September 24, 2011

It's starting to come together

The last two days have gone very well. I'm starting to become more organized and better at getting my assessments, charting, and care provided for one stable patient. My goal for next week is to accomplish this for two stable patients. I've accurately interpreted all my heart rhythms thus far, though I haven't had any real difficult ones. My preceptor is telling everyone what a good job I'm doing so that makes me feel good. The best part....I am absolutely LOVING my job. I love talking to my patients, getting to know them, getting to help them, getting to teach them. Seriously, there is nothing I dislike (so far).

I loved pediatrics. But I do believe, I'm loving this even more. I'm probably an "all around" nurse. Meaning, I love working many different specialties. I love peds, adults, elderly. Age doesn't matter. I'm loving critical care. I loved med-surg when I did that as an agency nurse. I loved home care. I loved long term care. There were always aspects that I didn't particularly enjoy (such as the under staffing in LTC or politics in homecare), but really, I love all areas of nursing. I truly hope that one day I can add ER nurse and even flight nurse to my list.

One thing I have noticed, critical care nurses are VERY opinionated about a patients DNR status. They tend to get worked up and upset when somebody whom they believe should be a DNR is not. Either the doctor "convinced" the patient to not be, or the family can't accept that death is part of life, or whatever reason is applicable at the time. I have my own beliefs, but I don't have an opinion on what others choose....yet. I'm sure after I've cracked the ribs from doing compressions on a 90 year old frail lady or gentleman a few times, only to prolong pain and suffering for another month or two, I may feel a little differently.

As a new person on the unit, I feel like an outsider looking in sometimes. I see things that I aspire to do and be. I see things that I know I don't want to do or become. But I also realize that I don't really "know" yet, as I've got SO much to learn. All I know is that I hope that I can keep my passion for nursing burning well into my career.

September 19, 2011

Delirium tremens

Last week I helped care for a Vietnam vet who had come to our unit with an extremely high blood alcohol level. High enough that most people would be in a coma, or even dead with a level as high as his. He was a chronic heavy drinker, consuming approximately 4+ cases of beer per week. He has end stage liver disease, and because of the DT's he was sure to face and a GI bleed, he was admitted to our unit for close monitoring.

We talked with him about all of his options. He knows he is going to die. He openly told this to us. His wife divorced him, his daughter doesn't speak to him, and he is sure that his liver won't last the amount of time required for him to be "dry" before he could even become eligible for a transplant. He recognizes that he could have done things better, but his feelings on the matter? "If I'm going to die anyway, I might as well keep doing the things I enjoy". At this point, I'm not sure I could blame him for not wanting to quit. Despite the hell he was going through, his cravings for a cigarette and a beer, his hunger from being NPO, and the pain he was in, he had to have been one of the nicest patients I had cared for. Always polite, respectful, and appreciative. I'm not sure I could have been as nice as him if I was feeling only half as crappy.

Today he was readmitted back to the hospital, though not in my unit. His blood alcohol on admission was only around 0.08 or so. I was amazed, and I paid a visit to him during my lunch break. He looked awesome! I couldn't believe it. He just looked healthier and in better spirits. He informed me that he had just had approximately 4 liters of fluid removed from his abdomen. He told me that he was really trying, and is currently down to about 4-5 beers a day. He looked very happy to see me, and told me how much he appreciated me coming to visit him. I think it's important to show people you DO care, and it can be doubly important for someone who doesn't have that family support system and believe that nobody cares about them.

He will have to continue to have fluid drained from his abdomen every 4-6 weeks. I hope he continues to try to improve his health. I wish him all the luck.

September 10, 2011

Why I became a nurse

I've been struggling with my desire to share this part of myself versus the difficulty in writing this and the memories it stirs. Ultimately, I think I will share, but I believe I will leave out a few details as it's just a little too painful to talk about.

Growing up, I was my mother's best friend. She had this innocent, child-like soul. Emotionally, I was often more mature and responsible. Not that that was a bad thing. It just was.

She also had many ailments that plagued her. Often “sick”. Now that I know the things that I know, I wonder how much of it was psychiatric in nature. When I was a preteen, my mother suffered an injury that led to her paralysis from the waist down.  One that I also now believe was psychiatric in nature. I was her caregiver for many years.

In my late teens, she suffered another injury. A 22 gauge shotgun discharged, with the barrel resting against her chest. Her injuries were extensive. She “died” several times in the first couple of weeks. She spent months in an intensive care unit. I was young, oh so young. I was terrified. I was grieving. I was confused. I was angry. I was a mixed bag of so many emotions I couldn’t even begin to recognize them all.

The nurses in the ICU were absolutely wonderful. Not only did they care for my mother, they cared for me. They were a source of emotional support. They were patient and understanding. I was so thankful for the care they provided us. I was so thankful that there were these wonderful kind souls who were willing to sign on to do all of the undesirable tasks that nursing entails. They were my mother’s lifeline. They were my lifeline.

After many months, my Mother WALKED out of that hospital. It was a miracle in of itself that she survived. How was it even possible that a woman who was paralyzed for 7 years not only survive such horrendous injuries, but regain feeling in her lower extremities and relearn to walk? I never believed in miracles until that day.

Fast forward 5 years. I had made a bit of a mess of my life, but I had finally gotten my shit together. I had some thoughts over the years about what I wanted to do, but finally got to a point in my life where I was able to take action. I enrolled in school to become a nurse. I wanted to do for others what those wonderful nurses did for my mother and me. I wanted to help, I wanted to be a resource for families and patients, I wanted to help people in their time of need.

I became an LPN first. My mother was proud of me, she encouraged me the entire way. She was my motivation. When I started classes part time for my associates degree, she was again proud and my source of motivation. She lived long enough for me to achieve the title “RN”.

That year, her health rapidly declined. Her problems were directly related to complications of her injuries from the gunshot accident. She passed away prior to my making the leap from pediatric homecare to critical care. She was proud of me throughout nursing school, she was proud of me when I worked at the nursing home, she was proud of me when I worked in homecare. I miss her so much it hurts, but I know she is up there smiling down on me, and I know she is proud of me now.