It's been so long since I posted in this blog but I just can't resist to share this forwarded email. Quite fitting for Labor Day,eh?  Pretty much everything in the the list fits us to a T. It's scary but true.

Nurses - God Love 'EM?

1. Did you hear about the nurse  who died and went straight to hell?  It took her two weeks to realize she wasn't at work!

2. You know you're a nurse if  ... you would like to meet the inventor of the call light some night in a  dark alley.

3. Your sense of humor gets more warped each year. Almost everything  can seem humorous ...eventually.

4. You know the smell of  different diarrheas and can identify them.

5. You can tell the pharmacist  more about the medication they are dispensing than they know.

6. You  check the caller ID on your day off to see if anyone from the hospital is  trying to call and ask you to work.

7. You've been telling stories  in a restaurant and made someone at another table, throw up.

8. You notice that you are using more 4 letter words than you did before you started nursing.

9. Every time someone asks you  for a pen, you can find at least 4 of them on you. (in your hair or behind  your ear!)

10. You live by the motto "to be right is only half the battle, to  convince the doctor is the more difficult part."

11. You've told a confused  patient that your name was that of your coworker and to holler if they need  help.

12. Your bladder can expand to the size of a Winnebago's water  tank.

13. You find yourself checking out other customer's veins in grocery waiting lines.

14. You avoid unhealthy looking shoppers in the mall  for fear that they will drop near you and you'll have to do CPR on your day  off.

15. Your fingers have gone places you never thought  possible.

16. You have seen more penises than any prostitute.

17. You can go from cleaning up poop, straight to lunch  and not think  twice about it.

As I've said before, a family member's illness or death can bring out the best and worst in people. We've seen a lot of the negative repercussions on the media in recent years. It should home in a vital point of being prepared for these kind of issues. You may not need a trust, an elaborate estate plan or even a will. But unless you want a stranger making important decisions for your and your family, there are some things you do need.

If you get in a car accident and die, your estate will be distributed more or less efficiently. Get in a car accident and end up in a coma, and you could be in a world of hurt. Who would be authorized to pay your bills or wrangle with insurance companies about your care? Who would decide whether to sue that driver who hit you -- or shut off the respirator that’s keeping you going? The state will eventually find someone to fill these roles, after a potentially costly and time-consuming court hearing. But it might not be the person you would want. So at a time when you’re most vulnerable, life-and-death decisions could be made for you by a stranger -- or an estranged, distant or greedy relative.

That’s why you need the following documents:

• A durable power of attorney for health care, which lets you name who will make medical decisions for you, and
  
• A durable power of attorney for finances, which designates who’ll handle money decisions
  
• A living will, which tells doctors exactly what kind of care you do and don’t want to receive if you’re terminally ill and incapacitated.

Although courts have allowed family members to disconnect life support from unconscious, terminally ill patients who didn’t express their wishes clearly, judges are reluctant to set a precedent for “minimally conscious” patients. Thinking about these issues is not fun, which is probably why most people avoid it. You have to ponder some of the grimmest circumstances imaginable. Do I want to be on a respirator if I’m conscious? If I’m unconscious? Do I want food and water withheld? How about pain medication?

The person handling your finances may be able to do so remotely, although you may still prefer to name someone who lives relatively close for convenience sake. In addition to paying your bills and handling insurance claims, the person handling your finances may also need to sell your home or make other complicated moves that require more proximity.

There is one group of people who should absolutely, no question, have a will, and that’s parents of minor children. Even if you can’t agree on who gets the crystal, you need to agree on who would take care of your children in the event of your death. No matter how icky you feel about planning for your own demise, you owe it to your kids to spare them the potentially ugly and drawn-out custody battle that could ensue if you don’t make these decisions now.

I just got done with taking report on my fourth patient when the pm shift nurse gave me the info on my fifth, Mr. Tower*. He was a male patient in his late 60s and was admitted in the afternoon after a diagnostic procedure was postponed due to acute renal failure. His service wanted him to stay in the hospital to resolve the problem and to monitor him before he gets rescheduled for the same test in a few days. Upon checking his chart in the computer, he didn't have much of any doctor's orders put in yet.

I was about to do my rounds for my assignment when Mr. Tower's call light  came on so I decided to check in on him first. I knocked on his door, " May I come in, Mr. Tower? What can I do for you?"

