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Our patients are not quite as critical as advertised, for the most part, but occasionally we’ll have one who’s pretty sick. Actually our sickest patient is chronic, and if she could get stable enough she really belongs in skilled care or maybe even rehab. She was in a horrible MVA last year sometime and she’s lucky to be alive, if you can call her current status living. She must have been in a bad T-bone crash; everything on the left side of her body was smashed. She was on the vent for an unconscionable amount of time and still has her trach. Had a PEG tube too when she arrived, but no longer does. An external fixator on her left humerus. Foley, of course. And naturally, decubiti from hell, including one I could probably lose my fist in. There’s a total of six dressings, but only two of them fall to my shift, being twice a day. The first time I did them it took me an hour. I’ve gotten faster and learned to combine the dressing changes with her bath, which means she gets cleaned up at an unearthly hour, but I’m not real sure she knows what time it is since she’s been in the hospital for so long. I suspect she also has a traumatic brain injury–how can you get that much of you smashed and not have one?–although some think she has ICU psychosis. Well, why not both? Anyway, after an initial period of circling each other cautiously, we seem to have come to a point of actually liking each other. At least she usually smiles at me when I come in, and I’m beginning to think we have similar senses of humor. One night when I had finished the worst of her dressings and rolled her back onto her back preparatory to doing the other, she looked at me and said “I need a drink!” I said “So do I!” and we both laughed fit to kill. She gave the nurses hell on Thursday, but when I came back Friday she seemed glad to see me. That does kind of make me feel good.

My apartment is sort of stuck right now until I can get some paycheck into it, so it looks like I’m still moving in. I think once I get my queen mattress in and can move into the master bedroom the puzzle will unlock. I’ve started on my garden, gotten it tilled at least, but lately it’s rained almost every day I’ve had off, and I can’t get the raised beds built, so all my plants are sitting in their containers on the patio. When I do manage to get it in, I’ll have tomatoes and peppers, green beans, greens, radishes, beets, cucumbers, eggplant.and sunflowers!

And now for a non-nursing note.this morning I got up and as usual while having my coffee perused various news sites from places I used to call home. Imagine my surprise when I saw this picture on both the local paper of my former home town AND a tv station website! The occasion was the dedication of a new veterans’ memorial for Iraq vets, of which my son is one. He’s the skinny guy on the right front of the pic. His name doesn’t get mentioned in the article, but I knew he was working on the project. It’s just like him to do the backstage work and let someone else do the talking (the husky dude on the left front, who is his best buddy in the guards). He can’t help being so photogenic! Am I proud of him? You bet.but I wish he hadn’t had to go, that one of the guys he worked with hadn’t encountered a roadside bomb and been permanently disabled, and that so many hadn’t been killed and wounded. Now his outfit is on alert again.dammit, somebody stop this insanity!!!
Anyway, here he is, my pride and joy.

In recent weeks I’ve had a lot of patients with gastrointestinal (GI) issues. Some are pretty straightforward, the usual sort of tummy bug that will put our frail and elderly in the hospital just because they get dehydrated. Then there’s the “interesting” stuff, of which I’ve had a good bit recently.

