Learning to be "flexible"

"Have any of your patients died?"

"Yes, they have"

"Do they die on the floors?"

"Yes, they do...but I think I would love to be home surrounded by my own things, in my own bed, with comforts of my home when I die...not here in this cold hospital"

"I haven't thought where I want to die yet"

This was one of the conversations I had with my patient given a 4 weeks to live diagnosis. It is amazing how these death conversations aren't as hard to have as one would expect and it is needed...they need to talk and express and think through this thing of death which we all have thought about but haven't faced yet.

I was in the ICU overflow in the PACU this past week, the ICU was full of bad traumas and we needed to use the flex space for the less "critical" patients. It was a pain! Noisy, monitors we werent use too, and constantly running back to the unit for this-or-that which you didn't realize you didnt have until you needed it.

At first, I wasn't a happy camper! But by the end of my 3 days in this overflow area I realized I was blessed by my patients and I was there for a reason. I was able to truly care for these patients and let them know someone thought they were special and worthy of love. It is when you are pushed out of your comfort zone, literally, you can experience the beauty of life.

Fresh Meat...I mean New Grads!

We have hired 3 new grad nurses into our unit! Whoo! I'm not the least experienced in the unit anymore! ;) I am looking forward to working with some new nurses and encourage them on their journey and their first stressful year as a new nurse in a trauma icu like i was encouraged by my fellow co-workers.

Connections with Patients

The best times of my job are when I connect with my patients...and more importantly, when I can bring a smile to their face. Comfort, rest, peacefulness. I don't always achieve that goal...maybe as much as I try, their pain can't be controlled, the situation is too much to handle for an already anxious person, or we just dont "click". I click with almost all of my patients, but they are people too and we are all different.

This past week I had three moments with patients that bring a smile to my face as I think back on them. I wish my patients knew that they bring as much joy to my life seeing them smile as they tell me I do to them.

My patients name was "Esther"...just like my mom! I started my night out letting her know my mom's name was Esther and people are always forgetting the "H". She loved that. She had just suffered a MAJOR complication with a throat surgery so she was in pain, tired, and worried. No doubt! I was able to get her cleaned up, wash/brush hair, warm lavender lotion back rub, new gown, new linens, tuck her into bed and get her pain under control. She slept like a baby for the rest of the night. For the rest of our interaction (until I discharged her to the floor the next night) she held my hand, called me "mija"and gave me lots of kisses before she left.

My other patient was a very sick, tired and worn out Vietnam Vet (who may or may not have been homeless...either way, living on the edge of poverty for sure, so sad). He wasn't really opening up to me, I just couldn't get him to smile! Halfway through the night, my back was turned getting some medication ready for him and I must have left an alcohol swab on his covers so I see this alcohol swab sailing through the air for a basket into the trashcan...it missed. Before I turned around I said with a laugh in my voice "I saw you miss that basket!" The smile on his face when I turned around was like a kid laughing at an inside joke. We had a great two nights after that...he also was discharged to the floor my last night, which is always a good thing!

Finally, there was a chronically sick patient of another nurse that I was helping with. Just through the entire interaction his gummy smile was one of the best smiles I have seen. It brought a smile to my face and heart.

I am thankful for these moments with other human beings in my care.

Beringer White Zinfandal

Beringer White Zinfandel...whose tasting notes read "Beringer’s winemakers highlight Zinfandel’s characteristically bright, fruity characteristics to create a light, refreshing blush wine. Immediately following gentle destemming and crushing, the must (pulp, juice and skins) is quickly chilled to preserve its fresh strawberry, raspberry and orange peel aromas and flavors. Just as a slight rose hue develops, the juice is pressed off the skins and fermented at carefully controlled, cool temperatures. To impart a slightly creamy texture and round out the vibrant berry and citrus flavors with notes of pear, apple and nutmeg spice, Beringer’s winemakers blend in approximately twenty-percent barrel-fermented Chardonnay" (http://www.beringer.com/)

Ah, this all sounds very nice and can be quite enjoyable on a hot summer day or evening in Phoenix when we are living in temperatures in the 100's. And everyone knows that I enjoy a nice glass of wine and appreciate it for what it is; however, when I am at work alcohol, wine, drugs, etc are NOT tolerated, by my hospital or by me!

