been handed over that he will be discharged either today or tomorrow, but there is no solid information regarding this, is he alright to go home today post his doppler scan if they are clear?" It was 11am, and I had nothing better to do than organise my patient's discharge.
"Aren't you leaving?? What are you still doing there?"
"oh for gods sake Dr, I'm not leaving till December! And I only told you I took a new job yesterday! Can we get back to the issue at hand please?"
Most people are too frightened to call Dr W. He is notoriously rude on the phone and often will challenge you for ringing him. I've had arguments over the phone with him that go much like this:
"Im calling re: *insert important health issue here*".
(very rude tone) "Sister, do you really think this is a good enough reason to be calling me?"
"Well yes. Otherwise I would not be calling.."
(tone increases in rudeness) "You know I come in everyday sister, could this not wait till then?"
"Well Dr, it's been 3 days so far since *insert important health issue here* needed attention, you came in yesterday and you didn't do it, so I am calling to make sure you do it today"
"No one reminded me to do it yesterday, sister."
"and thats why I'm calling you Dr. To REMIND YOU." (insert triumphant laugh here).
(defeated tone) "Thankyou sister."
(smarmy tone) "Thankyou Dr".
I've gone so far as to call him smarmy and arrogant, to which he states he is actually cynical and jaded. When he does something I don't like, I tell him I am angry with him and not to speak to me, and people often tell me that no one else gets away with talking to him like I do.
When its 7:20 and im starting my round still bleary eyed and half asleep, he will come in fresh faced.
him: "WELL, GOOD MORNING SISTER! AND HOW ARE YOU TODAY!"
me: "Oh bugger off".
He has the worlds most difficult patients, and usually the worlds most loveable. He will operate when no one else will operate and he takes on very difficult patients with very difficult surgeries.
We have a mutual understanding, that generally involves him trying to piss me off as much as possible, and me trying to persuade him to do things for my patients that he doesnt want to do.
He's an arsehole to almost everyone, and he's one of the characters of the private hospital I work at, that I will most definitely miss.
"Aren't you leaving?? What are you still doing there?"
"oh for gods sake Dr, I'm not leaving till December! And I only told you I took a new job yesterday! Can we get back to the issue at hand please?"
Most people are too frightened to call Dr W. He is notoriously rude on the phone and often will challenge you for ringing him. I've had arguments over the phone with him that go much like this:
"Im calling re: *insert important health issue here*".
(very rude tone) "Sister, do you really think this is a good enough reason to be calling me?"
"Well yes. Otherwise I would not be calling.."
(tone increases in rudeness) "You know I come in everyday sister, could this not wait till then?"
"Well Dr, it's been 3 days so far since *insert important health issue here* needed attention, you came in yesterday and you didn't do it, so I am calling to make sure you do it today"
"No one reminded me to do it yesterday, sister."
"and thats why I'm calling you Dr. To REMIND YOU." (insert triumphant laugh here).
(defeated tone) "Thankyou sister."
(smarmy tone) "Thankyou Dr".
I've gone so far as to call him smarmy and arrogant, to which he states he is actually cynical and jaded. When he does something I don't like, I tell him I am angry with him and not to speak to me, and people often tell me that no one else gets away with talking to him like I do.
When its 7:20 and im starting my round still bleary eyed and half asleep, he will come in fresh faced.
him: "WELL, GOOD MORNING SISTER! AND HOW ARE YOU TODAY!"
me: "Oh bugger off".
He has the worlds most difficult patients, and usually the worlds most loveable. He will operate when no one else will operate and he takes on very difficult patients with very difficult surgeries.
We have a mutual understanding, that generally involves him trying to piss me off as much as possible, and me trying to persuade him to do things for my patients that he doesnt want to do.
He's an arsehole to almost everyone, and he's one of the characters of the private hospital I work at, that I will most definitely miss.
Thursday, November 16, 2006
Perspectives..
First thing I noticed when I walked into work this morning was a message on a printed email from a patient's daughter. I had looked after this patient for the last week of his life where his lungs were becoming hardened and slowly decreasing in size, and he so badly craved breath that he was on a mask that pumped pure oxygen and then caught it again in a rebreathing bag so that no air would be inhaled. Just pure oxygen.
He was on a lung transplant list and this was his last chance. His whole family had moved into a house nearby to be near their father and kept a vigil at his bedside all night, sometimes with 4 of them sleeping in the room at a time. They were sleep deprived and they were scared. Their father was getting sicker and sicker every day.
Anxiety was gripping him with every breath and his intake of sedatives and morphine was increasing. Not enough to stop him breathing, but enough to slow him down so he didn't struggle with the fear of not having enough breath to survive. Fans were on and with every attack we - being his entire immediate family and myself - would fan him with a towel because somehow feeling air on his face and body made him feel that air was available, even if he couldn't breathe it in.
