(no subject)
He is elderly, a man I had been taking care of for at least a month on my night shifts. I am a new nurse, baby nurse as they call it. Freshly graduated and new to the whole nursing world. I had done clinicals, a taste of working with patience. But this is different.
He was small and thin, hands and arms swollen from all the fluid his body was holding on to. He ate nothing, all his nutrition entering his body through a tube in his belly he had for years. His wife, a sweet gray haired woman, is always at his bedside, helping, doing things I should be but she rather. Feedings, giving meds in his tube, keeping track of when he urinates. Shes always there. There have been times I had to walk away from the sight of them both, wrapped in a tender moment. He would have her sit on the side of his bed and take her hand in his swollen one, and thank her for being there with him. I dont remember what she said, all I know is I found a reason to leave the room, and I cried as I shut their door letting them murmur to each other.
During the night I would have to come in and get his vital signs, and blood for testing. I would try to be as quite as i could so as not to wake her. Though it was him in the hospital bed, he tried very hard to be sure she was taken care of and got rest. So, i would do the same. She would have night terrors and he would call from the bed soothing words to quite her. Other times she would giggle in her sleep and he would smile and tell me shes having a good dream.
He was a LTC back in his day. I filed that information away in my head when he told me, and used it to sooth him during some of the more indecent moments of his hospital course. Like when he would need to be cleaned after using the bathroom, or use a bedside commode because he was to weak to walk far from the bed.
"This is so embarrassing, me needing to be catered to like this."
I reminded him as LTC he was more than likely in charge of a battalion of soldiers, and had to take care of each one. " you took care of your soldiers, now let us take care of you."
I would watch over the weeks as his swelling would come and go, breathing getting better then worse. And then I would come in for my first day shift, my night shifts behind me for now.
When i saw him he was gripping the bed and taking rapid shallow breaths from his mouth. This has happened mostly when he attempts to get out of bed, which i new he wasnt trying at the moment. With his oxygen in his nose via nasal canula, the mouth breathing wouldnt do much if he was having oxygen issues.
I remind him to take deep breaths through his nose, and try and calm him, asking if hes ok, how he feels, if hes in pain. He denies it all, even though he clearly looks like somethings wrong. I take a set of vitals on him, outside of a elevated heart rate ( which has been his norm through his whole stay) everything checks out fine. Blood pressure, oxygen saturation, everything. I just need to get respirations on him ( a count of how many breaths you take in a minute.) But, he seems so upset. So instead I coach his breathing under control and try and calm him. Once again asking if he feels short of breath, if he is in pain, dizzy, anything... and he says no.
After calming him, i get my count. 20...
I tell the charge nurse what happened, and both the charge nurse and other nurses who have had him recently state he has been having increased issues but refuses help... they know.
This scene repeats throughout the day with each visit i pay him for meds, vitals, anything. And always he says he is fine, always his vitals are fine, and always i am able to calm his breathing. I ask him if he would consider a face mask for oxygen and not the nasal canula, perhaps he starts having issues breathing because he keeps forgetting to breath through his nose. He snaps at me that he doesnt want it, says its uncomfortable and he cant breath with it. It isnt the first time i have asked over the weeks, and this isnt the first time he says no. But his reaction makes me drop the subject.
Later, I was called into his room. the charge nurse says he called and wanted to speak with his nurse. So i came in.
hes looking down at his lap, still breathing fast, and finally admits he is short of breath. i bring up the face mask again, this time being given the time to explain it is not like a CPAP, which he assumed is what i was trying to talk him into. He considers it, and I go to call the doctor about whats going on, and the respiratory tech. I let the nurse training me know he is finally asking for help and what we plan on doing. i explain my coaching of his breathing all day, and what i think may help. My RN ( for i am only an LPN) goes into the room to get respiration count.
When i get back to his room, the doctor is in, she is checking him, listening to his lungs. As he leans forward his breathing quicks even more, but he usually has this issue when moving around.
After the Doctors exam, my RN tells me he is breathing 40 breaths a minute...40!!!
