The Chain of Command

When we were kids in school we learned about the chain of command. As the students, we were the peons and had to have permission to even use the bathroom. The teacher had all the power we could see over us, but she didn't have all the power she needed to help her do her job, this is where the principal came in, who had to determine if the teacher was as crazy as we thought or not. No matter what kind of child we were, each of us defied the rules, and at least once, the principal took our side. But sometimes the chain of command gets screwed up, and then problems arise.

The nurses station was buzzing with phones ringing, voices yelling and white coats creating a blur as they passed. As they walked, the interns, brand new from med school and our own batch of young doctors, griped. "I cannot believe the nurse wouldn't give my patient denture cream!" A blond, skinny doctor said in disbelief to her colleagues. She wore high heels and too much makeup, and looked much younger than she probably was.


"I cannot believe it either, I mean what the hell is her problem, the woman needs denture cream!" Another doctor, a short brown haired-boy said. He also looked too young, but was wise enough to wear scrubs. The third doctor, looked to be about thirty years old, he stayed quiet and watched his colleagues intently. He held the patients chart and laughed to himself, but said nothing to the others.


As they entered the patients room to discuss this mishap they stopped and stared at the patient speechless as the elderly lady they were worried about smiled at them, showing off a full pair of natural teeth, complete with a gold tooth on one side.


My pager buzzed endlessly in my pocket, but I couldn't seem to escape from a certain patient. She had something wrong with her, but no one could identify it. I kept thinking back to a scrubs episode where a patient kept thinking everyone was a clone of themselves and trying to hurt her. Her lip trembled as she rambled on and on about going upstairs to a unit that didn't exist. She kept talking about promises that doctors made, and kept talking about doctors screwing up her care. I approached the nurse as soon as I escaped, who rolled his eyes. So I took action. Wearily I walked over to the case managers desk and sat down next to her. She looked over at me. "What?" She grumbled, looking back to her paperwork.

"I need your help." I said, my voice shaking and knowing full well that I could get in a lot of trouble for doing what I was about to do. The case manager looked at me and took off her glasses, studying me. I took in a deep breath, then continued. "I have this patient, who hasn't had a psych consult, and I think she needs one. Also, her nurse seems to think she is crazy, so none of her needs have been met yet. And I am not sure who can call for those or what can be done, but I know you are a patient advocate, and so am I. Can you help me?"

She nodded and put her glasses back on. "I need a patient name and medical record number."

"So you can help me?" I asked.

"You bet your ass I can." She replied.

Thirty minutes later a psych team came to her room and new labs were drawn. The patients needs were met, and she felt better about her care, even if she was crazy, and without a doubt she had some psychological issues. No one knew it was me that told on the nurse about the patient. No one knew that I had overheard the interns arguing over something ridiculous, but the aide that I had to tell on knew that it was me, and for once, I regretted the chain of command, for this information getting slipped.

"I'm not taking report from you, your a bitch." She said, her acne scarred face sneering at me as she scratched the table with her dirty nails and chipped nail polish.

"That's fine." I said, handing my report sheet to one of the male aides. Anger and despise came over me and I felt meaner and nastier than ever as I watched her. Finally my eyes turned to the aide I had handed my report sheet to. He looked at my report sheet and a smile crept across his face.

"You even have their medications on here?" He asked. I nodded. "And their place of work, and their stories?" He looked at me and smiled. "I'm gonna switch shifts just to get report from you." He said. I smiled and clocked out, without a report to give I was burning time.

As I walked out the charge nurse tried to send me back to the break room, but when I explained the situation to her she sighed and apologized. I smiled at her and thanked her for her hard work, then walked out of the hospital, which seemed to be empty.

As kids we never realized all the things we did until it was bedtime, when mom and dad tucked us into bed and asked us about our days. It wasn't until we laid awake wondering what problems tomorrow would bring because of today's actions. As adults, we do the same thing, but our problems don't include apology letters or time out. As adults the repercussions of our actions are much, much bigger...

Abuse, TV and MRI Results

She was my height, my age. Her diagnosis seemed worrysome, and after talking to her we realized it wasn't due to the injury the doctors had written it was. They had it reported as an athletic injury, it was a fall. As she talked to me about her life, the horrifying stories were told as if it was nothing, and I looked to the nurse as we listened, within our eyes a conversation was held.

In medical dramas and TV shows you see patients who have been abused multiple times and the criminal got away. You watch as the doctors and nurses stare at each other and you can read their thoughts. Its a popular subject, but by the end of the 45 minute television episode all is righted in the world. The abuser is in prision for years and the patient has found herself and is happy. Its really depressing that real life is nothing like that.

