Life continues in Chico

Chico Travel Blog

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I have today off (yay!).  Yesterday, despite loving my job at Enloe hospital, I wished I were not there.  One of my patients was having trouble breathing (on 6L O2, still his oxygen saturations were in the 80's), and he and his wife spoke so little English I couldn't help them understand what was going on.

Wife: please, does he oxygen?

Me:  Are you asking if he needs the oxygen on?  If he needs to wear it?  Yes, he needs to wear the oxygen for now.

Wife:  No, does he oxygen?

Me:  Are you asking if his oxygen level is okay?  His level is low, but he's okay right now.  He needs to wear the oxygen.

Wife:  No, does he breathing?

Me:  Are you asking if he is breathing? (this saga goes on, off and on, continually all day)

Another patient of mine, a wonderful man who had had part of his left lung removed, was NOT having trouble breathing.  However, he had a middle-aged daughter in the room that knew only enough about medicine to be extrememly nosy about everything we were doing, and extremely picky about it too.  Heaven forbid I follow my nursing experience and the doctor's orders when taking out his epidural catheter; oh no, I should call the doctor and bother him to ask if he wouldn't prefer to give the patient hydromorphone instead of hydrocodone for pain (to which the answer would be a resounding NO).  I can't stand taking care of people who think they know what they're talking about and don't, or especially those who actually know what they're talking about (like nurses, or doctors - they make the world's worst patients, and I will probably be one one day).

Me:  I'm going to take out your epidural at 4pm.

Patient:  Okay, that's fine.

Daughter:  If they're leaving the chest tube in, I'd really prefer they leave the epidural in.  Is there a way you can ask the doctor that?

Me:  No, and I'll explain why.  (I go into a long, nice explanation of the risk of infection and spinal abscess related to leaving epidurals in too long)

Daughter:  But it's just one more day

Me:  The anesthesiologist who put this epidural in thinks it's best for it to come out today.  We're going to follow his orders.  And your dad will be able to take this pain medication by mouth; I'm giving him some now so it will take effect by the time I take out the epidural.

Daughter:  I don't think that medication will be strong enough.  Won't he be in pain?

Me:  Well, (talking to patient) sir, have you ever taken Vicodin before?

Patient:  No, I don't take much of anything

Me:  Well then he certainly won't have developed any type of tolerance to it, and anything more might make him drowsy or confused.  And what we really want is for him to be as active as possible, so the best thing would be to try this first, and if it doesn't work, we call the doctor.

Daughter:  Well, it just seems like hardly anything.  I've heard of people going home on hydromorphone, not Vicodin.

Me:  (smiling politely as I give the Vicodin)

Daughter:  can't he have anything else?

Me:  (smiling even MORE sweetly as I whisk myself out of the room) Not for now, I'll check back in a few minutes to see how he feels!

And my third patient was just waiting on a procedure.  But his wife, I'm convinced, is the most talkative woman in Chico.  She will talk about anything at all, and talk until there's nothing left to say on the subject.  And she also happens to know a little medical stuff, and be hypercontrolling!

Me:  I'll let you know if I hear anything about when the procedure will be.

Wife:  Thanks.  You know, is there any way we could call and find that out?  Because that's really all he's waiting on, that's why he's here.

Me:  No, right now doctor -- is on the phone with the surgeon to see if it can be done today.  If I called the OR, they wouldn't know anything about it.

Wife:  Well that's really the whole reason he's here, and I know he's going to be hungry later. 

Me:  As I said, I'll be happy to let you know if I hear anything.

Wife:  There's no way to know?

Me:  (disguising my frustration) No, not for now.  (I go into a long tirade about how the whole process works and how we couldn't possibly know anything until the surgeon decides to take the case and until they make room for him on the OR schedule, etc).  As I said, I'll be happy to let you know if I hear anything at all.  (I start inching toward the door)

Wife:  You know, the other night I made a tamale pie, and I put (listing off ingredients) into it, and it was just delicious, but he simply isn't hungry.  Do you make tamale pie?

Me: (not wincing but wanting to) As a matter of fact, I do!  But I don't put olives or (other ingredients) in mine, because my husband doesn't like those.  But tamale pie sure is good, and...

Wife: (interrupting) Well there are so many kinds you can make!  You can make it italian by putting (ingredient list again) into it, and boy, that one's good.  Or you can (this goes on for about 10 minutes as I desperately try to make eye contact with anyone outside the room for help)

Me: (after politely listening and trying for a chance at a polite way to excuse myself) I'm so sorry, but I'm going to have to go see my other patients now.

