Death, NGTubes, Kindness & Spanish

Monday I got my assignment and was told that one of my patients is actively dying. He had a cardiac arrest on Sunday night and came to the ER. Once in the ER it became apparent that he was not going to make, so they admitted him to our floor to let him die. He had a morphine drip & was getting Valium IV q 3h. All of this was a completely new experience. I got past the pharmacy hurdle of pushing IV Valium, you are supposed to have the patient hooked up to a monitor, but in palliative care Valium is obviously given for a different reason, in this case, seizures. I learned how to hang a new bottle of the morphine drip and how to titrate it for comfort. Let me just say one thing about that, that is totally a subjective call. One person thinks you should bump it up, another thinks you are actually causing them to die. I know there are HUGE debates about hospice, I now understand why. On another note, I thought I would feel differently when caring for someone as they are dying, but at first I just felt awkward, then I felt fine with it. Feeling fine with someone dying was very surprising, that made me feel weird. I'm still undecided about that whole thing. In the end he didn't die on my shift, just 4 hours after I left he passed away. May he rest at last.

Tuesday started out with an NGtube connected to a Gomco with low intermittent suction. Ok, this is what you talk about in nursing school, but this was the first one I had ever seen. Instantly I scan through the vast book knowledge stored somewhere in my brain to remember the vital do's and dont's of an NGT. HOB eleveated? check. Placement check? check. Anything else? who knows! It wasn't that bad, but last night the patient pulled it out "accidentally" and today there was an order to reinsert it if nausea continues. HA! I've never put one in before & she didn't want it in, so I just left it at that. Unfortunately, I ended up having to get her ready for the OR b/c her small bowel obx was getting worse. I hope she does ok, she was really sweet.

The kindness of some people goes beyond words. My manager showed me a letter from a patient's family memeber about our unit, and they mentioned me. I think I blogged about this patient before, the one who gave me the gift card, etc. Well here is the paragraph about me: "The entire staff of XX was wonderful, techs, housekeepers and nurses. In particular though, her nurse Jamie XXX deserves special praise. We all felt so fortunate that Jamie took care of our mom her entire stay. That continuity of care meant so much. Jamie is so kind and conscientous - it's hard to believe she is a new nurse. I hope you realize how lucky you are to have her as a staff member. She is one of a kind." Wow. I didn't make that up either!! My manager told me today that the people higher up want to frame it?!

Last but not least, another "nursing school only" special. Thursday we got an ER admission at 6am, the ER computer was not working so we had NO information about her, oh, and she only speaks spanish. Ummm. Does anyone know where the interpreter phone is? Of course not! The patient was really sick too. By 11:30 I found the interpreter phone, learned how to use it and was able to talk to her, what a relief. I can't imagine how she must have felt. By the end of the day she needed and NGT too, another possible bowel obstruction, go figure. Must have been a special on NGT's and gomcos. But hey, now I know how to use a gomco, the interpreter phone, and feel more comfortable with NGT's.

What a week! Just one more day left to go I wonder what I will learn tomorrow!!