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Diary of a Trauma Nurse
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About Me

My name is Cory. I am a mom, a wife, a NaNa, and a critical care nurse that lives in Nashville, TN. I have found my calling in ER/Trauma/ICU. Each day I find myself experiencing life changing events and hope that by reading my posts, you will experience and feel some of what I do. If you read nothing else, please take time to read "The Hardest Question Ever Asked". It's my very first posting. And if for some reason you think you see your story don't. It's not about you or anyone you know. =)


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Places to Go

Nursing Wiki
Am Assoc Critical Care Nurses

Nursing Blogs

A Day In The Life Of An Ambulance Driver
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Backboards and Bandaids
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Kathys Lifes Journey

Wednesday, August 01, 2007

Patients who are P.I.A.s

Ok, so I'm getting report on a patient on Monday morning. I get all the basics, demographics, history, admitting diagnosis and the prognosis that he will most likely not live through this hospitalization. He had a medical history as long as my daughter's Christmas list that included DM, COPD, CAD, new onset rapid A-fib but mainly Cirrhosis of the liver. (He was found noresponsive with a bp of 57/23 when he was brought in). He had been diagnosed years prior and at this point hospitalizations were for paracentesis (to drain the fluid from his abdomen)and respiratory issues from fluid overload. He was ventilated, on multiple cardiac drips, vasoconstrictors and the wonderful "milk of amnesia" propofol . Oh, and let me not forget, he had MRSA, Pseudomonas, VRE and God knows what other bugs not yet identified. His skin would peel off when we turned him. He was only 61.

We continued to care for this man and were able to extubate him and wean his sedation. As I came back day after day, I would get various reports from nurses and it seemed that many had the opinion that this man was a P.I.A. He woke and was able to talk and ask for things. A LOT of things. He wanted to turn every 15 minutes or so because he was in so much pain. Any nurse can tell you that NONE of us have time (or energy) to turn a patient 36 times in a shift and do everything else that we need to do. I was lucky enough to only have one patient on my last day (the 4th caring for him) and have time to spend with him, to talk to him, to hear about his wife (Ms. Mattie) who always took care of him but had died a year earlier. He spoke of how they were so compatible, how she listened to his never ending stories, how she loved him regardless, even through all his years of drinking before he decided he had to stop. I spent the afternoon between assessments, medications, treatments, and charting taking him ice cream and feeding it to him now that he was able to eat. He did show me that day that my emotional and physical limits are beyond what I ever dreamed...... (worn the h*** out).

When I returned on Monday I was on the "high side" in the ICU and decided to go over to see if he'd made it through the weekend. His smile made up for the aches and pains that required my husband to rub my back and feet for hours. I asked him how he was feeling and he told me "fine" and I asked what was new over the weekend while I'd been gone and at that point I noticed his trembling lip........ he must have seen my expression and then he said "the doctor just left....... he told me that I have less than 3 weeks to live." Wow. What a wake up call for Monday morning. The only thing I could think to say (because I'm a firm believer in NEVER lying to a patient) was "well, doctor's have been wrong before BUT if for some reason they aren't this time, I know Ms. Mattie is waiting with open arms for you." He thanked me for being so kind to him and for staying with him when he was scared. (I never sensed he was scared but should have known by him always wanting something - he wanted someone in the room with him.)

***My point to sharing this story is I hope those of you who may be burned out, or new to nursing and get "frustrated" or those who are just tired of people asking for things (because most ICU nurses are happy with a ventilated patient on propofol or fentanyl and versed) to remember that we never truly know what is going on in someone's life and as long as we are standing beside the bed, we CAN and DO make a difference."

CoryTraumaRN posted today at 9:45 PM

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