RN58186 3,827 Views
Joined Jun 19, '11.
Posts: 143 (63% Liked)
Perhaps it's different in psych nursing, but out here in the field, nurses with psychiatric problems are often mistreated and almost ALWAYS misunderstood.
We had a diverter in our ER that I was very close too, I feel like beating my head against a wall still that I missed any sign, and looking back, honestly I still can't believe this nurse was diverting (not that addiction was a choice, it's a disease, and she was sick.) But, what I mean, I know the signs/symptoms, and she was never late, absent, first to help you, last to complain, didn't take frequent breaks, no track marks, etc. Drug counts/wastes 100% accuracy. She was very well kept, never sleepy, well liked by staff, and just a great person.
But anyway, we all came in to work and they had all the staff with narcotic access quarantined off in a pt. room, even people that were off shift. (I thought something horrible had happened, but once they started calling us out, one by one, I knew what it was.
They called it a random screen, but everyone there was witnessed (I by a female), which I was kind of wierded out by it (I was 19 and the DON was 54 (took me like 5 minutes to pee, and then drop, by drop, by drop. "bladder shy," when I came out with my urine, I seen her confessing, and handing them vials (before her screen, she was next). I ran back into the bathroom and vomited, I was in shock. I knew the road ahead for her (she has since been found dead of an overdose,) but I was hoping it would JUST be red tape, financial strain, and hoop jumping. But it took her life. I feel partially to blame. I will always feel that.
These situations are horrid, nasty, and disgusting to do. Addiction is worse. It leads you to one of 3 places, Death, Prisons, or Institutions.
I am sooooo sorry this happened to you! Though, Justice provailed.
Random and Suspect Drug Screens save lives, they might make that life a living HXXL for a while, but thats Temporary.
Death is Forever.
It's amazing how your views change with age. That feeling of, "Please sweep this under the rug for her, she supports her children financially, alone, and has no one else!" "Give her time off to handle this!" "She's an Awesome Nurse and a good person with a bad problem." All of these lines of thoughts walked her to her grave. She quit, and was at another hospital diverting before BON could address her.
"I still had those old attitudes, and thought she was treated unfairly, but had the reporting worked, and alternative program/discipline began, by now she might be in the ER making us laugh this weekend again!"
Who's Afraid of the Big Bad Psych Patient?
Whenever I tell people I use to be a psych nurse, I usually get one of two reactions. "That's so interesting--tell me more." Or, far more often--"Yikes! Psych freaks me out. I could never do that."
It's no wonder. Very few of us had more than a brief flirtation with psych during nursing school. In class, we were introduced to Freud and Jung, Maslow and Erickson. We learned about normal brain function and the myriad ways it can falter. We covered a long list of diagnoses and the signs and symptoms that went with them. And we made lists of meds. Lots and lots of meds. Next up--the psych ward where we made hesitant contact with patients, attended group sessions, and did our best to conduct therapeutic conversations. Remember active listening?
But psych is a complex area and we barely had time to scratch the surface. Add to this the fact that we didn't want to say anything offensive (So, how does it feel to be psychotic?) or set anyone off, and it's easy to see why we were relieved when the nurse locked the ward door behind us on the the last day.
It seems so rational, even somewhat sensible to be afraid of psych patients, but is the fear justified?
Consider that there are approximately four million people in the US with severe mental illness. Out of that number, just 40,000--one percent--are violent. And, according to Jeffrey Swanson, a professor at Duke University, that violence is mostly mild behavior--shoving, pushing, punching--more associated with resisting someone else's control than intending to cause them harm.
The stark reality is that mental patients are 13 times more likely to be the victims of violence than the perpetrators. Limited resources, rough living, and the fact that they aren't the most credible witnesses, turn folks who struggle with mental illness into attractive targets for criminals and opportunists. Often, patients are their own worst enemies, forgetting (or deciding not to take) meds, giving away money and possessions, and choosing unscrupulous or unstable companions.
But none of that makes the news. The mentally ill people we hear about are the crazed gunmen or the serial killers. With extreme criminals providing the "face" of psychiatric illness, it's little wonder that even the word "psych" freaks people out.
In reality, if you want to see what a typical psych patient looks like, take a peek in the mirror. That isn't meant to insult, but to illustrate how "normal" mental illness is.
According to the Kim Foundation, in any given year, approximately one in four American adults will suffer from a diagnosable mental illness. Unfortunately, many people will not actually be diagnosed, and of those who are, many will not request or receive treatment. Nevertheless, a quarter of our population lives with one or more psychiatric afflictions. What could be more ordinary than that?
Let's take a step back from the machine gun-toters and the axe-wielders and recognize them for the statistical anomalies that they are. Much more common are everyday people who struggle with mood disorders (depression, bipolar disorder), anxiety disorders (panic disorder, obsessive-compulsive disorder, PTSD, generalized anxiety disorder, and a variety of phobias), conduct disorders, substance abuse, eating and body image disorders, ADHD, autism spectrum disorders and Alzheimer's disease.