At my panicked face, she explains he was also moving around a lot, and visible calms his breathing as i coach him down. So, we give him a moment to settle, and i get another RN to count them under the guise she is watching me detach an IV line. She gets 37....
We call a rapid response team, and as the team floods in, hooking him up to different monitors and assessing him, giving him the mask i have been trying to convince him into, I feel like im exploding, my mind racing..
i shouldnt have listend to him, he obviously needed this earlier...
if i didnt listen and called the RRT earlier, he would never have accepted the help or ever admit anything is wrong again....
But he could be dying or worse off because i waited for him to ask for help, and i kept coaching his breathing instead of seeing how he was breathing on his own....
but it was helping....
As i wared with myself i watched this frail old man with his giant swollen arms look up at everything happening around him with wide little boy eyes. His head whipping back and forth among the people gathered around him.
Later, as he is settled, a full face oxygen mask on and the intervention that needed doing complete. I walk over to him and we kind of look at each other in a knowing way...
Hes dying, and he knows it. What we are doing is helping, but it will always be a catch up game. he has so much going on with him, if it isnt one thing its will be another that does it. During the whole ordeal I watched his wife write down everything that was happening and who did it, a sense of control in something she has no real control or ability to help in.
He wants to die peacefully beside his wife, holding her hand. And would could let that happen, if he put himself on palliative care. I think he doesnt only because his wife has so much hope. Earlier as i listened to her talk with the doctor, you can tell she is holding on to the idea he will get better. Walk again, be stronger... but hes not.
He refuses help because he doesnt want to die in the center of us fussing over him trying to prevent the inevitable, in chaos and desperation. He wants quite and love....
What do you say to that... what do you do...besides watch this man live for his wife, fight for his wife, all knowing its a loosing battle. Try and give her what she needs, to hope and fight and feel like everything will be better, while giving him what he needs, that moment of goodbye.
When a veteran dies in our hospital, the staff line the halls. They are wheeled out under the American flag, and those of us who serve stand at attention as he passes us. I have seen two since I have been here....I both hope i am there when he rolls by, and know i wont be able to handle it....
The hardest thing about being a nurse... is knowing there isnt a damn thing i can do...
He was small and thin, hands and arms swollen from all the fluid his body was holding on to. He ate nothing, all his nutrition entering his body through a tube in his belly he had for years. His wife, a sweet gray haired woman, is always at his bedside, helping, doing things I should be but she rather. Feedings, giving meds in his tube, keeping track of when he urinates. Shes always there. There have been times I had to walk away from the sight of them both, wrapped in a tender moment. He would have her sit on the side of his bed and take her hand in his swollen one, and thank her for being there with him. I dont remember what she said, all I know is I found a reason to leave the room, and I cried as I shut their door letting them murmur to each other.
During the night I would have to come in and get his vital signs, and blood for testing. I would try to be as quite as i could so as not to wake her. Though it was him in the hospital bed, he tried very hard to be sure she was taken care of and got rest. So, i would do the same. She would have night terrors and he would call from the bed soothing words to quite her. Other times she would giggle in her sleep and he would smile and tell me shes having a good dream.
He was a LTC back in his day. I filed that information away in my head when he told me, and used it to sooth him during some of the more indecent moments of his hospital course. Like when he would need to be cleaned after using the bathroom, or use a bedside commode because he was to weak to walk far from the bed.
"This is so embarrassing, me needing to be catered to like this."
I reminded him as LTC he was more than likely in charge of a battalion of soldiers, and had to take care of each one. " you took care of your soldiers, now let us take care of you."
I would watch over the weeks as his swelling would come and go, breathing getting better then worse. And then I would come in for my first day shift, my night shifts behind me for now.
When i saw him he was gripping the bed and taking rapid shallow breaths from his mouth. This has happened mostly when he attempts to get out of bed, which i new he wasnt trying at the moment. With his oxygen in his nose via nasal canula, the mouth breathing wouldnt do much if he was having oxygen issues.
