Thursday, August 23, 2012

Am I losing my touch with humanity?

Lately on our unit we've had an increase in the amount of deaths. Now I understand that eveyone has to die, heck we don't live in the age of the bible/torah/quran and live to be 800 yrs+

That being said, we've also had people on our unit who are DNR (do not resuscitate) who I can't help myself in thinking that many of these people I would rather see die... but only because IMO they are suffering.

The last shift I worked was one such case - I had a patient who's not very old - I'd say youngish, on TPN (since like 2001/02), was severely emaciated, had several comorbidities and had been in and out of units (whenever he gets readmitted he gets put back on our unit for some reason - totally unrelated to the fact that our unit is for neuro pts) for like a year+.

During this last admittance, he suddenly started vomitting blood EVERYWHERE and had to have an emergency scope to have varices in his stomach banded/cauterized. When he returned back to us, he required like 6-10 units of blood, plasma, IV fluids, etc...

To see him, he was CLEARLY suffering - and I'm thankful that he passed because you could see that not only was he suffering, but so was his family.

Another pt we've had on our unit is an older patient who is also a DNR, tho has late stage dementia. She's been on our unit for several months I think and recently became a DNR, the family was in denial about her condition for so long. This woman moans CONSTANTLY, is completely delirious and is VERY difficult to take care of, emotionally and psychologically because there's nothing that we can do to settle her. Even super strong anti psychotics don't touch her. She's REALLY difficult to feed or get her to drink and therefore she's starving herself. At least with the DNR in place, we don't have to give her a feeding tube. I'm hoping that she's passed, her family is having such a hard time seeing her waste away, physically and psychologically. They cry almost every time they come to visit but know that a DNR is the best thing to do. Thank goodness!!!

We have another lady on our unit who's on restraints because she has a neuro disorder that causes these involuntary movements. Now, in our province, no LTC (long term care) facility will take a pt with restraints, and therefore must stay with us in the hospital. This family, tho will not make her a DNR. I don't understand why, or maybe the Dr hasn't talked/pushed the family into making her a DNR. It's not like this lady's condition is going to improve, it'll only get worse! It's a terminal disorder. And I certainly don't want to be pushing down on this lady's chest when the time comes that her brain is going to deteriorate to the point where she stops breathing and I have to call a code on her, because she isn't a DNR. SOOO frustrating. I am surprised tho that this family comes to the hospital DAILY - for lunch or for dinner and personally feed her. It astonishes me because you think that that would eventually fade.

My question to you folk out there.... have you ever thought about delaying calling a code on someone who should VERY obviously SHOULD be a code????

Wednesday, August 22, 2012

Family & School

So I know that I don't talk about school that often, it's just that I haven't been really motivated to get much of it done. Doing school work from a distance is tricky with ADHD, however, I've managed to get 4 courses read and notes done, now it's time to challenge exam them.

On Sunday, my daughter and I head up to my hometown to spend some time with family and darling son. I'm looking forward to it but also dreading it a bit. I've run into some drama which has made me dread going up....

My son will be 11 in November, the court agreement indicates that I get him for the summer. This year, though, his father manipulated him (IMO) and had him indicate to me that he only wanted to spend 4 weeks (out of 10) with me. I was hurt but I allowed this to occur. Especially considering his father said that I was abusing him (my son) by indicating that his decision hurt my feelings and that I didn't want it to occur.

I made plans to go to my hometown in like April, not that I told my son or his father any of this (non of their business IMO) for the end of August, because I was going to surprise kiddo with the trip to hang with Nana & Papa while he was still with me - but that got taken away from me.

Now under the court agreement, I'm supposed to get him for the entire time that I'm in my hometown but instead I have to give my son to his asshole father for 3 days - there's so much more drama besides this but whatever. I always have to give up time, it's frustrating and hurtful.

Another thing has to do with my bestie and my mom, if either came to my area, it would be expected that I take time off from my job in order to spend time with them, but the same thing isn't being done when I go to my hometown.

My bestie, I can sympathize with (even though it saddens me) because her job doesn't have enough nurses to accomodate her getting time off unless it's vacation (and even then she still has to fight them to have it), but with my mom there's really no reason.

