Thursday, July 29, 2010

A farewell, and hopefully not au revoir

I mean that in the nicest way. PT G believed her docs and social worker would be coming up with a rehab and care plan which would see her out of the hospital and back home. She really wanted to go home, enough time in the hospital (I think it must be 3 weeks or so).

Today she was not "woofy" at all. Apparently one of the things her docs have been working on is figuring out which of her meds were having which side effects: woofiness (spacey and dozy) was one, another was dry mouth, and some other things. She reported that the docs had said that this could be due to one particular med she was taking. Her roommate, PT T, went home today and she, PT G, and I sat and chatted for a while. She works in another hospital nearby. She talked about how long people have to wait in ERs in NYC (possibly elsewhere in the US?). She said this seemed so bizarre to her, that part of that wait seems to be because docs here like to use all kinds of diagnostic tools (MRIs, CTs, etc) all of which require waits for results, whereas in Russia, they tend to focus on first aid and treatment of what can be treated ASAP and thus people are in and out fast. I was saying that perhaps it's due to the way people use ERs here in the US, but didn't get to elaborate on how this differed from A & E use in the UK.

The asthma PT I encountered on Monday was also going back home today. She was in much better shape and in very good spirits. She talked about where she lives - nearby in assisted accommodation, in a studio in a place where there's dining rooms and they do everything for you but you also have a kitchen. She seemed very happy with it, her only regret being that no pets are allowed since she'd love to have a dog.

PT M, who had been almost completely out of it yesterday was more with it today, but still was not eating. He complained of a painful throat.

PT K was still there and he talked to me about politicians and how he was a-political since corruption seemed unavoidable. Later in the day his wife (I assume) came to visit, which was nice to see.

At the end of my shift, I went to say goodbye to PT G. She said some very nice things, expressing her appreciation of my keeping her company and helping her out. She shook my hands in farewell and, of course, appropriately said "I hope I never see you again", which I echoed (unless, she said, it was by chance on the street, but NOT in the hospital!).

Bugs and nuts in the ER

The ER yesterday was fairly busy but not nuts like last week.
A elderly, but ambulatory guy came in who'd acquired bedbugs from a piece of furniture from a pal which infested his house. He'd been placed in a contact room, which then was off-limits until some clean-up squad could come and de-infest the room.

I fetched medical records a couple of times. Various unglamorous tasks - more cups, sheets for PTs, passing along information to the charge nurse (a tad fierce) from a resident (probably intimidated). Taking samples up to the Lab or sending them up by tube. Getting food for PTs, water.

One elderly lady started out in the trauma room, got stabilized and then ended up in a bed in the ER. She'd have made her way to the ICU by now, but one wonders how many hours she spent in the ER.

One elderly lady was in great pain and clearly suffering some acute intestinal distress - she had smelly diarrhea and seemed to get catheterized (not very comfortable if you're not already anesthetized or out of it in some other way). She moaned in agony periodically.

A young man, early to mid 20s, brought his mum in for detox. Elderly lady, utterly tanked, but aside from that respectable seeming and well kept. The same drunk from last week also turned up for detox; he was better behaved this time. No stroppy attempts at violent threats this day. There was another man in the other contact room who was clearly out of his tree on something. He was moving all around on the bed, and pulling at something on his clothes that wasn't there, gesturing and muttering. He ended up sleeping with his head down the "wrong" end. Looked uncomfortable but at this point he was out cold and wouldn't have noticed.

Woofy and Bad Culture Results

This Monday I did the usual mixed bag of tasks. Monday seemed like a busy day. There were several new admissions, including one guy who was very tearful (PT H). He was so very hungry but was NPO prior to some procedure.
One PCA who'd been away for three weeks on vacation was back. She's very bubbly and friendly so she was missed. Another PCA was collecting for a baby shower gift for the PG PCA and asked me to sign the card and if I wanted to contribute. I did. I'm not sure if I'll make the party since I may be home with the kids.
The MDS lady, PT G, was still there, and didn't seem hopeful about leaving the next day. She seemed somewhat out of it again ("woofy" as she calls it). I sat with her and she talked. This time she told me a lot about her family - the social worker had made her get in touch with her brother, despite MDS lady's protestations. She gets along fine with her brother, but he's not nearby and is not someone who will be able to deal with affairs in her house and so forth.
Her family - her brother married three times, first time to a girl he got PG in high school. They had four children. He then married another woman, but they were not together very long. He married another woman, with whom he had a son who is a good kid now in the navy (having completed college). They separated because he longed to move to Las Vegas and stop having to deal with NE winters. She wanted to stay put, near her family. Conveniently, she was diagnosed with cancer and died shortly after, thus ending the marriage. PT G (MDS lady) had got along fine with all of these women, and children. The problem was her mother, who sounded like a difficult woman. She'd never liked wife no. 1 and had also not engaged with those grandchildren. The father just went along with this, despite of whatever opinion or feelings he may have had. The mother died of lung cancer around 10 years or so, which, said PT G, was fortunate since no one would have wanted to take care of her if she'd died after the father. The father also died about 3 years later. The upshot is, PT G is relying on her friend and her husband for assistance. However, there'll be a problem soon since her friend has to have surgery which will limit her movements.

