Tuesday, January 29, 2013

a snapshot

For anyone who is not clear on what it is I actually do at work, like, specifically, allow me to describe the first two hours of a recent 12-hour day, which day actually was not that recent because immediately after said day I, have mercy, took off for Arizona and didn't touch a computer the whole time. (Unless you count iPhone, which I know totally counts, but I like to think I am capable of living with less technology for a few days. Go me!) So anyway, here is a rundown of the first two hours of this particular not-all-that-special day.

0700 - 0740: Get Report in the Report Room, i.e., eat oatmeal, chug coffee, and furiously scribble down notes on all 19 of the patients from the day and night before, paying particular attention to my assigned four.

0740 - 0745: Check my patients' orders really fast (BUT ALSO THOROUGHLY AND ACCURATELY) on the computer. Document on the computer that I have checked my patients' orders, by entering another order that indicates I did so. Yeah, I don't know.

0745 - 0755: See Patient 1. Who does not speak English and is from Honduras. I speak un poquito de Spanish. He was just admitted over night. He is sitting, tense and nervous-looking, near the locked exit door, fully dressed with his bags packed. I am able to glean from our strained conversation that he does not understand where he is or why he is here. There is something going on with his legs, as he keeps tapping them and looking at me and then looking at them. I tell him that the interpreter--aka "the person who speaks Spanish better than I"--will be here at 8:00. 

0755 - 0805: See Patient 2. Who has an intake appointment at a recovery house at 8:30 and needs to be discharged, like, ten minutes ago. Tell the patient to gather his belongings. Administer his morning medications. Complete his discharge paperwork, make sure his prescriptions are filled and on the unit, gather all his contraband which is stored in the Med Room to return to him. Sit down to assess and do discharge teaching with the patient. Patient has all his belongings on his lap and is eating a maple glazed donut. He has a distant, blank stare. (Have I told you we have maple glazed donuts on the unit pretty much daily? Help me Lord.) Patient expresses understanding of where he is going and what medications he is to take. He receives papers with this information on them, highlighted in bright yellow by me. I ask the patient to sign his paperwork, and he licks the donut glaze off his fingers and then takes my pen. I tell him he can keep the pen. He signs the papers and hands the pen back to me. I tell him again to keep the pen. He looks confused. Something is not quite right here. 

0805 - 0815: The interpreter for Patient 1 is here. She can only stay for 45 minutes. Which means all assessments, teaching, discussion--mine and the doctors'--must be done pretty much now. I do mine first. It turns out the patient believes there were a bunch of men drinking here, in the hospital, on the unit, in his room, last night. He saw and heard them. They poured beer on his pants on purpose, but it has since dried. He is upset about this. Dios mio.*

0815 - 0825: Kill two birds with one stone by getting medications for and introducing myself to Patient 3. Who has cerebral palsy which has left him unable to use one leg, a plastic splint on the other ankle because has he broke it a year ago and it was never fixed properly, and a cast on one of this arms because it was freshly broken in a bar fight. He is withdrawing from alcohol and narcotics. He is a little bit cranky, understandably. He wants to talk at me about his condition for what feels like a really long time. 

0825 - 0830: See Patient 4. Patient 4 is arguably the worst off of the lot, but he is on Constant Observation (i.e., there is a Certified Nursing Assistant watching him and only him and attending to his needs to the extent of his/her license 24/7). He is not going anywhere anytime soon, and I know he is okay. I know going in that he is on the autism spectrum, is non-verbal, i.e., doesn't speak ever, and has some odd compulsive behaviors. I knock on the door and open it and he is cowering behind the door, shivering and nude, except for his orange baseball cap which prevents him from hitting himself in the head. His observer says she will try to get him to put on some pants. I tell her that sounds good.

0830 - 0840: One of our Nurse Elders expresses concern that Patient 2 may not be appropriate for discharge. I reluctantly concur and tell her about the finger-licking-glaze-pen incident. She talks to "the docs" and performs a Mini-Mental State Examination on the patient. He passes. I call a taxi to take him to his Recovery House. I again make sure he has all his belongings and discharge necessities, and I send him down to meet the cab with one of our Support Associates.

