Tuesday, August 24, 2010

Rock, Paper, Scissors

I'm proud of this reflection, and of the day. My professor is using this paper as an exemplar.

Rock, paper, scissors. That’s how we determined who would watch the paracentesis. There were three of us students, but only one would be allowed into the room.

Marco the porter had clued us in to the situation. While we waited by the empty gurney, we played the kid’s game to decide who got to see the good stuff.
I lost right away. Damn.

So which patient is it, anyway? I asked Marco. He pointed to one of the rooms. Oh. One of mine. Double damn. She was an end-stage liver patient. When the CNA, (Ana) and I went in for her vitals that morning, she was on 5L O2 and never opened her eyes. He daughter was lying on a cot in the corner. She told us that her mom had fought the mask the night before. It was a rough night and she was exhausted.

My clinical instructor, 'Linda', found us and asked what was going on. We told her the situation and she tried her best to get us all in (she’s fantastic, by the way). No luck. She asked us what would cause edema in end-stage liver failure. One guess was portal hypertension. I threw out my idea; the liver was no longer making albumin, so without it, water was leaving the vessels. Linda smiled. I had my gold star for the day. But I still wasn’t going downstairs.

I kept my ears open and later found out that my patient was not coming back up, but was being transferred to the ICU instead. Ana and I went to her room to help her daughter load up their stuff to take downstairs.

On the way down, she started crying. I put my hand on her shoulder and told her it was ok to cry. She said she was afraid that they wouldn’t let her stay in the ICU, and if that were the case, she’d sleep outside the door if she had to. I told her that to my knowledge, they would let her stay (my mother-in-law had been allowed to stay with my father-in-law in the same ICU for several days). Then she talked a little about her mom, about what she meant to her.

When we got downstairs, I asked one of the nurses right away if she’d be allowed to stay, and of course she was. I helped her unload, and she thanked me for listening. She’d come out to Colorado expecting her mom to recover after a couple of days. That was a month and a half ago. They had no one else in town.

Later when we debriefed at the end of the day, we heard about the paracentesis. Yes, I still wish I could have seen it, but then I would have missed helping my patient’s daughter. In the end, I think I was in the right place. This is the kind of nurse I want to be; one who remembers that her patients are people with families and lives outside of their disease. By helping her daughter, I indirectly helped her.


  1. By helping her daughter, you helped her more than you think. Modern medicine has taken on a "fast-food" air that too often leaves the family left out. My sister-in-law is a PSA at the hospital here and from what she tells me, nurses are so overloaded that they couldn't really help a family member like that even if the thought occurred to them from the depths of exhaustion.

  2. Very nice Miss Nurse Ninja. It's so dehumanizing and frightening to be riding the medical conveyor belt. Any human touch is so appreciated.

  3. Amen. Medicine has a in-and-out feeling now that is sickening, and like meno said, very dehumanizing. That few minutes you spent with that lady's daughter is probably the only one-on-one time she had in that entire time that really felt authentic, because it WAS. Gold star for you. *smile*