i so wanted to engage in pillow therapy with one of my patients today. oh my god.
she is filled with cancer. terminal of course. our
big concern in her care is pain control. if you touch this pts IV TUBING she screams. yes, i do feel bad for her, im not heartless (but the family members are certainly taking the "joy" out of my job)
i went in the room to assess her and give her meds and she is sitting in a chair. her iv lines are all tangled and she is telling me that her pca morphine pump no longer works. her oxygen is on the bed.
of course in comes the family right then and i have to explain why this is when i dont even know myself. it took me forever to untangle the lines. i had to disconnect her to loosen the knots. every time i touched her line, or brushed against her skin she screamed. she wasnt like this two days ago but she has been having radiation for pain so maybe that has some effect on her tolerance.
i get her all untangled and the family is concerned that i have left her o2 off. her sats 96 to 100...she really doesnt need it.
i dunno i thought we were all about comfort at this point. boy am i dumb.
daughter questions me...i explain, tho i am ready to put the damn thing back on her just to shut them up.
i give her meds and have to explain what each one is. pt keeps thinking i gave her something i didnt. the daughter is helping her take her pills.
i go to see what the other 500 of my patients want me to do...
granddaughter comes out with the cup of pills and needs to know again...what they are...2 SENEKOTS, and two antidiabetic meds she has taken for years. i tell the granddaughter AGAIN. i could tell by the look on her face that she has no clue what im talking about. i considered her a good candidate for pillow therapy.
to save time in the long run i go back in the room and tell the patient for the THIRD time what those pills are. she of course is confused and keeps telling me she cant take magnesium with them.
i looked at her. i looked at the pillow.
she didnt have magnesium.
one half hour and 500 call bells later, she takes the pills.
mom thinks we took her somewhere last night. nope...even the roommate said mom didnt leave the room. daughter wants to know if we took mom anywhere....a prime candidate for pillow therapy.
pt has a duragesic patch and a morphine pca pump with a fairly high dose. although she still has some pain when she has to move, she is relativly comfortable.
i have orders to d/c the morphine and begin giving her fentanyl lollipops, 600 mg q 2. now i cant see these as being effective for this patient. its obvious to me that pain mgmt underassessed her pain so i am going to hold on to that morphine pca as long as i can. there is a problem with the suckers (the drug, not the pharmacists) in pharmacy....i can rightfully leave the pca alone.
i made the mistake of telling the family what moms plans were for the day, including stopping the morphine. (i look in the mirror and decide i might be a candidate for pillow therapy)
the son arrives. no question about him.
a nurse practitioner who is following this pt comes out and tells me that the pt hasnt had an iv all day (as reported to her by pt and family)and now i have to consider this nurse as a candidate.
and she goes on to tell me that the pump is off so mom isnt getting any morphine and hasnt all day. the family is demanding i stop the morphine and give her the suckers NOW.
im begining to get annoyed.
i got the suckers and i have to tell you, i felt bad because i knew i was going to be taking away her pain relief.
somebody shut the infusion pump off. (why cant families keep their hands off things?)
she was still getting morphine. i started the pump again.
i asked who shut it off...nobody knew.
i put the suckers on the bed and i said to the family...
i have been avoiding shutting this pump off all day but since you are requesting it be done right now, i will honor your request. but i have to be honest, and i will probably find myself in trouble for saying this, but i dont see these suckers providing nearly the amount of pain control the morphine does. i am not a doctor but these just dont look practical for your mom's pain. they have to be opened with scissors, mom has problems opening things. son chimed in that he didnt think mom would be able to handle using them by herself at night. they were taping the pca button to her hand at night cos she could never find it. i had to agree.
now if this were my mom and the nurse told me which pain control was better and how impractical those suckers were...there is no way in hell she would disconnect that pca pump.
not this family.
"well, we're gonna try the suckers"
no..THEY werent going to try ANYTHING...MOM was.
but ok...i spent about a half hour teaching about fentanyl, what it does and how she can/should use the suckers.
while i was disconnecting the pump the son begins to tell me that he doesnt like the suckers because it will take too long for us to bring them to mom.
if we even have them on the floor.
and it does take an hour for a nurse to come in the room.
NOW I WAS PIZZED.
i looked at the pillow. i could take the son but that daughter looked tuff.
since i couldnt kill them i said....