Mr: Tower: "I'd like to know where my medications are. I'm supposed to take them a long time ago." No time for pleasantries, I see. He was definitely looking very irate and agitated . He was breathing hard and was waving his arms around. Oh, dear

Me: "Mr. Tower, my name is PRNurse  and I will be your nurse till tomorrow morning. I understand you had been waiting for some medications?" I took  a few more tentative steps into the room like entering a lion's den .

Mr. Tower: "Yes, I take my medications at 6 pm and that was two hours ago. This is going to mess up my routine. I refuse to take my pills according to the hospital's schedule. I've been lying here for hours and nothing's been done. I don't know what's going on here. Nobody seems to know what they're doing." Oh, great! I have a ticking bomb on my hands and he's ready to blow up.

Me: " Mr.Tower, I just got started with my shift but I will be checking up on the issue right away. I will get hold of your doctor and let you know what's going on." I took a few steps back.

Mr. Tower: "Well, two doctors had been here already and I told one of them about my medications. He should have the information already. I just want my f ing  medications NOW!!!"

Me: "Mr. Tower, I'll be working on it as soon as possible." I was just about losing my cool at this point but I bit my lip to keep a retort from coming out of my mouth.

Mr. Tower: "You better get hold of that doctor and he'd better be here in less than 15 minutes or else..."  As much as he left a threatening tone with the last word, I seriously doubt I can make a doctor come up ASAP just because Mr. Tower said so.

Me: "I'll try my best, Mr. Tower." I walked out of that room like the devil was after me. What a foul, stinking attitude! I pity the doctor that will have to deal with him. Well, I pity myself more since I'm stuck with him for 12 hours!

I was able to contact   Dr. Wise* and notified him of the problem. He was busy with another patient on crisis in another unit but managed to come up to see the patient in less than half an hour later. I told him more about the patien't verbalizations (use of the F word particularly) to emphasize the mood he was in. Minutes later, Dr. Wise came back to the station and said, "I don't think he likes me either.  I told him that it was wrong of him to curse at the nurse, that it was an inappropriate and unacceptable behavior. He denied cursing and being rude. We had a bit of an exchange of words. He wants another nurse but I told him it's not necessary or possible. Just be prepared when you go in there, okay?" A-huh? ...

Yikes!!! Boy, do I have my night in hell cut out for me . Braving for the worst, I went in to the patient's room to inform him that the doctor was in the process of entering his medication orders and I will bring in the meds as soon as they are dispensed from the system or sent from the pharmacy. The patient looked like he had calmed down and was surprisingly pleasant this time around . I thought he was going to throw me out of the room but he seemed like a different person than the one I initially met. Wow!  I think what the doctor said probably homed in on him and made him think twice about his unfair behavior. Sometimes, patients can become so anxious and it gets manifested in other types of behavior. It's still no excuse to be abusive to the staff but it's understandable and expected at times.

The rest of the night still had some bumps and hitches but it went better than I anticipated. Mr. Tower had all his pills ( more or less 10 of them) and went to sleep . I thanked the doctor who made that possible. It is so rare that an MD would stand up for the nurses so it was a very refreshing experience . Most of them couldn't really be bothered to go an extra mile to make it easy for the nursing staff so kudos to those who respect our profession as much as we respect theirs.

* not his real name

All of us will meet our end one day . Some sooner than others. It's not exactly an uplifting thought to dwell upon but at one point or the other, we are  confronted by our own mortality. Sometimes a very melodramatic scene in a movie of a dying or dead character can bring forth this utter feeling of sadness... and maybe fear. In my particular line of work, I can't help but ask myself some very curious and to some, "morbid" questions.

First, let's look up the definition of the word . Death is defined as end of being alive: the ending of all vital functions or processes in an organism or cell. Hmmm... A very matter of fact definition but the word in itself evokes a whole gamut of emotions to a lot of people. Some have their individual reasons and experiences to feel a certain way but for some, it's a virgin territory that no one wants to venture into.

 How and when death will come knocking on our door might be something some people would like to know just so that they can cheat the grim reaper, much like in sci-fi time travel stories. To those who unwillingly gained that knowledge may use the information in their own varied or precise ways. For the terminally ill patients who were given the "talk" by their doctors about their poor prognosis and "time left", it could seem like a death sentence hanging over their head, pervading all waking and unconscious thoughts, paving a path to depression. For some, these facts might become opportunities for them to straighten out their unfinished business ( Last Will and Testament, reconciliations, vacations) and prepare themselves for that event. Quite a daunting task but once accomplished could make the experience an entirely significant and peaceful transition.  

