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

Nurses General Nursing

Published

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?

I can't hide my expressions either. I can tell an entire story without saying a word.

I've learned not to leave my cell phone on my desk in an empty office.

I've learned that my gut is correct.

I've learned that I can easily forgive a kid for stealing.

I've learned that I mean that. ^

I've re-learned that being a school nurse is one of the toughest jobs I've ever done.

Specializes in Medsurg/ICU, Mental Health, Home Health.
I only liked that post to show support, Far.

Even though it may not help, ((((Far)))). [emoji22]

What.she.said.

Specializes in acute care, case management.

Wow! Really warmed my heart. This IS the reason to be a nurse. To experience these not-so-happy moments in other people's lives. And to experience defeat, and the triumph when a patient bounces back to near prior level of function. This is amazing! This is what it's like to be a nurse. Not always sad, not always with great results. This is when we learn real life lessons that others don't get to experience. Thank you for sharing this.

One of the biggest and most life changing lessons I've learned is that death can be more merciful than life. Sometimes people die of their disease and that's okay because, for them, to live would mean ongoing suffering. Being in curative care, it's easy to consider death the worst case scenario, but I've come to realize that sometimes it's not. Death can even be beautiful at times. It really is the "final stage of growth" in life- accepting when death to the body is occurring, making their peace with it, and just making the most of their last months, weeks, or days. Sometimes the only time a person has really lived is after they're given the news that they're dying.

So, I'm back from MI! Not much I learned this week, except:

I must have learned something, since I received a 96 on my Critical Care exam! I honestly didn't study that much, but I've always been excellent with acid-base and electrolyte imbalances.

My newly-made friends from MI are trying to convince me to move there, and I am admittedly tempted. I really wanted to move out of the Midwest, but I just happened to find a job opening that would be perfect for my academic background. I decided applying there couldn't hurt, and we'll move on from there.

Diabetes causes all sorts of problems, and almost 10% of the U.S. has diabetes. Controlled diabetes is much more manageable, so education, education, education!

Specializes in M/S, LTC, Corrections, PDN & drug rehab.

I relearned that the parents on PDN cases can be fickle *******. Only the nurses that get kept are the ones that kiss ass. I don't kiss anyone's ass so the parents kick me to the curb. Anyone hiring?

Specializes in CVICU CCRN.

Far and OC: all the hugs to you. All of them. I'm a very awkward hugger but I will do my best. [emoji17]

Beautiful post, Ixchel. It resonated with me. I have had some crazy shifts but it seems that I tend to "like" the "unlikeable" patients. People trying to get clean and get their lives together, those trying to make a fresh start. I feel like I did some good advocacy this week. Don't know how lasting the changes will be, but all we have is now, and in those moments, things were just a little bit better for my patients.

I learned that ketamine can be used to increase respiratory compliance in an intubated patient with status asthmaticus who could not be mechanically ventilated. Really very cool. There is some excellent literature out there too. I was glad to see this patient come out the other side of a nearly fatal situation and I learned a ton from the case.

Excited about some upcoming trainings and the active growth of our transplant programs.

That's it for me this week. My mood is better, which is good.

I relearned that the parents on PDN cases can be fickle *******. Only the nurses that get kept are the ones that kiss ass. I don't kiss anyone's ass so the parents kick me to the curb. Anyone hiring?

I have sads.

Specializes in M/S, LTC, Corrections, PDN & drug rehab.
I have sads.

I have sads for you too. *hugs*

Specializes in ICU.
Diabetes causes all sorts of problems, and almost 10% of the U.S. has diabetes.

That's it, really?

...I didn't realize it was that rare. Just goes to show how much it screws you up, I suppose - maybe once a month or so I get a patient who isn't a diabetic, and then I'm all, "No way!" and insist on digging through the chart just to make sure, and then double checking with the patient/family/whoever is awake and can talk that the patient doesn't have diabetes because it's just so weird to have someone who's not a diabetic. I would have said at least 1/3 of the country has diabetes.

I learned that ketamine can be used to increase respiratory compliance in an intubated patient with status asthmaticus who could not be mechanically ventilated. Really very cool. There is some excellent literature out there too. I was glad to see this patient come out the other side of a nearly fatal situation and I learned a ton from the case.

I would be really interested in learning what you learned here. When we get to the point that we can't ventilate them, we paralyze them. If that doesn't work, we add in inhaled Flolan and/or nitric oxide, preferably the Flolan first because it's a heck of a lot cheaper than nitric. Where does ketamine fit into this picture? Do you try it before or after paralyzing?

We see ketamine, but we use it for complex regional pain syndrome as a continuous infusion. I've never used it for anything respiratory!

I learned my membership here got cancelled today. Page says new options coming soon for memberships, so I hope this means that it really is just a everybody thing and not a "Oh, look at calivianya pooping all over everyone's cornflakes, she's not good enough for a membership anymore!" sort of thing. I have been a bit of a Negative Nancy lately. I need to work on being more positive. :)

No. Same thing happened to me. I thought I was banned. PM Joe V.

Specializes in CVICU CCRN.

I would be really interested in learning what you learned here. When we get to the point that we can't ventilate them, we paralyze them. If that doesn't work, we add in inhaled Flolan and/or nitric oxide, preferably the Flolan first because it's a heck of a lot cheaper than nitric. Where does ketamine fit into this picture? Do you try it before or after paralyzing?

We see ketamine, but we use it for complex regional pain syndrome as a continuous infusion. I've never used it for

So, this was in a young adult who aspirated copious amounts of vomit during resus. Patient arrested at home because of status asthmaticus/resp failure. They used it *after* paralyzing. We had been bagging forever it seemed. Here's an article I found on the subject after researching the intervention. Not sure if pubmed links are allowed but the title may guide you to full text:

The pulmonologist was in charge of management at this point. Took 6 days of treatments but the patient made it to stepdown. Also, I sent you a PM!

+ Add a Comment