As I stand at the counter in my patient’s room. I’m preparing her medication for administration; crushing pills to mix in water and drawing up IV medication in syringes. My patient has a history of dementia. She’s very sweet and quite a talker. Her words have the same pattern as an abstract painting and are hard to follow. As I’m going about my work administering her medication, checking her temperature, charting her vital signs, doing my full assessment, and documenting these findings; she continues chatting. She’s talking to me as if I am a familiar friend instead of the ICU nurse she met 20 minutes ago. Suddenly my mind is snapped back to attention as she makes a statement about how she arrived to the hospital and the specific hospital she was at. Her statement is completely correct and I find myself taking pause for a minute. Prior to this, I had heard everything she was saying but I realized I wasn’t really listening to her. I had made assumptions about her mental state knowing her medical history. I was wrong.
Throughout the night, my patient’s respiratory status continues to worsen. I’m having to NT suction him every thirty minutes to maintain a patent airway. As I stand and listen to him, he sounds like he’s drowning; gurgles and audible external wheezes with every breath. Watching him, I can see his work of breathing is changing minute to minute. His abdomen is retracting with every breath he takes, his chest wall is moving in an out dramatically; he’s struggling to breathe. I have been in communication with the doctor all night. At 0330, I page the resident again. He calls back to discuss the changes. This time something is different; while I know he has been listening to my concerns and the words I’ve been saying all night, now he can hear the concern, fear, frustration, and exhaustion in my voice. This time he tells me “I’ll be right there.”
After a traumatic accident, the physician and I are giving the mother of my patient a complete update on what bones are broken in her son’s legs and arms as well as trying to explain the shearing injury he sustained to his brain. We talk about the outcome possibilities for her son and how vast the range of healing possibilities are. We discuss with her the treatments we need to do, the ICP monitoring that is important to observe for swelling in the brain, the ventilator support he needs, and the medication we use for cardiac support to ensure adequate tissue perfusion. She signs consents for surgery and line placement. I know she can hear the words we are saying and is trying to listen and comprehend what they mean. Tonight she is only able to focus on her son in the bed and the possibilities for his short life that might be lost. It will be days of her hearing this information over and over again before she is able to understand.
As my patient arrives in the ICU after a spinal fusion she is screaming in pain. She was receiving pain medication in the PACU and upon her arrival here I begin working to set up a PCA so she can administer her own pain medication by hitting a button whenever she needs it. The PCA is a patient empowering device, but throughout the night her pain stays stable 7-10/10 and without any relief she is getting angrier. She uses her call button every 15 minutes asking me for more pain medication. I continue to explain again and again that she has to push the button to give herself pain medication. Each time the nursing assistant and I come in to turn her, mobilize her, and help her on the bed pan her pain gets worse. I try to remind her each time that moving and mobilizing are vital to healing and lying still makes the pain worse over time. She has never had this surgery before, and I try to reassure her that in all my experience, I know the pain will be better tomorrow when she can get up and walk around. She is listening to what I’m saying but in this much pain I can tell she is not interested in hearing my voice.