Tag Archives: Nursing

Dx: Pneumonia

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I’m tethered. Captive in a small room, its walls closing in on me, shrinking it smaller.

I want to get out. I must get out. But I can’t. I mustn’t.

The door to the bathroom looms in the distance, three feet away. I must go there at least. The cough, the cough makes me want to go, and it makes me want to not move. For to move is to cough.

But I must go. The fluids, the fluids run into my arm continuously, 100 cc per hour. More than three ounces. Every hour. Who drinks that much?

I know if it was left up to me, I would not drink so much. For it only makes me need to get up and it’s hard to get up. It’s hard to maneuver the distance. I have to push the IV pole along with my right hand.

And I have to carry the densely solid electronic brick in my left. It is cold and smooth, heavy. It pulls at the circular patches glued onto my chest and abdomen when I forget it’s there. Its colorful wires mock me, can’t get away, they say, can’t get away.

It is my portable monitor, tracking my heartbeat and respirations. I imagine there is a main terminal at the nurse’s station down the hall where someone is keeping an eye on my rhythm. No, the nurse tells me, it is being read in another building. Another building?

Why can’t I be in another building? The one I live in for instance?

Another hour has passed and I must go to the bathroom again. I grab on to the bedrail and pull myself upright. I remember the box, grab the box. I stand. The room spins a little; the cough pushes me forward.

Afterward, I cross the tiny room to the sink. Why is the sink placed so far away, on the other side of the room? At least it’s not in another building.

I settle back into bed fixing the wires around me. The IV line must be on top of the covers or else it pulls at my left inner elbow, and it’s sore from receiving the powerful antibiotics. I bend my arm and feel around the entry site. It’s soft. That’s good, I think, the vein is holding up.

I lie on my left side, where the pneumonia is. I can hear the expiratory wheeze when I exhale. I shut out the room and concentrate while breathing in. There’s no inspiratory wheeze audible. That’s good. In between breaths, I hear the gurgling, the bubbling in my chest. It’s almost a purr. I sound like a cat, I say to the nurse when she’s in. She laughs.

Everyone is so nice, especially when they are carrying needles. I have to draw blood, they say. I groan. What is your full name and birth date, they ask me. I murmur my answer. I’ve said it so often, I no longer have to try to remember. I know it’s a safety check along with checking my ID band. I know the drill. I’ve been there, on the other side.

A Bubbling Mess

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I walk onto my 45-bed med/surg unit. The day-shift R.N. meets me at the nurse’s station with her typical greeting: “It’s a mess.”

No matter what is going on, in her world it is always a mess. Sometimes, though, she is right. She’d been trying all day, she says, to get an IV in. The IV nurse will be on her way shortly.

The IV nurse would have been the one to deal with the “mess,” but she’d seen her chance to go on to better things when I hired on. I couldn’t blame her. It was a big unit, and it took lots and lots of steps to cover it during an 8-hour shift.

After report, I gather my supplies and make my way to the lady who needed the IV. In spite of her bulk, she seems to disappear into her bed. She peers at me over the covers and her eyes get big and round when she sees what I carry.

“I promise,” I say, halting by the door, “I won’t try unless I think I can get it.”

I sit on the edge of her bed and gently massage her arm while I look for a vein that hasn’t been assaulted yet. She visually relaxes as I run my fingers lightly up and down her inner forearm. It is my favorite spot on “hard-to-get” patients. It offers a straight, and normally untouched, avenue, plus the site allows the patient both elbow and wrist mobility.

My heart goes out to her. I can sense her fear and her dread. I see the faint bluish line of the vein tracking up her arm. This is it. My one and only chance.

Her eyes never leave my face and I must betray my relief at the sight of flashback into the IV catheter hub for the strain leaves her face and she smiles.

“Where have you been all day?” she cries, as I secure the line and restart her fluids.

