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

Nurses General Nursing

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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?

Specializes in M/S, LTC, Corrections, PDN & drug rehab.
Maybe you kind of rushed in to this because you really needed the job. I know it's been rough for you, but try to be more selective for your next job if you can. ((((Chaos))))

I know. I will, I really will. I need a job but at what cost? I know there is no perfect job but I need something more reliable & have a better DON.

Late to the game, but a new week has started!

ixchel is doing the work grind, so you're stuck with me. Check it out.

https://allnurses.com/general-nursing-discussion/ixchels-3-7-1040108.html

-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.

You our cannot give NSAID's before SX.......you want to see a surgeon come unglued? It is a blood thinner and highly contraindicated for SX. Fact: that is one of the meds they tell you to stop taking 2/3weeks before SX.

Specializes in PACU, pre/postoperative, ortho.
You our cannot give NSAID's before SX.......you want to see a surgeon come unglued? It is a blood thinner and highly contraindicated for SX. Fact: that is one of the meds they tell you to stop taking 2/3weeks before SX.

Daily NSAIDS are stopped but we have certain surgeons who routinely order toradol pre-op. So no, it is not a hard & fast rule.

ETA: Our kiddos almost always get Motrin prior to BMT & even tonsillectomies.

I prepped a pt for a TURP yesterday that only had to stop his ASA 81 mg the day before per the surgeon's order d/t his hx while the coumadin was stopped for a week.

Specializes in OR, Nursing Professional Development.
-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.[/quote']

Depends on the patient. Some don't want them. Some aren't candidates due to spinal surgery/implants. I actually had a thoracic patient we wanted to do an epidural on. Neurosurgeon even came over and tried to help us. Couldn't do it. Others were on anticoagulants. Poking spine + tendency to bleed = potential bad outcome. Sometimes it's surgeon preference. Work with one who doesn't want epidurals on thoracoscopic surgeries. However, he will freeze the nerve to block it. Also uses local anesthesia around the incision. We also have a standing protocol that all thoracic patents receive acetaminophen 1g IV prior to leaving the OR.

Specializes in Med/Surg.

I would also like to share my happy tears experience...

I am still a fairly newbie nurse with a little more there a year of med surg experience. Just this past weekend, as I was getting report, one of my patients name sounded really familiar. When I went into her room to introduce myself I realized I met her last year when she was really sick and required an ileostomy bag placed. During this admission, she was getting better and was back in the hospital to get the ileostomy closed. She was really excited to see me again and started telling me how she told everyone about me after she was discharged. I was so happy that she was getting better that my eyes started brimming a little with happy tears. I am glad that i am part of her journey to recovery.

Sometimes, there are days when I question why I became a nurse, but seeing her made me realize why I entered this profession again.

Specializes in critical care.
I would also like to share my happy tears experience...

I am still a fairly newbie nurse with a little more there a year of med surg experience. Just this past weekend, as I was getting report, one of my patients name sounded really familiar. When I went into her room to introduce myself I realized I met her last year when she was really sick and required an ileostomy bag placed. During this admission, she was getting better and was back in the hospital to get the ileostomy closed. She was really excited to see me again and started telling me how she told everyone about me after she was discharged. I was so happy that she was getting better that my eyes started brimming a little with happy tears. I am glad that i am part of her journey to recovery.

Sometimes, there are days when I question why I became a nurse, but seeing her made me realize why I entered this profession again.

Jenny, high five on the awesome patient care and beautiful ending to a difficult story!!!

Specializes in Med/Surg.
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