Praying for the patient.

So it's 6:55 am. Just before the shift ends and as i walk towards the front nurses station, i decide to stop in the room of a patient i've had for the past 2 weeks but didn't have tonite cuz my preceptor isn't her. I heard earlier this morning that she's going for a surgery to have a PEG placed. The word out on the floor between 2 nurses was that the probability of her making it through it is really slim and that the doctors have told her that. Her nurse tonite was particularly concerned because the patient is not oriented or alert.
So i walked in, called her by her name and asked how she was and in her sweet irish accent, she responded "fine, thank you." So i go ahead and say " Good luck with your surgery today." She says thank you, you're a very sweet girl."
Then she says "Say a prayer for me" I thought i didn't hear her right so i ask, 'what did you say?"
And she goes "say a little prayer for me."
So i put my hands over her hands which are beneath the blanket and go:

"Dear Lord, I commit Miss ******** into your hands today. I pray that as she goes for a her surgery today you will guide her and be with her and make everything successfull. This i pray and ask in Christ Jesus name, Amen."

With that said, she said "thank you. you're very sweet." My response was
either i hope i see you and take care or i just said "take care." i prolly said
something more than that before i left the room.

With my little prayer said, i hope God hears and answers. I know he heard it,
the thing is the answer of the tongue is from God (proverbs 16:1b). Poor widow, May the Lord
be with her.

The cranky patient

The key to dealing with them is block out their nasty comments. If it enters your ears, let it come out. I mean i have a patient who was nasty on dayshift and as her condition gets worse, she gets more nasty and rude and blurts out nasty comments between everything. Some of her comments reflect her own nasty attitude but she made one stupid comment and my reaction was just to ignore what she said. Whatever it meant, i really didn't care to ask her. Yes, i understad the anxiety from an illness can bring out the rudness in a person but this person isn't that sick.
that said, i'm done.

Seniors and hearing aids.

So here's one thing with the older folks, specifically those who use hearing aids. I mean they take their hearing aids out and when they see your lips moving while staring at them which obviously means you are talking to them, they are bold enough to tell you "i can't hear you" or "sweetie/hon, i don't have my hearing aids on." Hello?!!!! Why do you have the hearing aid in the first place? to make ppl scream at you and waste all the 200 calories they got from their sandwich on you?
I mean think about it, if you can't hear cuz your hearing aids are out, why not put them back in instead of just going i can't hear.
Of course this came up cuz i have a patient who is practically deaf without his hearing aids. I mean it's atrocious and he keeps voicing his concerns. How am i suposed to explain things to you?!
Anyhoo, enougha that.

The $100 eyeshadow and gloss.

So while wondering what sorta foundation i'll need for my complexion, a coworker suggested i go to macy's and ask them to help me choose one. Well, there's a big Macy's right down my street here downtown so i decided to go there today.
I did get a whole facial with everything from cleansers, toners, moisturizers, foundation, lip treatment, eye treatment, everything. Well, The foundation i wanted wasn't there but i got two eye shadows, really little eye shadow, about half the size of the ones at the pharmacy and a lip gloss and moisturizer. That was $95.xx I mean to spend almost a hundred buck on 3 items of make-up is just a SIN!
I'm sure if they had the foundation i'd have gone above $100. I only got the moisturizer cuz when i asked for the prize, i thought i heard the woman say "thirteen" cuz her head was bent under the counter looking for a lip gloss for me. It turns out the thing was $38 so i guess that's what she said. $38 for a little container of moisturizer? i'm sure i coulda gotten one from neutrogena for less than $20. Anyway, that is the end of me. I cannot spend that much on make up.

On the other hand, i got a gift bag which had an eyeshadow set i wanted to get but passed on, and i got 2 brushes which i really wanted and a mascara, a lipstick, i'm not big on lipstick and some cream and fragrance. So i guess in some ways, they saved me me some money plus i signed up for a macy's card where i get the 20% off. i wouldn've signed up for it but i figured i really needed the discount.
I must say i do like their products cuz its fragrance free and my face felt really revitalize, plus Estee's sale's associates at macy's are really nice, helpful, courteous, u name it.

