Defending the Patient

I hate drama. HATE HATE HATE drama. I don't like to cause drama.
Unless there is a patient on the line.

We had a psych patient last night in a 1:1. The things heard coming from that room were screaming, crying, worrying and feeling frantic. I had approcated the aide and the patient a few times, and both times it was a situation that was under control. The patient was exactly as the board stated, a 1:1. It was an emotional patient.

Shift change came and the charge nurse told the night aides to do whatever they felt. BAD IDEA. Our night aides aren't smart, or sweet, or kind. They are know-it-alls and mean to our patients. I have had many incidents with our patients and this was no excuse.

They wrote all of their names on the 1:1 board, explaining that they would all do the 1:1 for 2 hours a piece. "What about the rest of the unit?" I asked. If the aide covering one area went in a 1:1 who would watch their patients? Would their assignment change.

"We are not doing the 1:1 for 8 whole hours." The oldest aide said. I was shocked and frankly appaled. I respected this aide, she was a nice lady. She kept quiet, her patients loved her and she did a good job. So why was she in this mood?

"It's a 1:1. A PSYCH patient." I repeated to her.

"Who has been screaming, crying, yelling and freaking out. I am NOT going in there." She said.

"Sounds like a 1:1 to me."

"You don't understand 1:1's." She said with a snitty tone and then looked away and kept writing.

"Bet me." I said, starting to feel a pissy mood come over me. "I did 1:1's for an agency for a year, and I do 1:1's all the time here. I get psych patients and if you want a decent evening with this patient you need to work with the patient."

"Its more convenient to do it this way." She replied.

"We ain't here to convenience ourselves we are here to convenience our patients." I replied stepping closer to her. If I was an inch shorter we would be eye to eye. "Yeah its gonna suck, but you aint here for yourselves. Ya'll are aides because you like to help people. This 1:1 is a PERSON." The other aides were trying to ignore the fact that I was verbally demolishing their plans. Meanwhile I was trying to hide my midwest accent that shows up when I am mad.

"You gonna do it?" She hollered back. A seemingly good comeback, if we were 12.

"Naw, I did my 8 hours of service. And I did it well. I busted my ass and took good care of my people. This patient." I said pointing to the 1:1 on the board. "Is a psych patient. She needs stability or she will be screaming and hollering and freaking out at all y'all all night long. This patient needs two aides every 4 hours or one aide in 8. She's been good with the 1:1's all night long. Only crying when something scary shows up." I sighed. "I respect ya as an aide, and thats why I'm gonna tell you this is bullshit."

She rolled her eyes and another aide wrote her name in there for the 8 hours. The rest of the assignment was written and I started to give report. The aide I gave report to looked to me worriedly.

"What?" I asked.

"Why did you yell at her?" She asked. I paused for a moment to gather my thoughts.

"We do this job for other people. If we wanted to make money we would have become automotive techs or lab techs. But we like people and we like making them feel better, so we become CNA's. We become patient advocates. There is a reason I learn as much about my patients as possible- so I can be on their team."

"So you pick your patients over your colleagues?"

"Yep. Everytime." I replied opening a patients chart. "Does that make me a bad person?"

I took her silence as a no.

Before I could clock out I was cornered by the charge nurse. He began to yell at me for causing problems with the other aides. I took it, for a minute, until I realized he hadn't been told what I got upset with them over. I calmly defended myself and asked him what he would have me do. He also said nothing.

I left work to see the 1:1 room assignment had been changed, and the charge nurse was hollering at the aides about it. When I passed the 1:1, the patient was screaming and thrashing around.

Hope it all worked out ok.

I defend my patients over my colleagues. I am a patient advocate. That does NOT make me a bad person.

Bad Nights

Everyone has bad days, everyone has bad nights. Everyone is entitled to these. It's a part of life.
Tonight I was placed in a 1:1. The guy was a generally cool guy, and all of his 'delusions' were proven true by his friends showing up and proving to me that he wasn't lying. I took him out for multiple smoke breaks. We talked alot about his emotions and feelings, I felt like I was making progress.

Until he decided he wanted to end it. He first began with beating himself, punching himself hard in the head, neck and jaw. He screamed out as I tried to pin him down, then with the help of the nurse we calmed him down. We then let him make some phone calls to his family, bad idea.

I dropped my notebook from on my lap and jumped over the side rail, trying to pry my hands from around the telephone cord wrapped tightly around his neck. I kicked the nurse call light on with my elbow and tried to wrestle him free from the cord, but he was too strong. Fists flew into my face, arms hitting my arm and knees into my chin as he tried to regain control. I could feel his carotid under my fingers as I fought to get grip of the cord. "I need some help in here!" I yelled, then got kicked back by a knee to my chest. I started to panic and the adrenaline kicked into high gear as I jumped back into action. No one came. We continued to wrestle for a minnute more, him spitting on me and swearing, dropping all the bombs in the book, he gritted his teeth and began to thrash some more. "I need some frickin help!" I yelled, this time a parade of Nurses, aides and the on-call doctor came running in and we helped get him free from it.

