Firefly

I recently had an elderly man as a patient, who was suffering with dementia as well as being very hard of hearing. He was getting a full medical work up. This particular day he was having a CT scan and needed some Gastrografin. I was dreading the phone call to give the Gastrografin as I wasn't sure how much the patient was going to understand and explaining it wasn't going to be easy.

Finally, the phone call came and the dreaded moment began.

Me: "You are going to go for a test, it's going to let us see your bowels."
Pt: "What?"
"You are going for a test!!"
"What kind of test?"
"A test to see your bowels!"
"What?"

At this point the conversation wasn't going anywhere, and I still had the 300cc's of apple juice to give him containing the Gastrografin.

Me: "Here, I need you to drink this."
Pt: "What?"
"I NEED YOU TO DRINK THIS FOR YOUR TEST!"
"What is it?"
"It is apple juice with a medicine that will help us see your bowels."
"What does it do?"
"It helps us see your bowels.
"What?"
"IT HELPS US SEE YOUR BOWELS!!"
"How?"

At this point I was giving up, I knew I was running out of time with his patience and needed to work fast.

Me: "It works by making them glow!"
Pt: "What?"
"IT MAKES THEM GLOW?"
"How?"
"LIKE A FIREFLY!!"

I was desperate, not quite sure what made me say that other than needing to get out of the room. I didn't think anymore of the incident until I stepped out of the room to see everyone at the nurses station watching me and giggling. Someone quickly asked "firefly?"

I guess it would be entertaining to here me screaming that from down the hall. But it worked, he drank the Gastrografin and the test was completed.

Rock and Roll Part 2

I'm remembering an elderly man who was with us at one point, he loved to scream "hey!!" at random intervals. It wasn't angry, mean, or demanding. He just had dementia and sometimes would forget that he was getting a lot of attention. He'd work himself up into a yelling fit that you could hear down the hall. Sometimes an unfortunately confused patient on the other side of the hall would hear him and yell back! We, of course having to hear this 24 hours a day did what we had to in order to survive the time he was with us. We laughed, we made jokes, we would try to time the "hey" with all sorts of creativity. There were times when we would drum and hum the chorus to the song that made the yelling of "hey" appropriate (Rock and Roll Part 2 of course). Other times one would tell a story with the word "hey" appearing at intervals in between, it was at times unbearably funny. The highlight was always when there would be a newcomer working with us on the floor, as we'd get to start up Rock and Roll Part 2 all over again to make the visiting resident relax and realize we weren't negligent and there was nothing we could do.

I hope people understand the nature of these funny moments, that nurses are full of compassion and empathy, but sometimes we have to find a way to release the emotions so we can keep going. If we didn't, no work would get done as we'd all be crying inconsolably. No harm is meant and there is nothing but respect, patience, and compassion going out to patients and their families. I want to make clear it is meant with the greatest respect, and the patient's dignity is always kept as a #1 priority. Dementia is heartbreaking. I give kudos to those that are caretakers of this special population as you are underappreciated and overwhelmed.

Where Doctors Go Wrong

I'm not sure how I feel about this article in Time.

Yes, it is true that doctors make thinking errors, but those same characteristics in thinking are what lead doctors to make the correct diagnosis in countless cases.

There was a similar article in the New Yorker at the end of January.

Thoughts on this?

Sorry I Couldn't Give More

I'm sorry I couldn't give more. It's not your fault that we were short-staffed for an evening and we were left struggling to care for you all. I know that if I could have spent ten extra minutes with you straightening up your room exactly how you like it (even though you could do it yourself) it would have decreased your anxiety greatly and you would have felt better. But the truth is...you could breathe, your heart was fine, and you could void all by yourself. There were other people who couldn't breathe, who's hearts where acting funny, and others who could hardly move. I wish I could have been there for you, but there was only one of me and four of you. I had to triage. I felt terrible, I could see the look in your eyes that wished for more.

In some ways you should be thankful I didn't have to sit by your side constantly, as you were doing well and were stable, I was able to do all that you needed but nothing extra. I wasn't worried about the possibility of things heading South for you. But I know what it is like to be sick, and sometimes you just need to be comforted. I want you to know that I recognized your need, I just couldn't do it as there wasn't enough of me to go around. For that, I am sorry. I wish I could have given you more.

In the end, I am glad that I was able to get a float nurse to come up to the floor and give you the extra attention you needed. After she spent thirty minutes with you I could see you finally relax and your anxiety dissipate. I'm sorry it wasn't me, but I'm glad I was able to find a way to help you.

