Compliance

this happens all too often.......

Obit Backtrack

when my wife and i first got married, 6-ish years ago, she did something that sorta bugged me. when we got the sunday newspaper, or any paper for that matter, she would read the comics.....and the obituaries. i thought that was kinda weird, and i asked her about it. she said that all nurses read the obituaries. i though okay, whatever. this was well before i had any plans or aspirations of becoming a nurse myself.

then we decided that i should go to nursing school as well. i got a job at my wife's same hospital working as a nurse's aide. and guess what? all the nurses there would read the obituaries.

i would shake my head in disgust. for some reason, that just seemed wrong to me. something about that sort of morbid curiosity that rubbed me the wrong way. i could not the justify the interest in the dead.

now i understand. i've been a nurse now for a little over a year, and guess what? now i too read the obituaries. i had my first patient appear in one, and our hospital got a brief mention in the thanks section of my (former) patient's tribute.

it's so weird, i never thought i'd be an obit reader, and now here i am.

Rapport, Rock, Hard Place, and the NFL playoffs.

–noun

relation; connection, esp. harmonious or sympathetic relation: a teacher trying to establish close rapport with students.

from dictionary.reference.com.

i had a patient who was gonna die. in a sense, all of my patients are going to die, but with a terminal illness, sometimes you know someone is going to die sooner rather than later. the patient was in a bad way. young (40's) and terminal. they had a form of cancer that had spread throughout the body, and the only treatment was one that would be really, really bad for certain organs. said organs belonging to my patient were not working, and had not been working for some time.

i had an instructor in nursing skool tell me that all medicines were poison. i still think of them that way. i mean, look at all the commercials for meds on TV. the majority of the time, they have time to state the name of the drug, what it might help with, then the remainder of the time left, they pay those used car sales guys to go thru, like, 50 bazillion side effects.

'depressed? try abilify! side effects may include, increasedriskofsuicidedepressionanxietydecreasedlibidosexualfunctioningdeathorworse.

so my patient had this cancer, and these crappy organs, and had apparently been using home/herbal remedies to try and fix said organs. the ROCK; the patient had cancer. a treatable cancer, but the treatment wrecks havoc on certain organs which THE HARD PLACE were in failure, necessitating a transplant. the patient really needed an organ transplant, but with the cancer, there was no way.

you get the picture? terminal.

so, i'm work a buncha days in a row, then i have a buncha days off. so i had there patient for a long time at night, while during the days, there were different nurses that came and went. most of the day nurses would report to me that the patient was in a sooper funk, and either depressed or in denial or inappropriately processing, if at all, the fact that DEATH was in the room.

however, the patient was totally 'with it.' for me.

why?

well, for one thing, i didn't talk to the patient about dying. didn't mention it. instead, i talked about stuff like college and pro football, favorite books i read/was reading. i spoke about my family. i asked about my patient's family. and really got to know about my patient and the life that was BEFORE.

where dayshift got one-word answers or no answers at all, i got life stories. i didn't walk into the room with a sympathetic look on my face and encourage my patient to 'just let it all out,' or 'give a good cry.' i refused to look in the corner of the room where DEATH was sitting, reading his copy of People magazine.

lest you think i'm some sort of genius or something for my approach, let me tell you why i did what i did. i am not good with emotions. i'm not a fan of how my emotions make me feel. plus, the mechanism that enables most humans to cry broke on me a long time ago and i never took it back in to get it fixed. when i cry, it sounds like hell and looks worse. snot, redness, weird noises and the works. NOT. PRETTY.

so i do not allow my self to get emotional. not for my self or for my patients. i don't want to cry, and i don't want my patients to cry either. that is not to say that i don't feel for my patients, i feel very deeply for them, just not while i'm at work. i save that feeling crap for my days off the occasional bottle of Blue Moon.

so DEATH is in the room. sitting at the bedside, in his dark rotting robes, playing 'angry birds' on his ipad, like everybody else. he's probably pissed that i'm ignoring him, or maybe not. i figure he's seen everything at this point. point is, i ignore him. and for twelve hours that is my shift, my patient can ignore him too. because i am babbling about Malcolm Gladwell and Brett Fav-ruh, and the Miracle at Qwest field. and my wife'd boob-feeding and how max drives me crazy.

and it is just what my patient needed. (disclaimer; i do offer to hold my patients hands, if needed and appropriate. i do practice appropriate therapeutic touch. and i touch my patients without gloves. at least a couple times per shift.)

Frustration & Delight

from Conversations with a 3.5 year old.

nurse j; 'please put your shoes on.'

max; 'put my shoes on?'

nurse j; 'yes. the brown shoes.'

max; 'these shoes?'

'no, the brown ones. the ones right in front of you.'

'these ones?'

'no, the other ones.'

'these ones?'

'no.'

'these ones?'

'no"

'these ones?' (as maximus continues to grab EVERY SINGLE PAIR OF SHOES HE OWNS, WITH THE EXCEPTION OF THE ONES I WANT HIM TO WEAR, WHICH ARE NEAREST TO HIM AND RIGHT IN FRONT OF HIM).

there is much internal cursing, nurse j head explodes.

