sick!

The sniffles started and then the coughing came.  I only have two more days of clinical before the semester is over and I have to get sick now, the day before my once a week scheduled clinical day?

I’m definitely the type of person to go to work sick, get the job done, go home rest and do it all over again.  However I have all too soon realized how different nursing care is from any other profession. As the cold was creeping up on me, I was asked what percent sick do I have to be before you call in a sick day.  The answer is zero percent sick.

This semester I’ve worked with transplant patients, who are all immuno-compromised from the medications they must take to prevent rejection of their new organ.  That makes them all the more susceptible to infection, it would be contradictory for my snuffly runny nose to provide nursing care for these patients.

I tried to fight it. I still went in Sunday, read up on my patient, and prepared my care plan.  I had a big bowl of Thai soup for dinner and was in bed super early at 9pm to get as much rest as possible.  Yet to no avail, I woke up with the same cough and sniffles and had to call in.  Most people enjoy the opportunity to stay home ill, but strangely, I feel as though I’m missing out on quality experiences.

There is always next week.

am i numb?

Taking a quick break between procedures, I escaped off to a corner to rest my feet and sip on some much needed coffee.  Immediately across from me, one table over, I noticed a middle aged woman by herself texting on her phone. She seemed obviously distraught and distracted, communicating some bad news to a loved one or about a loved one. I can’t pretend to know her mind, but she caught my attention and my wandering mind began creating scenarios to go with what my eyes were seeing.

I had just come from a triple aortic graft surgery where the doctors were dropping f-bombs left and right because they were facing complications with the graft. During this procedure the largest artery in the body is clamped off, cutting the blood supply to all the lower extremities and abdominal organs.  It is an intense procedure because if the time to perform is excessive, there is risk of necrosis of the tissue below the abdominal aorta.  As I witnessed the pressure in the physician team I couldn’t help but imagine the worst was going to happen. And although the aortic graft was finished with no complication other than increased cortisol levels in the surgical team, as I witnessed the women in the cafeteria I imagined that she was the wife or sister of someone who didn’t have a smooth procedure.  She was alone, bearing the burden of sharing the news with her family.

And then a tear ran down her cheek.

I wished that I could hug her, tell her that it would be alright, but I didn’t know for what she teared, and it wasn’t my place. I was in need of my coffee and had to get back to the OR for the next procedure.

Am I numb?

Part of the beauty of hospital work is that it exposes me to the raw human condition.  There are hundreds if not thousands of people filling the halls of any hospital.  It is a place of activity, where miracles turn around lives and disappointments end some.  There will always be women like this crying lady in the cafeteria, I think that I’ve learned that I can’t do everything for every one.  There is a time and place, for everything.

I get up, throw away my paper cup, and go about my day.

behind these walls

On the ground floor of UCSF Long Hospital, down a hall, around a corner, down and then up an oddly placed ramp is the Endoscopy unit.  The end of this meandering route couldn’t me more an appropriate location to perform the unique spelunking procedures navigating the caverns of patient’s bowels with a sterilized endoscope.

The unit has a factorial efficiency, with a large room used for admission preparations and recovery monitoring.  There are four procedure rooms where the physicians will send the scope down the throat or up the bottom to explore, take pictures, or biopsy with a claw-like jaw that slices bowels bits.

I had the pleasure of observing four separate procedures and as I hopped from room to room, seeing open throats and exposed behinds I was mostly amazed at the unique expertise required of the endoscopy physician jumping from room to room, arriving after the patient has been sedated and therefore blessed with a limited experience of patient interaction made primarily of a Blair-witch style camera view of the patient’s innards.  These physicians have invested a good 10 years of their youth in an academic career to end up being camera wielding bowel spelunkers.

It is hardly admirable or glamorous and I’m sure that the repetition hour after hour, day after day, has numbed them to the strangeness of what it is that they are doing.

there is a first time for everything

Scanning through the pages of this blog, I observe a catalog of new events that will one day, with practice, become second hand.  As is certain of time the habits of my practice will fail to inspire the reflections I chronicle here because with habit, all that is novel will certainly lose the luster inherent in the freshness of new experience.

However, I’m hardly at the point where I’ve grown fully accustomed to all the practices and skills required for nursing care.  I must admit that my sage like introduction above is partially a ruse to segue into a discussion of a first-time experience that many will find vulgar and disturbing.  So, if you have small children listening in the room you may want to turn down the volume.

I had not expected to begin my day giving a suppository to a 66 year old woman.  She had had a kidney transplant three days prior, was taking on a lot of fluid, had not had a bowel movement, and needed the help to get things going if you catch my drift.  Sure, I knew that giving a suppository would be an inevitability in my nursing career, but fingering a stranger’s rectum didn’t give me the same excitement I got when I first drew blood.   Of course, living in San Francisco I’ve stumbled upon many a conversation that celebrates such an act; however despite the propensities of my environment that realm of the human body hasn’t really interested my youthful explorations.  I don’t mind if you can call me old fashioned, I am who I am.

So, of course I had a little anxiousness about my first exploration into the nether world. It was even more awkward considering that my broken Spanish and her broken English were the only words of tender communication we could share to explain what I needed to to do to her.  Getting her onto the bed was easy, as was getting her to roll on her side to expose her bottom, but then I had to roll back layers of flesh to find the spot.  While holding onto the lubed up slippery little devil, I placed my finger up into her, completing my brief mission.  Despite the clumsiness of it, as I reached around to find the knuckle-length distance where my finger and the suppository would part ways, I was overcome with a strange sense of peace having performed this act.

