Jennifer, RN writes:

My name is Jennifer, and I am a staff nurse. Every day I enter the revolving doors at the hospital, and I am presented with a new set of challenges and experiences different from the last. Little did I know that one day in late November I would have the opportunity to care for a very special person who was facing the most challenging crisis of his life.

In report I listened to words like, “tough,” and “not very friendly,” and quite honestly I was a little apprehensive to enter the room of this angry man. “Bob” is a man in his mid 40s who has spent the greater part of the last five years in the hospital. Diagnosed with cancer and AIDS he has endured more testing and operations than most of us will experience in a lifetime. Bob was admitted with a high fever and cough to rule out tuberculosis and had been assigned to the isolation room on the unit.

I entered the anteroom, gowned and gloved. I peeked through the glass to see a frail man covered up to his chin in a mountain of blankets, shivering. I put on my respirator and entered the room. While I realize the importance of wearing the mask, there’s something about it I hate. It creates one more barrier between the patient and me. Facial expressions, especially smiles, are hidden away. There is something so impersonal about caring for a patient on precautions. Being “locked away,” as Bob called it, being approached by people protected by shields so they can’t catch whatever infectious disease is suspected. All of these thoughts came to mind as I knocked gently on the door and entered the room.

The room was cool and the whir of the ventilation system was enough to drive anyone crazy. Bob barely stirred as I touched his arm with my gloved hand and introduced myself. It was quite apparent I was looking at a gravely ill man. Emaciated and weak, Bob reluctantly cooperated and allowed me to complete my assessment.

When breakfast arrived I made sure that I brought him his tray right away. Often, patients on precautions get overlooked as their trays wait in the anteroom getting cold. Bob didn’t have much of an appetite, but he asked me for some extra jam for his toast. Although he didn’t say anything, he seemed surprised when I returned a minute later with three different kinds of jam. A few minutes later, he called me in again. He needed to be washed and have his linens changed. As I washed him, I could see the disgust in his eyes. This was not something he wanted or something he did for attention.

As the morning wore on, I sensed that I was gaining Bob’s trust and began to try to talk to him about his treatment. It was obvious from the beginning that Bob was beyond frustrated; he was losing all hope. He was fed up with hospitals, blood tests, doctors and nurses. He just wanted to go home. But he lay motionless in his bed, “a prisoner.”

After lunch, I entered the anteroom and looked in on Bob. He sat staring at his full lunch tray. I was wearing my usual attire that day, some silly scrub top with cartoon characters on it, my hair in a ponytail. I knocked on the anteroom door, surprising Bob, and gave him a silly wave and a smile. No mask, no gown, no gloves. Through the glass, I saw a hint of a smile. I motioned for him to eat… eat… eat! He responded by lifting his milk and taking a sip. I felt I had made a bit of progress.

I had been away for at least a half hour when I saw a commotion at the nurses’ station. Three Security guards were outside of Bob’s room! I immediately felt a surge of adrenaline and rushed to see what the problem was. Bob had called the local police from the phone in his room and threatened to commit suicide.

I was far from shocked, however, I was slightly disappointed that he hadn’t confided in me. We had spoken earlier of his discouragement, but never to that degree.

As I entered Bob’s room, the guards went on their way and I was once again alone with Bob. I sat close to him on the bed as I had earlier that morning. He sat on the edge of the bed, bent over, head down. He was so frail, so sick, so thin. I didn’t know where to begin so I just sat. I sat in silence with him for a couple of minutes with my gloved hand atop his cold, bruised, hand. Finally, I said “Bob, why didn’t you call me? I would have come right away.”

He just repeated over and over, “I didn’t know what to do. I just didn’t know what to do.”

When a person threatens to commit suicide, it is very serious, no matter how unrealistic the threat is. It didn’t matter that Bob didn’t even have the strength to lift a fork. His threat was real. I stayed with him for two hours, gowned and gloved from head to toe. As the beads of sweat began to form beneath my mask, I was finally able to begin to gain a better understanding of Bob. The bitterness and anger he had been displaying to the other nurses seemed almost justified.

