code blog: tales of a nurse

One of our duties as Nursing Assistant is Constant Care, where we sit (or stand, or run or walk) with a patient and watch everything they do, help them with everything and basically provide direct one on one care.

I'd been called to do a Constant Care on one of the more ruthless medical wards on the fifth floor. I told the Nursing Supervisor I'd be a bit late, mainly because it was a late request for a constant care.

Arriving late on shift (By only half hour, evenings start at 15:30) I get my assignment and head down to the room where my constant care is for the evening. The previous N.A. doesn't give me report on this person, and neither does the Charge Nurse. Even so, I go in and introduce myself to the patient. He's a very plesant old man, most likely somewhere in his late 60's early 70's. Quite young as far as health standards go. He's alert and oriented to time and place. He's able to remember my name and he's able to make coherent decisions on his own. When I got on shift, he was sitting in a Geri-Chair.

At about 5:30 he asks if he can go back to bed because he's feeling a little tired. I counter with "Well, supper will be up soon and I'm sure you'd much rather sit up in a chair for supper than be in your bed?" He agrees with me on this and instead decides to stay up in the Geri-Chair for supper. I asked him about his accent (As he was slightly hard to understand without his dentures, it made it doubly difficult when English wasn't his first language) and he tells me that he's from Austria and that he immigrated to Canada during the 1950's. Seems fair enough, I smile and nod, ask him a few more questions about Austria; What it was like, where were nice places to go, where's the grabdest city, that sort of thing. So over the course of dinner, he tells me about Austria, how he met his wife and how they moved to Canada. All in all, a wonderful story really.

At about 6:30, again he asks if he can go back to bed, claiming he feels tired. Me being the sympathetic soul that I was, asked the other aide in the room (There was another constant care in the same room as I) to help me get this gentleman back to bed. He's at least a two person assist and is very wobbly on his feet. After a great kerfuffle and production, we finally get him back in his bed and tucked in for the night. I still haven't gone for break yet, mainly because the floor was so busy with a heavy patient load that evening.

So my gentleman closes his eyes for a bit and starts sleeping peacefully. Half an hour later (At 7:00) he wakes and starts causing such a fuss and kicking up a storm, complaining that he can't breathe. Now, only being an Aide, I call for his Nurse. Breathing difficulty is not something I mess with, period. So I get him dangling at the edge of the bed, his feet almost touching the floor and I start to rub his back a bit, telling him to breathe in through his nose and out through his mouth and to relax a bit. The biggest thing about patients who cannot breathe is that they begin to panic. He does listen to me though, as I can hear him inhale shakey breath through his nose and exhale through pursed lips. He quietly asked me if he could lean against my hip, as he was "So tired", so I nodded and said he could and kept rubbing his back for him.

I'd hardly noticed anything was wrong until the aide in the bed next to me said: "Uhm...you patient is blue" and the Nurse at that moment walked in and called a Code Blue. This poor man that I didn't know anything about had literally died in my arms. They of course tried to save him, tossing me out of the way when the Crash team got there, but eventually they had to call it.

I still to this day am astounded on how quickly he went and how quietly he went. I see daily how many people die without their family members there to hold them, or have anyone there to hold them. Many of our elderly patients have no one left to call family or friends. But I was there for this gentleman, and he was listening to me even as his soul left his body. It provides me with a greater sense of acceptance knowing that he wasn't alone when he passed, That I was there providing him with some form of comfort, and that I was there to provide him with the emotional care that he needed. I rubbed his back, I held his hand, I told him that I was there and that everything was going to be alright.

I'll always remember him...and oddly, I can't even remember his name. I honestly couldn't understand why there had been a Constant Care asked for him. I found out later that the two nights before, he'd been rather unruly to deal with. Climbing over the side rails, being verbally abusive with the staff and generally being rather difficult to deal with.

I'm glad I got to see him when I did, I think it was better for him that way. I don't think he was confused about what was going on, I think he understood that he was going to die. It's strange how pateints have that moment of clarity and coherence right before they pass.

I just hope that when it's my time to go, that I have someone there for me and that I also have the clarity of mind to be at peace with what is going on.

Thanks to Kaylin!

I had one of those days a few weeks back, complete with two psych patients in our resident "Quiet" rooms (AKA Our Rubber room, where the potentially violent pateints are placed to avoid hurting themselves...or others.), one psych patient in our "Pastoral Care Room", one in the hallway (Yes Gary Filmon, Hallway medicine DOES exist) and Three Constant Care Psych patients in our "Re-Assessment" area. (We call it "The Pit")

So, not only am I dealing with the "Normal" patients who have come in for Chest Pain, Gastro-Intestinal Bleeds, P.V. Exams and Casting material, I get to run between 7 psych patients, helping the nurses deal with each patient respectively. Two of them are not too bad, sleeping when I'm on shift and the nurses weren't about to go in and wake them needlessly, but the other five...

The One in the hall is a little old lady who has had a stroke and has left side aphasia (In laymans terms, think Jean Chretien) and left side paralysis, needing a wheelchair to walk. Her doctor ordered Lasix for her (A pill that makes you pee until you can't go pee no more....and then you pee some more) so she was CONSTANTLY asking for the bed pan. We had to move her to our Shower Room so that she could use the pan in relative peace, then move her back to her spot in the hall. Funny thing was, she kept trying to "Escape" from the stretcher we'd put her in because she wanted to go to the bathroom on her own...even though she couldn't walk. She even fell asleep on the throne once or twice. Needless to say, we were up with her all night.

