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....

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