Recognizing is Believing

People can watch me in a patient's room all day. They can see me crushing pills, drawing up meds in syringes, and adjusting IV medication machines. They can see me frequently asking others to help me turn a patient from side to side, cleaning them from head to toe, and propping the feet and arms up on pillows. They can hear my explanations of the various medications, the breathing machine, the heart monitor, the oxygen monitor, the feeding machine, and any other high-tech machines aiding the kidneys, heart, brain, and lungs. They can see me pack up a patient's bed with multiple machines and medications and head out for CT and MRI scans. They can observe me standing at the computer in the room, changing values, adjusting limits, and entering data.

But what do I get the most comments on?

No really? Guess! In the cases of the sickest patients with the most machines and requiring the most attention, what do you think the families of these unconscious patients comment on the most?


Guess.







Brushing teeth.

Yup. Brushing teeth. I'm serious! The very high-tech, requiring-college-degree-level-knowledge, displaying-years-of-clinical-experience skill of brushing teeth...

And I think it's because they understand it as being not necessary, but ultimately caring. What families might not know is that for patients with a breathing tube, there is research of significantly decreased rates of pneumonia related to the simple act of cleaning the mouth every 4 hours. It's the protocol at my hospital for us to provide "oral care" every 4 hours to try to prevent this common consequence. There are other things too... keeping the Head of Bed at a certain height, turning patients, suctioning the breathing tube frequently but not too frequently, and getting frequent x-rays and blood labs to catch evidence of pneumonia early and then start antibiotics to prevent it from getting worse.

But families are familiar with brushing teeth. It makes their loved one look like a person again... not a body in a bed, hooked up to multiple noisy and foreign machines.

I've heard family members define me as being a "good nurse" after citing the fact that they saw me brush Momma's teeth. And only that fact! "... And Momma's nurse is taking good care of her. I saw her brush her teeth twice today!" Not the bath, cleaning up bowel movements, incalculable hours spent translating "doctor talk" to families via phone calls and personal conversations, or the delicate changes made to medication rates and machine controls due to my understanding of their function and the goals for the patient. My 12 hour shift, sore feet, pages of notes and thousands of dollars worth of supplies and medications can basically be summed up in 3 simple acts of brushing the patient's teeth during my shift.

It feels absurd... until you look at families' faces and finally see a glimmer of understanding and hope and compassion. Then it completely makes sense.

And because of that, I try to save this task for when I know families will be at the bedside. If seeing this simple action is going to reassure them that we are treating their husband or grandmother with the dignity and care persons deserve, then I would rather pay attention to this task with them present than waste my time telling them so.

Because seeing (and recognizing) is believing.

Signs and Symptoms of Improvement

I had a patient the other day who has been in the hospital for a long time. Many nurses and doctors all around the cardiac floor know about him. I've heard many stories about caring for him and quirks about his personality-- his dry humor in particular.

I'll admit-- I was pretty excited to take care of him! Dry humor! How refreshing! And I enjoy caring for patients in his particular state-- over the big hurdles, and now just trying to figure out how to live at home with this new lifestyle. It's a lot of regaining strength, regaining skill, and (mostly) regaining confidence.

So I was pretty disappointed to find him in his present state-- which is to say... personality-less. He was so sleepy from all the medications he was taking that he literally didn't have the energy for personality. I worked with the doctors and his wife on brainstorming how to best strike a balance between controlling his pain without totally knocking him out. (This was for his benefit, not my selfish desire to experience his personality... no energy = no physical therapy, no appetite and therefore no nutritional intake, and no teaching about disease/meds/etc). This man needed to WAKE THE HECK UP! So we adjusted a few things in his medication regimen.

... And evidence of improvement promptly followed. How could I tell? This convo:
Me: Mr. X, I've got another pill for you to take. Do you feel like taking it now with water or with juice?
Mr. X: Is it my birth control pill?
Me: Yup. That's the one.
Mr. X: Good-- I don't want to get too far off my schedule.

