Patience with Patients

pa·tience

ˈpāSHəns/

noun

1. 1.

   the capacity to accept or tolerate delay, trouble, or suffering without getting angry or upset.

   
   

   
   

   My patience was tested last night.  It was the first time in a year and a half I had to go to someone and ask them to go deal with my patient because I was getting frustrated.  An 18 year old should be dealt with at an adult hospital.  I understand some of them are seen at a Children's hospital and followed because the hospital knows them, but when they need resources that our hospital does not provide they need to be transferred out.  

   
   

   There was no working telephone number for a family member so the history was vague.  Who drops their child off no matter what their age and does not fill in the medical personnel that will be taking care of the person?  It took myself, two nursing assistants, another nurse, and two doctors to try to get through to the patient and we were still unsuccessful.  

   
   

   Why did I get so frustrated?  I usually can deal with most and have no issues, but I struggled.  I need to learn how to not get frustrated and remain calm.  However, I am glad I was able to walk away from the situation and find other help for the patient.  Some people cannot walk away from frustration and they end up becoming violent.  We must be able to tolerate a lot in our field and patience is something we can always work on.  

What is your purpose?

Do you ever ask yourself what is your purpose in life?  I have been contemplating this question since July.  When I was in a relationship with Ale, it felt like it was "the one."  After many months of a boring relationship and a guy who was unable to keep up with my adventurous self, I decided to move on and focus on me.

In the past few months my focus has been children.  Every time I go to work I want to bring a child home.  I have baby fever.  The only thing is….there is no baby daddy.  I contemplate finding a sperm donor and having a child that way.  But then how do you explain to your child that you bought them off of the internet and created them that way.  Ever since I have taken care of a child that was abused, I have thought about fostering a child.  Our camp director has fostered two children and I see the love she gives this little boy and the difference she is making in his life.  

The other morning there was a little girl who was diagnosed with T-cell ALL.  She is sick.  When she woke up at 4 am crying from a stomach ache, she was all alone.  I decided to get some cinnamon toast crunch and milk and sit on her bed and talk with her while she ate.  She immediately felt better.  I asked her if I could take her for a ride.  We went down to the main lobby and sat and watched the snow fall.   She rested her head on my chest and I played with her hair.  She looked up at me and said, "I wish you were my mom.  My mom thinks that my other brothers and sisters are important but what if this is my last Christmas?  She is not even here to watch the first snow with me.  You are taking care of many kids and you find the time to make my day."  She wrapped her arms around me and I started crying immediately.

The next day the papers I inquired about for foster care over two months ago arrived.  Obviously this is a sign.  The paperwork is in process and hopefully in about 6 months I will be able to foster my first child.

Our life may not be picture perfect like we imagined at 16 years old.  However, you will figure out what you are meant to do to contribute back to this world.    

Interact with love

Love and Interaction.

I feel like these are the only two words that you need to learn to become a parent.  After spending the past two months working in a pediatric setting I have learned a lot. 

Ever since I was young, I always played the mother in a house setting.  I always set my baby dolls up (the few I had because I was usually playing flag football or letting my dad shoot hockey pucks at my face in the driveway) and played house, always being the mother to them.  When I went to Italy, I was called the “mom” of the group because I brought along a TIDE to go pen (Who would go out of the country for 3 weeks without one?) 

A nurse is a mother, a father, a sister, a brother, a family member that you did not have when you walked in the door.  We act as the support for both the patient and their family members. 

All you need to show a kid that you care is love and interaction.  They want you to interact with them.  Nothing makes me more upset than when a child is trying to talk to a parent or cuddle with them and they are more worried about checking facebook or updating twitter.  When I was young, my mother never had technology to turn to instead of interacting with me.  I think I turned out just fine.  Next time you are in a cafeteria or out to eat, try doing this for me, look to see how many families actually interact or how many have ipads out or iphones.  It is obsurd to me how we rely on technology.  Call me old school but I believe in no telephones at the dinner table or in public places while interacting with others.  

