The following two incidents happened a while ago, but took so much out of me that I haven't been able to bear re-hashing them until now...

A patient who is dying of pancreatic cancer has been admitted to our floor a few times. His wife is, of course, devastated and isn't coping well at all. Essentially, nothing that anyone does for her or her husband is ever enough or satisfactory. Objectively, I realize that this is her way of dealing with losing control over her life and her husband's illness, but boy can it become frustrating. She was constantly lurking the halls, waving down any passing nurse for one thing or another. She had honestly become such a bother that her husband, the actual patient, was getting pretty sick of her and her antics. On one particular day when I was in charge, a coworker of mine was taking care of this patient. His wife came in, and when she did, the patient rolled his eyes and looked the other way. The patient had been scheduled for a CT that day, and the wife was getting herself worked up about why he was going for this exam. Right as this was happening, transport rolled up with a cart to take the patient down to CT. When my coworker announced their arrival, the wife freaked out and demanded to know why he was going down and begged for the test to be rescheduled. While this seems like a fairly simple thing to do, it's not at all, so Kim left the room for a minute to see if she could rearrange things. When she returned, she found one of our oncologists in the room, prying a handful of pills from the wife's hands while she threatened to take them all and kill herself. None of us have ever been presented with such a situation before (someone in the hospital who is not an admitted patient but requires immediate intervention), but luckily everyone teamed up and made a number of important phone calls that brought all the right people together within about 10 minutes. We had our nurses, the patient's medicine attending, a psychiatric resident, the psychiatric nurse liason, security, and a few others on board. Risk management had been called, and the plan was to calmly explain to the patient's wife that we needed to take her down to the ER to get a psychiatric evaluation. If she refused or put up a fight, security was going to have to forcible take her there. At first she refused, but eventually agreed to walk herself down there with this team of professionals escorting her. Then, of course, we are stuck with trying to decide whether the patient is safe to go home with her. For better or worse, she got cleared by psych and the patient actually went home with her later that day.

Made my day

So I started this blog after I was on a flight where I helped a passenger who was in need of medical care. At the time, one of the flight attendants took my driver's license and copied down my information. While my assistance was not motivated by any reward, I did wonder whether I'd get anything from the airline. It is now almost 2 months later, and I got an e-mail this morning from the Director of Medical and Occupational Health Services at American Airlines. They're giving me 15,000 miles!! I'm so excited :)

Bedside manner

This morning was an interesting one. After the night nurse gave me report on what happened overnight with my patients, I went to say hello to them. I walked into my first patient's room to find a doctor I had never met in there. This didn't exactly surprise me, as all new doctors started on July 1st. I was shocked, however, to learn that this particular doctor was the patient's attending physician, since he didn't look a day over 20. In any case, the patient had a few questions for him, none of which he could answer. He told the patient, "to be honest, I had the day off yesterday. I like to see my patients first thing in the morning, before catching up on all the notes that were written yesterday, so that I can address any emerging issues as quickly as possible, so I'll have to get back to you about the answers to your questions." The patient looked puzzled. The doctor repeated what he had said about seeing his patients before reading the charts, and then followed up with the following. "You see, one day in my residency, I came in in the morning only to discover one of my patients totally confused and we had to send him to the ICU! That's why I like to see the patients first, charts second." The patient didn't say much, but appeared to accept his explanation, and the doctor left. I spent a minute with the patient, catching up on what had happened overnight, and then went to check on my other patient.

When I walked into my second patient's room, the same doctor was there. Essentially, the same exact thing happened. She had a few questions for him, he couldn't answer them, and told her he'd have to come back later after reviewing her chart. She looked puzzled. She asked her questions again. The doctor said, "Can you imagine? One day in my residency, I walked into my patient's room in the morning and found her dead! That's why I like to see my patients before I look at the chart." The patient's eyes nearly bugged out of her head. She was brave enough to say "was it really necessary to tell me that?" He caught himself for a moment, and tried to relieve her by saying, "well, we expected it for her. Not for you!" My patient was not amused. She said again, "did you really need to tell me that?" The doctor kind of brushed it off and left. Again, I stayed behind to catch up with her and she could not stop talking about what he had said. "Where did he go to medical school? What kind of bedside manner is that? He's a nut!" Throughout the remainder of the day, she kept asking me about him and kept insulting his bedside manner. While I was also pretty appalled by these two discussions, I'm almost looking forward to my next interaction with this guy.

The double threat

Before I went to nursing school, I knew that I had trouble handling vomit. I worked at a clinic where I encountered a lot of people vomiting, and for weeks I'd gag every time they did. I finally got desensitized to that and was able to function like a normal human being while at the clinic. Unfortunately, a lot of time passed between stopping work at the clinic and encountering more vomiting patients, and I was resensitized to vomiting. While in nursing school, I also learned that I had serious problems handling poop, and feared that I might not make it as an actual nurse because of this problem. My med/surg clinical instructor even recommended that I work on a surgical floor because "those people never poop!" Since working as a nurse, I've gotten a lot better at handling bodily fluids and excrement, but still struggle at times. Yesterday was one of those times.

I took care of a patient who has a large abdominal mass that is keeping her from digesting her food properly. At this point, she hasn't taken anything by mouth in weeks. She was supposed to go for surgery on Friday, but due to a series of mishaps, she didn't get the surgery. She did, however, get her nasogastric tube (tube going into the nose down to the stomach that sucks out all contents in patients with this problem) removed that day. She was so incredibly relieved to have it out that even when she found out that she wouldn't have the surgery, she told the doctors that she'd rather vomit than have the tube reinserted. She made it from 5pm on Friday to 3pm on Saturday without puking. At 3 though, she barfed up a bunch of green crap. My major difficulty in handling fluids like this is the requirement to measure them, which means pouring them out into a graduated containter. As if the vomit didn't smell bad enough, pouring it out really made me wretch. I gagged a few times and thought I had it under control. I was holding the container of vomit as far away from my face as possible, in the bathroom, while I ducked my head out into the hallway in an attempt to breathe fresh air. The gagging would not cease, however, and I ended up puking in my patient's garbage can. For all the problems that I've had with gagging due to gross things, this was a first. Way to go...