I can see this lady clearly today because for five days last week, I was that lady. Knowing needles were coming, knowing that they were vitally necessary, but dreading them just the same. It seems ironic that shortly before this I’d written about my dislike of needles.

It started with a tickle in my throat. I thought, great, another cold, right when I’m having the house painted and Thanksgiving around the corner. By next afternoon, I knew it was no regular cold. I had chills, fever, body aches. But when body aches can be a constant in your life, it’s hard to give them much credence as a barometer of your overall health.

That evening, I made a trip to the urgent care, Influenza A. Fantastic. It’d been at least 20 years without a flu, so I sucked it up. Deal with it.

That was the plan, but 48 hours later I was in the emergency room. The urgent care had sent me there. My main complaint upon returning was chest pain, so they went into defensive mode: EKG, baby aspirin, and 911 to ER. They mentioned the possibility of pneumonia, but offered me an ambulance ride for good measure.

I said no; we’d drive the ten minutes. Once there they checked me out, started an IV, drew lab work and ordered a chest x-ray, and then booted me out to the waiting room for what seemed like hours. (It was. Definite way of knowing you’re not having a heart attack.)

I seriously doubted cardiac involvement, but I was quite worried about my respiratory status. I was weak and unsteady on my feet. I felt on fire and my chest felt as if the flames lit up higher every time I coughed. Worse was what I was producing when I did cough, and the amount increased steadily. I was bubbling over.

I worsened as I waited for an ER bed. Once there the nurse took my temp, 103. “Huh,” she said as she looked at the reading. She took it again. “Yep,” she said.

Yep, I was bad off.

 

Maskerade

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RA is such a handy little villain. So easy to blame for whatever feels wrong. If I’m tired, I blame RA. If I’m fatigued, I definitely blame RA. If my joints ache for any reason, it’s RA’s fault. If my hands are stiff, sore and swollen, well, we know why, don’t we?

So, this past week my hip hurt. Bad. Immediately, I thought bursitis. It’s back. Suck it up. It’s RA at work again. I downed some of my friend/nemesis, good ole Prednisone. 20 mg. Take that, RA.

But the next day, there was no improvement, rather it felt infinitesimally worse. How could that be? I downed another 20 mg. And what struck me as strange was that it did not hurt to walk. That did not jibe with bursitis, but I pushed that to the back of my mind and concentrated on the exquisite pain I felt just touching the skin around the right side of my pelvis.

I added the heating pad to my regimen, sleeping on it, exactly like you’re not supposed to do. I depended on its automatic shut-off. And anyhow, who was sleeping? 10 mg of Flexeril afforded me three hours tops. The pain was King!

Soon there were bags under my eyes from sleep deprivation and a funny little trail of pink dots over my hip. “I don’t like the looks of that,” said my husband. “Stop using that heating pad.”

But of course, I didn’t. It was palliative; it was a placebo for my pain. The dots got bigger and redder. But still I could walk without the slightest limp. How could it be bursitis?

Yesterday I caved. Went to the Urgent Care. My heart rate was 108, my BP was 160 over what I don’t remember. My systolic BP usually runs between 110 and 120, my heart rate 80 something.  Yep, I was in pain. In so much pain, I couldn’t even multiply 2.5 times 6 to tell the nurse what my weekly Methotrexate dose is. Me, who could calculate IV drips in my head couldn’t multiply simple numbers.

Later in the exam room, my husband verified that 2.5 x 6 was 15; I was on 15 mg of MTX. The doctor came in, did the normal drive-by history, then took one look at my hip and said, “Aha, you have shingles.”

Shingles!! (Insert four- letter word here!)

Well, blow me down. I’d never even seen a case of shingles in all my years of nursing, though I have read about it. Read about how painful it can be. And ironically, I just finished a course on pain management for my license renewal. How providential.

I was given a shot of Toradol along with some sympathy. The Toradol is for pain and inflammation, the sympathy was a bonus from the nurse. And then, I was sent home with a long list of prescriptions. The Percocet makes me sleepy and dizzy, so I’ve been catching up on my sleep.