It's a rare person that doesn't know someone affected by one of these maladies and many of us know half a dozen or more. (Pssst. And some of us are that "one in four" affected people.)
Do we hold all of these people at arm's length? Not usually. We often learn to keep a bit of protective distance, but we still interact and encourage the afflicted ones to seek health and make better decisions. That's similar to what happens on a psych unit. Doctors, nurses, techs, and other professionals try to establish a caring connection, offer a listening ear, and help the patient navigate through treatment choices and through their often challenging lives.
But isn't it frustrating to work with such messed up people? It can be. But "messed up" is a relative term. Some mental patients are fairly sane people who have been steamrolled by insane circumstances, time and time again. If you knew all that they had dealt with over the years, instead of shying away, you'd be proud to know them, and you'd see them for the resilient survivors they are.
Other folks have been tuned to a different frequency for most of their lives, but you can still see a spark of humanity in their eyes. Even the hostile, edgy ones have a good days mixed in with the not-so-good.
As far as the fear of "setting someone off" goes, when you work in this milieu, you learn ways to help patients deescalate. Or at least how not to push their buttons. This is a fantastic life skill to practice on a psych ward, but it can come in handy anywhere.
Another frequent bugaboo connected with psych is the idea of tip-toeing on eggshells when it comes to talk of suicide. When, at first, I was taught to ask patients outright, "Are you thinking of harming yourself? Do you have a plan?" I thought it was, pardon the expression, insane to ask a fragile mental patient such a loaded question. I assumed they'd either lie or become angry or both. Imagine my surprise when they almost always told the truth and expressed relief that someone had mentioned the elephant in the room.
Once the subject was broached, we could discuss the emotional triggers that sparked thoughts of self-harm and strategies for patients to get their needs met without drama or damage. They were happy someone cared enough to ask and often agreed to contract (make a deal) to keep themselves safe. They would agree to say a particular word as a signal that they needed a one-to-one conversation or they'd write rather than cut or they'd even ask us to put them in the quiet room where they could calm their racing emotions with our help.
Some nurses have expressed reluctance to deal with a population so given to (and good at) manipulation. Initially, you get suckered in. A lot. But then you learn. And pretty soon you get to a point where you don't even get riled up any more. When someone tries to play one staff member against another or take unearned privileges, you say things like, "No, you can't break the rule, but thanks for asking. We have lovely parting gifts for you. Thanks for playing our game." You laugh. They laugh. No hard feelings.
You might be amazed how many people you know--nurses among them--who either struggled with mental illness in the past or still do so today. Counseling, meds or both have allowed them to progress to the point where you would never be able to tell psych issues are or were a part of their lives unless they told you.
I'll leave you with two important truths about psych. One is that psych patients are just like the rest of us, only more so. And the other is that no matter what kinds of patients you work with (and who your co-workers are), you will always find psych training useful.
Law creates barriers to getting care for mentally ill
Working to Reduce Mental Illness Stigma | The Kim Foundation
NAMI: National Alliance on Mental Illness | NAMI: The National Alliance on Mental Illness
I've been a nurse for a lONG time -- probably longer than most of you reading this have been alive. Had I known what I was getting into, I probably would not have gotten into it. Fortunately, I had no idea. I say fortunately, because nursing has been an interesting and flexible career that has afforded me a nice lifestyle and kept me from being bored. I wouldn't go back and change my mind about going into nursing if I could..
Oh, and I met my husband at work. Another bonus!
If you're considering a career in nursing, make sure you're clear on why you're considering it. I'm not here to cast aspersions on anyone's motives for wanting to be a nurse. After all, mine weren't all that altruistic. I wanted a degree that would enable me to be a sought-after employee rather than me having to face rejection after rejection while hunting for a job. I know that doesn't apply now, but it did then. And my mother, who had always wanted to be an LPN, told me that I should go to school to become an RN because "all they do is sit at the desk and drink coffee and flirt with the doctors while someone else does all the work." It should be noted that my mother's closest proximity to hospital nursing were her two stays in the maternity ward, as they called it then. The fact that she didn't know what she was talking about has NEVER stopped her from having a strong opinion, however.
Some people go into nursing as a "calling." They figure that all they need is a compassion or a desire to help people or a willingness to put the patient first at all times and pour heart and soul into their care. Those things are nice, but a calling alone is not enough. You need to be a good enough student to graduate from a very difficult course of study and then a good enough test taker to pass the licensing exam. You need to be able to memorize drugs and their standard doses, uses and side effects, read and understand written English and be able to make yourself understood both orally and in writing. You need to be able to prioritize, to multitask and to run your buns off for twelve hours straight with only the briefest of breaks. Compassion is nice, but I'll take the nurse who has mastered critical thinking . . . I've worked with both and been under the care of both. In the best of all worlds, a nurse has both compassion and critical thinking skills, but compassion can be faked. Critical thinking cannot.
