kiss kiss

Oh this week at the hospital was a blur. I had a very very sick patient. Sorting through my preclinical paperwork on Monday night, rumor has it our nursing school is the most exacting in terms of the sheer amount of paperwork we must have prepared for our clinicals the next two days, the school also requires the most clinical hours out of all the other in this area. I worked from 1 to 8 making sense of all the infomation, then went to the gym for an hour and a half to burn off my anxiety. I was really concerned that my patient might already have died when I came in Tuesday morning, because a diagnosis a severe septic shock is one you never want to have. But the patient was still there with a pulse and clear lungs, even if everything else was going to hell. The patient was scheduled for wound closure surgery which I got to go to. Down in the PACU, prior to surgery, the transport nurse started relaying information about the patient to the anesthesiologist but he had the wrong information and I was able to sound like I knew what I was talking about and tell the anesthesiologist the patient's story, so I'm actually quite grateful for all that grueling preclinical paperwork because I was prepared. The transport nurse was super gracious and thanked me, which was very nice of him but I get the feeling that transport nurse is never not nice, a very chatty and up fellow. So to the OR. I absolutely love watching surgeries, it's completely fascinating to me, the more open and exploratory the better. But I couldn't be an OR nurse. For one thing the idea of standing in place for longer than fifteen minutes sort of drives me crazy. Like I need a nursing position where I can walk, usually very quickly, and move around a bunch because I'm a bit of a physical spaz. If I decided to became a nurse anesthetist I'd probably need to do jumping jacks or something because it tends to be COLD in those ORs too. But watching the surgeons do their work is pretty incredible. Plus my favorite vascular surgical resident, who is most likely a few years shy of thirty, was there, making me rue that I'm not fifteen years younger. At one point he called me muscles because I had trouble snapping off something which is ridiculously easy to do. But he'd pat my shoulder and he thanked me a few times for my help, which honestly was minimal at best. Sigh. That attention creates those teenaged heart thumpingly good feelings until I'm like, 'Are you insane? You're 42! He's just being nice.' And he is nice. To everyone. He'll pat anyone, male or female, on the shoulder. Still that boy makes me goofy, like my Tim Roth/Eddie Munster man at the gym. But I digress... Unfortunately they started the surgery but couldn't finish the way it was originally planned, the patient's condition started deteriorating too much. But when your body goes into severe septic shock the choices are between bad and worse. What choice can you make? The patient was closed up and brought back to the ICU, it was touch and go as to whether they would live through the night. I had gone back to the hospital later that afternoon to catch up on paperwork because I was so busy watching what was unfolding during the day that I wrote down nothing. I stayed up until 9:30 last night doing my paperwork and got back to the hospital at 6:30 and, thankfully, the patient survived the night. I talked to their family and my heart goes out to them. It is hard to know what to say in a situation so grave, but I just try to be an empathetic ear more than anything. I don't have answers but I do care for how incredibly difficult a period it is for them emotionally, hopefully that caring is felt. The patient aroused more through the day (the previous day the patient was sedated the whole time) and got restless a few times. This might sound weird, but I find that I bond with the patient more then. I mean I guess it makes sense and it's not like I didn't care whether they died or not before I had that response. But the interaction, even if it's brief, it brings the reality of this person, you see them, and their struggle for life, home to you. I think that's another reason why I wouldn't like OR nursing, I want to interact with the patient more. I think there's a delicate balance maintained between caring for the patient and being able to do your job thinking critically. I know I care, I know I can think critically but I don't feel incredibly skilled doing them at the same time. Do I get too emotional. Oh yeah. Does my anxiety cloud my judgement. Definitely. But my hope is that it's on the smaller things (shaky hands, little fumbles like that) that I can calm down about when I do it often enough. So I really struggle with this balance. Especially since this is a person who probably is going to die, unless some miracle occurs. And what can you do? The surgeon can't operate on them again, their condition is too grave. They've got more drips going than I could have imagined possible. Tuesday I was shellshocked by the amount of care the patient needed. But today I was actually able to help a bit, and even if it is in my awkward student nurse way, it still felt good. And when the patient roused and was anxious I'd hold a hand or stroke them along the forehead and tell them it's alright. I'm almost certain that it won't be alright but you can't let them lose hope. The patient and their family will be in my prayers.

So as for the kiss kiss title. The nurse I was working with today, an instructive co-assigned who also did this as a career change, was trying to squeeze the patient's two JP drains to close to suction properly and when he popped open the cap on the one a tiny spray of serosanguineous fluid hit me across the mouth (which was thankfully closed) and bottom part of my face. You couldn't even see it, it was like when someone accidently spits on you when they talk. Except this wasn't spit. It was a septic cesspool positive for Klebsiella and God knows what else, that has the patient literally at death's door. Needless to say when I got a chance to leave the room I went straight to the bathroom and scrubbed my face, especially my lips with the antibacterial soap. Ugh, I wanted to drink the soap. Sort of ironic this would happen when my last post made mention of my kick ass physical health. Let's hope it stays that way.