Every shift I turn up at work half an hour early. I grab a cup of coffee and sit in plain view of the ward. Its the only time you get a chance to do this. Once you start working you have the blinkers on and you cant really get a feel for whats happening on the rest of the ward. So i sit, and I watch, I watch where the carers are focusing the most attention (even if they dont realise it themselves) I assess which patients will need two for assistance with a wash and which will need one. I note the noisey dementia patient who was probably screaming all night and make sure that is the last bay I go to so the others in there can get some rest once I have moved her to a cubicle.
I sit there and let it wash over me. And I have to say, its an incredible feeling. I am definitely an acute ward nurse. The ward is my home, and whilst I have the highest respect for scrub nurses I could never be one, I dont have it in me, and as far as community goes? I dont have the stamina to see hundreds of patients who all need wound dressings every week. I love wound dressing but not in that quantity.
On equal note I dont think I could be a surgical nurse for all of my career. This is more down to preference I am a medically minded person. I love the intricies of renal failure and the challenges of COPD.
I am an acute medical ward nurse.
Sunday, 7 December 2008
Saturday, 6 December 2008
Laughter
Yesterday we saw one the patients the entire ward had grown very fond of die. Thankfully it was very quick and painless. The mood of every member of staff on duty, from the sisters to the domestics dropped. Later than shift we had a quiet moment, someone (one of the class clowns) cracked a barely amusing, entirely inoffensive joke. The resulting laughter from everyone lasted several minutes and washed away the low moods. It was just the catalyst we needed to release it all.
Unfortunately in this job you dont really have time to stop and think about the bad things. A patient you cared about dies, you have to keep going because if you dont other patients will. The job doesnt stop to let you heal. In some ways I am grateful for that because if I stopped to think about every patient on any one ward who died I would probably end up killing myself.
The Job doesnt stop, so we cant either.
Unfortunately in this job you dont really have time to stop and think about the bad things. A patient you cared about dies, you have to keep going because if you dont other patients will. The job doesnt stop to let you heal. In some ways I am grateful for that because if I stopped to think about every patient on any one ward who died I would probably end up killing myself.
The Job doesnt stop, so we cant either.
Friday, 5 December 2008
Three Patients
Well i'm back to fighting strength, which is good. I'm also doing really well on this placement....so I'm told. I have to admit that I am going to miss it. My time with them finishes on the 12th but I have four shifts to make up so it might be a little later than that. Its been a good placement and I've regained all the confidence I lost on my last placement. I am also enjoying being a student nurse on placement with no assignments hanging over my head.
Yesterday we had a patient who went for a liver biopsy, when he came back he hadnt had the biopsy and had an acitic drain inserted(a tube inserted to drain large collections of fluid). The bag this was draining into was only 500mls. after the first two hours of emptying this bag every half and hour I decided to attach a 1.5 litre bag. To my amazement the fluid was draining even faster, it appears as long as there is space it will drain incredibly fast. This fluid loss obviously had to be compensated for so we were hanging bags of FFP(Frozen Fresh Plasma) and towards the end of my shift we had to clamp off the drain and hang bags of saline. All in all the man lost almost 10kg in a few hours. This cant be healthy! but he said he felt great and the doctors didnt seem concerned.
We have another patient who was doing so well, he's been with us for months and was medically fit for discharge until he contracted the D+V the ward was closed with, he finally got over that and seems to be in decline again. His blood pressure is in his boots, he's tachycardic, and very pyrexial. All of which leads me to believe he's septic despite the high doses of antibiotics he's on. This is an example of a patient you cant help but get attached to and at 90 years old I am not sure he'll see discharge this time.
Patient number three had the entire staff of my ward in tears yesterday(myself included). He is dying, he is very much at peace with his fate, he has at best a few weeks left and just wants to die in hospital so his family dont walk into his room one morning and find him dead. He had written a poem to his wife that is by far the most beautiful thing I have ever read.
So theres my three patients, the healthy, the declining and the dying.
Yesterday we had a patient who went for a liver biopsy, when he came back he hadnt had the biopsy and had an acitic drain inserted(a tube inserted to drain large collections of fluid). The bag this was draining into was only 500mls. after the first two hours of emptying this bag every half and hour I decided to attach a 1.5 litre bag. To my amazement the fluid was draining even faster, it appears as long as there is space it will drain incredibly fast. This fluid loss obviously had to be compensated for so we were hanging bags of FFP(Frozen Fresh Plasma) and towards the end of my shift we had to clamp off the drain and hang bags of saline. All in all the man lost almost 10kg in a few hours. This cant be healthy! but he said he felt great and the doctors didnt seem concerned.
We have another patient who was doing so well, he's been with us for months and was medically fit for discharge until he contracted the D+V the ward was closed with, he finally got over that and seems to be in decline again. His blood pressure is in his boots, he's tachycardic, and very pyrexial. All of which leads me to believe he's septic despite the high doses of antibiotics he's on. This is an example of a patient you cant help but get attached to and at 90 years old I am not sure he'll see discharge this time.
Patient number three had the entire staff of my ward in tears yesterday(myself included). He is dying, he is very much at peace with his fate, he has at best a few weeks left and just wants to die in hospital so his family dont walk into his room one morning and find him dead. He had written a poem to his wife that is by far the most beautiful thing I have ever read.
So theres my three patients, the healthy, the declining and the dying.
Friday, 28 November 2008
Highs and Lows
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.
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.
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.
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