A strong stomach helps, too, but is not essential. That, too, can be developed. Do you hate the sight of blood? You can get over that. My husband did. But it's not just blood. Sputum is my own personal vomit trigger. I've seen other nurses puke right along with their patients. You'll have to clean up poop and pee and all sorts of other bodily fluids, and you'll have to do it with a smile and without making the patient feel worse about it than they already do.
There are those who go into nursing so they can take care of cute little babies all day, or maybe it's sweet little old ladies. I've taken care of a number of sweet little old ladies, but then there are the emmigrants from Hades who make your entire shift a misery, and you have to take care of them as if they were likable, too. The cute little baby who "fell off the table while I was changing his diaper" for the fourth time this month may wind up in your care and no matter what you think of the mother, you can't tell her. If you don't think you'd have the backbone to contact Child Protective Services, consider growing one. Pediatrics is a popular choice because everyone loves little children. Consider the fact that some of your patients may be victims of child abuse, and the abuser is right there in the room with them asking when they can go home. Or that sweet little boy with the big blue eyes may be dying of leukemia. The neonate in your NICU may have been born addicted to heroin and is going home with his mother anyway. No body likes to see this things happen, but as a nurse, you'll see them. And worse. It'll tug on your heartstrings, or it'll rip your heart right out of your chest and shred it. But you WILL see these things or worse, and you'll need to deal with them.
Can't deal with crazy people? Obviously psych won't be for you, but you'll deal with psych patients in ER, ICU and Med-Surg as well. And in Rehab, the endoscopy suite and even in the nice outpatient clinics with the great fountains and real paintings. Not just crazy patients, but crazy visitors as well. You'll also have to deal with people who are drunk or DTing, high on drugs or withdrawing and with people who are just plain entitled, nasty and mean.
Still interested in a career in nursing? Understand that hospitals are open for business 24 hours a day and 365 days a year. Working nights, weekends and holidays is a given. I don't understand how so many people manage to make it all the way through nursing school without it dawning on them that they, too, will really have to work an overnight shift, but there are some every year. And there are those who are convinced that they are so special they shouldn't ever have to work those undesirable shifts. Honey, if you're that special, don't take a job in the hospital. (But that's where the money is, you say? Make up your mind. If you want to work in the hospital setting, you take the bad with the good)
If you live in the snow belt, you will be expected to work when it snows. Even if it snows a lot. Every year, there are posts from new nurses who don't feel they should have to drive to work in a blizzard. They have small children or their car isn't good in snow or they've never learned how to drive in the winter. None of those are good excuses, and you WILL be expected to work. If there's a hurricane, bring four days worth of clean underwear and prescription medication, because you'll be at work for the duration. Or you won't have a job. Have a plan for your dog, your children and your elderly parents because part of working in a hospital is coming to work when everyone else stays home. And while I'm touching on that topic, you will be coming to work when the neighbors are hosting the neighborhood Block Party, when your husband is out of town on business and when your kids are sick. Have a plan in place for those times.
We see posts frequently from folks who want to know which specialty requires the least math, or if they really have to be able to do math at all. The answer to the second is "Yes." The answer to the first is less polite. Your patient is 198 pounds and the physician has ordered 2.5 mg. per kilogram of medication per day in two equal doses. How much do you give now? And that's an easy one.
There are the posts from those who wish to choose the specialty with the lowest stress level. My stress level peaks when I'm in the well-baby nursery and those kids start shrieking for what is probably a very good reason, but I can't figure it out. Home Health makes me shudder . . . I remember my Community Nursing clinical as a special slice of hell and hope I NEVER have to enter a patient's home again. A nice calm, code, though is another story. Your milage may vary. I haven't heard of ANY non-stress specialties, however, and even if there WAS one, you'd have to get through nursing school and acquire some experience before you'd be qualified for a job like that.
If you're the type of person who looks for unfairness or bullying everywhere you go, you'll find it in nursing . . . whether or not it actually exists. Better to go into it looking for smart, helpful team workers who will save your butt when it needs saving and teach you something while they're doing it. You'll find more of those if you're looking for them. And if you cannot handle criticism, get over it. Lives are a stake here, and if I see you doing something stupid, I'll tell you about it BEFORE you can harm your patient. In private if possible, but if not, not. One thing nursing schools don't teach -- and should -- is the ability to handle negative feedback constructively. It's a valuable skill in any career, but it's vital in nursing.
