Monday, May 30, 2011

When Things Fall Apart for Other People

Brother and Co whittled down their numbers earlier this year by the breaking of the relationship with the other half. She played a gambit, and lost. The thing is with men, when they are ready to get married...they will do it. Ultimatums for marriage from a guy who has already bought a nice house, converted his basement for your home salon, made your car payments, and created a stable home life for you and your children is generally not a good idea. My brother had already changed much of himself for her, and yet it wasn't nearly enough.

Brother isn't too horribly upset about it. He's got his little princess, and really has no burning desire to strap on the old ball and chain. If it ain't broke, don't fix it. His ambivalence towards Baby Mama infuriates her, now she's got her current boyfriend sending brothers emails on how to raise his own daughter. Baby Mama proofreads the emails before they are sent. How did we not pick up on The Crazy before?

Meanwhile, paradise for Redneck Brother has descended into hell as his wife has also become afflicted with The Crazy. She quit her job because she decided she didn't want to have one anymore. You'd think that without a job, she would tend to the home fires, but no. She doesn't cook, she doesn't clean. She barely cares for her two children. Instead, she spends all her time on the computer. Redneck Brother discovered a webcam and lingerie that she doesn't wear for him. She wants to go back to the days where she could go out and party and sleep with random men as long as they pay for her beer tab...which is pathetic when you are a haggard-looking 34 year old mother of two. Meanwhile, the two kids are bordering on beyond control because Crazy-Lazy Mom has already gone to work turning them against their father. So, with only one income, Redneck Brother is behind on all his bills, and is teetering on foreclosure, with a family that hates him.

Mother and I have decided that if the boys ever do decide to want to get into serious relationships down the road, we will have to personally interview them. I am currently designing a psychological test. Mother is formulating the application...complete with references: job, past boyfriends, and a full-scale workup for STDs.

I know my brothers will come out of these trials fine. We're a resilient, resourceful bunch. But still, I hate that they have gone through this. What's a big sister to do?

Sunday, May 15, 2011

Nurse Follies: One of the Grossest Moments in Nursing

My job is not always pieces of whole fruit and patient insults. Sometimes, we encounter things that are the equivalent of a neon sign screaming, "Get the hell out of nursing, you idiot!"

This is one of those stories. (Warning: Not for the faint of heart.)

We had a patient once, a paraplegic who had come in with something GI related that required a colonoscopy. As standard with our paraplegic folks, he got himself a nice Clinitron bed. For those who don't know what that is, it's a huge bed, that looks like Barbie's swimming pool. Filled with air around the perimeter, in the middle is a recessed area filled with sand. When turned on, hot air blows into the sand, creating a very soft, pressure-free, floaty environment that is supposed to be ideal to prevent skin-breakdown. Hot air blows up through the sandy part of the bed, but the sand stays in the baffle. The bed itself is a pain in the ass. Heavy to move. Patients hate it. Not to mention you get one tiny hole in the sandy part, your room turns into the beach minus the fruity rum drink with the little umbrella.

As also with patients who are lucky enough to win a colonoscopy, they get a bowel prep. Some places just give you repeated enemas, and you are done with it. Other places, the preference is Go-Lytely. A huge gallon jug that has some sort of additive to it, we fill with water, and you have to drink the WHOLE DAMN THING. The makers of Go-Lytely at one point decided to be a little more sympathetic to the plight of the poor person drinking it, and added little packets of flavoring. So, instead of drinking bland bowel prep, you get a choice of Cherry, Orange, Lime, or Pineapple. I once combined Lime and Cherry and told the patient to pretend it was a Cherry-Limeade from Sonic.

The end, and desired, result of drinking Go-Lytely, is that it cleans out your colon. And by clean, they want you shitting out Go-Lytely without an iota of color. But what if you don't run clear after your gallon? Well, you get gallon number 2, and you will be shitting until Rapture. For this reason, I have renamed Go-Lytely to Go-Lotly.

