Sunday, November 16, 2008

Just Enough.

Just when I think I don't know enough, don't understand the workings of the mind and body, I'm shown that I do know "just enough."

A mother brought her 16 year old son in with a lacerated finger. She was very mad at her son.
She said he was fighting with his brother.

Each time I came into the room to set up for sutures, to check on the Dr's needs and progress, and then to clean and dress the repaired wound, I could see that mom was calming down. As I cleaned and wrapped his finger, we talked about what had happened.

His brother has ADHD and is difficult to get along with. I said to my patient, "So you have to be the strong one a lot don't you." He said, "I never looked at it that way before."

His mom said, "I'm sorry I got angry son. I have a hard time dealing with your brother. How can I expect you to do it any better."

I really felt like I had opened a door for these two to walk through together.

I knew just enough.

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Tonya and I just got back from Cabo San Lucas. A week in the sun always helps me keep my perspective when I go back to work. There is a big world out there. Mine is such a small part of it. And standing on a beach watching the waves come in, the sound, the smells, the ocean breeze, these things stay with me for a long, long time.

Tuesday, November 4, 2008

When accents matter.

The triage nurse came into the nurses station and said the man she just triaged was delusional.
"He may be a mental case." she said.

"Why do you say that?" We asked her.

"He says the gods dropped him off. He says the gods were after him and then the gods dropped him off at the hospital."

After further evaluation it was found that the man had a New York accent and was talking about the guards from the jail, not the gods.

Thursday, October 30, 2008

Cat's Whiskers

Sometimes I wish my older patients had their life stories as part of their medical records. When the mind goes, we have no way of telling who that person was or what they did.

"Cat's whiskers." I heard her say in a high pitched voice.
"Cat's whiskers." She said in a deep toned voice.
"I'm a crazy lady." She said without eye contact or change in facial expression.

As I cared for her, she repeated these phrases over and over.

A daughter in law came in to see her. "How sad it is to see her like this."

Then she told me about this woman.

She was a pilot in WW II. She helped invent and test a zoom lens used to take pictures from the air.

No matter what we do in this life there must be someone who will remember for us. May we all do something worth remembering.

Saturday, October 25, 2008

A daughter and a nurse.

I sent this piece to a nursing magazine in the answer to their question "Who was your most unforgettable patient?" They didn't publish it I think because it is as much about me as it is the patient. So I'll share it here.

My most unforgettable patient was my father.
He looked so frail in that hospital bed. A stroke and a fall resulting in a subdural hematoma took him from ER to brain surgery. Now, in ICU, I was told that my mother and I could only visit ten minutes every hour. The word 'visit' really bothered me. I thought, "I'm not a visitor. I'm his daughter and his nurse.

I obeyed this particular rule while sorting through my conflicting thoughts and emotions. Did I stop being a nurse when I clocked out at work?
I heard people tell me to be a daughter now, not a nurse. Confused, I thought, "How do I do that? Forget what I know? Tell my eyes not to notice his skin color? Tell my fingers not to rest on his pulse? Don't check out his blood pressure and O2 Sat?"

I realized there were a lot of things I had to look at differently. I was truly there to be my father's advocate while he was unable to ask for what he needed, unable to call for help, unable to communicate at all. I knew I had to be with him.

My father was moved out of ICU. I was expecting to be at his bedside now. It was getting late and my mother needed to be home before dark. She doesn't see well at night. She was worried about Dad being alone at night and I told her I would stay with him. I never once thought that I wouldn't be allowed to. After Mom left, I went to my father's room and pulled a chair close to the bed. My father was showing signs of brain trauma: agitation, pulling at every tube, trying to sit up although he wasn't strong enough.
It felt so good to be there holding his hand, telling him I was there. I got lotion and gave him foot rubs and did gentle range of motion. These are basic nursing interventions that I usually don't have time for at work. I knew these nurses probably didn't have time for it either.

When visiting hours were over I was asked to leave. I said I would like to stay with him and I was told that family isn't allowed to spend the night. I asked to speak to the charge nurse. As Dad continued to pull and strain against his restraints, I began to strain against my own. The charge nurse gave her scripted answer. "We feel that family members need their rest. We encourage you to go home."

I left the room but only to find a phone. I called the hospital operator and asked her to please page the administrative person on call for that evening. Someone just had to see how wrong this was. I only wanted to be there for my father.

