Day Two

Second day and I am still figuring out me way around the ward, the rooms number sequence jumps around as the ward is almost figure eight shaped with the reception desk in the middle. When the call bell lights up above the desk with the room number that is calling I have to walk round the ward mentally before I can figure out where the room is.

Attended handover again today, a lot of the nurses get on well and its a nice atmosphere to start the day in. There does seem to be little cliques of nurses, particularly the enrolled nurses (ENs) who stick together and all obviously have decades of experience, the new grad RNs who get higher pay and responsibility than the ENs, making both groups slightly defensive and resentful. Already I can see there is a lot of political play.

First job of the morning was for the nurse and I to assist a man to empty his ostomy bag as he struggled seeing what he was doing and had uncooperative hands. This was my first real interaction involving offensive body functions and as the nurse drained the bag into a jug I was momentarily taken aback. The odour was very strong and thick and permeated throughout the room and corridor. I focused on keeping my best poker face, we had been told to watch and monitor facial expression as clearly they could hurt the patients feelings and were unprofessional. But shortly I stopped focusing on my own reaction and took note of the patient. He was clearly embarrassed and distressed through the whole process, he appeared queasy and struggled to reseal the bag at the end. I was immediately ashamed of my initial reaction and felt only for the man who sat there frustrated with himself as the nurse gently explained how to fold up and seal the ends of the bag. As much as this now sounds like a badly written sob story, this was a big event for me. This man who had been diagnosed with cancer and gone through difficult and painful treatment had now come to us. His rehabilitation sounded simple compared to others. He had to learn how to live with his colostomy when others had to relearn how to walk. But I realised that to this patient it was the massive step before he could go home. 

My preceptor said to me afterwards that teaching the steps of ostomy care was the simple way of beginning to teach a much more difficult lesson, helping the patient regain confidence, independence, and dignity.

So another level of understanding and it wasn't even 8am.

I was allowed to perform the obs today by myself. Everything went smoothly until the 5th and final patient who was very thin and consequently had a much smaller upper arm. I attempted to change the blood pressure cuff attached to the machine to that of a smaller size, however somewhere in the process the machine stopped working and when I turned it back on was greeted with ERROR display. I returned the machine to its spot and worried obsessively until another nurse said they are highly temperamental and it happens all the time. Relieved I didn't now owe the hospital several thousand dollars for equipment I charted the obs. This was a joy in itself, the observation charts, as with all paperwork, are legal documents and very official looking. I felt rather important and awfully like I was on House or Grey's Anatomy, minus the ridiculously dashing doctors. 

I emptied a night (urine) bag and measured the output, then I observed a line removal, and the rest of the day seemed like it would be fairly steady. That is until I hear yelling and the sound of the emergency bell going off down the corridor. My heart skipped a beat and I was ready to run in and do CPR (I jest of course), then it all quietened down. A short discussion with the nurse at reception revealed that we had a new patient admission from a medical ward. She had come in to hospital for an operation which was now all sorted but due to the anesthetic she now had post-op delirium. I was surprised to discover that this is relatively common in older patients who can simply take days or even weeks to recover from anesthetic induced delirium (strangely it is also worse if the patient has a UTI). This new patient, understandably further confused by the change in environment, had become violent threatening staff and other patients with cutlery and a walking stick. She had been calmed and placed under the care of a special, a carer specifically trained to watch one patient during the whole shift to ensure no harm comes to the patient or others. 

Witnessed an ugly situation of a patient with very reduced quality of life who has expressed his wishes to go to the hospice essentially to pass away. However his family are holding on and creating barriers at every turn to delay the process, not for love of the patient but because they are arguing over money involved in the patients will et cetera. An extremely sad thing to be a part of, the family's attitude disgusts me and I want to go up to them and shake them all. I simply cannot understand how people can think like that. Alas I am unable to act in any way other than be a positive presence in the patients day, and here I think that at this stage a smile is my greatest weapon.

Later on medication rounds I spilt a cup of liquid panadol that was sitting on the table. Reaching to pick up the patients glasses I knocked the panadol all over the floor in a massive sticky white mess. I was red faced as I tried to clean it up (an extremely difficult task, it stick and slimed on everything) but the patient burst out in rolls of laughter and seemed delighted she didn't have to take the foul tasting stuff. From then on she was given a better tasting crushed form of panadol, so silver linings and such.

Daily reflection - I didn't think I would enjoy work with the elderly, but I am loving it so far. They are used to people caring for them and for the most part seem comfortable with nakedness which has in turn made me more comfortable. They are very funny and endearing, I suppose that when you get to that age you are wise enough to take everything with a bit of humour. One patient is barely skin and bone but loves the radio and has the cheekiest smile, another winked conspiratorially at me before passing wind in the preceptors face, others are fiercely independent. But  no matter who you are attending to you are immediately viewed as a nurse. The student part of your introduction seems to fall on deaf ears. So although the patients and their families think you know everything you have to remind yourself that you haven't even scratched the surface.