Love and interaction.  Do not ignore the little things in life.  Interact with strangers.  Show your love to those you do not know.  You never know when the interaction of love will make a difference to someone. 

I've got confidence

Ive got Confidence.  I know my friends believe in meeee.  No matter what the day may bring, I know I can believe in me. 

Confidence can be destroyed very quickly.  I was confident in my nursing skills before.  When I left Henry Ford all that confidence was quickly lost. 

IV’s and blood draws…piece of cake for me.  There were times when other nurses would ask me to start their IV.  It was just something I picked up on because of my great preceptor, Matt, at St. Charles.  When I was told I had to draw blood on a two month old I almost passed out.  Where was that confidence that I used to have?  Suddenly what you know is out the door and you are afraid.  Why was I afraid?  I have no clue, maybe because it is unfamiliar. 

We tend to become afraid when there is an unfamiliar situation.  However, why be afraid when we have support all around us?  God was not perfect, he failed at times so why can’t we fail?  We have grown up in a society where failure is looked down upon.  Failure is actually the best way to become stronger and more confident. 

I did not fail in that situation, I actually got the blood right away.  Thank god because the mom was staring at me, the baby was crying, and I was sweating bullets.  Another thank god that I did not pass out, as I have done in a hospital oh, three to four times before in front of coworkers. 

My confidence is now back where it was when I left Henry Ford Hospital in some aspect.  I do not give myself enough credit and I was reminded of that when this email popped up in my mailbox:

Hi All,

I just wanted to forward the kind words extended to Megan Maiani, one of our brand new IRP orientees.  Thank you, Megan, for stepping up and doing such a great job.  We are glad to have you here at CHM and part of the IRP team!

Thank you,

MANAGER (name removed for privacy) RN,BSN, ANM
@ Children's Hospital of Michigan

---

From: D, C
Sent: Sunday, December 01, 2013 10:38 PM
To: B, J
Subject: IRP Megan Maiani

Ms. Bowersock,

Hi I am the alternate charge RN and occasional fill in preceptor on 5 West.  I had the wonderful pleasure of precepting Megan a week ago or so and she was AMAZING.  She critcally thinks on the fly, takes wonderful care of pts and was on top of everything it was refreshing to precept her.  On 11/30 I was in charge and she was my IRP RN, when I found that out I wanted to do back flips.  I unfortunately had to give her the split assignment which she took with no complaint.  At 11p the NAM decided I can keep her for the whole night and I had an on call RN come in, so I unsplit Megan and brought her down to 3 pts.  Later that night I was paged with two pts both of them had different diagnoses but they oddly enough both had scabies, yuck!!  I assigned one to Megan and one to another RN but Megan volunteered to take both so only one RN would be exposed to the scabies.  I absolutely love working with Megan, kind of sad she is an IRP and not a 5 West RN.  Megan is an amazing team player and a very skilled RN and just a joy to work with.  I just wanted you to know that we on 5 west appreciate the IRP help we recieve.

Thank you,

C D, RN

This boosted my confidence overnight.  It is not something that makes your head bigger, but it makes you realize that you do not give yourself enough credit for what you do know.   Even though patients are different sized and experience different illnesses than what we are used to, they are all the same, they need help.   We criticize ourselves too much and try to always be better.  Sometimes we need to be content with what we have/are and know that we are making a difference, big or small.

So next time you are doubting your confidence, know that someone somewhere is appreciate and recognizing what you do.  You know more than you think, and you are better than what you expect.   

Use your words wisely

"Stop it, you guys are trying to kill me," is not a quote you would like to remember.  However, the events that transpired in this encounter have changed me for the better.

I was in the ED and we were covering trauma, which can be very boring if nothing is coming in.  My adventurous self decided to wander down to one of the pods and offer my help.  Little did I know I was signing myself up for two holds for IV starts on 5 year olds.

The little girl touched me the most.  She was five years old, and weighed more than I did.  I thought about how this all was going to go down as children are usually small and sometimes easy to hold.  Well, I held, another nurse attempted to started the IV.  IV's are not as easy in people who have an excess amount of skin on them.  It is a lot harder to feel for veins let alone see them.