I've seen this countless times, only the names and faces are different. Death can bring out the best and the worst in people. It can unite or tear a family apart . It can rouse up the green-eyed monster or expose a bleeding heart. It can inspire loyalty or may cause abandonment.

 One patient (Mr. Adam*) in the past shared to me his feelings of regret that he will never get to see his grandchildren and that they will never get to know him, the cool "biker" grandpa .This lament particularly tugged at my heartstrings since it always make me sad that my father didn't live long enough to see my offsprings (none so far) . So, after listening to Mr. Adam, I made a suggestion that perhaps he can ask his kids to help him create a scrapbook   about his life so that one day, his granchildren might be able to browse it and have a sense of what sort of a person he was. Another idea that was tossed around is a DVD/video  documenting his living out his last days with his family and friends. He was expressly appreciative of the suggestions and resolved on making them a reality once he gets home. I was glad to see that spark of interest and enthusiasm in his eyes. I'm sure there'll be crummy days ahead of him but hopefully, he will stay on course and finish this one mission.  

* not his real name

For the past three weeks I've been experiencing shooting, sharp and nagging pain  on my left foot particularly the arch. I thought it was precipitated when I did some vigorous dancing  at a party we threw for Halloween but was past ignoring and hoping it will go away. I have had to call in sick  last week since I ended up limping after a particularly gruelling 12 hour shift. A few co-workers have surmised that perhaps I need a new pair of work shoes. And I was like," Are you kidding me? What's wrong with the ones I'm wearing now? It's not falling apart yet or anything. Sure it could use a little bit of cleaning but it still looks good to me. Plus, I like the color (ceil blue)." I've gotten a few compliments on them, in fact. Also, I've been wearing it for more than a year and never had this problem before. So, I went about my business and suffered a few nights of agony whenever I have to pace the hallways like I was on a walkathon .

With my husband's urging yesterday, I finally got fed up and decided to stop being cheap and purchase a new pair. It took me almost an hour to find a pair I felt was worth replacing my old ones. I was a bit skeptical  about going to work last night as I felt my foot truly needed a break from all that walking but I would have to forfeit my holiday pay if I called in sick again. So, with my new unbroken pair of clogs, I braved another night shift of pounding the hospital hallways.

For the first two hours I felt guarded and a little bit achy but the rest of the shift went fine without pain shooting up my leg. In the midst of rushing to finish tasks, I almost forgot about my foot problems. Boy, was I glad to be wearing these shoes. Anyway, why am I devoting an entry on this? What does it have to do with nursing? I'd say it has a LOT to do with the job.  Being a nurse and on your feet 12 hours a day (or night), we need shoes that are comfortable, practical and add an element of joy to your hard working feet. My new shoes are just that. I bought the Quark Quarky white clogs.

 This is the product description from their website:

Designed with revolutionary new proprietary technology the original Quarky clog is out-of-this-world. It is the lightest clog in the world at 4.2 oz. and weighs less than $.43 in change so it feels like you’re walking on air. The patented compound of EVA and rubber will stretch and mold to the shape of your foot for superior comfort and a perfect fit. The removable foot bed provides extra support under your arch where you need it most, and utilizes DRYZ Moisture Management to regulate the temperature inside the clog, keeping your feet cool and leaving the shoes fresh for the next day.

Anyway, short of sounding like shilling for the footwear company, I hope I made a wise selection. It remains to be seen in the next few days.

The one thing I learned from this experience was to listen to what your body (or parts) tells you.  A lot of this minor ailments could have been prevented or treated by using the common sense and acting in a timely manner. So many patients have ignored their symptoms for long periods of time that when they finally paid their MDs a visit or went to the ED  , their disease are far into its advance and malignant stages. I, for one, am guilty for not doing my BSE (Breast Self Exam) regularly. Admittedly, sometimes it's out of fear of finding a  suspicious lump one day and not knowing if I can deal with that possibility. All I can do is to muster that courage from time to time when I am in the shower and happen to remember the many women who have not survived breast cancer due to a  late diagnosis and treatment. I'll just have to imagine hard enough and try to be in their shoes so I don't have to make that painful walk feeling like there's a knife hanging over my head.  

