"Yes, Tori Robinson. Please call me Tori." I gave him my birthdate and he proceeded to give me my intravenous antibiotic and a magical drug called "Toradol." Toradol is an anti-inflammatory. Much like Ibuprofen, Advil, or Aleve, it is the only available injectable form of an anti-inflammatory. Generally, post-surgical pain is related to swelling so this is a great way to relieve pain without snowing a patient who still has enough anesthesia on board to drop a hippo. It was 9pm on St. Vincent's Ortho floor and I was hurting. I was shivering but not because I was cold. My anesthesia was wearing off. I was more aware of my incision and the fact that I just had my hip replaced about 12 hours ago. I was restless and shaky and knew sleep was not coming anytime soon. I must not have looked very good because Roderick had that "concerned nurse" look.
"Are you okay?"
"Yes, I'm fine."
By now the Toradol was taking effect and I was starting to have some relief of my pain which was also good for my anxiety. However, I knew I wouldn't be falling asleep anytime soon and would need some help.
"Do I have anything for sleep?" I asked.
"Yes, they wrote you an order for Ambien."
Egads, Ambien. I was a little worried about Ambien. There are all kinds of horror stories out there about how Ambien made perfectly sane people kill their entire families without their knowing it. I was a little concerned about taking a sleeping pill that I had no experience with and with the shivering and my vital signs in the tank, I didn't want to be drastic. It was time to be creative.
"Roderick, didn't Dr. Warnicht (my anesthesiologist) order Benadryl?"
"Why? Are you feeling like you are having a reaction?"
This is one of those moments where you don't want to lie to a perfectly good person that you just met. However, Benadryl has a side effect of drowsiness. When a physician writes an order for a medication, they write it on an "as needed" basis and must provide a condition for why it is needed. In this case, the order probably read something like: Benadryl 25mg, IV as needed for itching or urticaria (hives). Parents sometimes use Benadryl for travelling so their kids will sleep during long car rides and airplane trips. Shift workers such as night nurses use it to help them drop off to sleep at odd hours or during daylight. I wanted to use it for this reason but when my nurse got his license to practice, he had taken an oath not to give any drug that would knowingly cause harm or be used for unintended purposes. Roderick seemed like a good guy. I wanted to keep him honest and preserve his plausible deniability.
"Why, hmmmm, come to think of it, yes, Roderick, I am a little itchy on my back."
"Let me take a look." he beckoned.
I sat up and he looked at my back. I already knew it was red because that is where my epidural was. It wasn't a bold-faced lie. It really was a little itchy back there. Epidural morphine tends to cause a reaction which is very common.
"Yes, you do look a little red. Any trouble breathing or swallowing?"
"nope."
"I'll go see if I can get you some Benadryl."
Mission accomplished. I felt very satisfied that I had abused the privilege of my education responsibly.
Roderick was a young, African-American gentlemen who started this evening's shift with a rapid response code in the room next door. There is no better way to start a night shift than with a code because it leaves the rest of the night for paperwork....lots of it. Hopefully, you don't have an annoying patient/nurse who calls you into her room every 5 minutes. I had great potential. However, I liked Roderick from the start. He told me that the word on the floor was that I wasn't one of "those" nurses.
"Those nurses?" I prodded?
He said, "Yeah, the ones that tell you how to do everything, and complain about what you're not doing right. I heard you haven't caused hardly any trouble today!" He smiled.
Clearly, I wasn't trying very hard. Either that, or he was lying up front to send me a message that trouble would not be tolerated.
I made Roderick a deal.
"Roderick, I promise not to code for the next 12 hours, if you promise to bring me a quad venti nonfat latte in the morning."
He thought that was amusing, but couldn't make any promises.
I said, "Okay, Benadryl will do."
"I can keep the aide busy until 5am." he offered.
Now you are speaking my language. I had orders for vital signs every 4 hours, which meant they had to take them at 11pm, 3am and 7am, or put more simply, there will be no sleeping. Pushing my second set to 5am meant he could turf the last set to day shift, and give me 2 more hours. Roderick was a good dude.
The Benadryl hit me quickly. The shaking and shivering was starting to subside and I was starting to relax. Aaaaaaahhhhh, (read Benadryl junkie). The feeling was so calming and I was so happy to be able to control my own movement. My leg still ached a little but the Toradol helped a lot. I put a pillow between my legs and laid back. This not being my first rodeo, I knew that the sounds of a busy hospital floor would wake me up, so I brought my trusty Nano iPod. I put my headphones in and drifted off into peaceful slumber. It was roughly 1130pm.
At 5am sharp, the nurse's aide came in to take vital signs. 70/30, heart rate of 56 and a temp of 101.4. I do not look good on paper. Roderick came in shortly after.
"You have a fever."
"Yeah, cuz I was shivering for 4 hours yesterday. I'm sure it's nothing."
"I"m giving you Tylenol anyway."
