Current mood:

thoughtful

Quality of life
For awhile there I thought I was going to have the kind of patients that didn't give me much to talk about...a smorgasbord of cardiac arrhythmias in patients who could pretty much do for themselves, just needed some tuning up with drugs. Then last week I got a guy who was pretty much of a train wreck, history of head, neck, and bladder cancer but with acute problems having little to do with those...septic as hell, with an apparent intra-abdominal abscess that was draining bunches of gunk, and a rapidly dropping blood count that may or may not have had anything to do with it. The night I got him I was basically stuck in the room all night, giving blood and platelets just as fast as I could decently run them, trying to hydrate him enough without filling up his lungs, and eventually attending to the (ick) drainage from where the abscess had been opened up. The next night was more of the same, without the blood transfusions, but with a couple of patients added....a new onset diabetic with some seriously weird family dynamics and a post-op laparoscopy who'd had some arrythmias the night before but was fine for me except for having to get up to pee about every hour on the hour, a process requiring something like an expeditionary force to accomplish. That was an exceptionally busy couple of nights! I was thankful for the 4 nights off I had taken for a birthday holiday.

So this week it's back to work, and my first night back I picked up a new admit. It seems that the Short Stay unit is pioneering a rapid admissions model, but I hope this patient wasn't indicative of what they're going to do, because they didn't do much of any of the admitting process. That would have been bad enough, but my unit had only 2 nurses for the patients they had, and she made #7...and there was no tech. Needless to say, nobody was very happy. The patient is a 62 year old female with cancer who's been in either the hospital or rehab since March. She looks far older than her stated age and has already made herself a DNR. At this point she was just sick, diagnosed with pneumonia and a heart rate in the 140s. She was on an amiodarone drip and it didn't seem to be working all that well. She was also on antibiotics even though her white count was only 6.6, not indicative of bacterial pneumonia (hello, antibiotic resistant bugs!) and basically felt like hell. She just wanted to be left alone.
A couple of other rather unremarkable patients kept me at least somewhat busy. Last night I came back to find she was still there and I also had another patient who was a total train wreck. This one had been in NeuroVascular ICU since January! She's an old (1999) heart transplant and dialysis patient who showed up on New Year's Day with altered mental status and seizures. Her course had been one horror after another....brain abscess, craniotomy to drain that, prolonged time on the vent with failure to wean, which led to a trach, blood clots which meant she got a filter to deal with that, PEG tube with feedings which she sometimes did not tolerate, just one thing after another. She came to us on the one day I had off before I started this weekend. And guess which one is NOT a DNR? Last night she refused her 4 am feeding, did not want a bath, and only wanted the bare minimum of care. Well, if I'd been in ICU for 7 months, I wouldn't want to be messed with either! When you're in there, someone is always doing *something* to you, there are lights on most of the time, and the noise level can be pretty hideous, if not your alarms, the ones in the next room....who wouldn't want nights of dark and quiet and minimal messing-with? I personally think baths on night shift are pretty barbaric unless the patient doesn't really know what time it, and both my ladies were alert and oriented x3 and well within their rights to refuse a 5 am bath.

All this only strengthens my resolve that I will NOT be that kind of patient. I do not want to be in the hospital having things done to me if my outlook is that bleak and I have no better quality of life than these ladies. Of course I don't want prolonged dialysis either. It's a tossup whether dialysis or a trach would be worse, but I guess it would depend on how well I could get around. In point of fact, I don't want either. Just give me my pain meds, leave me alone, and let me go wherever it is I'm going. Thank you very much.