….has been on my mind a lot lately. Hell, it’s been 21 days since my last post! When I began this blog, I committed (to myself) to post once a week. Slacker.
What is traditionally known as “the most wonderful time of year” when relatives separated by distance rush to be with each other is often replaced with the melancholy of relatives rushed through emergency room doors. Half of me is playing Now That’s What I Call Christmas Vol I and Love Actually over and over and over again while hanging greenery and ornaments while drinking Baileys and hot chocolate. The other half of me is constantly thinking of all the patients I have taken care of over the years and how I’ve let them down. I think of the tragedies that await me each shift. With each parting of the sliding glass doors, death, debilitating disease and destruction of human life await. So much for ”the most wonderful time of the year.”
Mr. G.I. Joe served our country and was also a POW in the Vietnam War. One Spring day seven years ago he was involved in a rollover MVA. He broke 2 bones in his neck, ruptured his spleen, lacerated his liver, fractured his left femoral head and broke several ribs that punctured his lungs.
At first G.I. Joe was the perfect patient, unidentified (which equals no family), intubated, sedated and chemically paralyzed. Aaah. I could go about my nursely duties uninterrupted, sometimes meaning that if I wanted to sit and chat with my coworkers about the latest selections in the Victoria’s Secret catalog, I could do so without the disapproving looks of my patient’s family. Uninterrupted also means that I can share information with G.I’s team of doctors over his sedated and chemically paralyzed body without worrying how to phrase our discussion so as not to offend or demean Mr. Joe. We could talk freely about his current condition, where it needs to be and how best to get it there. I could change his dressings, complete oral care, pin care (G.I’s type of neck fracture necessitated him being in a halo and the pins securing the brace to his skull required cleaning every 8 hrs), hang new I.V’s, change tubing, change his position and activate the percussion/vibration mode of his bed all without having to make idle conversation. I’m not good at that.
All was going well, until G.I. Joe woke up after being weaned from his sedation and chemical paralysis. Don’t get me wrong, waking up is a good thing because now we get to find out G.I. Joe’s identity, determine the presence and in Joe’s case, absence of brain injury and get physical/occupational therapy on board to ready Joe for transfer to rehab. Plus it had been nearly 3 weeks, so it was time for Joe to be awake.
But he was confused. And scared. And uncooperative. Not surprising. And he was having war flashbacks. This is one way of things not going well when we wake a patient. I have to admit that one of the weaknesses of medical staff is to dismiss psychological breakdowns as delirium and use restraints and medication as an antidote. Now, I am the last person to rope and dope my patient. OK, maybe not dope, but Joe was so deep in the recesses of his Vietnam capture that he would swing and kick (with his good leg) at anyone who came near him. He would also spit, which is gross, and try to bite. So one of my colleagues applied restraints as another asked for an order of Haldol (Vitamin H as we affectionately call it). This was a distressing site, much more so than the broken, pale and deformed body of a fresh accident victim. Once Joe was more sedate and manageable thanks to Vitamin H, the reality orientation began. Every hour, sometimes as much as 8 times an hour, Joe would be reminded that it wasn’t 1964, that he was no longer in Vietnam, that he was involved in a car accident and in the hospital recuperating and that he was safe. This was tedious and annoying but in a few days time paid off.
Then came the crying that accompanies the realization of one’s injuries, the uncertainty of making a full recovery and the loneliness. And the loneliness isn’t what I like to think about. Some patients aren’t fortunate to have loved ones visit, to occupy the dead space which is basically 24/7. Another failure of medical professionals is that of spending any quality time with their patients, that’s what family and friends are for. Joe’s sister and nephew lived states away and once Joe’s companion was able to track him to the hospital 80 miles from the scene of the accident, he was only able to come down on weekends because of work. So that left us, his nurses who prefer social interaction among ourselves over talking with our patients. At first I rationalized that Joe had plenty of interaction, physical therapy stopped by every day to work with him. For one hour. Oh, his meal trays were delivered by our nursing assistants who would chat with him. Another 15 minutes occupied. And let’s not forget housekeeping, xray and his doctors. 7 more minutes down. This is pitiful which is why I brought a deck of cards with me to work and would play Gin Rummy, 5 Card Draw and even Go Fish whenever I had some down time and wasn’t looking through the Victoria’s Secret catalog. It was the least I could do.
But for now I’ll go back to hanging my decorations, watching my DVD and drinking Baileys hot chocolate. And when my mind drifts to thoughts of G.I. Joe, I’ll try to remember that he was eventually discharged to rehab. He came back to visit my unit 3 months later, walking with a cane and thanked me for taking the time to play Gin Rummy and the like with him, the 4 times that I did. Turns out it’s not necessarily the amount of time spent with the patient but the quality of the time spent.