Last night I took care of a man who was on suicide watch. This crops up occasionally, usually when someone has taken an overdose or has some other acute medical issue going on that prevents them from being directly admitted to psych. Instead they come to the ICU, where we can monitor them closely until they are stable enough to go to the psych ward or be discharged. I had the luxury of plenty of notice that this patient was on his way (something that has been in short supply lately), so I was able to set up the room to my liking, restock supplies, even read through the patient's chart for the back story I knew I wouldn't get in report. I brought my coffee into my room, despite the fact that this is forbidden, and tried to drink as much as I could before my patient arrived. I had grabbed a mug from the break room that said "HO HO HO!" in clusters all around, and as I sipped and perused the chart I looked around and thought of the scene that this must set. Working leisurely, with an out of season and forcefully cheery mug in hand, thinking detachedly about the man on his way to me who appeared from his chart to be severely depressed and unable to cope.
When my patient finally arrived, at his side was his wife who had obviously been crying. I suppose this shouldn't have been surprising, but the truth is that most of the time patients on suicide watch have families that have long gone home by the time they reach me, tired of yet another emotional crisis from their loved one; that is, if they have any family at all. So the crying wife got to me. I got my patient hooked up, assessed, and settled. He seemed plainly depressed to me, slow in his movements and though process, with a flat affect. No tears from him. When I was done the wife came back in and they talked in low voices, with lots of sniffling. I sat outside, "HO HO HO!" in hand, and tried to chart, but mostly I was thinking about how just another day at work for me was another worst day ever for my patient and his wife. What would I do if it was my husband lying in that bed, trying to explain to me why he had decided to empty the rest of his painkillers into his belly, then changed his mind and decided to, of all things, take the bus to the hospital? What if it was me sitting there sniffling, trying to understand this awful situation while a stranger sat just outside, drinking coffee out of a Christmas mug?
Thursday, March 17, 2011
Monday, January 24, 2011
Oh, poop
I remember the moment I first learned there was such a thing as a rectal tube. I was in my last semester of nursing school (a school that, it should be clear, was more focused on community rather than hospital nursing) and was in a clinical with a fellow nursing student. We were talking with a nurse manager and he mentioned a rectal tube. My schoolmate and I looked at each other. We looked at him. I asked him, trying to muster all of my professionalism, "A rectal tube? Like a Foley? But for poop?" It's hard to be professional when you are simultaneously floored and trying not to laugh.
One has to be pretty sick to earn a rectal tube. And, I suppose, to allow someone else to shove something up your butt. My husband continues to be amazed that such a thing exists and has a personal fear that I will, shall we say, bring my work home with me some fateful night. But those tubes do come in handy, because as any nurse knows a good part of the job is wiping butt. It is for the patient's benefit as well, of course- the last rectal tube I placed was in an unfortunate gentleman who was having frequent loose stools and a perineum that was getting redder and more sore with each one. I knew I had made the right decision when the small amount of fuss he made over having the tube placed was minuscule in comparison to the pleading and moaning he did with each wipe of his sore butt.
Placing a rectal tube, at least in my experience, is a nursing decision. You are the one caring for the patient, you decide, you do it, and then you notify the doctor. Most of the Drs I've worked with seem fine when I call them to inform them of what I've done. I did have one Dr tell me that she "didn't like" rectal tubes. Well, I'm sure the patient isn't a big fan either, but it sure is working isn't it?
At my facility we have a fancy new rectal tube with a fancy name that I won't mention. There are a few "fecal collection systems" on the market, and they all work about the same- insert the business end into the business and add a very specific amount of water in order to inflate the business end to an alarming size... inside the patient. By alarming, I mean donut size. Really. In your butt. Because this fancy system is so expensive, there is an actual decision tree posted to help nurses decide if the cost is worth it. Patients pretty much need to have a wound or very near one in order to justify the cost of inserting a donut up their butt, which I guess is again the lesser of two evils.
My absolute favorite thing about the fancy fecal collection system is their advertising- if you read any nursing journal you may have seen this. The bag and tubing is pictured, with a white background and some generic text that only hints at the actual usage, while simultaneously praising the product. Looking at the picture of the bag however, the bag appears to be filled with dark clouds and lightning. There's a storm a' brewin' folks, you guessed it- a shit storm. Which again, is far preferable to the Niagara falls of poop, which I have personally experienced. But that, my friends, is a story for another day.
One has to be pretty sick to earn a rectal tube. And, I suppose, to allow someone else to shove something up your butt. My husband continues to be amazed that such a thing exists and has a personal fear that I will, shall we say, bring my work home with me some fateful night. But those tubes do come in handy, because as any nurse knows a good part of the job is wiping butt. It is for the patient's benefit as well, of course- the last rectal tube I placed was in an unfortunate gentleman who was having frequent loose stools and a perineum that was getting redder and more sore with each one. I knew I had made the right decision when the small amount of fuss he made over having the tube placed was minuscule in comparison to the pleading and moaning he did with each wipe of his sore butt.