I crawled up on the stretcher and started to ask the patient questions to keep her mind off of what the nurse was setting up.  She kind of half answered me and then we grew silent and started watching Curious George.   She grabbed my hand and started to play with it.  Where else can you watch cartoons and snuggle with a child at 4 am while working?

She started to cry and get upset….this is when the battle began.  Her mom held her and I held her arm.

We found a great vein.  The other nurse went for it and there was no flashback of blood.  As she tried to find the vein the little girl was screaming louder than any child Ive ever heard.  She was thrashing, kicking, screaming, hyperventilating and I had to remind her to breathe.  She would stop every so often and go, "Hey guys," "yes, I would say," "Just take it out."  It was hard not to laugh at this little voice and smile trying to break through.

Unsuccessful.  Begin second attempt.

I let her feel my veins and showed her how we figure out which vein to pick to distract her.  I came up with the explanation that our blue squiggles are like straws.  When we drink juice through a straw it takes the juice to our stomach where we need to get the vitamins.  Our blue squiggles take our blood through our body like a straw to help us live.  I told her we needed to put a straw in her blue squiggles to take the water through her body to help her live.  She looked at me like I was crazy.  However, it calmed her down.

She would say, "It tickles," while we were trying to start the IV and it just made me laugh every time.  The second attempt she wanted to sit by herself.  As soon as we started to go for the IV she became violent.  I had to sit behind her wrap my legs around her and hold onto the stretcher around her waist because she was bigger than me.  It kept breaking my heart to watch her become so traumatized by this experience.

Success.

Another nurse had come in to see what the commotion was and the little girl told her, "They are trying to put straws in my blue squiggles to help me live.  Its kind of like when you drink through a straw it helps your body live."

Kids listen to everything you say.  Use your words wisely as you never know what someone will comprehend from them.

Code Blue

Someone asked me if I had experienced a code blue before….

Why yes I sure have, and I will never forget the only code I have called myself instead of having a Dr. tell me to call it so we can react quickly.

P255.  The room in the corner that was so big.  There was so much room in there and there needed to be.  Two IV poles, 3 pumps, 10 chambers, one PCA pump, a foley, and a fecal management system.

2100-went in to hang TPN, lipids, and restring some tubing, pt resting comfortably
2200-went in to check on pt, noticed blood in tissues, he says, "oh I'm fine its just a little blood coming out when I spit" assess pt, look in his mouth: lots of blood.  look up nose: lots of blood.  look into tissues: clots of blood.
page Dr. on call-he comes, assess pt, looks at me in the hall and says "I have a bad feeling, I am glad I am off at 10.  When I think someone is going to die they usually do."  Great, thanks for the encouragement that I now have to be afraid each time I walk in the room
2230-PA on call for night asks for report, I tell her, she orders some meds after calling the fellow and tells me, "Watch him closely I don't have a good feeling about this"
fast forward
0400-hung vancomycin, pt resting comfortably
0445-go in to hang cef, blood all over the pt chest and back of bed, call Darryl (another RN) and say I need your help cleaning pt up.  VS: O2 sat 88%, HR 145, BP 90/50's, RR 14, pt states he feels fine.  Page PA on call and Rapid Response and PA shows up, Rapid will come if the status changes
0500-started drawing labs anticipating a code situation, and the PA looks at me and says I think we need to call it…I start to get dizzy because as I'm drawing blood its clotting immediately, blood is flowing into the rectal tube, clots are being spit up, I think DIC and I am going to be covered in blood by the patient I call grandpa and have a close relationship with.
0505-Darryl takes over because I need to sit, I am ready to faint
0510-I walk into hall and walk back in and hear grab a venti mask, o2 sat 68%
I immediately pull the code and call it in so they can call overhead, I can't lose him.

Pt is transferred to ICU, I tell him I will see him in a few days when he comes back to our floor, he's tough and he will just need a little extra support but will be back in no time.

