… then it is important that others lie for him.

This is the infamous story submission from Bongi, submitted to me a whopping 5 years ago. Bongi is a surgeon that blogs at other things amanzi, which is easily one of my favorite blogs.  Read on:

i was working in a private casualty unit to make extra money during my surgery training. (don’t tell the prof. it was strictly forbidden. one day i’ll post about the time i got caught.) it was some ridiculous hour. i was catching a nap when i was rudely awakened. the sister said an ambulance was expected to arrive in about 5 minutes with a possible epilepsy patient. i dragged myself out of bed. a medical case! absolutely wonderful. and at this time of the morning. just the thing to warm a budding surgeon’s heart.

i stumbled into resus just as the ambulance crew came casually strolling in with the patient. they told us they had been called to fetch the guy from work where his colleagues said he simply collapsed. they didn’t know why. something was wrong. he was restless. he was also pale. i felt his pulse. it was thready and fast. very fast. he had no drip up. being surgically minded, i thought that if i didn’t know better i would say he was bled out. fortunately the ambulance crew could tell me that his colleagues at work told them that he had been working in a dairy cold storage facility when he simply collapsed. i asked if there had been convulsions. they didn’t know. meanwhile one of the sisters was getting a blood pressure. 80 over 30 didn’t fit with epilepsy. a quick glucose test was normal. the only alternative was cardiogenic shock from myocardial infarction or some exotic dysrhythm. but once again, it didn’t fit. the patient was black. (white south africans have about the highest incident of ischaemic heart disease in the world, but south african blacks don’t have much of it at all.) then it happened. the patient, now gasping for every breath looked at me and said, “help me doctor! i’m dying!”

if you’ve been in medicine for a while you’ll know that most times, the reason a patient says he is about to die is because he is in fact about to die. i believed him. my blood went cold. it just didn’t fit. i wanted to tell him we’d do everything we could (although i still had no idea what i was capable of doing for him). in a reassuring way, i placed my hand on his chest. with every breath i could feel bones grinding against each other. i pulled my hand back in shock. he had broken ribs!!! epilepsy or cardiogenic shock or some heart problem does not cause broken ribs!! this was trauma! this was surgical! i jumped into action.

at that moment, the patient breathed one terminal gasp and promptly stopped breathing. for good measure his heart stopped beating too. nice bloody epilepsy, this, i thought. i delegated one sister to start cpr and another two to get iv access as i moved to the head to get airway control. the sister pumping the chest immediately stopped.

“everything is crunching under my hands” she said. what could be done? circulation is fairly important for survival, so i told her to continue. at this stage i was intubating. as i inserted the laryngoscope, fresh bright red blood came frothing directly out of his trachea. the trachea was also way over to the right. i shouted for someone to prepare an intercostal drain and slid the et tube in. the sister was fast. by the time i moved around to the left flank, the set was ready. i stabbed the blade into the chest. there was a gush of old dark blood. i shoved the tube quickly between the ribs into the pleural space. immediately one bottle filled with blood.

we consolidated. the patient was on a ventilator. two lines were running full tilt. with a touch of adrenalin, the heart started beating again (although i think the removal of the tension hemothorax also had a part in that). we got emergency blood going and got x-rays. we also called the thoracic surgeon.

the x-rays showed the worst disruption of the thoracic cavity i have ever seen, before and since. every rib on the left was broken and the fractured surfaces were about 5cm from each other. this basically meant there was a tear of the lung from top to bottom which was about 5cm deep. i gingerly reflected that that would explain the constant stream of blood draining from the intercostal drain.

as could be expected, the patient decompensated again. this time there was no bringing him back. when the thoracic surgeon arrived, the patient was already dead.

as usually happens, the story did come out. what the patient and his colleagues didn’t know was that the cold storage facility where they worked had closed circuit tv. this was probably to prevent night staff from stealing. or maybe to prevent them from racing around on a fork lift chasing each other. yes, dear readers, that is what they were doing when one of them lost control of the fork lift and drove into my patient, crushing him up against a pole. they figured they were in trouble already, so it seems they decided the depth didn’t really matter. if you are going to be in crap for messing with the machinery at night and for killing your colleague, then why not lie also to really confound any chances of the paramedics and the doctors to try to save his life. go figure.

