Nurse Jobs London

Some other things have happened to make me think. A good friend’s brother died in a freak accident, suffering a traumatic brain injury; he was an organ donor and was in good health, and I am told that as a last act, even though it was not a conscious one, he gave “right down to the marrow of his bones.” At almost exactly the same time, I heard from one of my dearest friends in the entire world (literally–he lives in Israel!) that he had been placed on the list for lung transplant and was told that the average waiting time there was 4-6 months. Not that one affected the other, but it seemed an odd coincidence that they happened so close together. Less than two weeks later he was called to the hospital and was actually prepped and waiting for surgery, lying on a gurney with arms outstretched.and when they opened up the putative donor, the lungs were in too bad a condition to use! I got a very funny e-mail from him after that, entitled “Dress Rehearsal Rag,” detailing what went on and what he thought. (With his trademark off-center humor, he described his position on the gurney thus: “They spread my arms out from my body, supported by the arm rests, and attached the IVs etc. to them. And i glanced at myself and thought: Hey fellas, just remember what happened the LAST time they stuck a Jew on a cross.”) Anyway, about 10 days ago he was called to the hospital again, and this time he actually HAD his transplant. He was supposed to be discharged on Thursday, but I have not heard yet from either him, his son (the designated communicator, who gives “taciturn” a whole new meaning) or his erstwhile girlfriend that he is indeed home.

So on to last night, which was busy but not horrendous for me.and was hideously so for my partner, who inherited not one but two from CCU, plus one that I’d had the night before.which was the one giving her fits. When I’d had her she was pretty confused at night and had some issues with her blood pressure, but not totally out of character for a 70-something with a sacral fracture and on some pretty heavy-duty pain meds. Last night, however, was an entirely different story. Apparently through the day she’d had increasing problems with her blood pressure, or as the day crew said “We kept thinking her head would blow off!” and they’d finally decided that since she was also trying to climb out of the bed, the problem was anxiety, and they’d gotten an order for Ativan which chilled her pretty much.until about 8:30, when she woke up and was utterly, totally, and completely bonkers. And then her blood pressure started to climb to unreal levels. At that point something started niggling at the b back of my mind. I’d seen this before.and history of multiple falls recently.do you suppose? So I wondered aloud if she’d been taking something before she came in that had somehow escaped her med list, something like Xanax, maybe.a favorite drug of little old ladies and one that has notoriously nasty withdrawal. Still, the more I looked at her, the more I thought of something else, and I said to my partner, “You know, she looks like the DTs.” My partner didn’t think so at all, and between dealing with that patient’s blood pressure and the correspondingly low pressures of the one in the next room, and the trauma survivor besides, she didn’t really have time to think about it. I didn’t say anything more, but the thought didn’t leave my mind. Meanwhile, the patient’s blood pressure kept climbing, her anxiety level kept rising, she had tremors, and her behavior became more and more bizarre. All meds to control the blood pressure were proving useless, and when the patient became sweaty and wheezy, she called the doctor. Of course it was the on-call, and she had to go into the history, but he asked one very pertinent question: could she be in withdrawal? While we waited for him to come up, we went into her room and she asked her a few pointed questions, like did she drink and how much and what. We got some confused answers, but enough to make us conclude that this might just be the problem. And when the doc came up, he took one look at her and said in his Chinese-accented English, “Yep, she is in DTs.” From then on it was pretty straightforward detox orders.ativan, banana bag (IV with multi-vitamins, so called because of the yellow color of the fluid), B vitamins, etc. She chilled out.and didn’t her blood pressure come down?

I guess people don’t think of little old ladies having drinking problems. Nobody probably thinks anything of granny’s nighttime glass of wine; hell, my own grandma had her *one* glass of Mogen David before bed every night of her life, though she would have been quite offended if anyone had offered her a second. But alcohol can be anyone’s problem. I lived with it for a long time, and worked at one time in a unit where, if we didn’t have two or three drunks or druggies detoxing, we just weren’t living right, so maybe I just picked up on it. Did I feel vindicated? Yes. Did I gloat? No, because I have missed things that should have been obvious, and I will again. Still, it feels good to know you’re right now and then.

This particular case was a man who came to the ER in respiratory failure, but with so many other problems that he was almost a one-man Merck manual. Diabetes, end-stage kidney disease, peripheral vascular disease, and chronic obstructive pulmonary disease were just the high points. He’d recently lost one leg above the knee because lack of circulation led to gangrene, and the suture line looked horrible, dead for an inch on either side. The other leg was looking pretty much the same way, necrotic just about all the way around the calf. Necrotic areas on the fingers, too. Decubitus on the sacral area darn near to the bone. He’d been getting tube feedings but hadn’t been tolerating them, so they were suspended. He’d been on the vent long enough to be trached and for the trach to be nice and solid and not draining any. He was barely responsive, only withdrawing to painful stimuli, would open his eyes at random but didn’t track, didn’t follow commands and barely moved at all, certainly not purposefully in any way except for the withdrawal. A recent EEG wasn’t flatline, but showed diffuse slowing, in other words very little brain activity. Most of us would call him “dead on the vent.” His family (wife and numerous kids) has been told, in very blunt words, that there is no hope of recovery, that he’s not really in there, yet they don’t seem to get it. “But he opened his eyes and looked at me!” (No, he just happened to be turned that way) “But he moved his hand when I touched him!” (He withdraws from all touch) So we continue to maintain him on the vent and on dialysis three times a week, and we do all sorts of things to him, many of which are painful.and pain is the only thing that seems to reach him. Why? I think the short answer is “because we can, therefore we have to.” Nobody, least of all the family, seems to be looking at his quality of life, and no one will make the decision to do the compassionate thing, to stop all the painful treatments, stop his dialysis, keep him comfortable, and let him go peacefully. After all, his heart (an electromechanical pump) is still beating, and could go on beating for a long time, even if his brain did go flatline, so he’s “alive.” Right. Lying there rotting while a machine breathes for him and three times a week another machine filters toxins from his blood because his kidneys don’t do that any more. Where’s life in that?

I have informed my children if they even consider doing such things to me when I can’t protest, I will sit on the heads of their beds and haunt them for the rest of their natural lives. Think about it. How much would you torture someone you loved if you knew there was no hope of recovery? And if you haven’t already done so, make your advance directives so no one will do the same to you.