Compassion and Caring

"Love and compassion are necessities, not luxuries.  Without them humanity cannot survive." ~ Dalai Lama

Compassion is something that one would thing is a given with nursing and the medical system.  Compassion is the one thing that is not delivered in a pill, an IV push in a manufactured way.  Compassion is genuine.  Compassion is ignited from within.  Compassion in the one thing that we can give of ourselves to comfort those who are suffering, as we give it, we also receive great benefits in return.

Why is it in our field there is a lack of compassion.  In order to provide compassionate care we must have received compassion. As we care for our patients and provide compassion it is equally important that we treat the members of our hospital teams with compassion.

http://www.ted.com/talks/view/lang///id/1216

Joan Halifax highlights this concept in a short Ted Talks episode.

New Clogs vs Chest Tube

I found the perfect clogs.  They were so comfy.  Did I mention that they were perfect. Beautiful shiny black paten leather, light weight, I was in shoe heaven.  I was gracefully and comfortably gliding to the busy ER, no discomfort.  My feets were happy.

I went into check on a patient who was complaining of coughing for a few days and shortness of breath.  He had taken off his oxygen, and his oxygen saturation was looking crappy.  

Like a good nurse I chat with him for a moment and then listen to his lungs, or should I say lung.  

That's right he only had lung sounds in one lung.

I find an attending physician and alert him to the pneumothorax (collapsed lung),  but the doctor doesn't look phased, no blinking of eyes, no getting up from his chair, he didn't even send a resident over.  So I order a stat chest X-ray and beg the tech to pull it up in the ER for me.  How I love digital technology.  

My hunch was correct-- pneumothorax!  So I grab a resident, ask him to read the xray to confirm the diagnosis (because I'm a silly nurse and I can't diagnose anything).  I quickly walk over to the lazy unimpressed attending to tell him that "the patient has a pneumo."  

"How do you know", he asks.  

"I ordered a chest xray and it shows one, and there's that whole no lung sounds thing", in a slightly smart assed tone. 

He gave me the oh shit look and got up, quickly walked over to the patient and took a listen, then walked over to the computer to check the X-ray.  

So now it was time to fix the problem at hand.  

I gave the patient some pain meds, explained to him that he needed a chest tube and what a chest tube was.  I got the equipment set up.  Now we were just waiting for a doctor to show up, but I had on my comfortable new shoes.

So the resident comes bouncing over and looks thrilled.  How they love to put in chest tubes.  

So Resident A begins putting in the chest tube.  He has a medical student and an intern at the bedside with him.  He in on the bad lung side and I am on the other, holding the patient's hand and talking him through the process.  The patient is doing well, suddenly I hear the splash of fluid hitting the floor.   It's a lot of fluid.  Realizing the residents on the other side are fumbling with the pleurovac and seeing the floor covered in fluid I move over to the other side of the bed, my new clogs are splashing in the lung juice.  I  hook up the chest tube to the pleurovac.

"Thanks I owe you", the resident says.  

"Yes, you do to the tune of about $120 for a new pair of clogs".  

Vasoline Man and Bath Salts

It's always fun when the medics roll in with a slew of cops.... you never know what that means.  Could it be a stabbing, dude with a GSW or some other type of trauma?  The possibilities are endless.

There is a flurry of activity in the ER bay. There are medics, police, residents, doctors and some fellow nurses.  I see the glistening man in the stretcher, a paramedic says, "he needs a line, I lost it".  I weave my way past the residents, my IV set in hand.  The man's eyes are darting from side to side.  I tell the patient my name, he seems unimpressed.  I see a nice sized vein in my sights.  I lightly grasp his arm to position it, but my hands slides off.  

"Guys", I say to the medics, "why is he so slippery?" I'm not talking about a little slide, I'm talking about a slimy slide.

The medic looks at me and says, "Vasoline, it's Vasoline."

"Why?", I ask.

That's when the medics and police start giving us the play by play.  Apparently the person's neighbors called to police for complaints of loud noises.  When EMS responded to the home they opened the door and found the patient naked, covered in Vasoline and apparently preforming on a webcam with various toys.  

When they checked him out they saw he had a pulse in the 160s, and was probably on bath salts.  

Gotto love the bath salts! 

Don't Choke the Nurse

Hospital ER's have become the dumping grounds for drunks.  Unfortunately ERs also act as the holding place for mentally ill patents waiting for a disposition (either being admitted to a psych facility or discharged home).  Often our intoxicated patients have underlying mental health issues which can make a bad situation worse.

A few months ago a known "drunk" with a psych history got dropped off at our ER by an ambulance squad. He was assigned a stretcher.

