Musings of a Night Nurse

My journal for musing about being a night nurse, life and death, life in general and my passion for knitting

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Location: New York, United States

I have been a nurse for 30 years in long term care. Now don't make that face! I believe we need to care for our elderly and they deserve a loving, dignified end of life experience. I am married to the most wonderful man in the world for 18 years. I have no children of my own, but due to my step-sons I have a wonderful 5 year old grandson! I am mom to 2 17 year old cats and a BIG black lab/great dane Buddy (yes he weighs 146 lbs) that is either the dumbest or smartest dog around! LOL

Tuesday, May 09, 2006

A need to vent on a barbaric happening

OMG! In 30 years of nursing, I have never, ever seen anything so barbaric. I am shaking so badly that it is hard to type. My heart is breaking, I want to smash something (or someone) and I want to get falling down stupid drunk! I do NOT drink! so does that give you an idea of where my mind is right now?

How do I start..........with the HIPPA laws as they are I have to be very careful and not give out any identifying information. Oh Hell here goes. I have a 69 year old resident that is a stroke victim. He is aphasic (can't really speak, but is able to get his wants and needs known) This man never complains about anything! He may swear at you now and then if he doesn't like whats happening but I have never known him to complain.

Friday night I went to work and the evening nurse tells me that he is complaining of abdomenal pain. Now this is the deal. you ask him a question he says yes or no. So I ask him if he is in pain, he answers yes, I ask him to show me where the pain is, he puts his hand on his abdomen. Now the evening nurse has alread gone thru the bowel movement thing, and given him a suppository which did not relieve his pain. I take his temp, hmmmmm its 103. Ok, time to do a full assessment. Lungs clear, uring clear, palpate the abdomen.......uh oh, guarding on the right and a very definite positive rebound. I call my supervisor and tell her I believe he has a hot appendix. She comes up does the same thing I did and agrees with me. Simple so far right?

She calls the doc, first roadblock. Resident is comfort care which means no lab draws, no x-rays, no hospitalization. With alot of convincing on the part of my supervisor and myself we get him to agree to send the resident out for evaluation to the ED IFFFFFFFF his wife says it is ok. Ok, this should be simple right??? WRONG!!!!

The wife refuses to let us send him to the ED. WTF???????? sorry about the language! So I give him an IM narcotic analgesic. NO effect from it. I spend all night trying to make this man comfortable.

The next AFTERNOON the wife finally agrees to let him go to the ED to be evaluated. Can you all guess what they found? A RUPTURED appendix! DAMN! if we had sent him in the night like we wanted, it would have been a simple lap appendectomy, and boom back at the nursing home within 24 hours. Now once the appendix ruptures, they have to make a large incision, do a peritoneal lavage (flushing out the infection and gunk) LEAVE the incision open and let it heal from the inside out. Meanwhile the patient would be on heavy duty IV antibiotics and be in the hospital a while.

Do they do this? Hell no! The wife wants him to stay at the nursing home. So they send the man back to me in excruciating pain to die of peritonitis. Again excuse the language but WTF!!!!!!!! Saturday night, Sunday night and last night I am with this man while he is in indescribable pain. The doc keeps upping the Morophine but it isn't helping.

Last night I was giving Roxinal (liquid morophine) 10mg by mouth every hour and still could not control this mans pain! Dear Lord! I had to go into the med room and close the door and kick something. I wanted to hit someone! Just wasn't sure if it was the wife for being a heartless bitch, or the doc for possibly not explaining to the family how horrific this death would be!

I so wanted to call in sick Sunday and Monday night. I did not want to be any part of this barbarism. The only that stopped me was knowing that I would do my damndest to make him comfortable. The family was not there all night to hear this man in pain, I was. My poor CNA's did not know what to do when I burst into tears this morning. But I knew there are a lot of nurses that are hesitant to give morophine when respirations are already suppressed as morophine will suppress the respirations more.

As I said, I have been doing this for 30 years and in that time I certainly have learned to be able to take a step back and do my job with out letting my spirit be crushed each time there is a death. Of course there are always those that get to you no matter what, but you learn to be objective and proud of being able to be part of a loving and peaceful passing. Just couldn't freaking do it this time.

If you read this far, thank you. I think I will go take my Vicodin and flexaril and Elavil and try to sleep and hope I don't have any more nightmares.

Please folks, be very careful and choosy who you pick to be your health care proxy, who you choose to make medical decisions for you, and make sure they know what your wishes are!

12 Comments:

Anonymous cathy said...

awww poor man what ever happened to him??

5:49 AM  
Blogger Susan said...

How powerful this story is. I was a hospital chaplain for 19 years and learned early on that the nursing staff and aides carry the burden of so many decisions. This painful situation was made better by you, but at what price.
You are in my thoughts these days.
Take care.

7:24 AM  
Anonymous Andrea Bailey said...