Our Pastoral Care guest was a "Frequent Flyer" for us. Someone who's been kicked out of going to Community Service Homes like the Salvation Army because he's either High on sniff or disruptive to the other residents. This man's personal care isn't the best either. I think he's also a diabetic because his feet smell something fierce...like a cross between cheese and moldy bread. He'd been in to see a friend of his who was brought in by Ambulance, but ended up staying until the local Police Detachment could come and get him. He'd been drinking (of course) and went to use the bathroom in our Stretcher Bay. I found him later when the cleaning lady (Housekeeping) had asked me if there was someone in the bathroom. Finding this guy passed out with his pants around his ankles kinda split me in three ways: Annoyance, Hilarity and Pity. This guy was harder to rouse than a patient on 10 mg's of Haldol or Ativan, so once I actually got a verbal response from him (Which consisted of some nasty words that shall not be repeated here for the sake of those poor sailors out there) I basically told him he had fifteen mins to finish up before I was going to turf him from my department. No word of a lie. Harsh, yes, but with patients like those you need to be tough.

Anyways, I come back fifteen mins later to find him passed out again on the throne. At this point, the nurses are getting slightly worried and the patients are justifiably nervous, so I make a call to the police department (Non-Emergent call center) and contact security to come and remove the vagrant from my toilet. Our psych Nurse (Who is an angel in disguise I tell ya) tells security and I to put him in the Pastoral Care room until the police come to get him, and give him a sandwich to tide him over. Well, Security and I had to DRAG this guy out of the can, but the moment he heard the word "Sandwich" he was walking, talking and heading towards the Pastoral Care room.

Our Third patient was a little old bird who was very slight and very fragile. She was also VERY demented. No really...she suffered from Dementia. Problem was, she couldn't tell us when she had to go to the bathroom, and she couldn't walk to the bathroom either. The Nurse gets the bright idea to give this lady a foley cath instead. They'd already tried on the previous shift to get a cath in this lady, but apparently she pinched, scratched, bit, hit, punched, swore and kicked up such a fuss that they couldn't landmark properly to get the cath in.

So, I not only hand to hold her hands down to keep her from hitting the nurse, I also had to hold her leg open so that the nurse could see what he was doing. This pateint started off near our the end of the bed. By the time we got the cath in, she was nearly falling out the head of the bed. She'd also pinched me a couple of times, and swore so bad that she made ME blush (and I was in the Army for six years).

The other two weren't so bad. They were actually quite pleasant to deal with and very understanding. I think they were trying to jump through the hoops so they wouldn't be thought of as nutters.

I now affectionately refer to that day as "The International Psych Patient Care Day"...

and people ask my why I hate dealing with psych patients.

~Kaylin

The elderly didn't bother me per se, but neither did I think I'd get enough experience for when I went to nursing school. Little did I know that I would meet some of the most wonderful people, both coworker and patient.

Two that stand out are "Rosie" and "Harry." They were husband and wife and were on our floor at the same time; she for a rehab'ing a broken hip and he for end stage cancer. They shared a room and were the sweetest people I can remember meeting.

Rosie was so tiny that when she sat in a wheelchair, her feet never touched the footrests. Harry would forever thank me for anything I did for him and constantly listened to jazz tapes. He was at the stage where his appetite wasn't very good. He'd never eat the hospital food, but his family would bring him chocolate shakes and fast food from Subway, which he would nibble on a bit.

Rosie also had Alzheimer's. She was definitely forgetful, but sweeter than sweet at all times. Whenever she saw me, she'd take my hand, bring it to her face and tell me what beautiful skin I had. Consequently, although she never minded having Harry in her room with her, she almost never remembered that he was her husband of 50+ years.

One day, Rosie was up in her wheelchair, legs dangling and all, and I rolled her by Harry's bed. He looked up at her and said, "I love you, babe." She looked at him almost lovingly, then peered up at me with this look that some Alzheimer patients have - sort of a cross between "do I know this person speaking to me?" and "are you going to answer him, or shall I?" Finally she glanced at him again, shook her head a little and said, "Poor guy - so skinny!" and giggled.

He just smiled. She was pretty irresistible when she giggled.

She was constantly asking me if she could recite the Lord's Prayer. Because I was a nurse's aide at that point, and a kind of new one at that, she scared the bejesus out of me (ha ha! that was a pun!). I had simply not run across someone so blatantly creepy before.

One day I walked into her room and was almost beaned by a flying stuffed animal that she'd had on her bed. I glanced at her; she was sitting calmly looking at me with those eyes. I asked her why she threw the toy, but she didn't respond. When I went over to pick it up, a Kleenex box landed about a foot away from me. Great. Creepy AND stealthy.

I was assigned to her the next day as well. When I went in to feed her lunch, she was especially ... chatty. After asking me if she could say the Lord's Prayer for the 10th time, she then looked across the room at a crucifix hanging on the wall. Her eyes widened as she looked back at me.

She got very quiet for a moment and took a few bites of lunch. Then she asked if I could get her that crucifix off the wall.

Dude, I was born at night, but it wasn't the night before. After her little demonstration the day prior, I wasn't about to give her anything more lethal than her little stuffed animal. So I told her that I wasn't able to give her that crucifix. She was very suspicious of this. I went over to the wall and faked trying to pry it off. When she was at least half satisfied that I wasn't lying, she said, "God will tell me the truth" and proceeded to level me with that eerie gaze.

I hope He understands.