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Sunday, March 13, 2011
A Day at Hospice House - The Conclusion
My new patient is a heartbreaker, an eight year old with brain cancer. He is here for what we call Respite Care, a time for caregivers to take a breath, catch up on their rest and in general, recharge. His mother will stay with him here, but she will not have to worry about meals or too much company. We will take care of that. It is 12:30, and I have orders for my little boy, so I can get him settled as soon as he arrives.
Checking on my patient in Room 412, I find him again having jerky tremors and wearing a frown. I give him more medicine, then I call his doctor and ask for an order for a continuous drip. This sliding in and out of pain and agitation is hard on him - and on his family. A continuous drip will deliver a metered amount of the drug every hour. I order the drip from our infusion center, and they agree to deliver it as soon as possible.
It’s 1:30, and I have actually had time to sit down and eat my lunch - a diet entrée I brought from home. On this rare day, all of us nurses eat together.
Out again to check on my charges, I find the patient in room 406 becoming agitated again and short of breath, so I give him a bolus of morphine and titrate his pump up by 1 mg per hour, then I give him some Ativan and call his doctor and ask for an additional drip - one of Ativan. I get the order and fax it off to the infusion center. Now I am waiting for two drips.
2:30 and my young patient has not arrived. We nurses are all anxious about his admission. Each in our own way, we dread having young patients. It seems so wrong for them to be dying, never having had a chance to live a full life.
I check on my patients and all is well for now. The drips arrive at the same time, and I am tied up for nearly an hour getting them started. In addition to programming a new pump for my patient in room 406, I must start another subcutaneous infusion site.
3:30 and still no word from our youngster. The phone rings, and when our secretary answers, she quickly hands the phone to me. There has been a scene at the home of our little boy involving his divorced parents. His father has taken him to his house, and his mother has called the police to report his father for violation of their custody agreement. The police have arrested the father and returned the child to his mother. Whew. What a mess.
At 4:30, our little man arrives with his mother. He is hysterical. Hysteria is not uncommon in patients with brain cancer, but this little boy has been torn from his mother’s arms, retrieved by the police and taken to a strange place where all he sees is nurses in scrubs, never mind that we are all dressed in soothing pastels. All he sees is strangers dressed just like all the other strangers who have prodded and poked and in general assaulted him with chemo and radiation and needles.
I shoo everyone out of the room, then I leave myself. These people deserve some peace, and it is my job to make sure they have some.
I tend to my other patients, both of whom are resting quietly.
Then I spend an hour sorting out the medicines that arrived with our eight year old. He has been in hospice care at home for some time, and there are many drugs to sort through. I separate out the opioids and lock them in the med room. The others, I take to his mother so she can administer them to him as she did at home.
Ester, my great friend and hospice mentor, checks on my other patients for me. I didn’t have to ask her. Teamwork is what makes this possible. Without it, we would all sink under the burden of all that this job piles on our heads - frustration, sadness, feeling torn between patients, and yes, fatigue.
Back on my feet, I reclaim my patients and prepare to give report to the night nurses. They will start arriving around 6:30, and I want to be prepared to give them a coherent and factual report.
At 6:45, we count opioids and the count is correct. My flow sheets for continuous drips are in order, so I give report, pass along the flow sheets and other medication records, and prepare to leave.
I drive home in the dark, just as I had arrived in the dark. Daylight savings time will start this weekend, so I can look forward to leaving during daylight on Monday afternoon. My dogs are happy to see me and I them. I feed them and sit on the deck while they play and take care of business.
A hot bath with the jets running in the tub - then off to bed, where I write a little but mostly stare blankly at the TV. 4:45 AM will be here soon after I close my eyes.
© cj Schlottman 03/13/2011