estrogen

46 y.o. IV drug user infected with botulism. Spent cca. a month at our facility, on a vent, completely paralyzed including his face, with 0 muscle tone. I'll admit that it took me a couple of days to realize that he is not in a coma, but all in there, with a completely clear mind. Over the course of a couple weeks, he started getting a little better, started moving his right hand slightly and signal thumbs up, thumbs down as a means of communication and eventually with a lot of help he started writing on a note pad. I was excited, because unfortunately, we don't commonly see people getting better / overcomming their condition at out facility. I had high hopes and I honestly thaught, (it seems like most of the other nurses did too) that he will pull out of it. Over the last few nights, he complained to me about being constipated and asked me to do a digital to get the poop out several times. He complained about pain and the feeling of fullness in his rectal area and an upset stomach (no vomit, no residual). His stool was pretty soft and formed. He had spontaneous BM's regularly, he just wasn't getting all of it out, so I did not suspect and impaction. One time he wrote on his pad "I'm suffering". I asked him if it's due to his rectal discomfort and he signed yes... I did another digital, gave him his scheduled methadone and ativan that he asked for and when I asked him, he stated relief. The next day, I learned that he coded sometimes during the day, had a cardiac arrest, was resuscitated and sent to the hospital. The next day they called us that he died. Maybe I didn't recognize the severity of his suffering, because he didn't have the usual means to express it. Maybe if I would have kown and sent him to the hospital, he would still be alive? Or maybe I was mistaken and he never had a chance. He was a nice guy, just a year older than my husband. As far as I know, he was pretty much alone. He must have suffered a lot during the course of his disease. I wish I knew what's going to happen. I would have sat with him through the night, I would have held his hand, said more kind things.

...And that's exactly what I'm planning on doing. I have a quite consuming life outside of the facility. Thanks!!

...Not quite yet, but keep having your fingers crossed for me :wink2: Thanks!

I thought I owe you guys an update... I just spoke to our DNS yesterday to hear what's new. According to her, out of the seven nurses that were on night shift, two are moving to evenings and two are looking (or allready have) new jobs. Which leaves me and two other nurses, which is the amount we need. "It seems to be working out nicely", the DNS said...haha. Isn't that kind of telling of what the strategy was? Let's slam them with the news and then wait it out and see who bails and who prevails. But I guess that on the management level of a company it's the thing to do and one would get rewarded for a great move... Afterall it makes them look much nicer than if they had to fire people, right? ...Still can't help it though and as a common floor nurse, it leaves a bitter taste in my mouth either way. But that's the nature of the game, I guess... Afterall we have to be managed and as I allready said, better this way then by handing out pink slips... So, now that we're down to the "final three", the battle for the schedule begins. The DNS again handed the resposibility over to us nurses: "If you guys can't come up with something, It'll be simplest for me to implement a 4 on 2 off rotating schedule for everyone." Well, in my opinion, 4 on 2 off on NOC shift sucks. all the other nurses seem to agree with me, however everyone is incredibly passive, shrugs their shoulders and doesn't try to come up with anything. so I sat down and figured out a set (non-rotating) schedule, that accomodates the other two nurses wish to work full time and my wish to actually work less than full time with as little need for day care for my kids as possible. I presented it to the DNS and she said "Oh, yeah! That would work. Thanks for doing the work!" I presented it to my co-workers and they again shrug their shoulders and said something to the effect of "yeah, sure...whatever... as long as I get my 40 hours." So now, we have to have a meeting about it with the DNS to see if everyone officially agrees with my proposal so that the DNS can officially implement it. Again, she for now refuses to set a date for this meeting herself. "It's up to you guys, i'll come in any time of day and night." My colleagues, yet again are shrugging their shoulders.... I'm tired. I hate this. I honestly hate to be the one who pulls and pushes everyone else along, yet somehow I find myself in that position a lot. At work AND at home. (I'm sure there is some kind of a Freudian explanation for that.) I kind of feel like I've done my share, I'm not goint to be organizing a meeting now too. Somebody else can do that... Hey, I have a new name for this way of management: Let's call it The SURVIVOR method or The BIG BROTHER method! Can you tell I'm a big reality TV fan? :chuckle Man I'd make a great manager! Unfortunately I would probably hate every minute of it and with my other traits like sensitivity, tendency to take things personally, anxiety, fear of the unknown and strong need for structure and predictability I would probably also go crazy in a very short amount of time.