The doctor was refusing to inform the family that this man would die before getting the transplant and I was becoming increasingly pissed off seeing the family holding hope, having to encourage them to keep hope that any second those lungs could come in.
"There is a 20 year old girl on a ventilator in ICU in the public hospital who will get lungs before he does, and even if the match came in, he's too ill and far gone now to operate". This is what I was being told. Compared to "Anyday now, you never know. Just keep hope.. " was what the family was hearing.
The Dr and I walked out of the room after I called her in following a particularly nasty attack. "This man is dying", she said to me. I turned to her "Then maybe you need to tell that to the family". Immediately his daughter comes out in a florrent of tears. Almost pleading, begging with the Dr she explains how much her Dad deserves this transplant and how long he has waited. Begging, crying, requesting that he father not be overlooked, the Dr calms her and explains that her father will not be overlooked. In the seconds that follow a psyche patient runs down the hallway and the Dr takes the opportunity of distraction to quickly get into the lift, leaving me with the hysterical daughter who begins asking me if her begging was inappropriate. I sit her down and explain that she needs to prepare herself and her family for the fact that the margin between being operable and too sick to receive a transplant was getting very close and that her father may suddenly deteriorate any day now. Part of me was terrified that my boss would find out and I'd be disciplined for doing something that is only the responsibility of the Dr, but part of me felt I was doing the wrong thing by giving them false hope.
His morphine dose was subsequently increased as the attacks got worse, and I left that day with a heavy heart, and a guilty conscience. He died that night.
To my right, a card on the bench behind the reception desk was an almost identical match to the email. Inside were 2 photographs of the man I cared for, when he was healthy and vibrant.
I stared at this man. This man that I cared for. He looked almost nothing like the man I saw everyday in the hospital bed. Seeing him, as a person, as a healthy, REAL person.. not a sick and dying patient changed my perspective and I suddenly burst into tears. "We wish you could have seen Dad when he was well, he truelly was an amazing man" "I hope one day you all think of dad, and smile".. I'll never ever forget these words. I'll never forget that card, and I'll never forget that family.
The lines blurred today. Between patient and person, and instead of being scared I'd not be able to save someone when I moved over to the ED, I was scared I'd not cope seeing people die. Its a fear I've not ever felt before. Death is death.
When I resigned, I cried. My boss was amazingly sypathetic and she expressed how much they would miss me. Everyone is shocked and everyone is upset. Including me.
But I'm excited about this new journey, and as of January 8th, 2007.. I will be an RN in the ED.
He was on a lung transplant list and this was his last chance. His whole family had moved into a house nearby to be near their father and kept a vigil at his bedside all night, sometimes with 4 of them sleeping in the room at a time. They were sleep deprived and they were scared. Their father was getting sicker and sicker every day.
Anxiety was gripping him with every breath and his intake of sedatives and morphine was increasing. Not enough to stop him breathing, but enough to slow him down so he didn't struggle with the fear of not having enough breath to survive. Fans were on and with every attack we - being his entire immediate family and myself - would fan him with a towel because somehow feeling air on his face and body made him feel that air was available, even if he couldn't breathe it in.
The doctor was refusing to inform the family that this man would die before getting the transplant and I was becoming increasingly pissed off seeing the family holding hope, having to encourage them to keep hope that any second those lungs could come in.
"There is a 20 year old girl on a ventilator in ICU in the public hospital who will get lungs before he does, and even if the match came in, he's too ill and far gone now to operate". This is what I was being told. Compared to "Anyday now, you never know. Just keep hope.. " was what the family was hearing.
The Dr and I walked out of the room after I called her in following a particularly nasty attack. "This man is dying", she said to me. I turned to her "Then maybe you need to tell that to the family". Immediately his daughter comes out in a florrent of tears. Almost pleading, begging with the Dr she explains how much her Dad deserves this transplant and how long he has waited. Begging, crying, requesting that he father not be overlooked, the Dr calms her and explains that her father will not be overlooked. In the seconds that follow a psyche patient runs down the hallway and the Dr takes the opportunity of distraction to quickly get into the lift, leaving me with the hysterical daughter who begins asking me if her begging was inappropriate. I sit her down and explain that she needs to prepare herself and her family for the fact that the margin between being operable and too sick to receive a transplant was getting very close and that her father may suddenly deteriorate any day now. Part of me was terrified that my boss would find out and I'd be disciplined for doing something that is only the responsibility of the Dr, but part of me felt I was doing the wrong thing by giving them false hope.
