Service...

Over my winter break I had many opportunities to catch up with friends and family, which meant I talked about what I've been doing for the past few months many times over. In doing so much talking about what I've been doing, I had the chance to reflect upon my experiences more and engage in a number of different conversations. Ultimately, it made me more aware of the fact that I'm very much engaged in all of the core tenets of this program. They are: Serving the poor and marginalized; living simply; living in community; and personal/spiritual growth/development. I'd like to spend some time blogging about my experiences in each of these.

At the end of 2010 I wasn't feeling like I was getting the full effect of serving the poor. My role at SFMC has me often interacting with a great number of patients but in very short interactions. I often will spend 2 minutes of less with a patient. While many of our patients come from poor environments, I don't often get to hear there stories. I was feeling like I was serving the nurses and staff at SFMC who serve the poor rather than serving the poor.

Last week I met and interacted with a patient who made me realize this isn't true. I got to work on Monday to find that I would be covering a float from the 6th floor. I had a few nurses remind me that I was not to do his work, but rather get my job done as covering RN (Initial Assessment, a note and IV piggyback and push meds) and go about my business helping others on the floor. Well, one of our patients was...challenging. She was very frustrating with the care she had received thus far (She was at SFMC late December, they found a small bowel obstruction and she left AMA-Against Medical Advice. Of course, she came back about a week later). She had surgery a few days prior. She was most disenchanted by her pain control. She has breast cancer and was taking 10mg morphine (A hearty dose) at home every 4 hours as needed.

I tried to listen to her concerns and offer some solutions, apologizes and gather more information; however, she was very tired of telling so many people the same story. During this interaction she complained to me about things I had nothing to do with and had no control over and didn't want to listen to anything that I had to say about things that I could do for her. After a challengling initial interaction and assessment we got out of the room and onto our other 4 patients. Fortunately, the surgeon came by and I told him before he went in the room what's been transpiring. He wasn't surprised. In fact, I believe it went something like this:

Me: "Hey Dr. Stafford, I'm really glad you're here!"
Dr. Stafford: "You have the patient in bed 14 today don't you?"

Clearly, this was nothing new for her. Ultimately, he changes her pain medication. She had a PCA-patient controlled analgesia (The one where the patient pushes the button when they want medication). He increased her settings. She went from getting 2mg continuous infusion every hour and 2mg on demand every 5 minutes to 2mg continuous to 5mg every 15 minutes. She was still frustrated she had to push the button and wanted to just be able to get the 10mg every four hours as need. The PCA didn't go higher and Dr. Stafford convinced her to stick with the PCA. Oh, he also took off the bandage on her abdominal incision.

I'm covering someone for break around noon at the front nurses' station. I get a call from the LVN saying that she wants me to come look at some drainage from the incision. I ask why he doesn't look at it. He says he did, but she wants me to see it. I tell him that I'm covering someone for break and didn't have time but that I'd be back later. This is especially frustrating because I feel like I was babysitting this man in several ways and compound that with this difficult patient just made for a stressful day. She had taken to me a bit and vented her disdain for him. Part of this came from the 4 hour delay in getting her thyroid medication. She has hyperthyroidism, which can cause your emotions to get elevated and somewhat manic (explains a lot).

After I was done covering, I head back to the nurses' station where he was (we have 3 stations on our floor-8100, 8200 and 8300). Mayra, our charge nurse for the day and an overall great nurse, told me she went in and looked at the wound per the patient's request. She said it was fine. I went and looked. A scant amount of serous (clear) drainage. Very minimal redness. Dr. Stafford had apparently told her, right before leaving, his main concern was infection. While that is his job and he is totally right, it seems she interpreted his concern as something very great. To keep a long story from getting too longer here is a snapshot of the next hour:

Pharmacist at desk working on getting thyroid medication dose
LVN working on thyroid medication with pharmacist
Charge nurse calling surgeon
Nurse manager getting filled in on the entire situation
Myself-feeling very caught in the middle

I go in and talk to her. Surgeon orders prophylactic antibiotic. Manager talks to patient. Charge nurse fills in patient on her conversation with surgeon. I educate her on types of drainage and what they mean. LVN gets her the thyroid medication. I stay after the others leave (since I don't have anything else that I need to do as I'm a VSC and don't have my own patients) and talk to her. I come to find out the following:

-She lost her job last june
-She is unmarried and lost her only son when he was my age (I'm not sure when. the date was July 4th-I was under the impression it was 2010; however, based on a picture she had of him and her age I'm not sure. Either way she lost her only son)
-She lost her health benefits in the fall
-That happened around the time she was diagnosed with terminal breast cancer with metastases.

Quite frankly, I'd say her outlook was pretty great. She and I talked. She acknowledged she was a terrible patient and appreciated a lot of things happening. She had come to like me by this point in the afternoon and I to her. Later in the day she told me she apologized to the LVN for being rude and had a short conversation with her. I enjoyed our conversation and was glad I got past the challenges in order to get to know who she was as a person, not just the snapshot of her as a patient in the hospital

I saw her again Wednesday when I popped in to say hey. She was doing better, still not great, but was on the right track. She was thankful I stopped in and we chatted for a bit about stuff. A bit about her status and clinical stuff, but mostly just talked about stuff. I went in the next day a couple times. It was the day before her birthday, I wished her a happy birthday and said I'd be off until Monday. Hopefully she has since been discharged. I don't imagine she'll still be there tomorrow. Maybe.

Collectively, I spent a good number of hours in her room. I got a hug from her before I left Thursday. Quite the turn around from Monday. I think I would have had a good connection with her even if I was a staff nurse and she was my patient; however, I think that because I had the time to devote to her I got a deeper connection. That right there is part of why my role as a VSC RN is special. That is how I serve our patients.