She works at a grocery store and there's TONS of younger and less senior ppl under her that she can tell them she wants a couple of days off. It's not like my parents are hurting for money or anything. I even told my mom that it felt like I had to pay her to stay off from her work. My mom takes 4 wks of vacation during the summer - 2 wks to go to HER bestie's cottage and then 2 wks for all of her friends to go to HER cottage.... and I figured that I would come during the last half of her vacation so that I can see her friends and mom and then another week where her and I can hang out, without having her have to go to work. But this isn't the case. This has been this way my ENTIRE life, why would I expect anything different to happen? She told me like 2 months ago, that if I were to go up to my hometown, that she would take time off to spend with me... and then when I tell her that that's what I would like her to do, she tells me no way.

When I called her and cried because it was hurting my feelings so much, she FINALLY said that she would try to see what she could do.... I guess we'll see when I go up on Sunday.

I'm about to start my nursing courses for my pre-req to get into the program - I'm looking forward to going and spending some leisurely time, swimming and studying cuz when I return, I have to challenge four courses -
* Nursing care for the childbearing family
* Nursing care for the adult
* Nursing care for the child and family
* Nursing care for mental health (something like that)

While I'll be studying these, I also figure that I'll be studying to take my NCLEX-PN since I also have to take this when I return (probably at the end of September, beginning of October) seeing that I'm trying to get my license in Michigan in case we decide to move to the states.

Thursday, August 9, 2012

Death & Dying - what I learned

I was working the other week, and one of my co workers had a patient who had been going downhill. It was such a sad story - the husband and wife came to Canada from out east to visit their children and the husband had a stroke and the wife forced her husband to come to my hospital. He of course was admitted. Now of course when ppl go on holiday they don't (always) think to get health insurance so now that they're at my hospital, there's no way to pay for the care and so the hospital goes after the children's ability to pay.

During grand rounds I learn that this person has been going through cycles since coming to the hospital - that his doctor had been trying to make him healthy enough so that he could get on a plane to go back to his parent country. Unfortunately, he would get well for about a week and then would start to spike a temperature and would have to be held up and begin a round of antibiotics, and that would be the cycle. It was like EVERY time he was well enough to get a clean enough bill of health as is required by airlines to allow sick ppl onto their airplanes, he would spike another temp and wouldn't be able to go back.

The shift I worked, I was told by the nurse taking care of him that he wasn't doing well, his BP was REALLY poor but his O2 was alright, but that he didn't look good. Thankfully the family had made him DNR so at least if things went awry we wouldn't have to pound on this poor patient's chest to revive him and keep him alive for longer than he needs to be.

The nurse came out and explained that she thought he would die during that particular shift and felt that there wasn't anything that could be done to alleviate any suffering. She called the on-call doc, who just happened to be one of my favorite docs and he ordered some dilaudid for him and some scopolamine as this med dries up secretions and the "death rattle" is less so the family isn't as upset by it.

The doc agreed that he was in the final throes of dying and that it wouldn't be long before he died. I was talking to the doctor and a couple of the other nurses when the wife comes out to the nursing station speaking Hindi - a language that not enough of us speak but we did have a couple of ppl on at that time and we pulled one of them (the male of the two) to translate as the wife was trying to speak to the doctor and pull him back into the patient room. Now when we pulled the male nurse to translate the face he was making was hilarious and it was almost as though he had NO idea why we were grabbing him and it was hilarious so I laughed.

I found out when the doc came back to the station was that her husband had just breathed his last breath and was coming out to indicate this.

I felt soooooooooooo bad that one of the last things that this woman may remember will be laughing when her pain was excrutiating. I am not someone who enjoys seeing another person in pain. I wish I coudl have spoken the language with enough fluency to apologize for any pain that I may have inadvertently causing her.

Morale of the story - get health insurance whenever you travel, you never know what's going to happen and you really do need to be covered. And never laugh at ANY point in time if someone is dying on your unit, because it may be perceived in another manner in which you meant it. ESPECIALLY if someone speaks another language. They have NO idea why you're laughing, and nothing is funny when your loved one is dying.