If you've read all this and you still think you'd like to be a nurse, good for you. In the 34 years I've been a nurse, I've been spit at, slapped, kicked, punched, cursed and threatened. I've also been the recipient of grateful smiles, wonderful thankyou notes and boxes of chocolate. I've had horrible days where I couldn't do anything right and felt behind the whole day, and I've had wonderful days when I know I really made a difference to someone. I've worked night shifts, days and evenings and I've worked all of them in the same week. I've worked Christmases and Thanksgivings and Mothers Days and Easter. But I've had my birthday and my wedding anniversary off every year, and not many office workers can say that! When my car's engine needed to be replaced and I had no money, I worked overtime. Lots of it. Can't do that in the office. When I needed to be home with an elderly parent, I arranged my schedule so that either DH or I would be home at all times. Can't do that in an office, either. I worked every weekend when I was in graduate school, going to school full time and working full time. When my then-boyfriend moved out on Christmas Eve, I traded shifts with a nurse whose boyfriend unexpectedly flew back from the Gulf War for Christmas, and when my father knew he wasn't going to make it through the winter, someone traded shifts with me so I could drive 1000 miles to cook him Thanksgiving dinner. Not only would that not be an option in office work, office workers probably would not even think about it as valuable.
I've learned to laugh at things that would make me cry if I didn't, and I've learned to appreciate what I have because plenty of people have less. I cannot imagine what my life would have been if I hadn't been a nurse, and if I had to do it all over again, I would.
May a shift from hell be followed by one that reminds you of why you are a nurse.
That is all.
The music was piping through the speakers, the turkey was in the oven, and my mother-in-law and I were sharing laughter and love while cooking dinner together for Thanksgiving. My husband was in the living room watching football (I love him for being a fan!), and called me into the room to watch and excerpt on ESPN.
Chris Henry, a wide receiver for the Bengals had passed away last year after suffering injuries in an MVA. Because his mother decided to donate his organs, several people received a new lease on life. My husband knew that I would find this story interesting because we had JUST had a conversation the day before regarding the increased incidence of trauma and transplants in the holiday season. Misty eyed and quite humbled, I want to share a Thanksgiving experience with you.
I drew the short stick and had to work in the OR one Thanksgiving. Although I was disappointed that I would not be having dinner with my husband and our friends, I went in knowing that we would only be doing emergency cases. I expected a relatively light working day filled with organizing, straightening, cleaning, etc. How wrong I was.
Within minutes of clocking in, our staff got a 'black tag' alert from the ER. They received a very young patient with a self inflicted GSW to the head. The patient was kept on a vent until the family was informed. The family consented to organ donation. With a heaviness in my heart that I cannot begin to verbalize, I scrubbed in and set the room up for an organ harvest.
I spent 15 grueling hours assisting in meticulous organ recovery. When we were done, I sent the staff out of the room. I sat beside the OR bed and looked at this poor young man, his head swathed in Kerlix and lines coming out of every orifice. I picked up his lifeless hand and held it in mine. I wondered what would lead a thriving young man to take the route of suicide. I was immediately aware that this young man would not be spending Thanksgiving with his family ever again, that his family would forever hold Thanksgiving with little joy for years to come. I shed several tears during this time...for him, for his family, for the horrid events that lead to him choosing to shut the door to life.
When I felt more composed, I walked out of the room, washed my face and tried to focus on the next task at hand. I walked to the front desk to receive my next assignment and was caught off guard by the raucous laughter and banter I was hearing in the pre-op holding room. It sounded like a party was going on in pre-op, so I went to take a gander.
Several men in full military garb were standing around a slight young man lying on a stretcher. The man on the stretcher was a soldier that had been on the transplant list for quite some time after contracting Hep C from a needle stick while attending to a patient en route from the field to a military hospital overseas. The family was so excited because this brave man would be getting the life saving liver that I just helped to harvest. I couldn't help but get misty again. One life has ended and another was beginning.
I went home EXHAUSTED. Thankfully, I live close to the hospital and didn't have far to drive. My dear husband had dinner re-heated for me, but I could not eat. My friends saw the tired look on my face and knew that I needed space. I went outside to clear my mind and rid myself of the sadness I was holding in my heart. A few minutes later, I heard the helicopter buzz over my house that carried my patient's heart, lungs and kidneys to another location. Smiling, I understood in that quiet moment that so many patients and their families would be experiencing the very same scenario that I witnessed in pre-op. I received a letter a few weeks later informing me that another solider received a kidney, a pediatric patient received both the heart and lungs, and a dialysis patient got the other kidney.
I spent that Thanksgiving with a very heavy heart, but learned a very valuable lesson: to GIVE is precious. To be thankful is humbling. I witnessed both that day, and I will forever be honored to be a part of that.
A friend of mine sent me this and I wanted to share as a gentle reminder for all of us who work in the health care field:
When an old man died in the geriatric ward of a nursing home in North Platte, Nebraska, it was believed that he had nothing left of any value.