0840 - 0841: I take a mental tally of what is going on. Patient 1 is still with the doctors and has no medication orders yet. Patient 2 is discharged, hooray! Patient 3 is medicated and yapping away at the breakfast table. Patient 4 needs his meds. I know he doesn't always take his meds, or will only take them from certain people. I cross my fingers. 

0841 - 0845: Patient 4 accepts his meds. Aaaaah. I now understand why other nurses have been saying how cute he is. He is really quite adorable, and he looks up at me with deep, soulful puppy dog eyes. (His making of eye contact knocks him off the straight autism diagnosis and onto The Spectrum.) He lies down on the bed and begins choking his stuffed toy monkey with his hands, which is one of the few activities that helps him calm down. A-ok!

0845 - 0846: I am behind on my documentation but everyone got their meds and everything is under control! I got this!

0846 - 0848: I am needed at the Nurses' Station. I have a phone call. Our Support Associate is calling from the hospital lobby. She, for valid reasons, briefly turned her back on Patient 2 and when she turned around, he was getting into the wrong cab and took off before she could do anything. Not just the wrong cab, but a cab from a company that we do not have an account with, like we do with the correct company. I tell her to come back to the unit because, really, what else can she do?

0848 - 0850: I go to the bathroom for the first time in several hours and/or tell The Team what is going on with Patient 2 and/or compulsively pick all the nail polish off my fingernails . . . I don't really remember, so I'm just making an educated guess here.

0850 - 0852: I have another phone call. I pick up the line and it is a man with an accent. He sounds very angry. He tells me that he has a passenger who told him to go to X neighborhood, but the passenger does not know where in X neighborhood he is supposed to go. Also the passenger does not have any money. I tell him that actually the passenger is a patient of mine and is not supposed to go to X neighborhood at all, but to an address near the hospital which he has on a sheet of paper which is on his person. The man says he will call the police. I tell him to return to the hospital, where he will be paid for the whole roundabout ride in cash. The man agrees.

0852 - 0858:
 I attempt to get caught up on my computer documentation and sign of meds I have given and whether or not my patients are experiencing any pain and what, if any, interventions I have provided for said pain.

0858 - 0900: The man calls again. He is downstairs. He says the fare is $12, but he will charge $10 because this is a patient. I thank him. I go find my wallet. There is a $10 bill in it thankgod. I assume the man is not expecting a tip at this point, though he certainly deserves one. The Support Associate, who has since returned to the unit, says she will pay the driver with this $10 and escort the patient to the Recovery House on the bus. I thank her.

Here is a picture of two Shetland ponies wearing cardigan sweaters: 

Image courtesy of Buzzfeed/my friend FAB

*As it turned out, despite a tumor-with-metastases-to-the-brain scare, this patient appeared to have been suffering from alcoholic hallucinosis, which is like a slightly less horrifying and much less dangerous cousin of delirium tremens. Which is a deadly condition that happens to people quite frequently, actually, and is not just a craft beer from Belgium.**

**Delirium Tremens the beer is the third Google result for "delirium tremens." It also, apparently, inspires extreme nerdery from beer reviewers on Beeradvocate.com.
Upon the pour, it yields a deep golden showcase with massive fluffy white crown that stands with exceptional retention. Let the time fly, the head slowly sinks to decent foamy layer covering atop along with plenty of spotty and patchy lace. Rather high carbonation pushes the wave of eternal bubble to run actively towards the crest.

Mmm, beer....

Sunday, January 06, 2013

self help

On a diagonal side street in a desolate little pocket between Baltimore's stately, academic Charles Village and the fairly decrepit Greenmount Avenue (which, under the Google heading, "searches related to 'greenmount avenue baltimore'" are "baltimore police beat" and "worst street in baltimore"), lies a warehouse-y building that is home to The Book Thing. The Book Thing is a magical place where there are multiple rooms stuffed full of shelves and piles and bins of books that are organized by category. You know, like a bookstore. Except everything has been donated, there are no checkout counters, and everything is free.