The Code - an addedum

[see original post below]
So, last nite, the nurses were talking about the code. i believe i made a comment that all i saw was people doing cpr in the room. I hope i mentioned in the post that i had been doing vitals elsewhere and came by to watch everything later. So last nite i actually heard what happend.
Remember i said that when the guy was found, he still had ryhthms, just unresponsive which is why a RR was called instead of a code. Well, the general comments by the nurses was that "it was a sloppy code." According to them, compressions weren't started till about 2omins time and they felt compressions coulda been started early. " it didn't seem like the knew what they were doing during the first minutes" one commented.
Two of 'em felt there shoulda been someone higher than the residents running the code because both the residents and interns were new and the one who was actually dictating the code said it was her first time.
One agreed but felt the it's not really necessary to have a higher doctor running the code, however, there should still be a higher person who would stand there and say "no, don't do this or do that."
The other pointed out the didn't even start pushing meds early and weren't sure of what they were doing.
Like i said in the original post, from what i observed, when they were asking for some meds, pharmacy didn't have like 2 meds they asked for. it coulda been more, i only know 2 meds weren't given.
Also, the lack of communication was soo bad no one knew what was going on.
One nurse said what about cardiology and while the other pointed out that the cardiology guy just came in to observe, another pointed out that the only reason why the guy came to our floor was because he was on the floor right above us when the thing was going on. I think i mentioned in the original post that he showed up toward sthe last 3rd part of the code.

One question i asked myself the night i blogged was that would the patient have made it through the code if the meds pharmacy didn't have had been there.
Today, the question i ask is: would he have made it if compressions had been started early and there'd been a much senior resident or some higher doctor there? I really believe he woulda made it cuz he had rhythm, he had a much higher chance of surving. Starting CPR on an unresponsive patient with rhythm 20minutes after a code starts is just a SIN!
Other thing i'm wondering is why didn't these nurses voice their concerns at the end when the cardiologist asked for opinions? Go figure!
All, in all, i've heard there've been some "sloppy" and "nasty" codes that have taken place on the floor and while this one was terrible, i heard it was a lot better than some of the nasty ones.

These docs should be glad the family is not screaming "bloody lawsuit" cuz if all these things come to light.......Only God knows what the outcome will be.
For me, it's a learning experience, i did learn from it and i hope it makes me a much smarter and better practioner.

Interestingly rude answer?!!!

So, my preceptor was making a comment that last nite was my last nite. Then she added, well, it's not her last but it's her last with me. Another drexel co-op sitting infront me while i add my I&O goes "is your last night?" Trying not to loose focus on the numbers i'm adding, i respond "you heard what she said." Poor **** opens her mouth and goes "that's an interstingly rude answer."
If i wasn't a Christian, my first reaction woulda been wtf?!! But then again this is someone who has serious issues with stuff that comes out from ppls mouth or even ppls reactions. So, i refused to pay attention to what she said or say anything and she got up and left. I was not gonna drag that negativity she was trying to breed onto me and make it something hugh. I just didn't care if that was what she thought it is. I am soo sick of that attitude!

This person takes things soo personally that even when it doesn't relate to her she claims it does and creates huge mountains out of mole hills. I mean the other day, i got off the shuttle and she tells me someone is asking to speak to me. i looked back when she called me, stood to listen to what she said then kept walking. She followed me to ask "why r you ignoring me?" if i was ignoring her i woulda kept on walking when when she called and not even stood to listen to her. And btw, this was after a test where i was semi-depressed about the whole exam thingy.
Last time, she comes into a session with julie and i. Oh, i saw her tutoring, said hello and said i'll see her at work. Then she comes to know on the door where Julie and I were, opens it and goes "what are you doing?" While i understand that curiosity is part of human nature, what i don't get is how the heck is that part of a her silly business! So, since we had a recorder taping everything and i didn't want to go like "get out of here," i politely say, "you're taking up our time" and sorta point to the recorder on the table. She still stands ther and keep going what are you guys doing for like 2 more times and i say the same thing and even add, we're on the clock here and then she goes are you playing a game. As much as i wanted to scream the hell out of our session, i still kept trying to tell that noozy nosed person to in the same way to stop taking our time, we're recording something. Finally, she gets it, says sorry and leaves.
She sees me at work and goes "thanks for screaming at me." Huh?!!! why would i scream in front of a stranger. So i reply, thanks for intruding on my session.