Placing a rectal tube, at least in my experience, is a nursing decision. You are the one caring for the patient, you decide, you do it, and then you notify the doctor. Most of the Drs I've worked with seem fine when I call them to inform them of what I've done. I did have one Dr tell me that she "didn't like" rectal tubes. Well, I'm sure the patient isn't a big fan either, but it sure is working isn't it?
At my facility we have a fancy new rectal tube with a fancy name that I won't mention. There are a few "fecal collection systems" on the market, and they all work about the same- insert the business end into the business and add a very specific amount of water in order to inflate the business end to an alarming size... inside the patient. By alarming, I mean donut size. Really. In your butt. Because this fancy system is so expensive, there is an actual decision tree posted to help nurses decide if the cost is worth it. Patients pretty much need to have a wound or very near one in order to justify the cost of inserting a donut up their butt, which I guess is again the lesser of two evils.
My absolute favorite thing about the fancy fecal collection system is their advertising- if you read any nursing journal you may have seen this. The bag and tubing is pictured, with a white background and some generic text that only hints at the actual usage, while simultaneously praising the product. Looking at the picture of the bag however, the bag appears to be filled with dark clouds and lightning. There's a storm a' brewin' folks, you guessed it- a shit storm. Which again, is far preferable to the Niagara falls of poop, which I have personally experienced. But that, my friends, is a story for another day.
Wednesday, January 5, 2011
Another day, another...
Today it's another confused patient. He's mostly concerned that he's gotta go potty, despite his Foley, although for a while he was very upset I wouldn't let him have a dog. Sigh.
Last night the tiredness hit me at the end of the night like a ton of bricks. I didn't get much of an afternoon nap but I wasn't feeling too bad until 4am, when I went to draw labs and just couldn't. I don't know what the problem was, really, aside from the fact that my patient was soooo shaky. Usually I give up after 2 tries and ask someone else for help, but the guy wasn't with it and I was determined so I tried it again... major fail. Because I was so tired, I almost started crying. That, on top of the choice 4 letter bombs I was dropping, create the professional picture of today's modern nurse. You know; tired, cranky, and prone to emotional outbursts. Hah.
That end of the night tiredness happens a lot, actually. I can usually gauge it by how long my morning report is. More rambling = more tired. When I see the day nurse's eyes start to glaze over, I know it's time to wrap it up, finished or not. Also, I like to take the stairs down to the parking lot, but it's four flights down, which is a lot of winding around and around. On more than one occasion I have found myself at the very end of the stairs in the the basement, needing to climb back up to my exit and not sure how it got past me. When I first started working in the ICU and was constantly feeling overwhelmed, I would routinely be surprised by the door to the parking lot in the stairwell, as if it had materialized out of thin air right then. Good thing there are no snakes in the hospital. I hope. Don't even ask about the drive home.
Still, I can't help but think that I would be equally groggy at 5am if I had just woken up, the disadvantage there being that the shift would just be starting rather than almost over. maybe it's not my less-than-succinct report that creates that glazed look. I'm going to have to go get another cup of coffee and ponder that. Well, that, and what kind of dog would be best suited for a combative alcoholic in restraints.
Last night the tiredness hit me at the end of the night like a ton of bricks. I didn't get much of an afternoon nap but I wasn't feeling too bad until 4am, when I went to draw labs and just couldn't. I don't know what the problem was, really, aside from the fact that my patient was soooo shaky. Usually I give up after 2 tries and ask someone else for help, but the guy wasn't with it and I was determined so I tried it again... major fail. Because I was so tired, I almost started crying. That, on top of the choice 4 letter bombs I was dropping, create the professional picture of today's modern nurse. You know; tired, cranky, and prone to emotional outbursts. Hah.
That end of the night tiredness happens a lot, actually. I can usually gauge it by how long my morning report is. More rambling = more tired. When I see the day nurse's eyes start to glaze over, I know it's time to wrap it up, finished or not. Also, I like to take the stairs down to the parking lot, but it's four flights down, which is a lot of winding around and around. On more than one occasion I have found myself at the very end of the stairs in the the basement, needing to climb back up to my exit and not sure how it got past me. When I first started working in the ICU and was constantly feeling overwhelmed, I would routinely be surprised by the door to the parking lot in the stairwell, as if it had materialized out of thin air right then. Good thing there are no snakes in the hospital. I hope. Don't even ask about the drive home.
Still, I can't help but think that I would be equally groggy at 5am if I had just woken up, the disadvantage there being that the shift would just be starting rather than almost over. maybe it's not my less-than-succinct report that creates that glazed look. I'm going to have to go get another cup of coffee and ponder that. Well, that, and what kind of dog would be best suited for a combative alcoholic in restraints.
Subscribe to:
Posts (Atom)