Conflict

Have you ever been in a sticky situation, where it called only for split seconds to make decisions? I often find myself doing that.


I once had to do a straight catheter on a man who had urinary retention. He'd been calling all shift for assistance to the bathroom, each time with zero output. Bladder scanning revealed 306ml of urine. I obtained an order for a straight catheter, which would immediately empty his bladder and offer relief. I was right INSIDE, about 4-5 inches, when a CNA slowly knocked on the door and whispered to my ear, "Sorry to interrupt, Cherie, but whenever you are done, Ms. X in Room So and So had died."


WHAT? The nearest nurse was a floor away. I told her to call the Supervisor. BUT at the same time, I had to do something, immediately. Pronouncing the dead was one thing. Making SURE that the person was truly deceased was another. To top it all, leaving the present procedure you are doing right in the middle of it just complicates everything else. What to do?


The urine by now was NOT flowing. (And to this day, I wonder why. Catheterization is a very easy procedure, and one I'd done countless of times prior to this incident.) I inserted a little more. Thirty seconds more. None. I decided to withdraw, and explain to my patient that there was an emergency. I said I was going to be back as soon as possible.


I rushed to the said room with my stethoscope, and did my assessment. The patient in Room So And So was really gone. I pronounced her dead by 1:45am. The Supervisor did not show up till after 20 minutes after that. I couldn't have waited that long.


In the meantime, no action from Mr. Catheter's room. Then, about 30 minutes after I left him, his call bell rang. The patient had GONE on his own, for some reason. My earlier poking must have stimulated his bladder, and as a result, he went and WENT, wetting his bed, and everything. By this time, he had also been waiting for me. But the CNA and I were busy with the body. And then I had to do the necessary notifications. It was all bad timing. The CNA rushed to him as soon as she was done. I was fortunate to have worked with a good one.


Needless to say, the gentleman was not very happy. To him, I would always be the nurse who left him, and from that day onwards, would not allow me to do any catheterization on him, although he would let me stick his arm for blood work.


Looking back, given the same unfortunate circumstance, I don't think I would have hesitated to do exactly the same thing. But it is instances like this that leave me bothered, wishing in my heart that things could have happened differently, but also knowing that just at that very moment, couldn't. And I am often left feeling bad about myself, sorry for the whole sick situation.

This Flu Season

It is so funny - I wrote about us Filipinos heralding Christmas by the first of September. The weather starts getting cooler in the Philippines then. Well, guess what. It did over here, too. NC weather is so dreamy now. And I have started imagining the leaves turning into a mass of colors. Autumn is my favorite season of all, it is so pretty. But alas, autumn, too, brings with it a host of respiratory diseases. Many cold viruses thrive in low humidity, not the least of them H1N1.

Well, today, I received a letter from the county of Durham Health Department, and it goes thus:

Dear Licensed Nurse in Durham County:

Your name was made available to our health department by the NC Board of Nursing. We requested the information to assist us in developing a list of currently licensed county residents that will be available to help with a mass H1N1 immunization effort. Names of nurses were also provided to other health departments across the state.

At this time, it is projected that the H1N1 vaccine will be available between October 15, 2009 and January 31, 2010. As a community, we plan to inoculate up to 60,000 residents (depending on the guidelines), and we expect each person to require two vaccinations. It is during this time period that we will need many volunteers to help us staff mass immunization clinics.

If you are willing to volunteer, please fill out the enclosed survey and return it in to us. The survey can be folded and stamped for mailing. There will be no payment for your service, just a 'thank you' from many grateful citizens.

Sincerely.

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My friends, I encourage everyone to please have yourselves be vaccinated against H1N1 and the seasonal flu. They are different from each other, but are equally hazardous. Always wash your hands, and avoid touching your mucous membranes. Stock up on juices. Air out your house as often as possible. Keep warm.

Looked Like Jesus

When I was very new working in the States, and we were still living in Pittsburgh, PA, a member of the staff told me one morning, "We have a new patient in Room ___. He looks like Jesus." Eventually, that man was assigned to me. I knocked and entered the room. I looked. True enough, lying there in bed was "Jesus." He was white, gaunt, with shoulder-length sandy brown hair, and a bushy face. He looked very handsome in his sleep.

I remember feeling scared because whenever he was awake, he had that serious demeanor and a look in his eyes that told you he was thinking. He was as curious about this "Asian girl" as I was of him. He was soft-spoken when he talked of his family growing up, hippie days, a broken marriage, about brushes with the law.

