btp is a teacher now

So here's one of them.

When I first started working at the hospital I had about a month where I followed around another PCA and basically helped her out with whatever while she trained me and explained how to do what it is we do.

I think it was during my second week of work that she took me into the equipment room and finally just showed me everything there. Ice packs, extra gloves, nasal canulas, the pink bucket (oh gosh how I love that pink bucket, so many uses. and it has only failed me once. See: fell out of the bottom of the bedside commode while a patient was on it. Pee everywhere.). Eventually she showed me a big plastic container which she explained was a body bag.

"Have you ever had to use this?" I asked.

"Just once. Just a few months after I had started working here..."

I've forgot the story she told me. Basically she was surprised and it freaked her out and the nurse was like "can you go get that bag"

Now this story all takes place during the same day. During that day, we got a new patient in, an elderly man who was accompanied by his supportive wife.

This guy died by the end of the day.

At this point, I had started to do some work on my own: get people water, assist to the bathroom, bug the nurses, all while my PCA trainer did her thing, and occasionally we'd catch up or she'd call me over for a task I wasn't familiar with yet.

So I brought this couple some water, socks, tissues, just the basic things you get when you come into a room. They were very friendly. They smiled and talked to me. I explained the room to them - how to use the TV remote, how to press the call button, how to use the phone. I wasn't entirely sure what they picked up on but it seemed like they got it.

A little time went on and this guy's family came over to visit. They had a nice visit but I overheard the son (or maybe son-in-law) saying: "Now remember to stay in bed." in a rather authoritative tone.

uggggh crap I just remembered I need to get over to the eye-doctor to pick up things before they close. This is what I get for staying up till 5 and then sleeping till 1. okay I'm gonna hurry this up.

So that guys' family leaves and his wife presses the call button and I come over and she asks about how to use the TV.

I had just told her how to use the TV, but hey learning new things is hard. So I told her again, but before I finished she asked me how to turn it on which is something I just told her. I spent about 10 minutes going around in circles trying to explain how it works when I finally had to go and told her something like: "If you have any trouble using it give me a call"

Maybe five minutes later I got a call on the little phones we carry around. "Get over to room # your patient in there fell."

Whaaaaaaaaa? I thought, not already knowing the outcome of this story.

When I got to the room the guy was sitting on his butt next underneath the wall mounted tv. A couple of nurses were trying to help him up and I came in. I heard the wife say: "He got up to change the channel on the TV." And the guy said, "I slipped on my sock."

As far as I know, this guy didn't hit his head, just landed on his rump. But I don't know for certain.

There was a little moment of frightening realization when I came in the room and she said those words. I hadn't put a bed alarm on this guy when I left the room because I figured since he had family in there it wouldn't be a problem. I knew he had a small degree of dementia but for some reason it didn't click that his wife was confused as well.

So, falls are a bad thing in a hospital. People can die from fall-related trauma and if it's on your property where they're trying to get better it is pretty much your fault.

This guy seemed a little shaken, but otherwise okay. Nobody noticed any trauma, and I'm not sure if it was the trauma that killed him. Of course, at this point, he was still very much alive.

We had him move rooms so that he'd be closer to the nurses station. We called his family to let them know, and they came back over, and we placed an order for a "low-bed" which are nice little guys that sit very close to the ground and have little gymnastic pads on either side of them just in case you fall out. Of course "I" didn't do any of these things, I just focused on the rest of my group and figured I'd go check on that guy again once everything died down...wait bad word choice.

Ugh. I'm not good with emotional situations. Oftentimes I use poorly placed jokes as an attempt to avoid them. (anyone who has seen me post frequently will be like: "ya, think?") This is especially bad when the humor is only funny to me. I've been chastised about this by a teary-eyed girlfriend too often. The point is I just inserted a joke in a story that really should be somber, and when viewed with any sort of seriousness or honesty it really is.

So I was sitting at the nurses' station after the guy's familiy had returned. It was uncomfortable. The earlier authoritative sounding son/stepson was back and he was full on belligerent, not to the nursing staff, to his father. "Don't get out of bed! Do you understand me!?...No. No say that you won't get up! Look at me!"

It went on like that for ten minutes probably (it felt like thirty). All the while I'm sitting outside the closed door putting in this round's vital signs into the computer and thinking: "He's confused. He doesn't understand."

The next time I went into his room, the family had left, and they were transferring him over to the new - low bed. There were maybe 5 or so hospital staff (nurses, equipment techs and myself) in the room.

He had this pale look on his face. He didn't say anything, he just kept his eyes closed and shook a bit while we moved him. The thought came to me: this guy is acting different but I didn't say anything. Nobody said anything.

His wife was sleeping on the pullout bed next to him. She was out for the whole thing.

Mentally though, I just labeled the guy's lack of speaking and demeanor under "confused". "Confused" I realized that day is a very dangerous word in the hospital. It can help prepare you for a patient's dementia, and put you on guard against irregular behavior, but it also has a tendency to get you to ignore otherwise critical changes in the patient.

Sometimes that's a good thing, like with the "157 lady". She was confused, and her agitation at night was different than her calmness during the day, but it wasn't indicative of anything medically worrysome, and needlessly fretting over that isn't going to get you anywhere.

But in this case it was different. When someone dies in a significant way to you, you try to make sense of it. You try to give it meaning or a purpose so that it doesn't seem so pointless. When I realized that this guy had died, I tried to ingrain into me what I could learn from this to better help other patients and people in the future. What I came up with was just returning to an old mantra from EMT school. Know the patient.

Everybody has a "normal" their baseline for health and activity, and everyone's normal is a bit different, but patients don't shift from their "normal" unless something has caused them to. This guy had a noticable shift from his normal level of activity. He was disoriented, but he talked with you. This time, he didn't. If you have that nagging: "Something is different." even when you're not certain, it's best to check it out.

At least that's what I tried to take away from this.

I went into his room later to check his blood sugar. I was getting the equipment ready when the nurse walked in. She took just one look at him.

"Oh shit!" she gasped.

She went over and checked his breathing. Absent. Pluse rate. Nothing. He had died.

I didn't even notice. I was so focused on setting up the task at hand that I may have not even noticed he was dead until after I pricked his finger. Maybe not even past then. Though I don't know for sure. I'd like to think I am not that terrible.

I didn't have to get the body-bag out. Someone else took care of that.

The wife was asleep the entire time. The family came back to pick her up and wheeled her home. I don't know if she realized what had happened. She seemed like she was in a tired daze.