How We Communicate

I am teaching students again and loving every second of it. There is something about seeing the spark in one's eyes when the pieces are connected and watch the growth of a student over time. One of them this week asked me, "What is it like when you have a difficult situation? When you go home does your husband understand?"

This was a great question and I reflected back on some of the emotional moments I carried over the last few months. He always listens and is always there for me to vent about my day or ponder questions of life. He wants to understand but cannot always understand what exactly happened because he is not in healthcare, in the same way I can read his papers about geology and engineering and correct punctuation, but the concepts are way over my head to assess the accuracy of the paper. This is not a fault on either part, it is just an aspect of our occupations that are better understood by those in our field. A group of geologists stayed at our house this week and Caleb was so excited. "They understand me!" he exclaimed. This was no blow to me, but simply the fact that they speak the same language (geology).

I am fortunate that my best friend is a nurse. She gets things on a different level and is a sounding board when things get rough. I can express my feelings, concerns, frustrations, and she speaks nurse. My husband refers to it as "nurse talk" which is inevitable any time we are together.

Nurse talk expands beyond the aftermath of a day into the clinical setting itself. Nurses communicate by action and the way they communicate with their patients. I observed the care of a few ICU nurses recently that touched me. In the ICU nurses are very used to talking to their patients at all times, intubated or not. In observing one nurse care for a patient, she effortlessly spoke to the intubated, sedated patient dictating her care. It struck me as I had forgotten to speak to this patient in the midst of the tubes and lines I was managing. I then watched the husband take her hand and speak to her as if she were alert.

They can hear. They may not be totally aware of surroundings, but they say they can still hear your voice. It was a reminder to slow down in my day and remember to see each and every patient as a person every time.

Did I Forget You?

Start the morning with one patient who has been waiting for a bed several hours and is still heavily intoxicated.

Vitals are stable, patient is sleeping: Respiratory Rate even and unlabored, no s/s withdrawal or agitation at this time. 

An hour passes and now there are two more patients. I run around ensuring labs are sent, urine is collected, patients are assessed and comfortable. I run in to hang the bag of fluids ordered on patient #1.
Still sleeping, RR even and unlabored, but awakens upon entering. Speech slurred and mumbled but asks for a blanket. Warm blanket provided and patient back to sleep. Still waiting for a room.

One patient discharged and another in by ambulance. Patient one now has their call light on.

Pt requesting food. Gatorade and sandwich provided. Still waiting for bed assignment. Fluids running, vitals stable. 

Now I have four patients and one pulls at my heart. I am slightly more attentive than normal and tend to assess their pain more than the average patient. They make me laugh and I connect with them. I am extra attentive to their needs. I'm attentive to all my patients, right?

Patient is more agitated and tremulous, Ativan administered per withdrawal protocol. 

Five patients now and I'm getting in my steps for the day up and down the hall. Meds passed, splints applied, vitals checked...My "favorite" patient at the time was up for discharge. I wheeled them out the door proud of the care delivered and holding a connection made in my heart. I pass off report for a lunch break...

Did I forget you? You were sleeping and stable last I checked...you got a floor bed while I was at lunch and had wet the bed, sheets were astray, and you were confused and unkept.

Did I forget you? Your socks were filthy, blankets were on the floor, your gown wasn't on anymore.

Did I forget you? Did I neglect to pay attention to the details because you were asleep and drunk? Did I give you the time I gave to each and every other patient? Did I give you time like I gave to the patient that won my heart? Would I have offered to change your dirty socks and spent more time chatting with you if you were someone else?  

When I learned of the events my heart broke inside. I had been so proud of my care for my patients and yet one had fallen through the cracks. I like to think I care for each patient the same way no matter who they are, but forgetting you this time makes me more conscious of my priorities and actions.

I'm sorry I overlooked you that day. I hope you are healing well and I thank you for reminding me what it means to treat each person as I would want to be treated or would treat a family member.

Next time I promise you will not be forgotten.