Oh my good grief what a week.

[Indy, LPN, LVN]

That's the nice way of putting it. I had 4 patients each night, for 3 nights running. Nice ratio. 3 of them I kept all 3 nights. Two of them were dying, one actively, one about a few weeks behind the other. One was our frequent flyer who's really huge for her height and usually works the nurse taking care of her so hard that she normally has a different nurse each night.

It's a really long story. Not gonna go into the entire thing here. But patient number one, dying of cancer and supposed to discharge to hospice when pain is under control, I found out today is still there. (had to go pick up schedule, and be nosy and peek at the board.) So pain control is just getting more difficult for him.

Patient number two was alive when I left him but only just barely; he died the next night and they tell me he went peacefully and not in pain. I'm so relieved that I helped make that happen by calling the doctor to get his orders changed, yet I feel bad that he had to suffer before we figured out that comfort care should be his ticket. I still think that I'm gonna have nightmares about the sound of his breathing, with all that gurgly awful noise that I did not think to suction until long after my shift was over. I'm glad that I managed to get his only relative to come and see him, before he went comatose so he had about 5 minutes of conscious happiness in my 3 days.

Patient number three is a frequent flyer who comes with her sister, and they are quite a pair. They usually get a different nurse each night because they work the nurse so hard. I took 'em back for 3 nights mostly 'cause I knew them and didn't want an admission. The known is better than the unknown, I figured. I figured out the first night that in order to get anything done I had to write down a laundry list of things they wanted when I would go in there, and try and bring as many as possible to cut down on simple "go fetching" and make 'em happy if possible. This worked so well that we were joking about the laundry list by night 3. What I also saw happen, was the patient herself take on a little bit more initiative to get up and move, and make me have to assist a lot less. My back is very grateful. In the end, I found her and her sister the least worrisome of my 3 patients and all it took was the normal way I do things plus a box of tic tacs for the smell. (yes, they bathed and it doesn't really help much.)

Anyhow, I know we get a LOT of experience in our first year but wow. I'm ready for flu season to be over, really.

For my dying patients I could not quite figure out what to say to them. Conscious or unconscious, I was at a loss for words. I asked my charge nurse and she had some good advice. She basically told me that I know when I've done everything I can for a person. If I don't feel that this is the case, then I should just find a way to open the conversation and see what happens. Don't miss out on the chance to talk with these people just because you're tongue tied. If they don't want to talk, they will tell you.

So eventually I did open up with patient number one, and he didn't have much to say but he did smile. I could not for the life of me, think of what to say to patient number two. I just held his hand whenever I could spare a minute. Patient number three of course noticed that I looked like the world was ending, and when I told her I was upset over a patient that would die soon, she and her sister spent all night of my third night trying to make me feel better. This was the most emotionally draining week yet.

There, vent over.