I posted my reports out of order. Friday's was actually supposed to be today's, and vice versa. Mea maxima culpa, and also whatever dude.
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Started out this morning with a couple of sweet pts—my
first day back since Tiberius died. I was kind of hoping for a pair of raucous
assholes I could joke around with and care for without working too hard;
instead I got two cute tiny old folks, both with Parkinson’s, both with lung
cancer.
One had undergone a right mid-and-lower
lobectomy, leaving him with nothing of his right lung but the upper lobe. The
other had undergone chemo, had a really rough time of it, and then come back
for her checkup to find that the cancer had spread quickly, after which she
developed a UTI and sepsis. The former will be going home in a few
days—the surgery was successful. The latter will also be going home in a few
days—antibiotics will have her comfortable enough to enjoy her remaining months
at home.
The lobectomy pt had a little extra
challenge to face. He’s orthostatic at home: when he sits or stands up quickly,
his body can’t keep his blood pressure steady, and he faints. He fell a month
ago and broke a small bone in his foot, requiring him to wear an immobilizer boot
whenever he gets up to walk. Not that he was walking far; the previous shift
had tried to take him for a walk down the hall, and he had made it as far as
the med cabinet before his eyes rolled back in his head and he dropped like a
rock. His chest tube made it even trickier to mobilize him, since it drained
into a big square box called an atrium that had to be carried along everywhere
he went.
And he really wanted to walk around. His pain
was well-controlled with an epidural in his back, which numbed him from nipples
to liver, preventing him from feeling the full impact of the huge surgery. Pain
control is crucial in major thoracotomies like this one—I think Tiberius had an
epidural too, immediately after his pneumonectomy and before things went
south—because, as with cardiac surgery pts, this pt population
is at huge risk of death if they lie still for too long. They need the
pulmonary hygiene of coughing, which is almost impossible to manage if you’re
in agony every time you breathe in; they need the blood-pumping action of
muscles massaging their legs’ veins to return the blood to their hearts; they
need to be able to breathe deeply, so their lungs don’t collapse, and the
volume of air you breathe in declines sharply when you’re in bed all day.
None of these things are particularly compatible
with a fresh open chest. If you’ve ever cracked a rib, you know what I’m
talking about: fighting the urge to cough, breathing in sips and whispers,
cursing your significant other like the Nosferatu because he strolled
through the room and made a stupid pun and you laughed unexpectedly.
I cracked a rib about a year ago because I was
at the pub for Drink & Draw with a bunch of my artist friends, and was
invited by one of them—a massive Hawaiian man whose job is an even split
between “draw monsters for video games” and “travel around the world giving
workshops on how to draw monsters for video games,” both of which are hard-drinkin’
jobs—to help him finish off some shots that a group of art students had bought
for him. I am an inveterate lightweight who gets a little woozy after a couple
glasses of wine, so it was deeply stupid of me to take him up on his offer. At
some point I asked him if people tried to fight him in bars, and joked that I
(one hundred twenty-five pounds of hair and freckles) should totally fight him
sometime. He responded by picking me up in a bear hug, which cracked my rib. He
was very sorry and expressed disbelief that anybody could break that easily; I
was very sorry and expressed a lot of
vomit and groaning.
Anyway. This dude had to walk if at all
possible. With fear and trembling we propped him up on the edge of the bed, and
let him sit there for a while, reminding him over and over that he needed to
wait to stand up until his body caught up with its new position. A few false
starts later, and we propped him up on the cardiac walker—its big elbow
cushions make it easy to walk with, and staff are known to rest their forearms
on it and dangle their feet to help relax their spines during a hard shift.
Heck, I like to lean on it and sail down the hallway, propelling myself with
gentle taps of the toes, scaring the piss out of the CNAs and smacking into the
medicine cabinets as I go. (This only happens in the late afternoon, when
things have calmed down a bit.)
On the walker, he made it out into the hallway
and down the hall before he turned white, slumped sideways, and said: “Leave me
alone, I feel fine.” His eyes stayed open, but his head sagged and his knees
wobbled. The charge nurse came running up, pushing a rolling recliner she’d
snagged from a nearby room. “I ain’t sittin down,” said the gentleman
as he slowly toppled, trailing his chest tube behind him.
“Sir, you’re passing out,” I said, trying to
maneuver his swerving backside into the recliner while bending around the
walker and juggling the chest tube atrium. “Please, sit down.”
“I feel fine,” he repeated. He was definitely
staying awake, but his body was absolutely done with this standing-up bullshit.
“You look like a package of used hot dogs,” I
said. “Sit the hell down.”
He started laughing, which I guess was too much
for him, because he lost consciousness and slumped back (mostly) into the
recliner like a sack of wet bricks. Thirty seconds later, as his body caught up
with the change, he came back to… still laughing. “Hot dogs,” he said. “Hot dawgs. This girl’s a pistol, bang bang.”
I’ve had worse compliments. Once a pt told
me: “I’d marry you, honey, but you’re a bitch from hell.” Still a little
heartbroken over that one. But I have to agree with him.
His chest tube had kinked off when he
flopped over on it, and the pressure differential had him feeling a little
stuffy by the time we got him back in his room. I straightened the tube and
hooked the atrium up to wall suction, and he gave a little start as a huge
bubble slurped from the tube through the water seal. “Whatna hell was
that,” he barked.
