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.

Hannah Kate

Hannah Kate has arrived! She was born on Sunday, April 18, 2010 at 9:56 PM. She weighed 7 lbs 8.8 oz and was 20 inches long. She is such a beautiful little princess. My sis had told me the day before that she was having contractions 3-5 minutes apart. I kept my phone in my pocket all night at work in case she went into labor. The next day I came home and went to sleep but got a text saying that she had gone to the hospital. When I woke up, I still didn't have any updates. I texted everyone in my family to see what was going on but nobody responded. Finally I called the Sharlows and John said that Jill had been sent home and wasn't feeling very well. I decided to take a shower and get ready for work, just in case Jill went back to the hospital. Sure enough, I got a call from Jill around 7:30 saying that she thought her water broke and was going back to the hospital. I quickly finished getting ready and met my mom at the hospital shortly after 8. We got up to the room shorly before Jill got her epidural. I quickly learned that everyone had to be quiet and not talk during her contractions. The anesthesiologist then came and started her epidural. Jill was back to her old self. About an hour later, the nurse came in to put in her Foley. She quickly discovered that Hannah's head was right there! We just laughed because the same thing happened with Harrison. The nurse called the doctor and Hannah was delivered less than 10 minutes later after 1 push! She is such a precious girl and we are so blessed to have her in our family!

Jill waiting to meet Hannah


Aunt Brittany and Hannah Kate



Love all her bows!

Work Stories

A few weeks ago, I was talking to my family about how I don't have much to update my blog with because my life is so boring and I don't have any kids yet. I then told a funny story about work and it was suggested that I write about these stories on my blog. Well, here ya go.

One of my most recent patients was a woman in her 50's who was admitted to rule out stroke. She has a history of somatoform disorder which is a mental disorder in which the patient mimics physical diseases but has no cause for the symptoms. Stroke had been ruled out and every time I went into her room, she had a new complaint. During the NIH (specific stroke assessment), she would shake her legs when I was testing the motor component. She complained of shaking throughout my shift but only seemed to shake when I would look at her. Near the end of my shift, my CNA advised me that she thought the patient was having a seizure. I looked at my charge nurse and said, "She is not having a seizure" but proceeded to investigate anyway. My charge nurse followed me in to her room but left shortly after. I found the patient shaking her arms and legs but was completely conscious. She stopped shaking a few seconds later and said, "I haven't had one of those in a long time." I asked her what she was talking about and she said she had a seizure. I promptly explained to her that she was not having a seizure. Her response? Well, it is a "shaking seizure". Hmmmm. This must be a brand new diagnosis. My charge nurse later joked that we should inform all of the doctors about this new kind of "seizure". Ah, the joys of working on neuro.

Last night I think I found a ghost on our floor too. I was sitting at the nurse's station when I heard a tv turn on with the volume on pretty loud. I went into an empty room nearby to see the tv on and the bed spontaneously moving. A fellow nurse walked in and we just started laughing. We tried to stop the bed but had to unplug it. It still continued to move. I also turned the tv off. A few seconds later, the tv then turned on again, this time to a different channel. The hands on the clock were spinning too. It was the most bizarre thing. Later I admitted a patient into that room and warned his family about the previous events. They thought it was funny but a little freaky too. They asked if anybody had died in that room recently. There was patient in that room the night before but he was young and had been discharged. I will definitely have to keep my eye on that freaky room!

Finally, a favorite quote from an ADORABLE 92 year woman as she was washing her hands and looking at herself in the mirror. "I can't believe how good my hair looks!" So cute!!!

