Things Only a Nurse Like Me Will Tell You

Things Only a Nurse

Like Me Will Tell You

By Cindy Altman, RN

Copyright © 2013 Cindy Altman, RN.

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ISBN: 978-1-4624-0564-0 (sc)

ISBN: 978-1-4624-0565-7 (e)

Library of Congress Control Number: 2013905095

Inspiring Voices rev. date: 4/12/2013

Contents

Prelude

Chapter 1 My name is Cindy

Chapter 2 Growing as a Nurse

Chapter 3 The Human Body

Chapter 4 Going to the Hospital

Chapter 5 Alcohol and Cigarettes

Chapter 6 Death and Faith

Chapter 7 Dying

Chapter 8 Non-Compliance and Abuse

Chapter 9 Body Image

Chapter 10 Cattiness of Nursing

Chapter 11 Prolonged Term Care

To Sandi,

My knowledge helped her live to see and know 7 new grandchildren as she survived 11 more years, I hope it helps others half as much.

Prelude

When I started this book I didn’t know my sister would be diagnosed with terminal cancer. Also, I didn’t realize how little the average person really knows about Diet and general Health Maintenance (as the information is available), until I was trying to explain to her what her test results meant and how she could make more energy for herself with proper diet and activity. She is now in remission after being given 4 months to a year to live and many things I taught and explained to her are in here. She changed many things in her life, developed a peace, and the cancer calcified and stopped. So now it has become more urgent for you to know because the truths are all that work even if truths are hard to hear. The main reason I have always been thought of as a Special Nurse was because of my ability to teach how to deal with the Truths of your Health status by all the facts, rather than by any other particular skill I possessed. Every day I see families who could use this information, some may only be only discussed here.

My sister said she seldom ate vegetables and she often lived on chips and donuts washed down with soda. She had primary site colon cancer that could have been found with her 50 year recommended colonoscopy, she didn’t have. She also will tell you she did know better, but it was easier. Fast foods work in a fast life, but we really are what we eat. How can we be any thing else? And there is no easy fix or pill to make us all better and our bodies’ healthy, only hard work. Most doctors tell you only the minimal. They are afraid to offend you or scare you so they only explain the tip of things. They may say your heart isn’t working too well, but what does this mean to you? With proper questions you can determine many things about quality and quantity of your life and even the proper questions to ask. Do you know these questions and do you want the answers? If you or someone you know goes to the hospital, here is your guide to tests so you can understand the truths as I have learned them. As you read my stories hopefully you’ll understand, we must motivate, we must participate, the life you get, you’ll surely enjoy.

Chapter 1

My name is Cindy

My name is Cindy and I am your Nurse today. That is how I have introduced myself to all I encountered on my work day for over 30 years now. I have never started formal. In the next few hours, by virtue of what I do for you as I care for you, we are about to become very intimate. I’ve done just about every type of Nursing Care there is including 25 years of various Intensive Care Units, Coronary Care, Cardio Vascular ICU, Neonatal ICU, Neuro ICU, Pediatric ICU, Medical ICU, several ER’s, even a totally Pediatric ER, a doctor’s office, two stints at Nursing Homes, and now in the local ER, whatever. I’ve been there, done that, and yes, I made it all better. I bought a shirt that said that and ‘Genuine Antique Nurse’ and I guess after that many years I do qualify as an ‘Antique’. The funny part is the smallest shirt size available was a Large. Sad, even the distributors feel all old Nurses are big. I am not. And that is partly why I wrote this. I have been there, saw that, and do know what it takes to get and stay better longer.