Recently, someone asked if they could use my logo on their brochure (neat!!).  I gave permission, then realized that maybe it would be nice to have a real logo.  I asked a dear friend of mine if she wanted to work on it and she agreed.

So what you see there at the top is the new logo!  I absolutely love it.  I think she did a fantastic job, and I wanted to give her credit here!  Her name is Meg Pike – this is her website, and this is her Facebook page.  Thanks Meg!!  It’s perfect!! (Don’t blame her for the colors – I picked them out.  Ha.)

I have a confession to make.  I have always welcomed story submissions (and I still do!), but I am not always very good about posting them.  To my great embarrassment, Bongi sent me one in 2007 that I held on to, but never posted.  Apparently in addition to being severely procrastinatory, I also hoard story submissions.  I emailed him to ask if he’d already posted it to his own blog; I’m assuming he did.  If he didn’t I’ll post it here.  (I promise!  Right away!  Fast fast!!)

I do have a submission from Jeanne from 2009.  She writes:

Have you ever leaped to the conclusion that a patient is a bit confused only to have him redeem his grasp of the situation by proving himself to be spot on?  Consider a 92 year old patient  who required assistance out of bed by myself and a nurse’s aid. He was your quintessential little old gentleman whose English pronunciation, as well as  sensibilities, had all the old world charm of European Italy. We also knew him to be vague, at times, with poor insight.

As we assisted him to the side of the bed for a transfer, he began to moan, “I’m a man, I’m a man.” We assumed that his consternations were related to his need to be assisted by women, and were strictly sociological in nature. We reassured him that, as a “man,” he was gaining strength with physical therapy, and that he was a “fine, strong man.”  Nonetheless, his protestations persisted, “I’m a man, I’m a man.”  We, in an effort to get the transfer accomplished, continued to reinforce to him  just what a fine man he was. Nonetheless, he continued wailing, “I’m a man, I’m a man.” Finally, I  got right down to eye level, hoping I could focus this gent back onto the task at hand. He looked me straight in the eye and proclaimed, “I’m a man. I’m a man. And I’m sitting on my goddam balls!!!”  Needless to say, this brought everyone down to earth in very short order,  and situation resolution was achieved.

 

Oh my.  Another story, this one from Alan RN, (also from 2009):

One of the times I felt I really helped a patient as a nurse occurred in the early ’80′s.  A male in his late 30′s had a motorcycle accident requiring a below knee amputation after post-op infections.  I worked with him in the ortho clinic over many months and learned he was a Vietnam veteran.  I was a Navy corpsman in the early 70′s but with no deployment to Vietnam, yet he still called me “doc” and we swapped military stories.

About a year later he returned after another motorcycle accident, now requiring another below knee amputation.  He was post-op on the ortho floor when I learned he was back. He was quickly earning the negative reputation among the nurses and physicians as a “biker”–throwing stuff, swearing, etc.  I talked with him and he confided in me that he was “going crazy” because of the child crying next door.  In short, the crying triggered what we now are learning more about–post traumatic stress syndrome and he was afraid to bring it up to the staff and not appear macho. Fortunately I had seen this in war vets while on active duty.  I spoke with the nursing staff and residents, and advised them to “back off” him and change his room.  Things went better for him after that and he calmed down enough to work with the staff through his admission.  These days with shorter length of stays it’s tough to learn enough about a patient–something to keep in mind if a patient is acting out, with more vets returning to civilian life now.

And finally, here is one from Linsey, RN (from 2010.  Hey, we’re getting there):

I hope that everyone reading this can congratulate me on my first ever blog experiences.  I am currently studying for my BSN and learning about blogs was a assignment of mine.  CodeBlog has stood out to me because it is unlike any other blog that I found and I will visit the blog regularly to see what interesting stories people are sharing. (Thanks Linsey!  Sorry it took me 2 years to give you your first blogging experience.)