Girls day, Hannah, North Carolina

Today my mom, sister, and I had a girls day to celebrate my mama's upcoming birthday. We went and had wonderful pedicures and then went to dinner at Outback. I chose this font color because it is similar to the nail polish that I picked for my toes! We had such a good time together and didn't have to "clown" each other once! We decided that we need to have more girls dates together, without the guys or kids. Well, Hannah could probably come once she gets here. Speaking of Hannah, she is going to be here in about 4 days or less! I think we are all getting so excited to meet this precious baby girl and see what she looks like. She looks identical to Harrison in her 3D ultrasound pics but I am curious to see what color her hair is. I think my sister is especially excited for her to get here as she is getting pretty uncomfortable. Jill is scheduled to be induced on the 21, a reason why we celebrated my mom's birthday tonight, which works out perfectly since I will be getting off work that morning.

Next month Chris and I will be flying back out to North Carolina to visit Bobby and his family. Bob and Camille will also be coming out. Bobby, Alicia, and the kids were originally going to be coming here to Oregon to visit, but Bobby's deployment date was moved closer so there was a change of plans. I don't have a lot of PTO so I was worried that I wasn't going to be able to get the time off. Luckily, a girl who I work with was looking for some extra shifts and I was able to take some days off without PTO as well. We will be gone for a little over a week. I know Chris is really looking forward to seeing his brother (and he thinks he is going to be getting another tattoo) and it will be fun to spend time with the kids as well.

Here is a picture of us girls getting our pedis:

Hawaii

So, we have been back from Hawaii for about a week now and I must say that I am dying to go back. This Oregon weather is just not cutting it for me. It is so cold and rainy. Although our weather in Hawaii wasn't perfect, it sure beat this yuckiness. The first 3 days in Hawaii, the weather was perfect. After the tsunami scare (yes I can be one of the few to say that I lived through a tsunami), the weather was pretty windy and cloudy at times. It even sprinkled on us a few times. But, I'm not complaining.
The first 2 days, we layed out on Waikiki Beach and enjoyed walking what I will refer to as "the strip". I don't know that the official name of the street is, but it reminds me of the strip in Vegas. It is the waterfront street right on Waikiki Beach where there are lots of stores to shop in. Day 3 we got a wake up call at 5 am from my dad who advised us that Hawaii would be experiencing a tsumami that day due to the earthquake in Chile. I naturally freaked out and questioned whether we should use our rental car to retreat to higher ground. We were staying at a hotel only 1 block from the beach. Chris went and spoke with the hotel staff and after eating breakfast at 6 am, we decided that we should be pretty safe on the 34th floor. For the remainder of the day, we experienced tsunami sirens and kept our eyes glued to the news. Luckily, the tsunami was nothing to get excited about and we were able to resume our vacation as planned. Unfortunately, we pretty much missed a whole day of sun coooped up in our hotel room.
A few highlights of our trip include driving over to the North Shore, enjoying a luau at the Polynesian Cultural Center, visiting Pearl Harbor, snorkeling with a huge sea turtle, and hiking Diamond Head in addition to enjoying some time together. This was our first time to Oahu and it seemed that we were pretty busy the entire vacation. I was actually pretty exhausted when I got home and then had to rush and throw a baby shower for my sis the next day! (We'll cover that in another post). I included a few pictures to just give you a taste of our vacation. I will probably post more to facebook because I get less frustrated uploading pics there than I do to this site. I am not sure how to delete pics here. The first pic is offcenter and the 4th pic is not the one I inteded to upload as it is blurry. I also have a video I want to post but it is sideways and I don't know how to turn it. Oh well. Anyway, enjoy!

We hiked all the way to the top which I believe was .8 miles one way. Not too shabby!

View from the top of Diamond Head. Absolutely gorgeous.

Stupid picture that I didn't mean to upload. Blurry pic of Chris and me at the top of Diamond Head.

I had to get one stereotypical Asian picture in. All of the Japanese tourists literally posed like this in every picture!

On our way back down. Don't worry, most of the hike was pretty uneven.

Trying out the bunks on the USS Missouri

Arizona Memorial

Chris and me at the Polynesian Cultural Center

Nuuanu Pali Lookout which was sooooo windy but an awesome view

North Shore. Pretty chilly that day

Updates cont.