My hands shook as I continued to hold him down to the bed by his wrists. We all had adrenaline pumping and tried to calm him down as he yelled and screamed, trying to break free. I could feel his radial pulse pounding quickly, and then realized it was my own pulse I could feel.
I went numb after that, and thank goodness shift change was ten minutes away. I looked at him, feeling empty and insecure, he lay quietly on his bed, watching Scrubs. I just held down a man who tried to kill himself in front of me.

Now I am home, have had a whole long drive, and even tried to eat a little, but it takes it out of you. I know I did the right thing, I had doctors, nurses and other aides shake my hand and inform me I saved his life and did a good job...but I just watched a man try to take his own life.

I'm not quite sure how to feel about it all.

Suicide, Attempted and Accomplished

They were the same age, had the identical diagnosis and were from completely different places of life. One was a wealthy woman, who wore more jewelery than any patient I had ever seen in my life. The other was a poor woman, who wore a motorcycle jacket and had no teeth. Both had ODed on over-the-counter drugs in an attempt to end their lives, and I was taking part in their 1:1. Both patients lived, both patients were going to be fine, but both patients were upset, the consequences of their actions made them regret everything and they vocalized their depression and anxiety about all of it.

Oddly enough I love working 1:1's with psych patients. If they are alert and oriented, we can talk to them like old friends and not like patients, but if they are not alert, oriented or even close to, they are fun because they say things and do things that simply make your day better. For example, we had one of them on a NPO diet, and she wanted Ice chips so badly. We tried to explain to her as we swabbed her mouth- but she didn't understand. "So do only the pregnant women get ice chips then?" She asked me, her big blue eyes looking into mine with genuine worry. I tried so incredibly hard not to laugh as I tried again to explain, but she was long asleep by this point.

Its something we deal with day in and day out. Life and Death. When you get a bunch of EMT's, CNA's, Nurses, Firemen and even Cops together eventually the subject will be brought up. How will we go? Going through schooling we always laughed at those kids who slashed across the street and were 'too stupid' to go down the river. We laughed at those people who thought a handful of baby aspirin would do them in, didn't they know that a whole bottle was needed at least? More than once have I talked about how I would go, and I always imagined myself doing something heroic. I'm not one who has ever wanted to be a old person, sure, I want to see grandkids, but I don't want to be that old that I only see them on Sundays when they come to the care center.

I hate it when patients attempt to kill themselves, and they succeed. I really hate it when they attempt, we care for them for nearly a month and they pass unbelievably quickly. Its terribly sad, and horrible for all of those who are doing the post-mortem care. I wasn't the one to do it- but it was terribly sad to know that another soul had passed on and that two of my colleagues, who had put their blood, sweat and tears into caring for him, had to now place him in a bag with a tag on his toe.

Not many people know this, but I pray when we loose someone, locking myself in the locker room or taking that extra few minutes before turning over my engine and heading home. I pray that their soul can find its way home and to peace. That all of their pain and suffering will disappear and they will finally find rest. At times I feel like the only person who does this, and I know my colleagues would laugh if they knew this, but its what I do to give myself clarity and peace of mind. Maybe I am crazy for doing it. Maybe I am just a believer.

Despite it all

I don't live anywhere near the hospital, and that comes with pros and cons. Pro, is that I have time to mentally prepare myself for whatever my shift may hold. Con, is that at times, things happen, like cars don't work. Rides are too far away. Within a matter of minutes my personal life became a mess and as I wearily drove into work I was looking forward to loosing myself in the service of others. The car had broken, our new room we had remodeled was falling apart and was still not finished, friends and family were all hitting on sore spots, I felt like a wreck. As I walked into work I kept looking for opportunities to loose myself in service.

Leaning against the wall across from the time clock I cursed everything I would have to deal with when I returned to this spot, 8 hours from now. Shortly after, I clocked in and checked the whiteboard. Another 1:1.

As I walked into the room and got report, I looked at each bed's whiteboards. Both's patient goals were to get better, as report was given I found that both patients illnesses were self caused. I love working in 1:1's because you can actually give the patient(s) the attention you feel they need, but today I felt frustrated with my 1:1s because it was more severe than what we were used to dealing with.

Vitals were unstable, Mental Statuses declined, quickly it got to be overwhelming, one patient was receiving a chest xray, then the other a ABG test. While physicians were in the room for both patients I stepped outside for a moment and exhaled, running my fingers through my hair. "Despite it all, they are still human." I told myself. "Despite that they cannot remember their families, that they did this to themselves, they are still human."

Before too long I was pulled from the 1:1 and placed on the floor, with a few patients. I really am starting to love this unit the more I understand what to do, however a few nurses seem to think that I am 'too slow' in learning what to do. (Whining will precede, be cautioned) I am with a full patient load now, doing tasks I wasn't doing the week before, and I only ask questions when I truly don't know, so I go to those who DO know. Generally speaking the nurses are excellent at answering my questions, and I love that they do that, but almost every week without fail my patients happen to be Nurse (Meanie-Britches) patients as well, and she asks me to do a lot of things I don't know how to do. I ask her to elaborate, to explain, when she'll slam the doors and throw things onto the counter grumbling 'Fine! I'll just do it myself!'