Once again, she takes that on the offensive side, and i really didn't care this time. She starts giving me a cold shoulder. i figured if she needs to talk to me, i'm always open and will answer her so i went about my business. One nurse tried to find a picture on my facebook profile and since i wasn't willing to show it, she asks "girlfriend" here to show her. So i follow her and when i got near girlfriend, her first reaction was "why are you intruding in my email?" What the bloody ****!!! I wanted to go "have i held your hands or the keyboard or am i hacking into the computer you're using but i just left for the sake of peace.
Now that was SUPER childish. I mean a six-year-old coulda behave better, than she a 22-year-old. I told her right there she has serious issues and she goes in the most angry, irrate almost to the point-of-tears-tone that i should never say that to her. Like i give a crap what she said, i just left her to her bitter misery. I'd already removed the picture from facebook.

Of course, she stopped that cold silly attitude of hers and i guess she stopped cuz i just said hi to her or what i needed to say to her and went about my business. I really haven't given much of my time to her since then cuz i just can't deal with her. She's too much of an emotional and physical burden for me and i just refuse to carry it. I honestly have no hard feelings towards, if there was anything at all, which i don't think there is, i have let it go and forgiven her. I just don't have time to deal with her self-centeredness where she things everything is about her. Maybe i'm being a li'l bit of a harsh critic here but onvr upon a time, I, too, used to think the everything was all about me and i hope i don't hate this trait cuz i possess it myself, cuz i think i'm done and over with.

I just pray to God to help me life a peace with everyone here so i can have my peace of mind, Amen.

Something i don't get.

I recorded 30 as a pt respiratory rate at 19whatever it is. Patient c/o of chest pain like 15 or so min ago so i did another set of VS and went to document it only to find that beneath my respiratory rate, my preceportr wrote s/p ambulation...24@rest. Huh?! The patient was actually sleeping or so when i counted that thing. And it's still 30 even when i did it on separate occasions now.

What i don't get is that whenever an abnormal V/S comes up, my preceptor has to make sure the follow up is better than the first one. What's wrong if a patients BP was 154/60 but a manual shows it's 180/90. What is wrong with stating the hard core facts as they are. Why do we have to make it look better even when it isn't? It's not just the temperature but it's practically everything else, whether it is that BP i heard so perfectly cuz it almost burst my eardrums or whatever it is, it's like when she rechecks it, it has to be lower thean my value. At first, i thought she was trying to show me as someone who is incompetent or whatever but now, i think there's more to it than just that.
Anyway, she decided to put the pt on oxygen and in her words to the patient..."we're going to put you on oxygen for comfort." So when recording the V/S, i ask how much O2 the pt was on so i could document it and the MD goes "she doesn't need oxygen." My precept goes, yes she doesn't need O2 but she was asking for it. Huh?! i taught the patient was told blank without a choice that she was gonna be put on oxygen.
EKGs fly around here even when they aren't needed and people are put on telemetry sometimes when it's not needed. I don't get certain things that go on here. ICU nurses sometimes don't see eye to eye with the docs. These nurses are by the patient all the time so they see what the docs don't see and most of the time they are right. A few times, they are wrong and the docs are right. Perhaps, by observing from a distance, they are able to see what the nurses can't see. So yeah, i'm just a student, i may not get certain things... i may be right and i may be wrong, i don't know which is which but i hope to understand someday.

