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Monthly Archives: October 2011

Craziness and Cookies for Peace

This story does not make me look like an angel. Yesterday, I was severely annoyed by a patient. This patient drove me so crazy that I wanted to pull out my hair, ignore her completely, or worse, make her disappear. It wasn’t that bad from the beginning. While I knew she had a psych history, and had been to multiple ERs with the same complaints, and had same tests done and had been medically cleared any number of times, it’s not in my nature to immediately distrust a patient that I have never met. But with a large load of patients already, and a busy day ahead, it soon became clear to me who was the truly ill and who fell to second (or fifth) priority. And with a steady stream of complaints and demands with seemingly no relief, I soon grew exasperated. Probably more so than I have felt ever before in this setting. It is not a good feeling, and it colored the quality of my care for this patient and tinged my mood for the entire day. I was not at my best. Less than super nurse, to say the least. She was with me all twelve hours, my lovely lesson of the day. She was constantly telling me how sick she was – as if I could forget. She told me again and again that the regular doses of pain and anti-nausea medication that I was giving her had done nothing at all and she would rate her pain as ten out of ten, and later twelve out of ten. When I paid attention to her it was almost worse than when I ignored her. I hate to say it, but I realized that I had to be firm and set limits with her so that I could safely care for my other patients as well. It was a hard lesson, but very necessary. And when she was finally medically cleared (with yet another CT scan, that she demanded) she still wasn’t ready to leave. Multiple physicians tried to use reason, and I did my best as well, but we could not get through to her.

Then suddenly, while I was in the midst of drawing up medications for another patient, an old man appeared at my side. He said he was her father. He looked nearly as tired as me. But with a sweet smile, he asked me if she was medically cleared, and if so, could he take her home? Unanticipated, a huge sigh whooshed out of me. I told him that yes, she had been cleared. Another sad little smile and he said, “If she is clear, then I can take her off your hands.” This small stocky man with the unruly grey Einstein-esque hair and disheveled appearance–sweater pulled taut over a slight paunch–was my knight in shining armor. And after a full day of caring for this patient with no relief or remission of symptoms, arguing with her about her diagnosis (or lack thereof) and just generally sweating over her care, she meekly followed her father out the door. That easy? For me, it was. That was one day for me. One hard day and then I get to wash my hands of it. But guess who doesn’t get to do that? Her kind mother who called earlier in the day to inquire about her status and her sweet father who came to escort her home and ultimately ended the circular game of discharging someone against his/her will, sick or not. Mother and father will never wash their hands of their daughter’s illness and neither will this woman herself, who is clearly sick in a way that the medications in our Pyxis simply cannot treat. I left very sad, and frustrated. Our system isn’t very good at dealing with the mentally ill. In fact, I would even go so far as to say that the system failed this patient, despite our well-intentioned efforts, and that makes it fundamentally flawed. Clearly, I don’t know the whole story. I only saw a small piece of the puzzle. But, I know something different should have occurred to stop the cycle of her using the ER like a revolving door. Should she have received a psych consult even though every complaint she had was physical in nature? The clues of prior visits point to yes, although clearly this is not a means to a permanent end since prior psych consults have not yielded answers or an end to the behavior. And should she have been assessed for an addiction? Perhaps. It is hard to say without knowing more of the story than her singular ER visit.

What I do know is that the very next day, while putting a chart away at the charge nurse’s desk, a little piece of me shriveled up inside when I heard her voice behind me saying, “Oh, Rachel…I’m back. This time I am really sick!” There she was, brought in by EMS…AGAIN…on a stretcher. She told me that she was still feeling terrible, and that “they” had called her back because they had seen something on her CT scan when re-reading it. I have to admit, I held my breath and crossed my fingers that our team wouldn’t be assigned to her care. And it wasn’t. But the Communications nurse later told me that the look on my face was priceless when the patient called out my name, she said she cracked up, and only for that reason was the patient not assigned to our team again Only in blog-land can I admit how grateful I was. After another 12 hours of her in the ER, with so many other patients, I may have quit my job on the spot. Obviously, I need to learn to better outlets to control my frustrations, because not every patient is pleasant or kind. I am working on learning not to let my crazy patients make me crazy as well because then i really can’t help them!