Later, when the nurses were going through his meager possessions, they found this poem. Its quality and content so impressed the staff that copies were made and distributed to every nurse in the ...hospital. One nur...se took her copy to Missouri.
The old man's... sole bequest to posterity has since appeared in the Christmas edition of the News Magazine of the St. Louis Assoc. for Mental Health. A slide presentation has also been made based on his simple, but eloquent, poem.
And this little old man, with nothing left to give to the world, is now the author of this 'anonymous' poem winging across the Internet.
Crabby Old Man
What do you see nurses? .. . . . . What do you see?
What are you thinking . . . . . when you're looking at me?
A crabby old man . . . . . not very wise,
Uncertain of habit . . . . . with faraway eyes?
Who dribbles his food . . . . . and makes no reply.
When you say in a loud voice .. . . . . 'I do wish you'd try!'
Who seems not to notice . . . . . the things that you do.
And forever is losing . . . . . A sock or shoe?
Who, resisting or not . . . . . lets you do as you will,
With bathing and feeding . . . . . The long day to fill?
Is that what you're thinking? . . . . . Is that what you see?
Then open your eyes, nurse . . .. . . you're not looking at me.
I'll tell you who I am. . . . . . As I sit here so still,
As I do at your bidding, . . . . . as I eat at your will.
I'm a small child of Ten . . . . .. with a father and mother,
Brothers and sisters .. . . . . who love one another.
A young boy of Sixteen . . . . with wings on his feet.
Dreaming that soon now . .. . . . a lover he'll meet.
A groom soon at Twenty . . .. . . my heart gives a leap.
Remembering, the vows . . . . . that I promised to keep.
At Twenty-Five, now . . . . . I have young of my own.
Who need me to guide . . . . . And a secure happy home.
A man of Thirty . . .. . .. My young now grown fast,
Bound to each other . . . . . With ties that should last.
At Forty, my young sons . . . . . have grown and are gone,
But my woman's beside me . . . . .. to see I don't mourn.
At Fifty, once more, babies play 'round my knee,
Again, we know children .. . . . . My loved one and me.
Dark days are upon me . . . . . my wife is now dead.
I look at the future . . . . . shudder with dread.
For my young are all rearing . . . . . young of their own.
And I think of the years . . . . . and the love that I've known.
I'm now an old man . . . . . and nature is cruel.
'Tis jest to make old age . . . . . look like a fool.
The body, it crumbles . . . . . grace and vigor, depart.
There is now a stone . . . . where I once had a heart.
But inside this old carcass . . . . . a young guy still dwells,
And now and again . . . . . my battered heart swells.
I remember the joys . . . . . I remember the pain.
And I'm loving and living . . .. . . life over again.
I think of the years, all too few . . . . . gone too fast.
And accept the stark fact . . . . that nothing can last.
So open your eyes, people . . . . .. open and see.
Not a crabby old man . . . Look closer . . . see ME!!
Remember this poem when you next meet
an older person who you might brush aside
without looking at the young soul within.
After seeing some of the posts here, I went back to see how long the OP has been a member to see if this was a "troll" post as some of the posters seemed to be sensing. I looked at the previous posts by the OP and they all seem to be complaints/criticisms of nurses and the healthcare profession in general. In light of this, I would like to amend my previous post and just my..... this is a board for nurses, students and allied health professionals(but primarily nurses) to confer, vent and share with each other. Feel free to "lurk" but your condemnation of our profession is not welcome.. at least not by me.
Could it be that the MD already has a protocol in place that the nurse has to follow regarding patients, including accessing the files of his patients? I find your entire post rude and degrading. Why exactly are you on a forum for nurses if we sicken and disgust you so much?
As nurses, we consider it a good day's work when nobody has yelled at us or thrown bedpans at us. When we hear, "Thank you for being my nurse; you are so kind," it borders on the near miraculous. Then again, there are those rare and truly treasured patients that come along and say, "You made a difference to me. You're a great nurse." It is those heartfelt words that make all the sleepless nights in nursing school, the patient overload, the overtime, calming the confused or belligerent patients, the condescending, berating from doctors, the tired feet and aching back worth every torturous moment.
The following describes such a situation that occurred during the summer of 2005. I share this story with you not so much to boast but to remind us, as nurses, that we do leave lasting impacts on our patients and that there are rewards in nursing that go beyond quitting time and paychecks.
Since I am a tall and rather large person, I can present a rather intimidating appearance. To ease tension, I frequently use humor as a means of warming up to patients. At the time, I was a relatively new nurse and still searching for my own personal nursing doctrine. As such, I see each patient as a fresh opportunity to try new things or confirm tried-and-true practices. I have tried to live my life by the Golden Rule and make every attempt to be the kind of nurse I would like to have if I were hospitalized. If I made my patient smile, then I feel I have accomplished my goal for the day. My experience with the following patient forever cemented my conviction that my holistic approach, though not necessarily true to any one nursing theory, is the right one for me.
