I had it easy last week. My patient was only sub-acute and I had a lot of extra time to putter around bonding with patients. I think my teacher knew I wasn't being challenged enough so she gave me an extra complicated patient this week. I also got to start on medications.
This was my first experience with feeding tubes. I had only seen suctioning tubes before this, and we had only just learned about managing feeding tubes in lab. Now, here I was with a feeding tube before me. I was pretty intimidated.
However, once I had gone through the process of delivering medications by the feeding tube once, it began to seem pretty straight forward.
There's a lever on the tubing. You open the port, put the syringe in, turn the lever, and flush it with 10 ml of water. Turn the lever, take off the syringe. Suck up the medication (which is crushed and mixed with 30 mls of water), put it in the port, turn the lever, inject the meds. Turn the lever, take off the syringe, suck up more meds, do the same thing as before. When you're done, you flush it again with 30 mls of water, close the port, and you're done!
Okay, so it doesn't sound so straight forward in print. I swear it's easier in real life!
Anyhow, it was quite an experience, and I had to remember to keep the patient upright before doing this to prevent choking. I liked how the teacher gave me feedback on what she saw, and then asked me how I thought it went and how I wanted to improve for next time. It made me do some thinking and it helped me to review what I had read and what I had just learned from the experience.
This was also my first experience with Parkinson's Disease. The pt basically had no (or extremely limited) control over their own body (twitching, shaking), but the mind appeared to be aware of what was going on. Worst of all, the patient couldn't talk and sometimes could only whisper quietly. I found it incredibly distressing.
I felt that the patient was at the mercy of the nurses, and if something went wrong, the patient couldn't call for help or even push the call button. I didn't like seeing the patient with such little control over what happened. It would be one thing to be unconscious like that, or to be a baby, but this patient was aware of what was going on. I can't put my finger on exactly why I find that so frightening, but it is very scary to me. Maybe it's because it reminds me of being trapped in a doll that can't move or talk, but can move its eyes, think, and feel.
Anyhow, I did my best.
It's Worth It For The Smile
I told the patient every little thing before I did it so that they were not surprised, and I talked the patient through any procedures done by other people (ex. inserting IVs or drawing blood). I asked for permission before I did things, and the patient nodded or shook their head (thank goodness, they could at least move the head a little). I leaned in beside the patient's head so that I could catch the whispers when they came through, and heard little comments like "I'm scared" that broke my heart. I felt so bad for the patient.
I did get a smile once though. That was nice. Parkinson's often creates a mask-like expression in patients so I didn't expect the smile.
I don't even remember what I was doing, but I was walking/or speed walking a lot around the ward. There were always supplies to gather, people to find, things to do. My feet were super sore at the end of each day. I was walking gingerly when I got home. Maybe I need better insoles or something.
I was so tired. I was emotionally drained from wanting so badly to be good to the patient, and physically tired from lack of sleep and hard work.
It has been a good experience and good learning this week. I wonder what next week will be like?