I have never stayed long or enjoyed caring for sick kids, even though I love kids. I’ve found throughout my life if you treat children as the little people they are they respond well, not just when they are sick, but always. Sick, sometimes dying kids are just too sad though and I as the Nurse do things as part of their care that does hurt them or my role is to hold them down so the Doctors can do procedures on them. They cry when you walk by. It is way too sad! So I have tried to stick with caring for adults, most of whom you can rationalize with and/or at least rationalize their illnesses. I shifted to Long Term Care for awhile due to many events I will discuss, but also for Retirement Benefits through the (hopefully safe) State Retirement System and could not tolerate the standards accepted at Nursing Homes, but this recent stint has brought me many new Revelations about Health Care today in Long Term Care. I need to explain the hidden facts so you not just know, but also understand the Truths only ‘We’ know.

Nursing has been my life for over 30 years. It’s who I am, I Am A Nurse. This career has helped develop who I am, but who I am has made me the kind of Nurse I am. I know I am one of the best Nurses you can have at your bedside at your time of need. Doctors’ have requested me to care for their loved ones when they come to the hospital. I have cared for patients in many places and situations and some I remember well, but many (I am sure) will remember me well. Families have requested, via Management, that I be assigned to their loved ones after a day of my care. A few times I have had more than one request at a time and it is often the most difficult problem or worst complainer I get, as I am often able to defuse volatile situations, usually just by giving those honest explanations and straight forward answers.

I have been asked more than once if I am a ‘Special’ Nurse because of the care I give. The sad part is I don’t feel I give special care. I just do my job the way it needs to be done. I’m not perfect, nor do I give perfect care. But I do take ‘good’ care of my patients, try to be a true advocate, and treat everyone how I would want my loved ones treated. I had a Nursing Instructor tell us that and it made so much sense I have always followed that practice, to treat my patients how I would want my loved ones treated. I also have always followed my favorite saying, I can kill you with kindness or I can get you better. I take my role to get you better seriously, so you do, if you can. I do not do perfect care, but I am a Nurse who cares.

Trying to get this book published has been a trial and yes you must get use to rejection. But as time has passed and my Nursing career has grown and changed, drastically it seems at times, I have been shown many new facets of Health Care giving me many important facts to share with you. God does work in mysterious ways is true and this has made my book only more complete. I know I am a true Patient Advocate in every aspect of Nursing that I do. I always tell you what is actually happening to you, how we can best get through your crisis in the best way for you, what all your test results actually mean and should be pointing out to you, and how you can actually get Better, or Not. This ‘Real’ knowledge makes getting through your crisis and even life easier. Then you know what to expect and have no surprises. This is what has made me a requested, respected Nurse my entire career, the ability to explain everything we are doing to you, no matter your level of knowledge or intelligence, so that you can understand too.

Nursing has been a wonderful career for me. When I was a child I always said I wanted to be a Doctor when I grew up. But I grew up poor, almost white trash and the only goal my parents had for us was to graduate from High School and all 11, or 12 of us, depending on whose story you hear, did graduate High School. When I went to Nursing School I was accused of taking money from my family, not trying to ultimately make my life and my family’s life easier. Nursing has never made me rich but it has always made me a decent living, especially as a single parent most of my children’s growing years. And the benefits were always good and that is always an issue in life. I do wish I could have covered my children until 26 as I had good benefits and do like and hope no matter what that part of Obama Care stays. Plus, if my kids or I needed or wanted anything extra, the work is always available to a Nurse, especially one with my skills. I learned quickly that the more skills I acquired, the better care I could give, and the more marketable I became as well. I have done many overtime shifts wanting the ‘American Dream’ of giving my children more than I had. I’m sure if my hours were tallied I’d have enough hours to retire now.

