Seriously Ill Patient vs A New RN Who Clearly Did Not Know How To Work in That Area

[FranEMTnurse]

This happened to me about a year ago. I have several serious life threatening conditions that affect my heart and my lungs.

This particular time I was hospitalized is serious condition after waking up around 04:30 AM gurgurling on my own blood, and was desperately gasping for breath.

The Medics gave me 15 litres of oxygen via non-rebreather mask, and rushed me to the ER. My heart was tachy, and it felt like it was going to jump out of my chest.

As the X-ray tech came to take X-rays, I vomited about 2 1/2 quarts of blood. After I was stabilized, I was placed in a room on 6 litres of oxygen.

This happened about a week before Memorial Day weekend, and it was very hot and humid at the time, but was too early for the hospital to turn on the AC.

I was alright laying flat, and on the 6 litres of oxygen, but when my Pulmonologist entered my room a few days later, he turned down the oxygen to 2 litres, and placed me in the high fowlers position. Everything turned black, and I felt like I was going to pass out, and my heart began to race again. When my Physician and my Pulmonologist saw what happened, I was immediately placed in the TCU, with a monitor placed on me.

Then when Memorial Day arrived, my kidneys began to fail. How do I know? Because what small amount of urine I was putting out was black.

I was so uncomfortable, I eventually asked my nurse, (a GN who clearly did know which end she was supposed to think with,) to please place a cold washcloth on my feet to cool me down. She placed a sopping wet one on my feet, and it made me even more uncomfortable.

A short while later, an 8yo was wheeled in after being ejected from a van in serious condition following a head-on crash with a motorcycle. He died a short while later. How do I know? Because the charge nurse, who had a very loud voice, said; "He's gone."

Needless to say, I did not need to hear that, nor did I want my door wide open without my curtain drawn, and the hall light blaring in my eyes.

I rang my callbell, and asked her if she would turn off the hall light. She said she couldn't do that. So I asked her to pull the curtain so the light wouldn't blare in my eyes.

Her response; "I can't do that, because I need to watch you." My immediate thought was; " Wonder where you went to school, and how much homework did you do, or are you brand new, and not yet trained?

That was the worst experience I had in that hospital. When I mentioned about the boy dying, she asked me if I saw it on TV, or read it in the paper, I told her neither, but I just had a clear show-and-tell experience about it.

After I got discharged, I asked my doctor to please put me on hospice. I did not want to ever even see the inside of that hospital again.

Well, a few months later, I was back in there, but in a much more comfortable room. In fact it was private. But when they came to transfer me into the accute care area, I asked them if they hire brand new graduates and place them in the TCU for training. I said they did not belong in there until they learn something first, because they are placing peoples' lives in jeopardy.

After they got me into the Accute care area, the one nurse whispered in the reveiving nurse's ear about treating me with TLC, because I was onto them.

Is this standard practice in other hospitals, or is this dumbbell experience I had just an isolated incident?

[FranEMTnurse, CNA, LPN, EMT-I]

fran, i remember that hospitalization well.

and yes, her pcp was a pt's worst nightmare.

fran has very late stage copd as well as a remarkable cardiac hx.

i had been talking with her and over the phone, could hear her decompensating.

she shared her concerns about her pcp being dismissive.

i ended up calling this physician and ultimately he ended up seeing it my way.

but dang, it was like pulling teeth to elicit an iota of concern from him.

and so, finally with fran being transferred to a hospital, had already evoked a tremendous amt of anxiety.

afterall, if her own doctor didn't believe her, then fear of delayed tx could be a genuine concern.

fran ended up being tranferred to the tcu when labs/tests came back, showing how sick she was.

one needs to understand the perception of a very sick and vulnerable pt. who is not being taken seriously.

to lay a late stage copd'er in a flat position, is virtually cutting off their air supply.

diaphoresis should not be treated with a sopping cloth....

i'm not saying there were significant blunders in the hospital.

but they were such that propelled an urgent state to a panicked and urgent one.

at one point during this hospitalization, fran truly thought she was dying. (hyperventilating r/t panic)

they ran some tests, took vs and told her she was fine.

now, aren't we all supposed to know that copd'ers are prone to anxiety attacks?

i ended up talking to fran's nurse and telling her she needed a damned ativan.

fran told me later, how much that had helped.

can i say "duh?"

so being a part of fran's experience, i empathize greatly with her distrust and frustration.

there is nothing worse than medical staff downplaying one's concerns.

or worse, not knowing how to effectively intervene.

it just goes to show you that a pt's emotional state can seriously impede a timely and full recovery.

it sounds like fran is trying to take charge of herself and her life at this time.

no easy feat for one that lives alone with minimal support.

i think this is fran's way of asserting herself, her needs and her will to be heard.

good for you, fran.

keep it going. :balloons:

leslie

Thank you Leslie. I truly appreciate that. And yes, Leslie is right; it took her phone call to shake them up a bit and to focus in the right direction. After the dosage of ativan, I slept quietly all night long.

