Week 10 - MCA II Finale - real cute boy

Picture: Courtesy of the Web: National Association Down Syndrome - Adult Center)

We rounded out our medical surgical rotation with a nice little final exam on ICP and other complications from neuro trauma and the like (truly you don't want this) and we had a wrap up in the other classes with presentations and potlucks. I'd collapse in bed at night ...wishing for the end of term.

Clinical found me in the Med Tower with a leukocytosis patient with very loose stools. Nursing students somehow always manage to end up with these patients. I haven't had one until my last rotation day. I guess I was saving the best for last.

As I completed his assessment he asked for a hug and told me that he was a 'real cute boy.' How could I disagree? My patient was a middle aged adult with Down Syndrome. I practically pulled the rug out from under Trudy to get this patient. I have a real fondness for my friends with DS. Giving him a hug and holding his hand, I let him listen to his own lung/heart and bowel sounds. He had ticklish feet and the assessment felt like a fun little game, rather than a chore. Even when feeling like garbage, my patient was happy, albeit in a sore, dehydrated and slightly elevated temp sort of way. He didn't have a care in the world.

My last hours in MCA II were spent watching Bonanza with him and cleaning up some of his 'loose ends' ~ For some reason, I managed to go an entire 10 weeks without a single splash down until the final day. As Trude fetched me some linens and pads (probably relieved that it was me dealing with this for a change) I was intrigued with the notion that I didn't mind how unglamourous it can be (sometimes, it is dirty work)..but there we were -chatting up a storm about Hoss, Little Joe and Pa.

He giggled and laughed about everything and nothing at all. The 7-up tasted good. The rash hurt, the wash cloth felt good. The incentive spirometer was an exercise in futility. I think I needed it more than he did. I charted and tried to figure out what I could do about the perianal rash that was developing due to the two day advent of acid laden loose stools. After a nice paint job with barrier cream, we talked about friends and how everyone had nice eyes, pretty hair (especially care nurse Jaime). We talked about eating slow (I should really take my own advice) and not eating so much. He wiggled his toes, sat up in bed and wanted more 7-up. I remember thinking that the idea of 7-up sounded so good....

I think it was rather cathartic to end the term on this happy note...a pretty rank and dirty splash down...strip bed, paint job, one med, a couple hugs, ticklish feet and a real cute boy.

Bless your heart buttons...

Back to oncology this weekend. I had picked two patients on Friday- that one of the AM RNs said would be around for the weekend. One had INR issues and the other was supposed to have a chest tube inserted so she assured me they wouldn't be discharged. I prepped on both and discovered they both shared virtually the same diagnosis...malignant cancer of the lung. One had a stage IV pleural effusion that needed to be drained. The other was coming off chemo with a persistent fever of unknown etiology and needed to be stabilized before his next round of chemo.

After prepping on my patients, I knew I was going to learn a lot this weekend because one was a retired health care professional in a specialty that involved his own diagnosis, and the other was an independent retiree who reminded me of my dad. Nothing was keeping "my guys" down. They had loving, well educated spouses who had been married to them for over 40 years. One of the spouses was a retired ICU nurse and the other was a fireman's wife.

These men both enjoyed long fulfilling careers in their fields. They were fighters through and through. The medical guy knew exactly how things were going to go for him and he taught me a couple things I'll never forget about respiratory assessments particularly. For example, he suggested that the best way to ausculate the lung fields is from the back side and if you ask the patient to say the letter E with each field through all the points of ausculation..and it gets to a point where the E sounds like an A...that's the point of effusion in the lungs and you can mark it with a pen. Since he had a chest tube inserted, I got him out of bed and tried this technique. My care nurse and I were both amazed that the E does sound like A..and we didn't need an X-ray to know where the effusion was in his lungs.

It is difficult to explain what it means at the end of the weekend when you are either discharging your patient home to an uncertain future of months or days or whether you leave them not knowing if they will be back next week because of an infection or recurrence of their symptoms. I always try to say goodbye to my patients because the time spent changing their dressings, assisting with personal care, medicating them, injecting them or teaching them something important about their care, is a time when a bond of trust is established. I feel the same way about the families who stay with them. When I left Sunday night, I knew my 'teacher' wouldn't be there the next day. He made eye contact with me, wished me well with nursing school and we bade our farewells...he might be back soon because his diagnosis is terminal, but knowing him, he will prefer to be at home when that time comes. It's the kind of person he revealed himself to be and I was certainly humbled by the inherent dignity our patients possess when they are the most vulnerable to us as nurses. I was able to medicate him, obtain cultures, humidify his oxygen and change his chest tube dressings. The best thing I did for him however, was switch out the remote control on his television set. He went a whole week waiting for one. Mostly, nursing is about listening. I haven't always been a great listener...because I like to talk. I am learning to be a better listener.

