Last day at main place

Tuesday, my last day, turned out to be a pretty good day from the point of view of experience related to nursing. I started out doing assorted tasks: making sure gowns, gloves, etc., were in plentiful supply in their various locations. I then moved on to collecting breakfast trays. I went into PT SS's room to get his tray and ended up sitting with him talking (listening to him) for around an hour or so. He talked about his business - he was a furrier. He'd had a factory and had employed a number of people in the past. He'd had a partner, but he'd left the business - he'd been in poor health. Slowly over the years, PT SS had let the business get smaller. Now he was alone and outsourced everything. He kept at it because he enjoyed it so much. He no longer dealt with stores, such as Niemann Marcus, etc., as he had in the past. Now he had personal relationships with individual customers. He particularly liked this since you got immediate feed-back and got paid right away! He talked about the rehab options his daughter (he had two daughters) was investigating for him. He'd require about a week of rehab once he was done with the hospital. He was anticipating perhaps another week in the hospital. His skin had improved visibly in the short time since he'd had the chemo and he expected this to continue to the point of his condition being manageable at home. He did want to go home, of course, as one would, but he was particularly keen to get back to his wife who was missing him very much. She had COPD and was not very mobile. He took care of her. He also said that this (he'd previously been on the rehab floor for 3 weeks prior to the oncology floor) was the longest he'd been away from his wife throughout their 55 year marriage. This was hard on her. Their younger daughter's boyfriend - they lived in the building next door to theirs - was taking good care of her every day during his absence but it wasn't the same as having him with her all the time.

NH came in to give him meds and to talk to him about changing his dressings. She returned after a little while with his pain meds (to facilitate dressing change). Since the summer intern nursing student was assisting another nurse with a task I ended up assisting NH with the dressing change. I gowned, gloved, and masked up. Probably around 70% of his body was covered with medically impregnated yellow bandages. PT SS joked about being a mummy! He took it very well. This process required him to stand up for a long period of time while NH removed the old bandages, slowly and gently. Meanwhile, I started unwrapping the new bandages. These are individually wrapped in foil packets. They're very messy and smelly (sort of carbolic smell); they're approximately 3 x 5 inches). Once she'd removed all the previous day's bandages (now changed once a day, previously were changed twice a day), NH applied bacitracin ointment to the wounded skin and carefully placed one of the new bandages over each area, covering the wounds. Over the bandages she applied white petrolatum ointment. She slowly worked her way over his entire posterior body. Once posterior was complete, PT SS sat on a covered chair. NH then removed the dressings from the legs, arms, etc. and carefully repeated the same routine.
Meanwhile the PCAs had come and changed his bed, including placing a new cover over the sheet (anti-exudate cover, usually used for bone marrow PTs). PT SS carefully placed himself on the bed, seated, and with a little help as we held his feet and helped him move them, he got himself back onto the bed. We put a clean gown on him.
Now all clean, redressed and back in a clean bed, PT SS seemed very happy. He felt there was a distinct improvement; he certainly seemed in far better spirits.
Subsequently, I paid a brief visit to PT K. We talked about his lunch. He wondered if he could eat American Cheese. He has to avoid foods containing tyramine.
A PT's family had bought us pizza, so I had a great, tasty, HOT piece. There were also donuts, but I didn't take one. After lunch I spent the afternoon doing various maintenance tasks, refilling gloves, gowns, etc., then left for the last time at 2.30pm. Perhaps I'll be back on this floor at some point, we'll see.

