Thursday, December 7, 2006

Twelve more shifts of rehab

...and every single one is gonna be like climbing over boulders to the summit.

With hail the size of golfballs, and not having the sense to turn around and stumble down the mountain. And the black clouds boiling just past the summit, which you can see beyond Mt. Massive, for example.

It's nice that I can speak nicely of rehab on my days off. When I'm here, I can't. I'm cranky about having to go to work from the moment I wake up and notice that my bedroom light is dimming. As always, I like my patients. I spent good time with all four. Everybody is sleeping, pain-free (as far as the snoring tells me), properly anticoagulated (strokes, THAs and TKAs), have happily percolating GI tracts, are voiding adequate amounts, and the two with stage 1 sores are being flipped q2...and a few have specimens in petri dishes to see if anything grows.

It's my colleague who isn't managing the geriatric COPD'er with the new small bowel obstruction...the woman who has been wailing and gnashing her teeth for (Jo looks at clock) nine solid hours so far.

Snippets from a real conversations....
The players:
RN of six years experience, who took this job "because it was babysitting"

Other RN: "She might need an NG tube."
Me (who, at 0200, is already reading pulp fiction being done with everything I can think of to do): "Mmm. Might."
Other RN: "Would you like to practice putting an NG in?"
Me, looking up and she's avoiding looking at me: "Considering I'm the only nurse who's put one in this year, yes, I can do it for you if you don't feel comfortable doing so yourself, OtherRN."
Other RN doesn't reply. I go back to my book.

Other RN gets the countremand order to not place it, anyway. Other RN: "I don't know why Dr. K doesn't want one when Dr. B does."
Me: "Mmmmummmummm. (I don't know.) Maybe cos she's not vomiting and she pooped today and he's coming to see her early in the morning and the Xray was preliminary and he didn't look at it himself cos he was home asleep ...and he maybe figures she's NPO now. Dunno. An NG's gonna slurp up gastric juice, it wouldn't resolve an obstruction or ileus just by having suction, would it?" I wasn't being sarcastic with her. I genuinely don't know why no NG tonight. I'm not a gastroenterologist. Maybe I'd sink one, maybe I wouldn't. Not a GI nurse, either. I don't know these things, but apparently OtherRN is having a hard time thinking that through.

....But might it have occurred to her, since the woman has been moaning and crying for (Jo looks at clock) TEN hours, to get the poor thing something for pain?

Am I just mean? I feel mean.

She called the nursing supervisor to start a peripheral IV. Before attempting it herself, and before saying, "Hey Jo, would you look at her veins?" The woman might be elderly, but she had pipes. A drunken monkey could've found a vein and poked it.


Twelve more shifts. The vast majority of them with this nurse, too.

And I'm already dreading tomorrow, where we send two patients home and I'll have THREE tomorrow night. At least there's a NOC magnet meeting (yes, we're trying to join the club) to give me something to do for an hour. Gah.

It's only 5....

p.s. Of COURSE I *cough* suggested she ask the MD for more pain meds. Reply? "But I just gave her (insert mild narc here)." gah...

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