Oncology Clinical I

Hoo-boy.  I just got up from my post-clinical-crash.  As I've previously posted, what makes us so unbelieveably tired is that we go to the hospital at 4pm on Thursday, write down pertinent info for our preplanning paperwork, and then stay up til 12 or 1 AM doing the preplan. And concept map. And med cards for each. Med. On. The. MAR. (medication administration record).  I get it though; we need to be totally prepared to provide really good care to our patients.  When we are knowledgeable, our patients accept us as students much more readily.  They trust us.

And then we are at the hospital all bright and shiny for report at 6:30 AM at St. Big Dog's Hospital. (I'm done with Hospital-of-Changing-Church-Affiliations for now.)
Clinicals are done at 3pm, ahem, 1500.  Last night, my preplanning ran out before my caffeine did, so I was in bed at 12:45 spinning out and tossing and turning about getting up in 5 hours.  By 1:30, I had downloaded an ambient-sounds-maker App for my iPhone to listen to, to distract my mind.  Guess it worked; I awoke at 2 when ‘sounds of the ocean’ shut off, unplugged my headphones and awoke to my alarm 3.5 hours later.

Three of us tag-teamed a bed bath for an independently living  88 year old little-old-lady.  When my cohort was scrubbing her rear end and privates, she asked the patient, “Now I’m not hurting you, am I?” to which said patient replied, “No, that feels good.” Bwah!hahahahahaha.  I think she meant the amount of scrubbing force was good…not that she LIKED it, LOL.  Completely professional, the three of us exchanged knowing glances with one another, never cracked a smile, and filed that one away in the “things to laugh about in post-conference” drawer.

My actual patient today has Breast Cancer that a radical Left mastectomy failed to cure, mets to everywhere (aka it has spread. BAD.), and malignant ascites (cancer in a belly full of fluid where fluid doesn’t belong) blowing up her abdomen like a balloon.  Lower pitting edema  (swelling) 3 or 4+, (not sure due to my inexperience), and almost liver failure. As many of my patients who have already faced their mortality, she was a dear.  And you know what my big nursing interventions were today?  To teach her to not let pain become intractable, because when pain gets out of hand, it’s tough to stop, and speak up about getting pain meds.

Tip:  she was over 60 years old.  To those of her generation, you MUST teach this-- you will NOT become an addict if you start pain meds when you actually have pain!  Bless her heart; accepting a couple of Tylenols was really difficult for her today, even though she rated her pain on the high side with a 7 out of 10.  What a tragedy—to be dying in pain.  Teach your loved ones, too.  Even tolerance and physical dependence related to PAIN will not an addict make.  People become “addicted” in an unwholesome way when they take meds for which they have unequal levels of pain.  I had to convince her it wasn’t a bother either—those things are usually already on your med sheet for ‘just in case.’

She could not sit up in bed without becoming short of breath.  Most people can’t lie DOWN when they’re having breathing troubles.  Her pain of her swollen belly and the pressure from sitting up made it almost impossible for her to sit up any higher than 15 degrees.

…and then she had rectal bleeding today.  Which is a new thing for her.  And it scared her—a lot.  After the primary nurse showed me, and was gone, I was tucking her back in because she had been SO cold, and I could tell she wasn’t good.  I asked her if she was upset about the bleeding, and of course she said yes.  And then I used good ol’ nursing therapeutic communication and asked her, “Want to tell me more about that?” and she opened up and just cried and cried about the uncertainty of her future.  I dabbed her eyes with a tissue, tucked her in even more securely, and wanted to tell her that everything would work out.  But I can’t give someone false hope; never-ever.  Especially for her.  I stayed with her a few more minutes, patted her knee and told her that we would just get through the next hours, hour by hour.  She told me how great I was.

When I left for the afternoon, I made my way back to her room to say thanks for letting me care for her and goodbye.  By that time, her family was at the bedside.  I told the family “You’ve got a special lady here!”  They said they knew. J  I introduced myself to the family, who asked if I was a med student or a nursing student?  I told them “Nursing.”  The sister said, “Good!  You seem to actually care about your patients.”  They wished me luck.  I wished my patient luck.

It was a good day.