I don't remember who I talked to that night but I remember how well she listened. I spoke quietly from my heart. "I am a daughter of one of the patients in this hospital and I am also a nurse. I want to do for my father what I get paid to do for strangers. I want to do comfort measures for him, keep him safe and help guard his IV and catheter through the night. My father should benefit from my skills and knowledge and my caring. Please let me stay."

She said, "You're right. I believe you are offering us a service and well as being of service to your father. I'll call the charge nurse and tell her you may stay.

She understood the benefits to everyone. She bent the rules and allowed me to be a daughter who is a nurse. Through my father's illness and healing I learned how much I loved caring for him in that special comforting way that nurses have. I try to remember that every patient I care for is someone's father or mother, son or daughter, and I treat them as I would my own.

Thursday, October 23, 2008

The thumb.

I was young, a new nurse, scheduled in the ER. I was nervous. I pictured someone running into the ER with a cut off finger or some other body part. What would I do? I felt so unqualified. At around this same time I was going to AlAnon. I was learning a lot about myself..... Just because someone says something about me doesn't make it true, I don't have to be responsible for someone else's behavior and just because someone tries to give me something doesn't mean I have to reach out and take it.

It was a long time before someone actually came into the ER, held out his closed hand to me, and said, "My friend is in the car. He cut off his finger and I have it here." My first reaction a long time ago would have been to reach out with an open palm even before the man had finished talking. I went to a room and got a speciman cup and opened it so the man could drop the finger in it.

I look back at that time and think that it was nothing compared to what I deal with now in that same ER. But the lesson still works. You don't have to take the thumb just because someone tries to hand it to you.

Tuesday, October 21, 2008

A brighter smile

I Went to the dentist and had my teeth whitened yesterday. It was a little painful but I like the results. Just decided to do something nice for me.
Nursing story: This one left me so sad. In one bed was a man with terminal lung cancer. He had taken a lot of pills, left a well written letter of goodbye, but his family found him and called EMS and they brought him to us.
Across the hall was an elderly woman with non hodgkins lymphoma who could not start treatment because she couldn't pay for it.
One wanted to die, one wanted to live. We failed them both.

Monday, October 13, 2008

Life lessons from Grammy

I picked up my granddaughters, picked up my mother and went to Marsha's house. Jenni and the boys were there. The house was a wreck. Jenni was cleaning out Marsha's pantry. It is cute the way Marsha hangs on to every gift bag she gets. I wonder who gives her so many gifts. Doesn't anyone wrap a present anymore?. We just ripped off the damn paper and threw it away right? The bags are all so cute that they scream to be saved.
All five grandchildren together is always a great thing for me. I couldn't seem to get a picture of them all together though. Jackson was worn out and bringing two more kids into his home to play with his toys was an overload. The boys had a fight. The girls looked on and I saw them draw a little closer to each other. I looked at my mother's face as Jenni dragged the boys out of the room. And I had to talk to the boys.
I told them that their behavior made me cry. It made me sad. And I hope they will remember that. Probably only to think it was weird of me to tell them that. They are still my boys and I love them so much.

I took Emma and Grayce to see the dinasour tracks. We talked on the way. I asked them how they felt when the boys were fighting. They used words like "weird", "sad", "different". I told them how I felt. And we talked about how the way we behave can affect the other people around us.
The girls were about as impressed with the tracks of the big animals as the boys were in August. "Cool" "Grammy, can we play in the water?"
It's a time thing. A million years is meaningless information to them. And, "I thought there would be more". from Emma. The miracle of seeing one print of an extinct creature let alone six or seven all in one spot was lost on her.
The girls wanted to take their shoes off. We were hiking quite a ways. I said sure. Emma said, "What will we do with them?" I said, "Carry them". Then I hear Grayce yelling that she was stuck trying to get over a wet spot a rock away. She was carrying both pairs of shoes. I said, "Emma. Why is Grayce carrying your shoes?" She said, "I asked her to." So I said, "Go get your shoes from Grayce Please." After she did, I said "Now Grayce can you jump to the next rock ?" She happily jumped saying "My shoes are easier to carry when I want to jump over a rock."

I just started laughing and said "Grammy will teach you a lot about life if you let me. You see girls, If everyone carries their own load, everything is easier to do." It sounded great to me. Will they remember this crazy Grammy?