The social worker is working with PT G to find a rehab facility near her home. Seems like the doctors and the SW are beginning to come up with a plan for ongoing care.

I also visited with PT K, who had gone home. He'd returned early that morning having spent the previous day on a different floor and prior to that 17 hours in the ER. He'd been at his rehab place when they got a call with blood culture results: one was positive for some kind of infection. He was ambivalent about going to the ER about this, since, in his experience this would be due to his catheter and would probably go away with no serious consequences. He was thus annoyed with himself since he allowed himself to be "brow-beaten" into going. Since he wasn't acute or a trauma PT, he'd spent 17 hours in the ER waiting for a room, then he was on the wrong floor (orthopedic) where they didn't understand his meds. Finally he gets to the oncho floor, by which time he learns that the result was erroneous and due to contamination. He was due for some more chemo by now, so he was staying put for a few days.

It seemed like the PT in the first room - nearest the station and always occupied by the most sick/needy PT is now occupied by a youngish man who is dying of cancer. He was very nice, but from time to time moans in pain when sitting on his commode.

I also helped PT G's roommate, a Russian Jew, PT T. She has her own food. She's kosher, but doesn't want the hospital food (they supply kosher food). She has bowls of soup one of which I heat up for her.

Back in the first room I met PT G, there's a sweet lady next to the window having breathing treatment. I joke with her that it looks like she's smoking something sketchy. She's in good spirits.

I go into a contact room to see PT M who is not A and O x3 - he knows who he is but not where or when. He's having trouble eating. I try to get him to eat his breakfast, but he won't.

I'm not able to say goodbye to PT G before I leave since I have to leave the room when her doctor comes.

Wednesday, July 21, 2010

Insane ER

This afternoon I did my weekly 5-hour stint in the ER. Last week it was pretty quiet and I was able to take a break. Not today. The place was nuts. Didn't stop for the entire 5 hours. There were so many PTs they had to make all the visitors leave: over 70. They ran out of gurneys, rooms, wheelchairs. Lots of people dehydrated, a guy with a kidney stone, people with diarrhea, vomiting (lots of smells), infected abscess on one guy's neck, a couple of people in a car crash in a taxi with relatively minor trauma, a "cooperative" felon who got un-handcuffed so he could be treated more easily, some falls, respiratory/cardiac distress, habitual drunk in for detox who needed to be reasoned with, one lady very distressed who wanted to leave and needed "handling" and so much more!
So many EMT teams at the ambulance entry it was totally crowded. I talked to people, brought food trays, fetched/alerted nurses to their PTs' needs, took a Rx to the pharmacy and brought the drugs back, took another order to the blood bank for platelets and brought them back, took lots of samples/sent lots of samples to the blood bank and the patho lab. A good day, in fact for me, but not for those in the ER. There were people who were there when I arrived and were still there when I left.
Day before yesterday in main place: saw the MDS lady again (PT G), but doing much better and much happier. Felt like she finally had a doctor who understood what was going on and was on top of things. She got two lots of platelets, but first went in so slow her nurse had to move the IV, which she was not wild about. But new one was much faster. I also saw the ALL (PT R) lady who was also much better.

Eye-patch guy (PT K) had a new room mate, with a raspy voice (PT D). Seemed like a relatively young guy. He seemed pleasant. I reheated Mr Eye-patch's lunch and went around bringing various PTs ice water.