But now I need and want out. Physically I should no longer do this. Years ago I hurt my back and was off work for 4 weeks. My back burns before I get to work every day now until my Aleve kicks in. The drive home often brings the back spasms and need for more Aleve. Sleep is impossible without that last daily dose of Aleve. And I couldn’t figure out why my hands hurt but one day as I grabbed the pad we use to lift a patient I realized all the weight is lifted with my hands. I recently required hand surgery to remove a bone and allow room for more arthritis. But retirement is still too many years away so I live on Aleve, and yes, I do know all of its listed side effects. I’m not crippled, but I am aware what could lay ahead for me. I had to learn the best care for a worn out back personally! I have taught a Yoga based class I made up years ago as an adjunct to a Diet Clinic I managed in the early 80’s and it has kept me reasonably fit. But in case you haven’t heard the amount of obesity has tripled since 1990. And trust me I know, a 2 patient assignment in ICU, where patients are dead weight, can easily be over 600 lbs. We have sadly had some 600 lb patients alone and what can I do with that? I weigh 120 and all my injuries are from lifting too much, too many times. And with staffing always kept at a minimum things do happen and many of us are injured, and we work injured.

One person I was talking to asked, They have lots of lift devices now, doesn’t that help? Somehow they must get on that device and trust me they do not jump on it. Besides which what usually happens is that the patient stiffens in the sling or moving device and as we try to save them injuries happen. Moving bodies is a lot of work, it is a solid mass. And I don’t want to be like the Nurses I see waddling around on the regular Nursing floors. I noticed many in the scoping suites, either doing Bronchoscopies, Endoscopies, or Colonoscopies, (we all eventually have to leave ICU). I want to leave still able to get around and not just helping scope people’s colons. We float to all the floors and the level of care from ICU to floor Nursing is a step I don’t want to go to. So I stayed in the ICU, too long. We had one Tech to help with 20 patients and so we relied on each other. It is often hard to find one person to help pull up what gravity pulls down so to find two to pull ‘My’ patient up was difficult and I still feel guilty having people pull up ‘my’ patient. So I do it.

Emotionally I need out also. I have had so many people say to me that everyone needs a Nurse like me at their bedsides during their life’s crises. But I feel as I have done enough in that role too. I have given until it hurts enough times, thank you! Post Traumatic Stress Syndrome is a real part of this job. I have seen and done things you can’t believe and usually don’t want to know, especially if it is your loved one we are doing them to. I have cared for the ten year old head trauma victim that we changed the packing covering his nose so he wouldn’t look quite so scary for the family to take its last look as we were keeping his body alive for Organ Harvest. As we did we found brain tissue now protruding out of his nose. I just said to the other Nurse Oh, I hope we don’t have to change that again. In order to stay sane we develop a sick sense of humor. I remember another head injury on a gentleman who was boating and drinking who didn’t duck far enough under a bridge and took off the top 1/3 of his head. As we wiped away brain tissue dripping from his nose the other Nurse said There goes first grade, there goes second grade, and I had to giggle. It is always better than crying, though most grieving families don’t understand that.

I drove 61 miles to work, one way, several different times. I have always gone back to and stayed at jobs in the city. You use to get more advanced care in the cities, but the Internet has changed that somewhat. I think because Hospitals are big business though and in the city competition is right down the road and Hospitals do compete for your business, and the clientele are also more sophisticated and educated. Our ICU was in the top 100 rated ICU’s in the USA and they marketed that for all they could. I was proud to be a part of it. But that drive to the city also gave me my best and often worst thinking time and time to reflect.

I did recently go to work in the local ER. The ER is its own little spot and we are staffed with many Good Nurses and Kind caring Doctors, most of the time. I feel a good working bond with most everyone. The total benefit package of this Hospital compared to the city is much less and the ICU does not employ Critical Care Doctors so I would not work there but my husband likes me traveling less and the pay is less but comparable so I like it for now. The few episodes though that I have been reprimanded were for telling too much Truth, or stepping on a few Doctors toes that like Total control and like to keep Nurses in their Place, recently one over restraints. Of course the patient did require those restraints be replaced that we all knew he needed for safety for both he and staff but since she had not ordered them she, in front of families and staff, ranted she was refusing to write an order for the restraints EMS had help us place. But most know after 30 years I can quickly evaluate any situation and at least know when to get help and trust my judgment. And we do have 30 minutes to get an order. Trust me, I only restrain when necessary but this too is a frustrating part of my job. And if I keep getting in trouble for telling you Truths am I going to be fired? I have been warned.

