2/27 What I learned this week: crying on the job feels so much better when they're happy t

[ixchel]

Story time! With mood music. [emoji5]️

[video=youtube_share;A3yCcXgbKrE]

I count myself blessed to have been raised largely in part by my grandparents. My grandfather, a newly-minted 80-year old, conservative, successful man, taught me there is pride in self-sufficiency, and honor in good qualities such as honesty and humility. You earned what you have, and you certainly never asked for help, as that would admit weakness, or even worse, failure.

Society has changed a lot in the U.S. as we've adopted new ideas of what weakness and honor should mean. I don't think the ideas of Grandpa's values are obsolete, though my own values have evolved as society has. In fact, as much as I'm able, I still stick to those things that I know he placed in this heart of mine. I also think having the experience of being raised by his generation (as opposed to my mom's, which in the strictest of technical terms, is actually my own, if we go by years born) has helped me communicate and advocate for the patients of his demographic (whom I quietly refer to in my mind as "Men of a Certain Age") a little better than I would otherwise.

We have a frequent flyer on my unit. He is also a Man of a Certain Age (let's call him MOCA, or Moca). I first met him shortly after I was licensed. By then, he'd already experienced an event that severely impaired his ability to communicate. He was extremely frustrated with this, as anyone would be, but he was making it work.

The next time we met, not a huge amount of time later, Moca had had an emergent, but not overly complicated surgical procedure that included getting a prosthetic. Recovery was short, life resumed.

Until, it didn't. Moca started getting sick. Just sick. That's it. Fevers. Really high fevers. Multiple admissions. Decline in overall condition. Nervous system responses to the high fevers. Tremors, altered mental status, failure to thrive, profound weakness. He was just so sick, over and over, but no answers pointing at what was causing it.

The toll this took on Moca emotionally was profound. He'd deteriorated to a point that communication was impossible, and he needed someone to feed him. On one of my last shifts with him, I saw we were sending Moca a clear liquid diet. Clear liquids for a man with debilitating tremors. I watched this man's pride and dignity leave him. He traded health for a bedpan, full meals for broth spilled down the front of him.

I fought hard for him to be advanced to finger foods. I saw Moca brighten up. It wasn't a massive brightening up, but it was successful. The Man of a Certain Age, who was robbed of all independence by his brain and body, could do this ONE THING for himself.

So, Moca sunk into a deep despair. He let go completely. He gave up. The sadness in his eyes, as he cried over something so simple as putting the broth in a cup with a lid instead, stayed in my mind and my heart. I'd never seen such sadness, such defeat.

On the last admission, Moca had imaging that might be the key to it all - some vegetation was spotted on his prosthetic. Finally! A year of this back and fourth, a year of his life, a year of the loss of things that give Men of a Certain Age their spark. Gone.

The last time I saw him, he was on an EMS stretcher to get the infection removed surgically. He said to me, "I know I'm going to die on the table." He didn't say it with fear. He said it with despair because he actually, 100% believed it. Getting on that stretcher, in his mind, EMS might as well have been hitching a ride to his funeral. All pride gone. All honor lost. Just a man robbed of the things that he'd taken for granted. His eyes showed the depth of loss and humiliation he felt.

I've waited. He'd been there enough that if he died, I know it would have been talked about. There was no word. Months passed.

As I wrapped up my charting my last shift, I heard him. His speech pattern is unmistakable given the injury he had affecting his speech. After I wrapped up the last details of charting, I went to see him.

When he saw me, his eyes welled up. I hugged him fiercely, and like a couple of old fools, we sobbed happy tears as he told me how recent months have been. Never in my life had I seen despair run so deeply, and here he was, back again, but BETTER. Not only did he look better, but his speech improved exponentially, and all other assaults that had been suffered by his nervous system was reversed. GONE! He's better! He's LIVING his life!

This week, I learned that a nurse can cry happy tears on the ride home from work. What a beautiful joy! I'd go through months of horrible shifts just to experience that joy again! Victory!

I remembered why I became a nurse.

It's rare we get to know the end of the story. But this time, I got to. [emoji173]️

I love being a nurse!

You guys learn anything good?

[OrganizedChaos, LVN]

I learned the mother on my PDN case is just pure lazy. I'm tired of doing PDN but there are close to no other jobs around & this job comes with benefits.

My husband also got laid off from his job so I can't afford to go back to school right now since I am the one supporting us. It's major blah over here.

[CrunchRN, ADN, RN]

Neat ixchel!

[RainMom]

I learned that when I work a prn floor shift, I don't particularly care to have an orientee assigned to me. It didn't have anything to do with that nurse or trying to help a new nurse in general; it was more the fact that I had no idea what she had done so far, what she does well or needs to work on, & I would only be with her for one shift. She did just fine, but I felt useless most of the shift asking if she needed anything, had questions, etc, checking her charting & bugging the other nurses & the CNA to give me something to do. Yes, I'm complaining I had an easy shift. Crazy, I know, but I like to work the floor once in a while to shake things up a bit.

I've hit a rough patch of IV starts. The last 2 shifts I've had in pre-op, I think I've had to stick almost every pt twice & a couple pts, I had to get someone else to start the IV. Seems like I'm managing to hit every valve lately & can't advance. Felt a little better on one when the anesthesiologist also had the same exact trouble.