Bob had come to grips with the fact that he was going to die. It was inevitable, and it was going to happen sooner than he had allowed himself to believe in past hospitalizations. He had already refused any treatment for AIDS, and he was now beginning to refuse treatment altogether. We talked about this and what it meant, not only to him but to his family. After all, it was his 81-year-old mother who was “suffering the most,” being forced to watch him wither away. He said he wanted to “go quick,” so that his mom wouldn’t have to watch him suffer. In fact, he was not afraid to die; he was more afraid of the pain he was causing others.

Shortly thereafter, Bob was seen by a physician who ordered that he be placed on one-to-one supervision, meaning someone would be with him at his bedside at all times for his own safety. I completely agreed. The physician pulled me aside and told me she felt it was necessary to put Bob in soft restraints so that he would be incapable of physically hurting himself. A sense of anxiety came over me. Was I going to have to go back in that room and tie an already hopeless man down? What would happen to the relationship we had formed? I could not and would not do it. I told the physician how I felt, and together we discussed alternatives. I told her about my experience with Bob and the behavior he had been exhibiting for the last ten hours. I told her I didn’t think restraints were the right therapeutic intervention for this patient. If the physician felt it was necessary to apply restraints, she was going to have to go into that room and put them on herself, because I could not bring myself to do it.

We entered the room, and I have to admit, I was starting to get emotional, even angry. Thankfully, Bob was able to make a verbal contract with us, assuring us that he would not attempt to harm himself. It was that easy. The restraints were put away and I settled down.

Bob stayed for the rest of my shift under the watchful eye of a sitter. Before I left for the night, I stopped in one last time to say good-bye. I wouldn’t be back for a few days, and I thought Bob would be moved to another unit by the time I returned. I asked the sitter to take a break so Bob and I could talk like we had earlier in the day. Bob asked if I would be back tomorrow, and I honestly felt a bit of sorrow when I said no. I could tell he was disappointed, but I knew I had made a difference that day. I put my arm around his shoulder and gave him a squeeze. He looked at me and said, “Thank-you, Jennifer.” As I left the room, I heard the thud of the heavy doors and turned and waved good-bye.

I received this email from a dear friend of mine recently:

Hey everyone!

So,  for the last 2 1/2 weeks my husband and I have been seranaded with alarm tones every day.  We thought it was the new alarm system we had installed (it does a lot of automatic things we have since disabled), then we thought it was the smoke detectors…a new ringtone on our iPhone?… the battery charger on his new bike…his computer when his e-mail was hijacked?…the battery on my bike mileage computer?…my new alarm clock?…the refrigerator ice maker?…the clothes dryer? …everyday we checked everything, and everyday we thought we had found and fixed the culprit, until the next morning when we would hear it again!

It was not until yesterday morning when we figured it out… can you guess?

It was coming from my husband’s chest!  The battery on his pacemaker/AICD was alarming to let us know that he was just about out of juice!  Four years ago they told us we would hear that when the battery got low, but that was a very long time ago…and it just didn’t sound like it was coming from him!  We sent a modem transmission, and the doctor called back to say, “come on in!”

After talking with my friend later, I found out that her husband had his pacemaker replaced and all is well.  It took about 2 weeks to figure out where the alarm was coming from, since it only sounded once a day and only for about 20 seconds at that.  My friend expressed disbelief that it was so hard to determine that it was coming from her husband but surmised that going through body tissues helped the sound disperse enough to make it a mystery!

This left me wondering if any of Dr. Wes’ patients have had similar trouble with figuring out that their chests were alarming!

When University of Louisville nursing student Nina Yoder blogged about her experience watching a patient give birth in a post entitled “How I Witnessed the Miracle of Life,” she may have thought she was just blowing off some steam. Well her school saw things very differently.

When school officials read Yoder’s post, which included a description of the baby as a “creep” and “a wrinkly, bluish creature, all Picasso-like and weird, ugly as hell, covered in god knows what, screeching and waving its tentacles in the air,” they moved to expel her from school by calling her into an office, searching her for weapons (apparently because Yoder had separately blogged about her support for the Second Amendment), and informing her she was no longer enrolled at the school.

That’s right. No hearing, no notice. Expelled from nursing school for blogging.

Not surprisingly, Yoder sued the nursing school in federal court for reinstatement–and won. U.S. District Court Judge Charles R. Simpson III ordered that Louisville reinstate Yoder because her blog didn’t violate the school’s honor code, confidentiality provisions, or principles of professionalism; the judge concluded that although the post was “crass and uncouth” and that Yoder’s attempts at humor were an “abject failure,” it wasn’t written in a professional capacity or from the view of a representative of the nursing school.

