Sometimes on the unit we have the Enemy Prisoners of War (EPWs). These are the people killing and maiming our soldiers. The last couple of days I've had one as a patient. When caring for these patients, there are so many things to consider; keeping their eyes covered or the curtains closed in order to protect the local nationals working at the hospital, the Army soldiers that guard them, putting up with them spitting and hitting at you, the worry about what or who they know and if they will remember you. Besides all of that, the ethical and moral dilemma that builds inside when you have to care for them in the same manner you would care for an American they just maimed.
The Army guards who guard them are also an issue. They make comments about wasting resources on these guys and why do we take care of them. My answer to them is this, "First and foremost, I am a medical person. I am required by my profession to do no harm...to anyone in my care. How do you think it makes me feel to come in here and provide the best possible care for this guy and then run into the next bay to care for the soldier he just blew up?" We can't hate them. And before anyone gets upset, I'm not a bleeding heart. I don't condone what they do to our soldiers. But looking at this country and how poor it is, this guy may not be a Taliban but a farmer who was paid a few dollars to kill Americans. Maybe his family is so poor this was the only way to provide food for them, I don't know. I did tell these soldiers "If you did your job correctly, I would not be forced into this dilemma." I think they got my point.
Today I did take excellent care of this EPW. I shaved him, cut his hair (with his permission), bathed him and stayed on top of his pain. I know that some may not understand why, but I just wouldn't feel right if I didn't. I hate doing it because it takes twice the amount of energy for me to work through the anger portion in order to provide this person care to this person who is hurting my sisters and brothers in arms. I can't help but to see the images of the young men they mame. I know in my heart, when they capture our guys, they don't get the same treatment.
Monday, March 28, 2011
Georgia
When we admit patients whose names we don't know, we give them names of States in order to identify them. This afternoon, we received four trauamas; Utah, Hawaii, Iowa (?) and Georgia. These people came from a sporting event and were the victims of a suicide bomber. I went to the ER to help them and documented on Utah. When I returned to the unit, I found I was getting one of the patients, Georgia.
When I got report on Georgia, he was a young boy of eight who received two broken knees, peppering to his face, arms, and abdomen. A hole in his left shoulder and some other injuries. I quickly assessed him and we got him settled. I had learned that Georgia was a boy who did not have a guardian and did not speak Pashtu or Dari but Uzebekestanian. Of course we don't have an Uzbekestan translator! I felt immediately protective of this boy. All I could see when I looked at him was Kodi. How fearful he must have been opening his eyes to a bunch of strangers poking at him when all he remembered was attending Buzkashi (a Central Asian sporting event where use the carcass of a headless goat...don't ask).
When he opened his eyes and looked at me, I could see the fear in his eyes and I just wanted to console him. How was I supposed to tell him he was going to go to surgery or not to worry, he was safe? I just let my motherly instincts take over. When night shift came, I asked Lynn if she minded that I stay with him until he went to the OR and thankfully she said it was ok. I just didn't think it was fair for him to endure more trauma and for him to be able to see a somewhat familiar face that he could associate with during this mess.
After he went to OR, I cried a little because I just feel this overwhelming urge to protect him. I said a prayer for him and although I am off tomorrow, I will go and check on him. I had two thoughts going through my mind...1) I hope his surgery is successful and they find a guardian for him and 2) God forbid my sons ever find themselves in a situation like Georgia, I pray someone will show them the kindness I felt toward this boy.
When I got report on Georgia, he was a young boy of eight who received two broken knees, peppering to his face, arms, and abdomen. A hole in his left shoulder and some other injuries. I quickly assessed him and we got him settled. I had learned that Georgia was a boy who did not have a guardian and did not speak Pashtu or Dari but Uzebekestanian. Of course we don't have an Uzbekestan translator! I felt immediately protective of this boy. All I could see when I looked at him was Kodi. How fearful he must have been opening his eyes to a bunch of strangers poking at him when all he remembered was attending Buzkashi (a Central Asian sporting event where use the carcass of a headless goat...don't ask).