So, Paraplegic Man drinks his gallon of Go-Lotly because he's a good patient and doesn't want a tube down his nose. I don't remember what flavor he picked, and what's even more important is that I don't care.

Later that night, newish grad nurse pops out of the room, subdued and pale. She waves for me and Red to approach, looking very distressed. We answer the bat signal, and the smells hits us halfway down the hall. Immediately, my eyes begin to water.

"I need help." Newish RN tells us. Red holds her nose. Smo materializes, demanding to know what that smell is. Newish RN wrings her hands nervously, "I don't know how to begin..."

So, me and the others charge into the room like we're the Four Horseman riding into the Apocalypse (which is what the room smelled like). There's safety and numbers, and the faster we can clean this guy up, the faster we can get out of the room. The smell...OH MY GAWD THE SMELL!! A hot, thick odor that hung in the air and made you forget that there are good things in the world worth living for. Meanwhile, the patient, a middle-aged guy, is also holding his nose, and apologizing profusely because he couldn't control his bowels. It's okay,'re a para and you can't be expected to control such things and we're not going to eat you lunch for this. In fact, after this episode, we're not going to eat anything for a long, long, LONG time.

Then, we hear bubbling.

With flourish, I pull the blanket off the patient, "Let's see what the damage is." One sight of the situation, I put the blanket back over the lower half of the patient, put my hands on my hips and stare speechless at the other nurses.

"Holy Mother of God." I mutter.

Smo rolls her eyes at my penchant for the dramatic, and pulls the covers back off the patient. The sight that greeted us was a Clinitron bed literally full of the foulest smelling poop to ever been expelled by a living organism. The entire sand-filled area was covered, and the patient's lower half immersed like he was at a dayspa soaking in a mud bath. To make matters even worse, the hot air from the bed is being blown up through the mattress, causing the contents to bubble and spew like a damn pot of chili. It had the same color and consistency of chili, too.

"It almost looks like an evil moat from Lord of the Rings" someone observed. This was met with groaning.

Meanwhile, a tech walks into the room, gags, and immediately runs out of the room. I assume she went to go fill out an online application to Walmart.

Just out of curiosity, I demand the patient tell me what the hell he ate that day.

The nurses stare at each other, each covering our noses. So is the patient. But because we are a resourceful bunch of of night nurses, we start brainstorming as to the best way we are going clean this mess. Some suggestions included:

- Crafting a suction system where we can suck up most of the mess like a Shop Vac. Unfortunately, our tubing is too narrow and would get clogged frequently. We wonder if Maintenance would loan us one of their Shop Vacs.

- Getting styrofoam cups and bailing out the bed until we excavated the patient.

- Finding some nursing students and making them clean it up and call it a "learning experience". Sadly, we don't get nursing students at night.

We decided the bed wasn't salvagable, so we just transferred the patient to an regular bed, cleaned up what we could off the Clinitron, covered it with blankets, and pushed into the dark recesses of the back hall. I suggested we torch the damn thing, but considering these beds can cost up to $50K, the others thought that might make the higher-ups unhappy, and may affect our whole piece of fruit gift for Nurses Week and leave us with a coupon for a free cup of ice water and bonus bendy straw.

The bed people came the next day and picked up the bed. I don't know what happened to the bed. I can't imagine how they even got that thing cleaned. Maybe they did torch it, but one thing is for sure...

I wouldn't even touch chili for two years after that incident.

Tuesday, May 10, 2011

Nurse Follies: The Impossible Situation

Mr. Pickled arrives to the hospital on a Friday, sporting a yellow skin tone that makes him glow in the dark. The family, brags that he has come in for a liver transplant that will take place the following Wednesday. Nurses are puzzled. Liver transplants generally aren't scheduled in advance as they are transplanted within hours of retrieving it from a donor. Donors aren't exactly something you can predict. Not to mention that the Transplant Gods refuse to give a new liver to someone who can't put the bottle down for six months before the transplant and promise not to drink after.

