I picked up a shift on my old ward last night. First of all, night shifts are a lot more tiring than I remember - and last night I only did an 8hr shift instead of a 12. I was pretty bagged when I got home in the morning. Second, I'm not sure I can go back to my old job in April. Its a hard job and dealing with difficult patients is very very very frustrating. Anyway, on to the story:
I had this one patient, a 93 year-old lady with a fractured right femur. A broken leg is a painful thing to deal with, but when you're 93 years old its something you don't really deserve to have. Well, the docs weren't sure she was stable enough for surgery (we're looking at 4-5 hour anesthetic and close to 4 litres of blood loss) so she was laying in bed in traction. By the sounds of it, she would probably go for surgery, but in the meantime they had a few other docs look at her to make sure (you don't want to jump in to major surgery when you're that old). The problem is that she was basically laying there in pain - and we're talking a lot of pain, not the "oh I stubbed my toe pain", but the "oh, a car ran over my leg" kind. You're probably thinking, "can't you give her something for that?" Oh sure, I could give her morphine, but then you have to worry about respiratory depression, decreased level of consciousness, confusion and dementia, and whether or not her kidney can handle it. On top of the pain, you have to consider that if she has a foley catheter too long she's at risk for a bladder infection; if she lays in one position too long, she can develop bed sores and pneumonia, but you have to change her position regularly (every 2-3 hours) or else she could develop a clot that could move to her lung or heart or brain. At 93 years old, this is most likely the last few years of her life. I wouldn't want to spend my final days like this.
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