Therapeutic Communication

I have been putting off writing a blog about my career for a long while, but I'm not sure I can wait any longer.  I had my first week out of orientation this week a boy what a week it has been. On top of the average crap that comes in the ER this week I had 2 patients try to die on me. The first was on tuesday, my second full shift out of orientation. This pt came to the ED via EMS and had been vomiting blood. once he arrived to the ED he vomited so much blood that he lost consciousness and aspirated some of the blood into his lungs. We then had to intubate and sedate the patient and then gave him 5 units of blood and 2 units of plasma. Of course ICU was out of beds so I then became and ICU nurse and took him one on one for the rest of the day.

The second patient was today. A coworker of mine needed today off because he couldn't find a baby sitter. One of our other coworker said they would be willing to split the shift with me, and since it would mean overtime pay, I agreed. BAD IDEA. When I walked in today everything seemed remotely normal. I took report on my new patients and one in particular was a troubling case. This man came into the ED this morning because of a low blood sugar. EMS gave him and amp of D50 (a sugary fluid) en route to the hospital and we fed him once he got there and she sugar came right up. As he was preparing to be discharged he said his throat felt like it was closing up and that he had a lot of phlegm in his throat. When his nurse at that time took a look at his airway it was extremely swollen and she notified the doctor immediately. The pat was given benedryl and a steroid and then I came in. We gave him a second round of the benedryl and steroid and also an epi pen. His airway looked almost completely closed at this point and an anesthesiologist came to look at it. As she started to asses the patient he began gasping for air and suffocating. The ER doctor immediately prepared to put in a chrichoidotomy, meaning he would have to cut the patient's chrichoid cartilage and insert and airway into his throat. This airway was not ventilating the patient properly and the patient began to crash. We then popped the code card and began giving the patient compressions and medications to keep him alive until a new artificial airway could be placed.

Long story short this patient is still alive but only by the grace of God. There is a point, a fine line in my job where I become helpless and can only hope. This man was dead but is now alive. Of course he may now have a noxious brain injury and we are unsure of his neurological status, but can only hope for the best.  I pray for his sweet wife who accompanied his this morning to the ED with a low blood sugar and out with a new tracheotomy and unresponsive state.

If I have failed to mention this to you before I have a hard job. Some people like to complain about their jobs. And yeah, there are a lot of jobs that suck. I have been a McDonald's worker, a maid, a waitress, an office worker, I have worked for tyrants and pushovers but nursing takes the cake. I literally have to comfort family members when their loved one is on death's door. I have to put up with mean doctors, clean up people's poop, deal with belligerent drunk people and do it all quickly and with a smile and sometimes I really don't feel like smiling about it. Because the people I take care of often treat me like dirt, and I get tired of washing blood off my hands all day, and I get tired of having 10 min to go shove my lunch down my throat and every day I go to work I never know if I'm going to walk into a storm.

With all of this said I must also tell you I have the best job i the world. I have given babies their first bath. I have also had the privilege of giving a dead person their last bath. I explain what the doctors don't and I am an advocate for my patients when they need someone to hear their problems or speak up for their pain. I heal the sick and keep people alive. People come to me hurting and dying and sick and leave me most often than not feeling better and in less pain. Perhaps these things are even more rewarding to me now that I have seen the sick die, I truly treasure when they live. Of course there will always be the crazy and uneducated who come in for no good reason and waste our tax dollars, and I struggle daily to have patience, but all in all there is nothing, absolutely nothing like being a nurse.