I'm sorry that you feel attacked. That was not my intention.

This might come as a surprise to you, Gompers, but I also do not discuss religion with anyone, especially not it the workplace. I don't approve of any employees (or anyone actually) imposing their religious views on anyone else, and eventhough I concider myself privately a spiritual person, I am not particularly religious. I perceive spirituality and religion as something very private and individual. I may go to church every once in a great while and I have great respect for all religions.(...and that's as far as I will go with describing my own spirituality.) However this gentleman happens to be very religious. Religion is if not the most important then definitely one of the most important themes in his life. As far as my ethical dilemma, I am not really questioning the appropriateness of the gift of a Bible. If he was all about fishing, I would be looking into buying him a book about fishing. If he was into horticulture... you know what I mean... Also, if he was, say Muslim, I would look into buying him a Koran. The same goes for the book vs. "book on tape" issue that someone brought up. If he likes to read, why would I decide, that it's more appropriate for him to listen to a tape? (Eventhough I'm not denying that he may enjoythat also?) What I am unsure about, and am trying to find an answer to, is the appropriateness of any gift to a patient such as mine in general. See, I'm asking myself, what if he starts to think of me as a friend? What if I become "important" to him? ....Then, one day, what if I go to another job an he never sees me again? Could I actually possibly hurt him with my gift? Sometimes, humanity requires courage. and I don't know if I posess such courage.

Thank you Miranda! I've been reading your posts for a while and I admire your intelligence end eloquence. What an inspiration!

Thanks for your input and your suggestions....but... A).... I never said I'm religious. B) As I stated earlier, the man really likes to READ. Why do you assume that a book on tape would be a better idea? And why inspirational stories? I'm just curious how you arrived at this particular conclusion...

Oooops! Is this one time likely to get me in trouble? :chair:

When I was in nrsing school I got to watch a foot amputation once. Aside of the fact that it was tragic, very gross... and very cool A fem-pop bypas was even cooler... How they opened the whole leg up around the bone, as if they were opening a book... Very cool! I love surgery!

Yup... Agree!

Thanks for the great insight. I appreciate that!

Once, I crushed a Dilaudid pill for a pt. Then I realized I took it out of the wrong bingo card, that belonged to another patient. It was on night shift, everyone was busy and there wasn't another nurse around to be a witness. After all the Dilaudid was already out of the card and crushed, so even if I called another nurse to witness the waste, she/he wouldn't have been able to say, what it is that I'm wasting. So I dumped the powder into the sharps myself and I wrote it into the narc log as Dilaudid - one taken and wasted and signed it by myself. Was that a mistake? Did I set myself up for trouble?

Thanks so much for the support, CrunchRN and everyone else! I did talk to the DNS briefly. ...As far as reassurance goes, she did tell me, that she'd "most likely" go by seniority, if we cannot come to a concensus amonghst ourselves nad she also said, "I really don't want to lose you, since you've shown some falexibility and dependablility"...whatever she ment by that, how seriously she ment it... I given the previous events, that you mentioned earlier, I have a certain degree of mistrust. After all, as had been said before, for the most part, we are probably just numbers to the management... In regards to the employment situation in this area. I don't think that I'd have a problem finding another job. The question is, how dependable would the next job turn out to be? It might turn out to be even worse... You can't really tell before you've worked there. And I really like this job. I like the facility, my patients, the people I work with and - a BIG plus - it is five minutes from my house. So it's not that I couldn't find another job, if I had to. It's that I don't want to...

No. If the NOC shift runs from 11 to 7, istead from 7 to 7, that eliminates the heavy 2000 med pass, that required the three nurses on the floor. The rest of the night in my opinion is manageable with two nurses. I see the management's point there.