Saturday, October 8, 2011


Ten Weeks.  Today we have been here ten weeks.  Seventy days ago today we arrived in Bethesda.  There have been peaks and valleys along this journey, but we are making it.  Today, I thought I would kill a few along the way, but I don't need bail money.... yet.  Stand by.

Derek went to the OR for a dressing change.  They took him to the OR due to those dastardly BP issues.  Since it was just sedation and not full on anesthesia, his BP stayed up.  Next dressing change will not require the OR and can be done in the PACU.  He may also lose the trach this weekend.

Dr. Howard said the flap looks great.

While in PACU the x-ray techs showed up to take the x-rays of his pelvis.  I had asked that to be done while still under sedation, but no.  They gave him a bolus, but it didn't work.  His poor butt was on the plate, the arm was moving too much, and the techs did not seem to know how to work the machine.  After a few minutes, I dove in and grabbed a drape so I could hold the arm in place while they finished the films.  I told them they had exactly one more minute so they better hurry.  The woman yelled, "Is she a nurse?!"  The nurse said they had one more minute because the patient was in distress.  I think a blood pressure of 163/111 is distress.  When they couldn't get the last film and were struggling with the angle, I ended it.  Enough is enough. 

Dr. Howard called to give me an update as soon as they got Derek settled in the bed and he heard how upset I was, so he rushed right to PACU.  His interns and residents trailed behind him like little ducks following after their mother.  He said the arm still looked good and hadn't been jostled too much.
Brian, my brother-in-law, showed up right after that, and Derek was thrilled to see him.  We got Derek settled back upstairs, and I thought the rest of the day would be quiet.  Think again.

This morning, we spoke to the pain team about increasing/changing the pain meds because they just were not effective.  At around 10:30 they said they would be changed, but when we got upstairs, no changes were made.  I had them paged at 15:00, and it only took four hours for them to send a night resident to answer the page and tell me that nothing was changed in the computer.  Just wait until I see them tomorrow!  Keep that bail money handy.

I was a bit exasperated when Derek was settled in his room after PACU because everyone disappeared.  He is a one-to-one, and I was left alone in the room and no one asked if we needed anything.  Derek wanted a drink, and I couldn't go get it for him without leaving him alone.  I didn't want to take the chance and just leave to get the drink because he had just gotten back and he has a history of desatting after anesthetic. 

Also, he was given another new nurse with no experience.  When I came in this morning he was checking his flap the wrong way, and I had to show him how.  He left the room in shambles after returning from the PACU, and I refused to clean it. 

I went to the door and called for a corpsman. 

I vented to Brian and was overheard by one of the enlisted chiefs of the floor who took me straight to Major Reyes, the Service Chief.  I explained to her that I felt that with everything that Derek still had going on, the fact that he was still not out of the woods, and because he needed so much care, that it was unfair to give him a nurse with very little experience.  She agreed and asked me with whom I felt comfortable.  I was promised that an experienced nurse would oversee everything for the rest of the day and I would have an experienced nurse from now on.  I do not mind a trainee at all, and some of our favorite nurses in the ICU were the trainees, but I want an experienced nurse shadowing at least until he has less going on.  Sometimes the trainees are more attentive, but on the ward they seem to be more flighty.  If we cannot get a nurse with more experience, at least give us a corpsman or LPN for the one-to-one with enough experience to be able to do the job and not one who doesn't know what he or she is doing on top of the inexperienced nurse.  When I have to be asked how the J/G tube works....  please. 
This is why a step down unit is useful.  There are patients who need more intense care but do not need intensive care, and then there are patients who need less care.  On the ward, there are patients who are ready to be discharged to rehab and do not need to see their nurse all night, and patients who need two straight hours of care, like Derek did tonight.  There are patients who need the nurse to bring in their medications and nothing more and patients who need each every one of their needs met, such as Derek.
Tonight, we have the fabulous Michelle Bennett.  Derek needed a CT scan on his pelvis.  It appears as if the abscesses are working their way out.  To be sure, a CT scan was ordered.  Two corpsman, an LPN, a nurse, Brian, Krystina and I escorted Derek. 

We all helped move him to the CT table.  The tech didn't seem to understand the "not moving the arm" part of the equation.  Michelle got right in there and wouldn't let him move it an inch.  She had him position Derek in such a way that the arm was secure. She even put a vest on and stood with him during the test to ensure that his arm was secure.  That's caring about the patient.  That's real nursing.

We've had so many nurses over the last ten weeks.  I've kept a list of them all.  Most of them work hard and genuinely care about the patients.  They advocate for them and try to make sure the patient's needs come first.  There are a few who do the bare minimum.  When you get one of them, speak up.  Do not be afraid to call for the supervisor. 

You must advocate for yourself whether it be about the nurse, tech, doctor, etc.  Do not be afraid to speak up.  One of the most important things I have learned these past few weeks is speak up.

P.S.  I have it on good authority that the Feres Doctrine is on the way out......  don't quote me on it....  I have to do a little research!

Good night and God bless!

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