Finally a new post!

Finally A new post!

June19

So I am not sure why I thought it would be a good idea to start a new job just before summer got into full swing. Not only did I know I was moving in June but I knew that I would be on orientation on weekends! All this moving and crazy schedule stuff has got me all out of whack! Anyways I have had some seriously exciting melventures in the ICU in the meantime. I think I will pick up where I left off. Refresh with the last post Nights 4 and 5 if you have forgotten.
I continued to watch that patient deteriorate for the next 2 weeks. By the time I came in the next weekend the doctors were no longer aggressively treating this patient. I spent my first 2 shifts that weekend feeling, once again, very overwhelmed once again by the emotional strain involved with this assignment. After my first night that weekend I went home totally drained only to be greeted the next night with the same assignment and a new addition to the patients room: A CRASH CART! Apparently the patient had a very rough day… I learned in report that the patient had coded for close to an hour that morning and had been shocked 12 times! The family still insisted that they wanted everything done for the patient. At this point the patients had spent a long amount of time in the ICU – much of that time not breathing on their own. They had experienced cardiac arrest a total of 5 times and was dealing with several broken ribs from the CPR and a pretty extensive wound from an infiltration of emergency medicine at the IV site. I won’t get into specifics but from a medical standpoint it was becoming very clear that this patient was only further deteriorating and not showing any signs of improvement.
In my short nursing career I have experienced this scenario several times already. There often comes a time when doing what is best for you patient may not be directly caring for your patient. Let me explain: Sometimes the best thing for your patient is to attend to their family. It is a strange thing when advocating for your patient involves putting that purple DNR band on their wrist. When support is no longer the norm. Instead of insisting they take this pill or helping them to stick to strict fluid restrictions – You switch the focus from getting them better to letting them rest. Not giving up on them or stopping treatment. Just letting them rest finally. Stop with the tubes and the drips and the painful treatment. Stop with the unnecessary surgery and long hospital stays. What kind of quality do you want for your loved one?
So this was my assignment for the night.
After receiving a briefing from my trusty preceptor we started on a game plan. We decided she would do the talking. We were waiting for visiting hours to end when one of the family members approached us and summoned us into the waiting room. The family wanted to talk. We didn’t even have to bring up the subject. We were greeted with it right here. They wanted to make some decisions. We started the conversation and after many tears and a box of tissues at 2230 the family decided they wanted their loved one to relax. No more shocks. No more rib cracking CPR. No more emergency medicines. Not stopping treatment just no heroics. We spent the rest of the night caring for this precious patient and after we left the next morning all of the pain ended for that patient. We returned the next night to an empty room. Finally the patient and the family could rest. No more long nights sitting in the waiting room. No more worrying. No more questioning whether this was treatment or torture. Finally rest for one and all.
My next set of nights was heart wrenching and uplifting. I had a patient who was quite young for the situation that was presented. By the time I was lucky enough to take care of this patient they had already been through surgery and they were none the better because of it. The patient was not off the ventilator and I received them post op day 4. After report and my patient assessment I prepared myself for a grieving family- just then the double doors swung open and in came a group of 3 smiling from ear to ear. Just as I was thinking to myself, “They must be with a patient who is getting transferred out…” They introduced their selves as my patient’s family and even presented me with a basket of treats. After the family had thanked me several times I finally got a chance to introduce myself. I worked with this family the whole weekend and I am proud to say every member of the family was just as sweet. Even the ones who called to check on the patient took time to say thank you. They treated everyone this way from doctors to CNAs to the housekeepers. That patient received excellent care and actually last I heard they transferred to an extended care facility.