I can't sleep.  I am tossing and turning.  I look at my phone, text from the Nursing Assistant telling me pt has decided to be DNR/DNI and is enrolling in hospice and coming back to the floor.

I prayed that P255 was taken by another patient already.  I cannot watch him die.  I have been with him since he was diagnosed, a healthy, fit man otherwise.  No luck, he is back in P255 and I have two days left to work.  Selfish….maybe.  However, unless you have watched someone close to you die, you do not have any clue how it pulls at your heart and you just want it to end.

I watched many people die on P2, but three have captured my heart.  They suffered.  It was a long battle.  It was scary.

I came back to work scared, hurt, quiet.  I talked with him during the brief moments of alertness.  On my third day I had to say goodbye.  I knew when I came back in 5 days he would be gone.  Vitals were in the hole and it wasn't going to be long.  He didn't wake up for many people, but he woke up for me. He kissed me on the cheek, squeezed my hand, and said thank you granddaughter.

He died a few hours after.

Code blue…its not the end, its the beginning.  It either starts a journey to recovery, or starts a new life.  For my pt, it started a new life.  A life where he was not suffering.  For me, it started a journey to recovery.  A journey that now teaches me that death is a struggle for me and is one of my weaknesses.

Life is a box of chocolates, you never know what you're gunna get

Life sure is testing my strength this week.  Everyone thinks that I am such a strong person, however they do not know that us strong people are quite the weak links at times.

I spent my whole drive home crying.  Crying because life is not fair.  Why are some of us so blessed and others are not?  Why do some get chance after chance and continue to mess up and others never get a second chance?

I sat next to a chaplain today at orientation.  However, it was not any chaplain.  It was the Henry Ford chaplain who helped me after L died.  He recognized me right away and thought I left HF because of L.  Kind of in a way I did.  But it was more than L.  It was L, M, and A.  Ironically, L's wife called today and asked me to come help her spread his ashes that he had mentioned to her he wanted me there.  He did not want any funeral or service, so I feel more than honored that he wanted his "granddaughter" there.  Numerous times he let me know that I was going to be his only granddaughter because his daughter was never going to have kids.  It still hurts 2 months later thinking of that day he told me goodbye.  I was sad from this point on.  I shouldn't be sad, I should be happy because death of someone means no pain, it means peace.

Seeing a camper go downhill in front of me….watching the doctors all congregated in the room trying to help.  That is going to be a huge task for me as I take care of these kids I know.  I have an emotional connection to them and I am going to have to put that aside

News of a camper facing a hurdle that could have possible been a huge hurdle and a game changer.  I thank God that he had different plans.

News of a camper becoming hospice stung like a bee.  We became close this year at camp as I spent every morning sitting with her while her companion went to breakfast.  We shared secrets, no worries I won't tell, and we built trust.  She asked me at camp if she was going to die since I was a nurse and nurses are supposed to know everything.  I told her the truth, "I did not know, but if you do I pray that you are at peace with your life you lived."  Never ever tell a patient they are not going to die.  You NEVER know.  Empty promises as a nurse are the worst mistake.

Then finally, news that one of my girls whom I have watched grow up in the fashion show has hours to live.  WHY?!?!  She is only 9.  She has lived 1/3 of the time I have.  Why can't that be me so she can drive a car, vote, or graduate from college?  Why am I so lucky?

I am lucky because God has a plan.  I shouldn't cry because others are unlucky.  I should celebrate life, and keep touching others lives.  I have already talked to two other camp directors.  This is the push I need to achieve something on my bucket list.  I want to attend all the camps in the US.  This year I will attend Arkansas in June, Ohio in July, and Michigan in August.  I will help more children.  I will give them comfort and help them live like children for a week.

Sometimes you need sadness to bring happiness.  You need bad to bring good.  Do something today to make someone else's life better.  Set a goal and achieve it.  When life hands you a box of chocolates, don't be picky…embrace it all and make do with what you got.    