The first was a lady I admitted about 3 weeks back who had been suffering with nausea, vomiting, diarrhea, abdominal pain, anorexia, and weight loss for several weeks. She didn’t know how much weight she’d lost, but her family said it was “a lot,” and her admission weight was 98 lbs. She was clearly miserable, but she’d delayed seeing a doctor, maybe because she was afraid of a diagnosis, or maybe because she was depressed over a number of deaths in her circle recently. In any case, I pegged her as *really sick*, and over the next few days I got pretty impatient with her primary doc, who was one of the new hospitalists. I wasn’t the only one who seemed to think there was more to this than met the eye. When I came back the following weekend, she’d been through a bunch of tests and was diagnosed with a diverticular abscess (for the uninitiated, a little outpouching pocket in the bowel that had got infected). She’d had an incision and drainage and there was a drain in place, but it wasn’t draining a whole lot of anything and she was still in major pain. She kept getting progressively worse and her belly was all blown up when I came back again, and I came to the conclusion that she had an ileus, which basically means that things were NOT moving right along down there. The next night I was back again to find that the primary had finally been galvanized into action, called in the GI doc and re-consulted the surgeon. The patient had a tube down her nose into her stomach and was having a bit less belly pain, but was complaining of her throat hurting and extreme thirst, and she wasn’t being allowed even ice chips in any quantity. Still, she was much better until about 4 a.m. on Monday, when she suddenly snapped and accused the CNA who went in to change and turn her of trying to kill her. When I went to check on her she had just thrown her telemetry box across the room and was ranting that we were all trying to kill her. I medicated her, and she seemed to quiet down. Just before report in the morning, it was reported that she was swinging her legs over the rail. We barricaded her in, or so we thought, but right in the middle of report the day charge nurse came by and said she’d found her up at the sink, all tubings mercifully still intact, drinking cup after cup of water! She got medicated, and that was the last I heard. When I came back this past weekend she’d been to surgery and had moved to the surgical floor and due to confidentiality rules that’s all I know.

This past weekend I had a patient who’d come in with a small bowel obstruction which was resolving. He, too, had an NG tube, but he felt enough better with it in that he wasn’t complaining or trying to pull it out. He was very nice, and no trouble whatever. In fact, he wasn’t even complicated!

And then there was Sunday. I was told in report that I was getting a patient from ER, a 29 year old GI bleeder. Hmmmmm, thinks I, 29? When I got report (and ER was most insistent that report had to be given NOW) it seems there were some complicating factors. Not only was he puking up bright red blood, but there was alcohol involved, and they’d had to sedate him because he took rather violent exception to having an NG tube put down. I told my charge nurse there was no way he could go in the room he’d been assigned to since we could not easily see him there and there were significant factors that bore watching. She agreed, but in order to put him where we needed him, we had to move another patient and get the room cleaned. I called the ER nurse to advise her of this and that we would have the room cleaned as quickly as possible. Her charge nurse got on the phone and was as ugly to me as any peer has been in some time.the first time I’ve experienced that at this hospital. “Get that room cleaned STAT,” she barked, “because I’m sending him in 20 minutes. We’ve had that room assigned since 5:00!” Yeah, I thought, and you just now called report, while *we* were in report, and until then we had no idea that alcohol was involved since no one mentioned it. I did *not* say any of that, however, just went about getting ready. When the patient came up he had “uh-oh” written all over him. The first indication came when we tried to move him from the stretcher to the bed. He hovered in midair between the two, and when I tried to assist him over he pushed me and let loose with a lot of language. His girlfriend, who was with him, tried to apologize for him, saying “He just hates all medical stuff.” Well, too bad, buddy; you’re sick enough to be here, go along with the program. Fortunately, once we actually got him to the bed, he lapsed into his previous somnolent state. Then I connected the NG tube to suction and was not cheered by the amount of bright red blood I saw. The hospitalist on duty was paged and I waited for him. And waited. At some point I said to my charge nurse, who was aware of the patient’s condition, “He’ll probably drag up here in about 3 hours and then he’ll get all irregular about everything.” Which is, of course, what happened. When he finally did get himself up there, indeed 3 hours later, he immediately decided the patient should be transferred to ICU. I managed to get detox orders also, not a moment too soon, as the patient’s mother hove on the scene and he started acting like a bratty toddler, threatening to yank out his NG and leave. At this point, Ativan is your friend! I had to try to shut him down, soothe mom, who was of course freaking out, call report, take care of the girlfriend, and get him to ICU without losing his IV or NG tube. Somehow it all got done and I left him to the tender mercies of the ICU nurses, who weren’t particularly amused by his antics. Speaking as a nurse, I could have handled him right where he was; I’m used to this kind of thing. But on reflection, he really didn’t belong on our unit, and I think some of the other nurses would have been really freaked out. The patient I got to replace him was far preferable, even though he was a guest of the county (i.e. a prisoner). At least he was cooperative.

Just five more shifts left here, and then back to Tennessee until the next assignment shows up.