The CODE

just before 8pm. And guess what, it was on my patient. I was somewhere eles, doing my vitals. He was the last person i was gonna go to cuz i thought he was fine. I mean he was the last time i saw him, thinking about it now it was about 3 days ago.



The last time i worked, i was gonna blog about a patient of mine who came back here just when my co-op is over. I was gonna write that he looked good, he had hair this time, last time he was here he had a chest tube. I was gonna write how good of a shape he was in.

Ironic cuz he's the one who coded.

Thing is they did not call a code but a rapid response. Was suprised to hear them call it to my floor and i kept asking which room. I did not get report on him before i started doing my vitals cuz my preceptor was here yesterday and she gave me the low-down on him.

What i heard was that he was found unresponsive. Why not call a code then?! Later on, i heard he was breathing but unresponsive. Go figure what the real thing was. I went into the room early on and my preceptor kicked me out. Who else but her? Of course, if she hadn't commonsense woulda told me to come out cuz there were soo many doctors plus the nurses on the rapid reponse team and those here that i woulda gotten out.

I couldn't see much of the action when i came out. All i saw was people doing serious CPR and taking turns with that. Anesthesia was called and the thing is anesthesia would have been here if a code had been called instead of a RR. So yeah, they came, too. I wasn't really hearing anyone calling out anything like Heart rate blah blah blah or respiration so or so or anything. All i did hear was the call to pharmacy for meds, one i couldn't figure was "Amio." I was like huh?! so i looked on the vial and it was amiodarone...didn't occur to me the short name was amio. Also, some of the meds they asked for weren't here and i saw the pharmacist call down. Part of me wonders if that woulda made a difference in the outcome of the code had the meds been up here.



So yeah, after seeing ppl take turns doing CPR, I heard one resident or intern, whatever she was, she's still an MD, say over the phone that "we have 10 seconds!" Earlier on, i'd heard them say there was a bed in the MICU for the patient and i had been praying while standing outside that he'll make it. So in about 9 seconds after the MD said what she said, people started coming out of the room. Expressions on the faces had changed and there was this awkward sorta silence. I heard an MD say over the phone when he came out that "he died during the code." I thought to myself i didn't herar that right.No one was saying that much and i wasn't sure what was going on. So i asked a nurse infront of me about what was happening and her response was "they called the code." I wasn't sure if that meant they've stopped the rescucitation or if it meant they were finally declaring a code instead of the RR that had been called earlier. I think the later is a little dumb on my part but i can't be too certain, can i? I heard them ask for a doppler and part of me thought this thing is still going on but basically, all the docs were out and almost everyone was out except 4 or so nurses, one of 'em trying to apply pressure to the femoral line that had been used for the ABGs, i guess. But yeah, it was all over.

Boy, i took a long break after that last paragraph but where was i? Well, there was this MD fromt the "cardiology division" who i saw come in somewhere in the middle of the code. I noticed him cuz he wasn't wearing the regular green scrubs like the others, had this sort of interesting dark blue and black combination. But anywho, after the whole hiatus was over, he came out,and we sorta had this oval circle of nurses and MDs and i think 2 pharmacists or one...can just picture the younger looking one (picture a dinner table with people sitting around it except remove the table with the people still there - that was the arrangement), so he stood at what i'll call the head and asked everyone to comment on what they thought coulda been done better to help with the whole event. He started off saying he thought there was a communication problem. Everyone did go around saying their piece of mind. I did leave that circle cuz i had no comment and i didn't feel my place was there. I just thought what he did was really great...i mean having people reflect on the whole thing to see what could've been done better. (off topic but my preceptor just asked me to "get some tubes" so i ask what tubes to find out. For crying out loud, she's standing by a phone, all she has to do is call a different floor to tube us one, pretty simple huh? thought so but i'm sure it isn't for her.)