"you know, i have been in this room all day. i have come as soon as you called. i have been considerate to your mom and to you. and i have taken excellent care of your mom, but it seems to me no matter what i do, its just not enough or good enough."
this brought on a slew of apologies...we know its not your fault. we know about the staffing. (WHATS NOT MY FAULT? THEY ARE GETTING PRIVATE DUTY CARE IN A HOSPITAL...THE DOCS HAVE BEEN IN THERE CONSTANTLY)
i finished undoing the pca and wasted the morphine but i kept the pump because i knew id be hooking her back up in an hour or two.
the nurse practitioner returned and the family whined to her about how stupid those suckers were and they wanted something else..and of course how it takes an hour to get a nurse.
she came out and sat in an alcove beside me where i was charting. she began by saying...i know im getting on your nerves...lol
she was at least perceptive...she might not need pillow therapy.
we talked about how demanding and unreasonable the family was and how mom really did need pain control and how the family said they didnt know how to use the suckers.
i couldnt believe this. after all the damn teaching i did...what were they trying to pull?
i explained everything to the cnp. we paged the pain management service to reevaluate the pt.
i finished charting and ran downstairs to have a smoke. no lunch for me on my 13 hour shift.
i was gone no more than 5 mns. when i got to the desk i had 4 people talking to me all at once about all different things. i had phone calls on hold and phone messages. oh...did i mention i was charge today too?
one of the ppl in line was the son. mom is putting on her pajamas. she needs me to put the iv line thru her sleeve.
i go in the room and i am telling the family and the pt how impractical long sleeved pjs are with all of the tubing she has. we cant even touch moms lines without causing pain but now we have to deal with pajamas.
well im not too upset cos mom is dying and if long sleeve pjs make her happy then ok.
i pull the line out of her sleeve and everything is running. mom starts arguing with me saying that i never touched her line and she needs to have it out of her sleeve. this went on for about 15 minutes. the daughter kept apologizing to me.
my assitant tells me that one of my pts has developed a massive rectal bleed. i go to the room and its bad. there is at LEAST 2000 ccs all over the bed. massive clotting. i make sure he is stable then i call the resident. "i dont follow that pt anymore...you will have to find the resident who does" oh this doc is in dire need of pillow therapy.
so i call the attending..i dont care if she is mad or not. this guy is going to go real bad real fast if i dont do something NOW.
as i sit on hold waiting for the doc i am doing the staffing. (in my spare time) ..the granddaughter walks out and says that gma is kinda nauseated and needs her medicine.
i get stat orders for blood and im trying to get my bleed typed and crossed stat.
that done, i am waiting for the bloodwork to be processed and i decide to restart that pca pump. i go in the room and mom is eating. doesnt seem to nauseated to me.
her room mate starts complaining that she has been calling for her pain shot. while im hooking up the pump i tell her that i have a critical patient who is bleeding profusely and thats where ive been and thats where im going to be probably for the rest of my shift. i start the pca, and come back with the roomies pain shot.
mom is picking at her food and eating. mom can wait for her nausea meds. i have to check on my bleed.
my shift has been over for a half hour. they are waiting for report.
while in report one of the nurses comes in and tells me that this patients family member is at the desk demanding nausea meds for her mom. she said she had waited two hours (more like 45 mns to an hour) and she was staying at the desk until she got them.
good, as far as im concerned she will be standing at the desk until thursday morning then cos i am NOT leaving report to give them.
...please dont shoot the messanger...lol....
other candidates for pillow therapy today:
the pt who stood pacing in the hall under his call bell when his pain med was due (i finally told him to go in his room...lol)
the four different docs who asked me what my baby huey patient weighed.
the baby huey patient who just came off an insulin drip, had two ivs (one for each hand) and wanted to take a shower cos he didnt have one for 4 days.
oh yeah...im going to let him in the shower, he is going to pass out and i am going to deal with 400 lbs of dead meat on the shower floor. talked to the doc about it...doc said no. this goon called me ALL DAY AND ALL DAY I TOLD HIM TO WASH AT THE SINK. during my bleed episode the doc comes and talks to me about the shower thing. i told him why i didnt think today was a good day for a shower. he agreed. i answer his call light again and he tells me the doc said he could take a shower.
i call the doc and asked him what that was about...he said the pt told him his nurse said he could take a shower...
i couldnt give this guy pillow therapy. our pillows arent big enough.
transport took my patient to the wrong department...i got an emergency call from angio about this pt...scared me cos there was just a code in the dept where he was supposed to be and when i saw that call blinking i thought it was him. transport is being scheduled for pillow therapy.
and mgmt wonders why i despise daylight