The Honeymooners

I left work today at quarter to eight o'clock, just like usual.

The difference was, I felt exhilarated when I left, not shitty, guilty, pissed off, angry, or just so exhausted all I wanted to do was have a martini when I got home and go to bed, as per usual at my old job.

So can I just crow and say:

I just had the Best Day Ever at work.

I cannot remember a work day being so good, ever. It was like, if nursing was like this every day, we wouldn't have a nursing shortage; we'd have so many nurses working our ratios would be 2:1 on a med-surg floor and we'd all be content with working for minimum wage, because who can beat the ego-boost and sense of usefulness and purpose?

All my patients were just so sweet and friendly I could have kissed them. Mr. Rapid A-fib, Now Sinus Rhythm s/p CABG X4 Cardizem Push/Cardizem Drip Guy said to us during interdisciplinary rounds (in which nurses present their patients and patients are given the opportunity to ask questions and voice concerns about their own care), "Well, I think my nurse's great attitude fixed my heart."

Awwwwww.

He even gave me his e-mail and told me to write him and keep in touch (he's about seventy seven years old.) He teaches internet skills to senior citizens, is an opera buff (with an iPod!) and surfs the internet. He rocks.

Another patient told me what a great nurse I was and asked if I would say good bye before I left, and kept asking if I'd be coming back tomorrow (he's going for his CABG in the a.m.) and would he end up on our unit afterwards, he hoped?

I also had a cute little lady who was two days out from CABG, had a small left lobe pneumo so we couldn't pull her chest tubes, and was on an insulin drip, requiring practically hourly finger sticks, which she was really really nice about.

On top of that, I also had Nursing Superstar Assessment Moment with her. Around 4:30 p.m. I went in to do her sixteenth bloodsugar of the day, or so, and she said, "I see funny out of my left eye. It's all blurry, but only half of it."

With her CVA history, I immediately kicked into high gear assessment mode, taking a quick set of vitals (stable), making sure her bloodsugar was okay to rule out hypoglycemia or hypotension, and then doing a bilateral hand grasp (equal and firm) and asking relavent history, such as when it started ("At eleven thirty, but it was only a pinpoint then, and I didn't want to bother you."), if she'd ever had this happen before ("No."), if she felt any dizziness, numbness and tingling, ("No") and what happened the last time she stroked. ("I don't know. I was sleeping.")

It isn't astrophysics, I know, but there's that little thing in your gut that develops after being a nurse for awhile, which some call an ulcer, and I call nurse's intuition. When patients say things to me that sound odd or bizarre, I always investigate. Sometimes I have the feeling it could be just neurosis and hypochondriosis, but this was a lady that barely asked for anything at all, and I just, I don't know, had that feeling, just like I had a feeling when I walked into the room of my twenty-four-year-old s/p VSD repair/AVR to assess him yesterday and thought, "Oh shit, he looks like pre-code crappy." I wasn't far off, either.

Any ways, thinking, every-so-professionally, Oh crap, why does it have to be a neuro thing?! I suck at neuro! I ran to find the PA, who comes in to do a neuro assessment, along with another PA. The PA calls the attending CV surgeon, who orders a neuro-consult. Around change of shift, the neurologist comes up; very nice guy, the kind who asks questions of his peers, like, "What does that mean?" in an honest, sincere I-wish-to-learn-way, not in a you-suck-so-I'll-play-ironically-bored-with-your-drivel way that a lot of attendings cop in front of nurses, God, and everybody in between.

After the neuro assessment he comes up to me and says, "I definitely think she's had a small stroke in her right posterior occipital lobe, but it's a very small stroke; only her vision is involved. I'm guessing it's embolic--is she on aspirin?" I asked him if he thought it was likely to resolve, and he said only time would tell (can you tell neuro is not my strong point? Well, it isn't.)

So she ended up buying herself the million dollar work up--MRI, MRA, head CT, etc, etc.

I felt bad for her, because that's really got to suck, and she started crying while the PA was doing his assessment, saying, "I really was trying to be so good." How horrible she blamed herself for her stroke.

I know it sounds way, way cheesy, but some of my favorite moments in nursing are the ones when you get to hold the patient's hand and wipe away their tears, make them feel a little bit better and help guide them through the hospitalization ordeal. It's moments like those that make me realize how dependent patients are on our assessment skills (and appropriate response by medical team!) for good care, and I shudder to think the times I've begged docs to care that my patient is swirling-the-drain and got jack for response and a dead patient to boot.)

I also love having a great rapport with my patients--even my confused Alzheimer's patient was a nice guy, who didn't try climbing out of his bed every five seconds, crap everywhere, or swear and hit me. I've had alert and oriented patients who were about a bajillion times more of a pain-in-the-ass. He wasn't a pain in the least--although I did feel sorry for him, because he'd say, "Who am I? I don't know who I am... Do you know?"

And (are you sick of me yet?) to top it all off, after interdisciplinary rounds, one of the manager-type people who does research studies and such came up to me and said, "Are you a committed traveler, or are you thinking about maybe staying? Because you know, we really like you, and we'd love to have you stay."

Awwwww squared.

Some days, it doesn't suck to me. Revelation, that.