He had Hepatitis C. Incurable. And he was always bleeding from somewhere. As I said, I was very new so it made me nervous going inside his room. He liked to follow me around, too, not only with his eyes, but physically. So I was always afraid he might slam the door one day and attack me. Really. Such thoughts on "Jesus." But I was always firm though kind, and he was compliant. At one point he said, I was becoming more and more Pittsburghian, and I didn't need to do that. He said to keep being Asian. What he didn't know was I was truly scared so I think I may have upped my act a little bit to gain some confidence.

He was homeless. I guess he found solace in that little room, and the consistency of the staff that cared for him. But one day they moved him to another floor. That day, I was assigned to other patients. But he requested that I transport him. I did. He looked very sad.

Within one week, "Jesus" died.

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The kindness that we do today goes a long, long way. (I'd credit the person but I don't even know who said this.)

Gotta Love Our Heart

( photo source: my Friendster account)

A fellow nurse was reading the chart and droned on about a patient who was rushed to the hospital for chest pain, shortness of breath, nausea and vomiting, and indigestion. When she got to 'indigestion,' I said "Sounds like a heart attack to me." She said, "You're right! But how did you know, Cherie?"

It's simple, really. A heart attack's pain is usually on the chest, and in many people, it is found on the upper abdomen. Sometimes the pain is 'referred,' in that it is felt anywhere else but the 'heart' - like pain in the arm, neck or back gets referred to the upper abdomen, causing nausea and vomiting.

Whether we work in a hospital or a nursing home, HEART ATTACK is always one of the leading menaces the staff are on the constant look-out for. It, in fact, is the number one cause of death in the US. So here are the warning signs to help you think and act fast, when you are put in a situation where you or someone else might need help, where the heart is concerned.

Heart Attack:

Chest pain, or discomfort, which may be described as heaviness, pressure, tightness, fullness or acute pain ( One funny incident: I once asked a patient if it felt like an elephant sitting on her chest, and she answered no, that it felt more like a kitten sitting on her chest.)

Shortness of breath (either with or without chest pain)

Other symptoms (may or may not follow quickly): Nausea with or without vomiting (amazing thing is, some can still walk to and from the bathroom and clean themselves, and tell you about it!), cold sweats, lightheadedness, jaw or back pain, pain in one or both arms

In women, note also a persistent feeling of fatigue unrelieved by sleep, and anxious, nervous feelings.

What to do?

Don't joke around, it's not heartburn! Seek help immediately! If the person has a prescribed nitrogycerin tablet, capsule or spray, use as directed! Otherwise, call 911 if you're in the States. Or scream at the top of your lungs if you don't know what to do, to get somebody's attention.

Stroke, on the other hand, is the second leading cause of death in the US, so I'd like to write down the symptoms as well. Most Filipino men by the age of 60, suffer from this, too.


Stroke:

Sudden numbness or weakness
Sudden confusion with trouble speaking
Visual disturbances or changes in seeing
Sudden trouble walking, loss of balance or coordination
Sudden onset of severe headache without cause

Same thing, don't tell the person to rest, or drink a glass of water or anything else, but call for help! Call your doctor, if you don't have 911.

More importantly, PREVENT these things from happening by: living a healthy lifestyle - quit smoking, eat right, get more HDL (good cholesterol), exercise and maintain your weight, manage stress, and keep your diabetes in check. Some things we can't help if we inherited them.

For nurses and families who deal with these, be patient, no blaming, and include the patients in their care. Some nurses leave televisions droning on and on. Please. Ever heard of sensory overload? And I'm talking about healthy individuals. How much more people who can hardly breathe or have clots in their brains?



Gotta love our heart because there's so much to live for. Just a little reminder from your friendly neighborhood catwoman. Meow.

Why I Sanitize

I always apply what I learned in OR Nursing back in school - whenever in doubt, consider the thing unsterile. I have practiced Nursing for the longest time now, and I have not changed.

Can you imagine the plight of germs, in let's say, a pen? A co-worker forgets his pen and borrows yours to jot down the vital signs. She has not washed her hands yet, and has just come out of a room of someone with MRSA of the sputum. Then she returns the pen, not to you, but puts it on a desk, where an enterprising doctor who has just sneezed suddenly grabs it to read the brand.

Eeeeww. Poor pen!

What about the shoes? The housekeepers make sure the floors are vacuumed, sanitized, mopped, sparkling to a T! But how many pairs of shoes walk and run in the halls? How many EMTs wheel in stretchers, how many wheelchairs roll past? You walk in a room where a resident has recently vomited on the floor, although the vomitus has already been cleaned out. But what was used to clean it out? What if it was done in haste it being a weekend and the supplies just ran out? Ugh!