This is my first time adding pictures and I was messing everything up in the last post. So, I thought I would just put most of my pics in this post.



Grandpa and Grandma with the boys



Sharlow family


Granny and her girls


Sis and John

M & D

Kriegers



Harrbear

Grays/Sharlows/Kriegers


My sweet new apron

Hunter in his snuggie



Don't ask :)

Chris' turn



Chris and me

Breaking the wishbone from Thanksgiving. I won!

Updates galore

Once again, it has been forever since I have updated my blog. But, I have somewhat of an excuse. We were without a computer for over a month! It was terrible! A few days before Christmas, the computer just completely froze. I tried to troubleshoot it, and nothing worked. We ended up taking it to the Geek Squad at Best Buy the day after Christmas and they said that it was pretty much toast and that they needed to send it off to the manufacturer. Luckily, we had bought it less than a year ago so it was still under warranty. Chris blamed me though since I have a tiny tendency to download games off the Internet. I like to remind him that he has no proof that this was my fault :) Anyway, when the computer finally was shipped back to Best Buy, we then had to wait an extra week or two because we couldn't find the CDs that come with the computer or something like that. We set up out ancient laptop while our computer was out of commission, but let me tell you that using that computer makes you want to pull your hair out. It was sooo slow! To make matters worse, my phone then decided to die for no apparent reason and so I was phoneless for 2 days as well while waiting for a new phone to be shipped. $200 later, I have a new iphone. Let me just tell you how ridiculous it is that I am dependent on technology. Anyway, all is well now in the Krieger household.

Work is going really well. I really like my co-workers and feel like I am learning a lot. I kind of feel like a real nurse now! One thing I like about working on Neurology is that I have a lot of opportunities to practice my skills that I learned in nursing school. That was really important to me as a new grad to try to solidify my skills early on. A few nights ago I got to put in my first NG tube. This is a tube that is inserted through the nose down into the stomach. I must really be a nerd because stuff like that gets me really excited. I recently had an informal 3 month review and there wasn't anything that I needed to improve on. Score!

In November, Holly the Honda started to act up a bit. I was planning on getting a new car in the near future now that I had finally landed myself a respectable paying job, but she decided that I needed a new car sooner rather than later. She never once died on me in all of the years that I owned her and was pretty dependable for having close to 180,000 miles. Gotta love those Japanese made cars! Chris had previously looked at 4-Runners at the Honda dealership and had left his contact info with one of the salesman. Well, right when Holly was starting to show signs of distress, Chris got a call from the dealership that they just got a 2007 4-Runner in with 17,000 miles on it. Want to know what my only drawback was? It wasn't galactic gray like I was hoping for. Instead it was silver. Silly huh? But that reason alone caused me great turmoil for a couple of days. This 4-Runner was perfect besides and came with lots of bells and whistles including DVD players in the headrests (perfect for future Krieger kids). I finally stopped being silly and we welcomed Trixie the Toyota into the family.

Well shortly after we bought Trixie, Chris' truck started giving him trouble. He had a 2002 Ford F-150. We were not planning on him getting a new car anytime soon, believe me. When he was taking his truck to the shop, he drove by the Ford dealership and saw his perfect truck. It was like a sign from God. So after much debate, we decided that we could afford to go from no car payments to two. Yikes! Especially since Chris still has a motorcycle payment! But it was seriously too good to pass up and we thought about it long and hard. So, we now have added Tank the Tundra to the family as well.

Let's see. What else? Christmas was great considering there were a few bumps in the road. Being a new employee, I didn't quite understand the schedule and had thought that I had Christmas Eve and Christmas off since they fell on my normal days off. Chris and I had planned on going down to Klamath for a few days and then coming back on Christmas. Luckily I discovered about a week before Christmas that I indeed did have to work both Christmas Eve and Christmas. Wouldn't that have been horrible had I been down in Klamath? But, everything worked out and we spent Christmas day with my family and went down to Klamath for New Years. Here is the annual family picture: