midnightsjane

My patient today said the nicest thing to me at the end of my shift. She told me that my care had turned her around today, that she'd gone from feeling lethargic and depressed to feeling energized and so much more optimistic about her prognosis because of all I'd done for her today. I have to say I was touched and pleased, and that it is this kind of feedback that makes me really happy to do the work I do. And honestly, all I did was what I try to do all the time: listen, and respond in a respectful and caring manner to her words, and try to be the kind of nurse who makes her patients feel better, the kind of nurse I'd want to have look after me if I were ill.

Days like today make me happy I chose to be a nurse all those years ago.

Cornerofmadness asks why I chose nursing as a career, and for my thoughts and insights on my career choice.

I don't know that I actually chose to be a nurse. I mean, I don't remember a moment when I thought, "aha! I want to be a nurse when I grow up!" It just kind of happened. In the early 1960's, when I was in high school, the career choices for girls were fairly limited: teacher, nurse, secretary; that pretty much summed up what the guidance teacher had to offer. I didn't really even consider that there were other paths. My older sister went into nursing school 3 years before I did, and my favourite aunt was a nurse, so I had some role models. The other issue was financial; by going to a hospital centred nursing school there was no tuition, and we lived in the dorm, ate in the hospital cafeteria and received a small stipend of $14 a month for personal stuff. In return, we worked in the hospital during the three years of training. By the second and third years, we student nurses formed a major part of the hospital staffing. Training in a hospital based nursing program gave me an excellent foundation for my future work. We got a lot of experience in the real world of hospitals and sick people, saw the good, the bad, and the OMG. I think that today, most nursing students that I encounter have a much more limited exposure to what nursing really entails; I have met nurses who have never been present when someone dies. The first death I saw was about 2 months into my first year of training; an old man died while my classmate and I were making his bed. We turned him over, and he died. We thought we'd killed him.

I digress. Thoughts and insights into nursing as a career? I have some.
I think I was a natural born nurse. Over the 45 years I've been doing this, there hasn't been a time when I seriously considered leaving nursing for another career; I would hate working in an office, I'm not really a good teacher, and I find that I'm one of those people who like to take care of people. I'm pretty sure that is a fairly important characteristic of a good nurse. The other thing I have is a very strong stomach; nursing can be pretty icky, what with the copious body fluids and such. Not vomiting when a patient is doing the same, that's a good thing; important quality in a bedside nurse.
Over the years, nursing has evolved and developed, and we have taken on more complex and complicated roles. We do so much more than just carry bedpans and give bedbaths; we assess our patients' condition, watch and react to symptoms, make decisions about treatments, and yes, even teach the medical students. ( As my brother, who is an anesthetist, told his med students: "listen to the nurses, because they know what's actually happening with the patients, and have the experience and expertise to know when things are going badly. Also, they can make or break your rotation. Wise man, my brother.) I take care of extremely ill people, a job that requires me to think critically, to react quickly to emergencies, to use complicated pieces of equipment, and to always remember the reason for this: to help someone who is ill recover and get back to living his or her life.

It's a hard job, physically and mentally. I know so many nurses who have been injured on the job, who find the work emotionally stressful, and who have to deal with years of shift work. For me, the work brings more rewards than negatives; there is nothing quite like having someone who was on the brink of death come back into ICU to say thank you and goodbye before going home. That is what keeps me going, and what makes my career choice so satisfying.

It's also been a financially stable career; I have never been unemployed, unless by choice, the wages have risen over the years, and the benefits are good. I have a good pension plan, and I'm grateful for that in these difficult times.

All in all, I think I chose well when I chose nursing as a career. I've never regretted it, and I think I've been a good nurse.

It was one of those days when I wondered why the hell I'm still doing this. Today I was in CCU, a place I generally enjoy, today not so much. The guy I was looking after has severe brain damage and behavioural problems because of it, so I know he's not really responsible for his actions. Still, it doesn't make it any better when I get told at various times of the day to a)fuck off b)suck my cock, and c)lick the feces off the guy's foot after he smeared his poop all over himself and the bed. EWWWWWWWWWWWWW. There are no words for how icky that was. I was very tempted to just smack him upside the head. Eww, ewww.

Sometimes the milk of human kindness runs very thin, when the person I'm trying to care for is not the most likeable of humans. It's not supposed to make a difference, but it's a whole lot easier to look after someone who is pleasant and co-operative than with someone who is the complete opposite of that.

