Tuesday, June 24, 2008

Cops and Robbers

I went in for a day shift expecting a familiar patient load consisting of situations such as cp n/y dx’d (chest pain not yet diagnosed – I stared at that for a good 25 minutes before I gave up and asked what that meant), various dysrhythmias and diabetes. Well, I (along with my teacher) got assigned to be the nurse for a 35 year old man with a lackluster medical history but a remarkably colourful personal history. He was a prisoner and was jailed for a variety of offenses such as theft, drug possession and trafficking and assault. He was found to be confused and breathing very rapidly (Kussmaul respirations). He was later diagnosed with hyperglycemia. Of course, being a student, I was not allowed to go into his room alone, despite him being handcuffed, shackled and surrounded by 4 armed guards. Since interacting with prisoners is quite out of my range of experiences, I decided that I should go into the room with carte blanche. I don’t know how well that served me, but when my teacher and I went into his room to introduce ourselves as his nurses, we were greeted by a barrage of profanities and lewd remarks, the tamer of which included, “F@#k off b^&#$*s” and “I’ll kill you if you touch me with that thing [the blood glucose testers]”. A wonderful start to a wonderful day. As the day wore on, his comments became increasingly obscene until halfway through the shift, when he became a lot quieter and decided to let us do our work in peace. At one time, he even asked about an IV solution he was receiving and merely nodded when we explained its function.

Sadly, his tranquility did not last for the rest of the shift. Towards the end of the shift, my teacher allowed me to test his blood sugar levels. When I approached him and explained what I was going to do, he nodded in agreement and let me proceed. However, when I was about to lance his finger, he jumped up at me (he was still cuffed to the bed) and menacingly said, “Boo! Scared ya didn’t I sweetness?” Of course he did. I jumped back, dropped the lance, testing strips and created a mess that I did not want to clean up while his jeering laughter provided the soundtrack to the moment. I ended up leaving the mess because I did not want to be in that room any longer. I didn’t get a blood sugar reading

Having done a short stint in a mental health facility, I thought I would be better prepared work with ‘shady’ characters, but this man made me recoil. I did not feel sorry for him at all. He was convicted of and found guilty of serious crimes. He deserved to be in jail. And yet, I could not stop thinking about what being hospitalized meant to him. Did he see his room as a temporary respite from his cell? Or was this the same prison with different but weaker wardens? Is that why he felt comfortable trying to scare us? Did hyperglycemia and the ensuing diagnosis of type II diabetes really matter to him? Most of all, I wanted to know if he was sorry for the crimes he committed and if not, then how did he rationalize and justify his choices? I wanted to know the answers to these questions, but I did not want to be the one to extract that information from him. I wanted him to forget that I existed because knowing that I am known by someone who is comfortable with panning out brutal violence for slight provocations scares me. This is one abyss that I am happy to leave far behind

Friday, June 20, 2008

First Impressions

First impressions are powerful, but they’re not always accurate. When I first started my training, I was extremely angry at not only being denied the emergency department (my first choice), but being placed at yet another community hospital. I wanted to be in a downtown hospital so I could get away from the suburbs. The thought of spending four months in another ‘burb became too much to bear. But placements happens so I begrudgingly gathered my belongings and went of to start.

While I can’t say I love my placement (because commuting there is a complete pain in the gluteal area), I have been learning a lot (and not the clich├ęd kind of learning either). My first day after orientation began with meeting a sweet old lady who ripped two IVs out of her arms. Upon seeing her hands, gown and the floor soaked with blood, I let out a small scream (think Homer Simpson-esq), grabbed cotton wipes from the counter and applied pressure to those wounds like no-body’s business. Later on, my preceptor complimented my ‘quick-thinking’ and proceeded to clean up the mess. I learned two things that day; 1) if a sweet old lady pulls out her IV lines, the next step after applying pressure and panicking is to flush the line out with normal saline and lock it up to retain positive pressure and 2) getting blood stains of shoes should be done as quickly as possible.

