My most interesting patient

I am honestly having a hard time remembering my first patient in the hospital, but do remember it being the first time that I would have to try and get someone on a bedpan by myself.  In the nursing home, we teamed up a lot to work faster.  But now, we had to learn to manage our time as well.  It took me around an hour to get this poor person on the bedpan, wait for them to finish, and get them off and clean them.  And guess what?? It spilled.  So, now, after making a bed on a bedridden patient, I had to do it all over again.  It was horrible.  I kept thinking, “This is NOT what I signed up to do”.  It was not until later that I truly learned how important it was to know everything from the ground up about skills and how to care for a patient because I would certainly be training, delegating, and evaluating those who were also going to be doing these things. 

We finally got to give medications through the IV, in addition to starting IV lines.  My first patient that I started an IV on was a forty year old man who had Diabetes Type I, and numerous complications from it.  I can still see his face grimacing from such pain.  His kidneys had failed from diabetic nephropathy, his lower limbs had experienced diabetic neuropathy, renal hypertension, and he peripheral vascular disease with NUMEROUS arterial ulcerations that had become ridden with gangrene.  It was just awful.  He was a very sweet man, but looked like he had lived a very hard life. 

His current IV line was old and he needed a new one.  In addition, he had just gotten an order for surgery to amputate both legs below the knees.  I had to put in a really big IV since he was going to surgery and it was not going to be easy.  But I managed to strike oil with the first try (and I’m sure this poor patient was happy too).  I went in later to give an IV push antibiotic and ended up sticking myself with the needle (this was before hospitals had gone to primarily needleless systems.  I rushed out of the room and began to cry.  I was so upset.  Now I get embarrassed thinking about all of my ramblings about how I had waited until I was married to have sex, and now I was gonna contract Aids and hepatitis anyway from a freaking patient.  Living right did me no good at all!! I had no evidence that this patient had any diseases other than the non-communicable ones that I listed above.  But really, the guys looked like he had probably gotten around.  A lot.  It wasn’t like I had been stuck with a needle from some little 80 year old grandmother (not that they couldn’t have anything either).  But I just knew right then and there that I was going to die.

So, down to the Emergency Room we went and they drew a bunch of blood to run mine for HIV, hepatitis, etc.  Of course, my was negative.  But they were going to have to ask for the patient’s consent to test him, which he thankfully gave.  I was so worried all week that I would periodically call his hospital room just to hear his voice to see if he was alive.  Of course I’d hang up immediately.  I know that was horrible of me, but I was so scared that he had something and was going to die and I needed to know his status – at least I thought I did.  Anyway, all of his tests came back negative also.  Boy, that was a stressful time!

The following week, the same patient was there in the hospital after having his bilateral amputations of the lower legs.  I got to do an entire teaching session on “Phantom Pains” while my instructor watched and listened.  He was so excited to know that it was normal for him to still feel pain in his lower legs and feet even though they weren’t there anymore!! He understood then that part of the nerve was left, and yet severed, so it was confused.  He even smiled.

That poor man.  I came back the third week and he was somebody else’s patient, but was going to have to have both upper limbs amputated as well.  He would be only a torso.  He was clearly getting depressed.  Completely understandable.  He had a young daughter and was divorced.  I never saw him after that clinical.  I have a feeling he probably passed away soon after as he continued to deteriorate. 

I have to admit though, when asked in an interview who my most interesting patient was, he came to mind. 

Clinicals in the Nursing Home

As a first semester nursing student, you typically do some rotations within the nursing home. (This is, unless where you live has a lot of clinical space at the hospitals, which was not the case where I was.) The day before the clinical, you must go to the facility and get information on the patient which you are assigned. This can take quite a bit of time depending upon which patient you get. Most of the patients in the nursing home have charts that look like novels, and usually are broken down into more than one continuation of their chart. It’s really hard to find where and when problems originated, which is part of the information you are to collect. After doing this, we would go into the room and say hello and let them know that we would be their student nurse the next day. Okay, so I would probably freak out if I knew I had somebody practicing on me. But these folks LOVED having students. And the staff did too; it really helped them out! The nursing home residents would get extra attention and some interesting conversation for the day. I met some of the most interesting people during my clinical experiences.

Although it was a few clinicals later until I got to give medications, I remember just about freaking out over how many pills these people could take. And then you’d crush them all and mix them up in applesauce, YUK!!! Sometimes you would get residents that would refuse their meds, or spit them out at you. It was totally impossible to know how much of what medication they actually took in and how much they had spit out. This made it extra difficult when we would try to evaluate if a new medication was actually working.

Overall, aside from the smell that you pretty much have to get used to, the nursing home is a pretty good place to work. I can say this from experience as a nurse manager now. But at the time, I swore up and down that I would NEVER EVER in a MILLION YEARS work in a nursing home. Yeah, I’ve done a ton of stuff I said I wouldn’t do. Eating my words……is that how I gained that weight?