No big surprise there.

Still, one of those days when I think maybe I should just retire for good. And I would, if I didn't have all those horses who need to be fed and cared for. This week they're all getting their teeth done.....and I don't have a dental plan for them.

Guess that answers my question, eh?

Had the busiest day. Didn't stop from the moment I walked into ICU until the moment I walked out again some 12 hours later. Had a very sick unstable patient and he kept me busy all day. It was kind of fun, though. I haven't had a really sick patient for awhile, so it made me focus and think all day long. I was tired by the end of the day, in a good satisfied kind of way. Didn't actually get a full dinner break (because I wanted to get my charting caught up so I could get off on time) but I did take time for coffee and a nice back massage from the Shiatsu massage chair that a patient gave us. It's like a chair/pillow that fits on a kitchen chair, and it's amazing. I want one.

ICBC called me today, left a message that my cheque is ready. I have to take my car in, sign a release form, hand over the keys and take the money. First I have to shop for a new car. I have a week or so, so I've got to get busy.

It's cooler this evening, so hopefully I'll sleep better than I did last night. I was so discombobulated from the shift turnaround that I couldn't get to sleep, so I took a Benadryl. Woke up about 2 a.m., got up to make some warm milk, and somehow managed to do that as well as making some sort of weird combo of chamomile tea, warm milk and sugar...and I don't remember doing it. I found myself drinking it and thinking it tasted strange, but okay. This morning I found the cup of milk sitting on my night table as well. Man, I was out of it. Hope it's better tonight!

A mantra to be repeated over and over again, after the 20th time I was told to "fuck off!" and other variations on the theme by one of the patients. I know, he was totally delerious, but it does get wearing after awhile. I was being patient and caring on the outside, while on the inside I was busy smacking the guy upside the head. Some days. He went from singing to shouting for more water to cursing every one and their mother. Twelve hours of that, and I was so very happy to go home. I love my job. Yup.

Things have really ramped up in ICU, lots of sick people. There was only one empty bed left at the end of the day.

Glad I have a couple of days to recharge. 'cause I really do love my job, most of the time.

I had a good day today. Got up and went to work; I decided to take the car instead of the bus 'cause it was a crappy rainy kind of day. I don't mind the bus in the mornings, but after work I really hate having to wait for the bus. The bus stop is about a 4 block walk from the hospital, right outside a bar, and sometimes the area is a bit, well, rough. In the dark rainy evenings it's a bit of a drag. Anyway, drove to work instead, so stayed dry.

I took care of a young man who has been really very ill; today was his 75th day in ICU. He has come very close to death on more than one occasion, and is just a shadow of his former self right now. However he is improving and I think he's passed that critical point right now. His tracheostomy tube was removed a few days ago, and he can finally talk and communicate. We got along well, and he seems very motivated to get better. I tried to give him as much control over his day as possible, leaving it up to him as to when he had his wash, and his shave and whether he wanted his foot splints on now, or in half an hour, that kind of thing. When you are stuck in a hospital bed with no real say over when you get positioned and such, it must be so frustrating, especially if you also have no voice. Since it makes no difference to me when I give him his bath, etc. letting him decide really makes him feel better and more in control.

The high point of his day was dinner, when he got actual recognizable food for the first time! Chicken and mashed potatoes with gravy; he asked me if it was all pureed, and when I showed him his plate with the chicken breast, his face lit up like it was Christmas. I had to help him by cutting up the meat and feeding him, because he's still so weak, but he managed to eat a fair bit, and enjoyed it. When I went in to say goodnight to him before I left, he thanked me for my help and said he'd had a really good day. He's not had a lot of good days, so it made me happy to know today was one of them.

Days like today make working a pleasure.

Because I had my car, I was able to give one of my co-workers who lives near me a ride home, and ease my mild guilt over driving instead of taking transit.

