Thursday, December 6, 2012

I'll take the diarrhea

You may have an inkling of what your day at work will be like when you utter those words as your team leader is assigning patients at the beginning of shift. 

I'll take the diarrhea.

Backing up just a bit... 
Examine yourselves, to see whether you are in the faith. Test yourselves. Or do you not realize this about yourselves, that Jesus Christ is in you?—unless indeed you fail to meet the test! I hope you will find out that we have not failed the test. But we pray to God that you may not do wrong—not that we may appear to have met the test, but that you may do what is right, though we may seem to have failed. For we cannot do anything against the truth, but only for the truth. For we are glad when we are weak and you are strong. Your restoration is what we pray for.  2 Corinthians 13:5-9
I've been feeling a lot lately that my spiritual lessons are being mirrored in my workplace.  Or maybe it's that I'm learning the lessons in two places... one in theory and one in practice.  A lot of what Paul has been telling the churches has been extremely relevant between me and God and between me and my co-workers or me and my patients.  I can see very clearly how being a good worker is not separate from my relationship with God, but a significant part of it.  God says to love the Lord your God with all your heart, soul, mind, and strength... and also to do whatever you do with your whole heart.  I think that if you love the Lord with all your heart, everything you do will also follow suit.  

I want to strive for excellence in all areas of my life.  It is my intention... but sometimes you gotta know when to give a little and prioritize a bit.  Work is usually near the top of the list.  However...

When I first took this job, I did it more because I needed to.  It was an answer to prayer... a part-time day shift position that would give me a little more time to breathe and to focus more on school.  Also, since I interviewed for this position and made it very clear that I would need to quit or severely reduce my hours starting in January, it was generally agreed upon that I'd take the easier patients and that I probably wouldn't necessarily be trained to take on the more difficult or complex patients... just get exposure to them.  

I was thinking about last Sunday's sermon.  I remember movie titles.  I had to glance back at my notes to remember the things that stood out to me though.  At the top of my notes was a line I jotted down about momma birds making their nests prickly so that the babies will leave the nest.  I tried googling it and found a couple of blogs about "the way of eagles"... and how eagles teach their young.  First, the nest is really comfy.  The babies are well fed and cozy.  Sounds nice.  But eagles weren't meant to sit in their nests the whole time.  They were meant to fly.  The parents will then stop bringing food to the babies. They will also fly around the nest so that the babies can see them flying. And then the parents will grab the babies with their talons and place them at the edge of the nest so they can view the world from their perch... usually from really high up... like in a cleft of a mountain or something.  They were forced by necessity and placed in an opportunity where all they'd have to do is jump and let their instincts take over.  

I feel like my managers have been like... partially pushing me to the edge of the nest and partially preparing me to take bigger stuff and it's partially intentional and partially due to necessity.  I'm pretty sure it's about efficient use of resources... and also that my unit was semi-short-staffed... which is also why there was an opening for me to work there.  I was pretty happy to just sit back and take the "easy" patients and finish out my 7 months of work in relative peace and calm.  Fortunately or unfortunately, my nest got a little prickly and I've been taking some patients that I'm not necessarily comfortable with but I've always been given enough resources around me to be able to learn on the spot and get through it.  I can't say I've been perfect but I really do try my best every time I work. 

Anyway.  We had an exceptionally rough set of patients yesterday.  Even though we only take a max of two patients per nurse, usually, we'll try to pair a harder one with an easier one and not assign someone with two hard ones or two easy ones.  It took us 15-20 minutes to even decide which patients to match (usually takes less than 5) and then to assign which nurses would take those pairs took an additional 5 minutes based on who could take which, who would be available to do what at a later time....  Regardless of how hard the patients are... no one really likes to take the patient who's having diarrhea.  It is part of the job but it's a lot nicer when we have patients who don't need to be cleaned as frequently.  So I said the words, "I'll take the diarrhea".  

I thought the whole day woulda been giving fluids and cleaning poop but it was a whole lot more than that... talk about false advertising.  But just like Forrest Gump says about life and the box of chocolates... you never know what you're gonna get.  

