Vitamin H
Since my shift-of-agony with my previously wonderful and understanding preceptor, Julie, things have gotten distinctly better, though all is not resolved. For one thing, my next two shifts happened to be with Jessica, and I was busy and running, and she had to step in a couple times to fill little holes, but mostly they went fine. At the end of the second shift, Jessica just said (in a light, rather matter-of-course tone) that I gave very good patient care, and I just needed to work on my time management. This felt to me absolutely fair, and to be honest, I never did think that getting things done quickly and efficiently was going to be my strong suit. I truly think that the best I can hope for in that realm is a general adequacy, a level I'm all too aware that I haven't yet reached.
The non-big-deal-ness of it all made it much easier, then, the next shift I had with Julie, to meet her lingering attitude of Great Seriousness and Sober Concern with a (mostly genuine) brisk optimism. "So," said Julie, in the kind of tone one uses to ask about the results of a nasty court case or a biopsy, "how did your shifts with Jessica go?" I pretended I didn't notice the spirit in which the question was asked, and said, "oh, pretty well! I really tried to plan my whole days myself, and I think I'm getting there. Jessica had to help me out a couple of times, but I managed to get through most of it on my own." This left her mildly nonplussed, which I admit gave me some gratification, and then I bustled off to my tasks, which of course was what I was supposed to be doing. Julie did warm up a bit by the end of the shift, which was good, though we're nowhere near back to where we were when all was sunny and fine.
Then Julie and I had a PM shift (3-11) together last Friday. We agreed that I would take 3 of our 4 patients. One was supposed to be discharged to rehab just a couple hours into the shift, but due to a kind of ridiculous misunderstanding, that ended up not happening, and he had to stay overnight with us. But he was easy (and easy-going), as was my friend the 28-year-old woman with the tattoos, Buddha-calm, and nasty leukemia. They both needed medications and vitals, but that was really about it. Which was good, because patient #3 was a lady with a very extensive psych history (let's call her Ms. Q, because that's not her name) who was starting chemo that night. Ms. Q is a large middle-aged lady with messy hair and prominent eyes (that's from her thyroid condition, though it has the unfortunate effect of accentuating her appearance of instability). She was intermittently lucid and appropriate toward the beginning of the shift, if very needy and tearful and anxious as we got ready to start the chemo. She had a sitter, but was still continually on the nurse call button. Sometimes she'd have forgotten what she wanted by the time I got my gown and gloves on (she was on contact precautions, naturally) and got into the room. We nonetheless got her first unit of blood and her premedications into her without much in the way of untoward incident. Lots of hugs and reassurance, plus a milligram of IV Ativan, allowed the beginning of chemo to proceed as planned. (Originally she consented for chemo herself, but after involvement of the psych team and the hospital's lawyers, her brother also had to sign a consent.)
When Ms. Q's afternoon potassium level came back at 5.1, though, she needed an EKG and some Kayexalate to bring the level back down (5.1 is not horribly high, but when chemo causes the breakdown of cancer cells, even more potassium is released into the bloodstream, so you really need to stay on top of it). Plus she did need that second unit of blood. She refused it all. She switched from "I'm going to be brave; I'm going to fight this cancer" into "I just want to rest. No! Turn off the light! Leave me ALONE! You NEVER let me SLEEP!" (There were moments when I was just flabbergasted by how much she reminded me of Cassie at her tantrum-y worst.) Tom, the sweet overnight intern, came in and managed to talk her back into accepting treatment, but after he left, she changed her mind again.
It ultimately took me, Julie, Tom, and Soledad, the very competent and sweet nurse's aide, to wheedle and cajole and soothe Ms. Q. Oh, well, and there was a little bit of Haldol in there, too, I have to admit. And Julie brought her a grape popsicle. She got all of her treatment, and her EKG was fine, and she didn't spit out the nasty-tasting Kayexalate. She actually gave me no trouble at all about her bedtime insulin, which was a relief. Oh, did I mention that somewhere in there, she lost a huge filling from the front of her mouth? (I stuck it in an emesis basin on top of the refrigerator and promptly forgot about it until the next morning, when I had to call the floor and ask to speak to Ms. Q's nurse.) Anyway, then it was well after 11, and I hadn't done any documentation.
We ended up being there until 1 am. Julie gave me a ride home. AND she said something about how, time-management-wise, she just couldn't think of how we could have done it differently, to get out earlier. That felt to me like a significant change, because from my perspective, it had truly been seeming that whatever running and reshuffling was required, whatever fires needed to be put out, any failure to get everything done on time she considered solely my fault. Maybe it was the fact that she'd actually physically been there for most of this shift that softened her a bit on that point. Maybe she's actually mellowing a little. I guess time will tell. I'm still struggling with whether to say something to her or not. I've been playing it by ear, and there hasn't really seemed to be an opportunity yet. I don't know. It's possible I'm just chickenshit.