I first came to know Diana* as a patient when she was admitted to our local rural hospital as a rehab patient. She was 17 year old, but, because she was mentally challenged, had the functioning capacity of a much younger person. A few weeks prior to her admission, she and her family had been involved in a MVA with a semi-truck. The pictures of their car (an older model car--the kind made when they still had metal in it!) I later had an opportunity to see, showed a barely recognizable accordion of crumpled metal. How they survived the accident only affirmed my belief in a Higher Power and guardian angels. While her parents survived with only minor lacerations and bruising, Diana suffered the brunt of injuries. She had an open book pelvic fracture with additional dislocation injuries of the pelvic girdle and bilateral femurs. In addition to these, all her lower abdominal organs had been pushed out over her pubis bone, her liver was bruised, and her pancreas was lacerated; all of which caused sever internal hemorrhaging. In addition, she had a fractured right ankle and multiple abrasions and bruising over her entire body. The paramedics who pulled her from the car had little hope of her surviving but said nothing at the time. She spent nearly 2 months of touch-and-go in the ICU of a larger hospital and had multiple surgeries. Needless to say, by the time she arrived at our facility, although grateful for having survived, she was deeply depressed at the prospect of the long months of therapy that lay ahead and the prospect of never walking again.
The first day I entered her room, I saw a battered, bruised, sweet young, lady who was obviously in a tremendous amount of pain despite her PCA pump. Moreover, Diana was also slightly mentally challenged. To add insult to injury (pardon the pun), she had an external fixator attached to her pelvis and her lower extremities in traction. I determined to make her stay with us as pleasant as possible despite the long journey ahead.
That journey began on a rocky road. The second day of Diana's hospitalization, she received news that her beloved grandmother had passed away. This news hit me rather personally as I had recently loss my own dear grandmother. I let Diana express her grief as often as she needed. Since our personal experiences often come into play as a nurse, I shared with Diana and her family ways I had learned to cope with loss. In doing so, I frequently found myself sharing the little humorous anecdotes handed down from Granny. I often had Diana laughing. Her parents were more than overjoyed at the sound of their daughter's laughter.
Diana was a time intensive patient but I never regretted the extra time I had to spend with her. The insertion areas for the fixator had been sutured closed but, due to the frequent turning and repositioning and the little extra weight she carried in the abdomen, the sutures had pulled through the skin, leaving two gaping holes in which you could see all the way to the bone. These areas had to be cleaned and packed each shift. In addition, the fixator had rubbed raw places on her abdomen making padding part of the frame necessary. The dressing changes were the times Diana most feared. They reminded her of her injuries and just how far she had to go, not to mention painful. I always made every attempt to keep the pain to a minimum. While on the PCA, I gave her Lortabs prior to the dressing change; after the PCA, Toradol was made available. However, no analgesia can take away the dread. It was during this time that I most shined and forever earned the respect and admiration of not only Diana, but her parents as well. I told jokes and funny stories to keep her distracted. When help was available, I and another nurse sang all the funny little songs we could think of, including "Rubber Duckie" from Sesame Street. We became know as "the singing nurses." (If you've seen the movie Patch Adams, you will understand this scenario.) On a few rare occasions, the entire nursing staff joined in the songs. We eventually had other patients commenting how they were impressed with all our dedication to nursing. Because of the extra touches we put on her dressing changes, Diana actually began to look forward to these times. Each night before I left for home, she would always call me back into her room to tell me how much she appreciated all the extra effort I put in to helping her.
Slowly but surely, Diana improved. The traction was the first to go. Then physical therapy began passive range of motion exercises. The bruises and abrasions slowly disappeared. The foot drop Diana developed was a minor setback, but with daily therapy soon disappeared. In an effort to help keep her positively motivated, I frequently pointed out just how far she had come. I reminded her often that "the journey of a thousand miles begins with the first step" and "one day at a time." When these clichés failed to help, I let her vent her frustrations and we explored outlets. Most of all, Diana missed the connections with home, primarily her pet cat, Whitley. Another nurse brought in a stuffed, animated cat. While it helped a little, it was no Whitley. As it turned out, the rehab program had a pet policy and Whitley soon joined our staff. We brought in tuna fish and kitty treats for him to help him feel at home during his visits. It was during these times, Diana really shined.
In time, Diana left us for a day to have her fixator removed and to have a check up by her orthopedic specialist. He was well pleased with her success and how happy she seemed to be. We received a brief note to keep up the good work. He also added that he had never seen a patient before that was so animated about the wonderful nurses who provided care, especially singing ones. When Diana returned with her fixator in hand rather than in hip, we had a little celebration for her. Now the healing and therapy could begin in earnest.