Tylenol is prudent nursing practice for fever. He also made me put ice bags in my arm pits and had me do my incentive spirometry. When a body is immobile, it tends to not expand the lung fields. Over time, the small sacs called Alveoli, in the lungs, can collapse and fill with fluid. It's bad news. However, if a patient breathes deeply 3 sets of 10 times per day, this incidence goes down. The deep breathing activates the little sacs to stay open and be available for oxygen exchange with the bloodstream. This little exercise is a handy way to keep someone out of congestive heart failure. The incentive spirometer is a little, plastic, graduated column with a rubber stopper. Every time you breathe in, the stopper floats up to the top which is your goal. It's like taking a really big drag off of a cigarette....
"Here," I said as I passed the spirometer to my imaginary friend, mimicking a certain practice one might do at Snoop Dogg parties.
Roderick, the perpetual nursing professional stifled a laugh. I was glad to catch a glimpse of the human hiding beneath his professional facade.
Roderick left the room which I saw as a perfect opportunity and implied consent for me to go for my morning walk. I got my walker, hung my bulging foley bag off of one side and connected by blood-filled hemovac to my underwear and got up out of bed. I was stiff and sore like I had been hit by a truck, but my hip was working beautifully. I walked across the room, using my walker and pushing my IV pole out in front of me with every step.
Roderick came back with my Toradol and my antibiotic, and he started to scold me.
"You are supposed to call before you get up."
"I knew you would be back."
"How do you feel?"
"Dizzy, like I could fall any minute," testing his gullibility
"Really?" (okay, now I felt guilty)
"No. I feel great."
Roderick helped me back in bed. He gave me my medicine and said I probably didn't need my foley anymore. So he proceeded to take it out. I think he did this on purpose because I was really enjoying not having to get up and go to the bathroom to pee, not because I didn't want an excuse to get out of bed and walk. But rather, because sitting on a toilet was still uncharted territory. Questions of, would I have the use of one of my hands or did I have to hold the rails with both hands, remained unanswered along with how long does it actually take to drip dry?
Foleys are held in your bladder by an inflated balloon. You don't want to just rip these babies out, although I've seen it done a time or two usually by an Alzheimer's patient or someone with way too many substances on board. It looked quite painful. Imagine a golf ball being yanked through a garden hose. Yeah, it's like that. I was willing to wait for Roderick to deflate the balloon, and on the count of 3, he pulled it out. I was bracing for some sort of balloon-deflation failure, stinging sensation or plastic tube friction, but there was none. It slipped out painlessly and I was free. One tether down, two to go. I was less fettered. I couldn't wait to go walking. Just then breakfast arrived.
My "clear liquid diet" had been revised. I had graduated to soft foods. I was served eggs, coffee, something that resembled oatmeal although I couldn't be sure and more grape juice. I called my husband.
"Honey, I need two egg McMuffins and a Large nonfat latte. Can you swing it?"
"Sure, I'll be there in 3 hours."
"3 hours? What? You are only 20 minutes down the road!"
"It's 7am and it's Los Angeles Sweetie."
"Right.... Drive safely."
Roderick returned to take out one of my IV's. He was going off shift so he was "fluffing me up" for the next nurse. The look of resignation on his face was a telltale sign that he had a long and difficult shift. Probably mountains of paperwork and lots of annoying interruptions, albeit not by me, thankfully, but clearly by someone. He rechecked my temperature.
"99.6" he reported.
"Almost textbook." I retorted. "Since I've been such a good, thermodynamically-responsive, patient, can I make one request?
"What's that?"
"Can you take out the right side IV and leave the left one in please?"
I had two IV's. The one in my right arm was in my antecubital space which is right at the bend of the elbow. The one in the left was in my forearm, just down from my elbow. It was easier to bend, and was not in my dominant arm. However, it also had a surgical extension loop, which meant Roderick would have to get me a new loop, take off all the tape, disengage the surgical extension at the hub and change it to the new one. There was a risk of pulling it out or bleeding all over the bed and it was clearly more effort than Roderick was willing to put forth. The thing is, he knew that this would make a difference, that this was the right IV to leave in (because it was also bigger) and would probably mean more convenience for his patient. I offered to do it myself.
"Just leave me a loop, a flush and a tegaderm and I'll have this done in a minute."
He was neither amused nor convinced of my one-handed prowess. He was a man of dignity and integrity and a nurse who gave a damn about the little things. At the end of his long shift, Roderick went the extra mile and agreed to honor my request. By the time he returned with supplies, I had the tape removed, the IV pump turned off and was occluding the vein. All he had to do was disconnect the old, connect the new and tape it down. It was a very successful joint venture, of which I was very grateful. He then proceeded to take the IV out of my right arm. I was now free of my intravenous leash. Another tether removed. 2 down, 1 to go.
It was at this time that I would say goodbye to Roderick. I thanked him for his excellent care and wished him well. My impression was that he hadn't been doing this job a long time. He was a "by the book" kind of guy and really cared about his patients. He still had a new nurse's shyness about touching people or giving patients instructions and he worked the night shift which is usually where new nurses start. He was kind, unpretentious and worked hard, uncharacteristic of a nurse who has been working for more than 10 years, such as myself for example, nurse of 12 years with all the compassion bled out of her one whining drug addict at a time. Thank goodness Roderick was bringing nurses like me to a new level. I hoped I would see him again before my sentence at St. Vincent's was over. And I hoped he would be bringing a quad venti nonfat latte......
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