The school had argued that Yoder broke confidentiality principles and the school’s honor code by disclosing “the following identifying information about the birth mother: the number of her children; the date that she was in labor; her behaviors; the treatment that she underwent (an epidural); her reaction to labor (vomiting); and the reactions of her family.”

The court rejected that argument, though, finding that such information was non-identifying; types that would be considered identifying, according to the judge, include “the birth mother’s name, address, social security number, or the like….age, race, or ethnicity….‘financial’ or ‘employment related information’ [and] where she was in labor.”

Yoder maintains that her blog post (and others, such as those in which she mocks a suicide patient and calls alcohol abuse “a choice”) “is a mixture of fiction and satire, aimed to be an emotional relief from daily stress.”

Well Yoder won this round in court, but what do you think? What should students in RN programs be allowed to blog about? Did Yoder cross the line?

Guest post by Michelle Fabio, About.com Guide to Law School and frequent contributor at LegalZoom.com.

My particular take on this is that she crossed the line.  I’m not sure that she crossed it enough to be expelled without due process, though.  She was technically within the lines of HIPAA and thus did not break any laws.  But there are more appropriate ways of letting off steam.  Others will probably disagree with me, which is fine.  I personally found her comments very unprofessional.  -ed.

Nicole writes:

Doctors in general are type casted to fit a certain mold of the friendly family-man who helped you when you were a child.  You typically grow up with this mental image of your first pediatrician and the way he gave you lollipops when you behaved yourself during traumatic incidents like shots.  Doctors have typically been painted in the light of a saint, because for many people around the world, they have served to offer them a bit of humanity when the rest of the world turned their back.  The doctors who have helped treat patients in Haiti, African nations, or even war and poverty-stricken area are some of the most outstanding individuals that modern society can produce.

One of the first books I read in college was entitled The Rape of Nanking, which chronicles the destruction that the Japanese army caused on the Chinese city of Nanking.  Some of the main stories that stood out to me at the time (other than the fact that this huge massacre goes largely unnoticed in history books) was the account of the many Western doctors who offered their services to the residents, risking death in order to stay with their patients.  Once the war fully broke out, most foreigners fled the city, although around 25 remained in order to provide some protection for the citizens, establishing the Nanking Safety Zone.  The Zone itself was centered around the U.S. Embassy and was run by Nazi Party member John Rabe who was responsibility for saving nearly 200,000 Chinese citizens from death.  While this is an example of an old historical event, it is still a telling sign of the dedication to many of these aid workers; the Westerners who remained in this zone were true humanitarians who risked death every day in order to provide their services to Chinese refugees.

These types of scenarios are still occurring around the world, with more and more doctors opting to work in non profit sectors, thereby bringing aid to disease ridden nations.  Zimbabwe is one of the African nations which contains a multitude of illnesses with no funds to combat them; Doctors Without Borders “is an international medical humanitarian organization” which helps assist citizens who live in areas like Zimbabwe where diseases run rampant without government interference.  This non-profit organization was created in 1971 in order to help people around the world who are plagued by epidemics and violence; many third-world countries are unable to sustain their own populations and are in desperate need of such aid.  Zimbabwe itself is currently amidst the deadliest cholera outbreak in two decades because of the lack of proper sanitation and water supplies.  Many doctors around the world have flown to such places, leaving the comfort of their Western way of life, in order to make a difference in the lives of these people who have been driven to the brink of survival.

While these specific descriptions of doctors are no longer what many people around the U.S. imagine when they bring up doctors, it still holds firm to my own beliefs.  In a country where there are more lawsuits against doctors than praises for them, we need to remember that the entire purpose of a doctor is to save lives; this may not always be the case because of drastic circumstances, but they are true saviors in a time where many countries need them the most.

This post was contributed by Nicole White, who writes about ultrasound tech schools. She welcomes your feedback at Nicole.White222 at gmail.com

I don’t really read poetry… but this is the first poem to be submitted as a story to codeblog and I actually kind of liked it.  Richard Greenall writes:

Mine is not a story as such but a poem about a woman I cared for on m general ITU who had suffered lung trauma after smoke inhalation.