Image borrowed from this random internet person. Thank you, random internet person.

Today, I was feeling particularly sorry for myself for personal reasons I would've blogged about in 2004, so instead of staying in bed all day with the covers over my head like I so desperately wanted to do (although I did spend a good deal of time doing just that), I biked my sorry ass the 3.4 miles (uphill both ways!) in search of more stimulating reading materials for my psych patients. In the approximate words of my all-time favorite advice columnist, Carolyn Hax--when you're feeling blue, you must 1., eat healthily, 2., not abuse substances, 3., get enough sleep, 4., exercise, 5., spend time with loved ones, and 6., try to focus your attentions outward. I'd already had a pile of pancakes with a friend, so this activity would take me to 3 out of 6, and I figured that 3 out of 6 ain't bad (you can take a wild guess as to which 3 I am still, um, working on).

I love shopping for other people, partially because, hello, it's SHOPPING, but there's less guilt because it's not for you and lord knows you don't need any more crap, but mostly because it's fun to think about what people might like to get that they wouldn't necessarily buy for themselves. For example, this Christmas I bought my parents deluxe dog toothbrushes. They were a big hit.

Anyway. So I acquired 23 books, a couple of which--okay, five--were for me. I hope some patients enjoy them, but even if only one book makes one person's day a little better one time, the back strain from carrying 23 books in my backpack on the way home is worth it to me.

I couldn't resist a 1962 copy of "This is the Pekingese," because Pekingese are so captivatingly weird looking and also the author repeatedly uses the term "germ plasm" in the chapter on how dogs (and humans!) perpetuate their genetic material. I also got a collection of Rumpole stories for a smart, sarcastic older man who used to love to read but is so depressed that he hasn't in years (I have no delusions that I will be successful in getting him to start again, but might as well try?). I got Volume 9 in the photography-heavy series "The Ocean World of Jacques Cousteau," because, the most recent day I worked, one of our chronically ill patients perseverated at me for like 30 minutes on how much she loved another volume in the series that we already have on the unit. That one is about dolphins and killer whales, and I figured I'd shake things up a bit and show her some coral reefs.

I also picked up a dictionary--we've had several requests for a dictionary from patients who like to play Scrabble--and I managed to find the same one I grew up with, Merriam-Webster's Collegiate Dictionary, Tenth Edition. Then there's some easy fiction--James Patterson in large print and Michael Chrichton; a couple classics--"National Velvet," "2001: A Space Odyssey," an abridged, illustrated version of "Last of the Mohicans"; a book of tres novelas in Spanish that looks somewhat okay from what I am able to translate; picture books on nature and the history of footwear design; some hippie dippie self-help stuff (that I am totally going to read before I bring in); a couple of books on writing techniques and exercises--I have a fantasy of doing little writing groups with the patients, though our unit serves people at such varied levels of functioning and also I have no clue how to go about leading a writing group; two National Geographics from the early 1960s (I am keeping one--it's worth it to me for the rad Mad Men-esque advertising alone). And something super cheesy and Christian-looking that I am also totally going to read before I bring it in called "My Angels Wear Fur."

Don't judge me. 

And last but not least, and not dog-related, is "The Witch of Blackbird Pond." I was thinking the other day about my favorite childhood books after reading about a girl crush of mine who has images from her favorite childhood books tattooed all over her arms (I already have one). And I thought of TWoBP for the first time in literally decades, and I remember when I was reading it, it was the first time I knew I had to go to sleep to get up early for something in the morning, but I simply could not put it down. Also it scared the living crap out of me. As soon as I saw it peeking out of the children's bin, I knew it was going in the backpack, and I'm looking forward to seeing what kind of effect it has on me 20 years later.

Thank you for your donation, Candice Myerson!

[Insomniac Update: I originally ended this blog post with the sentence, "I am going to die alone under a pile of furry animals," but I thought I should be more positive and cut out the pity party so I threw in the paragraph about the witches book. Not that dying alone under a pile of furry animals would be the worst way to go, all things considered.]