;P

That old saw about surgeons thinking themselves as higher lifeforms than the rest of us mere medical mortals? In the case of a certain cardiac surgeon, it's totally true. Yesterday I had a fairly decent day, until just before 7 p.m. My patient was quite sick, had some issues with possible bleeding into her right lung, so we'd taken her down for a CT scan, and then were giving her blood, consulting respirology and then surgery to decide what needed to be done. Hadn't heard anything by 6:50 or so, when someone from the OR showed up at her bedside, to say that she was checking out what lines the patient had, and oh, by the way, the OR would be coming over in 10 minutes to get her....say what? It would sure be nice to have some sort of advance notice so we could, oh, call the family, get a consent, prepare the patient properly (and even tell the patient, novel concept!) Hearing that we had no idea what was happening, the OR person left; 5 minutes later the cardiac surgeon arrived. Yup, taking her over now, get her ready to go, by the way, take some blood work, give her 4 units of plasma stat, and oh no, she doesn't have a big central line? Whatever are you guys doing here? How incompetent, not being psychic enough to intuit what we'd decided to do without telling you. Never mind, just get me the central line kit and help me while you do all the other stuff as well.... Not to mention that it was almost end of shift and I had other things like charting and meds to give. I held onto my temper, did what I could, and luckily one of my co-workers had time to help with the line insertion. I asked the surgeon to call the lady's son because he was next of kin, and it is the surgeon's responsibility to get consent; he assured me he'd call. Within 30 minutes I'd managed to get everything together and get the first unit of plasma up, and the chart together, and try to reassure the poor woman, to explain what the surgery would be (since the surgeon hadn't said much to her besides, lie still, I'm going to put a big IV in you, and there was all this kerfuffle going on around her). The OR team came and got her, and then five minutes later someone came over to say, oh, by the way, did you get a consent signed? Um, no. That would be the DOCTOR'S JOB.
Really. That whole thing could have been handled so much better if they had just communicated with those of us looking after the poor woman. It's not like it was going to be a matter of life and death in the next five minutes, there was actually time to be organized. I guess the surgeon is used to being able to snap his fingers and have everything ready for him in the OR; just doesn't work that way outside those hallowed halls.

:headdesk:

Oh, well. In other news, I had a day off today. Took my car in for servicing. I was a little nervous, because it was way overdue for a tune-up and oil change, and the last couple of times there have been extra things that needed fixing. My car is almost 16 years old, on her second engine, too. Hurray, all is well. The mechanic said it was in very good shape. Good to hear.

After I dropped the car off, I walked up Fourth Avenue, got some stuff at Shopper's Drug Mart, then stopped in at Terra Breads for a cup of coffee and a very yummy pecan-cinnamon roll. Then I took the bus home, cleaned the apartment, made some stewed rhubarb (from rhubarb from the garden at the farm) and drank tea and read a book until it was time to go get the car.

Got home, made some scones for tea. It's very strange: I have made the exact same recipe many times, and today the dough was super sticky for some reason. Maybe it's the damp weather. I know altitude affects baking, so I guess humidity must too. Anyway, the scones turned out fine. I had some with the stewed rhubarb, it was delicious.

I was supposed to go to an ICU education day workshop tomorrow, but the staffing office called to ask if I could work a dayshift. So getting paid for 12 hours trumps 4 hours pay.

Time to get lunch ready.

And it's the weekend already. Time just flies by these days. I know, they say that time seems to speed up as we get older, and it seems to be true. I remember the long ago days of my youth, when the days seemed to last forever, perhaps because I was impatient, wanting to get on with being an adult, making my dreams come true. Now that I'm a ways away from my youthful dreams, and I know that I've lived more of my life than I have left to live (I seriously doubt that I'll live to 128 to make this my halfway point, LOL), time seems to have hit the accelerator. Maybe I'm just having a mini age crisis or something; the other day I looked at myself in the mirror and all of a sudden it hit me that in five years and a few months, I will be seventy.....it kind of took me by surprise, and made me think about the fact that I don't have an unlimited life span ahead. Freaked me out just a little bit. I certainly don't feelold, I have lots of energy and interest in life, I don't think I look my age, but now I understand what my Mother meant when she said to me once "I look in the mirror and wonder who that old lady is, and how the hell did that happen!?" I get it now, Mom.

No matter how old we get, we're all still children in our parents' eyes. This was made clear to me the other day at work, when I met the parents of the person I was looking after. He was 61, critically ill, and most likely to die in the next 24 hours. His wife brought his elderly parents in, and it quite broke my heart to watch them. They must have been in their late 80's, and he was their only child..the tears rolled down their cheeks, and his mother told me what a wonderful son he'd been to them. He was still their little boy. I had to swallow a few tears myself.

