Saturday, July 31, 2010

We're All in This Together

She is delightful. Her eyes twinkle when she talks, and her stories---often repeated, I'm told---reveal her cultured European upbringing and her very good memory.

She sits in her chair most of the day, looking forward to happy hour at five. She's lived a good life, and there's nothing that will change her habit of drinking a bourbon and water (or two) at the end of each long afternoon. Nearing 100, she's even taken up smoking a cigarette with her bourbon, and there's nothing that will change that, either.

"I never expected to live this long. Who could have imagined it?" she says with apparent sincerity. And when questioned about the new habit of smoking, she says, "And why not?" with a smile.

"My life has been lovely, my children are wonderful, and I have no complaints other than my loss of mobility. Still, life is good and my days are my own."

I inspect her toenails and decide that a podiatrist should be the one to tackle their impenetrable thickness. Her ankles are without swelling, her abdomen is soft and non-tender, and her cognitive functions are intact. Her vital signs are stable, her pacemaker works like a charm, and her positive attitude certainly makes up for the deficits that have significantly reduced her independence.

"Life has been an adventure, and now I get to sit in this chair, look out at this wondrous view, and have myself a nice stiff drink at the end of the day."

Her daughter winks at me knowingly, and acknowledges in a whisper that there's now more water and less bourbon than ever at happy hour.

"Well," I say, "I wish I could make up excuses to stay here all afternoon and chat, but you're doing so well there's nothing more to say. I'll come back in a few months to see how things are going with the home health aides. Call me if you need anything, OK?"

I shake her hand, but it's apparent that she wants a kiss, so I lean down and peck her on her powdery cheek. She smells like lemons.

"Thank you, dear," she says. "Please come back soon, and don't just wait til they tell you that you have to come back. The door is always open." We smile at one another widely as I exit her immaculate bedroom.

"She's a wonderful woman," I say to her daughter as we walk to the driveway. "She's lucky to have you and your brother."

"Yes, she is wonderful. We love her, and we're just as lucky as she is. We're all in this together." She beams at me as we shake hands, and I walk to my car, sinking into the driver's seat with a satisfied sigh.

Chiropractic on BlackDoctor.org

My new editorial on chiropractic is now published on BlackDoctor.org. Feel free to swing by.

Thursday, July 29, 2010

Saturday, July 24, 2010

Change of Shift, Vol. 5, Number 2

The latest edition of Change of Shift is now published over at Emergiblog. I actually managed to submit two blog posts to this edition, and I'm pleased to have been included.

Tuesday, July 20, 2010

In the ER.......

The emergency room is busy, but we're ushered in quickly after registering. My client was having liquid diarrhea and vomiting after I arrived to his house this morning, so I called the case manager and she came right over. She agreed to transport him to the ER in her car as I followed close behind.

It's the usual ER scenario: the same questions asked multiple times, a desultory exam by the attending Physician Assistant, and a long wait for blood to be drawn and an IV started. As the nurse starts the IV and draws the labs, we chat about nursing.

"I've been a nurse for thirty years, and it's just gotten worse and worse," she says as she pokes my client and draws five vials of blood before starting the IV.

"I almost always work without a break, and when I complain, they tell me that this is the ER, and if I don't like it, I should go somewhere else." She places the vials of blood on the counter near the sink and fingers the IV until it's running at the rate she desires.

"They treat us like shit," she continues, "and there are always new grads ready to take our place. I don't know why I put up with it. I don't even have time to eat, and you'd think the management would care that their nurses' basic needs are met. But they don't. They just don't."

She leaves the room, the vials of blood still sitting by the sink. Contrary to safety protocol, she leaves the rail down on the side of the bed where she's been working. She also leaves all of the detritus and trash from the blood draw and IV setup in my client's lap, and dirty gloves on the floor. It's the end of her shift and she's ready to give report and go home.

I overhear a conversation in the hall, the nurses paying no heed to the fact that patients and visitors can hear their every word.

"How's your day going?" one nurse asks her.

"Terrible. It's one of the worst shifts ever. I can't wait to get out of here. I hate this."

She shuffles off to give report, my patient's blood vials still on the counter by the sink. I try to catch her eye but she's already down the hall.

Almost an hour later, she's back, and the blood is finally sent off to the lab, and then she's scribbling madly in charts as the new nurse comes on duty.

The eight hour ER shift has obviously taken a toll, and our original nurse seems fried beyond reason. I quietly excuse her lapses and hope that she can go home and rest.

The new nurse who has just come on duty bustles into the room, greets my client, introduces herself, asks some questions, and shakes her head as she realizes that the previous nurse failed to hook up an automatic heart monitor and oxygen saturation machine on my client when he was first admitted. She untangles the IV, smooths his forehead, offers me a drink and a snack, and bustles out as cheerily as she came in. Meanwhile, I wonder how she'll look and feel in eight hours.

With telephones ringing, bright lights, loud conversations and the constant beeping of monitors, machines and intercoms, the emergency room is no place to rest. In fact, it's not a place anyone ever wants to be, even most of the people who work there. Still, it's an essential place, a human place, and a place where the ill, the broken and the traumatized come for succor and emergent care. But if the nurses and others who staff these emergency rooms are truly treated like so much expendable waste, then how can things ever really change?

