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Sunday, February 20, 2011

A Day At Hospice House

Disclaimer: This series in no way represents real patients. It is a compilation of many different patients and many different situations. Any resemblance to actual patients is purely coincidental. There is no such thing as a typical day in hospice care. Some are busier than others and each individual patient has his or her own special needs.

My eyes flap open at 4:43 AM, two minutes before my alarm clock beeps to wake me. It happens every work day, but I am convinced that if I were to fail to set the clock, I would somehow oversleep. It’s just another crutch in my life.

Honey, my Lhasa Apso, begins to lick my face, and Belle, her buddy the Boxer, walks around to my side of the bed and pushes her nose onto the bed next to my arm, demanding that I pet her, too. There is no resisting either of them, so I haul myself up on the side of the bed and turn off the clock.

The three of us shuffle through the house to the door to the deck and back yard, and off they go, returning quickly, knowing that a dog bone is be ready for both of them. I snap a pod into the coffee maker and eagerly push the pulsing blue “brew” button.

I take my coffee out onto the deck and when the weather is cold, light the propane heater. It has been cold a lot lately. I sit, check my e-mails and texts on my Blackberry, smoke (No, I haven’t completely quit yet), and in general, wake up. I simply cannot wake up and jump into my scrubs and rush out the door. I need the waking up time to center myself. Sometimes I practice a short yoga program to further ground me.

At 6:15, having kenneled the dogs in their playpen, I leave for work. It is dark, not trace of light yet in my neighborhood. I arrive at work at 6:30, 15 minutes early, so I can get some coffee and organize myself for the day. I retrieve my stethoscope from my locker, get out several of the report sheets I have designed for myself, and at 6:45, I clock in and get report from the night nurses.

There are three of us nurses here today, and we have nine patients, so we each take three, trying always to have the ones we had the day before.

As soon as report is over, I make what I call “sneak a peek” rounds on my patients. I check to make sure they are sleeping or at least comfortable if awake. Then I check their charts for new orders and take their medication records out of their notebook and put them in mine. That is when my day begins in earnest.

I begin with physical assessments. Today, I find that the patient, in room 406 (lung cancer that has spread to his liver and lymph nodes) is awake and restless, a little agitated. He is only 58 years old and was a heavy smoker. So, the assessment goes on hold while I get some medication to soothe him and give him some peace. The medication does little to calm him, so I give him a bolus of morphine, which is delivered via a subcutaneous catheter in the skin around his belly button and connected to an electronic pump. He begins to doze. I continue the assessment and enter the data into our system using a computer in his room. He is sleeping when I leave the room.

The patient in 411 (end stage Alzheimer's) is still asleep, and I quietly do her assessment, finding that her respirations are slow, and that she is having episodes of apnea. The expression on her sleeping face peaceful, even childlike. Her husband, who spent the night on the daybed in her room, expresses his concerns about her condition. He is a devoted caregiver who is exhausted, with health issues of his own.

The phone on my hip vibrates. I reassure the husband, reminding him gently that her slow breaths are part of the process, and I walk out into the hall to answer my phone. I learn that the patient in 406 is once again restless and agitated. I check my watch. Only an hour has passed since I medicated him.

To be continued next week......click here.

© cj Schlottman


Linda @ A La Carte said...

This is really interesting...I look forward to more. hugs, Linda

Poetic Justice said...

Such a beautiful blog...I am sorry for your loss. The love between you and your late husband leaps off the page with these simple but heartfelt words.
Glad to have found you.

Kat said...

Your morning routine sounds much like mine, except for the dogs. Just a cat, but she is a demanding little vixen in the morning. I'm looking forward to reading more of your day. The work you do is so important, and I don't think most people realize just what all goes into it. Kat