The disease process of a crapped-out liver runs its course, and inevitably we come to the part where Mr. Pickled is going to die, and the family has decided that they have no choice but to let him go. Wife and sister hold a beside vigil while Mr. Pickled prepares to transfer to the Eternal Care Center.

Now, palliative patients are near and dear to me. I find it rewarding to help in this transition. To help the patient be comfortable, to help the family cope with the impending loss. It's a highly personal experience, and I am honored that family members trust me enough to share in their journey. It's an area of nursing I am very good at, but have no inclination of doing it full time.

Sadly, I'm not taking care of Mr. Pickled, and get to wear the charge nurse hat. A friend and colleague (Salty) gets to care for the Pickled Family (because it Palliative Care, the focus is just as much on the family as it is on the patient). She is a newer nurse, and somewhat uncertain, so I help her when I am not dealing with the phantom toilet flushing in the staff bathroom that's causing the other nurses to freak out.

Mr. Pickled goes into his agonal breathing pattern, which is to say his breathing becomes shallow and slows to 2-4 breaths a minute. The first time this happens, the family assumes it's his last breath and begin the emotional release that comes with the death of a loved one. Then he takes a breath. The family stops crying, blinks their eyes, and the vigil resumes. This happens three other times. The crying stops and starts like a faucet. Emotions are raw. It's as if you relive the death of a loved one over and over again.

Death is different for everyone. Some go quick. Some like to hang out for a while. Mr. Pickled is unpredictable and no one can be sure how long he's going to keep this up. The family asks us to give them a time frame. We can't.

Finally, Mrs. Pickled cries, "Can't you do something to stop this? Can't you give him more Morphine to end this? I can't take it anymore!?"

Salty and I look at each other, speechless. Narcotics are given to keep the patient comfortable, alleviate air hunger, pain management. Yes, there is an unspoken understanding that it could hasten the inevitable, but never before has a family outright asked us to expedite the process.

Finally, Mr. Pickled passes away an hour or so later, without further nursing intervention. Mrs. Pickled crawls into bed and spends the rest of the night sleeping, for the last time, by her husband's side. It freaks out the younger nurses, but we just let them be until morning. When the wife leaves, she thanks the staff and makes no mention of her previous outburst. I wonder if she looked back upon it and kicked herself in the ass.

There are medications that some patients take that are life sustaining. Any cessation of these meds will result imminent death. Some patients, after a while, opt to stop the drugs, which results in their imminent death. The patient knows that this will be the end result because doctors and nurses make sure they know it. Would this be considered the same as an assisted suicide? Why is this more acceptable than giving someone a high dose of something that is going to hasten the death of a terminal patient? Euthanasia is not legal, but it also encompasses a HUGE gray area that no one speaks of.

Maybe, folks need to start talking about it. And not in the final hour when you want the nurse to do it.

Happy Nurses Week!!

This June, I will have been a nurse for seven years. SEVEN!! The time has raced by faster than a man to the bathroom after having a one-liter enema. In that SEVEN years, I have been hit, kicked, pinched, spit on, shit on, pissed on, vomited on, cursed at, threatened, injured, insulted, emotionally drained, and exhausted physically.

So, how does ACME Hospital honor me, honor us, on this most sacred and holy of holidays for nurses?

With coupons for a piece of whole fruit. We were puzzled it specified whole fruit. As opposed to what? A half-eaten banana? Last year, we got coupons for a service that turns out they didn't pay any money for, but was a promotional card for some spa business that they handed out to anyone who wanted one. For free.

I don't think I want to guess what the higher-ups get for their bonuses. It will probably throw me in a deep depression that ends with a full psychotic break and I run around the hospital lobby. Naked and covered in powdered sugar singing about being a donut in my former life. Trust wouldn't be pretty.

I'm just going to assume they got two pieces of whole fruit instead.