Oh, somewhere towards the end of the code, i heard my preceptor insisting that we call the patients family. The MD was really, if not super hesitant to call the family. So my preceptor had to tell her how close the guy was to his niece and how they'd want to know and blah, blah, blah before the MD called. I actually found that a little puzzling cuz even when i did my last co-op, i had to call the emergency contacts when something happened to a patient, whether it's a fall or whatever. And i know when my other patient fell that one time, the MD had to call the family so why was this lady having a hard time calling the family when their loved one was coding? I mean...i just don't get it! But anyway, after the guy had been pronounced dead i heard her asking for opinions as to whether to call the niece and let her know or wait for her to get her because the lady had said she was getting a ride her and she, the MD, had told the niece she'd call with any updates. Well, she waited till she got her.

When the niece came in, she looked like she'd been crying. She went to the room and called the patient by name in a way a child will say "mommy" to a sleeping mother and keep saying it as her voice lowers with each "mommy" she says and finally it just trails off. Except in this case, you could hear the tears in her voice. Yes i was outside the room at the nurses station just out of curiousity. I heard her wail. The gentleman who'd come with her stood outside, his eyes looked red but he wasn't showing any outward expression of emotions but it was obvious that he'd been crying. The charge nurse directed the lady to the confrence room cuz the docs were there. It was just a sad senario. Sad because i heard the whole family was here last night and they had a blast. The guy looked a lot better this time, he came in with fevers and he wasn't even febrile the night i admitted him. He was ambulatory, everything was fine. Of course he's on oxygen but this is someone whose had a lobectomy, and everything else to his lungs and still smoke. The last time he was here he had a chest tube and he'd still go out and smoke...and he was on oxygen back then. When i was taking his things out of the drawer and saw the cigarrette, i thought for a second there whether quitting smoking woulda made a difference.

Anywho, i forgot to say i finally did get to go to the room after the whole thing was done and see the dead guy. Didn't even get to do his vitals or do anything on him tonite. I did clean up his drawer, saw some money, a pack of cigerrete and forgotten what else i'd pulled out. His bag was open and atop of everything was a "Holy Bible." When i saw that, i thought to myself...i hope he read it today. I didn't even know he had a Bible. I did shove the stuff i found in the drawer on top of it. I took a good look at him, and the nurses had managed to put his red shirt on him and made him look presentable. At that moment, i don't think everything was real to me. It's still not real to me, part of this feels like a dream. I mean, most of the people here who die pretty much know they're gonna die. They come in their conditions worses and wham! out you go. The only surprises are people who are walking around, have massive GI bleeds, go down to the MICU and die later and even those you know they're gonna die, the only surprise stems from how sudden and unexpected the bleed was. You don't have patients who are perfectly fine and ambulatory 2hours ago and unresponsive when u check them.

I guess it reminds us man is but a breath in the site of God, quickly it comes out and quickly it vanishes into the air. I hadn't planned on having a code tonite, i mean who plans for that sorta thing. But as it's written, in his heart a man plans his course but the LORD determines his steps. I've been pretty lucky during this co-op. I know those who worked here last year had a couple of deaths. This is my first patient dying. I did have a 24-year-old die when i first came but he wasn't my patient. I decided to help with the post morterm thingamajig cuz i figured i was gonna have a lot of 'em ahead of me. Interestingly, everyone seems to die on the nights when i'm not here which is not bad at all. So today, just one more night before i'm done with my preceptor, it hit us, unexpectedly. I don't think she's had a death before cuz she made the expression we get to do post-mortem care. Like myself, she's been pretty lucky but i guess there's a day for everything and tonite was our nite to get hit with ti.

Reflecting on the family, a good number of them did come here and i've had to pause for a second to think of how it would feel like to be called and told someone whom you'd seen the previous day perfectly healthy just kick the bucket? How hard that must be. My heart goes out to them and i'm not super emotional now, i'm sure i will be once all this sinks in.

Poor guy died with an ET tube in his mouth.
May his soul rest in peace