How Life Changes

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Shock to the heart

On Saturday, I floated from my regular post-op cardiac surgery unit to labor and delivery, where a 28 week pregnant woman had come in for an irregular heart rhythm. The patient had her own L&D nurse, as well as myself. The purpose of my assignment was to monitor and document her rhythm, and take vital signs every fifteen minutes.  As I got report from the previous nurse, I quickly realized that this patient’s irregular rhythm…

Nursing 101: Keep it to Yourself

One of the biggest challenges of day to day nursing is seeing a bigger picture that the patient or the family can’t or won’t see, and trying to figure out how much of that information to communicate or hold back.  The obviously depressed post-op patient.  The terminal cancer patient.  The 80 year old who hasn’t been able to swallow since surgery and who now has a permanently placed feeding tube.  “When will he eat again?”…

Staffing by pizza

I floated to a different unit yesterday, one with a reputation for lousy staffing.  Rather than the typical “step down” ratio of three patients to one nurse, they often have four patients to one nurse, with multiple admissions and discharges.  This is also a unit where there are never enough supplies, and where there are often no nurse assistants or relief nurses to help. Sure enough, within an hour of my arrival I was given…

Cutting, pasting and throwing things away

I’ve been struggling with this section of my novel for several weeks now, trying different voices and points of view and writing a ton of repetitive material as I spin my wheels towards the end. I’m not in a rush but I’m not very happy with the churn either. Today I saw the pages from last week and did what needed to be done:  ripped some from the notebook, rearranged others, forced myself to move…

Families

It’s often tempting to see patients in isolation — as individuals with histories, current admission goals and priorities, challenges, etc. — but inevitably patients are just as much extensions of their family systems as they are unique people with problems to solve. Family members help, and they hinder, and they almost always have their own, very prominent goals.  “Don’t give him/her any pain medication.  She/he has addictive tendencies.” “Make sure he walks, he’s a big baby…

First You Make a Map

One night in graduate school, a writing teacher gave our workshop this simple advice, when presented with a room full of overwhelm about plot and structure. As novice writers, sticking to the most basic chronological storytelling, we were asking for a slick shortcut to making things more complicated. Our leader went to the chalk board and created a hypothetical flow chart of circles and arrows, connecting dots from character to setting to place and time.…

Denial

Is a river, as the cliche goes. But denial in health care settings is a particularly turbulent river. What do we say or do when a patient presents in a complex, difficult way? How can we make these conversations meaningful, empathetic and fundamentally truthful? For the past two days I have cared for a patient in my unit who is 100% medically stable, ready to go home from the standpoint of the health care team.…