Weariness, like a wave,
Cascading through my head.
Causing thoughts, too deep to voice,
To be thrown up deep inside.

Awake! A cold rush of air to the lungs,
Feels good to breathe,
In… and out. In…. and out.
So easy, calm… effortless.

Beside me she lies there still,
Looks calm – thoughts racing inside.
What has life come to?
A monitor and peering eyes.

If she could talk, what would she say?
Will I get through this day?
The power of life, the call of success
Would make my answer, a sure yes.

Copyright Richard Greenall 2007

Lindi writes:

I’m a young nurse who works in a Pediatric Cardiac ICU.  I live in a house with three other roommates who all work hard but I don’t think they have any idea what my days are like.  It is refreshing to see 20-somethings act like 20-somethings, burdened only by the chain linked fence that will replace our rustic wooden fence in the back yard… And not by the child that just died today.

I return home from what should have been an easy day at work with a patient who remained in the ICU for some HFNC. . . . Enter an 18 year old mom.  This mother has been in the hospital for 5 months with her first born.  She is proud of what she has learned and is very comfortable with the equipment on her daughter.  She makes comments like “don’t you think I should be a nurse?”  I encourage her but in my mind I think about how much she needs to learn about her own daughter first.

She calls me at 1130 am for an update on her daughter.  She confesses that she just woke up.  I politely laugh and give her an update.  Her daughter finally gets to sleep when she arrives with the baby’s father.  I tell her she just fell asleep but she goes in and tries to wake her.  Talking loudly.  Lifting the baby’s arms up.  Turning the lights up.  Putting a cellphone up to the baby’s ear. “Your daddy is here! Wake up, you haven’t seen him in a while!”

Sure enough the baby wakes up, crying.   “Nurse she is awake and I think she needs her diaper changed.”  Frustration hidden with a smile I change the diaper.  I explain that in an ICU infants need their rest.  It is important to their recovery and growth. (Shouldn’t she know this after 5 months?  I think to myself)  With nothing but attitude she asks why her daughter is naked and not wearing her onesie.  I explain about her getting warm with a low grade temp.   While on my lunch break she has another nurse help her dress her little princess.  Sure enough her daughter overheats, spikes a temp, and now has to be pan cultured.  For 2 hours we stick needles into her without any success.  Mom stands there telling us we need to stick her in the forehead because that was where they got blood from her before.

Meanwhile, the child is naked again, fever gone.  Her temp was most likely environmental since her WBC were trending downward and she had no central lines… chest was closed and healed. We are torturing her child and she continues to tell us what labs we need to draw, how to draw them, what lights are to be dimmed, what the signs of infection are.  It is exhausting dealing with this woman.  I understand that parents feel helpless and having any sense of control over their child’s care makes them feel better.  But this woman needed to be a mom and not a nurse.  I am kind to her, although I really just want to call her at 5am when I wake up, put a cell phone to her ear, cover her in blankets and stick 10 needles in her forehead and  see how she felt about all of it.

At home my roommates laugh in front of the tv.  Talking about things that amuse them.  I enter a little high strung wondering about a crock pot that had been cooking since the night before.  I am asking questions trying to figure out if it had ever been cooled.  I realize their food poisoning was not that big of a deal.  Let them laugh about co-workers, eat spoiled food, and be 26 years old.  It might rub off on me and relax me.

Cat writes:

First, I’m not a nurse. But I wonder what you think of this (and this is NOT a criticism of anyone–just an open question.) My Mom is on a Telemetry floor after passing through the ER and ICU. She went unconscious during the night. Her BP fell and she was found to have double pneumonia. She has had congestive heart failure and spinal stenosis for several years. She has very limited mobility (sits and sleeps in a recliner, can still use a bedside commode with assistance.)

Okay, so I’ve been wondering why she’s in so much pain. I’ve asked every nurse that has come on shift (not in a pushy or rude way, either). I have carefully explained that I have never seen my Mom in this much pain, and she is not a complainer–but she’s complaining non-stop. She whimpers, cries, pleads and begs for help. Well, this has been going on for over 10 days. Today, they noticed her leg was rotated out and took an X-ray of her hip. Yup, she has had a broken hip for probably the entire time she’s been in the hospital. How did this happen?? (Or rather, why have my questions been ignored?)

