The good, the bad, and the ugly
- 9Jan 21, '13 by R!XTERSo much has been going on at work lately, I just wanted to start this thread for us to share one or two lines on each to reflect recent events at work. I'll start:
The good: the last two shifts I worked have been so much better than the way its been lately in terms of volume and acuity. Here's hoping it continues.
The bad: I had a near miss with a med error that really shook me up. A reminder to be even more hyper vigilant and I'm so so thankful it was a miss.
The ugly: family members rescinded a DNR/DNI on an 85yr old with a bowel perf r/t c-diff colitis. Pt was taken to OR with approximately zero chance of survival. How is this even allowed?
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- 20Jan 21, '13 by SwansonRNThe good: I don't want to go into too many details but I just graduated last May and I got a very very sick admission in the ICU, no blood pressure, pH non compatible with life, etc. I had little help because the unit was so hectic. After work the charge nurse emailed all the unit managers including my boss telling them how impressed she was with how I took care of that patient. I was on cloud 9! Bad: Withdrawing life support from my favorite patient on Christmas. Ugly: Dropping and shattering a glass container filled with a liter of tea colored paracentesis fluid in the hallway. Awesome.
- 15Jan 21, '13 by TakeTwoAspirinI'm sorry, but there comes a time when the doctor needs to step up, grow a pair, and spell it out to the families real nice and simple! The families need someone to tell them "no" so that they can feel less guilt about not trying everything possible I know, but there really comes a time when we are just torturing these folks.
- 2Jan 21, '13 by imintroubleGood: I stopped trying to reason with my pleasantly confused pt, and started to smile at the absurdity of her behavior AND mine. It ended my frustration, as well as theirs.
Bad: Sick people who love to be sick. Want to be waited on, and whimper all the time.
Ugly: Listening to a new nurse report a change in condition to the MD at 0400 in the AM. I really wish he'd run that idea by me before he made the call. No wonder MDs think night shift nurses are idiots.
- 2Jan 21, '13 by ClearBlueOctoberSkyThe good: I got my morning med pass done before eleven.
The bad: I was told to cut down on the overtime accummulated by charting. (As I was filling out not one, but two, incident reports.)
The ugly: I had to deal with the passive-aggressive bully nurse when she found out a residents not-needed anti-psychotic medication was d'cd. If anyone makes me want to drown myself in a tub of chocolate and wine, it's her.
- 6Jan 21, '13 by VivaLasViejas GuideThe good: Only two falls (and two incident reports) over the weekend.
The bad: Our 99-year-old-resident (who was only two months away from becoming a centenarian) broke her hip and died on the operating table.
The ugly: Corporate is micromanaging us now because our building sold last week, and another management company will be coming in to replace them. Like it's our fault. Sore losers.
- 2Jan 22, '13 by Aurora77The good: one of my patients, who I had last week, looks a million times better. I'm so happy for her.
The bad: another patient is, as one of my coworkers likes to say, on my last nerve. I'll be lucky if I make it to 0700 without saying something I'll regret. Grr.
The ugly: I have to be smiley and kiss butt to annoying patient in the name of good HCAP scores. Normally that's not hard for me, but tonight, it's a struggle.
- 8Jan 22, '13 by CheesePotatoNot just the good...the @#$% good: Mom survived in spite of everything. Baby came out kitten squalling and pink. It's a girl! (and nothing short of miraculous!) Boo yeah!
The bad: The coffee maker just broke. I think I may have to harpoon someone before the night is out. Either that, or you will find me in the corner of the lounge, weeping, wailing and throwing dirt in my hair.
The ugly: Thoracic Aneurysm + 60+ years of plaque build-up + spike in blood pressure = the red sea. Possible burr hole in someone who got into a fight with gravity and lost....six hours ago = decerebrate posturing and my own posturing of gentle head-shaking and pondering why. Abdominal pain is buy one get one down in the ED which could equal a lot of frequent flyer points for bowel obstructions, lap appy's n' the like.
Oh, and did I mention the coffee maker?
- 6Jan 22, '13 by CheesePotatoQuote from TakeTwoAspirinIf only it were so clean and simple.I'm sorry, but there comes a time when the doctor needs to step up, grow a pair, and spell it out to the families real nice and simple! The families need someone to tell them "no" so that they can feel less guilt about not trying everything possible I know, but there really comes a time when we are just torturing these folks.
And for the record, most <--key word, surgeons do "grow a pair" and explain in great and graphic detail the odds of a surgery doing a patient any good. I have stood by with many surgeons and participated in this discussion as support and witness. In fact, it is in a physician's best interest to do so as a way of being able to document that such things were discussed so when it comes time for the heartbroken family to file a law suit (because that is the kind of crazy country we live in) there is documentation stating that risks and benefits were addressed in great detail and the family insisted.
Remember, it takes two to tango and, sadly, due to the rampant nature of lawsuits, etc. many surgeons are trapped into providing care as any delay that could somehow, in some remote fashion, be even kinda sorta tied to the harm of a patient opens them up to having the britches sued off of them.
I am, in no way, saying that I don't agree that there comes a point where it is just time to stop, I am merely pointing out that in many cases, such permission has been given and has just as quickly been discarded.
And this, my friends, is why having advanced directives and your healthcare wishes known is just so vitally important as it is you, the patient, the loved one, giving the ultimate permission to your family to stop.
Now back to your regularly scheduled thread.