Thursday, December 20, 2012

Holistic Pedi care in the ER

Her little blue eyes darted from her mother to me repeatedly as tears built up and dropped onto her cheeks. I smiled at her and set my equipment down on the counter.  Her little chin quivered with fear as she struggled to compose herself.  Her mother quickly rushed to her side on the stretcher and held her tiny body close as she explained, “I’m sorry honey but we have to do this.” 

I sat on the stool near the counter, a few feet away from the stretcher, waiting for this little girl’s mother to finish consoling her child.  I was well aware of the fact that this little one knew all too well how painful things were about to get and she was trying so hard to be brave.  (2 months prior to this date this child came in and had to have a large MRSA boil lanced and the IV didn’t go so well so she was drawing on the only experience she had and FEAR was very palpable…)

“Do you have to do the IV?” she pleaded with her eyes for me to say NO.

“I’m sorry honey, but Yes, I do have to put in an IV…BUT I’ve been doing this for 23 years and I promise you I will do it quickly!!” 

“The other nurse last time didn’t get the IV and someone else had to do it…it hurt as bad as when my brother hit me in the head with his body on the swing set and knocked me over.”

I tried not to laugh but she was being so cute!!  I smiled and said, “I can only imagine how bad that must have hurt~ But I put that numbing gel on you so this needle won’t hurt so much.”

“Okay I guess I’m ready…but I might still have to cry.” 

Sympathy gripped my heart as I gathered my things and moved to the stretcher…I sat down to her level and let mom adjust herself to a holding position.  Little sniffles echoed through the small room.

I explained each step and then I explained that, “If we sing Rudolf the red nosed Reindeer this won’t hurt much at all.”  On the count of three we began singing~~~ loudly.  J

By the time we got to “very shiny nose” the INT was in place and I was drawing blood…we kept singing and by the time we reached “All of the other Reindeer…” I was done.  Her tiny little eyes grew large as she excitedly exclaimed, “I didn’t even know you did it~~~ the singing worked Mom!”

An hour later we were finished with the minimal conscious sedation procedure of lancing 3 large MRSA boils and my little Pedi patient was waking up nicely.  Her mother hugged me tightly and thanked me repeatedly for my nursing care.  “You were an expert with comforting my daughter and I’m so thankful for your IV skills!  Thank you so much.”

As I reflected on that experience I realized that often times I get thanked for things of comfort provided but today I was thanked for both my comforting of her daughter, the distraction techniques used AND for my nursing skills… As nurses we have so many responsibilities and requirements of knowledge~ but it truly is our total package of experience, knowledge and caring that give the patients and their families what they need.  It was a good day.

Tuesday, October 16, 2012

holistic nursing and the surgical patient

A category 2 abdominal pain patient was brought into room 5 from the waiting room of my ER…She was an early 20 something who happened to be 17 weeks pregnant…she was complaining of diffuse belly pain, fever and nausea that had escalated over 48 hours.  I watched the tech wheel her by the nursing station to go into room 5.  She was petite in stature, and even smaller in appearance as she hunched forward guarding her stomach with her arms.  A very worried looking older woman accompanied her. 
I quickly exited out of my charting on the computer, grabbed her triage information and scanned it.  I went to the med room and collected an IV tray, saline, and a Doppler.  As I entered the room I quietly laid my equipment on the counter and walked to the stretcher.  Worried eyes looked at me from the face of this attractive young woman.  She sat on the stretcher in a semi-fowler position with her knees drawn up to her stomach.  She held the older woman’s hand and barely changed expression as a tear fell from her left eye. 
I outstretched my hand to her as I introduced myself to them both.  “My name is Bobbi and I will be your nurse tonight, I promise to take very good care of you and make you more comfortable as soon as possible.” 
“Thank you…and my name is ***** and this is my mother….I’m pregnant” she tearfully answered.
After she finished telling me about her abdominal pain I examined her, assessed her vital signs again and started an IV, drew blood and hung NS at 150/hr.  Using the Doppler I found her baby’s heart beat to be a bounding 176…this brought a fresh tirade of tears from both women as they visibly exhaled with relief that the baby was okay.  Her temp was 102, respiration's 22, heart rate 122 blood pressure 126/70, lungs were clear bilaterally with a room air sat 100%.  Her skin color was pale and very warm to touch.  She rated her pain 8/10.  She had positive bowel sounds all quads and was extremely tender to the slightest touch with positive rebound tenderness. 
As the next couple of hours went by with tests and the diagnosis of appendicitis ~ I carefully took care of this patient as we awaited her trip to the OR.  She was quiet but strong…she was childlike when the pain intensified and somewhat soothed by her mother’s reassurance.  I administered morphine often in small doses to alleviate her pain…I gave her cool cloths for her forehead, dimmed the lights and sat with her.  I offered her constant reassurance that her baby would be okay~ when my interventions for her and my other patients were completed,  I was able to give her a hand massage and Reiki as we waited. 
What I noticed, as did her mother, was that during the hand massage and during the Reiki treatment her pulse significantly lowered and her breathing slowed as her face relaxed.  The pain meds helped of course but the visible transformation of her facial and body features during the relaxation therapies was so obvious that her mother commented on it several times.  As I wheeled her to the OR she again asked me for reassurance of her baby’s safety…I gave this to her.  Before I left her in the care of the OR team she tearfully took my hand and thanked me for caring about her and her baby…she thanked me for the way I cared for her in the ER… “the touching therapy helped me so much…thank you…Can you come and take care of me when I’m in labor? She asked with a grin”…
Walking back down to the ER I felt so thankful that I was able to take care of this patient in her wholeness…body/mind/and spirit.  I have been blessed these last few years to have my nursing skills enhanced with the knowledge of holistic care and the learning of alternative therapies like hand massage and Reiki.  My BSN classes included a Reiki course to which I became a level 2 practitioner… I now have the awesome pleasure of teaching Nur. 101 and I’m able to pass on the teachings of holistic care with real life examples of what it looks like.  Being able to nurse someone holistically positively affects not only the patient but me as well… I have a very grateful heart.