By the way, that doctor, who got renamed by me, but I will not even mention the name here, was insulted because Leslie stuck up for me. I even have documented proof in my medical records about some of his nasty remarks.

[CyndieRN2007]

Fran,

If we can't vent to each other, then who do we have?

Here, here! I agree totally. Only us nurses know what we all go through. Sometimes we just need someone to support us in our times of need and frustration. Sorry this happened to you Fran. Hope you are feeling better. I havent read any of your jokes, but I'm looking foward to it! Im always up for a great laugh!

[rn/writer, RN]

I have two chronically ill grandsons and our family has seen this kind of situation many times.

For most people, a hospitalization is a straightforward event that affects them momentarily and then is over. They present with a specific set of needs that conform to medical and nursing pathways, and, while there might be brief deviations, they never stray too far from the expected route to resuming their health.

People with serious long-term issues have a much different perspective. For one thing, they "color outside the lines," meaning that they don't keep to the pathway expectations because their bodies have learned adaptive and maladaptive responses to chronic demands. COPD'ers are a prime example. They become accustomed to O2 sats that would indicate imminent death in the general population. But those low numbers are normal for them. Most docs and nurses "get it" where COPD is concerned, but there are many, many similar situations that don't generate the same kind of understanding.

When you have medical personnel who look only at the textbook values and reject what is staring them in the face, they become the enemy. People who don't listen, who don't connect, who don't try to get creative when flexibility is needed are downright scary to those who KNOW their grasp on life is tenuous.

Unfortunately, this guarded demeanor often comes across as "difficult," and the patients find themselves branded as troublemakers. I have seen this with my daughter as she tries to protect her sons. She has saved their lives more than once by insisting that a certain test be done or that a doc be called in the middle of the night. She has taken residents to task for slavishly following a protocol while ignoring obvious signs of distress. She has had to demand that cares be grouped so that her child can get some sleep instead of being awakened willy-nilly throughout the night.

At least she has the wherewithal to go to bat on their behalf. If SHE were the one who was ill, she would be at the mercy of others who might not have a clue.

This isn't only about skill and knowledge. It's also about common sense and sensitivity. It's about being able to blend many little pieces into a big picture.

Chronically ill patients are sometimes scared to death that little misses here and there could cost them their lives. Even if a mistake doesn't cause any serious harm, it's a reminder of that frightening vulnerability.

The new trend toward using hospitalists can be helpful. Where specialists tend to look at their fragment of care, a hospitalist is able to see the whole patient. It doesn't always work out that way, but I've seen it happen enough times to know that it's possible.

Chronically ill patients who have periodic crises need to know that someone is in their corner, that someone will listen to them even when they sound irrational, self-centered, and crazy. When you have to live at a level of hyper-vigilance, you can't help but be wired a little too tight. Being able to trust just one person to hear you out and connect with your concerns can make a huge difference.

Fran, I'm so sorry that you have been through so much. You have my admiration for all you have accomplished and for the fact that you still reach out to others despite the bad things you have encountered.

I'll keep you in my prayers.

[FranEMTnurse, CNA, LPN, EMT-I]

I have two chronically ill grandsons and our family has seen this kind of situation many times.

For most people, a hospitalization is a straightforward event that affects them momentarily and then is over. They present with a specific set of needs that conform to medical and nursing pathways, and, while there might be brief deviations, they never stray too far from the expected route to resuming their health.

People with serious long-term issues have a much different perspective. For one thing, they "color outside the lines," meaning that they don't keep to the pathway expectations because their bodies have learned adaptive and maladaptive responses to chronic demands. COPD'ers are a prime example. They become accustomed to O2 sats that would indicate imminent death in the general population. But those low numbers are normal for them. Most docs and nurses "get it" where COPD is concerned, but there are many, many similar situations that don't generate the same kind of understanding.

When you have medical personnel who look only at the textbook values and reject what is staring them in the face, they become the enemy. People who don't listen, who don't connect, who don't try to get creative when flexibility is needed are downright scary to those who KNOW their grasp on life is tenuous.

Unfortunately, this guarded demeanor often comes across as "difficult," and the patients find themselves branded as troublemakers. I have seen this with my daughter as she tries to protect her sons. She has saved their lives more than once by insisting that a certain test be done or that a doc be called in the middle of the night. She has taken residents to task for slavishly following a protocol while ignoring obvious signs of distress. She has had to demand that cares be grouped so that her child can get some sleep instead of being awakened willy-nilly throughout the night.

At least she has the wherewithal to go to bat on their behalf. If SHE were the one who was ill, she would be at the mercy of others who might not have a clue.

This isn't only about skill and knowledge. It's also about common sense and sensitivity. It's about being able to blend many little pieces into a big picture.

