I was supposed to be working this weekend. Instead I got begged to take days during the week because of other nurses’s childcare issues and got the weekend to play! And I did the other nurses a favor at the same time. Isn’t it great when you can be a good samaritan and still come out ahead? I did my first overtime shift on Wed. The charge nurse called me on Tuesday and said that they would give me incentive pay + $5/hr. I had no idea what that was but later that day, I found out I would get time and a half plus $5 for the first 8 hours and double time +$5 for the next 4 hours. Awesome. I just earned some vacation money.
So needless to say, I got no knitting done. I worked 3 days in a row and was just too exhaused to pick up my needles. In exchange I got to meet some interesting patients and their families. My first patient was a woman I admitted on Monday night. I had Tuesday off and didn’t get assigned to her until Thursday. When she came in, she had suffered a massive stroke and could only move her right arm which tremored. Her eyes did not react to light which is an extremely bad sign. I got to know her daughter really well on Thursday and Friday and she told me all about the extraordinary woman her mother used to be. She and I cried together (which doesn’t happen to often to me anymore). She told me that her mother was a very intelligent woman who wrote and volunteered at the local senior center and had many people who loved her. I told the daughter that her mother lived a good life. And she told me that her mother would never want to be hooked up to any ventilators or have tube feedings or CPR performed. So I was completely shocked when her attending comes out of her room and asks me to get the patient prepped for a PEG tube. A PEG tube is a feeding tube that is placed surgically in the stomach. I asked him if the daughter really wanted that and he answered of course. So I go in to a very upset daughter and ask for consent. I ask her if she understands all the pros and cons and she tells me “The doctor says that it’s necessary”. Now this is a woman who had the biggest stroke I personally had ever seen. So… the daughter signs the request. And I begin prepping the patient. One of the things you have to do, is insert a tube in her nose. The doctor placing the PEG tube will use this tube to blow air into the stomach and place the PEG. So… I put the tube down her nose. Of course her right arm, the only one that moves immediately tries to pull it out. I explain to the daughter that I will have to restrain her hand to keep her from pulling the tube out and that I’m extremly sad that I have to do it. The daugher says it’s what’s best for her mother and that she understands. I check on this woman frequently because of her being in restraints. The OR calls me and asks me if the patient is ready to go down in 10 minutes and I say yes. I’ll get everything ready to go. I start pulling the chart and verifying that everything is checked off. So, I get a frantic call from my tele tech (the guy who monitors everyone’s rhythm and heart rate) that my patient’s heart rate is in the 150’s. She’s already in atrial fibrillation which isn’t the best heart rhythm to have. So I run into the room, and there is my patient sloughed to the right, her hand pulling the tube out. I call the OR and tell them to cancel the peg placement for today at least and I call the patient’s neurologist. The doctor was in complete shock when I tell her that this woman was going to get a PEG placed. She told me that that’s not what the daugher wanted. I told her that I thought so too and that the other doctor had explained the procedure and that the daugher wanted it. The doctor said that she would come in after her staff meeting and to delay the peg placement as long as I can. It’s almost like this patient knew what was in store for her if she got the tube placed.
To make a long story short, the daughter never wanted the PEG placed. The attending had told her it would be in her mother’s best interest. But it wouldn’t have been. This woman would have no quality of life because of the stroke. The patient was placed on hospice care on Friday and we began comfort care. I had 4 patients on Friday but I spent a good part of the day with this patient and her daughter helping her to understand the death process. Which is kind of funny because I still haven’t seen someone who died. All of my hospice patients have died after I leave them. At the end of my shift, the daughter thanked me for everything I had done to support her and care for her mother. I thought to myself, this is why I became a nurse. I also learned that I have to be a better patient advocate. After the doctor went in, I didn’t talk about the consequences for her mom. I just went in, made she that’s what she wanted and had her sign the consent.
My other patients were also interesting and heartwarming but I’ll remember this lady for a long time. I hope that she has comfort in the next few days.
Since I have the weekend off, I have to think of something to do to unwind after these intense 3 shifts. What else but knitting… and maybe yarn shopping.