5. WASHING HAIR

I was thinking that I should document a really good example of what my day is like while working as a nurse.

Part of my job, aside from supervisory functions in the office, is to do home visits. The company I work for is applying for their Medicare license, and part of the deal is to have a certain amount of active patients (not "active" as in moving, but "active" as in under our care). Since they are not allowed to bill for these services yet, the hospital has been giving us patients who are either indigent or do not have any health insurance.

My most recent patient was a 33 year old female, who, like a responsible un-wed mother that she is, went ATV-ing in her backyard, hit a bump, and fell into the canal in back of her house. On her way up to the surface for air, she ripped open her left inner thigh. She was treated at the hospital, then sent home with antibiotics and wound care orders. After not following any of the treatments given, the wound became infected, she returned to the hospital, had the flesh on most of her inner left thigh removed, and lucky me received the order for wound care with a wound vac. I have to tell you that wound vacs are extremely expensive, and that this service was being provided for gratis by the company that manufactures the machine, as well as the agency paying for me to care for this wound and not being re-reimbursed.

First this lovely woman did not bother to give her correct address or phone number, to avoid receiving any bills for her hospitalization. So I spent the afternoon driving 35 miles to her imaginary address only to be met at the door by an irate young mother who was "sick and tired of getting bills and mail addressed to this person." I apologized, called the agency to let them know, and went home. About 2 minutes after walking in the door, I received a call from the agency to notify me that this patient called demanding where her nurse was.

The following day I went to change the wound vac dressing on this patient. I made the appointment for 10:00 AM and was met by her domestic partner's grandmother who told me that the patient was still asleep. I was actually supposed to be off this day, having a personal appointment a distance away (this was a Saturday), so the grandmother was kind enough to wake her highness up.

This was supposed to be an indigent patient. Her acrylic nails and sprayed on tan must have been donated with the wound vac.

I heard every kind of epithet spew from this woman's mouth, blaming everyone for what had happened to her leg. Not once was there any personal responsibility owned.

After the dressing was done, I told her that I would be back Tuesday morning at 9:00 AM sharp, as I had to work in the office as well that day.

I showed up at the house at 9:00 AM sharp (I'm a stickler for punctuality). This was during the cold spell that we encountered down here. It was 40 degrees. To Floridians, it might as well have been below zero. I know it's not biologically feasible, but our blood does thin and we do not do well with the cold. So there I am, banging on the door (no doorbell), and no one is answering. I'm calling the house from my cell and getting the machine. I called the grandmother, who was away from home and she told me to go around the back and bang on the sliding glass doors to this woman's bedroom. I banged so hard I'm surprised the glass didn't shatter. No answer. I left.

I came to the office and read her chart, which now contained more information that the office did not share with me initially. She is a drug addict. She pops Dilaudid like Pez. She refused to have her wound vac changed in the hospital. She chased people, including physicians, out of her room if they did not do what she wanted. I told the agency that they were setting themselves up for a lawsuit. One of the owners, who is clueless about the nature of people, could only see that we have another "active" patient, and disagreed with my assessment. I spent the day leaving messages to no avail. I called the physician to notify her that we were unable to change the wound vac since the patient did not call us back.

The next day was a repeat performance. No call back. I called the physician to let her know that the patient is non-compliant and we are discharging her to her care.

Lo and behold, about 3 hours later I get a call from my new BFF. "Hey, where are you?" she asks. "I called you back 3 times yesterday and you never got back to me," she has the balls to say. I told her that she had been discharged and to seek further medical care with her physician. To say she went ballistic is an understatement, but by that time I had hung up. A bit later in the day the 2 owners of the company came la-li-dalling into the office and non-chalantly told me that they had spoken to the discharge planner who gave us this lovely patient, who informed them that the patient is suing the hospital for negligence. Duh.

So tonight we had Ms. Diamond again. I really like this woman. We went over the material for Monday's exam (exam!) and then we did another zero degree haircut on the same mannequin that my cat had attacked. Since I was done about 40 minutes before everyone else, I had some time to start my weekend homework and studying. When the others caught up, we got to wash each others' hair. We are learning about scalp massage, and I thought this would be pretty cool.

I washed one of my fellow student's hair, massaged her scalp well, and then she got to reciprocate. I think she has never washed anyone besides herself. The massage I so anticipated was performed with barely touching fingertips on what felt like a scalp with very little shampoo, a quick rinse, and, when I blow dried my hair, shampoo residue.

When I came home, I realized that going back to school has cut down on my consumption of alcohol. Not that I'm a lush or need to drink daily (do I sound defensive?) but I do like a glass of wine or 2 when I come home from work. Since I cannot go to school smelling of alcohol or risk cutting hair in an intoxicated state, and by the time I come home I'm either ready for bed or need to study, I do not drink from Monday-Thursday when I have classes. I should also tell you that school is year round, with only very few days off for major holidays such as Christmas, New Years , Memorial Day, Labor Day and Thanksgiving. And if you are absent (which I will be for 3 days next month) you will be screwed, judging by how much work is given at one time. And I thought this was going to be a breeze!