Just Another Average Day

Actually, there is no such thing as an average day. While nurses have some general expectations, the only thing that is predictable in this profession is that you know that each shift will be wholly unpredictable.

I always try to see my patients in a certain order. I start with the patient who is the  sickest and work my way around to the patient who is healthiest and closest to being discharged. But there are always events that thwart my carefully laid plans. Sometimes the events are small and only sidetrack me for a couple of minutes and sometimes they are huge. It is a constant juggling act.

An example of a small event would be someone calling out for assistance to the restroom. Most patients really do not want to bother the nurse or patient care technician (PCT) unless absolutely necessary. This means that they wait until they HAVE TO GO NOW! Inevitably, your PCT is already helping another patient, after all, everyone has just woken up and the first thing people do is hit the restroom. You have 5 or 6 patients. Your PCT has 12 (there is one PCT for every two nurses most days. Some days we have only one PCT for 4 nurses). Neither of you can be in more than one room at a time, so you take one and your PCT takes another. That's when patient No. 3, your 82 year old female call for assistance, too.

Here's what you need to know about old people. When they have to go, they have to go NOW. Most of them suffer from frequency and urgency. They have been marginalized by society and are often talked down to, which makes them angry and embarrasses them, and compromises their dignity. If someone cannot come and help them immediately when they call for help, they will not wait. They are trying to hold on to what dignity they can and absolutely will not soil themselves. However, they are sick and weak and at much greater risk for having a fall than the 23 year old patient who was admitted for acute pancreatitis secondary to gross over consumption of alcohol. So, someone has to go right away or that old person will get up, get tangled in their IV lines, fall and probably break something. So, you finish getting the 23 year old you were already assisting, when your 82 year old called for help, to the bathroom, tell him that you will be back as soon as possible and not to get up without you. He is undoubtedly on some form of narcotic pain killer and also a fall risk, but is more willing to wait than the 82 year old. Then you RUN to the 82 year old's room.

Meandering Moment: I work on a Gastroenterology floor. We get new pancreatitis patients every Friday and Saturday night like clockwork. Fun times.

Of course, while all of this is going on, what you are not doing is passing your morning medications. You know, the ones you have to administer by 10 am or you will get pinged for not administering them "on time." The important medications, like insulin and anti-hypertensives. You may be thinking that it is more important to give insulin on time than to have someone wet the bed, but you would be wrong. Patient safety comes first and foremost. Of course, if there is someone having a dangerous medical situation, then I may have to let the 23 year old hold it, or wet the bed, but I still have to attend to the 82 year old and the medical situation simultaneously. If another nurse on the floor is available, he or she may be able to help my patient to the bathroom while I deal with the medical crisis. But the other nurses are usually handing multiple crises of their own.

The irony of all of this is that, while we, the nurses, are running around like chickens whose heads have been lopped off, the patients that are not getting their morning meds or being assisted to the bathroom are wondering where on earth their lazy nurse has gone and are thinking about filing a complaint with management. I spend about 10 hours out of every 12 hour shift on my feet. I spend about an hour and a half sitting at the nurses' station, charting on my patients and checking the doctor's orders. Yet, invariably, I walk into a patient's room and he asks, "Where ya been? I been waitin' for my Flomax for 20 minutes. I take it every morning at 8 am and it's almost 9!" Or something like that. I am not kidding.

I am not allowed to tell the patient, who probably thinks I have been gossiping at the nurses' station, that I have been busy with the patient 3 rooms down who had a dangerously low blood pressure and I had to call rapid response and get the patient stabilized and transferred to the ICU before I could bring him his Flomax. I am never allowed to imply that I have been busy helping someone else because management believes that it gives the patient the impression that I am too busy and overworked to take proper care of him. Which is actually the case. Instead, we (myself and the other nurses on my floor) are to carefully choose a therapeutic, calming statement that will make him feel as if he is my highest priority at all times. Something such as, "I'm sorry I wasn't here sooner, but I'm here now and, look!, I've brought your Flomax with me. (smile, smile) Tell me what else I can do or get for you while I'm here. This is when he tells you that he would like a bed bath and a shave... but you still have 2 more patients who haven't received their morning meds and your PCT is busy cleaning up the bedridden 90 year old who acquired C. diff. (a bad GI infection that makes you poop a lot) at her nursing home, and has had her 5th bowel movement since 7 am.