It took me an hour or so (after I finished cleaning diarrhea twice) to fully assess both my patients and figure out what my plan was for that day.  I distinctly remember looking at the monitor... looking at my patient... and images and stories from lectures were flashing through my mind.  Tachypnea... tachycardia... no fever... but two criteria is enough to meet SIRS (systemic inflammatory response syndrome) criteria... and he's hypotensive and on a vasopressor (to bring up his blood pressure...)... if it was just dehydration, the fluids woulda been enough... but he's still hypotensive and... looking at the vitals from when he first came to the unit last night... it's getting worse.  And he's got an infection.  And he had diarrhea for 3 weeks.  My gut was telling me something was gonna start going seriously south... but all my co-workers were busy running around and putting out fires of their own... and their fires were serious emergencies.  I did have a little more time to ponder mine.  And ponder I did... until I found a few minutes to ponder with my manager and that's when everything started to happen.  

It was non-stop running to keep my patient alive for 8 hours... it was a really rough day which was riddled with complications.  Nothing went smoothly or as expected, for me or for every single one of the nurses on my unit... actually everyone... respiratory therapists, xray techs and secretaries included.  I'm not sure if it made it worse or better that there were nursing students there... (actually better... I did need an extra set of hands quite a few times yesterday)... AND people going around doing audits and taking up computers and space in the nursing station.  I had never been so behind on charting, nor scrambling so much for so long.  Thankfully I had a few grown-up eagles there to help me along.  I would NOT have been able to survive the day without their help.  I stayed two hours longer after my shift in order to catch up on 12 hours of charting for two patients.  I never clock out late.  Yesterday was pretty... exceptional. 

It was textbook sepsis... rapidly deteriorating to septic shock.  At the end of the work day... after I finished giving report... I looked at my patient... he went from 2 IV pumps to 8, he went from breathing 2 liters of oxygen with a nasal cannula to having a breathing tube and a ventilator, he went from no isolation to contact isolation for C. diff (a really nasty bug)... it was a big change in just a few hours.  My heart was still racing from being in emergency mode for so long.  And at the end of the day, I had a gut feeling that he wasn't going to make it through the night despite my best efforts.  I kept thinking to myself... how it all started when I said, "I'll take the diarrhea".  

I haven't had such a sick patient in a while.  After such a whirlwind events, I was laying in bed pondering everything that happened.  I kept trying to think about what I should have done, what I could have done better, what I could have done faster... what should have been done in the ER... where did our system fail us... could we benefit from more education?  Are there any systematic changes that could be implemented to improve outcomes?  

I've been considering the same thing in my own life.  What am I doing... what could be done better... in what ways can I systematically prepare for a more successful outcome... what do I want... what am I passionate about... am I living a life full of love... and what do I love... who do I love... a lot of times, my actions show what I love without me consciously thinking about it... anyway... it's a lot to ponder and sometimes I end up feeling overwhelmed but... I think it's a good way to think.  To test myself.  Analyze and evaluate... and then form an action plan.  With deadlines.  

Or I could just wing it.  

Speaking of winging it... I was reading about the eagles and someone had written that eagles fly directly into a storm instead of seeking shelter and riding it out... the gusts and torrents actually provide lift and help the eagles soar higher and fly faster.  If I want to be the kind of eagle that soars high and flies fast... I think I'm gonna hafta push myself outside my comfort zone and fly directly into the storm... or maybe to a trauma 1 hospital for training.  I am scared that I won't be good enough... but I won't know what I'm good for until I push myself to the limit.  Yeah.  It sounds good in theory.  We'll see how I feel when I'm perched at a precipice with miles of space between me and the ground...with dark, thunderous clouds in front of me... and torrential winds blowing straight at me.  Or maybe it'll just seem like storms when in actuality, it's just a gentle breeze and a passing cloud as I'm perched on a low-hanging branch of a tree in a park.  

I'm thankful for so much.  Thankful for my co-workers... thankful for that my other patient got through his day smoothly and without crashing... thankful for the doctors and their help... thankful for training... thankful for remembering that story about the septic lady that I heard in a lecture... thankful for experience in the ICU... thankful that I wore the more comfortable shoes that day instead of the ones I almost wore (which probably would have made me fall since I was running back and forth so much), thankful for the nursing students who helped me do blood sugar checks and helped me turn my heavy patients... thankful that my mom packed me lunch that particular day so I could eat it for dinner after work cuz I had no time before life group to eat anything else... and also thankful for life group so I could calm down and be around people and laugh and chatter about all kinds of stuff non-related to hospitals and dying patients... and just overall being thankful for a job... thankful to be a nurse... thankful to be an ICU nurse... thankful that the sons of my patient were able to make it to the hospital and that they seemed to have effective coping mechanisms and thankful that I had good rapport with them as well.  I'm thankful that I went to work yesterday even though I really didn't feel like going to work when I woke up.  All in all... a good day. 

Still pondering...
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