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
Gloves
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??