Tuesday, October 2, 2012

past and present reunite

I could hear her crying and screaming in pain as I entered the ER for my evening shift.  The door to her room was closed but the bone chilling cries echoed out beneath the wooden door and filled the airspace of the nursing station.  I inquired of her... “She got here almost an hour ago and we cannot seem to get a handle on her pain…”  I looked at the board to see her name~  I knew her…  My heart raced and I felt a lump gather in my throat…I hadn’t seen her for almost 9 years now.  My mind sped back to a time that our paths had crossed. 
I was doing home health nursing then and she was a teenager with a newly diagnosed sarcoma…I was to care for her while she received treatments.  I was in her home several times a week for a several months…we bonded and I cared about her.  She knew my daughter~  I wanted her to live…I prayed for her day and night.  She was tough…strong and determined.  She had spirit and spunk far beyond her years…I wanted to take care of her… her case brought out the best in me but also that part of me that wanted to take over and do it all…  I struggled with my sense of ego and pride…I struggled to not let her into my heart…it was a losing battle.
Life changed for me and I took another job~  I left her in the hands of my co-workers and I cried for days…I battled with the feelings that I had abandoned her … I had crossed the line with her~ I knew that my feelings for her were deeper than they should have been.  I took on more of her care than I should have or at least more than was professional… when I left it broke my heart.  I did not know that it broke hers too….
I was pulled back to the present by the day nurse wanting to give me report…I would be getting this girl that so long ago claimed a piece of my heart…  I listened to the report and then went in to meet with her.  As I opened the door the crying and begging for pain relief hit me in the heart.  I looked at her and saw a grown woman whose pale face was contorted in pain. Tears soaked her face as she twisted and rithed on the stretcher.  “Please help me, I can’t stand this pain any longer…”  I left the room, went to the orders and saw she could have another dose of dilaudid now…I retrieved it from the med room and quickly returned to her. 
As I sat on the stool next to her bed and injected the pain medicine I prayed for relief for her.  Her mother sat close by holding her hand.  I introduced myself as I cared for her…she looked at me and started a fresh tirade of tears… “Oh my god, is it really you Bobbi?” 
“Yes it is” I replied with a smile. 
She reached across the stretcher and put her arms around my neck and pulled me close as she cried into my neck.  We stayed like this for several moments.  I let myself feel the heart wrenching feelings that I had let go so long ago.  “I think of you so often,” she said between sobs.  “you were the best nurse I have ever had…I measure everyone next to you.” 
I smiled and let the compliment enter my heart.  “I missed you terribly when you left,” she said.  I told her that I had missed her as well and so often had prayed for her.  I told her that I watched her in the newspaper and from afar at school…I told her that she was one of those patients that never left my heart. 
I managed to get her pain under control with meds, hand massage and presence…and we enjoyed catching up with one another.  She was admitted and I went home …  As I thought about the encounter I realized that as a young nurse I tried so hard not to let anyone into my heart for fear of being unprofessional… I knew she had entered my heart deeply and it scared me.  I always thought of her, prayed for her and worried for her, and struggled with the feelings that I had abandoned her…as I let myself feel the rush of emotions that occurred when we reunited I realized that I was wrong all those years ago… It wasn’t the fear of being unprofessional; it was the fear of not being able to help her that kept me bound…
Jean Watson’s theory of human caring talks about caring moments and allowing our hearts as nurses to be present with our patient’s heart.   I did not realize what was occurring way back then BUT I do know the power of presence now.  Being present with this patient gave her and I both healing that night in the ER… allowing myself to care for her all those years ago touched her and in return in touched me.  As we reunited and told one another the power and effect the other had on our lives…healing happened.  Watsons theory came alive for me that night in the ER and I will never be the same.

Thursday, September 6, 2012

The mind/body/spirit connection

I went to room 13 to check on the patient I had just received report on… the ER was CRAZY but for some reason I felt the need to check on him first.  Late teens, sick for 3 weeks with diarrhea, waiting on a stool sample (all other labs were back and relatively normal), loss of 20 pounds… I found him asleep on his left side with his left arm outstretched to expose the 18 gauge needle in the anticube with IV tubing attached to NS running at 400/hr (second liter).  He was a handsome boy but pale and thin with dark hair all messed up, skin was dry and monitor showed a normal sinus with a rate of 96.  His oxygen sat was normal at 99, blood pressure also normal at 120/76.  The room was empty except for him of course and a purse…pink with brown trim (I’m assuming not his). 
History was that he had been experiencing diarrhea several times (5-8) a day for 3 weeks, no fever and no vomiting.  Pt. does however have pain in his lower abdominal region that is intermittent but ranges from a 7-8/10 on the pain scale.  Pt. had a prior bout of this diarrhea last year around this time.  No other medical history…otherwise healthy.  Pt. comes from an intact home of original parents and he is the oldest.  
I went into the room and tidied up.  His mother arrived and I introduced myself.  She told me that she was concerned her son was dehydrated.  I reassured her that his vital signs were now normal (he was tachy upon arrival at 126)and that his orthostatic vitals revealed he was a bit dehydrated to start but that this liter of saline hanging was the second one and we would assess those vitals again shortly to show her his improvement.  I told her I would be back and left to check on my other patients.  She thanked me and sat down next to him.
After I finished my rounds I returned to room 13 to check on my boy.  He was awake and in fact had just returned from the bathroom where he had left me a stool sample.  “Oh joy,” I remarked with a laugh and went to collect the sample… I’ll save you the details but I will say it was very foul smelling and it left me suspicious of C-diff.  I brought the sample to the lab and returned to the room.
My boy needed something for nausea and pain so I checked with the Doc in charge and then medicated him with Zofran and morphine.  As I sat on the stool to the right of his bed and slowly administered his meds, I began to ask the questions that nagged at my brain.  “Tell me about the day this diarrhea started…” 
After several minutes of talking I found out that this young man was under tremendous stress at home and school…he was the oldest of 3 and his dad was out of work…his mother tells me that he is “OCD” about stuff and “worries about everything”  to which he agrees with her.  He tells me that he lies awake at night worrying about the family with money…that he is afraid of not measuring up at school and in sports…about how his dad is angry all the time now that he isn’t working and how he fears that they will lose their house…I also find out that for several months he has been taking Advil, 600mg twice a day for headaches… I bring this info to the Doc. (The Doc addresses this with them in the seriousness of such a dose so often and how it may contribute to his issue and instructions are given to not take any more for now). 
After his second IV has finished I cap the INT off and sit down.  I tell my patient that his labs are normal and we want him to come back for a follow up in 2 days if he is no better.  His mom begins to cry… “So what is wrong with him?” she asks.
As I looked into the eyes of this mom and then her son I saw fear…We talked for the next 15 minutes about the stress going on in the home and how her son was internalizing it…and now the compounded fear that her son has about having to start school and play golf with the added pressure of having diarrhea multiple times per day~ he then began to get teary.  He told me that he just felt sick all the time lately and his stomach was in knots when he thought about the family and school issues… I told them that of course stress is very real and it can turn into illness in the body because we are made up of mind/body and spirit not just body..., but that they of course needed to come back for a follow up if he was no better in a couple of days…
I remembered what helps me to get problems off my mind…writing…I offer some advice ~ “carry a small notebook around and leave it on your bed at night~ write all your worries and concerns in it as they float into your mind…when your mind relaxes close the notebook…do this as often as you need to and if you are a Christian you then can ask God to take that notebook full of fears from you and carry the load himself.”  My boy…the patient and his mother both thank me through tears.  “We are Christians and that advice is well received I can assure you” she said and “I’m going to do the same thing myself.”   
I prayed for them several times that night and again the next day as I felt so heavy hearted for them both…Another day with another patient I just knew was in my path for a reason.  J