Coffee?

A physical therapist told me this story yesterday.

The PT walked into the patient's room, and right after a warm greeting the patient asked "would you like me to make you some coffee?"

The PT chuckled a bit and replied with, "I don't know, where is your coffee maker?"

The patient looked around the room, and in a shocked voice ended with "I...don't know!"

Think it is time to re-orient the patient?

4 Things I Can't Live Without as a Nurse

Thank you to Labor Nurse who tagged me about listing 4 things I can't live without and 1 thing I covet. This little game was started over at a nursingjobs.org and I'm happy to add my thoughts to the growing list.

1. Scrubpoc For all those nurses who hate cargo pants and are tired of emptying their pockets unintentionally I have a solution for you!! There is this fabulous poc (the patients tend to refer to them as our tool belts) that you can get at Smart Scrubs. These pocs hold all your flushes, scissors, pens, IV connectors....everything, but not too much. It's perfect and it is out of the way. You can sit, run, bend over, clean up a code brown, and help transfer a patient without it being in the way.

2. The internet. How else could I look up if patients usually get a strange taste in their mouth after a Heparin flush? I am also amazed at what as happened with my blog. I don't know if all of you realize, I started this blog in 2004 as a way to keep in touch with friends. I also never told anyone (other than my boyfriend) about it as about 7 months ago it turned into a way for me to get my work stories out of my head and help process my day. About a month ago Paul Levy decided to link to this blog on his site, then boston.com, and here you are today reading my thoughts.

3. Stethoscope. I can't imagine not having my DRG stethoscope. It's so great I can hear all the lung sounds clearly in a room where the patient's pneumo boots and TV are on, complete with a loud family visiting the roommate. Thank you to my family for the excellent graduation present.

4. Paging system at the hospital. I can't imagine having to wait for a doctor, or having to spend time calling around to find them. The paging system is well used, and well loved (I'm sure only by people who don't carry pagers!!)

The 1 thing that I covet. Ooooooh....I'm going to have to say private rooms. I would love to work in a place where patients have complete privacy as an expectation, not by luck of the infection. When you are feeling crummy and contemplating your existence, a roommate in GI distress is not what you need. Of course these rooms would also be designed so there is room to walk around their bed, walker, commode, and recliner without feeling like one is in a Mission Impossible movie.

As for who I'm going to tag....I'm going to get oncrn, and Head Nurse.

Motivation Shift

One of the gentlemen in my care today was a bit short on motivation this morning. He was a bit down in the dumps, upset about being in the hospital for so long with the complications and at this point having difficulty standing. I decided it was time to focus on some PT and motivation, to see if he would feel better after getting out of his room and feeling more in control of his environment.

He felt fantastic after I helped him get into a wheelchair so his visitors could push him around for a bit off the unit. I don't think anybody had seen him smile so big since before his hospitalization! I had no idea the monster I created until later in the afternoon when I hear a voice coming from over the counter at the nurse's station and just see a hand waving at me. I stand up to see him and there he is. He got into the wheelchair all by himself (with a little help from a visitor) and was so pleased he just had to wheel himself out to show me. Somehow in the course of the day his spirit had come back.

I think the best part of the day was when I was going home and he took my hand and said a heartfelt "thank you."

Some days make all the tough ones worthwhile.

Blast From The Past

A friend of mine recently found this and reminded me about this article I wrote while in college the first time (BU, class of 2000, Simmons College, class of 2005). I think I wrote this in 1998. Man have times changed, but at least my passion is still in the same place.

Nigeria's nightmare a worthy student cause.

Panic Attacks

I'm currently reading a book about panic attacks and anxiety. I find a number of patients suffer from this and I'm interested in learning more. Where does panic stem from, what is it really about?

The following is a quote from the book "Don't Panic: Taking Control of Anxiety Attacks" by R. Reid Wilson:

The Surprise Attack

To add to your confusion, the attacks are not always consistent. You might get hit with symptoms at a restaurant one evening, have a problem only once over the next three times you go out for dinner, then on your fifth time out begin to feel the same trapped sensation again. It is like spinning the chamber of the pistol in Russian roulette. Mentally, and even physically, you begin to brace yourself in anticipation. You become constantly on guard. For some, these fears translate into a desperate need not to feel trapped, becuase being trapped implies surrendering control. "Staying in control" is the primary objective.