When he opened his eyes and looked at me, I could see the fear in his eyes and I just wanted to console him. How was I supposed to tell him he was going to go to surgery or not to worry, he was safe? I just let my motherly instincts take over. When night shift came, I asked Lynn if she minded that I stay with him until he went to the OR and thankfully she said it was ok. I just didn't think it was fair for him to endure more trauma and for him to be able to see a somewhat familiar face that he could associate with during this mess.
After he went to OR, I cried a little because I just feel this overwhelming urge to protect him. I said a prayer for him and although I am off tomorrow, I will go and check on him. I had two thoughts going through my mind...1) I hope his surgery is successful and they find a guardian for him and 2) God forbid my sons ever find themselves in a situation like Georgia, I pray someone will show them the kindness I felt toward this boy.
Tuesday, March 22, 2011
Comfort Cares
The day started like normal, I had two patients. One of whom was to have an ethics committee to decide if he were going to be placed on comfort cares. Prior to the meeting, I had done normal cares for both my patients and was getting ready for the meeting. I had received a coin from Lt Col Witten, one of our Army folks who was grateful for the care we gave to some of his soldiers and the Afghan National Army (ANA) personnel we receive. My spirits were pretty high.
This particular patient, Akbar, was a high ranking member of the ANA. There was an assassination attempt on his life two weeks ago and we took him, operated and thought he would recover. He got two very drug resistant bacterias and his condition was worsening. Yesterday, he was trached and when he returned to me his blood pressure started to drop. We had an ethics meeting at that time and it was decided his mortality rate was >80%. He was to be made a DNR and be given 24 hours to show improvement leading to today.
He did not improve last night so the meeting was held with his family members and it was decided to put him on comfort cares. As a nurse, comfort care is very important to me. I want my patients to die a dignified and comfortable death. Whether they feel pain or not, I want them to just fall asleep quietly. I placed a scopolomine patch behind his ear to help with his secretions and started a morphine drip to help with his pain, or work of breathing. In the Afghan culture it is very important that as many artificial things be removed from the body prior to death also a woman is not to be present when a male dies and vice versa. Andrade and I took everything except the fresh trach, one IV line and the ex-fix on his arm. After all was done, I got Dr. Chung to remove the ventilator.
I left the room and watched his sats start to drop and then I got busy with something else. Andrade came into the breakroom and said "Lt Sanders, your patient needs more pain meds, he's thrashing about." I went into the room and saw this man suffocating. I turned up the morphine and then discovered he had pulled out the line so he had been without medication for a while. We gave him a couple of shots of different drugs but it wasn't helping. I stayed in the room until he was more calm and then went out to Dr. Chung and said "Dr. Chung, please help me. This man is suffering and what we're doing isn't helping." Then I started to cry. I have never cried like that but it hurt me so much to see this man gasping for air.
I know some days I come in and I'm crabby, some days I don't do as good a job as I'd like but I have always been adamant about giving someone a good death and today I failed Akbar. I learned a few things from this and hopefully I will never experience this again. I hope I can forgive myself and I hope Akbar and his family can forgive me. I know it happens, but I'm the nurse and I was responsible.
This particular patient, Akbar, was a high ranking member of the ANA. There was an assassination attempt on his life two weeks ago and we took him, operated and thought he would recover. He got two very drug resistant bacterias and his condition was worsening. Yesterday, he was trached and when he returned to me his blood pressure started to drop. We had an ethics meeting at that time and it was decided his mortality rate was >80%. He was to be made a DNR and be given 24 hours to show improvement leading to today.
He did not improve last night so the meeting was held with his family members and it was decided to put him on comfort cares. As a nurse, comfort care is very important to me. I want my patients to die a dignified and comfortable death. Whether they feel pain or not, I want them to just fall asleep quietly. I placed a scopolomine patch behind his ear to help with his secretions and started a morphine drip to help with his pain, or work of breathing. In the Afghan culture it is very important that as many artificial things be removed from the body prior to death also a woman is not to be present when a male dies and vice versa. Andrade and I took everything except the fresh trach, one IV line and the ex-fix on his arm. After all was done, I got Dr. Chung to remove the ventilator.
