Kick It Up

Sometimes I think life is all about perception.  I am often struck by how different my life is than how others perceive it.  More often I am struck by the realization that other people’s lives are so different from my own in so many ways.

I thought I would share a day in the life of this nurse.  Maybe a few examples will help people know what nursing can be like.

One day I woke up around 6am, greeted my children as they roused themselves, and drove them down to the end of the driveway to watch them climb onto the bus.  I was scheduled to work at 11pm, but I had things to do, things to do, things to do.  I hoped I would get a nap in later.

I took the car for an oil change, transmission something, and repair of a recent recall. While I waited I sat in the dealership’s business center and checked my emails, surfed around the internet, figured out a few things that had been stumping me on the technical side of blogging, and wrote a blog post.

I arrived back home in time to greet the kids as they returned from school and had our typical after school day.  Talking with each other, some housework and laundry, cook some dinner, and around 7pm, laid down for a nap until 9pm.  I had a hard time falling asleep and then woke up around 8pm and couldn’t get back to sleep so I got back up around 8:30pm and got ready to leave.  I had a few minutes before I left at 9:30pm alone with my husband to chat a bit uninterrupted.

When I arrived at work after an hour and a half drive (which I filled with listening to “All the Light We Cannot See” by Anthony Doerr) I discovered I was not on the schedule for the 11pm shift.  I checked my phone to see if I had my dates wrong.  No.  I was supposed to be there.  Then the charge nurse put out a call to their staffing office and I called my agency to clarify if they had received a call canceling my shift.

Unfortunately, in the life of an agency nurse this happens more often than I would like.  If I show up for a shift that I was scheduled for and the facility fails to cancel me and doesn’t need me then they are under obligation to pay me for 2 hours.  Not bad for a 3 hour round trip commute, eh?  (Not to mention time lost napping that I could have been doing chores or other.)  On the other hand, if the facility canceled my shift and my agency failed to notify me then I am paid 2 hours by the agency.

My agency called me back within ten minutes and assured me I was on the schedule and had not been canceled.  Meanwhile (the plot thickens), one of the staff nurses had not showed up for the night to work, had not called in unable to work,  and was not answering the calls that had been put out to her to determine if she was on her way or not.  So I eagerly (not wanting to lose my shift) say I’ll take report on her patient’s and stay until she arrives.

The staffing office called the charge nurse back within a half an hour and assured her I had been on the schedule and a message had been left for the agency cancelling my shift.  The charge nurse then announces she is making “the executive decision” to keep Catherine and if contact is ever made with the staff nurse she will tell her to stay home.

So I boogie off to get report on my patients.  By now it is about ten til midnight and I am 50 minutes behind starting my shift.  Nice.  It would take more than that to set this nurse into a tizzy.

I took a look at all my people (making sure that the one wearing a Fentanyl patch still had it on and no crazed person had ripped it off to chew on or sell) and started in on my assessments of them.

When I arrive at the last room I am asked, “What do you think about her respirations?”

“Uh, well,”  I’m stumped.  Her respirations look fine to me and I am trying to read what the questioner is meaning.  “It looks like her respirations are even and not labored.”  I stop to count the rate for a minute or so and continue, “Her rate is about 12-14 breaths a minute.  To the low side of normal, but okay.  Do you think she is having trouble breathing or something has changed with her respirations?”

“No.  They are just different.”

Hmm.  I know the family wants to hear me say something black and white about what this change may indicate.  But I’ve got nothing to offer them except, “I’ll keep an eye on her breathing and check in periodically.  If you notice any restlessness or difficulty breathing let me know.”

I am at a hospice facility so all of my patients are deemed to be within the last 6 months of life.  I feel that maybe two of my others are in the last week or so of life and one has probably a few months.  This is just my assessment.  I don’t really have a crystal ball.  It is just based on my nursing judgement and “my gut.”

Right next to my patient’s room is a family sitting room.  A couple of the nurses and a nurse aid have gathered there and are having a lively conversation.  I’m annoyed because I know that their conversation and liveliness can be heard in the room next door where my patient and family are suffering.  But I say nothing.  This annoys me even more because within the last month at another facility I was rebuked for having a normal toned conversation with an aid in the nurses station.  “I know you are in the nurses station,” we were scolded, “but your voices travel all through these hallways.”

I say nothing because I know that I have to choose my battles.  If I need the help of my team I want them to be there for me.  Besides, everyone is busy and I doubt they will be there long.  There is usually not much time for socializing.  Sure enough, they broke it up within about ten minutes or so and went about their work.