I thank God I don’t remember any of my dreams. A friend of mine tried to teach me ways to remember your dreams, but I don’t want to. I have enough nightmares in real life to last a lifetime. We all learn about Burnout; ways to prevent it, how to detect it, and how to get over it. I have a real hard time with people in any field in life who are disabled with Post Traumatic Stress Syndrome. Come see and do what we do as daily care on these people and claim you have dealt with worse. We clean poop, vomit, spit, sputum, bile, urine, blood, boogers, . . . if you excrete it, we clean it. And Drunks, Abusers of every type, cranky, sick people usually at their worst, and think nothing of it most of the time. Detachment though is the only real answer to burnout and that can not be me because of who I am. I know my Nursing care has touched thousands of lives, mostly in a positive way. I had one family say to me, It doesn’t matter what you do in this life you already bought yourself a place in Heaven. I know good deeds do not get us to heaven. Hopefully the grace, dignity, and peace I share with you as I give my care will be more that answer. And what Nursing has given me is peace in myself, because I know as I cared for you I always only want you to get better and /or alleviate pain. I have never wanted anything else. It has been my pleasure to serve you and also my pleasure to work with many wonderfully kind Nurses through the years, and see them serve you.

But being a Good Nurse means you will get the assignment of the nightmares. The 15 year old Ectasy/Alcohol overdose that was found unresponsive (dead) at home, that they restarted the heart on, because they could, because it is excitable cells and she is young and her heart is healthy. This has left the Organ Donor people waiting, hoping to have something good come from this. But you send the Organ Donation people away because she is not Braindead, just severely damaged. The heart can be restarted, but brain damage occurs in four minutes. Parts of the brain restart, I’ve seen, even after a time. Another time we had a ‘severely damaged’ ‘Near Drowning’, she was diagnosed as. But she was in the water 45 minutes and not ice water where things slow down. She had drowned. We were able to bring back a few sad functions. Only deep functions like breathing and coughing, and of course that young heart, but the person you knew is gone quickly. These are the Karen Quinleins and Terry Shiavos of the world. I have seen many of these and have only deep respect for family who love them enough to let them finish dying. To open your eyes, ‘but not be home’, as we say, to yawn and grind your teeth, to Posture or contract into certain specific patterns that tell us the depth of damage when we touch you, this is not living.

The 15 year old overdose later dies, but she coughed and gagged (which is a very deep function) when I suctioned her which is why I sent the Organ Donor people away. Only 42028.jpg of one percent of people who die are candidates for organ donation as they must be classified ‘brain dead’ with cessation of all brain function, and it must be all. That is rare and we know the rules. You often wish tragic deaths like hers had at least that good. It is a sad thing to be good at helping people deal with a death. She was a troubled young girl with a broken, dysfunctional family, like most of us, and I needed to find words to help them deal with her death. I am sure she drank too much as the Ectasy gives you energy for awhile and later passed out and only after a time did they notice her not breathing. No one probably thought it would or could go that far. But what actually killed her now was a coagulation dysfunction, or not clotting right (we call this DIC). This probably happened from trying to circulate blood that had already clotted, while sitting with no heartbeat in her vessels before we ‘recovered’ her.

Those are times you can’t pay me enough for what I do as part of a regular day. That part of my job made me search for my own answers so I could have and teach Peace at Death as that is a large part of my job. And I have searched and found a Peace. But each person I have realized must find his own Peace. Most of us were raised on Faith. The Church was a big part of most of our lives. But the churches too often taught fear and guilt instead of plain and simple ‘Love’. So, there’s now a whole generation of people that believe they are way too guilty and have fallen short way too many times to trust God’s love so they are afraid of Death. Scared to Death of Death. I deal with people at their most vulnerable times, always near death, and what I’ve learned to do is just remind people of their ‘Faith’, nothing else, and that seems to lead them back to their own Faith. I tell people I believe ‘Love Bonds’ don’t die. Many of the older generation can not remember their ‘Peace’, so spend their adult years miserable and their poor families. Sometimes they can’t wait for the miserable person to die. That is what many have become, because they have fear of dying, knowing they are dying. My job is to satisfy the patient’s needs though and if it is that miserable person, I still need to help him find Peace, and I do pretty well, in most cases.

