MRSA Oh My!

For most people MRSA sounds like something out of a horror movie that recently invaded our society. For people who work in health care it's old news. Of course, I'm new to everything and I'm so becoming germaphobic!

My patient this week: 42 year old diabetic with end stage renal disease and a massive MRSA infection on contact isolation.

I was real paranoid at first but I had a suspicion I'd get a patient on contact isolation. I just knew it. Just ask Melissa, she'll tell you. I talked her head off about it the whole way to DeKalb LOL
Anyways, I need to shape up alot when it comes to my diabetes. I'm never exposed to anyone who has it so I don't really have a role model to learn from. And my doctors aren't too strict on me. I've really got to find an endocrinologist. I hear they'll kick my ass for my blood sugars. So I'm thinking that seeing this young patient in end stage renal failure will be an eye opening experience.

My first impression of her was ok. She just received a heafty dose of pain medicine a few hours earlier so she was practically comatose. She didn't have an easy morning. She was throwing up everything she ate. She also has a MRSA infection in one of her eyes. So she requires eye drops EVERY hour. And she has 4 of them, not to mention 2 insulins and about 10 oral meds. And it's up to ME to keep track of them and juggle their administration between AM care, vitals, blood sugar monitoring, and 30 pages of paper work. Not to mention having to complete a drug sheet for each med. On 2 hours of sleep.

But something really kicks in when I wear my uniform and assume the role of a "nurse". It's almost motherly. It's weird. I just feel this intense nurturing feeling. Protective even. Almost whatever I see becomes a non-issue to me. My patient was puking in a basin and it didn't matter to me. She has MRSA and it didn't prevent me from caring for her. I jumped right in.
Today she was much better. The doctor is just keeping her on Morphine for severe pain and she tolerates that better. She talked with me more, we even traded "diabetic stories" LOL What scares me though is she has severe kidney problems and receives dialysis 3 days a week and her diabetes is better controlled than mine! That really scares me. What kind of damage is occuring to my body even as I type this blog?! I'll get to my issues with the insurance company in a little bit.

The nurses I deal with have been excellent. They compliment me so much and believe me, they can be some bitter bitter people. So I really feel honored. I reported to the pts nurse at one point today and she's like "I love a nurse that's on her toes" LOL Then later on the pt asked the nurse and I how much nurses make. I was like "Well, I'm not a good one to ask because I don't make anything" LOL

Like my other patients, I really enjoyed taking care of her. She was a really great lady. She's been hospitalized for several weeks now and I told her to get better and when I come back in 2 weeks she "better not be here when I get back!" She really laughed about that. She wants out of there so bad. Just wants to get back to life again. That MRSA that you hear about is some ugly stuff. It's treatable, but it's still ugly. She got it in her eye and lost vision in that eye. And now she can't hear on that side either. Bad stuff.

Ok, the insurance company. I was using Accu-Chek but wasn't too happy with it. Bayer sent me a free Ascensia Contour and some strips. I love it! So I called my drs office to call in a prescription for more. These things are 50 for $49. Expensive, especially when the dr wants you to test 4 times a day. With insurance I can get 100 for $30. Good deal. Anyways, the dr calls in the prescription and I get to Kmart and they won't give them to me. Blue Cross had an underuse precaution on me. Apparently I don't test my blood sugar enough. Ugh. Ok don't complain that I don't test enough and then not let me get my strips.

So I go home, call the drs office, and tell the nurse what Kmart and Blue Cross is saying. She thinks it's insane. The next day the nurse calls me. Blue Cross faxed them a form about "will I use more than 100 a month?", "have I used this brand in the last 30 days", etc etc. Turns out BCBS has a contract with Accu Chek (Roche) and they really push Roche products. They don't have a contract with Bayer. It's not a "prefered brand". How much BS is that?! Just let me freaken treat my freaken diabetes before I end up in kidney failure and you have to pay much more for my freaken dialysis! Ass wipes.

Anyways, 3 days go by and I FINALLY get a call from the drs office. BCBS doesn't mind if I get that brand of strips. ARRRRRRRRRRRGH! A fuggin week to get strips.

Clinical Update

Well I'm officially half way through clinicals! Hell freaken yeah!

I went to the hospital Wednesday and picked up my patient assignment. Ok. She's on literally about 40 drugs. For each of those drugs I have to go home and research them and compile the data on a med sheet. So I'm thinking "Shit. And I have to be up at 4:00 am? I should just practice for MD residency now while I'm ahead. No sleep for at least 3 weeks eh?" Not to mention the pre-clinical paperwork I have to complete, including research on her condition and medical tests.