I left the room and watched his sats start to drop and then I got busy with something else. Andrade came into the breakroom and said "Lt Sanders, your patient needs more pain meds, he's thrashing about." I went into the room and saw this man suffocating. I turned up the morphine and then discovered he had pulled out the line so he had been without medication for a while. We gave him a couple of shots of different drugs but it wasn't helping. I stayed in the room until he was more calm and then went out to Dr. Chung and said "Dr. Chung, please help me. This man is suffering and what we're doing isn't helping." Then I started to cry. I have never cried like that but it hurt me so much to see this man gasping for air.
I know some days I come in and I'm crabby, some days I don't do as good a job as I'd like but I have always been adamant about giving someone a good death and today I failed Akbar. I learned a few things from this and hopefully I will never experience this again. I hope I can forgive myself and I hope Akbar and his family can forgive me. I know it happens, but I'm the nurse and I was responsible.
Friday, March 18, 2011
WTF?!
I wasn't really sure what to title this blog but since this moment is time is bothering me so much, I felt like I needed to write about it. Last night, Gen Briggs came through the hospital to visit as he always does. I think it's really nice because he doesn't see the Air Force as "flying" only, but sees the role that we play. He wanted us to cover up the 8 year old in bed one and seemed pretty insistent on it. I was off shift and ready to leave so I sarcastically went over and pulled the covers from between the boy and said "Okay little one, Gen Briggs wants you covered so I'm going to cover you. Please stay that way tonight." And then I left.
What bothers me about this interaction is that this child looked so peaceful when he came through, usually all the patients do. But the night before and yesterday he was like Rosemary's baby! He would wake up and start climbing all over the bed, trying to jump out. I know he's frightened and he has a head injury, spent many days on drugs and had a nurse that probably aggravated him... I understand this. I just wish sometimes these "visitors" would see the physical work we do trying to maintain patient safety and not be concerned with why the boy isn't covered.
Which leads me today. I had the same kid, plus a gun shot wound and was getting a third patient; an American. The kid literally beat me up all day. He was such a wild thing; I was hit, scratched, bitten (Capt Baker yelled out during rounds "He just bit her!"), kicked and wrestled him to keep him safe. He was not covered at all. As a matter of fact, he peed himself twice in the bed and laid in it. Yes, I did clean him up but that's just what kind of kid I was dealing with. Did I mention we had a planetarium of generals come through the ICU, and when they did, this kid was angelic. The Chief made a comment "Oh, is he playing a game?" My reply "Oh HEEELLLLL NO! This is the calm before the storm!
The American came to be around 1400 and I found out I had 20 minutes to get him manifested on the flight leaving at 1739 this evening! If he didn't get out then, he'd have to wait until Sunday to leave. I rushed around and worked really hard to get him on that flight, and he made it. My third patient decided to drop his sats and increase his heart rate. Oh by the way, Beeland has never learned the art of not freaking out. He came running up to me in a panic "Sanders! Your patient's sats are 92 and he's tachin' up to the 150's!" My reply, "Ok."
This guy was a gun shot wound too but he's bleeding into his lungs, not a surgical issue apparently but nonetheless, bleeding. When I finally left, I had done everything for these patients that I could do and felt so accomplished. As crazy as it was, it was a good day.
What bothers me about this interaction is that this child looked so peaceful when he came through, usually all the patients do. But the night before and yesterday he was like Rosemary's baby! He would wake up and start climbing all over the bed, trying to jump out. I know he's frightened and he has a head injury, spent many days on drugs and had a nurse that probably aggravated him... I understand this. I just wish sometimes these "visitors" would see the physical work we do trying to maintain patient safety and not be concerned with why the boy isn't covered.