“Well, sir… your chest farted.”
More laughter. “Does your mama know bout your
mouth?”
I assured him that my mother was a good,
upstanding Baptist woman who would rather not know about my mouth, locked the
chair brakes, and went to the break room to open palm slam a cup of coffee and
two ibuprofen for my unhappy back.
I try to take care of my back. Lots of nurses
get hurt and end up on disability. Back injuries build up over time and then
suddenly seem to happen all at once, and I don’t want to end up slipping a disk
mid-turn. I use the equipment at hand, follow strict body mechanics protocols,
and am shameless about demanding help from other staff. Still, nursing is a
high-contact sport, and sometimes you just throw yourself between someone else
and the floor.
I’m not always funny, either. Sometimes I hit a
charming, exhausted zone where my filters are down and the words fly fast, but
shortly after that I turn into a blathering mule who can’t get three words out
in a row. Panic increases my chances of witticism; exhaustion makes me sound
clever. People are often surprised that I can tell a quippy story
with a solid punch line and then be asleep before everyone is done laughing.
So I tell people about black holes. They come
from supermassive stars, I tell them: huge flaming whirling nightmares so
massive that hydrogen is crushed into iron at their cores. At last each one
collapses under its own weight, crushing itself into nothing, waves and
particles of radiation squirting out of its terrible fist at every crack and
seam. And just as the star reaches the point of no return, ripping through space-time
itself, swirling into the inescapable singularity, an enormous gout of
brilliant blue light pours out, scouring everything in its path with searing,
perfect illumination: Cherenkov blue.
That’s me, right before I collapse. I get tired,
groggy, lazy; then, for a few moments, I am brilliant and clever and
unstoppable and incisive; then I am lying on the break room sofa in a puddle of
my own drool.
Anyway. I digress, boringly.
My other pt, the one who will go home on
comfort care, is loopy as a rabbit in the grass. She is also deaf as a loaf of
bread. She has hearing aids, which she hates wearing, and I don’t blame her
because they scream constantly from the feedback hell of being turned up to max
and shoved into her wax-plastered brain-holes. She grimaces and nods and looks
completely confused while you try to talk to her, and the whole time there’s
this distant metallic squeal like robots fucking. She is, however, so cute I
can hardly stand it.
She keeps saying these things that sound like
complete wacko non sequiturs, that make sense a few minutes later in context.
She was cold, so I brought her a blanket from the warmer, one with blue stripes
on it. She declined it: “Not with the red! I’m not a traitor!” Okaaaaaay.
She did have a big red allergy bracelet on. I got her another blanket, one with
no stripes, which she accepted.
A little later her family arrived, and as I
relayed this story to them, they nodded sagely. “Of course,” they said, “those
are XXXX University colors, and she cheers for XXXX State.”
I mean, I like football. I hated it when I lived
in Texas, where football is a religion and the weather during football season
is the best evidence we’ll ever have of God’s wrath, but since I moved to
Seattle I’ve learned to enjoy it. (Something about how obnoxious and balls-out
gleeful the fans are, and also about how Richard Sherman was fucking hot even before he opened his gorgeous mouth and
a whole higher education drifted out of it like a fleet of sexy butterflies.
Pardon me, I’m going to have a drink of water now.) I am the worst possible
kind of football fan, and I still don’t think I could maintain that level of
team spirit while slowly dying in a hospital bed.
We got her up to the chair for a while—yes, we
ICU beasts have a total obsession with mobilizing our pts—and then had
trouble getting her back into bed a few hours later, during shift change as I
passed her off to the next nurse. Fortunately the oncoming guy was strong and
good-spirited, and we wrestled her back into bed without dropping her somehow,
even when she wobbled and her knees went completely limp. “The black-eyed ones
always did that to me,” she quavered as we tucked her in. “Weak in the knees.”
I was halfway home before I realized she was talking about the night nurse, who
is a genuinely attractive young man with lots of muscles who quite literally
swept her off her feet.
My lobectomy pt transferred up to
telemetry immediately after that, keeping me late to give report to the
upstairs nurse. I stressed the importance of taking things VERY SLOWLY with
him, and told the whole grisly story of his afternoon walk. “Are you sure he’s tele status,”
protested the nurse, and I don’t blame her, because nobody wants a pt who
can turn into a floppy lump at a moment’s notice.
“Yeah,” I said. “Bye!”
I am a dick. Sorry, folks, that you have to know
that about me.
(Generally speaking, orthostatic hypotension
isn’t a reason to keep a pt on the ICU, especially if they’re
orthostatic at baseline and need exercise to get moving again, which the tele floors
are better at administering since ICU is focused on early mobility. It would
have been very bad form, and dangerous to the pt, for me to pass him off
without explaining how serious his orthostatic hypotension could be, but I
honestly didn’t have time to coax the upstairs nurse into recognizing all
this.)
As I left, they were already moving a new pt in,
a tiny little lady who screamed and thrashed and hit everyone within reach. Her
daughter stood in the hallway, dancing from foot to foot in that telltale
hand-to-breastbone posture of a family member who is going to be ridiculously
anxious the whole time. I will bet you one US dollar that I get that pt in
the morning, and that she hits me.
Maybe I can jinx her into being a perfect doll.