Yet Partial Truth is also the way the Hospital and the Health Care System is being run. I really have a hard time with that and it will probably be my demise as I do tell the truth, and the whole truth. Often you have not been told the ‘whole story’ and so not the ‘Truth’. I follow the Patient’s Bill of Rights which includes the Right to Know. But trust me on this, we say different things when we walk away from your bedside and often it is that ‘they just don’t understand’. Seldom though have you been given information that gives you complete understanding.

I am a Grandmother and Nursing is the only profession I know of where I need to tell my patients I am old. I am a grandmother. This interprets into, I am Experienced. But looking young and healthy has helped me be allowed to say things to my patients others can’t get away with. Like you need to lose weight, and diet, and exercise. The sad part of doing this job so long is I know what you look like naked and often it is a scary thought. When I say to you that you need to change your lifestyle because I know what works, and what’s not working for you, you might listen. I don’t want to retire and do nothing, but I want out of caring for the sick, and teach you to be well. I think I deserve to see happy people now. I have stepped off the elevator or through the door enough times in the midst of another distraught family to last me a lifetime. And even if I have Peace with myself each new family in crisis is in real and acute distress, and we must also care for them.

I have also used humor as I care for everyone, even in this role. That is another reason patients and families have always wanted my care. But I am still honest about all aspects of your care. I hope that is really how I am remembered. I didn’t do well in Management roles because I tell the truth no matter what. I am a Diplomat in that standard but that doesn’t make you a good diplomatic Manager, unlike Maureen, Doreen, Lynn, Anne Maries, and a couple others I have had. I tell you everything you may or may not want to know. I tell you anyway because the more you know about yourself and your care the better you do. There are no surprises and no blame, just better understanding.

And along with a sense of humor I use lots of Narcotics. Morphine is a great drug in the ICU and in the ER we use more Dilaudid which is very similar, often being more effective. When Hydromorphone and Hydrocodones (drug in Dilaudid, Lortabs, and Vicodin) came out they were a semi synthetic of Morphine and Codeine which the Drug Company said was less addicting than the originals. We have now learned this is not true it is way more addicting, hence all the problems of drug diversion and thefts. I have to watch out, the Narcotic Police are always trying to catch you stealing Drugs. I have had Morphine 2 times in my life, both times after surgery, but I swear some people have stolen it and the rest of us then live in a paranoid state for any use of the drug. And they are great drugs. Morphine not only relieves pain, it decrease anxiety and relieves the work of the heart. So I risk the Narcotic Police and give a good amount of Morphine, and now Dilaudid especially in the ER, or any other sedation ordered as it is usually best to forget ICU, get through your crisis that brought you to the ER, and so relieve all levels of pain. What I have found of those who remember ICU is that they remember fear and pain, the nightmares of ICU. Mainly in the ER you come with pain. Pain relief makes your ER experience then related to that. Trust me, it is usually best not to remember ICU or what brought you to the ER. The group that remembers was not relieved enough. Almost everything we do in ICU hurts you in some way. We try to get you better, but rolling around with tubes in every orifice is not without discomfort so I often had given my patients all Morphine before 8 AM and I start their care. But because of the ‘Narcotic Police’ I think many patients are under medicated for pain. I usually also teach everyone to Blow out with each activity as when you start to move with pain the natural response is to hold your breath which makes everything we cut or fixed tighten, and that is what causes pain. This may be the most important simple trick I tell all and wish more Nurses used: Blow, not hold. It works for ALL pain, not just childbirth.

That gets us to the last reason