As the doctors came in for rounds the nurse demanded they talk to her and that she recieve a psych consult. Phrases like 'my life in ruined', 'i hate my f***in life' and 'im glad i hurt, he dont hit when your hurt' were scattered throughout the night. There was no hiding it, this girl was a victim. The doctors only half listened as they flipped through the paperwork and then told us what we already knew - go to case management. Before night shift clocked out we waited to see case management go into the room- then paged the doctors again to ensure she got appropriate care.

All was not right in the world when my episode ended. The patient was still with him and he threatened her during the day, all things the other staff should have noticed. As I cared for her my heart broke and my pulse raced. I knew the problem would return in the morning and I worried about my patient and her care as soon as she left our unit. Sometimes worrying is all you can do.

I also got my MRI results back last night and spent hours staring at it, trying to see what the doctors could see, and failed miserably. However, I did find a way to save these images, and since I the patient give my consent, here they are for your viewing pleasure.

Understanding

In previous posts I have discussed my many recent visits to the doctors offices, and how badly I hate doctors when I am not working for them. Last week I spent time seeing a non-surgical Orthopaedic specialist, getting an MRI and an hour spent getting Xrays, only to be referred to a Surgeon (who I have to see today. Ick.) Every time I whine about it to my fiance, he always reminds me 'this will make you better at what you do. You will understand what the patient is going through because you have been the patient.'

At the hospital I always try to remember that. During my training as a CNA and as an EMT the school where I got my training always had us remember one thing - if you're gonna do it to a patient you better do it to yourself first. I have been restrained as a psych patient. I have had to wear a c-collar for hours at a time, I have been rolled, moved and repositioned, I have had thickened foods and mushy meals. I have ingested activated charcoal and had glucose ground into my gums. I have been the patient, but it has truly helped me be a better caregiver. I can explain the patient what it is in my own words, and tell them that I have done those things before.

Last night I had young patients, which is rare enough as it is, let alone patients who know the system, both of them working in medicine and working towards their RN. As I received report on one of them the NSI I got report from got quiet and looked sadly as he started to explain the situation about the patient.

'I'm not gonna name names,' He said sadly clicking his pen and pausing, as if he was wondering whether to tell me or not. 'But the aide last night was really mean to the patient and must have told her she is being a baby about her pain or something because all morning the patient made comments about being a baby and being in 'too much pain', because of this her pain is out of control, she is now very emotional and is not doing well. She works in a hospital, she knows whats going on.'

Sadly I nodded, whoever the aide was better not find me because my wrath for shit like that isn't right. I started my shift and found my patient to be just like the rest of us aides, a good kid just trying to make it to living the dream. As I worked with her I felt angry, how dare someone do that to another human being.

At one point in the night the patient was feeling anxious, was maxed out on pain meds and was crying, feeling overwhelmed and sad. I shut the door and sat on the end of her bed and rubbed her back softly. She stopped crying long enough to spurt out a line that almost made me cry. "I'm sorry, I know I'm a problem patient and that I'm taking time away from other patients. I know I'm a pain in your ass." I stopped. Patients don't just come up with that kind of stuff on their own.

"You are not a pain in my ass and if my other patients needed something there are other aides on the floor to help me, hell there are even nurses." I replied, continuing to rub her back. She sobbed and kept apologizing and wincing in pain. "You know, this is gonna make you such a good nurse." I said.

"How do you figure?" She replied.

"Well, when your patients are going through this and dealing with the pain you will be able to honestly tell them you know their pain, you know the situation." She rolled over and I handed her a box of Kleenex. "Some of these RN's graduate and are frankly snitty, they are mean and have no idea what the deal is. If this was light and fluffy and fun you would do this from home where you could wear your own stuff. You are gonna be able to be such a cool, compassionate nurse."

She smiled a small smile and embraced me, then asked me to help her figure out pain meds, which she immediately received and she was able to sleep through the night. Before I left I packaged my bracelet with a small note and placed it on her tray, knowing that when she awoke it would be there for her. From one student to another.

As I sat down to give report I felt good about myself and my shift. I did lots of things I don't generally do. Lots of UA's, lots of DCing foleys, and lots of things I do often, vitals and blood sugars. The other aides sat down next to me at the table and we all awaited to give report to each other. As I began report to the aide sitting closest to me I watched her pop a diet coke and chug it, then slam it down and stare at me oddly. As I watched this I felt awkward and had an odd gut feeling. Report finished on my other patients and now it was time for the patient I was most worried about.

"Oh my gosh she is such a snot. Every hour she is in pain- its like boo-frickin-hoo get over it."

My jaw dropped. "Her diagnosis is EXTREMELY painful, I have seen the strongest, most tough of men drop to the ground when they have it. Don't you dare." Then I finished report, complete with her eye rolling and her shitty comments. My stomach churned. My mind raced.