What about spectacles and sweaters, and uniforms? Perfect hosts for all sorts of bodily fluids! Take the tiny amount of blood as you did the labs in the morning, accidentally dripping over your sleeve as you slide the plastic tube over the butterfly. Or the urine that splashes on your pants as you undo the catheter? Or even the feeding tube you're trying to unclog but which decides to spew undigested food back to God knows what part of your anatomy? Let's not even mention what conditions/diagnoses the patients have.

For twelve hours.

Let's stop there.

Nursing is a good job, it is a fulfilling happy, gooey job. Stinky, pleasant, funny job. Hair-raising, gut-spilling, faithful job. And I love it, love it, love it. That's why I wash my hands in between patients, before and after a task.

And I sanitize before I leave. My glasses, badge and rosary are treated to warm running water and soap. My pens and similar accoutrement, with Cavicide, including the pencil case. My shoes I remove before entering the car, and go straight to a shoebox where they are sprayed with Lysol. I wear slippers in the car. The car gets Lysol treatment after I get off, and I go straight to the laundry room, AFTER I enter the house with the hems of my pants rolled up. My duty bag and lunchbag have their special place, and my scrubs go straight to the washer. Then I run to the shower before I kiss all my boys. P.S. Nothing wrong with jewelry, but for obvious reasons, I don't wear any to work.

I am not alone, I can already tell you that. I have friends who strip right in their garages. Another one keeps her laundry (scrubs) in a bag outside the house. (I also keep a separate bag just for scrubs when I can't wash right away.)

No telling what virus or bacterium or fungus is on the loose, and can't take risks!

What about you? What do you do, and do you feel the need to sanitize like I do? Come share!

(Photo source: Public Domain Pictures.net)

Scrubbed

Who says 12 hours of shift work can't be fun?

Two days ago, we went to my favorite uniform store, the Uniform Junction for some new scrubs. We were given our yearly uniform allowance and I couldn't wait!

See, their scrubs are so creative and stylish, and there's plenty to choose from! I chose designs of butterflies and flowers in colors of purple, blue, orange. They have laces and ribbons and are loose enough so you can move around and run in an emergency, and climb on beds, and reach for the bags hanging on the top of the IV poles. They have pockets big enough for pens and scissors and a penlight, my rosary, my celfone, and a small pad. They are pretty enough to keep my patients' attention while I poke and palpate and percuss. They are inspiring enough to motivate my co-workers to buy the same and come to work feeling good about themselves, ready to clean up goo, and lift and turn, and spread some smile.

I love my work and I don't mind the grit. But it's a good nurse who takes pride not only in patching up broken bones but also in how she commands respect in how she looks while doing so that is tops in my book. So, who says 12 hours is a drab? Not with the right attitude! So put on your best scrubs and comb that hair back! Be ready to roll!

Not Just Patients

There are collections of Nurse's Prayers, all of them beautiful. But one of the lines I like goes Dear Lord, please give me courage as I approach each hurting bed...

Mr. Franklin had COPD, a bad case of Diabetes, and a host of cardiac issues. We had to use a hoyer lift on him for transfers. He was always in pain. But he never complained. He liked to talk about the time he was in the Philippines, as a young soldier. One day, his kidneys malfunctioned, and eventually, he died.

Ms. Butler used to be a Chemist. She went to college at a time when most women just stayed at home. She has skin cancer. She gets Ambien at night to help her sleep. Sometimes, she gets up around 3am, and we have cocoa together. She encourages me to learn how to swim and make strawberry pies.

Ms. P is a Jew. Her bones are so brittle, they all broke on their own. We handle her very gingerly. She used to love to read and was an articulate speaker. She doesn't talk anymore, her mind ravaged by Dementia. She blows me kisses as I dress her wounds.

Mr. Tommy wanted to go home for July 4th, and it was difficult to deliberate. He was dying any minute, completely dependent on Dobutamine and Dopamine drips, but he was adamant about sitting on his porch to watch the fireworks. I asked Dr. T, how far does he live? And thought that even if 911 got there in 10 minutes IF something happened to the drips, there would be nothing they could do. Ten minutes was too long. We held a family conference at the hallway. One relative was a nurse. Finally, if a bit reluctantly, the doctor said he could go. After several instructions to both the family and patient, I wished them all a happy 4th.

Mr. Johns has Parkinson's and calls a lot for the urinal. He was a popular writer, and used to mingle with President Bush. He says he coughs, and asks for cough syrup. I don't give him cough syrup. I suspect he has a swallowing problem, and reposition him. I encourage small sips, and later recommend a swallowing study.

Faces with names. All of them my patients. Each one touching my heart, every single one my professor in the university of life...

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In accordance with HIPAA laws, all names and conditions have been changed.