Nervous Prostration

I want to be diagnosed with some antiquated name for a disease, like consumption, or nervous prostration. Just because it'd be funny, and future PMD's would ask, "Who was your former primary, and what's with the "consumption" dx?"

I swear I need a pre-syncopal work up, even though it's because I'm probably constantly hypoglycemic, eat less than 1000 calories a day on a normal work day, have lost my appetite, and work 12 hour shifts dehydrated with probably half a liter of fluid intake if I'm lucky.

Today at work I had stomach pain all day long, diarrhea, and every time I turned my head around quickly, my vision went blurry and I felt dizzy. If I stood up too quickly, I felt faint and saw blotchy spots in front of my eyes. A couple of times I thought I might faint.

I also weigh now 92 pounds with clothing on, which means I've lost three pounds in the last couple of weeks. I'm in competition with the thinnest person on our floor, a slim, tiny framed, pretty Vietnamese nurse who has two children and yet looks completely nulliparous. She weighs four less pounds than I do, and she's tiny. I look like a normal sized human being next to her, and I'm small framed to begin with, so weighing less than 100lbs = not healthy.

I need a PEG tube and feedings, stat!

I also run into things a lot at work, and have five large bruises on my bilateral lower extremities. I look like a victim of some odd form of domestic abuse.

I want to eat, sleep and drink like a normal person!

Incidentally, speaking of normal, on my float yesterday, I had a woman who was admitted for "mental status changes," which basically meant in her case she was dying, and her poor son was there with his head in hands, because mom was basically aphasic, and lethargic, except when you touched her. Then she'd scream and punch you. It didn't hurt, because she wasn't strong enough to do any damage, but every time we had to turn her and such, it sounded like we were flaying her alive from the screaming.

There were student nurses on the floor that day, and one them had another one of my patients, and she kept running into the screaming, dying lady's room with these wide, anxious eyes. And I'd say, in a deadpan, disinterested you'll-get-used-to-it-too voice, "Yeah, she does that. She's out of it." The student kept looking at me like I was some kind of hard-hearted, cruel bitch, the kind of nurse she'd never be, thank you very much.

I felt bad, because I wanted to explain the thing that you can't explain until you've been there for awhile: you get desensitized to the suffering. The screaming, the agony, the hellish noise-- you hear it, but it phases you a lot less when you realize there's not a goddamn thing you can do about it, except say pointlessly in a soothing voice, "I'm sorry, dear, I know this hurts. It'll be over soon. I know it's horrible to be here in the hospital."

Even her son said to me in this despairing kind of voice, "She doesn't even know where she is any more. I don't think she has any clue what you're saying." I think he thought I was nuts for even talking to her.

The thing is, I even talk to my deceased patients. I probably sound like a nut case, but I still believe that they deserve to be treated with respect, like the people they once were. I remember doing my first post mortem care ever, I think right before I became a nurse, and taking out the IV, and cleaning her and turning her and talking to the patient as if she was still alive. The tech looked at me like I had lost my marbles.

I'm not religious, I'm not even very spiritual, but I believe in respecting humanity, even if it is the memory of humanity. It's important to me. I would never want my parent to be gawked at by a bunch of bystanders as they are dead, naked, and about to be toe tagged and zipped into a plastic bag. I would never want them to be treated like a dead slab of meat, even if that's technically what they are at that point. I would want their nurse to treat them like the humans they were in life, even in death. Wouldn't you?

I remember the first patient of mine that died, and how a student wanted to come in and "see the dead guy." I didn't say anything, because I didn't have the balls, honestly, but I really wanted to say, politely, "I'm sorry, but this isn't the time for a learning opportunity for you; someone's father and brother just died. Please just let us take care of him now."

Dead is dead, I know that.

Still, the absolute worst part for me is after the family (if there is family) comes to view the patient, you have to tag and bag them, and zipping up the body bag feels antithetical to everything you're taught as a nurse. I keep thinking irrational things like, "Oh my god, they're going to suffocate in that thing! What am I *doing*?!"

I guess I'll get used to tagging and bagging one day, too.

Just like every time I see a copious, nasty bleed these days I just go all reflexive and immediately start holding manual pressure and get into "where's the sandbag? and who can page the HO for me so I can get them to come up and look at this guy?" mode. If it ain't arterial, or a massive GI bleed, it doesn't phase me any more, even though it can be alarming to see venuous oozing. Sometimes I pull IVs and the patients don't hold pressure long enough on the site, and start freaking out at the sight of 30 ccs of blood. They must think I don't care, because I act like it's no big deal, tell them to hold pressure ("What?! I'm BLEEDING HERE!") and glove up and grab some 2X2's and hold pressure myself. The family and patient usually look horrified, like I'm trying to kill the patient, but it would take hours for you to bleed to death that way even if you didn't coagulate normally.

Here's the irony, and why I am really a hypocritical bitch:

You know you're becoming a real nurse when someone finds out they've got cancer and they start getting all anxious and horrified and needy, and you go outside the room and immediately complain to the next nurse you see, "Good GAWD that woman is a pain. I mean, yeah, she was diagnosed with cancer and everything, but geez, she's fifty years old--there's a lot of treatment options out there nowadays, and I've seen a lot sicker people, I wish she'd stop whining." And the nurse replies, "Yeah, if you ain't tubed and vented, you just aren't sick enough to complain."

We don't mean it literally, of course, but it just proves the dichtomy of caring and desensitization that goes on in this field.

In the meantime, I suppose I should get used to students looking at me like I'm some uber-bitch when my demented, dying patient starts screaming, swearing and kicking all I say is, "Don't worry dear, this will just take a second and then we'll be done." And then I walk out of the room and go onto the next thing looking as unphased as if I'd gone into the room and had a nice, normal conversation with an alert and oriented patient. Meanwhile, the student is standing there with big round O-shaped eyes like, "OH MY GOD! YOUR PATIENT! DON'T YOU GIVE A SHIT?!"

Yes, I do. But in order to care, sometimes you have shut down the part of yourself that reacts emotionally. Emotion has to come later, which is why I'm such a mess. You're not allowed to feel things on the job, at least in front of the patient. To them, you have to remain calm, reassuring, I even talk to them about what's on t.v. at the moment to distract them from whatever blood is oozing copiously out their new dialysis catheter, or whatever.

All the emotional shit hits you later, around 2 a.m. at night, when you're wondering what else you could have done for someone who was dead-in-the-bed the minute they hit the floor.