Dialysis Daze

Back From the Beyond

2009-04-29T07:36:00.001-07:00

Hello dialysis fans.

Well it's been a long time since I've blogged. I've noticed people are finding my blog and making comments, and that has gotten me interested in talking about nursing again.

I haven't blogged for several reasons, the main one being that I was crazy busy for about eight months. The second reason is I was in a long learning curve with my new job and didn't have the most cheerful attitude about it. Anything I thought about blogging was negative and sarcastic, and that's not exactly the attitude I wanted to present.

So now that I'm more settled into my job and my life, I feel I'll have more to say that will be entertaining, educational and fun. But not today. Today I have some things that need my immediate attention. In a fit of utter insanity I decided to begin taking classes and working toward my bachelor's degree. Yes friends, I'm back in school.

But it's not entirely crazy. I have a lot of sit-down time in my job and I think it's a good use of my time. My feelings are that if I'm blessed with a job that lets me do this, then I should not throw away the opportunity. This morning I have an assignment due so I'm going to log off and take care of it. I'll be back to dazzle and amaze you with wild tales from the world of dialysis.

Thanks for reading.

More Than Just Dialysis

2008-07-18T20:21:00.000-07:00

Greetings, dear dialysis fans. Sorry I've been away so long. Work has been, well, work and very, very busy. Acute dialysis goes in cycles; for a time we are very busy, then suddenly the patients leave the hospital and go back to their regular lives.

I had a bit of a crisis this week. Being on call has all the charm of an attack of dysentery with a case of poison ivy thrown in for good measure. I'll spare you the details, but I am feeling better now that I've gone three days in a row without doing any dialysis treatment at all.

I have some plans for this blog. I want to create a few posts that explain dialysis to the unitiated. I've even been working on a few drawings so that you might get a better idea about osmosis and diffusion work because I know you all slept through that part of science class.

Hopefully over the next few days and/or weeks I can sit down and talk about dialysis basics in a way that you will find fun and interesting. Until then I'll tell you a funny story about a day in the life of dialysis. I had a patient who had been unconscious for quite some time. I had worked with her several times and she continued snoring as if I wasn't even there. Don't tell anybody but I hijacked her remote and watched whatever I wanted on TV while I was in her room. Shhhhhhh!!!

One day I was dialyzing her as usual. She had a central catheter inserted in her chest and this is used for her dialysis. Part of what we do when we dialyze a patient with a catheter is we change the dressing over the catheter site.

First we gather our supplies. Then we wash our hands and don a mask and gloves. Usually we ask the patient to also don a mask, but since this patient was unconscious I put the mask on her myself. I leaned in close to the catheter site so my face was hovering mere inches from her face. No need to worry about her breath or mine. The mask does an excellent job of containing halitosis. The next step is to remove whatever adhesive is holding the dressing in place. It might be Tegaderm. It might be tape.

Oh. It's Tegaderm. I pick at a corner of the adhesive to loosen it from the patient's skin. I hold the skin down firmly with one hand and pull at the adhesive with the other, keeping firm, gradual tension on it and pulling gently.

Suddenly the patient awakes from her coma and screams OOOOOOOOWWWWWWWWWWW!!!! right in my face. Scared the bejeepers outtta me.

The other day I dialyzed her for the last time. She was awake and talking, eating lunch, channel surfing and chatting with me about her plans for going home that day.

So there you have it, folks. An adhesive dressing did the trick and lifted her from her coma.

Just kidding. If only it were that simple. I can't take the credit for her miraculous recovery. It was the work of a highly-skilled medical team and the patient's will to recover that did it. Whatever it was, it was very gratifying to see someone so gravely ill eventually recover enough to go home.

Dialysis Machine Techs Rule the World

2008-06-25T19:27:00.000-07:00

Dialysis world is hopping.

I knew I'd work a lot of hours but I really wasn't prepared for how much it really is. For the past two weeks in a row I have worked almost 60 hours and it's only going to get worse. It's the medical version of the hydra. You send one dialysis patient home and seven more are admitted. Thankfully it's an easy gig - one where I get to sit down most of the day.

And the hours are crazy. Many is the night I don't get home until the wee hours. I'm getting into a routine of sorts but it still takes me forever to hook up a patient. It's not the patient care part - that's easy.

