A Discussion at the Nurse's Station

A new aide was orienting and she was talking to one of the nurses about getting attached to patients.  The nurse said she doesn't remember much about any patients and that she never got that close to any of them. Then the aide turned to me and said "what about you?"

oy.

I told her I remember most of my patients pretty well and if they died I always look up their obits after so I can learn about them as a person and that I hate knowing people just as "sick".  What I didn't tell her is that I blog about every one of my notable patients, and that I save obit pics on my hard drive so I never forget the faces of my patients who have died.

If the FBI ever looks at my hard drive I hope they also see this blog explaining why I have their pics on it.  Otherwise I'm going to have a lot of splainin' to do.

Like a sheep being lead to slaughter

Not really looking forward to my 3p-3a shift today.

A rare Saturday night post with sad news :(

The four point locked restraint stroke patient died on Wednesday.

That crooked smile of his will forever be etched in my mind.  I'm glad I brought him a little joy before he passed away. He probably had a long road of tube feeds and permanent paralysis ahead of him so in a way God was merciful in letting him go.. and his family was there with him when he passed, so there is that, too...

Rest well, my friend.  I'm sorry we had to restrain you like that, I hope you understand better now why we had to do it.

Top 10 things that contribute to a Work Day from Hell

1. Computer system being down.
2. 2 fresh strokes needing NIH scales and q1 hour neuro checks and frequent vitals the first 8 hours of a 12 hour shift.  One of which was a significant CVA with an NIH of 16 and getting worse with right sided paralysis yet able to SIT UP and launch himself off the side of the bed and give me a left hook to the jaw when trying to help him back into bed. Then calling security to come and put him into 4 point locked restraints and putting him on a 1:1 watch.
3. A 5'4" resident trying to tell me that he doesn't think restraints are appropriate and to try a BABY DOSE of ativan instead. Then watching the patient get his foot stuck in the bottom of the bed then turn and bang his head on the upper side rail. Then telling Security to put the restraints on the patient because he IS A DANGER TO HIMSELF AND OTHERS and if the resident doesn't think those restraints are appropriate that he can come and personally remove them because they are GOING ON NOW.
4. a patient signing himself out AMA because a Dr. told him he could go home but the nurse I got report from didn't have time to do the paperwork with him or discharge him... nor time to take out his IV- so he was found bleeding in the lobby after ripping out his own IV and bleeding everywhere because he's on Coumadin
5. While I wrestling with the CVA pt., my confused lady in Posey restraints pulled out her brand new PICC line which was placed hours before.. also on Coumadin.. it's a miracle she didn't bleed out.
6. Other lady trying to get her last dose of IV iron with an unusable opposite arm (post mastectomy).. both the charge nurse and myself were unable to get an IV site in her after her only usable vein/IV site infiltrated.
7. Confused little Jewish lady crying about how her daughter is going to put her in a home and take all her money therefore trying to escape and setting off her bed alarm.  Every. 15. minutes.
8. Clocking in at 230pm and clocking out at 430am without taking a break or eating anything the entire time.
9. Whiny nurse's aides about how BUSY they are.
10. Having a killer headache and cramps the entire time.

 And in keeping with the irony that is my life, my favorite thing about the day was talking to and massaging legs, chest and back of the violent stroke patient in restraints and getting a giant half smile from him.(couldn't even smile with the right side of his face.)  That picture of him is frozen in my mind and actually brings me to tears when I think of it.

Suicide Notes and Peyronie's Disease

Had a 60 something female patient come in post suicide attempt.  They recently closed the local large psych facility so once our psych floor gets full, we get suicidal patients and the occasional patient with psychosis  who attacks the staff with scissors.. but that's another story.  So, this 60 something patient attempted suicide by taking a bunch of ativan and vicodin and I think Seroquel.  So she says.. her vitals were stable but the ER report was unclear as to whether or not the induced vomiting or pumped her stomach.  I think she waited few hours to call for help so I doubt it would have worked if they had.   So as I am flipping through her chart and I saw her suicide note.  The first few lines were:

Dear Susan (daughter's name- changed for her protection):
YOU DID THIS....(commence a bunch of incoherent, half legible babbling for about 6 pages)

I spoke to Susan several times.  Her mother has a long psych history.  Susan was 8 months pregnant and had 3 other little children under 5 at home.  (she came in later that day) Her husband was very kind and patient with the whole thing, too.

I'm going to admit something.  That note not only rattled me- it pissed me off. How could someone 1. base so much of their happiness on a GROWN CHILD WITH HER OWN LIFE and  2. Try to kill herself then leave a note so the daughter (who probably would have blamed herself somehow anyway) can see it and know beyond doubt that IT'S ALL HER FAULT YOU ARE DEAD  ...while she's about to GIVE BIRTH.

What kind of self centered, immature, narcissistic piece of SHIT does that to their own child??  Who the fuck goes through 60 years of life thinking it's ALL ABOUT THEM?  The whole situation totally disgusted me.  I was actually going to ask for a different assignment (a good nurse knows when a situation is one where his/her own feelings might affect care).. but the other nurse who would have taken her was about half as compassionate as me on her best day, so I sucked it up and used my therapeutic communication skills-- which luckily means asking open ended questions and never giving your personal opinion or advice.. so thank God for THAT.


We also had this really odd, hard to read patient who was very non compliant with his insulin at home and rarely took his cardiac meds.  He told our poor elderly nurse's aid (the one I mentioned on the talented  boobie post) while she was taking his blood pressure that he neglected to mention when he was admitted that he has a condition called Peyronie's disease and we are "ALL going to get it now!"  So the nurses were at the nurse's station FREAKING OUT about this horrible disease and what is it OMG!!!  Well I knew every disease that you can catch from casual contact and that was not one of them I ever heard of, so I looked it up.

According to wikipedia: (http://en.wikipedia.org/wiki/Peyronie%27s_disease)

Peyronie's Disease (also known as "Induratio penis plastica"^[1]) and more recently (CITA) Chronic Inflammation of Tunica Albuginea, is a connective tissue disorder involving the growth of fibrous plaques^[2] in the soft tissue of the penis affecting up to 10% of men. Specifically, scar tissue forms in the tunica albuginea, the thick sheath of tissue surrounding the corpora cavernosa causing pain, abnormal curvature, erectile dysfunction, indentation, loss of girth and shortening.

So basically the guy told the nurse's aid he has a  dick with a right angle and we were ALL GOING TO CATCH IT.  So, I did what any good nurse would do.  I put a contact precaution bag on his door and pretended like he had a raging case of MRSA,  I told everyone to gown up and glove up every time they go into the room.  The guy was BUSTING A GUT laughing at how we fell for his scheme.  And just when I was about to break the news that we knew his condition was not contagious.. the Dr showed up.

Dr.:"Why is this patient on contact precautions?"
I looked at the patient and said "Do you want to tell him or should I?"
Patient (proudly): "I have Peyronie's disease!"
Dr.(flatly): "um.. that's not contagious"
Me: "Oh Dr., I don't know what we would do without YOU around!" *grabbing isolation bag from the door and scurrying out*

Ten minutes later, the Dr. came up to me and said "You knew what it was, didn't you?"

I just winked.

LOL