I even had one nurse sit with me for 45 minutes and, I have to say, very patronizingly “explain” to me that Mom’s pain, while real, was exacerbated by her anxiety and lack of trust. (Hmmm….wonder how trusting I would be of people who were torturing me–or so it probably seems to my poor, confused Mom.) Let me just say here, I don’t blame any of the nurses. In fact, I believe they are some of the best I’ve ever seen. So my question to you is, how does something like this happen? This is a state-of-the-art hospital which has received national recognition as one of the top hospitals in the country. Yes, I know that “things happen” and sometimes, that’s just the way it is. I guess I am frustrated and wonder what your opinion is (you, the nursing community)? Do you believe nurses don’t listen to family members? (The condescending nurse assured me that she could “see” that Mom was not in “that much pain.”)

I hope I don’t sound like I’m blaming the nurses. Is there anything I could do so that this doesn’t happen to someone else? I can’t imagine having an untreated broken hip and being shifted around continually, being given physical therapy, etc.? (Mom was on decent pain meds, but still…) Do you think elderly patients fall through the cracks?
Okay, I’m done. Thank you for any feedback. I genuinely want to know what you think, and I hope I haven’t offended anyone. Incidentally, my Mom was a Registered Nurse for many years. I feel sick at seeing her treated (even though unwittingly) like this.

————————————————-

I’m very sorry that you and your mom have been going through this.  It has not been my personal experience that a broken hip would go undiagnosed for 10 days.  I find it astonishing that absolutely no one noticed that your mom’s leg was rotated.

Of course we as nurses encounter family members who want to advocate for their loved ones.  Sometimes they can be overbearing with concerns that are fairly unfounded.  But when I hear stuff like, “She isn’t a complainer, I’ve never seen her in so much pain before,” it sets off warning bells in my mind that something is really wrong.

I do think that elderly patients fall through the cracks on minor issues, but I’m surprised about your particular issue.  Can you imagine if she’d had no one advocating for her?  No family around?

Thanks for the submission.  I hope other nurses who read this will chime in with their thoughts.

“Zookeeper, RN” writes:

I am an RN at a very large public safety-net/regional trauma center/teaching hospital. It is a very interesting place to work as a nurse as there is always some kind of drama going on. I work on a medical floor where we see lots of infectious disease (HIV, MRSA, VRE, TB, c. diff, you name it), complications of IV drug use and booze, diabetes, renal failure, and many psych co-morbidities. As we are a public safety-net hospital, we see a lot of the same people over and over again because, well, no one else in town will take them.

One such gentleman we see quite often, we’ll call him Sammy, was assigned to me recently. Sammy is what happens when you drink too much for waaaay too long. His liver is shot and all those toxins that a healthy liver would filter out have permanently damaged his brain, so he’s confused, but pleasantly so. He’s yellow as a banana, and he has a history of leaving AMA (against medical advice) – he often will just get up and walk out. Which is another reason why we see him over and over. But I digress.

So Sammy is my patient. He wanders a lot, around and around the unit, talking to people and going into other patients’ rooms thinking it is his . On this particular admission Sammy has been wearing a flowery silk kimono over his hospital PJs. It’s kind of dirty but he refuses to give it up and I have 9 zillion other things to do besides argue with Sammy about his wardrobe. During my shift, one of my other patients codes, so I am tied up for a good hour or so. When I am done, I go check my other patients. Can’t find Sammy. I check all his favorite hang out spots – no Sammy. I have him paged throughout the whole gigantic hospital – he does not come back. I call Security and they look for him (”Oh yeah! We know Sammy” they say) – no dice. I am starting to think he has left AMA again. The ER is screaming at us because they have 50 people in the hallway down there that need Sammy’s bed.

We are about to give the room away when our unit secretary answers the phone. She starts laughing. She’s laughing so hard her mascara is running down her face. She looks at me and says “It’s for you.” I pick up the phone to hear “This is Officer So-and-So from Central Booking. Are you missing a man in a kimono?” As a matter of fact, I am, I say.

Turns out, Sammy did indeed decide to blow that popsicle stand and walked out of the hospital. He wandered up the street to the nearest drug store, where he was promptly arrested for shoplifting. Now, keep in mind he kinda stands out – his skin is day-glo yellow and of course, there’s the splashy kimono. (Side commentary: WHY do we bother arresting this guy? He can’t tie his own shoes let alone summon enough brain power to plot a crime. Total waste of taxpayer money). Anyway, down to Central Booking he goes where someone at last notices the hospital PJs and his ID band and give us a call.