The gapping holes soon closed completely on one side and had a pencil thickness opening on the left. Diana could now sit up in bed. With the help of therapy, she was soon in a special wheel chair. The little trips around the hallways made her spirits soar. It was then that we all really could see the proverbial light at the end of the tunnel.
The day comes when all long term patients must go home. This day cay came sooner than we had all expected or planned when her insurance company informed the billing department that it would no longer pay for services. So we had to quickly put everything together and do impromptu lessons for dressings each time the opportunity presented itself. When she left, her parents were a little apprehensive about the care involved. We assured them that with the help of home health and PT, they would get by just fine. It's times like these you truly appreciate the other team players in the hospital.
We said our good-byes and sent Diana home with the help our local ambulance service. At best, we truly believed that she would be lucky to be in a regular upright wheelchair, for while she was with us, we discovered she had some type of deficiency which caused her bones to be brittle. I did my best to not let professional opinion dash her hopes of walking again. I suppose I succeeded somewhere along the way, for now I had a friend.
A few days before Thanksgiving, Diana came by to visit and show us her surprise. Her parents parked the wheelchair at one end of the hall and brought out the walker. I had to resist the urge to assist her to standing. She not only stood up alone but walked the entire length of our hallway with just the aide of a walker. I could only stare in humbled surprise and admiration at her determination. She walked up to me and reached out to me. She and I embraced for a hug and we both had alligator tears streaming down our faces. The surprises weren't over. While the two of us stood there hugging each other, the nurses at the station began to applaud. And they were crying, too. When we finally pulled apart, she said something that will stay with me forever--"I owe it all to you. You gave me the strength to go on each day. Each time the pain from physical therapy became unbearable, I thought of you singing 'Rubber Duckie' and it made me smile and put up with it. Thank you for having been my nurse; you made a difference to me." She and her family soon left and I attempted to go back to work; I wound up taking a small break to compose myself. That warm and fuzzy feeling melted all the heartache I have ever had. What she had said had left me speechless.
I thought of Diana for days after her visit and felt blessed at having had some small part in her recovery. She had gone farther than any of us had hoped. However, she had one more surprise for us.
Just a few days before Christmas, Diana and her parents came back for another visit. I was greeted with my supervisor telling me that I had a visitor who had been waiting to see me as I came to work. I had no idea of what was about to take place. I saw a small group of people standing at one end of the hall and did not recognize them at first until she turned around. There stood Diana and her parents. She had no walker, no wheelchair. The girl who wasn't supposed to ever walk again was walking to me. I was again standing there with my mouth open and the tears falling. Diana walked right up to me and gave me another big hug. We stood there for a few moments crying and thanking God for the miracle we had just witnessed. I hugged her parents and tried to dry my eyes. Diana took an envelope from her tote bag, telling me, "I just wanted to come by and show you I was walking now and to give you this special Christmas card. I wanted to let you know just how special you are to me. I couldn't have done it without you. You gave me hope to go on when I had none. On my darkest days, your smile brought me sunshine and your jokes made me laugh in spite of everything. It is you who helped me walk again." I tried desperately to reassure her that I merely brought out her own inner strength and couldn't take the credit for her healing. It was she who suffered the agony of all those long painful days, not me. And I had to give credit to God who helped her survive. While she admitted that God was influential, she made it clear that the strength came from me. "You're a special nurse with a special gift." I tried convincing her that I was merely doing my job. To which she replied, "It's more than a job to you. You put your heart into it. Besides, how many nurses do you know sing 'Rubber Duckie'?" Good point! I could only thank her for her kind words and told her she had left a lasting impression on me, too. Then I smiled and marveled at her as she walked away. It was then I realized that I was doing exactly what God had intended me to do and all doubts about my sanity for having chosen nursing vanished. I finally understood that nurses not only heal broken bodies, but also help heal broken hearts. Yes, I am a nurse and proud of it! Thanks to you, Diana, I now have the courage to look ahead and walk with pride as I go about my duties. Seems the "healing" goes both ways.
* Name of patient changed to protect identity.
It interests me when people say, "I have children and a husband..." As if the life of a single, childless nurse is of lesser value.
Official Latin term for some such individuals..... 'dingus batticus'......
He was a Vietnam veteran, a 61-year-old black man with a dialysis port in his chest and bilateral leg amputations who lay in his narrow nursing-home bed, watching an NBA game on the 42-inch flat-screen TV perched precariously on the wall shelf above his dresser. But his nearly-sightless eyes were twinkling and his smile was sincere as my co-worker introduced me to him as the new charge nurse on the ICF unit where he'd lived for the past five years.
"Hi, babe," he said in a soft voice as we shook hands. "How're you doing?"