Monday, August 20, 2012

A vessel of Hope

She came to the ER for complaints of dizziness, intermittent nausea and fatigue x 5 days.  She denied vomiting, diarrhea or pain. She told me that she is never sick and that this is “really bothering me because I play field hockey and I have to be able to practice…preseason.” Her skin was warm, dry and pink and her eyes were bright. Pretty girl… I evaluated her in the routine way…heart sounds, lung sounds, and vitals.  I put her on the monitor after doing posturals and then had one of our techs do an EKG.  This patient’s mother was glued to her side, so I asked her to leave the room for a few minutes of what I assured her were just routine questions we ask every teenager.  Her mother reluctantly left the room.  I sat on the stool to the left of the stretcher and asked the routine questions regarding drugs, alcohol, abuse and sexual history.  Pt. has a new boyfriend and yes they had sex, “but only once and with protection.” I collected a urine sample and left the room after I let her mother back in.
An hour and a half later after all test results were back, the only thing that was “wrong” with my little 17 year old girl was that she was pregnant.  I sat at the computer and tried to gather my thoughts. The PA on duty was not a usual for us and he was being quite flip about the fact that this young woman’s life was about to change…big time.  His answer, “you play you pay.”  I told him I that he was being as ass and that I would go and talk to them if he wanted…”ya, sure, whatever.”  I took her chart and went to the far end of the hall.  I leaned against the wall and closed my eyes…I was cheering at a tournament game for basketball and my boyfriend was playing.  I was 17 years old as was he.  The next day I was going to take a pregnancy test…the memory hit me hard, and I knew this girl was already concerned she may be pregnant and she was scared. 
I asked God to meet me in this patient’s room…to comfort this young woman~ and her mother ~as this news was going to change lives today.  Taking a deep breath I opened the door and went in.  I once again took the stool seat to the left of the stretcher.  I again asked the mom to step out of the room…(now this was difficult for me because I know that as a mother I would have wanted to be there…but far too often in this job do I see parents that do not support their children in these circumstances~  and the patient by law has a right under these circumstances to privacy.) I knew in that moment that this mother feared that I would be saying her daughter was pregnant…I saw it in her eyes and in the way she got up to shaky feet and left the room~ just before closing the door she told her daughter she loved her and in that moment I knew she would be a help to this young woman.
Her eyes were fearful as she sat there biting her fingernail…she looked so young in that moment.  I told her everything was medically fine but that the blood and urine samples confirmed that she was about 3 months pregnant.  Tears immediately filled her eyes and sobs escaped her mouth.  I sat on the bed and held her…she clung to me tightly and continued to cry.  I rocked her and just let her cry…I knew this pain and I knew the fear that was now slithering into her mind.  “thank you,” she said as she reached for a tissue~ when she stopped crying and blew her nose I asked her if she wanted her mother.  “will you stay in here with me?” 
I went to get her mother and we went back into the room, “Your pregnant, aren’t you?” she asked hesitantly… “yes,” she answered with her head down.  I stood off to the side and prayed.  “This is going to kill your father.”  A tirade of tears assaulted my young patient and I tried desperately to stay silent.
“Mom…please, don’t you think I know that…” she cried.  In that moment the mother began crying herself and went to her daughter and gathered her in her arms and wept with her.  I started to leave and my patient asked me to stay.  I stopped and just sat on the stool.  I took a deep breath and cleared my throat…I, in that moment, told them my story~ My teenage pregnancy and beyond.  The fear that turned to joy as my daughter blessed my “husband” and I’s life in ways that we never thought possible and how God used her to grow us into the people he wanted us to be…I told them that it was painful, embarrassing and life altering BUT that it was truly a blessing and I wouldn’t go back and change one bit of it…I told them they had many options to consider and that I could help with anything they needed.  They thanked me and I was thankful that I had that story to share, because in that moment their lives looked black and fearful~
Sometimes I wonder why I stay in bedside nursing…the hours are long and working every other weekend gets really old…the ER is a beast that just roars continually with pain and suffering ~~ but every once in a while I know that I was placed in a patient’s life that day for the purpose of hope and healing.  I received a thank you card yesterday from this patient…she was keeping her baby and going to go to a local college and stay home to have help.  Her parents are being supportive and she has hope for a nice future…Amen!!

Wednesday, August 8, 2012

Gone but not forgotten

The room was dark and quiet as I finished up my nursing note.  My patient was tucked into her own bed and finally asleep as her daughter slowly ran her fingers through her mother's white curls.  I nodded good bye and stepped out.  Once in the car I checked my phone and found a message from the hospice intake worker that I had another patient to go and see...and urgent open.  I read the directions and something tugged at my brain telling me I knew this address.  I ran into the office to retrieve the paper work.  Once back in my car I opened the file.  The name was that of my friend... my friend that was NOT in the end stage of breast CA with mets.  "what is going on?" I muttered to myself.

