It has been a slow night so far (suspicious about such things, we nurses never say "quiet" or "nice" or "slow" during the shift for fear that, the moment errantly spoken, the mere force of the word may push some bus-load of AARP convention goers into spasms of chest pain and/or Alzheimer's dementia.) We've had a few helicopters arrive ("Blue Alerts" or "Trauma" cases, usually the first of many bar customers attempting to gather just a few more neurons together to negotiate some curve in the road, a dimly lit stairwell, maybe even a baseball bat coursing through the air while attempting to make contact with a skull.)
I was assigned a patient from a few days ago, who continues to be paranoid about her abdominal pain (although, thankfully, no requests for data regarding cancer). We chatted at the beginning of the shift that all of the tests were coming back negative, and that the whole issue might be due to a minor problem with her gall bladder, a situation easily managed by some outpatient surgery. For the third night that I've been assigned her care, she couldn't have anything to eat or drink after midnight due to tests the following morning.
I also was assigned the patient that was receiving large amounts of Ativan IV due to alcohol and marijuana withdrawal. He was actually getting even more on an hourly basis, compared to when I last had him. Again, it's an uneasy compromise. A nurse could just give so much ativan that the patient just lays in bed asleep(and thus easier to care for). But this can cause problems. Oversedation can mean incontinence, a high risk for falls, reduced respiratory effort, and even respiratory failure. So I like to be aggressive with sedation, but every few hours I will hold back a bit to make sure they are still firing on all thrusters.
All of his thrusters fired unexpectantly shortly after 6am, while I was next door re-starting an IV. All I can hear through the wall is a nurse's voice, yelling out, "I need help in here." Then, "Get his hand! Shit!" Then "Shit, is it pulled out?" Then, " OK where is Eric, he needs to come look at this."
I didn't want to yell through the wall because I didn't want to upset the patient I was working on, and I had confidence in my staff's ability to handle the situation until I could get clear. So I just finished starting the IV, while listening to the circus next door.
The guy almost pulled out his central line, and managed to take a Race Horse Pee against the wall, the bedside curtain, two nurses' shoes, and the IV pole. Luckily, the line was saved.
Another patient was an elderly female admitted for a stroke. She reminded me a lot of the actress who played the lead in that movie, "Driving Miss Daisy." She was sweet, and very concerned about how my day was going. I rounded frequently on her, just to make sure she would tell me if any of her symptoms were getting worse. I was scared she would not tell me, in an effort not to bother me. So we sat in the dark ("I don't mind, I'm pretty much blind, you see.") We talked about her continuing worsening blindness (sounds like macular degeneration but, when I mentioned that to her, she didn't recognize it), her husband (who's own health is getting worse and worse) and her two sons (when asked if they could help her, I was haunted by the drawn, sad, pathetic look on her face, as thoughts of two thankless sons with too little time to take care of their own mother came to her mind).
Off tonight. I plan on another trip to our apartment pool/hot tub at 6am.