Tuesday, September 13, 2011

Kindness of a Nurse

It's always nice when the nurse who is about to start an IV asks the patient, "Where do they normally put your IV?  Do you have a good spot?"  This can potentially save time and headache.  But when that nurse looks at the best spot and quickly doesn't see anything, you try not to sigh and roll your eyes.  That is, if you aren't already tearing up from the pain of how rough and careless she was in tying off the tourniquet to begin with.

Here's where you apologize for being what they call "a hard stick."  Someone whose veins do not plump up.  Someone whose veins are wrecked from years and years of blood donations when you were healthy.  Someone whose skin is not pliable due to the scleroderma which marching on a slow attack through your body.

[This story isn't mine, but one of a dear loved one for whom I tried to advocate while not pissing off the staff in the ER last night.]

The first nurse makes one attempt to start an IV in the other arm instead, but it doesn't work as she went through the vein.  I mention that "Helen" - the nurse in triage who my mother recognized as being the person who finally started her IV in June the last time she came through the ER - has offered to start the IV if needed.  But her shift ends at 7PM.  It was 5:15-5:30 when she made this offer in triage.

Nurse No.1 brings in nurse No.2.  Now when No.2 ties off the "good arm" and proceeds to say, "I don't feel anything.  Did you feel something?  I don't feel anything."  Whoa.  Time to speak up...again.

"Helen has successfully started an IV before.  She offered to do so tonight if we needed help.  Can we ask Helen to come?"

After a brief look of what I can only say is annoyance and minor teeth grinding, nurse No.2 announces, "well, Helen isn't here."

"Oh, yes she is!  She on until 7:00, working triage." 

I get another special look however it is directed toward nurse No.1.  At this point, it is 6:30pm.  An ambulance brings an emergency into the ER and staff suddenly becomes very busy as they should be.  Time to wait.

I begin to wonder.  Did the nurse really go ask Helen to come help?  So around 6:45, I go to the triage area, knock on the open door to the room which fortunate doesn't have any patients being seen, and ask Helen the question.

"Did anybody request that you come start in IV?"  Helen responds no.

"Then you are being requested to come start an IV, please." 

Helen lets me know that she has 15 patients waiting in line to be triaged.  She is busy.  I look a bit pathetic I suppose as it's almost 6:50 and I know that Helen will be leaving at 7:00.

"When I'm done here and someone can relieve me, I'll come see about starting an IV.  I hope I can."  I thank Helen and return to exam room 11.

Nurses No.1 and No.2 return and say that they'll ask another person to come.  This is the secondary person working triage as I recognize his name.  We really don't wait to waste all the potential IV spots allowing everybody their chance.

"Wait, Helen said that she'd come by after 7."  The nurses leave.  OK, so now we wait.

Amazingly, Helen does arrive around 7:15pm.  "Now I feel all this pressure to get it right, like I have expectations to live up to," she says.  "Let's see."

Helen gets an IV line started in the very same place she had done so previously on her first stick!!  Whoohoo!  "Thank you oh so very much!"

It would be great if the IV saga ended here, however that would be too easy of course.  Hours later when the doctors decide to admit my Mom, it is decided that she needs a 2nd IV line.  That takes three techs and another five sticks to get accomplished.

Despite additional pleas for their "very best person who handles all the tough cases," a couple of cocky take their jabs before calling someone else in.  I even ask, "who does your pediatrics, call them."

Finally when the 2nd IV line is secure, I decide I can go home.  I pull into the driveway at 11:45pm.  Inside the house I find three very hungry kitty cats who had missed their supper.  I really should have fed them at 5:00 before leaving for the hospital.  But I was thinking, since my mother's doctor had called ahead to the ER alerting them to the fact that she was coming and what was needed, that I would be able to leave her there much earlier in the evening.

I'm so thankful that Helen came and started the first IV line.  She didn't have to do that, especially after her shift had ended.  Now THAT is kindness and dedication to the patient.