I called the intake nurse and asked about the call for this patient.  "I got an urgent call from her doctor telling me that she had just returned from Boston after recieving trial medications that failed...and she is days from dying~  and she wants to die at home...she asked for you."  My heart raced and my stomach clenched...tears ran down my face as I heaved in deep breaths...this cant be true...I just talked to her a couple weeks ago and she said how well she was doing...

I prayed for the 20 min drive for courage, wisdom and strength...I prayed it wasnt true. 

I arrived to be welcomed at the door by my friend's husband who was in tears.  "Thank goodness your here...she cant breathe!"  I rushed into the bedroom to find my friend gasping for breath.  Before I could even hug her and find out what happened, I turned up her oxygen (since when did she start using oxygen, my brain yelled!!!) to 5 liters and turned the fan onto her, then started talking softly to her as I stroked her hair off of her forehead.  "Just breathe in and out slowly...thats it, nice and slow...Im here now and its all going to be okay...slow in and slow out...thats it, just relax and let the oxygen reach your cells...its okay, its going to be okay."

As I comforted my friend I surveyed the room.  She was lying on a hospital bed, oxygen was being fed to her by nasal cannula from the compressed air machine and there were a dozen pill bottles lined up on the bed stand.  My eyes found her husband and I gave him a questioning look.  He motioned me to meet him in the other room.  I continued soothing and calming my friend until she fell asleep and then went into the living room.

Between great sobs of anguish he told me, "She was sent home last night by ambulance from Brigham's and Woman' die.  They set up the home 02 and the bed.  They ordered her lots of pain meds and stuff for are we going to do this?  She was fine last week and then she just got so weak and couldn't breathe...they xrayed her and said the cancer was all through her lungs now..."

4 hours later, after her sister arrived, I was driving home with an ache in my chest that truly felt like I would stop breathing myself.  I could not stop crying. I had prepared my friend and her husband as best I could.(she didn't have long)..I told her I loved her and that I was so sorry for what was happening.  I told her how much her friendship had meant to me and that she was a wonderful mother to her children.  I told her that she taught me how to relax and that she showed me how to laugh with abandon~  I told her she would be greatly missed.  She couldn't talk but she nodded with tears streaming down her face...she grabbed my hands and mouthed  "I'm not ready." 

5 hours after that I was called to the hospital to be with her.  She was too air starved to stay at home comfortably and her family couldn't take it.  I arrived to a room full of family~ her 2 children (my kids ages) and her husband, sisters and friends.  She was getting hooked up to a morphine drip and she was no longer in the present . Her eyes were closed but she gripped my hand when I knelt beside her and kissed her face...I wept.  I was no longer her nurse...I was just her friend... I prayed for her and her family.  I then did something Ive never done before... I just knew I was suppose to sing her favorite song...I softly sang to her, Jesus lover of my soul, and I watched as her breathing slowed and a peace entered the room and her faced relaxed.  I was aware that all eyes were on me but I didn't care about being embarrassed, I cared about my friends comfort...her soul.  I sang the song 2 times and by the end of it she was gone...

It was one of the hardest, saddest and most incredible days of my life.  My daughter and I sang that song at her funeral because her husband requested we do so. It was a privilege to honor her in that way.  I tell you all this because I have been thinking alot about her lately. I miss her and I honestly miss working at a job that allows me to connect deeply to a person and their circumstance. 

How does your job allow you to connect to another human being???  Are you using your talents to make another person more comfortable??? What is your story of human connection???

Thursday, July 26, 2012

human connectedness

I sat in the back row of the large Catholic Church and watched the young people and their families file in.  Most heads were bowed but some were looking around with sad eyes.  My heart was racing and I physically felt uncomfortable as I fought to not let tears escape my eyes.  The open casket at the front of the Church kept calling to me but I couldn’t look at it…not yet.  Her family was escorted in~ mom was crying and her little brother appeared fearful~ no father…they sat next to an elderly woman in the front row that I hadn’t met before. 
I have no idea what the priest said that day because as soon as he started talking my mind went to the images I knew of this amazing young woman.  Her room was painted in purple.  Let me rephrase that~  her entire room was painted in purple…including the ceiling!  The walls were lined with teenage posters and Polaroid pictures of her and her friends, trees, fish and her family.  She took Polaroid pictures of everything!! She had a huge fish tank on top of her dresser that held a multitude of fish that she cared for.  Each time I entered the room I was taken aback by the amount of clothes that could be found on the floor J.  She would always say with a giggle, “my mom is going to be so pissed that I didn’t pick up my room before you came over.”
She was obsessed with death and what happens after one dies.  Each of my visits would end with her asking me, “Before you go…tell me one more thing that the Bible says about heaven.” I would then tell her another fact from the Bible that I had looked up prior to going to her home…she would get quiet and just think it over.  Sometimes she asked about hell…I would answer that as well.  She often asked me about Jesus and how I was so sure that He was real…I answered her ~ 
I was this amazing young woman’s hospice nurse.  She was 13 when I met her and she was enduring end-stage leukemia.  I was responsible for administering antibiotics via her PICC line for the pneumonia she had contracted.  She lived with her mother and 6 year old brother in a third floor apartment.  Her mother worked full time and she babysat her brother during the summer…it was summer.  She was like any other 13 year old who had to stay home and babysit her little brother~ annoyed.  She was far too weak to leave the house and do anything else but she still was annoyed.
Her mom’s shaky voice pulled my mind back to the present…to her funeral.  Her mom talked lovingly of her 14 year old daughter whom she would miss terribly.  She told of her bravery, her passions and her fears.  She thanked all those that had helped them during the last 6 months of her life…and then she lost it…and we all lost it….
The funeral ended and I felt sick…my head hurt so bad from trying desperately not to cry…I felt strange, like~ I was just her nurse and I only knew her for 6 months…I figured I didn’t have the right to feel so sad.  I now know how wrong that was but at the time I didn’t realize it was ok.  As I walked to her mom to give her a hug I prayed for strength.  Her mom hugged me and cried…she asked me to wait a second and she went to her purse and came back to me.  She handed me a Polaroid picture of her daughter and I…the picture she had taken of us the first day I met them.  The tears wouldn’t stop.  The Polaroid picture is in my Bible…
We nurses do make a difference and we do have a right to feel and experience things with our patients.  It is when we let the patient into our hearts that they then feel the care we have for them.  A relationship can then form and that is when a shared human connection can happen.  Not all patients want that and there are patients that are so difficult that it just won’t happen…but on any given work day there is someone out there in patient land that needs their nurse to connect with them…believe me~  it is worth it!!

