2nd semester wake up call
So I asked my instructor why last semester I was at the top of my class and this semester I'm barely passing. (Passing is the minority, so I'm still doing okay, but damn it's scary and frustrating to be working hard with very minimal rewards and serious running-in-front-of-the-train fear of failing out.)
Her response:
”Last semester, you learned to make beds with hospital corners.
This semester you learn to save someone's life.”
Why didn't I have a passion for fish or kites or something?!
May not want to read behind the cut; gross.
So tonight I went to the nursing home to get my patient info and study her charts and labs and figure out how I'm going to make her life better and improve her health tomorrow and Wednesday.
As I'm trying to talk with her and do her assessment, she keeps zoning out.
I am the only one from my group at the facility. I'm too slow and everyone including the teacher has gone home and it's dark out, and I haven't eaten or drank a single thing all day. I start to realize, it is WAY past time to get out of there. I don't want to be here anymore.
So I think I'm going to hurry through my assessment, and I'll work on all her paperwork when I get home.
I try to listen to her heart. But I hear nothing. "ARE YOU KIDDING ME!?" I listen all over her chest and still hear nothing. And I realize that she has vomit or sputum or something on her near where her head is cocked.
I start to realize that there are some serious issues going on here. I leave the room, find gloves and put them on. Then I wipe my pen and stethoscope with alcohol.
I try to take her pulse, but she keeps forgetting what's going on and she keeps slowly moving her hand, with my fingers still on her wrist, underneath her, to scratch. She has puritis. (Itching. Serious itching!)
I go to test her capillary refill, which is how we quickly check tissue perfusion (circulation in the extremities). I go to push on her fingernail, and notice she has blood under her nails and on her fingers. Very fresh blood. Must be from where she's scratching under her.
She has a PEG tube, in her upper abdomen, this is how she is continuously fed throughout the day. But it isn't attached to her skin, which is how I thought they were all supposed to be. So this tube moves in and out, and is covered in slime, as she coughs or bares down. Which she begins to do as I'm asking her questions.
I check under her covers to see the color of her feet, check for pitting edema, and skin breakdown, and notice that the pillows that are supposed to keep her heels off the bed are stuck to her skin with drainage from a skin wound. So I can deduce that they aren't turning this patient every two hours as ordered.
As I’m there speaking with her, she’s attacked with explosive diarrhea and her diapers aren’t clasped because she has a catheter. She can’t move on her own, there’s no one around, I’m not even supposed to still be there. I’m in business casual and really not looking to have my hands under someone at the moment. I don’t think they make gloves that cover enough for what I’m going to have to deal with.
This is really gross and you guys don’t need to know this, but no one else wants to hear it either, and sometimes you just need to vent a little.
In a matter of minutes, I came in contact with this woman’s congested noses, mouth…something, tube feed stuff, bloody fingers, and all kinds of other things. Did I mention that I got the urge to get out of there and home to scrub, very suddenly? I have to take care of her for the next two days.
I have to be compassionate and proficient, and I’m scared to death.
I don’t know what to do for this woman!
I don’t think I can even make her bed with hospital corners.