Yesterday I got to run my own bay, with six acutely ill patients. There was no one watching my back, I had my own healthcare assistant and I was responsible for getting one of the qualified nurses to administer drugs when I asked them. If I didnt ask the patient didnt get. It was huge for me, I didnt screw up, it all came off without a hitch and was a massive step for my training.
Unfortauntely today I am feeling rough, very rough. My ward is still infected with norovirus and I was hoping the fact I had only just gotten over this virus meant I had a greater resistance. Unfortunately Virii have a habit of mutating so the immune system cant recognise it and you just end up getting reinfected.
Also given I have just reread this post It appears I'm not thinking too clearly either.
Friday, 28 November 2008
Monday, 24 November 2008
The Songs We Sing
I have mentioned before that there are certain songs that would lend themselves to the soundtrack of ward life. I thought I'd list a few of these based on the activities involved -
Performing CPR - Triumph - Fight the Good Fight
Having 1000 demands made on you at once - David Grey - Please Forgive Me
Trying to convince a dementia patient we arent stealing their blood Fountains of Wayne - Hey Julie
Trying to keep a mobile dementia patient from leaving the ward unnoticed
- Thin Lizzy - Jailbreak
Trying to get a doctor to canulate a patient at 0300 - Manowar -Fight until we die
Starting a Shift on a crisp, cold afternoon - Butthole Surfers - Dracula from Houston
A Moment of complete warm fuzzy teamwork - Iron Maiden - Children of the Damned
The end of a shift - Show me the way to go home
Performing CPR - Triumph - Fight the Good Fight
Having 1000 demands made on you at once - David Grey - Please Forgive Me
Trying to convince a dementia patient we arent stealing their blood Fountains of Wayne - Hey Julie
Trying to keep a mobile dementia patient from leaving the ward unnoticed
- Thin Lizzy - Jailbreak
Trying to get a doctor to canulate a patient at 0300 - Manowar -Fight until we die
Starting a Shift on a crisp, cold afternoon - Butthole Surfers - Dracula from Houston
A Moment of complete warm fuzzy teamwork - Iron Maiden - Children of the Damned
The end of a shift - Show me the way to go home
Noro Novo
I've spent the last week off sick due to a pesky little virus called the norovirus. The basic symptoms of this virus are D+V. When I got back to work yesterday and my ward is closed to all admissions and discharge due to this virus. 25 of our 27 patients have it. One week may not sound like a huge amount of time to have off sick but thats only the amount of time it took before I was no longer infectious. The 72 hours starvation and massive dehydrated have taken their toll. I've lost 10kg in 6 days and still feel week as a kitten. Now I am reletively fit normally and its hit me this hard. Imagine how its hitting the elderly and recently post operative on my gastro ward. Additionally all the nursing staff are having to work harder under more stress because they are massively understaffed and this is making them more vulnerable to the virus.
The patient who originally had the virus died shortly after she was admitted to the ward, in the space of two hours she manged to infect enough people to start this. The interesting thing is this virus is ancient, its been around since hte begining of recording history (that or virii very similar to it) and its learned to adapt and survive everything the human body can throw at it
I'm not saying we should all be in awe of this virus but I am. Its defied the basic principles of evolution - Survival of the fittest, and its not evil, its not a life form going about its dark purposes, its just an entity that is doing what all living things do, finding means to replicate, the damage it does to the environment that supports it is completely accidental.
It has been stated that the only thing that exists beyond good and evil is death which does not discriminate, does not seek the good or evil, it strikes all without thought or intention. I would argue that life also its beyond good and evil, the struggle to survive against any and all odds without intention or inclination towards either good nor evil.
The patient who originally had the virus died shortly after she was admitted to the ward, in the space of two hours she manged to infect enough people to start this. The interesting thing is this virus is ancient, its been around since hte begining of recording history (that or virii very similar to it) and its learned to adapt and survive everything the human body can throw at it
I'm not saying we should all be in awe of this virus but I am. Its defied the basic principles of evolution - Survival of the fittest, and its not evil, its not a life form going about its dark purposes, its just an entity that is doing what all living things do, finding means to replicate, the damage it does to the environment that supports it is completely accidental.
It has been stated that the only thing that exists beyond good and evil is death which does not discriminate, does not seek the good or evil, it strikes all without thought or intention. I would argue that life also its beyond good and evil, the struggle to survive against any and all odds without intention or inclination towards either good nor evil.
Wednesday, 12 November 2008
The Rain
As a gastro medical/surgical ward, my ward sees a lot of alcoholics. Many of these are frequent flyers. Many bloggers from the ambulance service tell you about the trouble drunks give them on a regular basis. So I thought I would give you a little insight into what happens when those drunks actually get admitted to hospital.