Thursday, July 19, 2012

Releasing some pain

Her tiny, delicate face haunts me
Perfect round structure
Purple bruises line her cheeks
Closed eyes, left one black

Wild dark brown hair
Fine and Full
Flat in the back
Long, wispy and straight out

Red lips in a perfect pout
Closed mouth
What truth is trapped inside?
No more breath

Creamy white skin
Limbs that lay limp
Ten fingers and toes
Soft and cold to touch

Metal and Plastic equipment
Mucous and blood
Sea green sheet
Everything lifeless next to her

Photographs and swabbings
Police and investigators
No family

Nurses, EMT’s and techs
Anger, frustration and sadness
Tears that won’t fall
Tightened throats

Hold her tight Lord
Kiss her tiny, delicate face
Heal her bruises
Give her life

Sunday, July 8, 2012

Prayer/Patients and Presence

Yes Maam…he says over and over during my triage of him.  His accent is thick and Southern.  He tells me he is “here in beautiful Maine with a Christian group doing some work at China Lake Christian Camp and that he has a little problem with some chest pain.” 
This young man~ early 20’s~ is a big burly kid with a smile that lights up the room.  He is jovial and kind, but nervous about his pain.  He tells me about an irregular heartbeat that usually doesn’t cause pain.  As I talk to him he continues to call me Maam and just smiles every time he says it… He calls the doctor, “Sir” and the lab tech “Sir”…he is so polite I can barely stand it.  (He is not our usual patient. )
After the IV is started, the labs are drawn, EKG is done and interpreted, chest xray completed…he and I just talked for a few minutes while we waited for someone to come and sit with him.  He is from the Bible belt~ a long way from home!~ and in a strange place.  I didn’t want to leave him alone until a friend arrived.  (He is my sons age…I felt motherly).
He went to college in Virginia and currently was doing work with his local church traveling to other States and doing work on Christian Camps.  He is from a loving family and his mother is a nurse… He tells me that, “she will be calling soon and she will be worried.”  I assure him I will talk with her and let her know everything that is happening, as long as he approves it.  “Oh for sure~ she would whoop my butt otherwise…you must understand that, being a nurse.” 
I laugh and tell him, “oh I understand…I have a daughter older than you and a son your age…I would be so scared and I would want to know all the details as well.” 
He just laughs and flatters me with how young I look…I tell him, “you know how to work the ladies…” he just grins and yes, “yes Maam.”   We continue to talk about God and religion…we are from similar denominations and I understand his faith~ I am impressed by his level of faith and expression of it.
As the night unfolds he needs some Adenosine to slow down his heart rhythm so we can see what the underlying rhythm is…for you nurses out there…his Pwaves were barried into the T wave…he was tachy but not really in a narrow or wide complex…so we prepped him for the Adenosine…he stated he was scared…his room was filled with several friends at this time and the room grew serious but remained friendly; he wanted them to stay.  The doctor and I explained the Adenosine and the feelings it would produce….he again said, “Just wait…I’m scared.” 
I asked him if he wanted to take a moment to pray before we started and he said yes.  They all looked at me.  I then asked him if he wanted me to pray for him and he said yes.  I put my hand on his arm and bowed my head.  As I started to pray out loud for him I heard his buddies begin to quietly pray out-loud for him as well (not uncommon in our denomination).  I prayed, “Dear heavenly Father, Please put your hand on this boy and calm his nerves…let your presence fill this room and quiet his heart.  I pray that you would let this medication do its job and show us how to proceed.  Take your child into your arms and bring peace.  In Jesus name, Amen.” 
When I finished, he said thank you to me…and he was ready to begin.  We gave him 12 mg of Adenosine and the effect of it was minimal on him…he did not get the full force effect of the med side effect wise but it did slow the rate down enough for P waves to be seen.  We captured the rhythm and the Cardiologist then had a plan.  His mother called and I spoke with her and she was then relieved.
As he was being discharged, he thanked me again for taking the time to care for him, to pray for him and to talk with his mom.  He said to me, “Your presence made all the difference in the world for me tonight…not only were you funny and able to take my humor ~ you allowed God to be present in my room and for that I am so grateful.” 
As nurses our presence is required to take care of our patients… If we take the time to listen to our patient and hear what is important to them we can then give them as much of that as we can.  I was lucky to have had the time to spend with this boy prior to the intervention so I knew that God was majorly important to him and that prayer would calm him.  Because I am of the same religion as he was I could pray for him in the way in which he was accustomed…
The blessing of the night was for me.  I saw God work in many ways that night.  I felt that I had made a difference and that our team had given amazing care that involved our presence…what I didn’t say in this story was that in the room during our prayer was a the group of Christian boys, myself, a Jewish doctor, a Buddhist intern, as well as another nurse (not sure of her religion).  What is so amazing to me is that during the prayer, all heads were bowed.  We all came together to care for the patient despite our differing religious views.   Very cool.

