psychology

So I thought the high census thing was over but it's not. ("High Census" in nurse world is equal to "lots of patients") I thought the high acuity thing was over but it's not ("high acuity" is equal to "really really sick patient").

So yah, I'm still working, like, all the time. It's a little thrilling to be a part of a team all emergency department-like to be all like, puttin' IV lines in STAT and drawing labs STAT and spraying nitro under peoples tongue and all that. It's different than what I usually do (chronic disease management... caring slooowwlly over tiimmeeee).

With my brief interactions with the emergency department's RNs and critical care RNs this week - I just, I dunno - I don't really like the whole emergency department thing. It's one tiny (important) piece of a puzzle that is patient's care. I see the patient the week after they are discharged from the hospital and they are scared at every little bit of chest pain - and of course my most seriously sick patients will never get their heart function back and hopefully become my transplant patients with happy new hearts - but only 3% of them become those patients. The rest are managed and cared for and seen every week and adjusted on alpha and beta blockade and aldactone and long acting nitrates and every little diuretic therapy known to man but in the end... it ends.

I had one of those conversations with a patient on Wednesday. I realized as I was talking with the patient that, wow, I've had this job for a year and a half. It started a year and a half ago when I followed the patient's care from the day of discharge from the hospital after the myocardial infarction, through all the tests and in and outs of the hospital, the desperate and the extreme measures, the implantable defibrillator bringing her/him back from death not once, twice - but three times. The LVEF is still 10% - and the conversation is "palliative" care. Comfort measures. IV drips at home with nurses coming in and adjusting them. The whole, "we don't know how long it will be, 3 days, 6 months, 2 years..."

It was a strange feeling - the patient was trying to decide if he/she wanted a particular medication that brings comfort & energy but also is known to "hasten" the end of life. Do you live happy for a few months, or "drag it out". The patient was crying as we discussed the decisions, and I thought I would have to - but I didn't. It was a different feeling, a feeling of accomplishment. We were here for the patient. We did all we could. We are letting go when he/she wishes us to let go. We have talked about God, the after life, his/her family. It's a peaceful ending.

Well, we'll see - but we both felt an overwhelming peace this week about it, as did the other staff here about the whole thing.

I'm starting to feel a bit more of a family here with the heart failure team - even the doctors who are grumpy. I would be sad to leave this work.