This Saturday I sent a man to the hospital. In a good way.
Every Saturday/Shabbat, myself or someone from our synagogue goes to the nearby Assisted Living Facility (ALF) to get one of its residents, GU (initials only for privacy), to come spend morning prayers with us and then we take him back after lunch. It’s about his one outing for the week and his one chance to do some serious exercise, walking the 2.5 blocks between the two locations. He’s in his 80s, but he’s strong and fairly independent, which is great and how I would like to keep it. When I pick him up, I walk alongside, stop as often as he needs to, but always encourage him to walk by himself as opposed to using a wheelchair as some have suggested. He does have mild dementia in that he’s always reminiscing about WWII and all the twists and turns that caused in his life, but it’s not like he’s not aware of the current time and place as well. GU is feisty and strong and he has it in him to keep on ticking.
So when I went to pick him up this past Shabbat and did not find him in his usual spot waiting for me, I thought that strange. Even more strange was that the nurse’s aide found him in his room, in bed. He said he didn’t feel well, and my reply was, “Oh, ok, no worries. Tell him that I came and I’ll see him next week.” This is where it turns out it was a good thing I was the one to go pick him up instead of another man from the synagogue: the nurse’s aide said that he had had an incontinence episode. I know GU and that is entirely out of character for him. When she offered me the chance to go see him in his room, I took it.
The moment I saw GU in bed I knew something was wrong. And I’ll be darned, nursing-mind took over immediately. Without being aware of it, I launched into an assessment. I checked awareness (AAOx3) and found him somewhat confused; he knew who he was and where he was, but not when. He knew it was Shabbat, but he was off on year. He also half-recognized me as someone Jewish but from the Veterans group, not the synagogue. Meanwhile I was taking his pulse, which I found to be very low and weak. I asked the nurse’s aide to take his blood pressure and meanwhile I counted his respirations, which were faster than normal. He kept drifting into semi-sleep, and was unaware of having been incontinent on his pants, denied it vehemently even. They used a machine to take his BP and temperature, and it being Shabbat I couldn’t operate it, so the nurse’s aide did. His BP was 178/92, which is Stage 1 Hypertension.His temp was 105.8° F. His pulse, which I had once again taken, was 54.
By this point the ALF’s nurse walked in and again, without noticing, I gave her a report of all his vitals and what I had assessed thus far. Just like that she turned around and said she was gonna call his doctor. GU was getting cranky so I opted to leave him alone for the time being. I also didn’t have my stethoscope so I couldn’t do the next part of the assessment I would’ve liked to, auscultate his heart and lungs. When I went out to the hall, the nurse shoved GU’s chart in my hands and asked me, what should we do?
It took me off-guard for a moment. I told her that I was a nurse student. She said she imagined so, based on the report I’d given her and what data I had gathered. Then she asked me again what should we do. I asked if she had gotten in touch with his doctor, and she said no. In that case, with such a high BP, I said to call 911 and have him checked and possibly taken to the hospital. Which is what she did.
The EMTs arrived 10 minutes later and again I gave them a report when they arrived. They rechecked all the vitals but the EMT thanked me for the thorough info. His BP was 159/89, lower than with the previous machine (I’m sure it was taken incorrectly earlier) but still alarmingly high, and his pulse was 59, right on the target range with my count. He was a bit more alert, but when they told him they were gonna take him to the hospital for a check-up, GU did not fight it at all, which is also very uncharacteristic of him. I helped him walk the bit of hallway to the stretcher and he was unbalanced. The moment he was put on the stretcher, he started having fast respirations again and very calmly asked to be taken to the doctor. He was very much not feeling well. I saw him off and said I’d check on him after Shabbat.
I was a nervous wreck the rest of the day. Had I read those numbers right? Were they really in the ranges I thought they were? Why didn’t I ask for his chart? Why didn’t I put this back on the actual ALF nurse? Did I make the right choice?
To be honest, a lot of what happened was almost in auto-pilot. I remember it all, yes, but the gathering and processing of the data and the acting on it, that all happened automatically. I heard the data, ran it through my database of nursing information, and acted accordingly. But, I’m only a student, right? I had flashbacks to the bus accident earlier in January, and to that feeling of helplessness at not being able to help people around me. Here it was very different. Here it was, did I make the right choice?
I went to the ALF this morning to check on GU. He was admitted to the hospital yesterday for observation, and though when I called they couldn’t give me too much information over the phone, I did confirm that the reason for admission had been abnormally high BP, hypertension.
Yes, I made the right call.
You know what? No matter what grade I get in my finals this week (as long as it’s a passing grade, that is), this week is already awesome, because I was able to actually help a patient with a situation that could have very easily turned dangerous. Yeah, this is an awesome feeling.