aino irene sofia 3/15/1922 - 11/3/2005

my grandmother died on thursday, november 3rd. the day before she had developed a fever secondary to a urinary tract infection, and the end came very quickly, 24 hours later. the day that she died, i got a call from my aunt who was vacationing in cyprus. she said that the health care center had just contacted her, telling her that her mother was doing very poorly. luckily i was still in school, which is located less than a mile from the health care center. i rushed to be by her side, and called my father who said he would leave right away. when i arrived, she was breathing very heavily. a nurse was standing beside her bed and was just about to give her a shot of morphin. the end came so quickly that 45 minutes from my arriving she was gone. my father got to spend the last fifteen minutes with her. her breathing just got slower and slower. a nurse was wiping the inside of her mouth with a moistened q-tip, trying to prevent her mouth from drying. when she did this, my grandmother yawned a few times, like a little kitten. soon after that, she took her last breath of air. we kept waiting for her to breath again but she never did. i grabbed her wrist to feel if she still had a pulse. i only felt a rapid flicker and then it disappeared totally just a second or two later. she was gone. my parents left pretty soon after her death. i stayed behind a while longer. i just sat beside her body, held her hand. then i pulled the sheet over her face and left.

it's hard to describe the feelings i have been going through. i am relieved of course, that she's not suffering any longer. she had become so frail, so very tiny. she didn't need that horrible disease that brushed her whole self away. i remember her a strong woman. she had great sense of humour. she never feared work. i wish she could have got to know my son. when she met my then 7 month old baby boy for the first time, her eyes got teary. she recognized me, saw that i had become a mother. and she was happy for me. proud of me. that means so much to me now. i dread public speaking. dread it. but i gave a short eulogy at her funeral, and it was surprisingly easy. i'm so glad i did it.

a little update

except for my last post (that has no point at all), i haven't updated this blog for months. a lot has happened over the summer, but i will get into that later.

i just finished a 5-week visiting nurse internship, which i loved. being a visiting nurse is something i might want to do when i'm all "growed up". got a first touch on using electronic charting system as well, it was so cool, and easy to use! i don't think the pediatric ward that has ordered the thesis from us uses the same charting system though. speaking of thesis, we've submitted the first draft of our research proposal! this week is also my last week of classes in 2005, *yay*!

next week i am to begin a 3-week internship at the pediatric ward, after that it will be another three weeks at a well baby clinic, and right after christmas i will spend three weeks in NICU. i have mixed feelings about the internships. while i am interested in learning about pediatric nursing, and it will be lovely to handle newborns and young babies, i don't know how i will be able to handle all this emotionally. my son had some very serious neurological issues as a baby and now that i am about to take care of seriously ill children and see their parents' anguish, it's like re-living my own nightmare again. i think it is good when nurses show their emotions, but i just hope i don't have to go bawling around the corner too often!

a tale from my surgical internship

this march i did my surgical internship at the gynaecological ward at our local hospital. the patients there were women having hysterectomies, laparotomies, laparoscopies, recto- or cystocele repairs, chemically induced abortions, d&c's, et cetera.

my patient was a young woman of 26 years, a mother of two, having a laparotomy for menstural pains & heavy bleeding. it turned out she had severe endometriosis, and it was during her surgery that the doctor decided to take out her left ovary.

some of the nurses categorized her as a "difficult" patient, because she kept asking for more pain medicine during the first night after her surgery. she had previously had some psych. issues, so they were essentially saying it was all in her head.

the next morning after her surgery, she pressed the call button when she was eating breakfast. the in-charge nurse asnwered her call. the patient said "i am bleeding really bad, please hurry!" we ran to her room. she was sitting on the edge of her hospital bed, her hands pressed against her scar, and there was a large pool of blood on the floor. we had her lay on her bed, raised her feet with pillows and called the doctor. her doctor arrived pretty soon, and started opening her stitches right there. the in-charge nurse and another nurse were assisting her. the surgeon gave her a shot of lidocaine c. adrenaline but it didn't take effect right away, as the doctor was pulling the stitches out. the poor girl was a) very scared and b) in a lot of pain. she was screaming from pain and terror, and kept asking if she was going to bleed to death. her doctor, she yelled at her patient. she said "you need to shut up, and stop this whining! you're a grown woman, for pete's sake!" as the doctor and the nurses were working on the patient, all i could do was to hold her hand, stroke her hair with my other hand, and tell her it was going to be alright. i told her that the analgesic also had adrenaline in it, which would help stop the bleeding, and how i could see the bleeding starting to diminish. the doctor repaired the bleed, stitched her up and added staples so the cut would hold better and left the room.