Which leads me today. I had the same kid, plus a gun shot wound and was getting a third patient; an American. The kid literally beat me up all day. He was such a wild thing; I was hit, scratched, bitten (Capt Baker yelled out during rounds "He just bit her!"), kicked and wrestled him to keep him safe. He was not covered at all. As a matter of fact, he peed himself twice in the bed and laid in it. Yes, I did clean him up but that's just what kind of kid I was dealing with. Did I mention we had a planetarium of generals come through the ICU, and when they did, this kid was angelic. The Chief made a comment "Oh, is he playing a game?" My reply "Oh HEEELLLLL NO! This is the calm before the storm!
The American came to be around 1400 and I found out I had 20 minutes to get him manifested on the flight leaving at 1739 this evening! If he didn't get out then, he'd have to wait until Sunday to leave. I rushed around and worked really hard to get him on that flight, and he made it. My third patient decided to drop his sats and increase his heart rate. Oh by the way, Beeland has never learned the art of not freaking out. He came running up to me in a panic "Sanders! Your patient's sats are 92 and he's tachin' up to the 150's!" My reply, "Ok."
This guy was a gun shot wound too but he's bleeding into his lungs, not a surgical issue apparently but nonetheless, bleeding. When I finally left, I had done everything for these patients that I could do and felt so accomplished. As crazy as it was, it was a good day.
Sunday, March 13, 2011
Frustrations and Aggravations
Today was pretty frustrating. It started with the charge nurse. This person has never been an ICU nurse and just graduated the fellowship and works in the ER. I don't fault her for not knowing things, because this isn't her area of expertise but I do fault her for being too insecure to take any advice from a person who has been an ICU nurse for five years. I asked about patients leaving the unit and her response was "We have beds, I ain't worried about it, I have other things going on." The fact is we had one Afghan bed left and we were taking three hits. This is not anticipating the needs of the unit. Then next thing was her patient required conscoius sedation yet she was nowhere to be found and I was yelled at by the doc to get the medication. This wasn't MY patient!! She was too busy hanging out in the breakroom with her buds. Then they came to pick up a patient to transfer to another hospital and she had no idea this was happening, neither did the nurse caring for the patient.
This leads me to the aggravation; Beeland. He is such a dumbass! Today he felt it was more important to finish his e-mail to inquire about Flight Nursing rather than preparing his patient to leave. I told him his e-mail could wai and he needed to package the patient. Of course, patient care isn't his priority so he continued with the e-mail. I haven't a clue how he got this far in life, but knowing how things work, he'll be one of those Colonels without a clue that the rest of us will have to shuffle behind, cleaning up his messes. We do that now.
I am also angry the docs didn't listen when I said I was uncomfortable with an order they gave regarding a pediatric patient. I gave my reasons and they continued with the order. The patient ended up having the drip stopped because of her decreased platelets. But who listens to the nurse. I know I have a lot to learn but I do know what I know. I hate being ignored and put off. I'm not sure why this happens, I think I'm vocal but maybe not enough. I feel like I'm losing my cool. I didn't go to dinner tonight because I just need to be alone.
I find I am angry with everyone lately and I don't like feeling this way. I have too much time to go, I think I'll just spend more of my time alone and stay away.
This leads me to the aggravation; Beeland. He is such a dumbass! Today he felt it was more important to finish his e-mail to inquire about Flight Nursing rather than preparing his patient to leave. I told him his e-mail could wai and he needed to package the patient. Of course, patient care isn't his priority so he continued with the e-mail. I haven't a clue how he got this far in life, but knowing how things work, he'll be one of those Colonels without a clue that the rest of us will have to shuffle behind, cleaning up his messes. We do that now.
I am also angry the docs didn't listen when I said I was uncomfortable with an order they gave regarding a pediatric patient. I gave my reasons and they continued with the order. The patient ended up having the drip stopped because of her decreased platelets. But who listens to the nurse. I know I have a lot to learn but I do know what I know. I hate being ignored and put off. I'm not sure why this happens, I think I'm vocal but maybe not enough. I feel like I'm losing my cool. I didn't go to dinner tonight because I just need to be alone.
I find I am angry with everyone lately and I don't like feeling this way. I have too much time to go, I think I'll just spend more of my time alone and stay away.
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