There is a unique trust that is placed in the nursing role.  If this woman and I were found on the street in our daily clothes, I would be arrested or shot for such a violation.   But here, in this place it is permitted and accepted as a necessary intervention to improve the woman’s health and well being.  She in her gown and I in my scrubs are different people than we are walking the streets of the city.  We have defined roles, and the role of the ill accepts the role of the health-care provider to conduct intimate and profound acts because the foundation of that acceptance is a hope that the interventions will improve their health and change their role from being one who is ill to one who is healed.

The novelty of performing this act will fade as my future self will have performed it hundreds more times. However I won’t forget her, and I won’t forget that what I do in this profession is done because I too hope that people such as her can reclaim the dignity found in a healthy life.

there’s no pill in team

This past Monday was clearly my most frustrating day on 9 Long.  Although both of my patients were easy going and I felt that I had developed good time management with two patients and even felt ready to take on a third, the frustrations were from the lack of teamwork that I experienced with my partner.

This RN named Getrudes was independently motivated and not very adapt at being a team communicator.  It became apparent that she had a routine that may make her a very good and efficient nurse, but not a very good nurse educator.  She was very focused on giving medications within the first half hour of the administration time of 0900 and it seemed that being on time was much more important than allowing me to learn or practice care.

Having prioritized the care of my two patients, I already had a plan for my medication administration that didn’t really jive with Getrudes’ agenda.  One of my two patients was eating breakfast late, so I was holding off on giving his medication until 0845, which seemd fine, because I wasn’t going to give my other patient his medication because he had a fever and needed Tylenol, but could not receive his Tylenol dose until 0915, since he was on a 4 hour limitation.   By time I finished with the first patient Getrudes let me know that she had already given the patient with the fever his medications.  This was completely contradictory towards the plan I had set out and communicated with her.

What’s worse it that it wasn’t until almost noon when I was giving this patient his additional medications that I realized that he had not received his Tylenol.  This was very frustrating because I had a plan of care that was curtailed by the other RN’s agenda and poor communication.  Now this patient was running an increasingly higher fever that could have been addressed much earlier if the RN had properly communicated with me.

Second case in point: the doctor’s rounds for both patients were both near noon, however Getrudes pulled me away from participating in patient #2′s rounds to give patient #1 his 1200 glucose check.  I found this unnecessary because I had already learned that this patient was a slow to start eater, preferred to walk before he ate, and had not yet had his walk because the doctor’s just complete rounding on him.  The task-oriented practice of giving medication or performing interventions on time doesn’t always fit with the patient’s specific needs.

It seems that the biggest lesson I gained from the day was that I had to double check my own work, double check the patient’s charts and medical record to verify what has been done without my knowledge, and maintain frequent communication with my patients to identify what interventions the other RNs may have already completed without my knowledge.  I suppose that the day was a nudge towards my own independence.  I’m grateful that I was paired with this RN this late in the semester and not the first few weeks because I would not have had the skill or knowledge to walk away from the day with anything more than frustration.

paranoia draws the line

This past Thursday morning I received an email from the nursing department that the SF Department of Health was providing the H1N1 vaccine at select clinics distributed throughout the city.  Having been told multiple times by my instructor that this was a requirement for all health care providers, including students, I made plans to go the closest clinic that evening since the vaccine would only be available Thursday, Friday, and Saturday.

When I drove up to 24th Avenue and Judah, I was prepared to wait in line for at least an hour, but in no way was I prepared for the mobs of people lined up around the block.  It wasn’t until later that evening that I learned that some people had begun lining up as early as 8 am to secure their vaccine dose.  If I knew that before I parked my car and got in line I would probably have given up and gone home, but it was a beautiful day, and I had my books with me to study; standing up outside or sitting down in a cafe, I would be doing the same thing: studying.

I had gotten in line just before 4 (when the clinic was supposed to open) and promptly at about 4:05 there was a jolt in the crowd like a car revving into gear as we felt the first movement of people enter the clinic around the block.  However that first jolt became a distant memory as 4 turned to 5 and I hadn’t moved more than 300 ft.  By that time I knew I was going to be there for the long haul, much later than the 7 pm closing time that was originally posted.

Most of my neighbors in waiting were families with small children and I found some amusement watching the kids making friends with their line buddies, running around to pass the time with innocent glee.  As I watched them, I wondered what association these kids would develop with lines after they had spent precious hours of their short lives to not ride the Matterhorn but to receive a needle in their arm.  Would their future selves harbor an unconscious fear of lines that caused them phantom pain in their deltoids?

As 7 pm rolled around and we had made it up 25th and onto Judah, I was surprised to hear a man yell, “Pizza here, come get some pizza if you’re hungry!”  Someone had ordered delivery of 12 pizzas to share with his fellow vaccine seeking victims.  It was just in time too, because I could see the hunger in the empty, eager little bellies as the children ran to get a slice.  Simple things like that man’s generosity are such a beauty and mystery.  I found it ironic that just 10 minutes later we were ambushed by some opportunistic proselytizing Jehovah’s witnesses; it was apparent to me who really carried out the mission of Christ that evening.

When I finally reached the clinic at 8:45 I never thought I’d be so eager to get a shot.  I really just wanted to sit down and rest my feet.  Why was I doing this crazy thing? Why did so many people set out on this evening to receive this vaccine that for all we know, may not even be effective?  Was this paranoia, collective hypochondria, or have we all been duped into some dubious hope that we were dodging this latest disease?  I don’t believe that these people were fools; the display of patience and desire was a testament that a portion of the population believes in preserving their health and is willing to invest hours of their lives to curtail the days and weeks that could be potentially lost if they were to come down with H1N1.  However, this reflective perspective may be skewed as I struggle to place value in my patience.  I’m aware that I was in that same line, giving 5 hours of my life to the foolishness of hope.