And so on, and so forth. You get the picture.

I cheat. If my manager knew, I would get reprimanded and maybe even written up. It would wind up in my permanent record. God forbid.

A few months ago I had a patient who was just mean. Every time I entered his room he had some disparaging remark. He had already told me that I was stupid for crossing my sevens and that only hoighty toighty nurses did stupid stuff like that! He's probably right about that. I erased the seven, rewrote it without the line, and drew a smiley face on his white board. The smiley face did not make him happy. (Do smiley faces ever make anyone happy?)

Anyway, he was going on about how unhappy he was with me. I apologized profusely and gave him the therapeutic line about him being my highest priority right now and how could I help him, etc.

(Believe it or not, despite my apparent snarky cynicism when protected by the veil of anonymity, I am actually very good at the therapeutic bolongna and get great customer satisfaction reports. It's true! Except from this guy.)

He was not to be deterred from his irate litany and continued telling me how I was lazy and stupid, was probably out flirting with some doctor at the nurses' station (this NEVER happens by the way... EVER. I HATE how nurses are portrayed by the media. But that's another topic for another day), and the nurse he'd had over night and the nurse he'd had yesterday were all a bunch of dummies, too. Plainly put, he was being abusive just to entertain himself.

I put up with it for a while, but by mid-afternoon I just couldn't take him anymore. When he kept on about how lazy I was I looked at him and said, "I'm sorry I couldn't be here sooner,  but I had a patient in another room who was having chest pain." This was true, but a no-no, nevertheless.

So, he asked, "Oh, what were ya doin'? Givin' him mouth-to-mouth? I bet he liked that!"

I just smiled and went about giving him is IV Protonix without saying anything. The silence from me irritated him. Finally, he asked in a very sarcastic tone, "So, did ya save his life?"

I still didn't respond. He said, "Oh, I get it! You won't tell me cuz I didn't like your stupid, hoighty toighty sevens!"

Now, granted, by this time I was fully aware that he wasn't just mean, but probably mentally ill as well. It is grossly unprofessional to mess with the psyche of mentally ill individuals. But it can also be fun if you don't take it too far.

"Why don't you like my sevens?," I asked.

Patient: "Cuz they're hoighty toighty."

Me: "Why are they hoighty toighty?"

Patient: "Cuz they are. Why do you make them that way?"

Me: "Because that's they way they taught me to do it where I grew up. It's so you don't accidentally confuse the 7 for a 1 or vice versa."

Patient: "Only a stupid person could confuse a 7 and1. 7 is 7 and 1 is 1! How hard is that?"

Me: "I guess it depends on how the person writes a 1. Sometimes it can be hard to tell the difference between 7 and 1."

Patient: "If you're stupid."

Me: "Is there anything else you need, anything I can bring you right now?"

Patient: "A normal 7."

Me: "Okay, well, if you need me before I come back, please call me on my phone. The number is on your white board, even if the 7 is stupid."

Patient: "So, what happened with that guy, you know, with the chest pain?"

Me: Look down at my feet and softly shake my head once, then walk out and quietly shut the patient's door.

He was so nice to me all after that. I don't know why. I think he felt bad about being so angry with me for not being there right when he wanted me after finding out that my other patient died...

Only he didn't. I slapped some oxygen on him, gave him 2 doses of sublingual nitroglycerin 5 minutes apart, got a stat EKG, which showed normal sinus rhythm, and a chest x-ray, which was also normal, then gave him some Ativan for anxiety. His chest pain was all related to stress. Of course, I didn't know that for sure at the time. I suspected it, but still had to jump through all of the hoops to rule out something more ominous. Once the Ativan kicked in, he was fiiiiinnnnnneeee!

I don't think I lied... technically. I just withheld the truth. But it made the patient lay off.

Was it right?

Probably not. If you have to ask, then the answer is usually no.

The next morning I was assigned to the mean guy again. I entered his room to put my name and phone number on his white board.

Me: Good morning, Mr. ___"

Patient: "Well, look what the cat dragged in."

I wrote my number on his white board, turned around and smiled at him sweetly, then turned back to the white board, crossed my 7, turned and left his room. I could her him chuckling as I walked down the hall to the next patient's room.

And we had a really good day together.

There is never anything expected or average about my days as a nurse...ever.

Yours Truly (well, most of the time),

Lady Sybil