Chronically ill patients are sometimes scared to death that little misses here and there could cost them their lives. Even if a mistake doesn't cause any serious harm, it's a reminder of that frightening vulnerability.

The new trend toward using hospitalists can be helpful. Where specialists tend to look at their fragment of care, a hospitalist is able to see the whole patient. It doesn't always work out that way, but I've seen it happen enough times to know that it's possible.

Chronically ill patients who have periodic crises need to know that someone is in their corner, that someone will listen to them even when they sound irrational, self-centered, and crazy. When you have to live at a level of hyper-vigilance, you can't help but be wired a little too tight. Being able to trust just one person to hear you out and connect with your concerns can make a huge difference.

Fran, I'm so sorry that you have been through so much. You have my admiration for all you have accomplished and for the fact that you still reach out to others despite the bad things you have encountered.

I'll keep you in my prayers.

Thank you Writer. You have a lot of insight. I'll never forget Leslie for going to bat for me that night. When I was in the ER, I emitted 2 1/2 litres of partially digested blood that covered the X-Ray machine, my bed, myself, and all who were in my line of fire. Thankfully, I have no memory of it. I just remember feeling like my heart felt like it was going to jump out of my chest, and its tachy feeling, and struggling to breathe on 15 litres of oxygen via full face mask. I was later diagnosed with Pulmonary hypertension along with my chronic asthmatic bronchitis. Thankfully, (even though it has taken me over a year to recover, I'm now able to walk and am strong enough to go out occasionally. I love life, and I'm living it to the fullest of my ability now.

[blueheaven]

I'm curious why you are saying anything about the fact that your pulmonologist turned down your O2 and it sounds like you were having symptoms of hypoxia?? Tachycardia is one of them, and so is feeling like you are going to pass out. Just wondering.

[bethin]

Fran, I'm sorry you had to have this experience.

Crohn's may not be as serious as COPD but I understand what you're saying. I don't fit 'normal' guidelines when it comes to medicine. I'm in pain all the time and doctors don't seem to get that. I have anxiety attacks because the pain gets so bad and I don't know what to do to make it stop. I had one the last time I was in the hospital and the nurse looked like she wanted to applaud me for my performance.

I go to the hospital for a test and I wonder if I'm going to come out days later. When I go for a US or any other outpatient test I pack a bag in case I have to stay. I know my history well and I know what works for me and what doesn't. When I tell a nurse or doctor this I get 'that' look - you know the one where they think you're full of it and they're already labeling you as difficult.

I envy the people that can be admitted to the hospital and everything goes well for them. They have their appendix out, stay 2 days and go home never to be seen again. Me, I wake up everyday wondering if today is the day that I'm admitted. I keep a bag constantly packed with everything I'd ever need for a hospital stay. My life is full of dr's appointments, shots every 2 weeks, medicines, lab draws, etc. I shouldn't have to worry about this stuff at 27.

I hope you don't have to go through this again.

[FranEMTnurse, CNA, LPN, EMT-I]

bethin, this message is for you.

thank you sweetie, and know that chrons may not be as life threatening as copd, but it doesn't mean it isn't as serious. i understand your pain too, and i feel for you.

in fact, when i had a pe in 2001, that bad physician left me in acute care instead of placing me in the more intensive care area where i needed closer monitoring. that was when i believe the ph began, because the pain never really left. that was when i was placed on dilaudid for my pain. in fact, a bottle of roxinal is kept here for when i get it. i havn't had one in quite a while, and i pray i never will get one again.

i was also suffering from steroid induced myopathy at the time that was affecting my breathing, but he didn't believe me, since the monitor read i was getting enough oxygen. i nearly died right in front of my family one day. i even had the cheynes-stokes respirations.

i had pneumonia x 4 the following year, with resp failure in the er x 2 where i was intubated and placed in the ccu. the second time the pneumonia, i wsd septic too. i have very little to no memory about my ccu experiences. that's when the copd was diagnosed.

the physician who admitted me placed me on demerol. i didn't know at the time that i was getting the opposite effect from what it was meant for. it was increasing my pain instead. that's what fibro myalgia is all about.

anyway, the combination of dilaudid, accompanied by atarax and benedryl, fentanyl duragesic, and mobic is what i had been living on the past 2 years.

i pray that you find the right combination of pain meds to relieve your pain and your anxiety.

mine didn't completely leave until i prayed fervently one night, not long ago, believing god was going to provide the immediate answer i needed. it was when i wasn't yet able to walk. the dpw ordered me to be moved downstairs into what i call the death room. it's a room half the size of my own, and is the room where numerous people have already died.

i got out of bed the next morning, and began to walk. i went off my dilaudid a few days ago, and i removed my fentanyl duragesic today. so far so good; no pain. i'm now only taking the mobic for my oa, and my pulmo and heart meds.

yes, sometimes we have to do things afraid, but sometimes we aren't able to too.

may god be with you all the way honey. i know he loves you.