Yesterday spent more time with MDS lady, but only after I'd done a bunch of things in the morning. She's carefully keeping track of all her meds and therapy in notebooks and also trying to keep track of bills that are coming due. I'd already found a couple of customer service phone numbers for her to call to pay bills over the phone. She agreed that she really did need to have someone - her friend, go to her house and get mail and other things. Unfortunately, the new IV line from yesterday proved short-lived since it was slow today. Her nurse (same as yesterday, and a good one) put in a new line on her other arm. Much faster. This day this PT had to get a transfusion (can take up to 4 hours), so she couldn't have a slow line. I went down to the gift shop, having stayed later than usual, to try and find some stationary supplies for her. I could only find the small notebook. If she'd mentioned it earlier I'd have been able to go to Duane Reade and get everything, but that would have taken too long at this point.

I visited with ALL lady who, again, was doing much better. In the morning, somehow due to a misunderstanding, she'd not had breakfast so I mentioned this to the PCAs, one of whom constructed a breakfast for her from what was left. She was doing so much better and was in such good spirits. She said some very nice things to me, which, of course made me feel good. It's nice to be acknowledged. At the end of my shift I went to say good bye to her; she explained that she expected to go home soon. So, I said, I hope I don't see you next week! MDS lady expects to be here at least next Monday.

This day the MDS lady had a new room-mate, who was very aggressive and offensive. This is the third or fourth time I've seen this on this floor (only once in my other place). But, this is a normal reaction to the fear and worry of cancer. Later in the day, her doctor came to talk to her and discussed this issue and the PT became tearful and sad. It surely must be terrifying to find out you have cancer in your brain. He talked to her about ways of dealing with this. From the time line discussed, it seems like she'll still be there next week. Perhaps she'll be calmer and I'll actually be able to talk to her.

The nurse who had previously shown me procedures this day showed me a blood draw and talked me through that. All very interesting. I had a longish chat with another nurse who had not realised I was a nursing student. She told me about the summer internship program and scholarship and urged me to apply for them or at least look into those when the time comes. She'd had both and were a big help.

I saw Mr Eye-patch and his room mate a few times over the day and got his room mate tea supplies a couple of times. Another nice lady I'd spoken with a couple of times got to go home today and I talked with her while she got ready to leave. She was very pleasant (the whole time she was there) and was clearly very happy to be going home.

Monday, July 19, 2010

ED switch - first day

The next day I was back at my one-day-a-week place. This time I started in the ED and spent an hour or so with a very helpful long-term volunteer who took me around and gave me a quick and dirty introduction to what I'd be doing in the ER. She'd been volunteering there and at the other site for many years and also acted as an interpreter for Polish and Hebrew. There's a main room ER, a "fast track" for problems easy and prompt to remedy, and a pediatric ER. The RN trainer also told me that it's one of the few places in the country with psychiatric ER and she told me that there are psych patients in other ERs around the place waiting for appointments since few other hospitals are set up to deal with this kind of emergency. In other words, if you're going to suddenly go loopy, do so near this place! This RN then spent some time with me introducing me to various people, to the colour teams and how they work. After that, I was by myself. I spent the time circulating around the various parts of the ED, looking for stuff to do. Suddenly I saw our priest and stopped to talk with him: he was there since his elderly mother had fallen and broken her hip. Some time later, I went to speak with the trainer RN, to whom I mentioned that I'd seen our priest. She was amused since she'd seen a priest sitting outside a room and had thought, that doesn't look good. It's OK, I said, her son just happens to be a priest, no one is dying!
My duties in the ER include, assisting new intakes and orienting them, fetching food trays for those who need them (whichever is there, the name is irrelevant - this I took on board when I decided to give the only "real" lunch to the HIV +, dehydrated man living in an SRO who clearly needed it way more than the rather overweight woman whose name was actually on the tray, and a choice subsequently lauded by the volunteer trainer RN). I spent the time either actually taking things to the lab or blood bank, or putting them in the containers and sending them by "tube". I walked around asking for jobs in the various departments, fetching food trays, offering and fetching ice water, or just chatting with people. I almost got to see a lumbar puncture, but the patient decided not to have one - he'd previously had that experience and, upon discussion with the doctor, it seemed highly unlikely that it would have been very helpful since he almost certainly did not have the meningitis the LP would have found. He had shingles on his head and, while the doctor stated that he was pretty sure he didn't have anything else at this point, the LP would completely rule it out.

In the end, I did more than my 5 hours. Much more interesting and "happening" than patient rounding.

