Oxygen part 11

The nurse today was young, and she reminded me of one particular student at Aristotle University: a Greek sculpture come to life. This one had her name badge on backwards, so I didn't know what to call her.

When I arrived, the bed was at a 20 degree angle. It was left there by the previous shift. I cluck about this and point out that the bed is supposed to be higher, looking pointedly at the sign on the wall. The nurse asks Marie if she wants the bed raised, and soon it is at 35 degrees. Marie is coughing a bit, and she has abdominal pain. She is due for her next painkiller at 9:30 and it is only 7:15.

The nurse takes her vital signs, and they are excellent - 106/63. There is some discussion about whether or not this pain is related to constipation. Marie says it IS bowel pain, but she has had a couple of movements today so it is NOT constipation. She rates the pain at 8 out of 10. The nurse goes away to see what can be done about an analgesic.

While the nurse is out of the room, Marie says she wonders if something has irritated her bowels. "Like what?" I ask. "Oh," she says, waving toward the feeding tube "all this stuff they keep pushing through." She is bored, she is uncomfortable, and she is wondering where she'll go next.

I want to say to Marie, "You HAVE to tell them when the head of the bed is too low," but there are several other things I want Marie to hear, and I am choosing my battles. After weeks of the staff not paying attention to the instructions in the book or the sign on the wall or the repeated instructions from family, I can hardly expect Marie to feel like they will listen to her.

It seems like such a simple thing to me: the patient cannot control reflux because of the procedure done on her esophagus. She is supposed to stay at an angle of 35-40% minimum for 4 hours after feeding. She is on continuous tube feeding, so she is supposed to be at that angle all the time. It has been almost two months, and the message doesn't seem to stick with the staff. I have spoken with the nurses, with the nurse practitioners, with the doctors.

They are all caring, in their way. I don't want to suggest they aren't. But many of them seem to lack the laser focus that Marie herself brought to nursing - the attention to detail that made her a gold medallist. The reasons why they are lacking in focus - well, I could speculate. Some have been undergraduate nurses who are learning how to pay attention. Others have been around longer, but they are overworked and Marie is supposed to be a fairly straightforward case now - heading to rehab.

The nurse returns. She has been authorized to administer Tylenol 3 through the feeding tube. So she puts some water through the line, then the Tylenol mixed with water, and then she flushes with more water. She accomplishes this with no fuss, no mess.