Yesterday evening got off to a rough start. I started my shift by spending about 2 hours (with many interruptions) attempting to straighten out a complicated discharge. When I finally got the guy out of the hospital, I still had 3 patients waiting to see me and was behind on giving my
meds, which weren't there of course.
Since it was Monday I was expecting to get an admit right away, but it never happened. The rest of the evening went so well. I only had 3 patients for the rest of the evening. That never happens on a Monday evening. Usually there are people lined up in the ED waiting for patients to leave so they can be admitted.
Since I only had 3 patients, I was able to spend extra time with one really sick guy. I can't remember his age for sure, but I think he was in his late 40's. He hadn't been to a doctor in many years. He self diagnosed pneumonia 2 times this past spring. Both times he treated it with antibiotics he got from friends in Canada and/or Mexico, never seeing a doctor for diagnosis or treatment. He comes to us with a diagnosis of 'failure to thrive', transferred from a smaller hospital about 1 hour away. He has been living with his mother in that small town for about a year now as his career as a musician has ended. He has pneumonia, empyema (with a right sided chest tube and JP drain with tons of puss-like drainage), severely enlarged prostate, diabetes and something abnormal about either his WBC or platelets (I can't remember which), and has unintentionally lost 10 pounds in the last month. He is a thin guy, with a decreased appetite and increasing weakness.
He has not taken very good care of his teeth. He is missing a few and the rest don't look that good, but I have definitely seen worse in my career. As it turns out, his lack of dental hygiene has probably caused his lung problems. They think he had some bacteria in his mouth/rotting teeth that he somehow aspirated into his lungs which caused this pneumonia and empyema.
Makes me want to go brush my teeth right now.
Anyway, this guy was super nice but appeared to have some slight mental or cognitive deficit, nothing diagnosed but he was a little off. None the less, he was very particular about positioning. He was always asking to be repositioned and just when you thought you were done, he would say, "Oh, I just think that pillow needs to be moved just a little more." He wasn't saying it to be difficult or controlling, he was just so weak that he really could not move on his own well enough to fix it. So, I spent a lot of time in his room positioning him and repositioning him, getting him special foods, cleaning him up (did I mention he was incontinent of urine and was dribbling constantly), putting protective cream on his excoriated groin, explaining how the chest tube worked, how the JP drain worked, giving him meds, etc etc. Now, those are all things I am happy to do and should be doing but usually I would never have time to do it because I have at least 3-4 other patients needing me. Usually I would defer a lot of it to the nursing assistant.
But last night I had time and I gave him great care. At the end of the night I was so happy I was able to provide really good care to my patient. Usually I can only get the bare minimum done and last night I was able to do everything he needed and more. And then he said it:
"Thank you for everything tonight. I really felt like you cared about me and like you had time for me."
He was so genuine when he said it. It's so rare that a patient recognizes that you go out of your way for them and it means so much to me that he could see that I cared and that I did go out of my way for him. Too often I am apologizing for taking so long or for not having time to do something.
It was a great end to the night. I work again tomorrow, I hope this wasn't the calm before the storm....
