Thursday, September 16, 2010

Sleepless

The title says it all. I haven’t gotten much sleep over the past couple of days. It’s all because I’ve had a lot to do and not a lot of time to do things. Between working (which is where I am now and was at yesterday) and classes (my lab class meets Thursday afternoons) as well as preparing two presentations that I am giving, I’ve been doing a lot. And I’m tired.

Yesterday was another busy 24 hour tour, and we caught a couple of unpleasant calls. One of them was a 40 year old female who committed suicide by hanging. Found by her mother. And being the medic on scene it fell to me to verify that she was indeed dead. It wasn’t difficult as she had been there for a while. But it was not pleasant.

I found out later on that there were a number of incidents involving members of her family and many suicide attempts that were either successful or not. That was unnerving, and overall it was just a difficult situation to deal with. I’ve written in the past about my issue with suicide in general and by hanging in particular. It makes me angry, and this one was no different.

On the overnight we went out three or four times – I lost count. One of the calls was for an elderly female that had had a surgical procedure done to remove a malignancy on her lower leg. As it turns out she probably shouldn’t have had the procedure done – she is on Coumadin due to a cardiac condition - and she started to bleed at the procedure site after getting up to take care of nature’s business. And she bled profusely; I’m not sure what the total loss of blood was but I know it was significant. We transported her into Boston as she’d had the procedure done at one of the hospitals there.

The other notable overnight call was to one of the nursing homes in Newton for a patient having difficulty breathing. And he was – 87 years of age, history of dementia among other things, and he had awoken with a sudden onset of respiratory distress. When we arrived we found a very sick individual. He was extremely diaphoretic and warm, hypertensive and tachycardic. The staff was a little more on the ball than the last time we were there, but one of the nurses sent me into orbit. My partner asked her a question – I don’t remember what the question was but I do recall that it was a simple one – and she answered him with the phrase “I don’t know because he’s not my patient.”

It’s not the first time I’ve heard a nursing home employee answer one of us with this response, but it really made me annoyed.

The most interesting call of the night was for a 42 year old male that was confused. He’d ended up at a residence that was not his own, although he thought it was. He also thought it was April 1 and that he was buying Halloween candy for his children. He was cooperative with us, though, and he let us take him to the hospital to get checked out. It turned out that a toxicity screen found that he was positive for multiple substances, including both benzo-diazepines and opiates as well as for PCP. He had no alcohol on board, though, and I found that to be interesting.

Tomorrow I am teaching a class for a number of the nurses that work for Martha. A primer of Congestive Heart Failure, which should be good. I had to make it so that it wasn’t “dumbed down”  but I also wanted to not get out of control with information. I think I was successful, but the proof will be in the time spent doing instruction.

So with all of that said, I’m going to prepare to get some sleep. And I’ll hope that it is much less active than last night was.

3 comments:

Susie Hemingway said...

What an amazing life you lead Walt and so much good is achieved during every day. I don't suppose knowing this helps to overcome the tiredness you must feel on really heavy days but what a totally worthy life you have. I am so proud to have you as a friend. Take care.

TOTWTYTR said...

Let me know how that CHF presentation works out. I'd be interested in seeing it, if you don't mind.

I think day 1 of NH orientation consists of learning to say things like, "I don't know, that's not my patient.", or "I'm only covering for the regular nurse, she called in sick today."

Karen Brook Westhaver said...

"Sleepless" is hard in itself, even when you don't have the level of responsibilities you do, Walt. I hope you'll get opportunities to grab some good rest and also some FUN which is so important, too. RE-creation. Somehow we have to find ways to do that if we're going to keep going. You are amazing in all that you do, the level of compassion you have (without compassion fatigue)and the tremendous varieties of tasks! I'm hoping you're sleeping even as I'm writing this, my friend (it's 1:22 AM).