North Carolina

Well, it is back to the real world after spending a little over a week in North Carolina. In fact, I have to leave for work in about 45 minutes. It sure is hard to have the motivation to go back to work when you have had 2 weeks off. We had a really good time in North Carolina. Highlights include wakeboarding and tubing on Bobby's boat, Chris getting a tattoo (yes, I finally gave in), celebrating Bobby's 30th birthday, and hours and hours of Yahtzee. Of course the family time was also a bonus. Heidi and Bobbo are so cute and so much fun. We stayed in a timeshare and right out our back patio was a huge pond with geese and tons of turtles. The turtles would all huddle together under a bridge in the water and you could pretty much feed them anything. A short walk away was a miniature golf course and a pool. We also were sure to fit in a lot of craft time. Camille brought some supplies and taught Alicia and me how to make these cute Kleenex covers and we also made some cards as well. We even made a trip to a local scrapbook store and I got some cute stuff. The girls also took an earring making class. I made a pair of dangly earring that I probably won't ever wear, but it was still fun to make. The boys spent most of their time out on the boat. We played mini golf twice. The first time was just the girls and kids and I won! The second time was the whole fam and I got second place to Chris Krieger. Ugg! After I had talked so much smack about beating him, he took the gold. On Sunday, the day before we left, Chris and his brother finally went to go and get their matching tattoos. Apparently tattoos on the ribs really hurt. I had a good time laughing at the boys at all the funny faces they were making. It was a really nice trip and we pray that Bobby is safe on this deployment.

On a side note, Chris and I just joined Courtsports Athletic Club. I have already worked out once and really enjoyed it. My hope is that paying money every month will be my motivation to get my tush in gear and start working out regularly. I will keep you posted!

Here are just a few pictures from our trip. They are out of order but I don't feel like taking the time to fix them.

Such a cute girl!

Playing with her new Barbie clothes (thanks to Aunt Brittany)

Brothers with their matching tattoos


Chris and Bobby with the tattoo artist, Nick

One of the many painful looks

Father and sons

We thought it was just a turtle on the side of the road...

And found it was actually laying eggs!

My athletic hubby wakeboarding

Uncle Chris taking Heidi out on the tube for her first time

Uncle Chris and Bobby on the tube

Heidi and Uncle Chris

One of our finished craft projects

Yahtzee!

It isn't always glamorous being a nurse

Have you ever digitally removed feces from someone's rectum? I have. Good times. I think I deserve a new Coach purse...

Bowel care is VERY important for hospitalized patients. It is something that is supposed to be addressed every shift and most patients have a standard bowel care protocol. We prefer that patients have BMs ever day but we try not to let it go longer than 2 days. One way that I have added a little spice to my job is to make a little competition out of providing bowel care. Another nurse and I have made a game. We award ourselves an imaginary gold star for every suppository that we administer on our shift. So when I give a patient a suppository, I go and tell Cassondra that I just got a gold star. We don't officially keep track of gold stars or anything, but it makes us feel better about our embedded obsession with shadoobies. We may be nerds, but it gives us something to laugh about. Bowel care rules!

Ethical dilemma

In nursing school we learned all about ethical issues surrounding nursing. At OSU I also took a medical ethics class as well. These past 2 days at work I actually got to experience a situation that involved an ethical dilemma and I just want to say that I don't like it! I took care of a 60 year old male who was in a car accident in which he had been drinking and suffered a closed head injury. He has already been in the hospital for about a month and was not making much progress. He apparently wasn't following commands and didn't even seem conscious, although he could move most of his extremities. When I started to care for him, his wife had decided to make him comfort care. This means that it was thought that his death was inevitable and we weren't going to do any extra measure to sustain his life. His tube feedings had been discontinued, we weren't taking vital signs or doing nursing assessments, and we weren't drawing any lab work. Basically we were trying to make him as comfortable as possible so that he could pass. My first night as his nurse, he squeezed my hand on command and wiggled his toes on command. I was sure to chart my findings and reported to the day nurse what he had done. That day his family met with the doctor, an ethics committee person, pastoral care, and a few other people to discuss his course of treatment once more. I was told by the day nurse that his wife wanted to continue with comfort care but the patient's mother and sister wanted to start feeding him again. It was ultimately decided to keep him on comfort care and transfer him to a nursing home. Last night as my patient, I was in his room and told him that my name was Brittany and I would be his nurse again that night. He very very softly whispered, "Hi, Brittany." I was in shock so I asked him to say that again. He repeated, "Hi, Brittany." I wasn't quite sure if I had heard right still because he didn't always follow commands and he hadn't spoken yet. I also wasn't sure if I just wanted him to be making improvements and was hearing what I wanted to. Later during my shift, I had a CNA in with me to help reposition him and I asked him to say hi. He did! I also asked him to say Brittany which he did also! He then stuck his tongue out on command, squeezed my hand, and wiggled his toes. I knew that he was still in there and it just broke my heart that we were literally starving him to death. When day shift came on, I took them into his room to try to get him to "show off" to the day nurse. The only commands that he followed was sticking out his tongue and wiggling his toes. I really wanted him to say something and after some persuading, he finally whispered "bye". I discussed him with the day nurse and deep down we both fear that nothing will change with his situation, despite these huge improvements. He can move all extremities well except for his left arm and I feel that if we start his tube feedings again to give him energy (he is literally skin and bones as he has been without food for over 4 days now), and he starts to be more consistent with following commands, he could start getting up with PT and make some sort of recovery. Apparently his wife said that he would not want a poor quality of life and wouldn't want to be kept alive with extra measures. Well, he is only 60 years old and is making big changes! I have seen patients on neuro who weren't expected to live and ended up walking out of the hospital. Sometimes it just takes time! Uhhhh! Unfortunately I have done all that I can do and this situation is out of my hands. All I can do is just pray for him and hope that he is given a chance.

*Update*
So at work last night, I saw that this patient had been discharged. I asked one of my coworkers what had happened with him. He said that he was this patient's nurse the night adter I was and that the doctor had seen my notes on his progress. He had discontinued the comfort care and restarted the tube feedings as well as other multidisciplinary therapies, such as PT, OT, and speech. PT apparently got him out of bed into a chair. Unfortunately, the patient was still inconsistent with demonstrating commands. The next day the doctor had another palliative care meeting with the family and said that although he could continue to slowly regain function, he would never be the same. The wife ultimately decided that if he was unable to return to work and function as he had prior to the accident, that he would not want to live that way. I believe that the patient was discharged once again on comfort care. This situation infuriates me so much. The point was that he was showing signs of improvement after a month of no progress. I can't believe that his family would give up on him so quickly. It is common to see families who want every intervention for their 90 year old mother who is actively dying, but not the reverse! I do feel like I made a difference in this patient's care although ultimately it was not enough to make a life saving difference.