The past is so easy to remember, the future is so hard to welcome

As I left Henry Ford I was happy.  A month later I am feeling a mix of emotions:

I am sad.  I miss my friends, I miss the familiar.  As a float nurse I get to learn a lot more than I ever expected.  I will know about so many diseases in a year instead of only cancer.  However, this is harder than I thought.

Where is Darryl, Crystal, Gina, Ashley or Chelsea when I need them?  They aren't behind me, they aren't down the hall.  These other nurses do not know how to read me.  They do not know when I am really thinking, "Shit is going bad quick…and I need help."  They do not know when I am thinking, "What the hell is this doctor thinking?"

I miss Matt.  I hated him on that first day of practicum and wanted to quit nursing school, only being 3 weeks away from graduation.  By the end, I loved him as a teacher and appreciated him keeping me for 2 hours past my 12 hour shift to teach me in the break room about stuff I did not learn yet.  I learned so much from him and can give him all the credit for molding me into a good nurse.  Most of my habits were learned from him, and they help me with my time management and ability to anticipate.

I miss Stella.  I will always remember my first preceptor as a RN.  She was my big sister I never had.  

Now I have a new preceptor on each unit.  Some are great.  Others are not.  However, we are not all good teachers and we are not all great learners.  I cannot be bias to Stella and Matt because they were great because you do not come across rainbows and butterflies your whole life.

A baby is life's greatest treasure.  I love grabbing a baby at 2 am and cuddling them and and feeding them.  I didn't hate dealing with adults, but let me tell you, feeding a baby at 2 am is much more happier to me than getting manhandled and strangled by a confused patient.

I haven't had to put a patient in a body bag in over a month.  Thats the longest I have went in over a year.  100% of my patients get discharged pretty healthy.  As a younger nurse, this is imperative to my success.  Starting off around so much death was beginning to ruin my perspective and attitude.  It has now been rejuvenated.

I work with a team.  Day shift does not leave anything for night shift to do.  WHAT?!?!  Yes, I said it.  It is not night shifts job or day shifts job to do a certain intervention.  It is EVERYONES job to do EVERYTHING and every patient is YOUR patient.  Amazing that there is that culture.  We eat lunch as a family at 1 am in the lunch room.  Everyone gives an update on their life, and this is time for many to share things that we understand.  It has fostered so much confidence in trusting those around me.

I miss Henry Ford.  I miss the Interns, I miss the Residents, I miss my friends, I miss my confidence.

I will be successful at CHM, as time will pass.  I will make more new friends, I will understand these doctors, I will gain confidence.  

Do not forget the past, remember it has made you what you are today.

New Beginnings

One of my friends told me that he was proud of me for taking my passion and going after it and achieving it.  I did not really think about it like that until he had pointed it out.  3 years ago, I began nursing school because I had a passion for being around sick children, thanks to Camp Quality and Payton Cram.  I never thought that 3 years later I would be getting ready to start working at a Children’s Hospital, let alone the job of my dreams. 

Scared.

I am scared.  I am going from a place where I was so comfortable with a majority of my co-workers and my patients to an unknown place.  Will my preceptor be as nice as Stella was and allow me to learn without making me feel uncomfortable?  Will I fit in with the nurses there?  Will the kids like me?  All these questions are going through my head and although I can answer them to the best of my ability, it still causes a bit of apprehension.  However, if there is a negative aspect to it, nursing is so diverse, we can move on. 

Excited.

I am excited.  I am going from a place where I was starting to feel out of place to a hospital where there are smiles and joy.  Working on the adult oncology unit, I was feeling more sadness than excitement the past few months.  I know kids are going to be sick and it will break my heart, but most of them are going to walk out of there smiling.  Next summer when I am in the ICU’s it may be different.  But for now, I am excited to have children wanting me to go to the playroom with them, color with them, and take care of them.  

Love.

I am loved.  I have all the support in the world from family and friends.  It means a lot when you are in such a demanding profession.  You have to rely on others in many aspects of your life. 

God. 