In ICU we have a lot of interactions with families; sometimes it seems we nurse the families as much as the patient. Usually it's a matter of comfort and reassurance and support, answering questions etc; sometimes it isn't quite as easy as that. Family dynamics can be...interesting, and moments of crisis can bring out all sorts of issues. Occasionally we get caught in the middle, and it can be rather uncomfortable. (It's not for nothing that one of the very dark bits of humour we indulge in is the description of our ideal ICU patient: intubated, ventilated, paralyzed and heavily sedated, with a tube in every oriface...and no family.) We don't mean that, of course, but some days it would be more restful.

I had another patient yesterday, and the family was one of those very involved and intense ones, the kind that come with a little bubble over their heads that says "nurses, beware". The kind that wants to know every single detail of their family member's care, and whose need to be involved sometimes crosses that line between caring and concerned to controlling and interfering. I have no problem with most families, and respect their need for information and involvement, but sometimes it's hard not to get annoyed when it feels like the family doesn't trust the staff. The hardest ones are the ones like yesterday, when there is a family member who is in the medical profession. One of the daughters is a doctor, and I was warned in report that she tended to overstep her bounds a bit trying to direct his care. I had quite a conversation with her about it, after she came in, pulled the curtains and pulled out her stethescope and started examining her father. While I respect her need to have more details, to know about things like blood work, there is a certain line that she needed to stay behind, in my view. I told her she needed to step back and be his daughter, not his doctor; that when she tried to control his care, it was making me feel that she didn't trust me, or the ICU doctors. One of my co-workers got quite bent out of shape by one of the other daughters who tried to get him to stop doing something that although necessary was also uncomfortable for her dad; it's a hard position to be in, and we nurses are human beings with feelings that get hurt, even when we know we shouldn't take it personally. I don't know, what do you think? If you had a family member in ICU, and you were a nurse or doctor, would you be able to stand back, to be the daughter, or son, or parent, and not want to take part in the medical care? I know that when my mother was very ill, I was aware that my family is probably one of those intimidating ones for the staff: in my immediate family my sister, my two sisters-in-law, my niece and I are all nurses; my brother is an a doctor with a specialty in ICU; we all were very careful about overstepping that line, because we didn't want to be that family. Not to say we didn't ask questions and insist on getting the answers, but we tried to leave Mom's care in the hands of the staff; she got excellent care, and recovered, happily. It's just one of those conundrums that working in ICU brings.

Anyhow. It was a gorgeous day, the sun shone, the birds sang, the trees are bursting into leaf, the rhubarb in my little garden is growing, the horses are all frisky and feisty, and the traffic home was only mildly annoying.

I made a huge pot of vegetarian chili last night, and it was one of the best batches I've made yet, I think. I had a big bowl for supper with a piece of rye bread toast. I baked scones tonight, with dried sweet cherries, and now I'm going to have one with a cup of tea.

Taking my foot of the gas for tonight. :P

Here's to spring! 'Bout time you got here, I'd say...but really, did you have to stop in Winnipeg first? I hear it was way warm there today. Seems like our weather took a detour back east. It actually snowed here yesterday :(

I was at work and someone said "hey, it's snowing!" and when I looked out the window, it was like a blizzard. Luckily it was a brief blizzard, and didn't stick around. Talk about weird weather patterns.

I am just about at the end of a long work period; I don't know what I was thinking when I booked my shifts, but only having one day off at a time is not a brilliant move. I am kind of dragging my butt here, and was definitely getting a bit cranky by the end of yesterday. I had a patient who was easy to look after, but she has the most enormous family..husband, 4 children, and 25 grandchildren! not to mention cousins, siblings and other assorted relatives, who all wanted to come in to see her. They were all polite and well behaved, but the un-ending stream of visitors wore me out.

I learned a new thing, though; how to say thank you in Haida. It sounds like 'howah', only more gutteral than I could manage. Cool.

Every once in awhile at work there's a patient who I feel a bit of a special connection with. Usually, although I care about the person I'm looking after, once I leave the ICU I don't think about them; but once in awhile there's someone who I kind of carry home with me. One such person was Don, a lovely gentleman who I had the pleasure of caring for over 4 shifts; he was just the nicest, most stoic man. He had a rocky road after some surgery, and had to go back to the OR a couple of times to stop some bleeding from stomach ulcers. On Sunday he was doing well, almost ready to leave ICU. I was looking after someone else in the same room, and when I went over to say hi, he grabbed my hand and said "it's such a blessing to see you again." He was sitting up in a chair in the afternoon, and his nurse and I were joking with him (someone brought in a chocolate cake, and I was telling him about it) He told me I was torturing him because he wasn't allowed food and he loved chocolate cake. I offered to get a little icing and put it on his lips. I was so happy to see him looking better. I came back on Monday morning, and his bed was empty. He rebled and died during the night. I felt like crying when I heard the news, and so did his surgeon when she came in that morning. We were all so shocked. It was very sad. But I'm glad we had a laugh and a little fun that afternoon, and glad that his wife saw it, and that his brother from back east was there visiting. You just never know when your time is coming up, so enjoy life while you can.