One LOL (little old lady) was on my unit this weekend with an acute bout of pancreatitis. I could read the body language of her son, who was irritated to be summoned to the hospital and it made me mad because he wanted nothing to do with her. As I took out her IV, she rubbed my arm and said "Bless your heart buttons." She was a dear. As a total stranger pulled up in the Lexus SUV to pick her up to take her back to the board and care home; they wanted us to scratch off the prescriptions we transcribed and phoned to the pharmacy, because they didn't want to pay for them. I knew the sweet LOL wouldn't be getting half the medications the doctor ordered for her because they owner of the board and care wouldn't pick them up at the pharmacy. As she waved good bye to me...I wished in my heart that her son would care enough and that she would never realize that he didn't. Bless her heart...sweet little button.

Easy does it

Couple things happened this weekend. I went back to surgery and had a nice run of abdominal cases with penrose drains and minor complications (peritonitis and bile leakage.) I have done a lot of dressing changes, so this weekend I perfected my skills at changing abdominal dressings and charting the character of bodily fluids draining out of incisions and drains. I also admitted my first post op trauma patient who had a dirt bike accident. Between these three, I had a three day run of staying busy and honing some skills. I dc'd my first foley and Trude inserted her first, so it was all good.

I didn't expect to wake up with a call from the school that my son had a accident at school. With DH following the ambulance team into the ED at the local hospital, Trude and I weren't far behind, all decked out for clinical . We saw the team in the ED (slow day) picking him up for radiology (Trude's first reaction upon hearing that he sustained a pelvic fracture, said, "We have a care plan for that"...yep. Irony reigns eternal.

Finishing up clinical early we trudged out with two weeks to go before start clinical for critical care. I would prefer not to have a parallel experience in the family while this is going on...so be careful people...easy does it.

Nursing outside the box

I am a changed person. I've seen the light. Call it an epiphany of sorts.

We've had a lot of lectures in health assessment about this topic and the focus this week in Medical-Surgical Care of the Adult II was OBEEEEEESITY (say that in the movie trailer guy deep slow voice), and all the resultant complications , I've pretty much lost my appetite. Trude will tell you I haven't eaten in a week. To top that off, after my theory instructor had a big story about a Pickwickian patient she had once that she found hard to forget and she shared quite a story with the class. Guess what kind of patient I had this week after my ARF patient when up to the ICU 15 minutes into shift? Yep, a very sweet P.W. patient with long lasting COPD and a health history that beats "Roots".

In any event, I had to pull a rabbit out of my hat this weekend when it came to nursing interventions for this woman. I absolutely fell in love with her. She had one of those big girl beds and I knew that for any kind of real nursing care, I was going in and under like 20,000 leagues under the sea..remember the arm story that Talitha told. We can do bowel management and that makes us good plumbers but really...the most important assessments are the spiritual and sexual assessments we do as nurses (I digress). Those of you who were present for April Fools Day lecture will understnad that line.

So, I decided to really take my time with her and just talk. She has a lot of neglect issues. I asked her the question (don't ask me why) "if she had one wish what would it be" and she said "I'd really like a hot guy with 6 pack abs and a tight ass to come in my room and talk to me"...

Missing my husband, I told her without missing a beat, that I could arrange this for her and asked DH if he would stop by Sunday night and see my patient. (not quite a 6 pack, but he is quite charming, very handsome and has his Zoolander moments.)

With flowers and a chocolate egg, he spent about 90 minutes with my patient, visiting with her, massaging her hands and talking to her about nutrition and friendship and her family.

I loaded her up all weekends with meds and assessments, but this by far was the best care I gave all semester. Trude doesn't think he's hot. But my patient fell asleep with a smile on her face.

This story is true. The opinions expressed do not necessarily reflect the opinions of my school or it's affiliates