Monday of my last week at my main place

Monday I spent a while talking with PT K. He seemed down. He explained that he had to rethink his plan. He thought he'd decided not to go for the brain biopsy suggested by his neurosurgeon since he'd understood that it would involve the biopsy, followed by 6 MONTHS of radiation, followed by another 6 months of waiting to see what the result was. He further explained that he'd been told that at best he'd get another 2 years of life. Thus, given the ordeal that the treatment would be along with the waiting for the results, he'd decided that it would not be worth it given how little he stood to gain. However, he'd lately been told that he could possibly have another 5 years and it would only involve 6 WEEKS of radiation. Further considerations were that the kind of tumor he has has a tendency to produce blood clots and there was a 10% risk of life-threatening bleeding during this procedure. He was also concerned as to the potential effect on him as a person, either personality change or some kind of incapacity resulting from the biopsy. His surgeon seemed confident that this would be minimal at most and not something to count against undergoing the procedure. He was pondering all these issues.
He further explained that given the initial description of the procedure's risks, the length of the therapy, and possible outcomes he and his healthcare advocate had decided that this was not the way to go. Now a major rethink was called for. They'd had a conference with the neurosurgeon, his healthcare advocate and PT K himself but not with his oncologist who was on vacation that day (and, apparently, hadn't provided enough notice to allow for a rescheduling). The neurosurgeon also said that there was a time window for doing this procedure (PT K assumed - as did I - that this meant in the next few weeks, and not a decision that could be delayed for months, but not something that had to happen over the next couple of days so, he would have time to meet with his cousins and healthcare advocate and give it due consideration). PT K's cousin had suggested that he talk to his original doctor at the first hospital he was at as to his opinion on the possible negative/positive outcomes of the biopsy procedure. He was nervous that perhaps this would require him to impune the skills and reputation of the surgeon he was currently with (who has done this procedure many, many times and is an expert). He asked my opinion. I said that I didn't think he needed to worry about that since he was not asking about the skills of the surgeon, he would be asking about the procedure in general which, no doubt, is performed in many places around the globe, furthermore, if the doctor did not feel comfortable responding, he didn't have to.  He seemed to decide then that he would ask his first doctor.
The chief point of the biopsy is to find out what kind of tumor it is: apparently it could be one of two (of the three kinds of brain tumor). The location is what makes it particularly problematic - at the pons.
I also visited briefly with PT SS. He'd undergone his chemotherapy around four days prior and did seem improved. Certainly he was in much better spirits so, one assumes, he couldn't be in anything like the discomfort he'd been in before.

Almost done

I told my main place that I would make next week my last. This feels good to me. I will come back after some months, but probably to a different floor. Given what I can do as a volunteer, I think I've got out of this experience all I can (from the perspective of a nursing student).
PT G was indeed no longer on the floor, which is great. There were a number of new PTs. PT K was still there.
Monday was a pretty uneventful day. I spent the time looking for things to do. I didn't really have any PT who needed particular help or wanted to talk.
Tuesday (yesterday) was somewhat more interesting. PT K seemed subdued, so I asked him how he was. "Not good," he replied. "I just had some bad news." Presumably there were unfortunate test results (he had been off the floor for a while the previous day, for tests one assumes).
He was so grateful to have his meal reheated, but disappointed by the lack of the vanilla ice cream he'd asked for. He had though chocolate would be OK, since the food service lady had offered him that flavour ice cream. There was no ice cream with lunch this day, but I found him a chocolate pudding. Again, greeted with gratitude. A short while later, I returned to his room. Turns out he's not supposed to eat chocolate since he has to avoid theobromine (something like that, I don't quite remember). He'd been on the phone with his doctor or the nutrionist. He still wasn't clear, but we looked at an information sheet he had and clearly, chocolate is a no-no.
There was a new PT. I immediately recognised a bulbous lesion on his leg - a pemphoid blister. He told me all about his condition. He'd had it for two years, managed with prednisone and cyprofloxin. Eventually his dermatologist decided that they should try and wean him off these two drugs (powerful and one a steriod). Gradually by steps they did so, finally it flared up again. Reestablishing the previous regimen didn't seem to work. He was here to try a chemo treatment (hence his presence on our floor). He was desperate. While this is not a life-threatening condition, it is incapacitating due to the pain and discomfort. E.g., he is unable/unwilling to go the "john" (as he called it) due to the pain from the sores/blisters on his behind. He is not constipated, just unwilling to endure the pain from the skin.

On another note, yesterday and the day prior there were parties! One for birthday people on the floor, the other was a baby shower for a pharmacist. This Friday I'll try and attend the baby shower for the person on our floor.

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!).

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.

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.

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".