Saturday, July 17, 2010

Wednesday, July 14, 2010

A Visit to the Doctor

The case manager and I have brought our client to see his new doctor, who enters the room smiling, his gray lab coat worn over a white shirt and tie decorated with multicolored stethoscopes and faux ECG readouts. He shakes each of our hands, in turn.

"So, you're Mr. __________. Very nice to meet you. I believe your son is my patient, as well."

My client is solicitous, friendly and smiling as the doctor greets him. "That's right. Nice to meet you."

"You seem very healthy for a man of your age," the doctor says. "We should all be so lucky."

As we talk, review our client's history and relate our concerns and needs, the soft-spoken doctor listens----really listens----and reflects back to us what he hears. Performing a cursory yet thorough exam, he listens to our client's heart and lungs, prods his belly, inspects his limbs, checks his eyes, and otherwise gives him the once over with gentle and learned dexterity.

"I think you're all doing an excellent job caring for Mr. _________. He's a lucky man to have such a team looking after him 24 hours a day." He leans over and speaks very loudly into our client's ear. "You're a lucky man!"

Our client smiles broadly.

After the exam, the doctor recommends a tetanus booster and a pneumonia vaccine, and we're stunned when he comes back into the exam room to prepare and administer the vaccines himself.

"I'm sorry," I say, "but I've never seen a doctor give an immunization before. Do you always do this?"

He looks up at me as he flicks one of the syringes with his finger to remove any errant air bubbles. "Oh, when the nurses are busy I like to help out. It's no big deal, really." He leans down and administers the two injections deftly, one in either deltoid. Mr. _______ never flinches.

"Well, it's a big deal to us. Most doctors would never dream of doing such a thing," my colleague says to him as he places the used syringes in a sharps container. "You've been very kind and attentive."

"It's my pleasure, truly." The doctor shakes each of our hands once again, hands us prescriptions, referrals and a signed application for a handicap placard, and slips quietly out the door.

"That is one fine doctor," my colleague says to me, shaking her head. "What a positive experience."

We wheel our patient to the elevator, all of us quiet, knowing that we have just had what might be seen by some as a very unusual experience. The doctor was efficient, kind, thoughtful, thorough, paid great attention to detail, and listened to everything we had to say. As nurses, being really listened to by a doctor is simply a coup d'etat, and we left that office beaming with our collective good fortune.

A fine doctor, indeed.

Saturday, July 10, 2010

A Kind of Life

He stares out the window, fumbling with his belt and drumming his fingers on the arms of his portable wheelchair. Wheeling himself to the table, he leafs through a magazine, the pages worn from days of similar activity, the corners greasy from his fingers. Unwilling to draw, refusing to be read to, staring past the TV towards the empty wall, eschewing the Play-Doh that we thought might be a fun and therapeutic diversion, engaging with him is significantly challenging. Throughout our 12-hour shift, he generally refuses food, readily accepts water or juice, and otherwise chooses to keep to himself with occasional brief conversational interludes.

And so the days pass.

Recently, he was saved from a deplorable situation where he was taken advantage of by acquaintances looking for money or alcohol, rarely washed or bathed, and lived a life that most people would find appalling in its squalor. Now, living with family in the countryside, he is safe from ill-meaning neighbors and so-called "friends", yet he pines for that other life with all of his might. Stripped of his freedom, his drivers license and his car, he is at the mercy of nurses and social workers who mind his every move with a keen and earnest intent to help him stay clean, dry, well fed, hydrated and happy.

It is without a doubt that this individual was truly a danger to himself and at risk of injury or death without the proper intervention. Still, assessing his current situation, it's also quite clear that his quality of life leaves a great deal to be desired. We do our best to provide for him, keep him comfortable, and afford him some level of contentment. Still, it's so difficult to witness a person who seems to glean so little enjoyment from life, made even more keen by the sudden loss of his independence. Yes, it's a life, but how can we make it better? How can we bring him joy? And how can we make up for the changes that have stripped him of his ability to make decisions for himself? These are not easy questions to answer, and as we grapple with the possible answers, he stares out the window wishing that things had never changed.

Friday, July 09, 2010

Change of Shift Turns Five!

Change of Shift, everyone's favorite nursing blog carnival, has just celebrated five years of publication with it's most recent edition. Congratulations and gratitude to Kim at Emergiblog for being a tireless advocate on behalf of the many talented nurse bloggers who pour their hearts out and share their stories time and time again.

Happy 5th birthday to Change of Shift, and may there be many years to come!

Friday, July 02, 2010

Home Health and Hospice

My latest article written for Working Nurse Magazine is now published both in print (in Southern California) and online. The article covers the specialty of home health and hospice nursing, and features interviews with three special nurses.

My next article for Working Nurse (on the specialty of nursing informatics) will be published later this month, and in August I will be providing yet another article on the specialty of oncology nursing.

I am very grateful to Working Nurse Magazine for these opportunities, and am pleased that my writing career continues to flourish, even in these uncertain economic times.

Thursday, July 01, 2010

100 Blog Posts That Will Make You a Better Nurse

One of my blog posts from 2009---The Nurse as Sisyphus---has been featured in a list of "100 Blog Posts That Will Make You a Better Nurse" over at NursingSchools.net. I greatly appreciate being included on this list, and hope that some inspiration is indeed gleaned by those who peruse the many offerings included there.