I worked the night shift (2300-0700) today and it was a night of firsts for me.
The first patient to come in for the night was a young adult male who was brought in by friends after he deliberately ingested liquid fertilizer. The intent, though unconfirmed because the patient was unresponsive, was attempted suicide. Allegedly he had been having personal problems and, prior to ingesting the fertilizer, had drunk a significant amount of Tuba (a type of "wine" made from the sap of certain palm trees). I did a little research and found the ingredients in the fertilizer that might have been the same type that the patient ingested:
Sodium
Ortho-nitrophenolate=0.468%
Sodium
para-nitrophenolate=0.893%
Sodium
Mono-nitroguaricolate=0.298%
Sodium
Ortho-nitrophenolate=0.468%
Sodium
para-nitrophenolate=0.893%
Sodium
Mono-nitroguaricolate=0.298%
The doctor called for a referral to the city and had him hooked to an IV (plain NSS) and ordered an injection via IVTT of ranitidine. This is the first person I've ever met whose attempted suicide. Even more, he's the first person I've met who is actively undergoing a suicide attempt. The thing that strikes me the most about this encounter is that I didn't have any sort of emotional response until after the patient had been referred to the city -- that is, I didn't think about it as a suicide attempt until after he had been stabilized and referred. It's impossible not to feel some sort of emotion when working with people. That's something I've come to understand working as a CNA. However, one of the things that has weighed heavily on my heart is wondering if I'll be able to cope with emotionally distressing situations. Working as a CNA helped understand part of that -- I have come to view the residents at the nursing home I work with as friends, and therefore we work as a team. But that kind of familiarity comes with time. This suicide attempt was the first time I had been measured against an immediate stressful emotional situation.
I remember about 2-3 years ago I had the opportunity to shadow a doctor at a gastroenterology clinic. I had just finished watching a doctor perform and upper endoscopy on a man and they found that he had incurable esophageal cancer. The doctor was showing me some of the images he had captured of the esophagus and told me had the patient come in just 4-6 months earlier, they might have been able to treat it. However, it was too late and the doctor said the patient had maybe 6 months left to live. The doctor said it without sounding sad, and I remember how I thought it was so dispassionate to just state the facts so plainly.
But now, I've come to realize that you have to maintain a level of emotional distance in order to keep your mind clear. Weighing down your mind with too much emotion can translate into poor decision making which can cause poor performance as a doctor/physician assistant/nurse. It's not that you need to lack passion, you just have to know how to keep it from clouding your judgement.
Another first for me that happened on this shift was exposure to a contagious patient. Obviously I've been around contagious residents back in Oregon (especially around the winter time with colds and whatnot), but tonight a patient came in and the doctors initial prognosis was TB. Of course, all of us were wearing masks, but it suddenly dawned on me that exposure to all sorts of pathogens will be inevitable when I work as a PA. The good thing is, even though I suddenly realized this, it didn't prevent me from continuing my work. Anyway, since it was after 5 and the lab technician was already gone, the doctor had the patient admitted and put in isolation until further tests could be done to confirm the prognosis.
I also performed an intradermal skin injection on another patient to test for an allergic reaction.
No comments:
Post a Comment