[FranEMTnurse, CNA, LPN, EMT-I]

I'm curious why you are saying anything about the fact that your pulmonologist turned down your O2 and it sounds like you were having symptoms of hypoxia?? Tachycardia is one of them, and so is feeling like you are going to pass out. Just wondering.

I was, but it was his way of diagnosing the PH. I was living on 4 litres of oxygen at the time since it was difficult for me to breathe on 2 litres.

[CHATSDALE]

BLESS YOU, FRAN

sometimes it feels like you have the worst experiences when you can lest handle them...problems seems to come in clustrs like grapes

sometimes nurses are just difficult...at a facility i worked at a patient died about 9 pm, we didn't have any morgue facilities because usually a funeral home could be summoned right away, and we didn't have any empty beds but we did have a meeting room and a caferteria and a long hallway that no one would have entered

there was another unit downstairs that also had a a room which could have been used in an emergency

anyway the nurse that was on duty refused to move the deceased woman out of the room and the woman in the other room was raising

all kinds of cane aabout being in a room with a dead person

the situation was left thesame until change of shift at 6am

takes al kinds to make a world

fran, we love you

[FranEMTnurse, CNA, LPN, EMT-I]

BLESS YOU, FRAN

sometimes it feels like you have the worst experiences when you can lest handle them...problems seems to come in clustrs like grapes

sometimes nurses are just difficult...at a facility i worked at a patient died about 9 pm, we didn't have any morgue facilities because usually a funeral home could be summoned right away, and we didn't have any empty beds but we did have a meeting room and a caferteria and a long hallway that no one would have entered

there was another unit downstairs that also had a a room which could have been used in an emergency

anyway the nurse that was on duty refused to move the deceased woman out of the room and the woman in the other room was raising

all kinds of cane aabout being in a room with a dead person

the situation was left thesame until change of shift at 6am

takes al kinds to make a world

fran, we love you

And I love you guys too hon. Berry berry much...:DAnd always remember, God only gives us what we can handle. If we don't think we can handle anymore, all we need to do is hollar Dad, HELP!! He'll then give you the tools you need to get through your mess.

[nursemike, ASN, RN]

I had a patient in stepdown, not too long ago, who came up from an ICU with an insulin drip. I had orders for a blood draw, and as I was preparing to draw it, he told me he was hypoglycemic. I believed him, so I figured I'd use a little blood from his specimen to check his BS. I was looking for a good vein when he repeated that he felt very hypoglycemic, but I was reluctant to stop his insulin until I knew what his glucose level was. Finally, after what was just a moment to me, but probably felt longer to him, it occured to me that a couple of minutes without insulin would, at worst, be no more harmful than a couple more minutes with too much, so I stopped the drip, drew the blood, and tested it for a glucose level of 30.

This was right at the start of my shift, and by morning we were on pretty good terms, but it was probably close to midnight before he decided I wasn't a total twit. And he was right--I wasn't a total twit--but I did learn an important lesson: LISTEN TO YOUR PATIENTS.

I once actually told a pt's family that if being comfortable was his highest priority, he would probably have been more comfortable at home, but that while he was in the hospital, doing what was needed to keep him alive and help him recover was our highest priority. Told my dad the same thing, when he was being a grumpy patient. But I did add, and understood, that patient comfort is a high priority, even if it isn't always the highest priority.

Fran, I only know you from these boards, but I care about you, and you seem like someone who would be a blast to work with. (My favorite people tend to be genuinely nice, but also a bit "colorful.") I'm sorry for your bad experience. I would suggest, as someone with just a little nursing experience but a good deal of life experience, that we read your post not as a nurse "eating her young" (which it isn't, anyway) but as a patient complaining about inadequate care. I'm not inclined, and I hope you aren't either, to rip that nurse a new one, but it does seem clear she could have done better, and next time maybe she will.

Meanwhile, I plan to try to profit from a bit of insight into what its like to be seriously ill.

[danissa, LPN, LVN]

Fran, you are so right on being given what you can handle! And, btw, you must have BIG shoulders and be one strong LADY, to endure what you have and still have that sense of humour!!!

Once, my nine yr old baby had ruptured appendix, even after the op, she was on Morphine for 5 days, and is left with adhesions to the bowel. One very wise paeds nurse told me, (in the dead of night when I needed her most btw!), that these things happen to nurses children..her reasoning...Dont know why, but Nurses kiddos always get the worst scenario.If adhesions are going to happen, it will be to a nurses child! She had SOO many years experience, She talked me right back down to earth, Sounds strange, but after that talk from her, I felt Strong, and able to cope. Guess this is a wee bit off topic, but sometimes, nurses are EXACTLY suited to what they do.