when i went to see her later during the day, she told me she's always been scared of being operated on without being under general anesthesia. when she had her first baby, she ended up having to have a c-section. she was given an epidural and the doctor started to make the incisions. the epidural had not taken effect, and she could feel it all. her doctor would not believe her and continued on. when she had the next baby, she demanded a general anesthesia. i don't blame her one bit. she said she wanted to get out of this place asap, to which i responded that i understand her feelings but it would be safer for her if she stayed as long as needed.

my next day shift was the evening shift, from 1:30 to 21:30. the patient had already been discharged when i arrived for my shift. the in-charge nurse (the same from the day before) told me that essentially she left against the doctor's orders. she also told me that the patient had asked her to tell me, that i was a big help during her bleeding ordeal and that she wished she had not crushed my hand squeezing it so hard. it felt good to hear that. really good.

P.S. i don't know what the point of this post is anymore! i started writing this in june but never finished it until today.

to puff or not to puff?

disclaimer: this post is not about drugs. it's about pillows.

my husband has a british acquaintance who also lives in finland. some time ago said acquaintance broke his leg playing floorball. he had to have the bone fragments screwd together, and his leg casted. he had his laptop with him at the hospital, so he was able to send a message to his buddies at one particular bulletin board that my husband is also a member of. in the message he sent he said that healthcare in finland is terrible. his main complaint was that no one had puffed his pillows, not even once, during that day! imagine that! now this is 27 yo. guy who was able to get himself to a sitting position on his own, was able to ask for more pain relief, and, was chatting on the internet through a wireless connection! he was certainly more than capable of puffing his own pillows. it could be a cultural thing, something he was used to. do nurses in britain puff their patients' pillows a lot?

now, during my summer job, i've come to realize that puffing the pillows sometimes is a good thing. my patients can't ask for pain relief or a drink, because they are no longer able to communicate. sometimes they get distressed and start wailing for whatever reason. it could be because the patient in the next bed has visitors and the other one doesn't. if they don't seem to be in pain, we usually offer them some water or juice, and puff their pillows. we turn the cool side of the pillow up and usually that calms them down, because all they need is some sense and knowledge that someone cares about them.

i hope my post didn't offend anyone, it wasn't my intention at all. i was just trying to share a story that i find funny from a finnish nursing perspective. i don't know what the pillow-puffing policy is in your countries, and it certainly is warranted in many cases. i am not even saying that finnish nurses should only puff geriatric, unconscious or otherwise helpless patients' pillows. we as nurses have to have our antennas up when working with patients. the one with the broken leg could also have financial worries, and by puffing his pillows the nurse could give the patient some sympathy without being intrusive. all i am saying is that the brit didn't seem that he was in desperate need of having his pillows puffed. he had a great job (still has), and he was in no way compromising his job by having to be hospitalized. he was cracking jokes at that bulletin board. but again, who am i to tell? i wasn't his nurse.

*edited on oct. 29, 2005 to clarify the title*

more about the thesis

my classmate and i had a meeting with the head nurse of the pediatric ward that we will be doing our bachelor's thesis for. it was a good meeting, a real eye opener. she told us that the ward will start piloting an electronic charting system this fall, which makes our thesis work all the more challenging. it will be certainly very interesting but very very challenging. i am almost a bit scared to think about it. it means that we have to really *learn* the new electronic charting system because how else are we going to know what its strengths and weaksnesses are? now i like working with computers and i am a pretty fast learner when it comes to programs and such, but i am certainly no geek. and the two other members of our group are very un-geek-like. so this should be interesting.

are there any nurses out there working at a hospital using an electronic charting system? what do you think is good and what is bad about these type of charting systems? at this point i know nothing about the system except that it is developed by a finnish company, and it's not used anywhere else but this particular hospital. what will be lost when one's individual writing is replaced by certain terms to describe a patient's condition? that is how i *think* the charting system will work, but i don't know for sure.

our next step is to write a letter to the hospital's pediatric cost centre's board, and ask for a permission to do our thesis.

my summer job

upon learning how to treat various aging related illnesses, such as cardiovascular disease, type II diabetes and cataracts, the fact is that we still can't stop our brain from aging. it is a very powerful reminder of our mortality. are we living healthier lives or just longer lives?