An hour or so later, Sammy returns to my unit wearing a new outfit: a bright orange jumpsuit and carrying his kimono in a little plastic bag (very sad!) I ask him if he is all right. He looks bemusedly at me and says “Well sure hon, why wouldn’t I be?” I explain he left the hospital and was arrested. “I was?” he says. “What did I take?”

At this point I am thinking Sammy has suffered no injury from his adventure. And then he asks me for a sandwich.

Anne writes:

A friend once said that if you throw enough putty at the wall, something’s bound to stick!  Well, here’s some unedited putty.

I’d been practicing nursing for 20+ years when I was diagnosed with lupus and fibromyalgia and there was a nasty bout with previously well-controlled epilepsy. I needed to stop working, stop practicing my chosen profession of nursing.

I began freelance writing to occupy my time and found instant success and satisfaction; hey, I had my own byline and received pay, (albeit poor), for articles! This was life affirming, and at the same time invalidated feelings of low self-esteem because I was no longer able to work in nursing.

Several years later, a new clinical editor was unable to increase my compensation for a column that I was editing, so she called to offer me a place on the magazine’s masthead instead. However, before doing that, she needed to do a routine background check and call me back.

I’ll never forget that telephone call. “Were you aware that your license is no longer active?” I hemmed and hawed a bit, then then realized the unpleasant truth. I had moved from one state to another and planned to apply for reciprocity in my new state – but forgot.

I felt naked and numb all at the same time. This license was part of my identity!  As a result of my forgetfulness to renew my license, I was stripped of a title (RN) although no one could take away my degree (BSN).

In spite of the fact that I believe once you’re a nurse you’re always a nurse, I’m no longer registered and I can’t say that I belong to that larger collective of Registered Nurses. I’m not like ‘one of you’ anymore. I never thought that losing a license could make me feel so small and so humble and insignificant.

I don’t usually post this kind of story submission, but it does ring a bit true.  I do know preceptors sometimes have a difficult time providing feedback to their preceptees at the end of the shift, only to spring problems and issues on them later.  Anne, RN writes:

It was toward the end of my orientation as a new grad when I got a message from my day shift preceptor, wanting to know “how orientation was going.”  When I called her back she proceeded to tell me a long list of everything I had done wrong over the weekend with my night preceptor.  I was at home on the phone and she was at work talking to me, so I felt backed into a corner.

Meanwhile, over the weekend, my night preceptor told me I had done a great job as she scrambled onto the elevator to go home. I had given an antibiotic late on Saturday night and I had acknowledged it and the next day made sure I gave it on time. My night preceptor told me when I acknowledged my lateness not to worry about it since nurses that have been working for 20 years forget things sometimes. So I thought nothing more of the situation, that is until I received this phone call.  On her long list of things I had done wrong was that I gave this antibiotic late. Her other criticisms included only giving IV pain meds when the patient had PO ordered, meanwhile my night preceptor had told me that since the patient was NPO i shouldn’t give them because it would make her sick.

Then she proceeded to blame me for another nurse’s needle stick, which she later apologized for. She also said that people were saying that I didn’t care and that I always looked bored, which is completely not true. Most nurses go into nursing because they DO care. After 8 weeks how do other people think they can judge you on something so personal?  I had a lot of respect for my day preceptor until that day when she backed me into a corner, since then I can’t think of her in the same light as I once did.

My night preceptor was awful as I am sure anyone can tell, always giving me positive feedback and going behind my back to tell others that I was awful. On my first night shift with her she was talking about sex half the night, which made me extremely uncomfortable and as a new person I didn’t think I could say anything. Luckily my night preceptor has since left my floor but I still have to see her on occasion and my day preceptor has an important position on my unit.  I wanted to share my story because I think it is a great example of how nursing eats their young.  There were many nights when I went home crying and wanting to quit nursing.  Nursing is harder than I ever thought in nursing school, but I am a tough person and I have since successfully completed 3 weeks on my own!

And since it’s been over a month since I received this submission, hopefully Anne is now off orientation and doing well!