This all leads me into the ridiculous story I have to share about this inexpensive wine. I had a patient (who I had been warned earlier that the friends were a little "suspicious"). She was on the floor but had developed a high fever, increased HR, and decreased blood pressure and they were worried she was going septic. They wanted to watch her overnight in the ICU...give her some good 1:1 care...watch her vitals, give her fluids, antibiotics, etc. No problem. Well, around 1 am her friends start arriving (would you visit your sick friend at 1am in the morning if they were at home??) and I noticed this one kid acting really boisterous and arrogant. I go to get her antibiotic drip and when I come back I see the curtain is completely closed....uhhh....thats a no-go in here. Unless there is a reason that has been discussed with the nurse, curtains aren't closed like that in the ICU. So as I walk in, the kid tries to keep me from coming in (that wasn't happening!) and as I walk around the side of the bed to the IV pole...what do I see open on the side table?

I went from 0 to 10 immediately on the anger scale. There are so many reasons why, the first being the idea you are trying to develop trust with your patient and vice versa...well, that was a big slap in the face and out of the question now. Second, I am giving this patient IV narcotics every hour for her pain and now I have the suspicion she could be consuming alcohol? And the audacity of these people to not respect the environment they are in. Not only are you in a hospital, you are in an Intensive Care Unit! I told them it was completely inappropriate, I couldn't believe they had the nerve to bring this in and that now I am under suspicion my patient may have been drinking. It was absolutely not tolerated, they needed to leave and I escorted them out.

Guess that is just one more night in the Trauma ICU....sure this won't be my first go-around with something like this!

Medical Ethics: Truth Telling

Had my first case where I was confronted with an ethical dilemma, to share the news of a diagnosis with a patient or to honor the wishes of his mother which was to tell him he was "okay" and "going to get better". In this case, he was a permanent paraplegic and yes, he would probably get "better" but not in terms of ever walking again. I stumbled upon this situation when he asked me why he couldn't move his legs and I explained to him what happened...only to find out this kid who had been in the hospital 2 weeks had not been informed of his diagnosis (or at least he was still under too much medication to comprehend what happened). In the end, after I talked to him about his diagnosis his attitude changed to one of defiance, anger and frustration from what I now see as being confused and knowing something was wrong with him but no one telling him to a cooperative, grateful kid who was facing his future head on. He went from pulling out tubes (PEG tube, self extubating, pulling out IV's, etc!) to brushing his own teeth, suctioning his own mouth and helping to reposition himself as best he could. I think in this case, it was better to talk with him in a kind, gentle yet honest manner instead of acting like nothing was wrong.

http://depts.washington.edu/bioethx/topics/truth.html

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I'm a 26 year old female status post graduation with my Bachelor of Science in Nursing from Grand Canyon University in Phoenix, Arizona 1 year ago. NKA and Full Code. No pertinent health history. I am interested in starting a blog about my boring and exciting nights in a Trauma Intensive Care Unit in Phoenix. I love my job and I love working nights! My co-workers are awesome, my unit caters Level 1 Traumas so when I clock in every night I literally don't know what the night holds. Sometimes, I run my butt off...other times I am able to really spend 1 on 1 time with my patients participating in their healing. I try and follow holistic nursing care and really view my patients as a person with a mind, body and soul. I hope this blog not only catalogs my experiences as a new nurse but will join me with a community of nurses who are sharing their experiences online!


I can't end without mentioning an important piece of my life that makes me who I am and contributes to everything that I do...my amazing husband, Rob, who is always there for me and helps me as a become the person and nurse God has intended for me to be.