It's the dialysis machines.

Yes, the innocent and benign-looking piece of technology is the bane of my existence. You see, the machine has to be tested before we can start dialysis. This all well and good. We have to make sure that all the setting on the machine that keep the patient safe will actually work when they need to.

The machines I use are old and tempermental. Little things can make things go out of whack. If the water pressure isn't strong enough or the water is too warm, the machine perceives this as a problem and won't allow the machine to pass any tests.

So after jiggling and fiddling and retesting several times, the machine morphs into this evil monster that threatens my sanity. Come on, baby. COME ON!! Pass dammit!

Someone finally schooled me on how to make things work - call the technician.

This piece of information has made my life sweeter. If that machine won't submit to my will then by all that is holy and sacred I'm going to call the tech and sic him on you.

So after a few pleading phone calls to the tech, and a few minutes of quality time watching him show the machine who's boss, I've learned a few tricks for making the machine pass, and I can get on with my day.

Thank you, dialysis machine technicians. You spin me right 'round baby!

It's a Bird, It's a Plane. No, It's the Dialysis Nurse

2008-06-20T19:28:00.000-07:00

I love being a dialysis nurse.

This job has another characteristic that I love. When I arrive on the unit, everyone is so glad to see me. Their eyes light up like it's Christmas morning. People smile. Someone always says "boy are we glad to see you".

Hospitals are busy places. People usually go to the hospital because there is something wrong or they have a complaint that is serious enough to investigate. That means tests - lots of them. Someone from the lab must draw blood. Radiology will be called to coordinate an x-ray, MRI or CT scan. Meanwhile treatment is begun. Respiratory therapy will be summoned to provide a breathing treatment. Physical therapy will be called to get the patient out of bed and walk him around. And finally, if the patient gets dialysis regularly, the dialysis nurse will be called to provide dialysis.

All of this takes a lot of coordination. Meanwhile the patient and family have had a chance to look over the glossy hospital brochure that the marketing department has put together. This brochure conveys the message to the patient that they are the only patient in the hospital. So while all departments are called to do whatever it is they do, the patient sets to whining. "What's taking so long? When am I gonna get my x-ray?" Forgive me, dear patient, but perhaps the other 112 patients in this hospital need x-rays and labs drawn too. I am sorry that we weren't able to squeeze you x-ray in between Judge Judy and Wheel of Fortune. Perhaps the brochure exaggerated a wee bit.

When I arrive with the dialysis machine, there is a palpable sigh of relief from the staff, for now there will be one less thing for the patient and family to whine about. For now, they won't be coming out to the nurse's station every 5 minutes to inquire the whereabouts of the dialysis nurse.

Still it's fun to imagine that it's me they're glad to see. Once again I have made the world safe from renal failure.

A girl can dream, can't she?

Queen of Dialysis

2008-06-12T07:09:00.000-07:00

I have been wanting to blog for forever, but my job has been keeping me so busy that I usually just come home and collapse. I have a lot of great stories to tell.

I must say that I love my job. It's fraught with problems at the moment, but I realize I'm in a learning curve. It's going to take a while for me to work more efficiently and not spend so much time on things. Still I get a sense that this is the perfect job for me. There's a lot of labor-intensive work getting the patient going, but once they're running I can sit down and chill - usually. Things go wrong now and again, but for the most part they get dialysis while I sit and monitor them.

My Mom must be spinning in her grave knowing that I have a job where I get to sit on my butt all day. You're right, Mom. I'm lazy. Who knew there was a job out there that suits me perfectly? Who knew there was a sit-down nursing job?

While our uniforms aren't nearly as attractive as this, they are comfortable, and who doesn't love a job where you can work in your pajamas? This picture shows how I would look in this dress intently monitoring the dialysis machine. I don't know what to make of the child lying prostrate at my feet. I'll just pretend it's a family member who has told me for the umpteenth time that I don't know what I'm doing. If looks could kill......oh wait, it WORKED!

I've heard some nurses say they would be bored just sitting there for so long. I, on the other hand, can sit on my butt forever. My favorite things in life involve sitting on my butt - reading, playing on the Internet, watching movies, doing crafts - and it's nice to know there is a niche for everyone. Still others look on in envy saying "Man, that would be so awesome to be able to sit down at work".