The CRNA who shall not be named will stick a 14 gauge in a sedated pt when there is a perfectly good 20 gauge in place & then doesn't even use it. It wasn't a case that has a large expected blood loss either.

Praying the call gods are kind to me this weekend.

Also, cancer sucks.

[Lauraingalls, BSN, RN]

I cried on my way home from work too this week.

A couple with 2 previous miscarriages finally gave birth to their first child. They parents wept for joy right after he was born.

I had tears then. The grandparents came and it was their first grandchild. They were proudly taking pictures and begged for pics of me and my preceptor with mom and baby.

They hugged us and we left at shift change. I cried the whole way home. Mostly because new life is a beautiful thing but also I cried because I am so fortunate to have three kids of my own.

[whichone'spink, BSN, RN]

-This week I learned all sorts of regional anesthesia blocks can be done, such as paravertebral, for thoracic surgeries, and transversus abdominus for abdominal surgeries. Why do our anesthesiologists not do these blocks? It would help so much for pain management.

-This week I learned pre-medication before surgery can also help with post operative pain management. One can give gabapentin, acetaminophen and even NSAIDs preoperatively. Patients could take a dose the night before and then the morneing of surgery.

-This week I learned there is a drink called Clearfast that patients who are NPO can have preoperatively up to 2 hours before surgery. It contains essential nutrients, which is helpful because frankly, starving patients for hours before surgery is just not cool.

-This week I found out exactly how much weight I've gained during my period. It sucks. I lost 5 lbs and gain 2 because of this damn period.

-This week I've come to the conclusion anyone that says they are spiritual but not religious may be saying I'm an atheist but am either not sure or don't want to tell anyone yet.

[Farawyn]

ixchel always picks the perfect song.

[LadyFree28, BSN, LPN, RN]

I learned:

I've been picked to be a delegate for my unit in our union contract.

I kept it under wraps because I was so nervous that the vote would go in favor of the corporation and management; we had an 86% YES vote; we have been unionized since the beginning of the month.

I learned how to infuse platelets-it was a nail biting, but interesting experience, so much I volunteered to be a "superuser" for blood product infusions, since we don't do it often.

Also-a little TMI, but I relearned how much I hate maxi pads.

I've been having breakthrough bleeding for months; I've been working with my GYN to have it stop; I had my prolactin levels drawn, and it was slightly elevated; then I just had them redrawn. I also was diagnosed with a "friable cervix", well, there's this pesky blood vessel that was leaking from time to time, so my GYN finally cauterized it, since I worked up the courage to get it done.

I'm hoping for the best...I'm wondering how my fertility is at this point...I may have the hormones but I want to make sure I can carry a baby to term and if my cervix can hold up, but then again, there's always modern medicine-I'll see what happens; plans are to follow-up soon for fertility testing in the near future.

[ashrose1992]

This week I learned:

That the NCLEX is as terrifying as they say. Nothing prepares you for that blue screen. However, the post test tears thinking how badly I failed were soon forgotten when the tears of joy from seeing my license number came. [emoji16]

That in times of need it is easy to see who will be there to support you and who won't because they have their own agenda.

How awesome saying "I'm a nurse" is. I am very proud to be a part of this profession!

That I miss my family. Living two hours away from them hasn't gotten much easier over the past six months. It probably doesn't help that I still haven't made any friends here. Maybe I will in my new residency program? I feel like a kid about to start kindergarten. [emoji29]

That though I have loved my nurse apprentice job in orthopedics, I'm very ready to leave and begin my adventure on a surgical floor of a new hospital next week!

[nutella, MSN, RN]

I learned that I am a weight loss and diet failure - my hormonal situation does not help, and I admit to not always eating right and not exercising enough. Now I will try the Mayo Clinic diet and see if that helps to refocus on healthy diet and regular exercise...

Almost 100-year-old patients who are full code in a critical care area face potential suffering due to futile medicine. However, Health Care Proxies will not always elect to forgo drastic measures and at least elect DNR/DNI given that the high age makes all resuscitation efforts unlikely to be successful. Perhaps the person would have chosen a different way, perhaps even comfort measures. but never talked about advanced directives and once dementia set in unable to do so.

Lays Chips come in new flavors but I should not even enter that food isle or buy those to eliminate tempting - see point number 1

Finally the college application craziness for HS seniors is getting less and less as decisions are coming in. My oldest will go to college this fall and I am excited for that!

[2011RN]

This week I learned:

1. Those that resist change are often the ones that complain the most about how things currently are.

2. Some people think that change is not possible. What they need to realize is that change is not just handed out you have to fight for it.

3. Too many people believe money is all that is important.

4. We are the earth's cancer.

[AceOfHearts<3]

With a heavy heart I found out something about a coworker that I really wish wasn't true. It is a major issue and related to patient care. Management had to be notified and from my understanding there will be repercussions.

i also learned how great it feels to really advocate for pain management for someone that cannot do it for themselves. It is also very sad I had to push so much and it took so long. Dementia patients deserve not to be in pain too. I feel like asking that resident how they'd like to be hospitalized with that issue and only an OTC med given for severe pain.