But the Lidocaine patches, mercy me, what a blessing. They suck away the peripheral pain from all over my right side. I can touch now without causing that electrifying agony, and paradoxically, my sensation is returning. My skin had felt numb, yet on fire. Neuralgia is a funny thing.  So funny, it almost made me cry.

Now, I have to concede that RA is only indirectly involved in this little incident. The meds I take for it leave me immunosuppressed. But this taught me something. To not let RA mask what might be truly going on. I suffered for four days needlessly. I should have sought treatment sooner. I shouldn’t have waited and self-treated. This lesson was driven home quite piercingly.

Meanwhile, the nurse said I am contagious so I had to tell everybody to stay away for a week. I won’t have my little ray of sunshine this weekend.

smile

My best medicine. A loving smile from my cutie.

Winning Hands

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It’s official. I am image 475 out of 1,073 images, as of this moment, on http://www.showusyourhands.org/interactive-collage/. It is humbling to see all those hands, a testament to what inflammatory disease cannot do to us. It cannot stop us completely, though it can and does give it its best effort. Together we are more powerful than it.

The images that touch me the most are the hands that are ace-wrapped or braced. I can feel the pain through the computer screen, a telepathy of sorts. I know intimately how that feels, and how difficult it is to do the wrap yourself, one-handed, and sometimes with the wrong hand, the non-dominant hand. On really bad days, one must needs wrap or brace both hands.

For the longest time, I was reticent to ask for help. Afraid to telegraph how ill I felt or how much agony I was in. I feared that would make me look weak. Maybe I didn’t want anyone’s pity or having them think less of me. But thinking back, I can see the pity in my staff nurses’ eyes as they opened a bottle of lemonade for me. I could not do it; I could not twist the cap off. Not only did I not have the strength to grip it, but the pain screamed at me if I deemed to even try. But even so, RA did not prevent me from running a department, and I can tell you, being a Nurse Manager is not for sissies.

As RA did its insidious work, it was the little things that affected me most, the little things that affected the big things. I had to give up my work at the bedside and the twelve-hour shifts, that turned into fourteen-hours at the whim of the wind. My feet burned after all those miles, my head hurt after all those hours, my belly grumbled having to make do with a liquid lunch on given days. Those parts of my body notwithstanding, I could take it and performed both as caregiver and resource. It was my hands that did me in.

When I first started out in my career, I worked in a surgical intensive care unit. Part of my uniform was the hemostat that I clipped onto my green scrubs, as were my stethoscope, scissors and surgical tape. You never knew when you were going to need those tools and could not waste time running to get them. Along with a pocketful of band-aids and alcohol wipes, we were good to go, ready for anything. At that time, the hemostat hanging from my scrub top in plain view did not bother me.

Fast forward about twenty years and I find myself reliant on that hemostat to perform various functions, like separating IV lines to change them. Even gripping their connecting ports with gloved hands gave me no leverage; my hands were gradually losing their strength and dexterity. That hemostat multiplied by two, one for each hand. Where before I wore the one proudly, now the pair shamed me and stayed in my pocket until I needed them.

This was before my nemesis had a name. By this time, my hands had a secondary problem. After all those years of scrubbing-in with a scrub brush, constant hand washing or cleansing with an alcohol rinse, and the wearing of latex gloves, they could no longer withstand the assault. I knew I had to move on and felt a deep sense of loss as I drove home after my last shift.

I soon dusted myself off and went to work in an office environment where I worked with fax machines, telephones and computers. I still delivered nursing care but by remote. It was while working there that the primary problem with my hands was diagnosed. I would have no further need for hemostats. And anyway, they were useless to open my lemonade with, so I asked one of my staff to do it. And they did, kindly.

***Above is an image from Wikimedia Commons of a curved tip and straight tip hemostat.