God is on my side no matter what.  I know that I left a great job to come to an even better one because God has a plan for me.  He knows what I am good at and he wants me to contribute to the worlds work in the community where I am placed.  

Do not be afraid, for I am with you <3

Overcoming Death

I had just taken my last walk out of Henry Ford and was smiling and happy because I knew my next adventure was bigger and better.  I was 3/4 of the way home and my mom texted me that my grandfather was taken by EMS to Oakwood Main (scary scary thought) as he was found on the front porch slumped over pretty out of it.   I told her I would go up there because he was just discharged less than 12 hours ago and something had to be wrong.  I wanted to talk to case workers and make sure he was not allowed to go home with anything less than 24 hour supervision.

After an hour went by while he was in triage, I began to get butterflies.  Normally, they would let a family member come back with a confused elderly patient.  They then moved us to our own private waiting room, put private do not enter signs on the door, and told us a nurse would be there soon to update us.  25 minutes went by and I found a clerk to go get a nurse.  I just wanted to know what was going on because the nurse in me knew something more serious was going on with the time it was taking.  I have learned over the past year that families need to know what is going on, even if you do not have answers, let them know you are working to find out.

I was not prepared for what was next.  "Virgil is sick.  He is intubated and we are headed to CT because his abdomen is swelling as we speak and we believe he is internally bleeding.  We have put a central line in and I will be back after I take him to CT."  I cried, and cried, and my uncle said, "Its not good is it Megan."  "Nope."  I knew what it was....either a AAA or a traumatic bleed of some sort.  The ER resident came in and explained that grandpa was very sick and they were doing all they could but we might want to get family there.  The nurse then came back and said he was back from CT, she just needed to hook him back up to the vent and she would be back for us.  An hour went by and I went to find someone.  It does not take an hour to hook someone up to a vent.

The doctor came out and explained what he thought went wrong.  He had no clue we were in the medical field and my sister and I looked at each other, rolled our eyes, and wanted to call him many names because his thought was obsurd.  Whatever, thanks for explaining, but say "I just don't know, don't say what you think."  I think that is was pisses me off the most about doctors, they never want to be wrong but are so afraid to admit they just don't know.  As a nurse, one patient told me that the thing they like most about me is if I don't know, I will find out.  Well duh....why beat around the bush.  Straight up tell someone you don't know but you will work to find out.

We finally got to see him, except for my sister.  He started coding and they shut the door.  He was rushed into surgery.  Two hours later the Dr. came out and started explaining what they did in the procedure and then said, "but he died."  Why get the families hopes up explaining everything that went on and then just end with, "but he died?"  Just give the bad news, don't try to be some sort of hero because to us at that moment, even though its not your fault, you are now the person we despise of the most given our circumstances.  All of the family began to cry and become emotional...but I, being a nurse and a very inquisitive person, started to ask questions.  He said that he did not know where the bleed came from but he was sure it wasn't a AAA.  How are you sure if you do not know?  Once again, we try to guess, but are afraid of just saying, "I do not know."

I could not comprehend death at this point.  This is what sucks about being in the medical field.  You begin to think, what if?  For a few days I do not think I realized he had passed away.  I of course tried to make jokes because thats what I do to lift the family up.  However, for my dad, losing his two parents 8 months apart, nothing really helped.

I went and got his medical records and am now at peace.  I found out why he died, and what killed him by reading back through a year of medical records.  Neglect.  Drs are so busy with the massive amount of patients they have that they often sign off on tests such as CT's and really do not do follow up.  He had a hematoma found last year in the same spot they found the bleed when he died.  It was recommended that followup be done until it was resolved since it was actively hemmorhaging and to stop blood thinners so that he would not bleed to death.  Well, thanks Dr. you overlooked that.

How many people are overlooked?  I urge you to get results of any test when you are hospitalized and ask questions.  Many doctors do not like me because I ask questions, but I am alive and so are my patients.  I do not regret not asking questions when my grandpa was in the hospital last December, but I trusted that the Drs knew what they were doing.  Now I doubt that and will always ask questions.

Be an advocate, your life is valuable.