*************************************************************************************

max; 'where we going?'

nurse j; 'to pick up mama from the dentist.'

max; 'to pick up mama?'

nurse j; 'yes.'

'from the dentist?'

'yes.'

we pick up the action in our story...............2 seconds later.

'we going to pick up mama?'

'yes.'

'from the dentist?'

'yes.'

2 seconds later.

'where's mama?'

cursing, head explodes.

************************************************************************************

just writing this down brings back that familiar, when-is-my-head-gonna explode feeling that i had when the conversations first took place. or when many similar conversations like these take place every day. the poor kid just wants to talk and be a part of the action, he just doesn't have the vocabulary to maintain a conversation longer that 15 seconds that doesn't center around Toy Story Free or Cars.

i wonder what an ART line would show my pressure was during those moments.

or this one, which probably happens just often enough to keep my head from ackshually exploding.

max; 'dadda...'

nurse j; 'yes, max.'

max; 'i love you.'

nurse j; 'thank you max, i love you too.'

'dadda, we best friends?'

'yes max, we're best friends.'

'i love you dadda. sing-you are my shunshine. gotta singy song to me, sing shunshine. okay, dadda?'

'okay max. you are my sunshine, my only sunshine............'

Exasperation

i remember conversations my father and mother would have that would drive my dad NUTS. he would ask a question of my mother and she would answer him in such a way i could ackshully see my dad's head hurting.

i used to laugh. it was funny.

one time my mom was trying to call our neighbors, but she kept dialing our number, which kept ringing back busy. finally, (we were sitting at the table eating dinner) when she told us what number she was dialing, and we told her that was OUR number, she burst out with, "why don't you answer when i called ME?!?!?"

it was hilarious.

back then.

now, i am married.

yeah, you know what's coming.

The other day i'm in super clean mode. putting away christmas, making trips to the storage garage we share with our friends, doing laundry, cleaning, etcetera.

I'm about to do a garbage run, so i ask my wife (who's breastfeeeding Brutus at the time-hey, maybe that's it-any chance she'e leaking brain cells in her boob milk? do they grow back? easy people, i just want my usually-smarter-than-me, more common-sense-than-me wife back) if the garbages need to be emptied.

it was a simple query. "are the garbages in the bathrooms empty?"

two things to consider; 1) the garbage bags in the bathrooms, 2) are they empty. question mark.

i was looking for either a yes (meaning the wifey had already emptied them, a distinct possibility, since i was already looking at several plastic garbage bags full of stuff), or a no, meaning the garbages in the bathrooms were still full.

yes (go empty the garbages) or no (already done).

what i got was, 'yes, they need to be emptied.'

i had instant brain freeze and flashback to all those times i'd laughed at my old man slowly being driven to drink/insane by my moms crazy answers.

so, do women go to school to learn how to do this, is it passed on from generation to generation, is it genetic or what?

Worst Patient Olympics

candidate #2

the end of the year means a lot of things to different people. to some, it means you eat a lot. to others, it's all about family.

to people who have met their health insurance deductible, it can mean only one thing-free surgery!!

the end of the year is surprisingly busy for certain kinds of docs, docs that do things that may be considered 'elective surgeries.' like getting that knee that's been bothering you some time looked at, or that pesky hernia you've had ever since you helped your uncle charlie switch out his big old tube TV for the new plasma, or even that funny growth you've had on the side of your neck removed.

so you've met your deductible. that means free surgery. THAT much you do know. you don't know much about medicine or anything like that, that's for the nerds you made fun of in high school (those nerds, coincidentally, are now your doctors and accountants and engineers-imagine that!). one thing those nerds with soft hands do worry about is what kinds of meds you use. now, you did have those stents placed in you heart in April (eat vegetables? more fiber? what do i look like, a rabbit? i'm a MAN, and i eat whatever the damn heck i feel like, and that means MEAT and POTATOES), and so you've been on blood thinners since then.

whatever. if being on that dang blood-thinner means i can't have my surgery now, while it's free, then i'll just stop taking it. or i'll tell him that i stopped a while ago. yeah, sounds like a plan.

so my patient blatantly lied to his surgeon about being on a potent blood thinner, or anti platelet aggregator. think plavix, only better and more badass. i did some research on the drug, and it turns out it is undetectable in plasma, which may explain why this guys presurgery labs turned out okay. also, it is a competitive inhibitor, which means that the only way to get rid of the stuff is to bleed it out. the website recommends stopping effient at least 7 days prior to any planned surgery. seven. not 2, or three, but seven. SEVEN.

did my patient lie about being on the drug? yes. did he discontinue the drug 7 days prior? no. did he start to bleed like crazy on the capillary level were he got his non-essential, non-life threatening, elective surgery days before Christmas? yes. did he end up almost dying and having to have emergency surgery, get intubated, right before the holidaze? yup, yup, yuppers and sure did.

the things people do. seriously.

Worst Patient Olympics

candidate #1

as i walk into the room to assess my just-got-her-knee-fixed lady;

"hi, my husband is an attorney, and he loves to sue people like you. so.......have you done anything wrong i could sue you for?"

the look on her face said she wasn't kidding. not one little bit.