'Despite it all, she is still human' I whisper under my breath, pausing long enough to exhale, then running after her to try to fix whatever messes may be caused on the way. I hate it when that happens.

I got surprised for my break, my boyfriend and one of my best friends came and brought me dinner and offered to help me with the vehicular problems. I gladly accepted the offer and spent my lunch break laughing it off. We joked about everything, and they being two of the best guys I know, saw my frustration and tried to make me feel better. My best friend came back from college with many vices, and slowly worked them away, except for two. His crazy girlfriend, and smoking. But we know he will never quit both of these habits and despite it all, he is still human.

As I finished my shift I did vitals, blood sugars, intake and output checks and all other nighttime activities that needed to be done. After verifying that I had truly finished all my tasks I read up on the different diagnoses that the unit was holding. It really amazed me at what a variety I saw, everything from Sepsis to Depression, Below the Knee Amputations to Pneumonia, we see it all.

There were a few abbreviations I didn't understand, so I asked another CNA, she sat down next to me and tried to figure it out, then explained 'since its a human that enters this information, not the computer, they enter the information that they know, not the generalized term so this sometimes happens.'

As I drove home I started to think about the quote just running through my mind all shift. What does it mean to be human? Does it mean we allow for addictions, mistakes and short-comings? As I listened to my play list the answer came to me.

To be human means to have a continuous heartbeat that does more than pump blood, it holds your love, your worry, and your emotions towards others. It means you do more than simply work, you think, you delegate, you educate and you learn. Being human means that from time to time you will have a vice, you will have mistakes, but you will overcome them and thrust yourself onto greatness. To be human means that you will continually want; want to better yourself, want to be healthy, want to learn and want to obtain your dreams.

Despite it all, all the crap, all the concern and all the hassles, it was a good shift.

Pneumonics

When your training to be an EMT, you find yourself overwhelmed at times, so the big shots decided that pneumonics would help the EMT-In-Training learn better and faster. Alot of these pneumonics are used for Nursing, for becoming a doctor, and even for becoming a first responder.

At first you think they will be easy to remember;
OPQRST (onset, provocation, quality, radiation, severtiy, time),
SAMPLE (Signs and symptoms, Allergies, Medications, Pertinent Past Medical History, Last Oral Intake, Events leading up to incident),
ETA (Estimated time of arrival),
AVPU (Alert, Verbal, Painful, Unresponsive- Stimuli),
PMS (Pulse, Motor, Sensory),
JVD (Jugular Vein Distention),
ALS (Advanced Life Support),
PERRL (Pupils are Equal Round and Reactive to Light),
A&O x3 (Alert and Oriented to Person, place and time)
LOC (Level of Consiousness)
ETOH (Ethanoyl-Drinking)
SOB (Shortness of Breath)
MVA (motor-vehicle accident)
But the easiest and most important pneumonic is this; ABCDE. Airway, Breathing Circulation, Decision to Transport and Expose (Trauma).

Last night at work I had a chance to review my EMT skills and remember my basics all over again. While sitting in a 1:1 with two patients, I was taking vitals of one patient between visits from the physicans. They spoke quietly to each other and then to the fairly alert patient, and then back to each other. They preformed small medical procedures, and then left. The patient's respirations had jumped from 20 breaths a minute (10 L on a face mask) to 44 breaths a minute (on a Bipap). Convinced that if it was an issue the doctors would have done something, because this occured while they were in the room, I pulled the call light to get the nurse in there, but only a CNA showed up. I instructed the CNA to go get the nurse and explained why, then was pulled to the other bed to tend for my other 1:1.

This was when my ill patients family member showed up. She shook my hand and kindly talked to me about his needs. I gave her as much information as I knew about her loved one, but then stopped and looked at him. She started to ask questions to which I didn't know the answer to, and then gave her the nurses' names, the doctors names and the interns names, so she could ask them. When I explained to her my title she understood and left the room briefly. I took his respirations again and realized they weren't adequate and thought to EMT class. Airway, he was sitting upright, mouth open, he had a patent airway, Breathing, he was struggling to get adequate air in, let alone talk, but he still had Circulation. ABC. The next step would be 15 L NRB, but he was on 10 L with a BiPap, I couldn't change the O2 due to the doctors orders.

I looked to the charge nurse standing in the doorway, recieving information and talking to the family member and told her, "His respirations are irratic and at 44 breaths a minute." This was when the nurse ran to the nurses station and seconds later the room filled with doctors, nurses, x-ray tech's and phelbotomists as they began immediate care that was almost the same as a code.

As I watched all of this hustle and hubub from the corner of the 1:1 I realized something. Medicine isn't as difficult as everyone makes it out to be. You just have to go back to the Basics. My patient is fine now, and is doing better, but we needed to step away from the cool fancy projects long enough to remember the basics, because without those, we wouldn't even have a pulse.
Until next time, BSI (body substance Isolation)