Saturday, July 17, 2010

This week I reacquainted myself with two patients I'd talked to last week, patient PT G who has MDS and PT S who has ALL. PT G (GR) looked much better since when I'd encountered her last week she'd received some pain meds that had knocked her for six. She was still not in great shape since she remained in pain, though, as she suggested, it might just have been from spending so much time lying in bed and getting stiff. Her problem was that it seemed to be taking some time to figure out a pain relief regimen (not helped by her not getting any meds on the Saturday). The medical staff also, she reported, seemed to think she was "malingering" and didn't want to go home. This seemed hard to believe, since she has a perfectly fine home to go to although she was going to have to rethink her lifestyle, as I previously mentioned.

Patient S seemed in worse shape. She was experiencing asthma-like symptoms and seemed in more distress. She didn't want me to stick around so I moved along. Another patient (PT K) I had previously talked too and assisted told me that he wanted bottled water since someone had told him that the pipes were not clean and were full of "bugs". He insisted a member of staff had told him about this. I asked the acting clinical nurse manager and another nurse who happened to be in the conference room having lunch at the time. They were both highly amused and had no idea who would have told him such a thing. There is bottled water for patients with especially challenged immune systems who feel more comfortable drinking that water rather than that from the tap, but we all know that the water from the tap is no less clean. This patient often wears an eye patch over his left eye due to a brain tumor that causes some problems with that eye.

In another room I encountered a patient who was not happy with his meal. He wanted a sandwich instead. He also wanted me to reheat his coffee and bring him various things. I asked his nurse for the day if he could have a sandwich instead of his meal. What I heard in response was very interesting: he'd had a sandwich earlier (and on another occasion prior to that). He'd not eaten it all and hadn't kept what he hadn't eaten. He'd been homeless for six days prior to being in the hospital. One assumes the novelty of some kind of control over his circumstances had induced the apparent "fussiness".

Friday, July 9, 2010


Thursday I returned to my other place, again with some degree of trepidation. It turned out to be a pretty good day however. I had three long conversations with patients who seemed to need someone to talk too. One was thankful she woke up in the morning and could get up and walk around. At first I thought this a daily mantra of hers, but it was in fact a sincerely realistic comment since she'd been very sick the previous week! She was very happy and eating well. She was a dialysis patient, part of a program she attended regularly but the heat and humidity had got the better of her and caused her hospital stay.

In another room was someone experiencing a sickle-cell crisis. She explained that her test results indicated an infection which was assumed to be at the site of her port. Apparently, most people are able to maintain one in one site for a few years before it needs to be relocated. Since this patient is very pain-sensitive, this procedure involves general anesthesia (usually it would require only local anesthesia). Since she'd had to undergo removal and insertion of her port eight times in far fewer years, she's unwilling to accept the apparently automatic assumption that it's her port since she doesn't feel this is the location of the problem. This is her conclusion, given that when in the past this was the location of such an infection she experienced local discomfort and obvious symptoms in this area. So, it seemed understandable that she would be reluctant to immediately go along with the doctors' desire to remove the port and put her through the trauma and hassle of inserting another.

She also told me that she smoked, she was also rather overweight and clearly had not taken great care of her teeth. This struck me as an interesting contrast to her fellow SC lady I had previously encountered in my other place. Given my attitude to health - being an informed consumer and trying to eat healthily and take regular exercise, I would think that if I were afflicted with some kind of long-term, genetic condition, I would take extra good care of myself. The lady at my main place didn't smoke, had good teeth, and was not overweight and seemed to take care of herself. She also seemed better educated, lived by herself and had a full time job; all of these imply a degree of self responsibility. The other lady, possibly even older than the first one, clearly wasn't taking good care of herself and lived with her mother who often interacted with the healthcare providers on behalf of her daughter.

Once I'd done my hours for the day I returned to the volunteer office to gather my things and head out. My departure was delayed since I received some good news; if I was still interested, I could switch to the ED. Absolutely I was still interested. Thus I ended up hanging around for a while until the ID office reopened after lunch since I'd need a new ID (enabling me to get into the ED at the weekend via the emergency entrance). I also got to meet the RN in the ED responsible for training volunteers.


Tuesday was the only day I went in to my main place this week. I spent a lot of time sitting with a couple of patients. These two have conditions - permanent and genetic, that require treatment similar to that undergone by cancer patients, though they are not cancer. Thus these two end up on our floor. One is young and has dealt with her problem on and off throughout her life (PT A). Currently, she's experiencing a particularly long "crisis" proving stubborn to treatment. Otherwise, she's in fairly good shape. Among her problems is pain in her joints just one of the many possible complications from her condition. She's very personable and chatty, clearly animated and intelligent, and thus lonely and bored. She's part of a large family who visit frequently, but even with that, in a hospital one always ends up spending large chunks of time lacking in company. She asked for drawing and coloring materials, which I got from one of the social workers. We didn't get around to actually producing any art, instead we talked about stuff, family, life. What she did, where she lived, her family. My family, where we've lived. She was somewhat in pain, but totally ambulatory - in so far as one can be with an IV. Despite her discomfort and uncertainty as to how long this crisis would last, she was in very good spirits.