With patients like the one above are providing awesome care is easy. A family that is so overwhelming nice you feel the need to go above a beyond for their loved one. Unfortunately more often than not you either have a not so supportive family or maybe no family at all. The next thing I want to mention is an even different scenario. As I was typing this I remembered something a coworker mentioned to me one night. There was a patient on the unit who was experiencing an esophageal bleed. This patient was a known alcoholic and that is what caused the varices in the esophagus that had now ruptured and were bleeding. The situation was quickly turning emergent and the endoscopy team was being called in at 0300 to perform a procedure. The patient was not mine but I was trying to help in anyway possible. I was getting suction equipment when someone made a passing comment about not knowing why we were making such a big fuss over someone who did this to themselves. This comment stuck in my head and I just couldn’t stop thinking that it is not our place to pass judgment. We are nurses and we need to give each of our patients equal treatment. And I obviously struggle with it just as much as the next one but seriously this patient is vomiting copious amounts of blood! So you want us to sit there and watch it? Maybe wave and say something like, “HA! That sucks for you! Guess you should have thought of that while you were drinking!” Of course we all want to say that from time to time but we are talking life threatening amounts of blood loss here! The family is at the bedside witnessing it because no one is sure if this person will be alive in the morning! Seriously? Anyways that’s my soap box about that. What if that was your loved one who had made some detrimental choices? Do you want me to watch them bleed to death? Just saying…
I had another quite interesting patient a few weeks ago. I came into work and received a strange report from the day nurse. This patient was orally intubated and mechanically ventilated but alert and oriented X 3. Which basically means they know who they are, where they are, and what day or at least year and month it is. OKAY so I don’t know about you but if I have a tube down my throat blowing up my lungs and what not I do not want to be aware of it!! I don’t want to know anything! So I pranced on into this room to do my assessment not really knowing what to expect when I arrived! Much to my surprise this patient was propped up on pillows, remote in one hand, and the yaunker suction in the other suctioning oral secretions out of their mouth! I tried my best to hide my shock but I am sure it was written all over my face! I continued on and conducted my assessment and when it was time for me to leave the room I offered my usual parting statement, “Is there anything else you need?” I have had some interesting answers, some very inappropriate, though most of the time its your basic run of the mill waitress duties: more ice more water… So this patient nods YES and writes on a piece of paper (GET THIS!)… A SACK OF MONEY!! Hahahaha omg intubated and ventilated and still has a sense of humor! The entertainment continued this patient requested a cheeseburger, a steak, carrot cake, and even promised to take me dancing before my weekend was over. That patient was the picture of humility for me. I have said it once and I will probably say it many more times I would probably be the worst patient ever. There is NO way I would be thinking of cheeseburgers or dancing if the roles were reversed.
While we are on the topic of things I am not good at… I am not sure if I have mentioned this before but our hospital is set up sort of weird. The structure actually consists of 2 buildings united by a sky bridge. The way it works out the old building holds orthopedics, respiratory, oncology, nephrology, gastro and pretty much all of the “floor” stuff minus cardiology. All cardiac and the ICU’s and the ER are located in the new addition. This is all fine and well but it is 0.5 miles round trip from one side back to the other. Once again this cool with me too. I mean I am tipping the scales for my height and the good lord knows I can use the exercise. But seriously a girl can only take so much! Now that I am an ICU nurse I think I am all high and mighty and I get to be part of the CODE team! (OMG honor, right? WRONG!) Congratulations Melissa now no matter what you are doing if the words CODE BLUE are announced overhead (and you are on the code team-which I ALWAYS am on orientation) you get to drop everything and RUN! (YAY my favorite thing- not- but I will save that for the weight loss melventures that are coming up!) So everyone holds their breath and hopes for a floor in the Critical care towers (or the pavilion) but alas I have journeyed to 5 codes so far and they have ALL been on the other side! And granted that is still cool with me. But the story gets more interesting. 4 of those codes were not even codes at all! One never lost a pulse – therefore no cardiac arrest. That is bradycardia and not considered a code BLUE! One was a DNR (DO NOT RESUSCITATE) also known as you don’t need me! And the other was breathing really slow so they called an anticipatory CODE! When I arrived the lady was talking! I RAN FOR THAT? Seriously? I don’t sweat! I’m a lady. Dewy at best. GAH!
That’s enough of the melventures for now. I hope I still have some readers left. Sorry I have been absent. I hope to start writing about more than work. Like maybe my awesome new apartment or my adventure to the SHRIMPOREE!! Thanks for reading. Goodnight.

If only I could sweat luxuriously like this girl!

so this is an aerial of the place I work the tower closest is where I physically work the tall one in the back is where I often run to