Wife:  So when do you think we'll know about this procedure?

Me:  (supressing shrieks) I'll let you know as soon as I know anything at all. (and running from the room)

That patient was fine until after he had a dialysis catheter placed in his jugular vein, came back to me and immediately started bleeding from the site.  From there everything went downhill.  Changing bloody dressings, placing a sandbag on his neck (can we say uncomfortable?), calling the doctor way too many times to give updates.  Then the patient's breathing got much worse, and we had to change him over to a non-rebreather mask to keep his sats up.  And the dialysis nurse was there trying to start that whole process.  We debated over sending him to ICU, then the doc said all he needed was dialysis and he could stay with me. 

Meanwhile, Spanish patient's wife (NOT turning on call light, just coming out to find me in moments of chaos):  Please, nurse, you come? 

Me:  I can come in just a minute, I'm dealing with an emergency.  Does he need something now?

Wife:  Si, si, now.  Please, bano, breathing.  Oxygen.  Bano. (rattling off spanish)

Me:  Does he need me right now?

Wife:  Please, please, bano!

Me:  April, will you PLEASE see what my patient needs in 8B?  I'm in the middle of this bleeding thing in 9.

(April goes off with Spanish wife)

Monitor tech:  Leslie, 9A's leads are off.

Charge nurse:  Leslie, the doc's on the phone for you for 9A.

So dialysis got started, and the doctor came up and put another stitch in the catheter area to make it stop its incessant bleeding.  Then the guy's blood pressure dropped to the 90's and his heartrate went up to the 180's, so we had to stop dialysis.  But in the meantime, the Daughter in the other room was demanding things (thankfully Gabrielle came to my rescue there, and I'll spare you the conversational details) AND we couldn't find the epidural keys anywhere:

Charge nurse: have you tried the Pyxis machines?

Me: Yes, both, twice. 

Charge: have you checked ICU? 

Me:  Yes, in fact they were trying to borrow OUR keys. 

Charge:  try calling pharmacy, maybe they have some. 

Pharmacy:  have you tried the Pyxis machines? 

Me (supressing screams): Yes, both, twice. 

Pharmacy:  have you checked with ICU? 

Me (nearer to screaming): Yes, they don't have any either. 

Pharmacy:  Check with your charge nurse, we don't keep any down here.

Me (wondering how I haven't gone off the deep end yet):  The charge nurse told me to call you!  I told you, the keys aren't here!  What is she supposed to do, miracle them out of nowhere??

Pharmacy:  We don't keep epidural keys.

Me:  Well, thank you very much for your help.

Meanwhile, Spanish-speaking patient's wife:  Please, please, you come? 

And the monitor tech: Leslie, 9A is calling for you.

Charge nurse: And respiratory wants to talk to you about him!

Ahhh, yes, an afternoon in the life of a progressive care nurse.  It can be quite overwhelming.  But later on, as I was preparing to leave (late of course, since during all the chaos I didn't get a shred of charting done), there were three more experiences for me.

First, I finally went and took out my guys epidural.  His Daughter had left and he said to me, "Boy, you are a jewel.  If it had been me, I would have told her to go deliver somebody else's baby!"  I laughed uproariously and said, "Well, you know, she's just concerned and wants the best for you"  He replied, "It wouldn't have mattered to me - I would have sent her on her way!"  :)

Next, the Spanish wife came rushing up with a cell phone, tears on her cheeks.  "Please!" she said, "Please!"  I took the phone and said "Hello?"  It was her grandson who spoke English.  I explained everything that was going on with his grandfather, making sure he understood that the patient was going to be okay.  I handed the phone back to the wife, and saw her expression change and tears stream down her face as her grandson explained everything in turn to her.  "Thank you, thank you, thank you" was all she could say.

And as I gathered my things and checked with the dialysis pt's night shift nurse to see if I could do anything else for him before I left, I felt a firm hand on my shoulder.  I turned to see the patient's talkative wife squeezing me and saying, with tears in her eyes, "You're a GOOD nurse.  Thank you."

I guess that's what nursing is really all about.  It can get crazy, but it enables you to reach into people's lives at the moments they need it the most; to actually serve them by putting their needs first, and giving them the benefit of the doubt.  It's a practice in patience, and humility, which can be hard at times.  But in those few moments when you get to glimpse what a difference you can make, it's all worth it.  And that's what makes me love it.


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