Why I actually do like being a nurse

Nurses are all about the nitty gritty of bodily functions.  I spent the better part of yesterday trying to get one of my patients to poo.  She didn't want to take a medication called lactulose because it tasted bad.  I assured her that the next step would be an enema, and I didn't care either way.  And I don't.  I see bodily fluids (except for sputum which seriously grosses me out) as part of the machine-works of the body and I stopped feeling embarrassed for the patients a long time ago.  Seriously guys, everybody poops.

Last night, I had a dream that someone wrote a group email saying something like, "Amanda worked really hard today: she didn't sit down for more than 5 minutes at a time, she only peed twice in 12 hours, and she didn't get to eat anything except for the sandwich that she inhaled around 4."  No one wrote an email like that, probably because everyone else was really busy as well, but that doesn't make any of it untrue; all those things really happened.

The social worker for our unit was telling me that her daughter wanted to be a nurse and she was trying to talk her out of it, because she (the mother) spends time around all of us who are run ragged by patients who mistake the hospital for a hotel, and doctors who apparently hate people (why do you go into medicine if you hate people?), etc.  And, it would appear to this particular social worker that we all hated our jobs because we complain so much.  Not so, I told her.  I really like my job.  I need a hard job.

Aside from the fact that I feel like I'm helping the universe move in a better direction, one bowel movement at a time, I like that it's challenging.  I like the fast pace and the pressure.  I like the science of it and that I have to think quickly and be smart.  I like chatting with patients about how they got that crazy scar on their arm while I start an IV.  I like the comrades-in-arms feeling I have with the other nurses and techs on the unit as we wage medical warfare on the masses.

When it is slow and I have to do chart audits because I have nothing else to do, I hate it.  I come up with elaborate schemes that allow me to go home.  I could never sit at a desk all day, I would go crazy.

Keeping Life at a 3

"Ambulation" is the medical term for walking.  After surgery, it is important to ambulate at least once on the day of surgery (usually) and then 3-4 times a day every day after that.    If you don't walk, your cells won't get the oxygen they need for healing; your lungs won't be expanding all the way, so fluid could collect in the bases causing pneumonia; and the blood could pool in your legs, giving you a blood clot that could break off and give you a heart attack or stroke; and your bowels won't "wake up" fast enough, possibly giving you an ileus. Ambulating patients drives most of what I do as a nurse.  I need to keep you rested, pain-medicated, cleaned up, and happy enough to get those walks in.

I try to keep my patients at a "3" on a 0-to-10 pain scale.  No pain is unrealistic because 1. you just had surgery and 2. if I give you enough pain medication to erase your pain, you will also stop breathing.  But a 3 you can work through and get your walk in.

Last night, I was reading my first How-To parenting book: Smart But Scattered.  It's all about "executive skills" and how to teach them to your child.  Executive skills are skills needed to execute tasks and be successful.  Lillian has problems with sustained attention, task initiation, and time management.  (I don't know where she got that from: my assessment said my weaknesses were in sustained attention, organization, and time management.)

Anyway, one of the Principles for Improving Executive Skills is to "Modify tasks to match your child's capacity to exert effort."  The authors suggest modifying tasks so that they feel like a "3" on a 1-to-10 effort scale.  This can be accomplished by breaking down the task into smaller pieces (clean just this room, instead of the whole house), decreasing the time spent on the task (clean for 5 minutes instead of 20), or increasing the reward so the task feels like less work.

I've been trying to force Lillian to sit for 3 hours and get all her homework done (because she doesn't do her work in school, we get to do school work AND homework), when for her, that feels like a 10 on the effort scale.  This is why it's not working.  Duh, Amanda!  This is why she flops around and can't concentrate and "forgets" how to do math even though we just went over it 10 times! I don't make my patients ambulate when they have a 10 on the pain scale... I give them morphine and then come back in 30 minutes.

I'm only about 100 pages into the book, so I don't know all the tips and tricks, but I'll keep you posted on how we do.

Broken Promise

I want to write all about how my heart is breaking for one of the patients on my unit.  I want to tell you all about what is wrong with her and how long she has been there, how they assign her to me every time I work and what her prospects are.  Because I take care of her so often, people ask me almost daily my opinion on when she is going to die.  The "if" questions stopped a long time ago.  I want to tell you all about how I thought she was going to die in surgery (I cried on and off the whole day she went in (I was at home, thank goodness)), but she made it.  I want to talk about how I kind of wanted her to die in surgery; to just go to sleep and never wake up.

I don't blog my hospital stories because I'm nervous about patient privacy, but this woman has worked her way inside of me and I want to write this down so I remember her when I read this in 5, 10, 15 years.  I'm not sure why I have grown so attached to her because she sleeps most of the day and isn't much for talking because she's in constant pain.  I just feel so sad for her.  I want her to get better so badly, but then I want her to not get better and go on hospice so she can have as much narcotics as she wants.

I promised her on Tuesday that I'd come back and paint her nails on Wednesday, and she smiled at the idea.  She smiled and I haven't seen her smile in weeks.  But then I was sick on Wednesday and didn't go to work.  I'm not scheduled to go back until next Tuesday, and I have a lot of anxiety that she won't be there to hear why I didn't come back with my pink nail polish like I promised.

I feel like breaking that promise was one of the worst things I've ever done.