Saturday, August 28, 2010

So I'm taking care of this dude who has cancer...

....really *bad* cancer, as in "you don't want this sort of cancer, ever" cancer, and I've just wasted about a half a milligram of hydromorphone more than was ordered in the tubing, so he's feeling pretty good.

So I lean over him, and I remind him that he should let me know if he's uncomfortable--because, what the hell, he's gonna die anyhow; the graft's fighting his body--and I'll bring him more meds. Even if it's not time. He doesn't need to know that; he just needs to know that once his pain hits a four on a one to ten scale, I'll be there with the happy drugs.

And he says to me, "How many counselling classes did you need to take before you learned how a person feels?"

I said, "None. It's all experience." I didn't tell him that grimacing and guarding and short, gasping breaths are indicators of pain, universally, that don't need a lot of training to recognize.

"Trial and error," he said, "that's bullshit."

"I've been doing this longer than I'm willing to admit" I said, "and you wouldn't believe the number of patients I killed before I got to you."

That brought a smile.

I'm sure there was some point, maybe working at Planned Parenthood or the abortion clinic, when I realized that what was coming out of the person's mouth didn't match what was on their face, or in their body language. I can't remember that particular moment, but looking back, I'm sure it happened like a lightning strike.

Ever since then, I've been much more conscious of what the person isn't telling me. I had one nursing instructor who bothered to touch her patients with an un-gloved hand, and I've followed her example ever since. Sometimes a simple skin-to-skin touch makes all the difference in letting somebody know that you're not just some sort of health-care-providing automaton; you're a person like them who actually gives a damn what they're feeling.

If I have to hurt somebody by starting an IV or a catheter, I try to touch them just afterwards without gloves on, just to make sure that their last memory of the whatever-it-was isn't plastic and pain. Sometimes I even hug my patients without a gown on, zut alors! despite the rules.

By the same token, sometimes it's best to just shut the hell up. The dude I was working with was worried that his insurance wouldn't cover his return to the ICU. I let him vent for about ten minutes about how stupid his insurance company was, and it helped. His heart rate went down, his blood pressure dropped. Shutting up and being a body in the room who's attentive is a therapeutic intervention just as much as a Cardene drip is.

And as much as I hate to admit it, a lot of nursing has to do with intuition and gut feelings. We don't get trained in intuition, but we all use it. You have to develop the skill, and so you do.

11 comments:

Anonymous said...

And if you are not able/willing to develop the intuition, you are a nurse but not a great nurse - like Jo! I had a professor once (not in nursing) who said that nurses were perceived as the most trustworthy group of professionals - more than docs, cops, etc.

Erica Rose said...

I'm filing allllll of your amazing nursing wisdom away in a file in my head, "How to me a kickass nurse like Jo". Thanks you for your blog.

RehabNurse said...

I'm with you, Jo.

This ain't all rocket science, as one of my instructors said. A lot is common sense, which can be sorely lacking these days.

me said...

Amen.

Middle-aged Diva said...

I ever need a nurse, Jo, I hope it's someone like you. I mean, I hope i never do. But chances are one day I will and boy, it's good to know there are nurses like you.

messymimi said...

Become a mentor to younger nurses. The world needs more like you.

'Drea said...

I think you have to care enough to watch faces and body language. I also think you have to trust your intuition and a lot of people don't.

I'm glad that you were able to make your patient smile...

Carolyn said...

I'm starting nursing school- today, actually!
And this kind of post on this kind of blog is one small part of what motivates and inspires me to do well and get my RN so I can help people and have a rewarding (albeit very challenging) career. Thank you!

Mr. C. said...

Stay tuned Carolyn, you will learn a lot about nursing here that your instructors don't have the time to teach you, although they wish they could....

REH said...

Nurses like you absolutely make life so much better instead of "just shoot me now" when you are inpatient for the umpteenth time. Thank you so much for caring enough to develop/use your intuition and for passing on the encouragement for others to do the same.

medrninja said...

So. True. Now if only (many, most?) Doctors would dare to step a toe out of the Temple of Science, put aside those blessed journals and sacred tomes (*gasp*), get their hands (and hearts) dirty for once, and figure this out too...

I needed to hear this today. Go Jo. My Hero :)