A report from this term studying Acute Care nursing, which includes time in the ICU, ER and the Psych unit. We are starting the last half of this term and it has been quite a ride both here at school and in my personal life. Since this blog is about nursing school, I'll focus on that.
First, the med-surg update, wherein I spent the first half of my clinical time taking care of VERY sick and dying patients in the step down critical care floors. I would describe this part of clinical as being thrown right into the deep end of the pool. Where previously I'd have the occasional challenge of more than one IV bag/ pump to deal with, the odd Foley bag or maybe an exciting deep wound dressing to change, usually it was just one of these things at a time to focus on. By contrast, with THESE patients, it was like the Nursing Gods said, "I'll SEE your bag of poop, your purulent wound, your bags of fluids....and I'll RAISE you a feeding tube, PLUS, three more pumps, AND a trach, a vent, heart monitor, an ART line, dialysis, and a couple of amputated limbs!"
The question was more like, "What WASN'T going on with my patient....?"
Like adrenalin? ...Become a critical care nurse.
You might recall my lingering fear of patients who have an artificial airway and the phlegm that is associated with it. Yeah...I'm pretty much over that. Each patient I had this term had this going on...sometimes to an alarming degree. My gag-o-meter did blip a couple times as I initially learned to suction, and I by no means relish this task, but because I did it so often, I became desensitized. I did have my nursing instructor's haunting words running through my mind as I dealt with the holes in the necks of my patients and tried to keep a reasonable distance from that opening. He said, "Make sure you keep your mouth closed when you suction...because a patient coughs and it will shoot straight in your mouth! So no talking!" I pray this never happens, and yet I can see how easy that foul outcome could occur. These folks generate a LOT of goop. Nuff said.
You might be wondering why I refer to exorcism in the title of this post. [Queasy people will want to skip ahead.]
Sadly, I was about to call a priest to fight the demons I thought must be inhabiting my poor patient one day. It was straight out of the movie. She needed just a crazy amount of medications that we needed to give into her feeding tube. It was a staggering number and I just kept thinking, any healthy person would feel sick after all this. [Foreshadowing.] There was also a decompression tube sticking out of her belly that emptied into a bag on the side of the bed filled with both stomach and bowel contents. It was a sick dark forest green / brown and I had to fight from walking in a circle around it just because I feared bumping it and somehow spilling the mess on the floor. The night nurse had changed it and had reported it was the most foul-smelling brew she had ever encountered. That was enough for me...and I was just grateful that the bag was not even close to full, meaning I wouldn't have to change it!
She also had a trach, so she breathed out of a tube in her neck. After a student and I had done our morning care, flipping her this way and that, tidying her bed up, we began raising the head of the bed back up and that became our exorcism nightmare. Suddenly noxious green-brown goop started gushing out of her mouth and down her chin! Terrified it was going to leak right into her trach airway and she would inhale it...I jammed my (gloved) hands under chin and began catching the stuff and my partner quickly tried to suction out her mouth! That's. When. The. SMELL. Came. And my eyes instantly began to water and my own stomach threatened to heave. Nothing could touch this...not a pus-filled necrotic wound, not poop, not vomit. This stuff made me want to run from the room and never return. And just as we would catch up with the suctioning, more would gurgle and froth from her mouth making me wonder just when her head going to start spinning around and she would levitate from the bed!
We eventually got her cleaned up and settled and I sent the trash far FAR from the room so the smell would fade. As much as I hated this, I just kept thinking how bad was it for HER?? This girl had so many things wrong with her I couldn't fit it all on my clinical paperwork, she couldn't talk, felt sick and then something as nasty as that had to happen. And she was MY age!!
Acute care has taught me that when things go wrong...sometimes they go very, very wrong.
So far I got to see and do so many things in the first half of the term, that it was very exciting and terrifying. I am now in my psych rotation and that is like moving from one planet to another. I'll end my term with 2 weeks in the ER, which could get really interesting.
I'm back from my day with the crazies.
Actually, my 2nd day. A few weeks of psych lecture and all of the conditions and their lists of signs and symptoms began to merge together. Depression, bi-polar, schizophrenia, severe anxiety. And we haven't even covered them all. Then I got to go to the floor and saw the real stories and the real people whose lives are utterly destroyed by these conditions. Many of them will never be okay and lead a normal life. But they are not just a list of symptoms to me anymore.
I observed an advanced case of schizophrenia in a relatively young woman. She sat and rocked, carrying on conversations with people who weren't there. I thought to myself how strange to live in this age when if I saw her walking down the street talking out loud like that, I wouldn't even wonder. I'd just think she had a hands-free bluetooth device in her ear and I'd walk on by. In decades past, that behavior would stand right out.
I interviewed another schizophrenic, a pleasant enough guy who was happy to talk to me. I got through a number of questions when he casually mentioned he'd done time for killing a couple of people, like he was commenting on the fine weather we were having.
Another young guy looked like he should have his whole life in front of him is debilitated with bi-polar disorder and completely isolated from society. He was smart and funny, and didn't mind that I whooped his butt in a game of chess. Then I read his file and saw the downward spiral he has been on and I grieve for his future unless medications can help correct his condition.
So many psych patients isolated from society for something they can't help. I'm profoundly sad about this and my experience with these patients has given me a lot more understanding of just how derailed and lost they are. I know for sure I'll never want to be a psych nurse because the hands-on care is part of the job I really like and I'm not sure I have the mental stamina to deal with what psych nursing entails, but I also know that I'm looking at the whole issue in an entirely new light.
