Sense of Dread....When Will It End?

AICU RN · Jan 8, 2012

She was no compressions and no defibrillation. We did both. She was a 76 yo with broken ribs and chest tubes. She was only intubated for airway protection d/t rib fx's and deteriorating MS at the scened. I was on a 12 hr dayshift and extubated her that AM. Got her down to a mist mask and then 4 L NC. She was doing fine and talking to me. Went in at 6:30 pm to do meds. She was talking and then just stopped. That's when we coded. While she was down she seized and lost a lot of what she had. Family was okay with the situation as a whole and made her comfort care. It was just messed up. I guess I wasn't thinking about her code status because she was alert and talking.

The way I've come to cope with it (at least in part) was that the doctor who ran the code was her CCM attending. So, yes, my preceptor and I should have remember sooner what she did/didn't want but her doc should have, too. It was the first time my patient coded and, yea, I took it hard but I know I will always pay attention to code statuses. I know it sounds silly, but I think sometimes we end up taking care of patients for a reason. She definitely taught me a lot.

AICU RN · Jan 8, 2012

Oh, and I didn't take your previous response as being grouchy at all. Just honest and that's what I need. A little dose of reality never hurt anyone.

fiveofpeep · Jan 9, 2012

Well if the MD is in the room, you are covered.

AICU RN · Jan 9, 2012

Ah, I get that. Just a tough situation to be in at anytime, especially as a neurotic newbie. There were things that made it tougher that I can't get into here for fear of breaching my patient's confidentiality. Suffice it to say, it was a terrible night.

Babs0512 · Jan 9, 2012

Oh, and I didn't take your previous response as being grouchy at all. Just honest and that's what I need. A little dose of reality never hurt anyone.

That's a great attitude. All nurses need to be able to take constructive criticism. Sometimes it is given quietly - one on one-, and other times, due to circumstances - like a code or other emergency, it is given in front of others - in either case - it doesn't mean your a "bad" nurse, just that it was something you needed to change, or do differently the next time. Never internalize constructive criticism, take it like a professional, learn from it, and move on. We've all been there. And we are better nurses for it.

You have a bright future, give yourself permission to learn, and remember that this learning never stops - there will always be new lessons. These may come from a doctor, RT, PT, nurses aid, and yes - even housekeeping. Keep your mind open, and you will be a great nurse.

Blessings

AICU RN · Jan 9, 2012

Thanks. I always try to learn. I think that a preceptor/coworker who saw me make a mistake and didn't tell me about but only told my nurse educator would bother me way more than someone one who told me about my mistake up front. I'm new. I'm in my unit to learn and if people don't tell me what I'm doing wrong or even if there's simply a better way of doing what i'm doing then how am I supposed to know?Thanks for the compliment, too.

Babs0512 · Jan 10, 2012

One of my best lessons, other than those that came from my making a mistake, came from a housekeeping person. I had this patient, Ca with mets pretty much everywhere. He was a quiet man, kind of stoic - whenever you asked him if he was in pain, he would often respond with "no, I'll tell ya when I'm hurting". That should have been my first clue - but he was alert and oriented, so I figured he would tell me, like he said. I was covering another nurse who was out on vacation - so I was fortunate to have him for several days.

A couple of days later, this housekeeper came to me and said "It's probably not my place, but I think Mr. Jones is in pain." I said "I asked him if he was having pain about 10 minutes ago, he said "no". So she said "but there are many kinds of pain, I talk to him while I clean his room, and he said "I hurt everywhere, especially my heart because I'm not ready to die." The housekeeper said she sat with him and just let him talk - a luxury we nurses don't usually have with all that we have to do, and large assignments. I told her that I appreciate her telling me, and that I would follow up with Mr. Jones. I reminded the housekeeper, that she did the right thing, and it is ALL our place to let others know about a patient. She left smiling.

I was bound and determined to find a way to spend a block of time with him, I looked at my meds still due, and the several complicated dressing changes I had to do (med surg at the time), the blood I had to hang, etc... and realized the only way to eek out time was during lunch. So I thought "Screw the rules", and when my lunch came, I brought it in to Mr. Jones room while he was eating and said "I heard we had a lunch date?" He looked at me strangely, but smirked. After a few minutes of silence, I said "Mr. Jones, I know you are in pain, please talk to me so I can help you." A few minutes later, he just started talking. Suffice it to say, he had a lot to say. I learned that to him, "pain" was something women had - for him "pain" was a "hurt" (terminology, got to find out the patients terminology for things) He hurt physically, mentally and spiritually - yes, often we treat pain as only physical, but like the house keeper told me "there are many kinds of pain". So, together Mr. Jones and I came up with a plan. When he was in physical pain, he would say "I hurt in my abdomen...a lot, a little, or in the middle" I asked the chaplain to come and see him, and I discussed with him possible medication for depression - and talking with a "counselor" - to which he was in agreement with. I also suggested he talk with his family about all that he is feeling and thinking about - he said "I don't want to burden them." So my response was "Ah, Mr. Jones, the burden is often that they want to help in some way, but don't know how - by telling them - your easing their burden." (line of poop, maybe, but it sounded good at the time.)

I made sure all of this was passed in report, I called the physician, he ordered a psyc consult, and the chaplain was more than happy to come up on a scheduled daily basis to sit with Mr. Jones and talk to him.

After that, It was easier to ease his physical pain since we now knew his terminology and ratings scale, the chaplains visits he looked forward to, and the psyc eval found he didn't warrant anti-depressives, but did set up a psychologist to visit with him a couple of times a week to assist him with his transition and eventual acceptance with dying. By the time I left a couple of weeks later, we were managing his physical pain, and his spiritual and emotional pain were also being met. He was actually "happy" and more outgoing.

So, you never know who you can learn from. The house keeper didn't tell me anything I already didn't know - she just reminded me to pay attention to those things in all patients - and I am forever appreciative to her for that reminder.

Blessings to you AICU

fiveofpeep · Jan 11, 2012

Babs,

What a beautiful post! Thank you for sharing!

AICU RN · Jan 11, 2012

Babs,

That was an awesome story. Thanks for sharing.

billyboblewis · Jan 11, 2012

I dont believe it ever really ends because there is always someone who thinks they know everything and instead of trying to fix things by talking to you first files all kinds of incident reports and complains to management getting everything blown way out of proportion. Also the hospital is always looking for scapegoats to protect their accreditation when there are patient and regulatory complaints. I have seen this happen to many nurses and many of them had excellent reputations.

annlewis · Jan 11, 2012

I have same problem, it does not happen every nite like it used too, and it does not last as long but still on any given day something will happen to make me question myself over and over. Sometimes it is staff issues and I wonder if I could have handled a situation differently for a better outcome. I have been a nurse now for 2 1/2 years and I remind myself this is normal thoughts to have and that helps. I think when you truly care about what you do that this is part of it and you will eventually get used to it. Hang in there, it sounds like you are doing what you were meant to do.

GLORIAmunchkin72 · Jan 11, 2012

"oh, our charting is completely electronic and it's a really good system. we, too, have that our window and if something is overdue a little red overdue button will pop up on your mar. i

hate that button being there."

i wished we had such a button. when things get crazy it might come in handy!