I am a new nurse and have been at this career for three years.  I think that I will probably consider myself to be a new nurse until I hit the ten year mark because some days I am totally comfortable but some days I am totally lost.  There are nights I go home and can’t stop thinking about the events of the day… did I remember everything… will I get the infamous phone call from my manager that I messed up one of the fifty pages of paperwork I did that day.

Since I was a little girl playing with my tea-set I wanted to be a nurse.  Some kids change their career aspirations but all I ever wanted to be was a nurse.  In high school I almost lost my dream and fell into a downward destructive spiral… And then I buried my ten year old cousin and close friend.  That experience made me realize that I was wasting my life and I lost my bad friends, made some good friends and jumped right into school.

This experience and those of my family who have also had similar problems have made me the kind of nurse I am today.  I have learned to be patient with those around me whether they are staff or patients.  I have learned to accept all people for who they are rather than what society wants them to be.  Finally I have learned social skills that can’t be taught in a class but only learned through one’s life experiences.  Nursing has completed my life and soul.  It is wonderful to be in a profession that on most days, I am excited to go to work, I am excited to help people and gives me opportunity to realize how small my problems really are…That to me is the essence of nursing.

 

So there you have it.  Instead of being 5 (FIVE!) years behind on story submissions, I am now only 2 years behind.  Thanks for reading :)

I know that she swears she isn’t making it up, but still I sort of wonder if it’s true.  However, since the only real criteria for a story submission is that it be interesting, this definitely qualifies.  Lauren writes:

This post can go under the heading of stories which prove that truth is indeed stranger than fiction. I returned to work last night for the first time since before Sofia was born (boo hoo). That was upsetting and new for us both but it is not, alas, the subject of this posting.

I was scrolling through my work emails furiously trying to whittle down 400 plus messages that had accumulated during the time I was basking in the glory if a 16 week maternity leave (by the way, thanks Mom for the flowers. They softened the blow a little tiny bit). I found reference to a strange story within the hords of mundane postings and notifications and decided to delve a little deeper by asking my coworkers about it. Luckily for me, the girl who had originally posted the tale was working in my area with me and she was most happy to fill me in, to my initial horror and eventual hilarity.

Apparently, there was a patient admitted to the ER with crushing chest pain or some such malady. She was bundled off to radiology for a CT scan and then sent to the cath lab for a cardiac catheterization. She eventually ended up, after taking a tour through these several areas of the hospital, in the ICU and the very capable hands of Teresa the ICU nurse. Teresa decided, being the excellent nurse that she is, that the patient would enjoy a linen change after her adventures of the day. She therefore turned the patient over in bed only to find a dead cat beneath the patient. Yes, dear reader, I did not mistype. She found a dead cat. Underneath the patient. After the patient had been through the ER, moved to the CT table in radiology (love to see that film someday) and to the cath lab where they insert large-bore sheaths (they are so friggin large that they aren’t even considered needles at that point) into her groin area and finally ended up in the ICU before anyone noticed that there was a deceased domestic animal beneath her. I swear that I do not make this up.

Apparently, an incident report was filled out, the house supervisor was notified, and the animal was disposed of after a quick and appropriately somber moment of silence. And this, I realized, was a clear and obvious message from the cosmos. “Welcome back, Lauren” the cosmos said. “We could tell you were gonna need something like this to get you back into the nursing spirit.” And, suprisingly, it did. You won’t blame me if I feel the need to check beneath my patients for dead animals from now on though.

So… was the cat left on the gurney during her CT scan?  Surely someone would have noticed it on her films, right?  Did the lady know who the cat belonged to or where it came from?  I’m just so perplexed.  More info from Lauren in the comments:  “Further info…the patient was in no condition to be questioned about the kitty, but when a call was placed to the patient’s family they confirmed that they did indeed have kittens running around and one of them was indeed missing.  I think the patient was quite large and was being slid, along with draw sheets and other assorted linens, back and forth to the Ct table and cath lab table.  Presumably, kitty just went along for the ride.  As for the CT film, I’m still wondering about that one.  And no, I’m not a sicko who thinks dead animals are hilarious.  If it had happened while I was there, I would have lost my lunch.  But hearing about it afterwards, with all the gruesome details was kind of…shockingly hilarious I guess.  In a very macabre way.”

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.

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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.