Wednesday, July 4, 2012

Self-Care and Yoga~Reiki~Prayer

I returned to Yoga class today after several months of being absent... life’s little interruptions…and what I found out was how much I had missed it~  Oh I knew what I was missing but what I didn’t know was how much my body was missing it too.
I was excited as I drove to class this morning; almost giddy.  I arrived a bit early, picked my spot and then just sat and enjoyed the silence.  Walking into the yoga studio was like walking into a little slice of heaven.  The studio is cozy, warm and inviting. Sitting on my yoga mat in the right lower corner of the room, I felt happy.  I sat with my legs crossed and my eyes closed and just let my mind wonder.  I took deep, long inspiratory breaths and let them out slowly~ I felt all my muscles relax and all my cells seemed to come alive in anticipation of the wonderful stretches and power stances to come. 
As people arrived and took their spots I continued to just sit and enjoy the moment.  I felt thankful for my life. As I sat and just breathed in and out I felt my heart of thankfulness.  I thanked God for the love and forgiveness I was granted.  I thanked him for my family, my life and the multitude of blessings that I am showered in daily.  I thanked him for the 45 year old body that was free of disease and could enjoy daily living. 
Class started and I was lost in one pose after another as my body responded to the memory of classes before.  I stayed in the range of safety for where I was and just let myself be present in the moment of enjoying what my body could do and feel.  During Shavasana, I completely relaxed and let all the thoughts floating through my mind go in and out.  Happiness was so strong of an emotion welling up inside of me that I thought for a moment I might laugh out loud! 
Driving home I felt peaceful and relaxed.  I pondered the question that so often tugs at my mind.  Why do insurance companies NOT pay for alternative therapies as preventative medicine?  Why do MCD and MCR not reimburse for them either???  Why are physicians so driven to just prescribe a medication when alternative therapies are effective and cheaper ~~Why as a nation do we stand for a health care system that just wants to clean up the mess and NOT prevent it in the first place
These past 2 years I have been participating in the wonderful world of alternative therapies and I can tell you that IT IS THE WAY TO GO!!  Yoga, Reiki and prayer… totally free your mind from stress, anxiety and fear.  Instead of medication… your body heals your mind.  God provided us with a multitude of ways to naturally heal, sooth and calm our bodies and minds. Tapping into them will only make you happier and more healthy.  Nutrition is a whole other topic as it relates to the healing of the body and mind…an area I too need to do better in! 
As nurses I feel it is our duty to educate ourselves and our patients on the BEST treatments for the BEST outcomes.  While I agree with most of the traditional Western interventions ~ I would love to see a world where the earth’s remedies are tried first and where “alternative therapies” are considered first line defense!!   As I get older I hope I am getting wiser…and with my aging process I want to engage in those things that make me stronger and healthier~  I want to educate my patients on the cheaper, easier and safer interventions that aid them in a richer life! 
I know Yoga nurse and Reiki nurse (here in Facebook land) agree~ as do their multitude of followers…how many of you nurses out there are using alternative therapies in your own self-care routine???  And how many of you are implementing them into your practice??? Id love to hear how its going!! 

Sunday, June 17, 2012

Behavioral health teen and the ER setting.

I stood in the doorway and watched my 15 y.o. behavioral psych. patient.  She sat cross legged on the stretcher, hands tightly clenched in her lap, head down and eyes closed…rocking back and forth.  A loud, continuous hum escaped through her throat…not a song kind of hum…but a static sound of humming. 
She came to us after being kicked out of her foster home for aggressive behavior and suicidal language and she now is boarding with us until a new home or psych hospital bed opens up for her.  Because of her suicidal language all of her belongings were removed from her and she was in our blue hospital scrubs, on a watch with security and in the behavioral health section.  The areas is small, has a TV, a bathroom and small area to walk around~ no windows. Hour 90 was upon us and she was melting down.  As I watched her, my heart broke.  This child was alone~ her life story is of abuse and neglect~ and now once again she is alone…Life isn’t fair for this child!
Earlier that day I silently prayed for her and I sat and talked with her.  She liked to write and to draw, listen to music and take long walks.  Her two siblings were with another foster family and she hadn’t seen them in over 6 months…and there were no relatives to help them out. She was afraid of where she would end up and wanted to run away.  Her suicidal thoughts continued and she wanted to cut herself.  
After speaking with the other nurses who were on that day we decided that we wanted to buy her some journals, drawing materials and get her some shampoo and conditioner (she has long thick hair and we do not provide shampoo in the ER).  The issue with this choice was that it was in direct opposition to what the ER docs had decided.  They were of the feeling that we shouldn’t pamper her in any way because she would like it too much and just continue to say she was suicidal and stay with us.  I totally disagreed~   this particular patient had a distinct problem and she was a child in need of some compassion, empathy and understanding.   The nurses and I talked with the ER doc who was on that day and he agreed with us that we could provide her with some materials to help her pass the time.
The nurses pitched in and on my lunch break I went to Wal-Mart and bought her some journals, colored pencils and drawing paper, shampoo/conditioner and a fancy pen.  When I presented these things to her she sat there staring at me with her mouth open...  “You and the nurses bought these for me?” 
“yes” I answered.
“I can keep them?” she asked in a confused tone.
“yes you can”
“why did you do this for me?” she asked.
“we wanted you to have an outlet for your pain…we wanted you to know that we cared about your situation.”
She cried.  The security guard teared up and had to turn away…
This patient was with us for a total of 146 hours!!  6 full days!!!  Before going off to a psych hospital and then back to her foster home… During her time with us she drew every security guard a picture and she wrote non- stop in her journals…I was rewarded with a poem about myself that hangs in my locker at work. 
I do not know if our nursing intervention helped her in anyway but I believe that it did.  We showed this child empathy, compassion and caring!  I can only hope that it meant something to her and that she will in her heart know that there are kind adults in the world…

Monday, June 11, 2012

Hand massage and the migraine patient.