You are in my heart and in my prayers. The poor man is lucky to have such a compassionate and loving woman as his nurse. You have earned your crown in heaven...
Although it has been very difficult for you to bear - I am thankful that you were there for that poor man - at least he has someone who truly understands the situation and cares about more than just his immediate existance.
You both will be in my heart and in my prayers. May God keep you strong and deligent in your care for him and your other patients.

9:56 AM  
Anonymous Andrea Bailey said...

You are in my heart and in my prayers. The poor man is lucky to have such a compassionate and loving woman as his nurse. You have earned your crown in heaven...
Although it has been very difficult for you to bear - I am thankful that you were there for that poor man - at least he has someone who truly understands the situation and cares about more than just his immediate existance.
You both will be in my heart and in my prayers. May God keep you strong and deligent in your care for him and your other patients.

9:56 AM  
Blogger Life's a Stitch said...

Thank you for very important food for thought,
Li

9:59 AM  
Anonymous Jami said...

I am glad to know there are still such caring nurses as you. It broke my heart to read this. I wouldn't want to be in the wife's shoes when karma comes back around to her.

I am glad he had you there for him!!!!

10:56 PM  
Blogger Leigh Ann said...

I am glad to here that you are there for him. He's lucky to have someone on his side. His wife better watch it. What goes around comes around.

How is he doing? I'll keep boh of you in my prayers.

9:13 PM  
Blogger Leigh Ann said...

I am glad to here that you are there for him. He's lucky to have someone on his side. His wife better watch it. What goes around comes around.

How is he doing? I'll keep boh of you in my prayers.

9:13 PM  
Anonymous Dee said...

I'm sorry you have had to bear the brunt of this but I thank God that he has someone that cares and tries to be an advocate for him. My husband is 48 has been on peritoneal dialysis for two years. He contracted peritonitis and we went to the emergency room on april 28. They did blood culture, fluid culture, and belly films and basically confirmed what we already knew. They gave him gentamicin and vancamicin iv and sent us home. The PD nurse called in a prescription of gentamicin to be put in the dialysis fluid and darvocette for pain. He had hiccups for two days because the infection irritated the diaphram. We did everything they told us to do and May 1st he finally couldn't take the pain any more and they admitted us to the hospital for pain management. His drain fluid was more like sludge that just cloudy and I continued to do his exchanges for him in the hospital because we knew what we were doing and some nurses have not had experience with PD and don't realize how critical it is to keep the cath end and cap sterile. For two days they never even asked about the drain bag weight or looked at the fluid. I was writing everything down and at one point a nurse even asked me if I happened to get the time she had last given pain med. There is much more to the story but I can't stand writing it never mind making you read it. We were in the hospital from Wednesday to Monday when I had him transferred to a larger hospital. During that time he was out of his head. I'm talking hallucinations. They were giving him demerol for pain which is metabolized in the kidneys and so by the time I got him to the larger hospital he was septic, uremic, and overdosed on demerol. We had some very good nurses but we had some that should never be let near a patient. If I hadn't been there they would have done surgery for diverticulitis which as it turns out he didn't even have. We are now trying to recover and he is back on hemo. An advocate is crucial for anyone going into the medical system these days and it is so sad that this man has one who doesn't seem to care. I have learned that I have to be aggressive and ask polite questions about everything that is done to and for my husband and if that earns me a rep as being difficult I don't care.I am placing my most precious and fragile possession in someone elses care and they may have the necessary knowledge but they don't have the emotional investment. Have a drink and keep doing what you're doing. Caring and observant nurses are the first line of defense for patients and it is your communication with the doctor and the family that makes all the difference in patient care. the outcome with this man is obviously horrific but you will know that you did everything you possibly could for him and in the end that's all we can do. It may feel terrible to you now, but how much more terrible if you didn't try to make him comfortable. Bless you and I pray the Lord gives you and this poor gentleman peace. Dee

7:43 AM  
Anonymous Heather N said...

Wow, that is TERRIBLE.
I am the staff scheduler at nursing home in Ontario and I can totally empathize with your feelings. I get so attached to my resdients, it's scary. Sometimes when I am on vacation or even off a few days I feel nervous to go back to see who died. I have my favourites, of course!
Next situation..... deep breath.... my brother, age 31 is in a nursing home with MS, very severe. His wife has POA and will not let him have a feeding tube so he is basically going to starve to death since his swallowing is not functioning. This is so frustraing to me. Thanks for telling your story and you are not alone with these situations as sad as they can be.
Hugs, Heather in Ontario
hethln@yahoo.com

4:05 PM  
Blogger THE KNITORIOUS MRS. B said...

It's because of nurses like you that I decided to enter the profession over 25 years ago. thank-you for reminding me!

God bless you for trying to make a positive difference in this poor man's life.

8:05 AM  
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