His morphine dose was subsequently increased as the attacks got worse, and I left that day with a heavy heart, and a guilty conscience. He died that night.
To my right, a card on the bench behind the reception desk was an almost identical match to the email. Inside were 2 photographs of the man I cared for, when he was healthy and vibrant.
I stared at this man. This man that I cared for. He looked almost nothing like the man I saw everyday in the hospital bed. Seeing him, as a person, as a healthy, REAL person.. not a sick and dying patient changed my perspective and I suddenly burst into tears. "We wish you could have seen Dad when he was well, he truelly was an amazing man" "I hope one day you all think of dad, and smile".. I'll never ever forget these words. I'll never forget that card, and I'll never forget that family.
The lines blurred today. Between patient and person, and instead of being scared I'd not be able to save someone when I moved over to the ED, I was scared I'd not cope seeing people die. Its a fear I've not ever felt before. Death is death.
When I resigned, I cried. My boss was amazingly sypathetic and she expressed how much they would miss me. Everyone is shocked and everyone is upset. Including me.
But I'm excited about this new journey, and as of January 8th, 2007.. I will be an RN in the ED.
Wednesday, November 15, 2006
Moving on.
This morning I got given a book by a patient who is a photographer.
Its a book full of photographs of nude women. He's even written in the front, an inscription dedicated to me. Something tells me someone has had abit too much morphine.
I've not been vomited on.. yet. Well, not on my clothing anyway, but I do regularly get my shoes filled with water while showering people.
I've had blood smeared up my arms and I've had to deal with wounds that smell way worse than any vegetable left in the fridge for too long. I have high maintenance, very wealthy patients who call me to pass them a glass of water, when they can reach it quite easily themselves. They think they're in a hotel, as apposed to a hospital.
I juggle IV lines and personality disorders.
I deal with grieving families and people dying slowly of chronic illness.
I work in a prestigeous private hospital in Australia, and I need a change.
I've been a registered nurse for almost 2 years.
I took me 4 years to do my 3 year training because I got failed in 2nd year for arguing with my facilitator over the correct care of a patient.
I was told I had an attitude problem.
I probably do. I argue still, this time with doctors. I fight for my patients and I'm not intimidated. I have amazing work friends a wonderful but terrifying boss, and overall, an enviable work environment. I'm deskilling in private nursing and I'm bored and frustrated. I've never seen a chest drain, I've not seen an intubation. I've never had to perform CPR on anyone bar the faceless dummy in the Education room.
On a whim after a conversation in the tea room over my future and my education, I applied for a job in the Emergency Medical Unit of a busy multi trauma Public Hospital.
I got the job.
And now I'm petrified and I feel like I want to throw up. I've not seen trauma before. I've got no idea what I'm getting myself in for. There is so much I don't know, and so much I need to learn.
There's alot of wonderful people I am leaving behind.. and the worst part of all.. I have to tell my boss that I'm leaving -- tomorrow.
Its a book full of photographs of nude women. He's even written in the front, an inscription dedicated to me. Something tells me someone has had abit too much morphine.
I've not been vomited on.. yet. Well, not on my clothing anyway, but I do regularly get my shoes filled with water while showering people.
I've had blood smeared up my arms and I've had to deal with wounds that smell way worse than any vegetable left in the fridge for too long. I have high maintenance, very wealthy patients who call me to pass them a glass of water, when they can reach it quite easily themselves. They think they're in a hotel, as apposed to a hospital.
I juggle IV lines and personality disorders.
I deal with grieving families and people dying slowly of chronic illness.
I work in a prestigeous private hospital in Australia, and I need a change.
I've been a registered nurse for almost 2 years.
I took me 4 years to do my 3 year training because I got failed in 2nd year for arguing with my facilitator over the correct care of a patient.
I was told I had an attitude problem.
I probably do. I argue still, this time with doctors. I fight for my patients and I'm not intimidated. I have amazing work friends a wonderful but terrifying boss, and overall, an enviable work environment. I'm deskilling in private nursing and I'm bored and frustrated. I've never seen a chest drain, I've not seen an intubation. I've never had to perform CPR on anyone bar the faceless dummy in the Education room.
On a whim after a conversation in the tea room over my future and my education, I applied for a job in the Emergency Medical Unit of a busy multi trauma Public Hospital.
I got the job.
And now I'm petrified and I feel like I want to throw up. I've not seen trauma before. I've got no idea what I'm getting myself in for. There is so much I don't know, and so much I need to learn.
There's alot of wonderful people I am leaving behind.. and the worst part of all.. I have to tell my boss that I'm leaving -- tomorrow.
Subscribe to:
Posts (Atom)