Yet another patient who made me temporarily forget my ‘burb induced misery was an Indian gentleman who is extremely hard of hearing, named Mr. S. Mr. S is a very demanding patient because he did not follow the rules of the hospital, which according to CCC (that’s client centered care for you lucky enough not to have it shoved down your throats) philosophy is perfectly acceptable. In fact, as nurses, we’re supposed to honor the client’s wishes. But not 45 minutes before shift change. Along with being nearly deaf, he has septic arthritis, which means he can’t ambulate without at least two people helping him. Describing the sequence of events in a chronological order is the best way to relay the sense of urgency and despair that I felt while taking care of Mr. S.

1845: 45 minutes before shift change. He decides to start shouting at around. We (being me, my preceptor and another student nurse) decide to indulge his crazy plan because our charting and 1800 meds are done. Wrong choice. Mr. S. takes 10 minutes to decide on the water temperature alone – and then soils himself.

1900: ½ hour before shift change. Mr. S. refuses to let housecleaning come into the shower to clean up the mess. The Eastern European lady comes in, takes a quick look and aptly declared, “that’s very stinky poo”. Meanwhile, I vomited up my 0500 breakfast. The other student nurse then rubs my back and asks if I’m pregnant!!! No, not pregnant. Merely revolted. Following my ‘pregnant’ pause, Mr. S. spots his son outside the shower (because he was called by my teacher to try to calm him down) and he starts to shout, “YOU BETRAY ME! MY OWN FLESH AND BLOOD BETRAY ME!” I believe sheer exhaustion and revulsion combined with residual nausea made me burst out laughing in the most inappropriate manner. Luckily he was hard of hearing and so my shameless laughter failed to further enflame his anger.

1915: 15 minutes before shift change. Mr. S. is smiling like a smug child who got his mother to buy him a candy bar after she refused to do so. “SISTER” he shouts. “Come, give me a warm blanket, a cup of coffee and something sweet to eat”. Did I mention he’s a very poorly controlled diabetic? His morning CBG reading topped of at 17 mmol/L. Not good.

1925: 5 minutes before shift change. “SISTER?”, he shouts once again. “Where the hell is my bloody coffee? SISTER?”. At this time, I have to remind him that he’s not getting coffee or anything sweet because we don’t want him to die in the middle of the night. “Mr. S. you can’t have something sweet right now because your blood sugars are completely out of control. And it’s almost time for bed. He replies, “you’re absolutely bloody useless. This entire hospital is bloody useless. Go. And don’t come back with something sweet for me. Some mithai (an Indian sweet) would be good”.

1930: Shift change. “Good night Mr. S”, To which he cordially replies, “You’re all bloody useless bandars (monkeys)!! Never come back in my room!”
“You sleep well and dream sweet dreams sir”.

1935: 5 minutes after shift change. I started to virox the blood and crap (literally) out of my shoes. “Frikkin crazies” I hear the other student nurse mutter to himself. “Hey, pass me another virox would ya?”

1945: We gave a very late report to the night nurses much to all of our chagrin.

2000: I never thought I’d be so happy to see my dad and his clunky old Nissan. “Hop to it popsie! I gotta shower and scour myself stat!” As usual, the day ended with a member of my family giving me weird looks while deciding if putting me in a psych ward would be a good choice or not.

Reflecting (yes, my school's favourite word) back on the situation, I wonder, did I honor the patient’s wishes? Probably not. Was I patriarchal in my treatment towards him? More than likely, I was. Did I practice CCC? Absolutely not. I practiced MCC (Maha Centered Care), which involved pursuing nothing more than a hot shower and my bed because my feet, knees, hips and back were screaming for rest. Could I have handled the situation with something better than snide remarks, vomiting and laughter? Probably. Will I try to handle a similar situation with more tact in the future? Of course, but it gets very difficult when a patient doesn’t respect your time.

So what do I think about my placement? I still say that it certainly is not as exciting as an emerg department might be, but the ‘burbs still have the potential to leave one shaking their head at the end of the day. My first impression: You betray me!