        I went to retrieve the 13 year old patient from the busy ER waiting room.  I took her chart and looked around the waiting area.  Amongst the noisy crowd; I saw a young girl, head in hands, lying in her mother’s lap.  I called her name, watching to see if this was the young girl with the complaint of a migraine headache.  Sure enough she briefly lifted her head, grimaced and then closed her eyes.
       I got her a wheelchair and brought her and her mother to room 14.  “I can’t talk right now,” she cried as she tried to lie down.  I assisted her to lie on the stretcher, covered her with a warm blanket, put a cold washcloth on her forehead and turned off the lights.  Mom and I softly whispered.
      “Does she normally get headaches?” I inquired.
      “This has been going on for a year now, we have been to her pediatrician several times and we see a specialist next week. “
       “Do you see a pattern at all?”
       “The first headache she got was 3 days before she started her period and they seem to come every month just before she starts…” mom replied.
         I nodded my head in recognition of awareness and then asked her if anything made the pain better or worse.  “Well ibuprofen and Tylenol seem to help a little but we cannot seem to find anything that gets rid of the pain other than getting her to go to sleep but that is so hard because of the pain and everything makes it worse. Her father and I do not want her to start taking narcotics.”  She sadly replied. 
         Handing off her chart to the PA that was to see her, I then went to start her IV and hang some fluids.  I quietly went into her room and explained to her and her mom the reason for the fluids and then swiftly began the task.  (You know a child is in pain when they just lie there and let you start their IV!)
         As I started her IV my heart was just breaking for this little girl who was in such obvious pain.  She was being so brave and trying so hard not to do anything to make her pain worse, like crying.  Mom asked me to be sure that her daughter would not receive any narcotics… I told her I would talk to the PA but that she would have to relay her concerns as well.  I told mom it was going to be several more minutes before the PA could get in to do his assessment.  I then offered to do a hand massage to my patient and she agreed as did mom. 
           The room was quiet but the sounds from the busy ER swirled through the walls.  I silently prayed for the noise level to diminish and for her pain to ease.  I took her left hand in mine and slowly and gently began to massage her fingers, palm and wrist.  I did this for approx. 10 min.  I then took her right hand and did the same.  I felt her relax and listened to her breath even out.  Mom freshened the cold washcloth.  After 20 min my patient was asleep.  I quietly exited the room and mom followed me. 
            Before I could fully close the door mom hugged me and began to cry.  I waited for her to talk.  “I am speechless! I’ve never been able to get her relax and I think she reacts off of my stress that she is in pain…it makes me frantic.  Thank you so much for taking the time to relax her like that…thank you.”
           “Thank you for being open to treatments that are relaxing and do help with pain…narcotics are not the only answer” I replied.
            Mom went back into the room and I went to the nurse’s station.  I found the PA and told him what had occurred and he gave me the look of ya okay…whatever and then just walked off chart in hand.   I won’t go into detail about what my brain was saying to him…
            This patient received 500ml of saline as she slept for an hour.  The PA examined her and after speaking with mom she was discharged home.  No narcotics were given and she left with no headache.  This experience, along with many others this past year have caused me to question the medical model of care that I have participated in over the last 20+ years… why do we always shove drugs at people first??? Why do we always treat the symptom and not the whole person??
           Even in the busy ER we have a few minutes to try interventions that are more nursing in nature and not so medical.  As I have learned more alternative therapies, I have found that they work…and they allow me to connect in a more relational way with my patient~  isn’t that what we nurses all want??             

Thursday, May 31, 2012

Fear/Children and ER nursing

I watched him pace the back wall of the emergency room, cry, kick and scream while he watched my every move. “What is behind your back?” he half screamed and asked. The left side of his flushed face was swollen, more swollen than it was 2 days ago.  This was our second encounter and the thought of him thinking I was going to hurt him ripped my heart apart.  When I saw his fear, and heard the question… “What is behind your back?” I was transported to a time when I was a small child, in the hospital and I asked a nurse that same question…she lied to me and said nothing…then she pushed me over and jabbed a needle in my derriere… I have NEVER done that to a child and I never will; I quickly showed him my empty hands and I slowly sat on the stool. 
A dental extraction that ended up infected brought this amazing little boy to me.  Our first encounter was 2 days prior…he was a week out of an extraction and his face was swollen and he was in pain.  I started his IV with minimal fanfare and he received pain med, antibiotics and fluid.  I gave him a hand massage for 10 min and he fell asleep~~ mom was happy.  He was discharged with a plan…all went well. 
This encounter was after another visit to the oral surgeon, a second extraction and debridement and 2 nights of no sleep, minimal oral intake and a now terrified little man. Mom asked for me and I was so happy that I was on.  She hugged me, he screamed and ran to the back wall….I didn’t take it personally of course but it broke my heart; the fear in his eyes was intense.  Again, this brought me back to when my then 6 year old son was acting like a caged animal prior to his second ear surgery…the fear he had and how awful it was for him and me!!!
I can proudly say that our ER team did a fabulous job orally medicating him with some versed and lorab~ effectively bringing his anxiety and pain levels WAY down…and then the IV was inserted and antibiotics, pain med and fluids were given and he then was admitted.  Mom was happy~ I felt relieved and pleased~ little man was back to talking to me and letting me near him without fear J
Part of my job as a nurse is to calm and reassure my patient and their family; reassure them of my ability and my concern.  Children create a special challenge as we all know.  I was so happy to head home the night after caring for this little man and know that I did my best job with him and his mom.  My experience came into play and my heart was open to them.  I connected with them and it felt good.  I was happy that I was there for them.  I pray he is 100% better now!!

Sunday, May 20, 2012

The gift in room 3.

Standing in the middle of the nurse’s station, I faxed a chart to Spring Harbor for our Psych patient in room 11 and I watched the patient in room 3.  Her twisted body was lying on the stretcher in a semi sitting position. She was covered in a blanket and her feet were hanging out, uncovered.  I chuckled to myself because that is how I lay as well~ I hate my feet covered!  She was talking to her husband~ He was gently rubbing her crooked hand…they noticed me watching and both smiled at me, so I smiled back. 
I finished faxing the chart and then went into room 3.  “So how ya doin in here?” I asked her. 
“Just fine.” She answered with a smile.
“Can I get you anything, or reposition you?”
“I would like to be turned.”
I grabbed our tech Paula to help me and we gently turned and repositioned her to the left side, propping pillows behind her and under her legs and between her knees. I gave her a back rub, applied some lotion and covered her with a warm blanket. She thanked us and then said “I’m so sorry to make so much work for you girls.”
“Please don’t say that…it is our pleasure to help you.” I answered with a smile~ and I meant it.
This woman has MS and it has ravaged her body…she is not old…she fully has her mind and can breathe on her own but she has no use of her body what-so-ever!  This woman touched my heart.  She did not complain once during her 12 hour ER stay before a bed finally opened upstairs to admit her to~ NOT ONCE!!  Beyond that she was kind, gracious and funny. 
After her husband left and my other patients were all settled, I went into her room and sat down.  I wanted to ask her something. “I wanted to tell you that you have touched my heart today~ your positive attitude and gracious nature is rare, esp. because of your situation…have you always been a glass ½ full kind of person?”
She began to cry…I got nervous.  “I’m so sorry; I didn’t mean to make you cry….”
She gathered herself, I got a tissue to wipe her face…“No…you didn’t do anything wrong…thank you for telling me I touched your heart…I never get out of the house for visiting anymore…I rarely get an opportunity to talk to other women and I thought I would never make an impact on anyone ever again…”
I cried…not a full out sob but tears…
We talked further and she told me her story~ 1 grown child who is away in Afghanistan…her husband of 34 years is her high school sweetheart…they live modestly…her husband has a small repair business at home so he can care for her as they cannot afford to hire care…she once sung in the church choir and she misses it terribly…
The reason she says she stays positive, “I have always been a happy person, though I did go through an angry stage when the MS started taking away my outside life…but then Jesus reminded me that He was with me…that I still had a purpose …and my husband is still my best friend…”
Could I be this positive in this situation?  Probably not~ but I would want to be. 
I thanked her for sharing her story with me and she thanked me for asking.  I’ve thought about her so much in the last few days because she has led me to pray, to ask God for more gratitude and to see all situations as gifts for growth…and I thanked Him for giving me the opportunity to spend some time with this woman~ to be present in her moment and for showing me the gift of her attitude.

