Tuesday, March 31, 2009
My first code. Of sorts. (part I)
Okay, I'm sorry about that teaser from yesterday. I was so beat when I got home that I was incapable of much more than becoming a bump on the couch. I pretty much vegged out with some Intervention and Project Runway Canada. And then I went to bed at 21:00. So here's a synopsis of my mind-numbing day:
We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Nurse McDreamy.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
Blink, blink.
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Nurse McDreamy.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Once complete with Mr. Willie, I scampered off to giggle with my clinical group for a few minutes over McDreamy. Another RN overheard us and, sadly, informed us about Mrs. McDreamy. Bummer! Anyway, totally unbecoming nonprofessional behavior aside, I went back to Mr. W to see if he needed repositioning or anything (he has a sacral ulcer) before I went to see my other patient Mrs. S. Mr. W, still not in the best mood, insisted that I get his bed bath going ASAP as he was expecting a visit from a physician and wanted to be clean before that. So I agreed and got his basin all ready, got all the towels primed, and who shows up again but McDreamy RN. Hooray, thought I, someone to help me roll Mr. W around this big bed.
My impression of this McDreamy fellow was about to do a complete 180.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
Blink, blink.
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Unfortunately, and I'm going to chalk this one up to plain old newbie-ness, I didn't stand up for Mr. W. I thought that McAsshole the registered nurse would know better than a first year student. I hadn't worked with Mr. W for a few weeks and, who knows, perhaps he really was able to walk to the bathroom....
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
Have any of you ever been faced with this? Someone who should know better but doesn't, and who you should speak up to but are afraid to?
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3 comments:
Everyone probably faces this, with varying degrees of spectacular results. In my case my failure to stand my ground eventually resulted in actual patient injury (a fall), and the fallout was bad enough that I decided I wouldn't keep my mouth shut again. It's easier when you've got the RN after your name. As a student or aide, you've got nothin' but guts backing you up.
I must say that I am waiting (rather impatiently) for the story of the rest of your day! It stinks that something that could have been so damn good, ended up being so damn bad! I guess we learn from it all! Good job on your blog...I enjoy it immensely.
If that RN had've been thinking at all...he should have got an incontinence pad and held it in place at the rectum....and a mess and the poor patient's dignity could have been spared....and yes, even tho I have been an RN for 33 plus years...it bothers me to see disrespect for the patients as demonstrated by your ex-McDreamy.....
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Thanks for your thoughts :)