Expect the Unexpected
Someday you will learn why you should never procrastinate! Everything is going smoothly after a bit of a bumpy start to the day. You have theater tickets for the best show in town and you hope to get off right on time so that you can make it without rushing.A Typical Story
Your last major task is to change the dressing on your least favorite patient. She is a cranky woman of about seventy who was admitted a few days ago for a severely infected wound. She had her leg amputated mid-femur some months back and she ignored the pressure sore that her prosthesis caused. She's still very angry about the amputation that was caused by some sort of accident. No one has taken the time to talk to her about the accident or her feelings. She is too cranky and demanding. In fact, everyone avoids her room and the door is kept partially closed so that nurses passing by aren't flagged down to assist her with a never-ending need to rearrange her pillows and admonishments for not knowing exactly how the pillows should be.
No one can blame you for making her dressing change your last priority. The wound is large and the odor is powerful. It makes you gag to see the flesh and the smell is more than your already queasy stomach can handle today. If you make it the last thing to do today, you can slip in, do it, bring her a pain pill, rearrange her pillows one last time, and tell her you have to rush off for report now — document and report off, your shift is over.
You finally assemble everything you need and even have her pain med with you. (The patient refuses to take it before the dressing change.) You walk in and hear a thud. Your heart stops for a moment and then you realize that the patient in the next bed has apparently fallen in the bathroom.
Compound the problem with the fact that you work in an old facility that is just now being brought up to code. The bathroom door opens inwardly and the patient who weighs about 200 pounds has fallen so that she is blocking the door. Your patient is frantic and screaming at you to do something. (Can't she see that you are trying to get the door open?!) The patient inside is not one of yours and so you don't know very much about her situation. (Just one more complication.) Oh yes, her nurse is on a break and you're covering because this one “is stable and shouldn't need anything for the next fifteen minutes.”
It seems like an hour has passed when you give up on the door. The patient is not answering you and you need to get some help. In what appears to be slow motion, you finally reach the hallway and flag down a coworker to go and get some help. Your coworker has panicked and called for the code team. The crash cart and all the bells and whistles will arrive any second and you hope it's not all in vain. In fact, it turns out to be a good call because when they finally get the door open by some miracle, the patient is on the floor in full cardiac arrest.
Her nurse is still on a break and so, by default, she is your patient now. The code team handles it, but you are required to remain present. You will be responsible for accompanying her to the ICU if they can revive her. If not, you'll be doing post-mortem care. Oh and you still need to change that dressing. Now the cranky patient has been traumatized by this event.All's Well
Long story short, the patient is revived, her nurse returns in the process and will accompany her to ICU after you give her a report on what you witnessed and document it all. Once you calm your own patient down, you do finally get the dressing changed. It's now way past time for you to be on your way to the theater and your friends have given your ticket away. (Good thing, you're too exhausted to go to a show now.)
The one good thing in all this is that you have an opportunity to talk to your patient. She opens up about her own fears and how horrendous her accident was. She has had her own epiphany today — at least she lived through it. She thanks you for your extra-gentle touch today and expresses admiration for how calmly and professionally you handled the situation with her roommate just now. Another story for your journal. Hopefully now you will remember to do the things you dislike the most first. Don't procrastinate!