That would be Harry's greeting at the start of every evening shift I worked for the next nineteen months. I usually met him at the door as he was being wheeled back to his room from dialysis, but on the days he wasn't scheduled, he'd say it when I was doing his 1700 fingerstick. Otherwise, he didn't talk much, and he rarely complained, no matter how much it hurt when I had to disimpact him due to the massive quantities of pain meds needed to combat his phantom limb pain and the neuropathy caused by his diabetes. Unfortunately for Harry, he also had a bullet lodged so close to his spinal cord that it couldn't be removed without the risk of paralysis, so his back hurt constantly from its impingement on the nerves.
Thrice-weekly trips to the dialysis center, and the frequent visits from his wife and his ten children, were his only link to any semblance of normal life. Otherwise, he left his bed only to be Hoyer-lifted into the bath chair twice a week for his shower; day after day, month after month, year after year, he had patiently lived his life in that bed, staring up at the ceiling or at the TV. While his mind was intact, he was utterly unable to read, use his laptop computer, get around the building, or even go outside to feel the sunshine on his face and the wind in his grizzled hair.
That would be my idea of life in Hell. For Harry, however, it was just everyday existence, and somehow, he managed to make it enough.
Over time, he began to open up to me. I doubt he'd ever been naturally outgoing, but there were those nights when he'd tell me stories about his years in the Army and the time he spent in Vietnam. Even though I was a decade younger than Harry, he seemed to appreciate the fact that I was a fellow Baby Boomer and thus we remembered many of the same events, albeit from different perspectives. His wife, Mary, was my age, and we became friends as well. There were some nights when I'd come in to do his 2100 fingerstick, and all three of us would reminisce about the "good old days". This invariably annoyed his roommate, who was 20 years older than Harry but had ears like a lynx: "Dumb kids," he'd mutter, which prompted the normally mild-mannered Harry to wave a single-digit salute in Roomie's general direction and his wife and I to snicker madly behind the privacy curtain that divided the room.
There were bad times, too; times when he'd bottom out at dialysis and come home with both his blood sugar and his BP in the toilet, and his clothing soaked with sweat. Again, he rarely voiced a complaint, even though he must've felt like he'd been run over by a truck. There were also times when he'd have to go to the hospital for a few days because his shunt failed, or because we couldn't get his BP off the floor, or because his stools had become so hard and dry that we couldn't have pried them out with a crowbar. We never knew when we sent him out if he'd come back.......how long can someone's heart hold out under this kind of stress?
But he did come back, and not long before I left this facility, Harry was picked as Resident of the Month. This was an honor that included the chosen resident's biography and photos put up on the bulletin board for an entire month, plus his or her story told in the facility newsletter. Well, when that board was full, we learned that Harry had once been quite the fashion plate---one memorable black-and-white picture showed a smiling gentleman in a sharp pinstriped suit and fedora! Others depicted him in happier days with his family and pets, and there was one especially striking portrait of Harry in his dress uniform, taken just before he shipped out to 'Nam.
He got to see the board only once, and that was because I made sure one day to wheel him back to his room from the facility van after dialysis instead of having the aides fetch him. They didn't have the time to stop in the hall and let him check it out; but the look on his face as he took in the brightly-decorated display festooned with red, white, and blue streamers made me instantly glad I'd taken the few minutes to show it to him. "Well, I'll be damned," he whispered in his usual soft voice, grinning widely. "I was a pretty good-lookin' SOB, wasn't I?"
I haven't seen Harry for quite a while, but I've never stopped thinking of him and his incredible dignity in the face of what many would consider a life not worth living. I didn't know when I went in to have my knee surgery last summer that I'd already worked my last shift at the nursing home; soon afterward, my hours were cut back so severely due to low census that I had no choice but to seek greener pastures elsewhere.
Unfortunately, I had no idea that I'd also heard my last "Hi, babe". Two nights ago, I was at home on the computer, scanning my Facebook updates, when I read a post from a former co-worker that made me forget all about checking out my forums here at AN: "We miss you and love you, rest in peace room 310A".
For a moment, I flipped through the Rolodex file in my brain, frantically searching my memory for residents' names and their assigned rooms in a facility where I hadn't worked in over a year. 310A.........310A.........who'd been in that bed when I was there? I wondered.
And then I remembered, and my heart dropped into the pit of my stomach. Oh, no.......not Harry, oh dear God, not the Sergeant! He was only a little older than my husband, and while he certainly wasn't in good shape, nobody had expected this. It didn't take long to find out from other friends that he'd crumped after dialysis again, only this time he never regained his blood pressure, passing on to the next world before anyone could restart his overworked heart.
Of course, I'm glad that our weary warrior has laid down his arms and gone on to a place where there is no more dialysis, no more fingersticks, no more pain. But at the same time, there is an ache in my heart where a person used to live, and as I deal with yet another loss---and in my chosen field of nursing, there's a lot of that---I can hear the sad strains of "Taps" playing softly in the background:
Day is done,
Gone the sun
from the lakes, from the hills, from the sky,
All is well,
God is nigh
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