I feel vindicated in a small way. While I was in nursing school I would sometimes complain about being tired, and would frequently complain about how much I hated clinicals. "Oh," said nurses ominously, "you'd better get used to being on your feet all day. That's part of the job."

To them I say "Ha!"

There have been many human resources hijinks that have kept me from getting my paycheck for six weeks. In a little while I'm off to drive about 50 miles to the office to straighten things out. I'll fill you in later. All hijinks aside I know that I love my job and I plan on being here for a while.

Renal Failure? What Renal Failure?

2008-05-29T07:05:00.000-07:00

I hate denial.

Yesterday I had a patient ask me when her kidneys would start working again. I told her that they won't; that renal failure is permanent.

She said "I don't believe that. I believe in the power of the lord to heal me."

The power of the lord is a whole different kettle of fish that I will talk about another time. I guess faith is an important part of healing and miracles do happen. But what happens when "the lord" doesn't heal someone? Do they blame the lord? No. They blame themselves for not praying hard enough or for having committed some horrible sin. "I stole a pack of cigarettes when I was 15 so God is punishing me by not curing my diabetes."

Hardly a productive state of mind.

The patient went on to say that her sister had diabetes when she was 20, but she "went into remission" and the diabetes didn't come back until she was in her 70's. "So I'm waiting for my diabetes to go into remission too."

The yawning gap between what people know about their bodies and what science has proven breaks my heart. I'm thinking the sister probably had gestational diabetes, which goes away once the baby is born. However, the patient with gestational diabetes has a higher risk of getting diabetes later in life.

This is not remission. It is the body doing what the body does.

*sigh*

The thing I hate most about denial is that the next stage is anger. That stage really sucks because the patient tends to take it out on the nurse or anyone else who cares for them. Some patients get stuck in anger and never get out.

If the patient manages to get past the anger, they enter bargainin stage. They do this by trying to control everything about their care including deciding for themselves when they will come to dialysis, if at all, and cutting their treatment time early. What sucks about this stage is that usually there is no next stage. By trying to control everything about their treatment and ignoring medical advice, they start on a downhill course that for the most part doesn't turn around. I have seen so many patients drop over dead from heart failure because they won't stick to their treatment plan.

I know it's hard, but the plan has been carefully thought out based on what kidney function the patient has left, if any, the patient's body size, and their labs. We're not trying to be mean. We're trying to keep you alive.

You just can't say "I told you so" to a dead person.

While you ponder that thought, enjoy this fun video about the stages of grief.

If You Say That One More Time.........

2008-05-24T18:58:00.001-07:00

Just a pet peeve of mine.

Stop calling it "kidney dialysis" people. Just say "dialysis". We know what you mean. What, is there another kind of dialysis besides kidney dialysis?

Grumble.

Settling In

2008-05-21T08:12:00.001-07:00

Today was working full time and on my own. I know that's only 2 days but both of them were harrowing. The work itself is easy. The problem is the TIME. We are paid by the case and anything that holds things up means we aren't getting paid.

The first time it happened was last week. I was sent to a rehab center - where people who have been hurt or had surgery stay for a time to get therapy until they can live on their own again. We usually go there at the end of the day because everyone is in therapy all morning and sometimes in the afternoon and so aren't available for use to dialyze them.

I was told to show up at 6:30 a.m. I would have just enough time to dialyze the patient before she was scheduled for therapy. I arrived on time, set up the machine and went to fetch the patient. She was still in bed and refused to come to dialysis. She said "I haven't taken a shower yet. I need to poop. I want to eat breakfast." It all seemed reasonable to me. If it were me and I knew I'd be tied to a machine for 4 hours I'd rather get a few things out of the way first. In reality though, knowing me, I'd probably just crawl into the chair and go back to sleep.

I was kinda bummed that I got up so early for nothing, but figured I'd just go home and hang out, run some errands and go back later. And I did, but it sure made for a long day.

Most of the other nurses don't show up to work until 8 or 9 a.m. Our manager sent around a memo telling everyone that they had to be set up and ready to dialyze the patient at 7 a.m. I ran this by my boss and she said "I know they told us that, but just about everybody ignores it. It isn't practical." I want to be a good newbie and follow the rules, so I've been showing up at 6:30 or 6:45 to get things ready. And the same thing keeps happening.