Michelle(obviously a pseudoname) has wrecked her body with drink. Her brain barely functions and she often just sits and stares at the wall, saliva streaming out of her mouth and pooling in her lap. She is perfectly mobile and can answer direct questions. Her liver barely filters out the everyday toxins that wouldnt cause a healthly liver any problems. These toxins occasionally accumulate and attack her brain further. She has been a regular on and off the ward for almost a decade. Every time she comes in, we stablise her with a regimin of vitamin supplements and iv fluids and discharge her. The doctors insist their tests show she is mentally fit enough to look after herself, so they release her back to her home which has no electricity, no heating, and no water because the complexities of paying bills is a little beyond her level of comprehension. That night shes found roaming the streets of her town, naked in the pouring rain. Shes brought back into A&E, they send her back to us and the cycle starts again.
Now section three of the mental health act states that any patient who is deemed a danger to themselves or others should be placed into an appropriate mental facility where they can at best be rehabilitated, at worst protected from themselves. However the medical team in their infinite wisdom suggest that this women isnt a danger to herself. Their tests prove it.
On this ward I am learning how truely frustrating this job can be. We are working ourselves to the bone in order to save people who dont want to save themselves. But we still do it, with the same vigor we show patients who havent brought their conditions on themselves.
Michelle(obviously a pseudoname) has wrecked her body with drink. Her brain barely functions and she often just sits and stares at the wall, saliva streaming out of her mouth and pooling in her lap. She is perfectly mobile and can answer direct questions. Her liver barely filters out the everyday toxins that wouldnt cause a healthly liver any problems. These toxins occasionally accumulate and attack her brain further. She has been a regular on and off the ward for almost a decade. Every time she comes in, we stablise her with a regimin of vitamin supplements and iv fluids and discharge her. The doctors insist their tests show she is mentally fit enough to look after herself, so they release her back to her home which has no electricity, no heating, and no water because the complexities of paying bills is a little beyond her level of comprehension. That night shes found roaming the streets of her town, naked in the pouring rain. Shes brought back into A&E, they send her back to us and the cycle starts again.
Now section three of the mental health act states that any patient who is deemed a danger to themselves or others should be placed into an appropriate mental facility where they can at best be rehabilitated, at worst protected from themselves. However the medical team in their infinite wisdom suggest that this women isnt a danger to herself. Their tests prove it.
On this ward I am learning how truely frustrating this job can be. We are working ourselves to the bone in order to save people who dont want to save themselves. But we still do it, with the same vigor we show patients who havent brought their conditions on themselves.
Thursday, 6 November 2008
Wow
Unbelievably one of the patients who had a GCS of 4 and was indeed on the liverpool care pathway came around. After two days being completely unresponsive with no pupil reactions she was sat up eating soup and chatting about her grand children. I have never seen anything like it.
Monday, 3 November 2008
New Ward
So I'm settled on my new ward. Gastro Medical and Surgical. Its an interesting place to be. I've experienced a surgical ward on my first placement, and a medical on my second. Caring for both sets of patients in the same place is interesting.
Yesterday we had two patients who were dying, very slowly. Both had a GCS* of 4. I have never known anyone come back from that. One was hooked up to an insane number of machines, and tubes, ranging from ECG to Riles tubes. This patient required a lot of care as the doctors hadnt officially stated he was no longer for active treatment. The ICU consultant came down to assess him and decided that ICU care would do nothing for him.
The second patient was on the liverpool care pathway** and whilst she didnt require regular monitoring she didnt have a riles tube in so despite the fact she was unresponsive she was constantly vomitting into her oxygen mask.
I have to admit, I have cared for patients who have weeks/months to die before, and I have cared for patients who are peri-arrest. This was my first experience caring for patients who were stuck somewhere in between. It was eye-opening.
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*Glasgow Coma Scale: a system of assessment that more accurately determines a patients state of conciousness. Lowest GCS is 3(one point in each of the criteria). Highest GCS(and hopefully the GCS of you the reader) is 15.
**LCP: A set care plan for the dying, It requires discontinuation of all treatments and close monitoring of medication for pain relief, nausea relief, etc. The idea is to make the patient as comfortable as possible.
Yesterday we had two patients who were dying, very slowly. Both had a GCS* of 4. I have never known anyone come back from that. One was hooked up to an insane number of machines, and tubes, ranging from ECG to Riles tubes. This patient required a lot of care as the doctors hadnt officially stated he was no longer for active treatment. The ICU consultant came down to assess him and decided that ICU care would do nothing for him.
The second patient was on the liverpool care pathway** and whilst she didnt require regular monitoring she didnt have a riles tube in so despite the fact she was unresponsive she was constantly vomitting into her oxygen mask.
I have to admit, I have cared for patients who have weeks/months to die before, and I have cared for patients who are peri-arrest. This was my first experience caring for patients who were stuck somewhere in between. It was eye-opening.
----------------------------------------------------------------------------------------------------------------------------------
*Glasgow Coma Scale: a system of assessment that more accurately determines a patients state of conciousness. Lowest GCS is 3(one point in each of the criteria). Highest GCS(and hopefully the GCS of you the reader) is 15.
**LCP: A set care plan for the dying, It requires discontinuation of all treatments and close monitoring of medication for pain relief, nausea relief, etc. The idea is to make the patient as comfortable as possible.
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