Anxiety is something I've seen many patients experience. Numerous times I will bring up the word "anxiety" with patients and they will look at me like I have no right to insinuate that some of their current symptoms are exacerbated by anxiety. What I try to remind patients of is that we all experience some level of anxiety, but when it is not controlled it can wreck havoc on our lives. Bring in the loss of control a patient has when hospitalized, and it's no surprise that patients often feel plagued with anxiety.

I wonder how many people suffer with undiagnosed panic attacks? A quick google search led me to a NIH site with a report dated from 1991 that states "1 out of every 75 people" worldwide will suffer with panic attacks at some point in their life. That's a pretty significant number for a disorder nobody likes to talk about. I have seen doctors and nurses recognize anxiety in a patient, but not bring it up with the patient. As healthcare providers we are generally more comfortable talking about bowel movements than we are about anxiety.

I'm reminded of a patient whom I had last year. He was a 20-something who was admitted with a strange cardiac issue (I remain vague on purpose, the time line is also changed). This first occurred 2 years prior in the month of October, and again a year later in October. Here we were 3 years after his first bout with the strange cardiac issue and he had it again, except this time it was July. I walked into the room and saw a diaphoretic, tachycardic, nervous looking man, who looked like a Wall Street trader on day 5 of a 5 day trading marathon. When I questioned him as to whether he was anxious his words for me were "I knew it would come back again a year later and it did, and I was so worried about it happening again that it came early this year."

Now, I'm certainly no cardiologist, and certainly cannot for certain state that it's very odd this strange cardiac issue would appear year after year in the same month. But one thing was for certain, this patient was consumed by his fear of this illness. The sad part was that no other healthcare provider had discussed his obvious anxiety, I was the first. When I talked to his other providers they overwhelmingly agreed he was anxious, but why had nobody else discussed it with the patient? Who knows.

The good news is that the patient was interested in learning about anxiety and recognized that he needed help. I was able to give him some names and books, and sent him on his way. I hope he is feeling better and learned how to decrease the amount of stress in his life.

The Drugs Are Good

I had to smile today when I went to the SICU to visit a patient I had over the weekend. He is a younger guy, and was quite nervous about the whole process being new to hospitals and never having had surgery. I told him a bit about what to expect when waking up, but not to worry as we had really good drugs to help keep him calm and pain free.

While briefly visiting him (he was still intubated but awake) I asked him how the drugs were. A big smile shone in his eyes and he nodded the little he could while squeezing my hand. Apparently, they were quite good. :)

Refugee Medicine

I went ahead and applied for the Thomas S. Durant Fellowship in refugee medicine. This opportunity has been a dream of mine for years, and I'm very excited at having the chance to achieve it.

My interviews are coming up in the next few weeks, and I'm realizing there is something I'm not completely solid on, although I have a few thoughts. I know I want to go to Central/South America, but I'm not certain as to what is the best place to be, or what organizations are already going there. I do know that I want to focus on preventative medicine, such things as HIV teaching, mosquito nets for malaria, vaccination programs, mom/baby health, vitamins, things like that.

Does anybody have any ideas to help me along with my research?

To the right I have linked to a couple of blogs this year's winners have been keeping in case you are interested in learning more.

Struck

I was struck today by a patient's story. While walking this elderly man I was able to ask about his life--he was more than sweet and willing to share. In his storytelling I heard a happy man, who looked back on his life with happiness and pride. He told me he has no regrets and a loving wife of 50+ years. He also told me about how he found out he was adopted as a teenager when he went to the recruiter to "sign up for the service." The recruiter wanted a birth certificate and he didn't have one, so he was told to go home and get a baptismal certificate instead. While back on the bus after a trip home to get the paper, he unrolled the certificate while sitting alone on the bus and read that his parents had adopted him. And that was that. No fuss, no nothing. He didn't launch into a story about the search for his birth parents, he didn't go into his anger at his adopted family, or how he never really felt loved after that because his birth mom left him, nothing. In telling the story there was only a shoulder shrug and smile. He simply kept on moving forward with his life, and off to the service he went.

In this complaining/whining age with blame thrown around to procrastinate analyzing our own lives, we often forget that many things in life are simply "just because." Sometimes it is important to accept what life has to offer, rather than try to control what life decides to give. Each day we are given a chance to move forward. We all open our eyes and decide what to do with our time. We can either whine, complain, and blame till our hearts are full of anger and take years off a life, or we can accept and enjoy what we have. The choice is ours.