Tonight I start a run of three night-12's, 7 pm - 7 am, with Jessica. It is often, if not always, less busy on nights, and with luck a girl actually can get to sit down a fair amount. Not if I'm assigned to Ms. Q, of course. Oh dear.
The non-big-deal-ness of it all made it much easier, then, the next shift I had with Julie, to meet her lingering attitude of Great Seriousness and Sober Concern with a (mostly genuine) brisk optimism. "So," said Julie, in the kind of tone one uses to ask about the results of a nasty court case or a biopsy, "how did your shifts with Jessica go?" I pretended I didn't notice the spirit in which the question was asked, and said, "oh, pretty well! I really tried to plan my whole days myself, and I think I'm getting there. Jessica had to help me out a couple of times, but I managed to get through most of it on my own." This left her mildly nonplussed, which I admit gave me some gratification, and then I bustled off to my tasks, which of course was what I was supposed to be doing. Julie did warm up a bit by the end of the shift, which was good, though we're nowhere near back to where we were when all was sunny and fine.
Then Julie and I had a PM shift (3-11) together last Friday. We agreed that I would take 3 of our 4 patients. One was supposed to be discharged to rehab just a couple hours into the shift, but due to a kind of ridiculous misunderstanding, that ended up not happening, and he had to stay overnight with us. But he was easy (and easy-going), as was my friend the 28-year-old woman with the tattoos, Buddha-calm, and nasty leukemia. They both needed medications and vitals, but that was really about it. Which was good, because patient #3 was a lady with a very extensive psych history (let's call her Ms. Q, because that's not her name) who was starting chemo that night. Ms. Q is a large middle-aged lady with messy hair and prominent eyes (that's from her thyroid condition, though it has the unfortunate effect of accentuating her appearance of instability). She was intermittently lucid and appropriate toward the beginning of the shift, if very needy and tearful and anxious as we got ready to start the chemo. She had a sitter, but was still continually on the nurse call button. Sometimes she'd have forgotten what she wanted by the time I got my gown and gloves on (she was on contact precautions, naturally) and got into the room. We nonetheless got her first unit of blood and her premedications into her without much in the way of untoward incident. Lots of hugs and reassurance, plus a milligram of IV Ativan, allowed the beginning of chemo to proceed as planned. (Originally she consented for chemo herself, but after involvement of the psych team and the hospital's lawyers, her brother also had to sign a consent.)
When Ms. Q's afternoon potassium level came back at 5.1, though, she needed an EKG and some Kayexalate to bring the level back down (5.1 is not horribly high, but when chemo causes the breakdown of cancer cells, even more potassium is released into the bloodstream, so you really need to stay on top of it). Plus she did need that second unit of blood. She refused it all. She switched from "I'm going to be brave; I'm going to fight this cancer" into "I just want to rest. No! Turn off the light! Leave me ALONE! You NEVER let me SLEEP!" (There were moments when I was just flabbergasted by how much she reminded me of Cassie at her tantrum-y worst.) Tom, the sweet overnight intern, came in and managed to talk her back into accepting treatment, but after he left, she changed her mind again.
It ultimately took me, Julie, Tom, and Soledad, the very competent and sweet nurse's aide, to wheedle and cajole and soothe Ms. Q. Oh, well, and there was a little bit of Haldol in there, too, I have to admit. And Julie brought her a grape popsicle. She got all of her treatment, and her EKG was fine, and she didn't spit out the nasty-tasting Kayexalate. She actually gave me no trouble at all about her bedtime insulin, which was a relief. Oh, did I mention that somewhere in there, she lost a huge filling from the front of her mouth? (I stuck it in an emesis basin on top of the refrigerator and promptly forgot about it until the next morning, when I had to call the floor and ask to speak to Ms. Q's nurse.) Anyway, then it was well after 11, and I hadn't done any documentation.
We ended up being there until 1 am. Julie gave me a ride home. AND she said something about how, time-management-wise, she just couldn't think of how we could have done it differently, to get out earlier. That felt to me like a significant change, because from my perspective, it had truly been seeming that whatever running and reshuffling was required, whatever fires needed to be put out, any failure to get everything done on time she considered solely my fault. Maybe it was the fact that she'd actually physically been there for most of this shift that softened her a bit on that point. Maybe she's actually mellowing a little. I guess time will tell. I'm still struggling with whether to say something to her or not. I've been playing it by ear, and there hasn't really seemed to be an opportunity yet. I don't know. It's possible I'm just chickenshit.
Tonight I start a run of three night-12's, 7 pm - 7 am, with Jessica. It is often, if not always, less busy on nights, and with luck a girl actually can get to sit down a fair amount. Not if I'm assigned to Ms. Q, of course. Oh dear.
posted by Rosie Bonner at 12:27 PM
1 Comments:
Hi...
That is indeed a very good information on vitamin H and its benefits. I had heard a lot about the vitamins A,B,C,D,E and K. But never knew that vitamin H also exists. Thank you for sharing such a nice information.
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