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…

Tuesday, May 1, 2012

Another life lesson learned.

Sitting in the waiting room I watched the others as we passed the time…were they waiting for a loved one, like I was? Or were they just the driver waiting to pick up the patient post- test? The elderly woman sitting by the large fern in the corner sat staring straight ahead, no expression, just staring.  She had on a clever little outfit; navy blue track suit with red trim, white slip on sneakers and a Vera Bradley bag (pink and light blue…didn’t really match her outfit) and she was alone.  The elderly man sitting a few seats over was watching Judge Judy on the TV (why is Judge Judy so popular anyway, the little woman annoys the crap out of me…) and biting his fingernails…he had on faded jeans, old Nike sneakers and a hoodie (just in case you were wondering) and then, there was me.  I sat in the corner, near the bathroom away from the others. I was situated so I could watch the door of the exam room in order to see the nurse come out to fetch me.  (I had on jeans, a new navy and tan stripped short sleeve shirt and my red nursing clogs…and a Tommy bag that was black…lol ) 
I sat in that waiting room, waiting on my husband who was having a procedure, (can you imagine that I had to wait in the waiting room and not in the procedure room….whatever!) and I prayed…I won’t get into particulars here but it’s been a few months of ongoing symptoms that finally were being checked out and I (we) am NOT used to being on this end of things!!  As I sat there I refused to give into the scary thoughts that kept trying to take hold in my mind…you know, cancer…tumor…metastasis….etc.… and instead I focused on the positive…the nurses I knew, so I was thankful for the wonderful treatment and care for my husband…his normal good health and our wonderful relationship…I thanked God for all of our blessings and for the test being performed today to “relieve our minds of anything bad being found” and for his full recovery…
As I sat there I also thought back an hour, to me sitting in the exam room with him and watching him answer questions…and then with him in the procedure room while waiting on the doc, as we laughed at the name of the equipment in the room and avoided talking about fearful things…I realized that I was nervous and felt so out of my element…I wanted to take my husband’s place, and do the procedure for him…I wanted to sooth his nervousness so I just joked and acted normal, or so I thought. ( I guess I didn’t hide my nervousness very well as he pointed out I was chewing my gum a hundred miles an hour and right leg was jumping up and down as my foot wiggled)  Seeing my strong, usually so in control husband lying on the stretcher in a Johnny, and with an IV in his arm was a moment I didn’t really care for.  I honestly did not like being on this end of things…
Praise Jesus that the test revealed NOTHING wrong!!!!  So the big fear of cancer is gone…Amen!!  I again thank God today for taking care of us and for giving us this moment in time…it does make things clearer…it does shift our thinking to what is important and what isn’t…and for me it does; once again, give me a perspective from the patient’s point of view.  We had a very good experience yesterday and I want that for all of my patients and their families.  The little things ARE important…like, I really appreciate how the nurse explained EVERYTHING to my husband and that she took her time and answered his questions…the area was clean and tidy…I wasn’t left alone long, and updates were quick. I am thankful for the reminder of how all of this is important to the patient and the family as they wait for answers…