On a happier note, this weekend is the first horse show of the season, and Goldie is entered. She's an awesome jumper, and this will be her first ever show. We're all excited, and we really hope she wins a ribbon of some colour for Jack's sake; he would be over the moon if that happened. He's so proud of his girl. Fingers crossed for Goldie! I hope the weather is as good as they're predicting.

Happy first day of spring!

Today was warm, with hope for spring in the air. I started thinking about how important hope is. Without hope for better things, getting through the hard days of life could be next to impossible for so many of us. It's that spark of optimism, that sense that if I can just get past this tough bit, the sun will shine again. Without hope, how does one carry the heavy weight of life's hard times?

Working in ICU, where so often there seems to be no hope at all, I am always amazed to see how powerful that need for hope is in all of us, and how wonderful it is to see despair turning to hope, even if it's just hope that there is hope. It's so easy to become resistant to the idea of hope in the face of overwhelming crisis, and I've seen it in the way we react when someone is at that crossroads between life and death; when what we as medical professionals see as a futile effort to keep someone alive comes up to a family who still hope. Sometimes we're right, there is no longer hope for any kind of useful recovery, and the best option is to keep the person comfortable and allow him or her a peaceful death; but sometimes, the hope is so strong that it seems like it's the one thing that pulls the person back from the brink. In my long nursing career, I have looked after more than one person who I truly believed had very little chance of recovery, and whose care made me agonize over our continuing efforts; more than once I've wondered if we were actually causing more pain than good, if we were guilty of prolonging the inevitable. In some cases I've been right; in others, beyond all my expectations, I've been wrong, and the person recovers, seemingly only cured by the strength of the belief that there was hope for it. I vividly remember several people: Harry, who was in a coma for months, with end stage liver disease, whose wife insisted he would recover, despite the doctors' gloomy prognosis. Every day, she would stand at his bedside and chant, in a singsong voice: "Harry Jones, open your eyes; Harry Jones, you're going to wake up; Harry Jones open your eyes!" We all would roll our eyes and think she was a little strange. Harry never showed any signs of waking up...until one day, after he had been transferred out of ICU to a medical ward where we figured he would die, he just opened his eyes and woke up. When I heard the news, I went over to the ward to visit him, to see for myself. Sure enough, there he was, awake and talking. In fact, his first words, according to the nurses, were to his wife. He woke up, looked at her, and said "where's my fucking cadillac?" We laughed about that for ages. It proved to me that there is just no way to really predict what will happen, even in the most hopeless of scenarios.

In ICU right now we have another example of hope shining out of a seemingly hopeless case...we have a patient, a young man who was in a motor vehicle accident almost 3 years ago; he sustained major head injuries and was in a coma for a year. When he recovered enough, his family brought him home..to their home in a refugee camp. Despite the difficulties faced by the family, they never gave up their hope that he would live; for over a year they cared for him 24/7, doing literally everything for him. He was unable to speak, and was a quadriplegic because of his brain injuries. A few months ago, the family was accepted by Canada as refugees, and they arrived here. The young man came to ICU directly from the airport; he has been with us since. He's a beautiful young man, locked in his body, able to communicate only by blinking his eyes, or moving one finger. His family are amazing; his care was awesome; not one blemish on his skin, not a pressure sore, care that I don't think we could measure up to. Their dedication and hope is inspiring. One of the best things we've been able to do for him is the work of our speech pathologist; she has been working with him to find ways for him to communicate, to get out of his locked in body and interact with the world. It's the combination of dedication, inspiration and technology that is making such a change to his situation; she is working on the use of spelling boards and is figuring out ways to use an IPad with him. I don't know what else she has in mind, but what she has done so far is enough that every time she walks into his room, he gets the biggest smile on his face. Communication and hope, a marvellous combination.

Hope, it's a good thing. When I feel overwhelmed by life, I think of stories like this, and remember to hope.