i got a summer job at my local health care center, and the ward where i work at is full of old people, who have no other place to go. most finnish nursing homes don't have doctors 24/7, so when these people get too sick to be at the nursing home, they are sent to the health center's long term ward, where they are to spend their remaining days. but too often the days turn to weeks, weeks turn to months and months turn to years. these are the people who rebuilt my country after ww II. my grandmother is one of them. she is 83 years old and has alzheimer's disease. she has been bedridden for 5 years now, and can no longer communicate in any way. the last time that i saw some emotion on her face was five years ago in may 2000, when she saw my then 7 month old baby boy for the first time. i had lived in the united states for 2½ years and had just returned to finnish soil from my "exile" in boston. at that time my grandmother was still able to sit in a geriatric chair at a nursing home. upon seeing me with a baby, there was a sense of recognition on her face, and her eyes got teary. soon after that day she was transferred to the health center because she regressed so much. she had a stroke in july of 2001, and we were told that it was only a matter of days. not the case. she was left with a paralysis of the left side, but her heart just keeps on beating. her daughter visits her every day, and feeds her from a sippy cup. she gets turned from side to side in order to avoid bed sores. she wears diapers around the clock. i feel so so bad for her. i hope her time here comes to an end soon. of course i can't speak for her, but i can't imagine her wanting to be in this shape, after doing something like five persons' work in her lifetime.

i don't have an answer to this situation, except to treat these people with as much dignity as we can. you may be changing diapers several times a day to a drooling patient, feeding him or her from a sippy cup and being cussed at by a demented and aggressive patient. they may be but a shell of the person they once were, but they are still human. they deserve to be handled gently. they deserve to have their hair combed and their face wiped from the drool. they deserve to be spoken to, with respect, even if they cannot answer back. the nurses and practical nurses at my work are very very good at treating their geriatric patients with dignity and respect. i have nothing but admiration and respect for these nurses. it is grueling work and they don't get many rewards as in seeing their patients get well and go home. a smile or some random words by the patient is pretty much the most they get. i feel that i am learning a lot during my time here even if this probably will not be the area that i specialise in. i haven't had a course in geriatric care yet, but i would be interested to know how this area of care is arranged in other countries.

in my ward, one female patient has a wallpaper behind her bed that has an angel drawn on it, and a written message that goes something like this (translated from finnish):

when i can no longer remember my name,
when this day has blended with yesterday,
when my adult children have again become babies in my memories,
when i am no longer a productive individual,
even then, please treat me as a human being.
care for me, give me love and touch me with gentle hands.
the clock ticks slower.
one day it will come to a complete stop.
but not yet.
please treat me with dignity.

- unknown

our thesis

i set up an appointment today with a head-nurse of a pediatric ward at the local hospital to discuss about our bachelor's thesis. two classmates and i are doing our thesis on nursing documentation. the pediatric ward in question wants us to define "the minimum requirements of nursing documentation" and what the important aspects are regarding documentation in pediatric nursing particular. in addition to the whole thesis, we also need to produce a booklet about nursing documentation for the ward's personnel, in the hopes of standardizing the personnel's documentation practices.

also finished writing my "goals" for my upcoming summer job. *yay*, it's finally done! i need to send it to my class tutor tomorrow. work starts tomorrow also.

first post

hello world!

i am supposed to be working on several assignements for school but instead i decided to start blogging. me? yes! and i don't even like writing. i know good writing when i see it but i don't consider myself much of a writer. so let's see how long i have patience in trying to keep this blog going...

so ok. this blog is going to be my feeble attempt at journaling my way towards a degree in nursing as well as trying to conceive and carry another baby to term. i am hoping to have the baby before i'm done with school. one can always hope, right? currently i am on sick leave because i've been diagnosed with a burnout. yes, a nursing student with a burnout. haha! i'm already burned and i haven't even graduated! and get this! i was just in the middle of my psychiatric internship when it happened... some nurse i am going to be. an angel of mercy if you will!

so how did i get to the point that i am almost ready for the padded room? answer: husband hospitalized three times just this semester only, son's possible adhd, old unresolved issues, too much school work (aren't there always?), no money, six miscarriages... woe is me.

ok, gotta go work on that assignment now. and i promised my son J that i would bake some pulla with him. it's a finnish treat. yes, we are finns, except for my husband who is an american. and our two dogs are american and estonian.