Went to work this morning and was pleasently surpised as we had four nurses in the unit today, which meant I only had to take two patients. That’s something that hasn’t happenend in months…yippee. For the most part both of my patients were stable. Both Patients only spoke spanish, which made things difficult but I managed and it reinforced my need to take spanish classes…sigh more school. My first patient was a high speed motor vehicle crash who actually was on the regular med/surg floor but started develping abdominal pain, so the docs did an exploratory laparotomy and found some mesenteric tears along his belly. This patient was pretty stable, I ended up sending him back to the med/surg floor by the end of the shift after I pulled out his NG tube, Foley, and removed over 30 staples from his abdomen and taped the inscision with steri-strips. Oh by the way, did I mention this guy is a pimp. The guy 27 years old, who I might add is Fugly as sin, has like 20 girlfriends, who are also Fugly as sin, who apparently don’t know about each other. It was fun to watch this constant stream of visitors enter his room as he played off who the previous girl was. So anyway, this guy was pretty uneventful throughout the day.
My other patient however…sigh…a nice enough guy, has cancer and a lot of of it. No one is sure where his cancer started but tests show he now has cancer in his liver, adrenal glands, throughout both lungs and has now settled in his brain. This guy is most likely going to die and in a relatively short time frame and probably in an unpleasant way. So you might be saying to yourself, “well ok that’s said but people get cancer what’s so different about this patient.” What’s different is the family is lying to the patient and has forbade the hospital from telling him that he has cancer. There are a few rare execptions that this is ok, but this case does not fit any of them. So now I am in a HUGE ethical delemma. The patient is alert and oriented to person, place and time and is fully capable of comprehending the situation and able to make decisions for himself. As it was explained to me in shift report, the family doesn’t want him to become depressed! REALLY (stated with much sarcasm) are you freaking kidding me. This guy is dying, facing life altering events and decisions about quality of life and invasive, painful treatments and you don’t want to tell him he has cancer because he’ll get depressed…WHAT! But I digress, so I let my charge nurse know, who already knew and I told my manager, who again already knew and then I did something I never thought I’d have to do ever. Something they tell you about in nursing school but you kinda blow off as fluff…I called the Hospital Ethics Committee. I had to, for the sake of my patient and his right to truthful information about his condition. It will be interesting to see what happens with this over the next few days. So I kept him as comfortable as I could, and I was proud that I was able to wean his oxygen down. When I got him in the morning he was on 35 liters of high humidity oxygen at 0.40% …put simply that’s a lot of oxygen. I was able to wean him down to 8 liters on a high flow nasal cannula…huge difference.
Since my patients were pretty stable, I was able to help the other nurses in the unit. Poor Debbie had to goto MRI. Going to MRI is a pain the butt because an MRI can take hours throwing your whole day off majorly. So I watched her patients while she was off unit for which she was very thankful.
I was sitting at the nurses station trying to get some charting done when I noticed that one of Terraca’s (my charge nurse) patients SPO2 was at 88% (norm is >92%) and dropping with a good waveform on the monitor. I ran over and told Terraca what was happening. She kinda blew it off saying she was fine and that it wasn’t a true reading, but my gut and brain told me otherwise. So I left Terraca to deal with it. A few minutes passed and I saw Terraca calling for respiratory to come to the room stat, so I thought it a good thing to grab the code cart and intubation kit. Turns out this lady was really loosing her airway quickly. OH…did I mention this lady is truthfully 105 years old and a FULL CODE! What the hell is up with people today family lying to family, people over 100 years old and full codes geez. We fortunately were able to get her levels up with a CPAP machine instead of throwing a tube down into her lungs but come on people lets think about what’s going on here.
When Kim was at lunch, I was covering her patients, well one of the docs came by and said I think this patient has an abdominal infection I’ll be back in five minutes get me *insert list of medical supplies here* so I can culture what I find…thanks doc (sarcasm alert). I got what he needed and helped him open this guy’s belly and watched as the pus poured out….yum…we got our cultures and the doc left him open. No sense in closing him if its all infected.
All in all a good day in comparison to the norm.