I peeked in a couple of times on my dying patient and see both she and the family were resting quietly.  Then the call light went on.  When I first went in my eyes went straight my patient’s chest to check respirations.  At first I thought they had stopped, but then as my eyes moved to her face I saw her eyes were open.  Then her right arm moved in the bed.  Otherwise she was still.  The look on her face was blank and she did not make any attempts to answer me verbally.  The family felt she was getting restless and needing pain medication.

She didn’t appear restless to me, but because of her disease process I had no doubt that she most likely had a certain level of continuous pain.  It had been almost four hours since her last dose.  She was allowed to have it every four hours so I gave her a dose through her IV access.  I let about 15 minutes pass so the medication could take some effect and then the aid and I changed her.  The patient tolerated the turning in the bed fairly well with minimal spontaneous movement, grimacing, or groaning.  When we were done changing her and repositioning her in bed I swabbed her dry mouth and felt she looked settled and peaceful again.  Here eyes were beginning to close for longer periods and she was looking like she was going to go back to sleep.

As I led the family back to the bedside from the sitting room where they had gone I was asked, “When do you think you’ll kick it up and give more than just the 8 mg of morphine she’s been getting?”

Hmm.  I know the family wants the patient to be comfortable.  I know the family is tired and probably wishing the whole process would be over soon – or at least wish that someone could tell them when it would be over.

As I looked upon my patient resting quietly I asked, “Do you feel her pain isn’t being controlled?” I did’t get an answer.  I feel they know what I am driving at.  So I say, “We’ll watch her and see how she does with this.  If you feel she looks to be uncomfortable  or getting restless call me and I’ll kick it up if we need to.”

I shared the story with the other nurse in my hallway.  She knew right away what I needed to hear.  “No.  You did the right thing.  Stick with what you know.  Your nursing judgement is right.”

Around 6am all my patient’s were good and I could hardly keep my eyes open so I began to pace in the halls waiting for the next shift.  I go to sign my name on some charting and my eyes close for a second and my signature looks like an illegible scrawl.  I peek in on everyone again and finally give report and go home.

I know I am in no shape to drive an hour and a half home so I drive about 20 minutes to my parents driveway (they are okay with this practice and today are out-of-town anyways) and nap in my car until my brother startles me knocking on the window because I am blocking his car.  Feeling bleary, I got my bearings and joked with him about whether he is nervous about his son’s wedding which is just a week away.  I moved my car and remembered that I had wanted to see if hospice needed any help 3pm-11pm.  I texted the office and shut my eyes again.

Again I was awoke with knocking on my window, my other brother was asking why didn’t just come in the house. I explained that I was waiting to see if I was going home or heading back to work at 3.  He told me to come watch the presidential inauguration with him, “It’s about an hour away.”  I checked my phone and saw the text advising me no needs at 3pm. Instead I signed up for 7am-3pm for the next day.

I went into the house to say goodbye to my brother, but did not find him.  I lingered in front of the TV long enough to see the Clintons getting ready to get into their car.  As I looked at their faces I tried to imagine what they were thinking.

I headed home listening to some more of my book.  When I arrived at the bottom of my driveway it was impassable for my low sitting Prius because of the rain that had fallen through the night.  I slept again in my car waiting for the water to go down.  A couple of hours later when I awoke again from a weird dream I was able to drive on up the driveway to my house, get cleaned up, and then get my daughter off the bus.

I had the inauguration set to record, but instead of watching it I watched the continued festivities of the day.  As I was doing dishes, laundry, & vacuuming I watched the motorcade make its progress down Pennsylvania Avenue.  I wondered for a minute why I was running the vacuum instead of sitting still and watching.  Couldn’t I run the vacuum another time?

Nah. Life doesn’t stop just because we have a new president.

As I cooked up a late dinner I got a call from the agency cancelling my shift for the next day.  After dinner I tackled taking some of the ornaments off the Christmas tree that is beginning to look brown and crispy standing unlit in the corner.

The television was still on and the balls had begun.  Then the president was dancing with our new first lady.  As I watched I couldn’t imagine that any of these people in all their finery had any idea what life is like when people aren’t serving you hand and foot.  But what do I know?  Maybe they clean toilets, do dishes, cook dinner, vacuum, and change sheets just like “the rest of us.”

And so what if they don’t?  Everyone’s life is different.  Everyone is born into a unique set of circumstances.

No matter what these circumstances are we can all kick it up to the song “I Did It My Way!”

Feature photo by Andy Fitzsimon.


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