Welcome back, Mr. X's personality :)

Short and Sweet

I got a patient from the cath lab yesterday. He was borderline unstable... like his heart was peaking over the edge of a cliff and deciding if it was daring enough to jump. His heart rhythm changed often with correlating blood pressure changes, and the poor guy could feel every bit of it. Although he was just starting to really wake up from the sedation given during the procedure, his family was very aware of all that happened during the procedure (arrhythmias, defibrillations, multiple medications, and the poor prognosis found). I explained to him all that happened in the procedure area, concluding with "But you could not have been in a more appropriate place for your heart to these kinds of issues-- you had the right doctors and nurses literally standing over you, knowing exactly what to do and how to fix it. You're one lucky guy!" His family, having already heard all of this by the procedure area doctors, nodded their heads, clearly holding back tears. The gravity of it all had started to set in, and they were getting the "glaze" most families get while processing this kind of info.
I had been told in report that there were several pastors in this family, so I felt comfortable looking into the patient's eyes and saying "Someone was certainly looking after you today."
Now, I don't often allude to God with patients. Partly because I've found that they're already terrifyingly aware of their mortality and (unless they're saved) the reminder of a Higher Power doesn't offer much comfort. I also don't want to start an uncomfortable debate about religion and spirituality with the occasional family who denies a Higher Power.
But, with this patient and his family, I felt it would offer some comfort, so I dared to say it.

This was (roughly) our conversation:
Me: I know you were supposed to have this procedure yesterday, but your case was bumped at the last minute. If this problem had happened yesterday or even earlier today when you weren't in the cath lab, things could have gone very poorly. You were in the right place and the exact right time.
Pt: That's what everyone keeps saying.
Pt's Wife: That's what scares me the most...
Me: Well, you were very lucky. Someone was certainly looking after you today.
*Pt looks at me... looking very attentive and intimate*
Pt's Wife: He certainly was! Thank God for that!
Pt: [very serenely] I know where I'm going. It would have been okay.
*Pt's wife looks down, again clearly holding back tears*
Me: Well, that kind of confidence is good to hear, but it looks like He wasn't ready to have you yet!
Pt: No, I guess He still has some plans for me. I think they involve spoiling my grandchildren.
*Pt winks at me, and his wife giggles weakly*

It was a short conversation, but I love any affirmation of the power and confidence found in the Truth. This wasn't a man sitting in a pew praying, or a man standing in church worshipping, or even a man at his friend's funeral contemplating mortality and heaven. This was a man who was recovering from a literal near-death experience, still with a little bit of human fear, but ultimately looking back with confidence and quietly reassuring his family in his final destination. I was trying to witness to and comfort him, but I think I ultimately got more out of that conversation. I think if you took a poll of nurses, asking who learns more from patient/nurse interactions, I think most would say that they, the nurses, learn equally or more abundantly from all these interactions. This conversation happened in the last 45 minutes of my 12 hour shift, but I'm still sitting here reveling in it.

This is the week following "The Week of the Nurse", a week where nurses are nationally recognized for our sacrifice, labor, and care. My hospital makes a big deal out of it, and even my family has showered me with admiration for my choice of profession this week. I've been hearing so much praise over the past week for my contribution to the wellbeing of others, for my sacrifice to benefit others, and for the impact of my compassion and knowledge.

But none of that is why I'm a nurse. I'm a nurse because I can have an occasional glimpse at Eternity with people.

Technically speaking... vol 1.

Last night, my patient greeted me with the statement "my stomach is a-bubblin'". This is how he described having gas, or feeling constipated, or feeling hungry. The jury's still out.

In the Beginning...

... there was a blog. Well, actually, there was a nurse and her roommate. Between the many stories of patients, co-workers, and inner turmoil, she encouraged me to document it all. I don't know who I really expect to read it, so I guess this is more for me than anything else. I've always been a "documenter"... I journal about everything. I reread my journals on a semi-regular basis. It reminds me how far God has taken me. It reminds me of things that I SO stressed over that are now SO old news. It reminds me that learning to be faithful in little things will build my character to be faithful with bigger things. Mostly, it shows me more and more that God has a plan for me that is playing out, although I don't often see it in progress. Sort of a "can't see the forest through the trees" mentality.

Hence, the blog. Document the week to week issues/stories/lessons, mostly from work, always seen through my eyes... my eyes that have been shaped by a growing understanding and relationship with my God, my eyes that have been shaped by my own insecurities and gifts, my eyes that have been shaped by what I've seen and heard and felt in the hospital. I hope to look back on these posts and have the familiar feeling of "Wow-- how far He's brought me!".

That's the goal.