Friday, February 17, 2006

on sleep

When I began working as a nurse I started on the night shift. As a brand new RN that was the only full time position available and because I didn't have a clue I grabbed it.
I loved the night shift. You are free to do what needs to be done without the interference of every other service. You don't have to stand around and listen to staff doctors filled with self importance torture the residents and fellows for no apparent purpose. At night it's just you and the resident. You work together doggedly fixing as many of the problems you can so both of you can stagger off for an unsatisfying nap.
I learned very early that sleeping on your break for me was a disaster. I woke disoriented and angry.
By five in the morning my nerves were rubbed raw and I couldn't find the patience to talk down my demented patients who were trying desperately to separate themselves from the web of technology holding them to the bed.
I used to feel terribly sorry for these elderly patients,confused and angry wanting nothing more than their freedom. That ended when one of these "poor" souls bit me. They can be terrifying in their violence so I now think nothing of restraining them.
They never cover this in nursing school, tying a patient to the bed against their will. At first I felt like a criminal and I would get the restraints off as fast as humanly possible but over and over again I was the nurse whose patient ripped out their IV or self extubated. I hated looking like a fool and having my patient gasping and turning purple because I thought they needed their freedom more than their life.
I tie people down now and I sometimes don't even think about how awful that is.
I think I would rather have my hands tied down then being drugged into a drooling idiot. At least with restraints the possibility of coming to my senses exists... to be drugged into compliance could mean days of incoherence while I don't cough, my gag sucks so I end up with aspiration pneumonia.
A lot of hospitals are moving away from restraints. Families rant and rave that it is cruel and degrading, ofcourse these are the same families that hire a lawyer and scream their heads off when their demented violent loved one climbs out of bed and breaks a hip. They howl "why didn't we stop it from happening?" and we answer because you made a huge stink about the posey jacket that held grampa in the bed and you demanded that the doctor make an order that said no restraints so tough luck. We have six other patients and we notice you couldn't bother to come in and sit with him so tough damn luck.
When you take away a safe restraint policy and have nothing to replace it with other than check on the patient more often what do you want ? It takes about thirty seconds for a patient to climb out of bed, we could be checking them every five minutes and still they could escape.

If you are so damned concerned about your loved one hire a sitter or better yet how about you give up a little of your own time? You don't want restraints? Fine then come and watch your grampa and keep him in the bed, I actually have to provide medical care to sick people and I am not a babysitter for the demented.

I want to ask families why they brought their eighty five year dementia stricken parent in for major surgery that is guaranteed to render them bedridden and completely incapacitated. These patients drift from sleep to mania back to sleep assaulting nurses , kicking, biting and lunging out of bed and then, exhausted collapse. Why did you do it? Why couldn't you have had a little mercy and let the disease kill them quickly instead of sentencing them to months of pain and terror. They have no capacity for understanding why we are causing them terrible pain. They know only that we are monsters that swoop in unannounced and maim them. We have no names, they don't know what hospital means anymore, they don't understand what operation is.All they know is over and over again they suffer pain and there is no escape.
Then I tie them to the bed so they don't pull out the IV, NG,ET and they can escape for one day the pain 0f reinsertion.
I think the trade off is fair. I save them from being assaulted that day and the price is only their freedom.

Why can't patients make a living will? What stops you from telling your doctor that torture is not a medical option for you?. Before you become demented appoint someone in your family you can trust. Don't pick the cuddly,compassionate family member,they wont have the guts for the difficult decisions..pick the family member that has always been good and cool in a crisis. The one that follows the rules. Make them understand that your living will is the rules of your life and your death.
Have some common sense and choose not to be tied to a bed for the last month of your life.

To family members: If you think it's just the kindest thing in the world to put Old Scruffy down when he can't eat , can't walk and can't make it outside to poop why the hell do you think it's just fine to force grampa to live that way? Does your DOG deserve more compassion than your father?
People deserve dignity and shoving a feeding tube down them while they lay day after day in the bed awash in their own waste completely dependent on strangers with no hope of recovery has no dignity.

What happened to taking your loved ones home to die? We do it in my family. We all work full time but somehow we managed to get together and make a schedule and pool our resources to hire care aides. Is your life just too busy? Or is it once again that ugly entitlement thing..I pay my taxes so do my caring for me..I just don't have the time or the want. I have heard it over and do it, it's your job blah blah blah..well if that is the way you want it
then shut up when we do your job okay?
You want a voice? Then pick up a washcloth, help turn, get bitten and kicked... BE THERE.

wow I feel better, that rant has been coming on for weeks. We are losing nurses to this, they can't stand to be a partner in torture because families refuse to make a compassionate choice.


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