Glad to be back.

I've been back at work for two days. My residents seemed to be glad to see me. I was glad to see them, that's for sure. Sadly, when you take vacation, you sometimes come back to find someone has passed away. That wasn't the case this time. Everyone is intact and there are even a few new faces in the facility.

On the other hand, when you go on vacation, you hope that some of the things that weren't working so well will have resolved themselves by the time you return. Unfortunately, I'm not seeing any of that either. Oh well. At least there aren't any glaring new problems.

A couple more days here and I should be able to collect some stories to tell. The other thing about returning from vacation time is that you have to get back into the swing of things and I'm not quite there yet. I'm having enough trouble getting my work done without trying to scribble down every funny thing I hear, too.

I'm Off

I am taking a week of vacation.

I hope I do not think about work while I'm away.

Since I don't plan on thinking about work, I don't plan on writing about it either.

See you after Memorial Day.

Honesty

"What are you doing?" Mrs. A asked when I knocked on her door.

"I need to give Mrs. B some medicine," I answered.

"Oh god! Please don't wake her up! She's finally sleeping and when she's awake, she drives me crazy."

Today is Pajama Day

We're having a kind of Spirit Week for Nurses Week at work. You know, we've done the hat day and crazy sock day.

Today is pajama day.

...

I am really glad I have today off.

Still More on Roxanol...

...and comfort care.

From the very little that I understand about the legal side of nursing, Durable Power Of Attorney (DPOA) is something you give someone who agrees to make important decisions for you when you can no longer make decisions for yourself.

So, your DPOA can decide to put you on hospice and have you receive comfort care only. They can say that you wouldn't want to suffer and that it's ok to do this. Sometimes this speeds up the end, sometimes it doesn't.

In any event, what if the resident's DPOA wants hospice (and therefore is vicariously speaking for the resident) but other family members want to do everything possible to keep the resident alive? Talk about a touchy situation. The family is fighting. The resident is sick and confused and gets combative when the "live forever" side of the family is in the room and is sick and confused and angry with the "rest in peace" side of the family is there. Regardless, you almost have to grit your teeth, focus only on the resident, and get out of the room and quickly as possible. There's no way you can satisfy the family's loaded questions, so you have to resort to referring them to the charge nurse. They don't like that either.

Sadly, it makes you wish the resident would pass away faster and that's an awful feeling, too. So here we are: feeling guilty for wishing the end would come, feeling guilty for giving comfort care, and feeling guilty because we are too uncomfortable to stay in the room for one second longer than required to do our jobs.

And here I thought this job was just about keeping people happy, healthy, and comfortable.

More on the Roxanol Question

When a resident is in a great deal of pain, the doctor will sometimes prescribe Roxanol. This is liquid morphine. It works fast, but it does not last very long, so we sometimes have instructions to give it every thirty minutes, as needed.

We have a debate every time this comes up. For some reason, no one wants to be the one to give that last dose of Roxanol before the resident dies. I don't get it and I don't have a problem with it. If I am giving it according to the doctor's orders and the Hospice Nurse and the Charge Nurse are aware of it, I'll be there with it when the resident needs it.

But, what if the resident doesn't want it?

The simple answer is not to give it. Yet, if they are curled up in the fetal position, refusing care, and crying because they are in so much pain, then what? Do we let them suffer, because that's what they want? Or do we cajole them into taking the pain medication, even though it may speed up their end? And, further more, if they let us give it, do we then keep them snowed to prevent them from hurting or do we wait until they are crying again before we give it?

Welcome to my position between the Scylla and Charybdis.

There's a cure for that?

Mrs. A went to the doctor and had some X-rays taken. I asked her how the visit went.

"Oh, they asked me if I had all kinds of diseases. Then they asked me if I had the menopause. I said I didn't know. But, you know, I think I had it once and it all cleared up."