Just Another Manic Monday

**VivaLasViejas**, ASN, RN

.....and all day I was wishing it were Sunday again.

You know it's going to be a tough week when you walk through the door at your workplace on a Monday morning and your senior medication aide comes barrelling out of a resident room, looking like the hounds of Hell are after her and yelling, "She's DEAD! Oh my God, she's dead!!"

The "she" in question was probably one of the healthiest 84-year-olds I've ever met; yes, Katherine had a touch of dementia, but otherwise was trimmer and fitter than most people half her age. She walked every day, went to exercise classes with her brother-in-law five days a week, ate right, never complained......so to say that no one saw this coming would be an understatement.

It was clear at first glance that she had died the way we all hope to: she simply went to sleep and didn't wake up again till she reached the Promised Land. Trouble was, it was also obvious that she had been gone for quite some time, it was an unattended and unanticipated death, and she had no advanced directive. So we had to go through all the formalities of calling EMS. the medical examiner, and the police to come out. What a cluster-mug THAT was.......paramedics and cops milling around in the hall, curious residents wheeling up and down to find out what was going on, staff trying to keep everybody out of the way ("There's nothing to see here, move on please"), family members wailing and carrying on, me going in and out of the room with various officials to confirm what every one of us knew, namely, that Katherine had transferred to the Eternal Care Facility and wasn't coming back.

It went downhill from there. While we were dealing with the deceased resident, another one who's been on hospice for two and a half years (that's right, ladies and gentlemen, I said "years") was circling the drain as well. According to staff, she had decided over the weekend that it was also HER time to make for the exit and stopped eating, drinking, and responding to stimuli. It wasn't the first time this had happened; she sometimes "played possum" and scared everyone into thinking she was dying for real, then perked up when she figured she'd gotten enough attention. She's three weeks away from turning 100 years old, and she's been telling everybody since she was 89 that she wanted to make it to the century mark. However, per staff reports, she'd been unresponsive Saturday night and all of Sunday, and she wasn't any better today either. So I went up to the room, met with family for a few minutes, and went into the bedroom to check on her.

I donned my stethoscope and listened to heart, lungs, and belly, none of which alarmed me; her skin was warm and dry, and there was no mottling or discoloration that might indicate impending death. As I walked around the bed to look at her from the other side, I noticed that her eyes were open........and following my every move. Then, when I bent down to say Hello, she opened her eyes wide, screeched, "WHADDAYA WANT?!" and began to clamor to get out of bed, go to the bathroom, get in her chair and find something to eat. That's why I swear that woman is not only going to reach 100, but she'll bury all of us!

By this time it was past noon, and having missed breakfast, I was ravenous. But I didn't even get a chance to wolf down half my lunch before the home health nurse who's been doing wound care for still another lady came looking for me. We've been dealing with this stasis ulcer for months now, and despite good care, vitamins, and nutrition, we're losing ground every week. So the home health nurse did a wound culture, and sure enough, it's lousy with both Pseudomonas and MRSA even after weeks of PO antibiotics. Unfortunately, this resident was also exhibiting delirium and had barricaded herself inside her apartment, refusing to let anyone in........which made us both suspicious that she might be getting septic. ARRRRGGGH! Phone calls made to the PCP, to the family, and back to the doctor again. I wound up sending her to the hospital and having her admitted for IV antibiotics, which is probably what should have been done in the first place.

I barely had time to catch my breath before the next problem presented itself: a resident who was normally independent in every way, but who just happened to have what she called a"little sore" that she'd never told us about until she was outed by a staff member who'd helped her re-tape "the patch on my bum", which I soon found out was a Duoderm dressing her doctor had given her. Unfortunately, he'd obviously NOT bothered to teach her how to apply them properly, let alone change them.......and when I saw the extent of her "little sore", I wanted to chew some major MD orifice, because hers was a mess! Red and raw between the cheeks, with three Stage II ulcers of varying sizes and shapes to add insult to injury---to say the least, I was furious.

More phone calls. By this time I was beginning to wonder if it was a full moon; I'd seen a rainbow on my way in to work, which for me is almost always a good omen. Not today, unless of course it was Katherine's way of letting us know she was OK. And then yet another crisis hit the fan: a resident who's been getting antibiotics for a UTI is more confused than ever and is hallucinating for good measure. Worse, she's spiked a temp of 102.4 and her BP is 84/50. Can we say urosepsis?

As we say in the LTC business: "When in doubt, ship 'em out". After I'd sent that resident to the urgent care center and talked to the family, I finally trudged back to my office, plopped into the low-rider desk chair, and contemplated the events of the day. It had indeed been terrible, horrible, and very bad; in fact, it was easily the worst day I've had since I've been at this facility. I wanted to go home. I wanted to wrap my face around the biggest, gooeyest doughnut I could find, then crawl into my La-Z-Boy and take a nice long nap with my dog.

But even as bad as this Monday was, I'm still able to recognize and be thankful for the fact that it was still better than my BEST day at some jobs I've held. It was a lot better than any of the ninety-two days I spent at one assisted-living facility, working for a passive-aggressive administrator.......or the nursing home where I labored like a pack animal at a job that was more of an endurance contest than anything else.........or the last 18 months at the hospital where the management made my life a living hell until the day I finally snapped, knowing I could not work one. more. shift. on that floor.

Small consolation for a day like today......but I think it's enough for me to go back and tackle Tuesday. :nurse:

Just Another Manic Monday

About VivaLasViejas, ASN, RN

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