Has it ever crossed your mind what will it be like when you're old and gray?  Of course, we can easily envision those physical changes that come with aging. We only have to look at our own parents and grandparents to see the possibilities and the inevitable. What I really mean to ask are about the other repercussions that come it such as illness, debility, and memory loss. Ever since I worked at a long term care facility (years ago), otherwise known as the dreaded "nursing home" , I asked myself these questions. What will I be like? Will I be the pleasant and benevolent type who seems to be liked by everybody (like their favorite grandma) or the type who is persnickety and cantankerous whom everybody avoids? I'd like to think it will be the former, I hope so... but another issue comes to mind. Will I still have my wits when that time comes? I shudder to think of the possibility...

I once came across a patient named Anna*.  She was in her early 70s. She was living a normal productive life at a nice retirement home in the West Coast when things started to change. She became increasingly forgetful, having visual hallucinations and with difficulty speaking. She once went to a bank and could not remember where she was and why she was there. It became apparent that she was unsafe on her own so her family decided to bring her to the Midwest so she can be looked after by another family member. Soon after arriving, the symptoms increased so she was brought to the hospital and had some tests done. The results pointed to a diagnosis of possible Creutzfeldt-Jakob Disease or CJD.

According to Wikipedia:

Creutzfeldt-Jakob Disease (CJD) is a very rare and incurable brain disease that is ultimately fatal. It is the most common of the transmissible spongiform encephalopathies (TSEs). TSEs (also known as prion diseases) are caused by a unique type of infectious agent called prions, an abnormally-structured form of a protein found in the brain.

Although CJD is the most common human prion disease, it is still extremely rare and only occurs in about one out of every one million people. It usually affects people aged 45-75, most commonly appearing in people between the ages of 60-65. The exception to this is the more recently-recognised 'variant' CJD (vCJD), which occurs in younger people. The first symptom of CJD is rapidly progressive dementia, leading to memory loss, personality changes and hallucinations. This is accompanied by physical problems such as speech impairment, jerky movements (myoclonus), balance and coordination dysfunction (ataxia), changes in gait, rigid posture, and seizures. The duration of the disease varies greatly, but sporadic (non-inherited) CJD can be fatal within months or even weeks.

 Due to the poor prognosis of this disease, the family decided to forgo any pursuits of aggressive treatment and the patient was referred to palliative care. Her disease was indeed progressing increasingly. She was unable to speak and walk and was at risk for seizures. She wouldn't eat or drink, became incontinent and seemed oblivious to her environment.

How heartbreaking it must be for the family to see her like this. I just hope that her remaining days will be painless and comfortable. She was lucky to have a supportive family who I feel will be with her till the end. Not all of us can say that... sadly. 

* not her real name

Born into a wealthy and well-connected British family at the 'Villa Colombaia' in Florence, Italy, she was named after the city of her birth. A brilliant and strong-willed woman, Florence rebelled against the expected role for a woman of her status, which was to become an obedient wife.
Inspired by what she understood to be a divine calling (first experienced in 1837 at the age of 17 at Embley Park and later throughout her life), Nightingale made a commitment to nursing, a career with a poor reputation and filled mostly by poorer women.

Traditionally, the role of nurse was handled by female "hangers-on" who followed the armies; they were equally likely to function as cooks or prostitutes. Nightingale was particularly concerned with the appalling conditions of medical care for the legions of the poor and indigent. Reportedly she treated 2,000 patients herself. She also contracted Crimean Fever. She is remembered today because of the compassion, care and administrative skills that she introduced to the profession of nursing, to patient care and to the maintenance of medical records.

Nightingale's work inspired massive public support throughout England, where she was celebrated and admired as "The Lady with the Lamp" after the Grecian lamp she always carried in her tireless evening and night-time visits to injured soldiers. Nightingale's lamp also allowed her to work late every night, maintaining meticulous medical records for the hospital, and writing personal letters to the family of every soldier who died in the hospital. The depth of her commitment to the care of her patients in Crimea earned her the everlasting respect and affection of the common soldier.

Florence Nightingale's lasting contribution has been her role in founding the nursing profession, and in the shining example she set for nurses throughout the profession of commitment to patient care and hospital administration. There are countless examples of Florence Nightingale's continuing legacy in the nursing profession that she founded, from the continuing work of the Nightingale School of Nursing and throughout the entire field of nursing education and medical records.