Week Twenty: March 29-30, 2010

I can not believe that this rotation has already ended! It was only four weeks long but it really flew by. On Monday, I was chosen to be team leader so I was given the opportunity to have somewhat of a break while overseeing my fellow students complete their responsibilities throughout the day. It was interesting to see how everyone was dealing with the new pressures of passing medication while also not forgetting to complete the many other tasks expected of them. I was given the opportunity to preform numerous blood sugar testing and insulin coverage which gave me more injection experience. I have noticed the more times you complete a new skill the more and more comfortable you are with it. On Tuesday, I had quite the day. I only was responsible for one patient. This man was completely dependent on the nursing staff for all activities of daily living. He was completely non responsive and had a very brief medical background, as he had no family members or friends to provide information, and he was previously living in a skilled nursing facility. He had acquired aspiration pneumonia, a urinary tract infection, a high fever, sepsis, and diabetes mellitus. He was my first patient on a gastrostomy feeding tube which also meant I would be giving him his medication through this tube. I was really nervous at first, considering I had never previously done this, but I knew my teacher would be with me and everything would be alright. I asked my teacher to check my medication and after she "okay-ed" it I crushed up the pills and opened the capsules so that they would easily pass through the tube into his stomach. Once this was complete, I grabbed my teacher and we went into the room. To set the mood for this upcoming hilarious story, I will first inform you that my patient was in isolation (meaning my teacher and I were both wearing masks, gloves, and gowns which makes it incredible hot and stuffy), my patient was experiencing something called TD (tardive dyskinesia) and EPS (extrapyramidal syndrome) which both for the most part are uncontrolled, involuntary (and somewhat aggressive in this case) movements of the face, tongue, and limbs, oh yea, and my teacher never makes mistakes, but on the other hand, throughout this story you will see that my teacher clearly made a mistake, if not one...more than one. With that being said, we walk into the room, I shut off the feeding, grab my warm water (to be mixed with the medication), disconnect the feeding tube and attach the syringe (acting as a funnel for the medication to enter the tube). I then pour a bit of water into the syringe and watch it go through the tubing, she then lets me know I can start pouring the medication. As she is struggling to hold my patient's arms at his chest to ensure he doesn't hit my arm or hand which, of course, is holding the tube and syringe and administering the medication, he continues to lick my arm something like 542 times, the medication is so thick it is struggling to fully go down the tube into his stomach, and she continues to get very frustrated with the amount of time this is taking, so she urges me to switch with her. She then grabs the syringe and as I am holding his arms she somehow lets go of the syringe allowing it to detach to the tubing (which of course has his levaquin-aka his very important anti-infective-inside of it) and oh wait it gets better...as medication is flowing out of the tubing my patient, of course, feels the desire to have a coughing fit, so not only is medication flying out of the tube but stomach contents including food and I imagine gastric juices are explosively exiting the tubing, simultaneously as my teacher is cursing herself, I can barely refrain from laughing, she is panicing about losing the levaquin as she is repeating "we're losing the levaquin, we're losing the levaquin!!!", she probably can not even bare the thought of having disconnecting the tubing in the first place because it was totally all her fault. I really don't think I am one to blame anyone for anything but to make it very clear I had previously asked her as I was handing the supplies to her"do you have it all?" (referring to the syringe held in place into the tube) and of course she replied "of course I do, now let go!" and somehow shortly after she fiddled with it, oh I'm sorry gravity somehow pulled the syringe out of the tubing, well that was when the volcano erupted. I could not even imagine how much green, nasty smelling "stuff" was all over my patient, his bed, my gloves, my gown, her gloves, her gown...it was a pretty incredible site to see. Afterwards, she told me to grab another order of levaquin from the pharmacy and I told her in the meantime (while she was passing meds with other students) that I would clean up my patient and his bed. She informed me that my patient was indeed "fine"and that he could wait to be cleaned up...funny thing is how incredibly messy he was at the moment. I was appalled at her request and didn't know what to do but to "obey my teacher?" An hour or so later she returned, we gave the levaquin, and I was finally able to clean up my patient which was a very difficult task in itself, thankfully, I had my friend Autum to help. I will never forget such a memory. Let's just say I am more than pleased to know I will return from spring break and will be working in the nursery and on the labor and delivery floor with a different instructor! I hope you had a good laugh...