I remind him to take deep breaths through his nose, and try and calm him, asking if hes ok, how he feels, if hes in pain. He denies it all, even though he clearly looks like somethings wrong. I take a set of vitals on him, outside of a elevated heart rate ( which has been his norm through his whole stay) everything checks out fine. Blood pressure, oxygen saturation, everything. I just need to get respirations on him ( a count of how many breaths you take in a minute.) But, he seems so upset. So instead I coach his breathing under control and try and calm him. Once again asking if he feels short of breath, if he is in pain, dizzy, anything... and he says no.
After calming him, i get my count. 20...
I tell the charge nurse what happened, and both the charge nurse and other nurses who have had him recently state he has been having increased issues but refuses help... they know.
This scene repeats throughout the day with each visit i pay him for meds, vitals, anything. And always he says he is fine, always his vitals are fine, and always i am able to calm his breathing. I ask him if he would consider a face mask for oxygen and not the nasal canula, perhaps he starts having issues breathing because he keeps forgetting to breath through his nose. He snaps at me that he doesnt want it, says its uncomfortable and he cant breath with it. It isnt the first time i have asked over the weeks, and this isnt the first time he says no. But his reaction makes me drop the subject.
Later, I was called into his room. the charge nurse says he called and wanted to speak with his nurse. So i came in.
hes looking down at his lap, still breathing fast, and finally admits he is short of breath. i bring up the face mask again, this time being given the time to explain it is not like a CPAP, which he assumed is what i was trying to talk him into. He considers it, and I go to call the doctor about whats going on, and the respiratory tech. I let the nurse training me know he is finally asking for help and what we plan on doing. i explain my coaching of his breathing all day, and what i think may help. My RN ( for i am only an LPN) goes into the room to get respiration count.
When i get back to his room, the doctor is in, she is checking him, listening to his lungs. As he leans forward his breathing quicks even more, but he usually has this issue when moving around.
After the Doctors exam, my RN tells me he is breathing 40 breaths a minute...40!!!
At my panicked face, she explains he was also moving around a lot, and visible calms his breathing as i coach him down. So, we give him a moment to settle, and i get another RN to count them under the guise she is watching me detach an IV line. She gets 37....
We call a rapid response team, and as the team floods in, hooking him up to different monitors and assessing him, giving him the mask i have been trying to convince him into, I feel like im exploding, my mind racing..
i shouldnt have listend to him, he obviously needed this earlier...
if i didnt listen and called the RRT earlier, he would never have accepted the help or ever admit anything is wrong again....
But he could be dying or worse off because i waited for him to ask for help, and i kept coaching his breathing instead of seeing how he was breathing on his own....
but it was helping....
As i wared with myself i watched this frail old man with his giant swollen arms look up at everything happening around him with wide little boy eyes. His head whipping back and forth among the people gathered around him.
Later, as he is settled, a full face oxygen mask on and the intervention that needed doing complete. I walk over to him and we kind of look at each other in a knowing way...
Hes dying, and he knows it. What we are doing is helping, but it will always be a catch up game. he has so much going on with him, if it isnt one thing its will be another that does it. During the whole ordeal I watched his wife write down everything that was happening and who did it, a sense of control in something she has no real control or ability to help in.
He wants to die peacefully beside his wife, holding her hand. And would could let that happen, if he put himself on palliative care. I think he doesnt only because his wife has so much hope. Earlier as i listened to her talk with the doctor, you can tell she is holding on to the idea he will get better. Walk again, be stronger... but hes not.
He refuses help because he doesnt want to die in the center of us fussing over him trying to prevent the inevitable, in chaos and desperation. He wants quite and love....
What do you say to that... what do you do...besides watch this man live for his wife, fight for his wife, all knowing its a loosing battle. Try and give her what she needs, to hope and fight and feel like everything will be better, while giving him what he needs, that moment of goodbye.
When a veteran dies in our hospital, the staff line the halls. They are wheeled out under the American flag, and those of us who serve stand at attention as he passes us. I have seen two since I have been here....I both hope i am there when he rolls by, and know i wont be able to handle it....
The hardest thing about being a nurse... is knowing there isnt a damn thing i can do...