Now I know more about her condition, and the long-term prognosis, primarily a severely shortened life-span, her cheerful disposition is a lesson indeed. As is her determination to complete her Bachelors, progress on which has been curtailed by dealing with her condition. She talked about where she'd wanted to study, the same place her mother studied. This didn't work out, but she did start at a good, local institution and made progress toward her degree. She really wants to get back to it and complete it.

Her fellow-floormate is an older lady who, while burdened with a similarly unfortunate and genetically predetermined burden it is one that did not afflict her until much later in life (PT G). She's only experienced it for a year or so, but it's made rapid progress. She's in the position of having to come to terms with possibly having to rethink her entire life-style. Until fairly recently she was able to go about her daily life - a leisurely retired existence, while making some accommodations to this newly present discomfort in her body. However, her current predicament suggests that this may no longer be the case. She has already handed her beloved cat over to her best friend; this is very sad, since he was great company for her. She was no longer able to take care of him, since she can't open cans or shop like she used to. Her arms and hands are somewhat weak - I open packages for her on her meal tray, and while she was able to feed herself and cut up her own food, her dining was slow. She was talking at length at the same time, to be fair, and if I'd not been there for her to talk to, she'd have been somewhat quicker, though I doubt much. I think her weakness is largely due to not having eaten properly for a while and not being able to sleep. Her condition means she's at severe danger from bruising and bleeding from the slightest knock, and even spontaneously in fact. With this in your life it means you've got to be really careful about everything you do. Anything could cause a horrendous health problem. The poor lady had also just had eye surgery that will take several weeks to resolve itself. Then she'll see better; in the meantime though, it means she can't see out of one eye. This was also impacting on her eating speed since the bad eye was on the same side as her tray table where her lunch was. She didn't want me to move the table since that'd be on the wrong side for her right hand.

She had been in pain in her back and down both legs. She'd been trying to deal with it at home, but her OTC options are limited due to anything aspirin-related being off the list. This had been going on for a couple of days or so, during which she'd had a minor fall on one knee. She'd gone to her local ER and was sent home with pain-killers, well, a prescription for some at any rate, but one which she couldn't fill due to her pain and condition. Meanwhile, her injured knee had produced an alarming amount of bruising down the bottom half of that leg, with a "slipper" of bruising along the bottom of her foot, just above the sole. This looked rather alarming to me when I first encountered her, but then she explained why she was there and that it really had nothing to do with this dramatic bruising.

She told me what she'd been doing in her life. She'd worked in finance, and continued to work full-time to the last possible moment she could until retirement. Thus she ensured receipt of the best pension possible. She'd been retired for around a couple of years and had been enjoying pottering around her house with her cat, watching TV, and generally taking it easy. She'd had no grand travel plans and such, as many do when thinking of retirement, which, as she said, has proved fortunate given her current health situation. She'd been part of a drug therapy study from which she was removed when the drugs no longer worked - they'd provided a brief improvement, but this was not to last. She had then been undergoing periodic transfusions, which became more frequent, and were now weekly. And now she was experiencing this current crisis, which was indicating that her condition had exacerbated.

Sickle-cell and MDS: long-term prognosis for either of these is not great.

Another patient I'd been spending some time with, who'd been there for quite a while was not on the floor (PT AH). This lady had been visibly deteriorating and had been recently almost constantly asleep. I asked where she was and was told that she'd passed away Saturday night. This was expected, unlike the fellow who'd died the previous Monday morning. He'd seemed in fairly good shape, given the circumstances.

Around five patients that I've had some contact with, some brief, some lengthy interactions, conversations, have died since I started on this floor. It's proved a wonderful opportunity, prompt perhaps, to ponder various of life's questions but also chiefly one's role in the room with the patient. Constantly one remembers that it's nothing personal for you, that who you are is irrelevant, it's about being available for them. This can mean just being there, as a comforting presence, providing a foil for light, distracting conversation, or a sounding board for life-style readjustment, amongst many other things.