Thursday, May 17, 2012

Reiki and the dementia patient

She kept calling out repeatedly for help, with a loud, shrill, shaky voice.  HELP, HELP, HELP, HELP….” I could not comfort her or reassure her that she was okay, nor could I get her to stop yelling for help.  The staff was getting weary and the other patients thought we were killing her…that fragile little 98 year old women with dementia in room 8. 
She came to our ER from a nursing home with the complaint of, “she won’t stop yelling for help and this is not her normal behavior.”  We worked her up for altered mental status~ and none of the tests revealed a reason for her behavior change… I tried everything to calm her; I dimmed the lights, I sat and held her hand, I turned the TV on and then off, I repositioned her repeatedly and called her daughter (who was in Florida).  The morning rolled on and she kept yelling.
The ER traffic flow subsided somewhat and an opportunity arose for me to have 15 uninterrupted moments with this women.  I turned off the lights, closed the door, turned on some music and performed Reiki on her.  I started from her head and went to her feet.  At first she didn’t appear to even realize I was there, let alone gently laying my hands on her head.  After approx. 2min she stopped yelling.  I continued.  The room was silent except for the soft music… I watched the monitor~ her pulse went from 112 to 88, her blood pressure went from 160/98 to 142/80 and her respirations went from 32 to 18. 
By the time I reached her pelvis, she was asleep.  She remained asleep for an hour and when she awoke she no longer cried for help.  The ER doc on duty that day was a skeptic of the power of Reiki~ he is no longer a skeptic! I gave report to the Nursing Home and sent her back…happy.
I took Reiki as a nursing elective last summer during my BSN classes…I have used it on many of my co-workers, family and patients.  The immediate relaxation it brings is amazing and powerful.  I do not often have time in the ER to perform Reiki on my patients but what a blessing it was for that elderly woman that day…and my co-workers love the 5min head and shoulder Reiki session at the nurses station!!
As nurses we have so many interventions available to us to relieve pain and suffering…it seems that in the last half of my nursing career the interventions went from physically assisting to chemically assisting~ I LOVE that we are now heading in a direction that allows us to get back to our roots…laying our hands on our patients is “old school” but it is what is lacking in our care today. Reiki, aromatherapy, hand massage, light touch, maybe even an old fashion bed bath and simply sitting and talking/listening to our patients are interventions that are free, and powerful…and according to the surveys on patient satisfaction~ those interventions are what get the most BRAVO’s from the patient.  These interventions allow us to be present with our patients…showing them that we do care about their issue and them.  These interventions also are what bring the most satisfaction to me as I care for my patients…

Saturday, May 5, 2012

The patient that enters your heart

I met her as she ran into room 1 carrying his little grey body…the triage nurse was just ahead of her with scared eyes.   The mom, carrying the little grey body, was not crying.  I wanted to.  I took the little grey body from her, he was heavy and stiff, and laid him on the bed.  The triage nurse ran to get more help.  I grabbed the Pedi bag mask and began rescue breathing~ actually there was nothing to rescue but I couldn’t not do it…there was no pulse and no activity but asystole on the monitor…he was gone.
“Please don’t do that…it’s his time to go and I don’t want him to come back…he has had a bad life, and we have a do not resuscitate order.” 
The nurse in me began screaming … “I’m supposed to save him…do CPR…intubate him…not give up!”
My mind heard her but my heart couldn’t take it in…I continued until the doc came in…he still had no pulse and he was mottled and grey…his eyes were open.
“What happened?” the doc asked. 
“I just found him this way when I went to check on him.” She answered.  No tears.
As the doctor and mother talked about the boy’s chromosome disorder and his pain I unwrapped the blue car blanket that held his little body.  He was naked.  This bothered me greatly. 
“Why is he naked?” I asked her.
“He hated clothes.” She answered.  My heart hurt.
Time of death 8:04am. 
I asked her if I could clean him up (his body released fluids).  She said yes.  She sat down on the bed next to him but didn’t touch him.  Another woman came in who was crying.  The mother got up and went to her.  They hugged.  She asked me to give them a few minutes with him.  I covered him up with a warm blanket and left the room.  I know the warm blanket was useless but it made me feel better.  I went into the bathroom and cried. 
The mother told me what funeral home to call and then she and the other woman left.  She left him with me.  I went back into room 1 and I unwrapped his little body from the blankets and I gently washed him up.  I cried.  I wanted to close his eyes.  I prayed for him.  I put him in a little hospital gown and put his cold, grey and blue body into the body bag, and I again cried as I zipped him in. 
I went to the nurse’s station, filled with chaos as usual, and I called the funeral home.  Security came and took his body.  I felt numb, sad, pissed off and confused.  I tried so hard not to judge the mother but I did.  My heart hurt over this boy~ over the detached last moments she had with him…I did not walk in her shoes and so I know that I have no business judging…
I closed my heart, took a deep breath and went into room 3 to start my patient’s IV and draw her blood.  I smiled and introduced myself…