This is the beginning of the day.

I clocked in at 0645. The nightshift handed me a stack of written reports. She also verbally reviewed with me. Because "there is this in-service at 0700." she said. In-service is like a 15-20minutes education course where there are new equipments or medications, or policy that all nursing staff are required to know.

Okey-dokey. Lets go ahead and finish the report in 15 minutes.

"...Rm349, 47y/o male, came in for left lower lobe pneumonia, is a walkie-talkie (meaning, he can walk and talk.)...." Alright! I deserve to have an easy patient once in a while.  

"...Rm350, 50y/o female, came in for UTI (urinary tract infection) but has a history of kidney transplant 5 years ago. Now on Rocephin piggybag q24h." Monitor urinary output and temperature for sure. I kinda put down my assessment checklist for this patient.

"...Rm351 67y/o male, had a massive ischemic stroke 3 weeks ago in february, now is a DNR. Airborn isolation for MRSA and Acinecbacter...." God d*mn it. This new acinecbacter infection is a very rare but lethal kind. It is ventilator colonized that occurs to patients who was once on a ventilator in ICU.  For now there is NO effective antibiotics to treat this kind of infection. "...he only open eyes, nonverbal, has a trach that requires suction..." Oh Lord! I feel the chill coming up and down my spine. Whoever has a right mind would suction him when he has acinecbacter isolation? I can understand why his family would like to sign for a DNR code. "...has a peg tube running 80ml/hr.." Of course he still needs nutrition. "...a foley..." Of course he still can pee. "...needs to be turned q2-4hr..."He is a TOTAL CARE. period.

"...Rm352, 87y/o male, came in for mental status changes, history of parkinson's, dementia and alzheimers..."Gee, who wouldn't? When you live to 87 years old you either has a malfunctioning mind or malfunctioning body. "...was suspected to have aspiration yesterday and thus put in an NG tube. Right now is NPO (nothing by mouth)..." but he has a NG tube?!? I was puzzled. "He has nutrition consult for it. " Oh i see, so that leaves to dayshift to deal with A. physician. To check and see if this patient still needs a NG tube since he had done barium swallow a couple weeks ago. And he had a dysphagia I diet. And B. dietician. If this patient needs a temporary tube to maintain nutrition, where NG is, then he still needs something to maintain nutrition...via the NG tube.

"... also he was appointed by the court to have a legal DPOA (durable power of attorney, who makes medical decision for someone who lost competency. A DPOA usually is the patient's spouse or family members. ) because his son refused to take care of him and his wife is just as demented as the he is...." How sad could it be for this little old dude? "...he can NOT be transferred to any nursing home until April when he has a legal DPOA then. " What are you KIDDING ME?! What kind of rediculous requirement is it? And who's paying for the 30 day hospitalization? the insurance? OF COURSE. No wonder there is this health care/ insurance crisis here in the United States. Cuz the longer people live, the longer they will be maintained (by the advanced medical technology and medications) to live and live and live. There is NO such thing that when people become old, they die during their sleep. They die in nasty infections, severe dehydration or malnutrition or multiple failing organs/systems of the body. All in all, most of them die in the hospital or other nursing facilities.

"...Rm353 80y/o female, came in from rehab for abdominal pain..." So who is the consult for GI? "Nobody." What the hell? What kind of attending physician or nurses would let this old lady stay in the hospital WITHOUT giving any treatment? This is not only a waste of time for the patient but a waste of medical resources from the hospital point of view. I feel disgusted. Disgusted by some idiots who can NOT do their job right. "...Hgb 8.8 yesterday and 8.9 today... " And I am angry. This little old lady had a hip surgery few weeks ago due to fall at home. No one has initiated to have a blood transfusion. Ever?

Same sh*t different day. I thought. My job is all about to pick up whats left and undone and carry on. I kinda realize it by now.