I found the other aide and asked her to keep an eye on my patient. As she agreed she asked why, I explained and her jaw dropped. We both agreed this was something that needed to be addressed to the charge nurse. I hate tattling on my colleagues but this was out of control. As I told the charge nurse she looked up at me worriedly.

"That's bull." She said. I nodded. "Dani, I appreciate you telling me about this. Its a hard thing to do, but its whats best for the patient." Then she looked to the board and quietly sighed. "But no other patient will take her as their aide."

As I left work I felt bad that I told on her. I feel bad that my patient was depressed. But I felt good, knowing that I did my job and I did it damn well.

"Heal"

On Saturday I went to a Family Reuinon for my Fiances' family, and needless to say I was SCARED to meet everybody! It was a perfect day, complete with playing in the sand (and a gorgeous sand castle!), playing in the water, eating great dutch-oven meals and sword fighting all the kids (we made them toy swords). There was even a station where everyone was crafting jewelery.

The jewelery was a washer and hemp yarn and they were using modge podge and gluing scrapbook paper to it, or stamping words into it, using a hammer and a stamp set. My future mother in law drug us girls over there and we all sat down to begin stamping and scrapping some jewelery. As I laid my washer out in front of me I could only think of one thing, and that was how much I didn't want to keep the jewelery for myself. So I studied the washer and then handed my fiance the letters and began measuring the yarn.

When we were all finished my mother in law studied it, not sure what to make of it. They did necklaces made of scrapbook paper, and they turned out cute. She smiled, told me it was cute and continued on looking at her other daughter-in-laws jewelery. My fiance took it from my hands and studied it. "Heal?" He asked and I nodded. "You didn't make this for you." He said, eyeing me with a small smile.

"Nope, I sure didn't." I said as he handed it back to me. "I made it so that I could give it to a patient."

"A patient?" He asked.

"When my brother got diagnosed with diabetes he got a teddy bear and a couple childrens books and such, and he really liked that. I can't do the same thing, but I can give a simple gift to a patient when the time is right."

My fiance smiled at me, then wrapped an arm around me. "That is really sweet." He then paused and gave me a devilish grin. "Do I need to go buy a stamp set and a new hammer?" I laughed out loud.

Today I am wearing my "Heal" Bracelet to work, knowing full well its purpose, its point and forcing me to keep my eyes open in all aspects of things. Its a small thing, a simple thing, but its the thing people love the most.

"God is Great, Beer is Good and People are Crazy"

'Life, is beautiful,

but its complicated, we barely make it.

We don't need to understand,

there are miracles, in our path.' - Life is Beautiful, Vega 4

When your rushing through textbooks and studying all the time for a simple certification you don't realize that as soon as your in the job everything will change. At 17 years old, working in a nursing home really is no fun, your lifting people heavier than you, some of the things you deal with are unsatisfactory and in the end, you feel really empty, you worked so hard and your blood, sweat and tears seem all for nothing. But there was so much beauty there, how did I miss it?

Did the doctors just love me enough to send me perfect patients last night? Did the nurses and the other aide love me enough to make sure they were in great shape and completely happy? Maybe my patients got a memo that I was off my game (and for those of you who read my OTHER post, I apologize, even then I was off my game), either way the night went perfectly.

Last night I studied up on my drugs, and still feel overwhelmed, so I'm gonna keep studying tonight. While hugging a tube of Bacitracin, I sat and studied up on Atropine, Lidocaine, Adenosine and a few others, still not sure why I'm having such a hard time with it, however my nurse is excellent and is having me do all my on-line and in textbook homework, before sitting me down for the lesson. She even pulled out a few 2mL syringes and marked them with the dosages of the medication, so that I could see the tiny amount those drugs need.

But, my mind wandered, and before too long Pandora was on and I was busy making flashcards on all the information I had found, and before too long I was singing along to Billy Currington's latest song which has a fitting chours for anyone in medicine.

'God is great, beer is good, and people are crazy.'

The drive home is amazing, no matter when I get off, but last night the city seemed to sparkle like a fresh cut diamond. As I drove home I kept thinking of how many hospitals and clinics I pass to get to work every day, and its a pretty large number, however, it is totally worth every minute of my drive. So I turn up the radio and sing for all I'm worth, because this is life. It only happens once, and I'll never re-live this moment again. So wasting my time whining ain't gonna happen.

I also promised one of our nurses I would post this photo. She had to give me my final Hep B shot in the series and I was giving her a hard time, telling her that my band-aid better be pretty freaking awesome. When she slapped it on my arm (I'm a bleeder) I saw that and busted up laughing. This is my definition of patient care!