Yesterday was terrible. I arrived on the floor ready to go at 7 and the nurse said "Oooooooh, she's gonna be maaaaaaaaad!" I asked what she meant by that. It turns out the patient's daughter left word that the patient is not to start dialysis until after she eats breakfast. I asked what time breakfast trays would be there and she said 7:30. I figured that when the trays arrive I'll start setting up and by the time she finishes breakfast I'll be ready to go.

Trays didn't get there until 9:15!!!! So I sat around cooling my heels for over 2 hours. When the tray got there I decided to run a couple of errands and come back at 10. I got back about 9:45 to find the patient gone......her room empty. Shit! I went out to the nurse's station to find out where she was and they had no idea. About that time here she comes down the hall with the physical therapist walking her. Argh!!! By the time the therapist took her to the bathroom, every movement done at glacial speed, and got her back into bed I didn't get her started until 10:30, nearly 4 hours after having arrived at the hospital.

So I moved on to my next patient and when I got to the floor the nurse there told me "Oh, she was supposed to go to have a small surgical procedure done. We thought you would be here sooner and so she could get her dialysis before she had the procedure. They are on their way to get her now."

Arrrrggghhh!!!!!

So I waited an additional 2 hours for her to have the procedure and get back to the room before I could run here. I didn't get home until almost 10 p.m. I wouldn't mind if we got paid hourly, but since we're being paid by the case this isn't at all efficient.

I called my boss to complain and she said "You're too nice, I've noticed." I could hardly keep from laughing. That is one thing I've never been accused of in my life. Too nice? This is what she meant.

She told me that I shouldn't wait any more than 10 or 15 minutes to do a case. If the patient says that they want to do X, Y or Z thing before dialysis then mark them down as having refused dialysis and move on to the next case. She said to lean harder on the staff - nurses and techs - to get the patient to the room, unit or bedside so you can run their treatment.

In my defense I've been fired from a couple of jobs for being less than nice, and I don't want to start any trouble with me or anyone else. I guess I'm overcompensating and eventually I'll find a happy medium. I've noticed that as a nurse I have a lot more power than I did in other roles. I have more autonomy and can make decisions for myself. I'm not a pawn or a puppet to management. What a concept! I'm not indispendable but it would take some doing to replace me, so I can have more strenuous boundaries than I've ever had before. After a lifetime of little power or control, this might take some getting used to, but I think I'll catch on quickly.

My boss said that our manager sent around the memo because things have been so busy lately that almost every day someone has to take a third case. She thought that if people would get to their assignments earlier, they could run the third case and be home at a reasonable hour. The way it is now, people aren't getting home until 10 or 11 p.m. My boss said that, yeah, in theory it's a great idea, but just as I discovered, patient's aren't ready to be dialyzed in the morning. Besides 7 a.m. is horrendously busy. Shift change is going on. The patient's chart is being passed hand to hand and you can't look anything up. People are scurrying around trying to start the day and are underfoot. Going in to dialyze at 9 or 10 works better because all the morning activity has died down, breakfast trays are usually gone, and the patient is exhausted from all the activity and generally will sleep through the treatment. Sleeping means they lie still during treatment which keeps the machine from alarming and everything runs smoothly.

But the reason management wants us to start earlier is because we get paid extra for any case that starts after 4 p.m. They're trying to save money. By going in earlier we might possibly be able to start our third case before then. I can see how the nurses' motivation for not starting earlier could be about money. After the experience I had two out of two days this week, I can see that it's about common sense too. They could change the policy and start paying extra after 6 p.m. or something, but as for going in earlier, it's just not going to work.

I also noticed that as the day goes on, lots of things change. I actually like that part of the job. During the day is when people are admitted and discharged, have catheters put in and taken out. As much as they try to give us our assignment the day before, it rarely works out that way, and I'm fine with that. She'll call up and say "Mary Smith has gone home, so could you go over to XYZ hospital and dialyze Bob Jones instead?"

Since my last two days were so exhausting, I asked my boss to let me go in at noon. She loved the idea. She didn't have the schedule ready yet and likes it that as the kaleidoscope twirls, she can just send me wherever I need to go at the last minute.

Yeah, the job is going to be fine. I'm going to be fine. It's just a matter of adapting to my new role and learning to stand up for myself.