WAIT! DON'T GO!
Home care,bad location Patient with multiple needs, nurse face her fears and helps patient
WAIT! DON’T GO!
I pulled the car to the side and put my hazard lights on.
“Ok, where is this I have to go?” I asked the staffer at homecare.
I jotted the address and put it in my GPS. That would be my last patient for the day.
When I finally made it to the address, my heart sank. I was in the middle of the projects. Huge buildings, drunks and drugged out people sitting on the benches. An occasional family sat on a bench, soaking up the sun. I saw very few kids outside. People looked me up and down as I passed them, my homecare RN ID prominently displayed. I plastered a shaky smile and wished people good afternoon as I passed them. Some ignored me, some smiled and some looked vacantly on. I finally got into the building. I was going to Apt 124 K on the 17th floor. The warnings of never to take the stairs in the projects rang in my ears as I waited for the elevator. The elevator was small with a gate that I had to pull close. On the 17th floor the corridors were long with dim lighting. My heart in my throat I started walking trying to find the apartment.
Every instinct screamed at me to turn back and leave but I forced my steps ahead. What would happen if someone yanked me into one of these apartments? No one would know. I would never see my family again I thought. I finally reached the apartment and rang the bell. No one answered. Hoping that the patient was not there, I rang the bell a couple more times. No answer. Relief coursed to me as I turned to escape back to the safety of my car and started walking.
Behind me, the door opened and I heard “Wait! Don’t go”! I turned around and froze.
A huge young black man stood at the door with a bare chest. His shorts were barely visible under his pendulous belly.
“Are you the nurse?”
“Yes, Good afternoon Peter! My name is Annie.” I masked my fear under a smile as I walked back towards him.
“Come in” he turned back slowly and walked into the apartment.
I hesitantly entered although my feet were trying to pull me in the opposite direction!
The apartment was cold and bare. I looked around. He had disappeared. I walked past a kitchen and saw a door at the end of the corridor and walked to it. Something cold touched my leg and I looked down and saw a cat. I entered the room and found Peter sitting on the bed staring at me breathing hard. There was no other furniture except a TV and a few plastic milk crates. The cat followed me into the room. I hung my bag on the door.
“I am sorry. I don’t have any place for you to sit. You could sit on the bed.” He said softly.
“Thank you but I think I found a seat!”I stacked the milk crates together, put a newspaper from my bag on top and sat on it.
“Thanks for opening the door”, I smiled looking him in the eye. Peter talked slowly and I realized that he was intellectually challenged. My brain went into high gear as I looked at him. He was short of breath and was breathing hard after minimal exertion. I could hear a slight wheeze across the room. Since all he had on was shorts, I could see his skin that was dry and the 3 plus edema on bilateral ankles. I saw a half-eaten Chinese takeout on his bed and a 2 liter Coke bottle on the floor.
As I went through a homecare assessment and a physical exam, I knew that he was in the beginnings of respiratory failure. His weight, diet, isolation and inactivity did not help matters. He barely cooked and relied on neighbors buying him groceries but that was a hit or miss. His sister lived an hour away but had her own problems. He could not walk to the store but relied on takeout food which did not help his congestive heart failure or asthma.
His black cat that he called Camper (he always wanted to go to summer camp but could not afford it) was his only company even though Camper made his asthma worse. When I checked his back, I saw a stage two pressure ulcer on his buttocks and rash under his belly and breast. I gave him a nebulizer treatment and taught him about asthma, prevention and treatment. I then sat there and made a few calls to help him. One was to his MD to increase his Lasix dose and get refills on all his meds and discuss plan of care and referrals I needed for Peter.
The second one was to his pharmacy to set up home delivery. The third one was to my central base to put in an order for a hospital bed and special mattress. The fourth one was to the social service dept. for an assessment referral and to hook him up with community services like meals on wheels and para transit for transportation. I spend around two hours at his apartment. I was subbing for another nurse that called out.
When I left, he hugged me and thanked me and said, “I wish you were my nurse!” I hugged him back and said, “Don’t worry! You are in good hands!”
He had tears in his eyes as I walked out the door and out of his life.
When I left the building, I looked back at it wondering how many more Peters lived in those building, all alone with no one to help them. I sat in my car and cried for Peter. I called back base and asked the director to put a compassionate nurse to take care of him as the perdiem RN who had him as a regular patient just went in, took vitals and left. The director promised to follow up. I thought about all my fears that had surfaced when I first saw him and I was ashamed of myself.
Then I thought of how I felt when I left his apartment and felt happiness and satisfaction that I was able to help a fellow human being. I realized that I was put in a position to help or ignore his needs and was able to make the right choice, even though it took an extra hour. The danger I faced going into the projects was overshadowed by what I was able to accomplish. That day, I was proud to be a nurse!
About spotangel, BSN, MSN
Nurse, mother, wife, writer, loves to love,cook and laugh!
Joined Mar '12; Posts: 114; Likes: 441.Apr 18Isn't it amazing that you could make such a difference in one visit, and yet the regular nurse did not in all of their visits. It's awful. Thank god you were able to care for him that day. You can't fix all of their problems, but we should attempt to make some improvements when possible.Apr 19I do home visits as well and some places are very scary to go to but the satisfaction we get when we help someone like you did is an AMAZING feeling. Keep up the great work!!!!Apr 19That made me tear up. I did home care nursing for awhile and can really relate to this story.
Prayers are being sent up for Peter.Apr 19Amen and amen! I did home care in a very rural area and even there some places are scary to go to. When I was on call I did some visits in town also. Both places have addicts and intellectually challenged people and especially very lonely people. It is amazing the difference a home care nurse can make to these folks. I miss it a lot, especially now that I'm retired. Keep up the great work!Apr 19Cases like "Peter" are sometimes where we have the chance to make the greatest impact with an individual patient And as the greatest reminder of what nursing is truly about.
I hope the director was able to find a primary case manager RN who is able to appreciate him as much as you were!
I'll never forget the day that one of my most challenging patients in my career told me that myself and a social worker for my agency were the first 2 "medical people" who he ever felt like listened to him and cared about him. That moment will forever stick with me.Apr 19An exelent written case of homecare.
It shows - once again - how important it is, to have a network:
MD, pharmacy, vet (for sure), paramedic, church community, social welfare, nutritional consultant, meals on wheels, chiropodist, barber, hairdresser, ..., and a base that is able to manage all this.
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