[If I wanted to dedicate more space to this story, I could tell you about the doctor who didn't answer my question when I asked for the specific numbers on the blood test results when he finally came into the room to examine my mother.  The numerous times I asked for a copy of the blood test results which at least two people said "sure" to, however I finally left without them.  The nurse who walked into the room and quickly glossed over the fact that she was hooking up antibiotics when the doctor had said nothing about needing them previously.  If I had thought quickly enough, I would have made her state specifically and clearly what the antibiotic was.  She did at least answer that the white cell counts were a little high, something I would have already known IF someone had given me a copy of the test results.  Arg.]


  1. It's hard to go through that when you, yourself, are the patient. It's way harder to watch your elderly parent endure being a pin cushion.

    I have been there and done that and totally empathize with you. Hope your mom is feeling better. <3

    Both my mother and I are "hard sticks" with small, rolling veins. I know that when you have an emergency situation it's impossible to "prepare" yourself for the IV, but if you have even a half hour's advance notice and are able to drink water, drink as much as you can.

    When I was in the clinical trial and had to be stuck all the time, a nurse shared that tip with me. From then on, as long as I had the time and the water, I was able to "fluff up" my veins and I never had another hard time being stuck.

    I probably just jinxed myself.

  2. Also, I meant to mention...

    I had been admitted once for IV steroids for MS and a nurse casually mentioned they could not be given simultaneously with the IV antibiotics I was supposed to get.

    Being allergic to almost ALL antibiotics, my ears perked right up and I asked what they were for. I didn't have an infection; I had MS. She replied that she didn't know why, but the doctor had ordered them.

    I asked her to call the doctor and verify why, and meanwhile I called home to have my boyfriend check the label on a bottle in my dresser that I had marked "ALLERGIC TO THIS". Turns out it was the same stuff. Levaquin.

    The nurse came back a while later to tell me in almost a jovial joking tone that it was a mix up at the pharmacy and they weren't for me after all.

    Some joke. Their sense of humor nearly killed me.

    You have to always be vigilant (or hope that if you are unconscious or incoherent you have and advocate standing vigil) to be at the helm of your health care.

    Doctors and nurses can sigh or roll their eyes all they want but they are working for you and at the end of the day if one of their mistakes kills you, it was just a bad day at work for them. It could mean your very life.

  3. I so agree with Tickled. Your Mom needs an advocate and you have kindly stepped up to the plate for her. Don't let the rolling eyes, signs of indignation or any of that influence what you know is right and just for your Mom. Hang in there, stay tough and keep at being the patent advocate for your Mom. She needs a solid voice in the arena of sometimes often confusing things that go on in hospitals. Hope she is doing better today!

  4. I hope your mom is doing better. Dealing with ER staff is such a nightmare.

    This brought back some bad memories. I had a traumatic emergency surgery 6 years ago. At the time, my MS was still misdiagnosed as Chronic Regional Pain Syndrome, as the symptom that was getting the most attention was neuropathic pain in my arms that I'd had for 5 years at that point. What happened was a long, gory story of medical ineptitude (it took two ERs before someone even believed that I was, indeed, dangerously ill and in excruciating pain). But I think the worst part was the night before my surgery when my IV began to leak and they decided to replace it.

    I was on the Maternity Ward, but my problem was gynecological and not involving pregnancy. The experienced nurse on duty came in and was literally poised with needle in hand just about to do the stick, when someone came in and announced that since I wasn't having a baby, I wasn't "important" enough for the experienced nurse. Then they sent in two bumbling inexperienced hacks who proceeded to turn my "pain syndrome" afflicted arms into purple pincushions, as I screamed and pleaded with them to stop. The corker was, this being the US with our crazy methods of medical billing, with each failed stick, the not-so competent nurses were careful to peel off the proper billing sticker to make sure I was charged extra for all the IV kits they were wasting on me.

    Good luck to you and your mom with everything.

  5. My grandmother is a "hard stick" and we've been told now at her hospital that when she comes in to request immediately that she be taken to the surgical prep area for the iv start, and that they can then take her back to the er. Those folks do nothing but start ivs all day and are often among the most experienced in our hospital at least at starting lines. And once you're there and explain tht you're a difficult case they'll often defer to their best shot. That said, I don't know if you're hospital will do this but maybe it's worth a shot?