And now, a recipe for peace. Tea and these cookies, combined with a little yoga on the side help me stay externally peaceful in the ER.

simple lemony cookies

Ingredients (I doubled this recipe and kept one log in the freezer for later use at a future tea party date!) From: VodKitchen
  • 9 Tbsp. butter
  • 1/2 cup fine sugar
  • 1 large egg
  • Barely less than 1 cup all-purpose flour
  • 1/4 cup quick cooking oatmeal
  • 1/4 tsp. baking powder
  • 1/2 tsp. salt
  • 2 lemons for zest
Preparation
  1. Put your softened butter into a food processor with the rest of the ingredients (save the lemon zest) and process until smooth.
  2. Finely grate your lemon zest. Stir the zest into the cookie dough and mix together well. Spoon on to a piece of plastic wrap and roll into a sausage shape with a roughly 2 1/2-inch diameter. Chill the dough in the freezer for 30 minutes.
  3. Preheat the oven to 375°. Get your chilled dough out and cut it into 1/4-inch thick slices. Place these on two cookie sheets, making sure you leave a good bit of space between the slices because they’ll spread while cooking. Place the cookie sheets in the middle of your preheated oven and bake for about 10 minutes, until the edges of the cookies are golden brown. Let them cool down slightly before transferring to a wire rack to let cool completely.

Also great made with orange zest instead of lemon, and served with tea, coffee, or hot cocoa!

 

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Comparing myself to overcooked pasta…

Every night leaving work, it’s like the energizer bunny coming to screeching halt after a nonstop day of go-go-go.. On autopilot, I resist collapsing like one big gelatinous noodle. In some recess of my brain I know that my bed is better than train tunnel for sleeping. Thus far, I have always won against my limbs, thank god. Not that I am actually complaining. This is exactly what I wished for: bedside nursing, interacting with people as much as possible, constant learning, and never sitting at a desk in a cubicle. I got all of those things. So far, no matter how tired, frustrated or emotionally drained I am at the end of a hard day in the ER, I am still excited to go back (after a solid night of rest). I can’t say how long this honeymoon phase of our relationship will last (me and the ER, that is) but I am really hoping it’s a not a fleeting feeling.

As a new nurse, I am always running, my brain whirring, trying to anticipate the next step. In the beginning, I had plenty of time to learn my patients and know them fairly well (at least well for a brief ER interaction) but now as I grow more adept with my few patients, I have been taking on more patients, and more. It’s hard to know them as well now, often, just staying on top of their medical case is the best I can manage. Sometimes I yearn to spend more time with just a few patients…respond to all their “real” needs as well as the self-professed “real” needs, instead of triaging their professed needs myself. (For example, bleeding wound=real need. Fix it: clean, gauze, tape, presto-donezo. While, “I’m starving, I haven’t eaten in 18 hours, get me some food now,” is not a real need…I am sorry but it’s not, when the guy in the next bed is bleeding.) I want to respond to all needs equally, which is simply impossible in the ER. I have to make snap decisions, which clearly doesn’t please everyone. The flip side of wishing that I only had a few patients, is that obviously there are some patients that you would much prefer never even crossed the threshold… Luckily, there haven’t been many of those.

Sometimes it’s impossible to miss a special moment though. Yesterday, I had an elderly patient with a laundry list of geriatric problems — Alzheimer’s, Parkinson’s, new onset seizures, the works. Oh yeah, and probable pneumonia on admission. The wife (who looked much better, I might add, and at least 10 well-preserved years younger) claimed that her husband, on a better day (pre-pneumonia, I imagine) walked around the house a little bit, and even spoke occasionally. Pretty incredible to believe from what I saw lying on the stretcher. Nonverbal, limbs contracted inwards, shivering and weakened by illness, he was a full workup waiting to happen. He was in my care all day, while being screened into the ICU and then waiting for a bed to become available. While we drew labs, waited for results, started broad-spectrum antibiotics and gentle fluids, and periodically changed his sweat-soaked sheets, I watched the wife interact with her feeble and febrile husband. He never spoke, but she spoke to him and seemed very certain of what he needed at any given moment. She, dressed in a smart red suit with perfectly arranged hair, sat at his bedside for hours upon hours. And this is no private room either. The ER is full of incessant beeps, whistles and alarms, combined with a cacophony of human-emitted noise – complaints, moans, the works. It can’t be pleasant for a patient or a family member (not that I particularly care for it, either). Yet, she calmly and gracefully sat by his side and thanked us for all the care we provided, not once blaming us for the slow pace of diagnosis and admission to the ICU. At regular intervals when I checked on him, she would be stroking his forehead whispering gently to him, or rearranging his pillows and blankets, or spoon-feeding him miniature bites of applesauce. It nearly brought tears to my eyes, such tender and private interactions that I witnessed as my patient’s nurse. These are the moments that I live for and that I strive to reproduce as a nurse for my patients that have no one at bedside. If this patient had been all alone, I might not have known a single thing about him other than the details of his illness. But with his wife at bedside, I learned that he had someone who loved him dearly, and he probably loved just as tremendously in return. Learning these little tidbits reminds me that my patient is also a person, with a story all his own beyond the hospital stretcher. On a busy day, there isn’t often time to find out the stories of every individual, but it’s important to remember that they all have one.

 
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Posted by on October 13, 2011 in Emergency Room, Healing Spoonful

 

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