Bright and early Thursday morning... like 6:00 am. I check my patients chart to see how she did overnight. SHE GOT DISCHARGED!!!!!!!!!!!!!!!!!!! Son of a...

I have a new patient. I spend the next hour researching HIS condition and meds. Ok, it's pneumonia no biggie. I've learned alot about pneumonia. God blessed me cause this dude was awesome. He took care of himself, was very independent, and had to have a million diagnostic tests done. Thursday I accompanied him for a Persantine-Thallium Stress Test. Took 4 hours, but it allowed me to complete 10 pages of paperwork on him.

So last night my sleep deprived bootie goes home and researches all of HIS meds. I go to bed around 11:00 pm. BACK UP at 4:00 am I feel like I'm catching a cold. It's pitch black outside. And raining. And Atlanta peeps don't do rain. I'm heading up 285 and it's not even 6:00 am and I'm TIRED! And night blind. And sleep deprived. Ok.

I get there and my patient is going to the Cardiac Cath Lab. How cool? I go with him and watch his test and the guy ahead of him. That was the coolest thing watching the doctor shove a wire in his groin area up to his heart. And I got to watch the tube go into his heart and shoot dye into it and watch it pump away.

Next I figure, I'll go ahead and get my 17 page, once a semester detailed evaluation done with him. He's a very pleasant patient. An hour before quitting time I go in his room and he's starving, but still flat on his back from the cath. It's time to allow him to sit up but first we have to get a blood glucose on him. The techs stole all the freaken Accu-Cheks! So the nurse and I have to go hunt down an Accu-Chek before this dude grabs ahold of his food and starts chowing down.
Finally we get it done and he just wants to be alone with his food. I give him his privacy and get a head start on my other 10 pages of paperwork I have to do. With half an hour to go before post-conference I go back to his room. They FREAKEN TOOK HIM DOWN FOR A PULMONARY TEST! Fuggin A man.

So what's my impression of clinicals this week?

!!!AWESOME AS HELL!!!
!!!GIMME MORE I LOVE IT!!!
!!!!!!!AHHHHH HAAAA!!!!!!!

My First Patient

Ok, I'm working on the Cardiac Telemetry Unit. My patient on Friday will definitely leave an impression on me for the rest of my life, probably.

She's an 81 year old woman admitted for pneumonia sepsis. She isn't quite with it and is unable to talk. Her skin is paper thin and she develops blisters and bedsores very easily and non-stop it seems.

I did all sorts of stuff with her on Friday and even got to give her a sponge bath. I Got her some clean, fresh bedsheets and gown. She has a special lotion that needs to go on her skin and I put that on after her bath. Then I gave her a real gentle back rub. The tech that was keeping her on her side said that she really enjoyed it. I was like "Really? You think?" and she was like "Yes! Don't you hear her?" She was letting out these really soft moans like it felt good! Oh I felt good cause I knew she's been in so much pain.

A few times Respiratory Therapy had to come in and give her breathing treatments and suction her out. That was hard to watch. She had tons of stuff in her. And I knew it was painful for her. But the lady from Respiratory Therapy was absolutely fantastic. She really talked to her throughout the whole thing.

She had this little stuffed dog next to her bed and I asked her son about it. He said she used to have a dog at home, but he died. So this was her dog. After my shift was up I went to her room, got her comfortable, and tucked her in. I got down next to her and called out her name. She opened her eyes and looked at me. I spent probably 5 minutes smiling at her and talking to her about her day. I told her she had a bath, a new gown and sheets, a backrub... I told her she was treated like a queen! I told her about all her visitors, including her granddaughter from Michigan. Then I showed her her dog and she looked at it and I told her he was going to lay in her lap. Then I told her that she was a very sweet lady. She just looked in my eyes like she was really listening to me and enjoying me talking to her. This was probably the first time someone really paid this much attention to her in awhile. At one point it even looked like the corner of her mouth turned up like she wanted to smile. At least I hope she did. I couldn't believe how much she was paying attention to me. The previous few days she was getting more and more unresponsive.

I don't know what's going to happen to her for sure. She probably won't be there next time I come in. I know her family was trying to decide whether or not to send her to hospice. But regardless, even if she has a few days left, I hope I really touched her and gave her a few minutes of peace and relief. I wish I knew her before she got this sick.

It was definitely a spiritual experience. I felt that we looked into each other's souls just about. It was intense. I definitely found my calling. I've always known I wanted to be a nurse but I never realized how badly. I am definitely not an office person dealing with a bunch of ungrateful assholes that stab you in the back and treat you like shit. I know I'll have patients that are that way but knowing that I'm there to help them might make it easier.

Happy to report week 1 of clinicals was more than successful!