Friday, July 25, 2008

Time Passages

How quickly it all goes by sometimes when you're not looking.

Or even when you're looking right at it.

What do I mean? Just this - not so long ago, I was struggling through nursing school - well, OK, pretty much coasting, to be honest. Not that it wasn't hard, but I didn't really have that hard a time of it. It just took a lot of time, effort, and study.

Suddenly, it was over, and I was sweating NCLEX.

Then boom, that's done - and we're packed and moved to a new city for my first job as an RN.

Then the whirlwind rush of getting unpacked (which My Loving Bride took care of, mostly, bless 'er) and getting oriented to the new job.

The ICU skills course, and all the extra course work. (And I thought school was over. Ha.)

Now I'm looking at my BSN program for the Spring term. Yeah, I like abuse. So sue me.

And somewhere in between all of this - my little girl, Rebekah, joy of my life and delight of my eyes, the Sugah Puddin' - went from this:

To this:

Where the hell was I?

Note to self: don't miss things - the clock doesn't run backwards.

Tuesday, July 15, 2008

Interventions and Outcomes

It's terrifyingly easy to become so task focused that I forget just what the purpose of all this work is. Tonight's patient was Mr. Blank- and like most of the NSICU patients, he was trached and on a ventilator. Unlike my assignments so far, he could nod in response to your questions to answer 'yes' or 'no', follow complex commands, and move his right arm and lower extremities. In short, Mr. Blank was alert and aware. He was also a train wreck. LGIB, dumping pressure so he was on Neo-synephrine, tachycardic so he was on diltiazem, blood hung, plasmalyte hung, IV fluids just pounding into him (in spite of generalized edema and a history of HTN - don't ask me.) Plus antibiotics, calcium replacement - and really, it's not a lot of drips, actually. And naturally, there's stool - oh, lordy, is there stool. Hourly. You can set your watch by this guy's bowel movements. Liquid, black, melena - such fun to do linen changes with all these lines, and the trach, and the vent ...

So about halfway through the night, as we're cleaning this dude's butt for the umpteenth time, and I'm thinking towards what task I have to do next, I happen to look at his face. Now don't get me wrong, I've assessed his pain, I've assessed his responsiveness, I've talked to this patient all night. Told him what we were doing as we did it, asked him about his pain, reassessed after each intervention, etcetera - straight out of Perry and Potter, baby. But I looked at him - at his eyes, at the one lone tear he let escape him at that moment - and connected in a way I hadn't imagined possible. I realized suddenly how all of this must feel to him - and I was ashamed.

We do a whole lot of stuff - and most of it is really good for the patient. It's all intended to help the patient. It's all designed to create the best possible outcome for the patient.

But somehow, in all this task- and goal- oriented stuff - it's easy as hell to lose the patient. Not physically, not clinically - but in a more critical and less tangible way.

Today I stopped caring for a patient and started caring for a human. I was humbled, and awed at what I was allowed to do. Not technologically - but spiritually. I held that man's hand, squeezed it tight, and said "I get it. We're doing our best for you. And please don't think that we don't know it's you under all these tubes and wires. Hang in there - we do care. I care." And he wouldn't let go of my hand for quite some time.

And in some ways, he's still got it.

Sunday, July 13, 2008

Fumbling toward competency

Note to self: next time you think you're knowledgeable, confident, and oh-so-smart ... shutdahell up.

My official start date was 28 days ago. On that Monday I walked into my new position as a Neurosurgical Intensive Care RN - fresh out of nursing school, the ink still wet on my license. But hey, ten years of experience as a Paramedic counted for something, right? I at least knew how to talk to, approach, touch, assess a patient, right?


Three weeks before I even saw a patient. Didn't even lay eyes on one till then - spending my time in classroom study, computer modules, competency testing ... til my head spun. Then - the day.

I actually get to do a floor shift. Cool! Here's what I've trained for, gone to school for, done all that clinical time - plus my experience in prehospital care and in the ER ... YES! Now I can finally start to do patient care!

Um. Hey. Is there a patient, in there, under all that machinery? And, um, I seem to have forgotten which way to turn the stopcock on the a-line when I zero it oh crap there's blood on the sheets I need to change the linen can someone help me turn the patient hold the tube mind the vent lines watch out for the ventriculostomy rezero the ICP monitor chart those vitals did you give the 9PM meds crud is it 1045 already what's the urine output I need to send off an osmolarity someone help me get him down to CT rezero everything again draw an ABG good waveforms neurochecks okay and damn did I forget anything here's report at 1500 ....

And this was a light assignment. With a lot of help.

Oh man, can I do this?