A few minutes later he got up and headed over to another patient's bed and started yelling and threatening to kill him because the other patient was the guy who tried to steal his wallet at a bar (the patient wasn't even at a bar earlier).

I managed to calm him down and divert him away from the other patient.

A few minutes later the drunk got up again.  He began walking towards another patient bed, where a patient with a traumatic brain injury started screaming and flaying about. Seeing what was about to happen and the crazed look in the drunks eyes, a male nurse and myself positioned ourselves so that he could not attack the other patient.

I calmly talked to the drunk patient attempting to redirect him, but it wasn't working.  My co-worker, a male nurse also attempted to talk him down with no avail.  In the blink of an eye the drunk man lunged at my co-worker enclosing his hands around his throat.  Two visitors, myself, and a lab tech attempted to free this drunk psychotic man's hands from the nurses throat, my co worker was being choked.  Two other people came to the assistance.  The lab tech pulled the man's elbows back, myself and another nurse tried to pry his fingers off, while visitors secured his legs from kicking.  Our secretary called security, paging them nearly 10 times with no response, she finally had to call the local police.  We finally got the nurse free from the choke hold.  I ordered for someone to get the leather restraints and bring a stretcher closer.

We wrestled the man onto the stretcher.  From the look in his eyes there was no remorse.  He continued to fight as we moved him to a private room.  He attempted to bite, spit, punch and head butt the staff. Security looked stunned.  As I began drawing up Ativan I told security to put the restraints on him, they continued to just stand there looking at me.  "Put on the damn restraints" I ordered again.

Just as they began doing their job a very tall intimidating police officer entered the room.  The patient immediately knew that the game was over.  Security looked at the officer, but they were working at a snails pace. The police office looked at the security guys saying, "any day now".

The patient remained  in the ER overnight until he was sober.  While the charge nurse filled out an incident report the nurse who was choked did not press charges.  The incident was not debriefed, nor did the head of security ever meet with the staff that was involved.

While one nurse was choked, luckily in view of others who could come to his aid, another nurse was punched int her face.

I wish that my friend who was choked had pressed charges.  My profession for some reason just lets this stuff go.  Being assaulted is not part of the job description but we have adopted it as such.

Perhaps we should have let the patient go, let him attack the other patient.  If that should have happened then there would have likely been a lawsuit, and possibly a change.

As if rubbing salt in the wounds, a few weeks later, I was talking to some of the security guards about the incident.  One of them responded, "I don't get paid enough to get hurt", as he was looking at his Facebook page on the hospital's computer.

Safety in the workplace is an issue for everybody.  It doesn't matter how much money you earn.  I work in two ERs one in the inner city, and one in the suburbs.  I can assure you that I am far safer in the one in the inner city.  Our security there is top notch.

Nobody wants to go to work and get hurt, just as nobody wants to go to work and see someone getting attacked.

Roach, Crack Pipe, and Other Party Favors

Working in an inner city that has been labeled one of the worst cities in America, is always challenging and interesting.  It reminds of that  Forrest Gump line, work "...is like a box of chocolates, you never now what you're gunna get", or what you might find, or what might be given to you.  And in the spirit of giving, sometimes our patients give us the things we least expect.

Like the lovely gent who graciously gave up his well used crack pipe to one of our interns... The look on the interns face was priceless as he looked at me shocked, "what do I say?"  My response, "Thank him."

Then there was the time I was restocking one of our OB exam rooms and found a blunt (for those of you not use to the hood terms, it like a joint made with a cheep cigar .  Maybe it was a medical marijuana blunt they had intended for later use? Or maybe they felt bad for the staff. 

There have also been the offers of half eaten food, thank you, but no.  

Nationally our city gets a bad rap.  Sure there is a ton of gang violence, but the spirit of giving is all around.  

Great Lengths

Sometimes nurses have to get creative.  Let me rephrase that very creative.  One morning an unconscious man arrived in the ER, a present from the EMTs.  From the looks and smells of him he was likely homeless.

In our ER we have standing orders so that the nurses can get the ball rolling.

A couple of nurses and a tech immediately undress this gentleman, triage info is gathered, a finger stick completed, IV lines in, labs drawn.  The final thing needed was a urine.

This of course would require a straight cath due to his unconscious state.

One of my co-workers attempted to insert a foley, it was unsuccessful.  She attempted another sized foley, but was unsuccessful again.  She came over to the nurses station shaking her head and asked for some assistance, her face was flushed.

While the foley fringe was not the issue the length apparently was.  This gentleman was not of average size.

After a few attempts and a run to the supply room, we enlisted input from  one of our attending physicians, and that's when the brainstorming came to a solution.

Our solution was a NG tube!  A successful cath complete UDS and UA sent to the lab.

Nurses, we're a creative lot aren't we!