The Mushroom Nurse

Yesterday, bearing in mind that staff at Homeland are still actively restricted from any overtime hours, I gave away over an hour at the beginning of the shift to a meeting. Coming out of that, I briefly got my ducks in a row and took report from the day charge nurse in the Solarium. Then I gave some attention to Dr. Wildman, here to see a new admission from the other day; a resident who, since he persists in removing his WoundVac negative pressure dressing, was reasonably deemed to no longer need it.

Meanwhile I set up to receive an admission later on, noting the orders, arguing on the phone with the Pharmacy to send the IV antibiotics and a pump sooner than oh-dark-thirty--the Pharmacy claiming that this specialized medicine designed to combat multiple-drug-resistant bacteria, which was going to be running directly into the Superior Vena Cava of the heart, could be administered just fine with a primitive device called a Dial-a-flow, in the absence of a pump. A position with which I disagree, but the Pharmacy pretty much holds all the cards.

So I was noting orders for the new admission expected about 5 PM, hoping he got to Homeland while the very excellent treatment nurse was there to assist with the skin check, and giving my attention also to Dr. Demure who needed to see two people and their medication records. I was also receiving the facility's phone calls while the receptionist gave a tour.

Fast-forward two hours. Up to the desk comes the daughter of Mrs. Dunnfore, who was admitted about two months ago with severe liver failure, the color of a spaghetti squash and never very lively, and on Hospice care; now persistently dying for the last two weeks and the color of a pumpkin. Mrs. Dunnfore's daughter, out of the blue, calmly informs me that she has just called the mortuary for her mother. My jaw drops.

It turns out that this resident, at the very time I was receiving report from the day charge nurse, who confidently reported on her oxygen saturation, vital signs and so forth, was actually dying at that moment. I never got around to doing rounds. In two hours, not one person had informed me that Mrs. Dunnfore had expired: not the treatment nurse, who was there; not the Hospice nurse, who was there; not the medication nurse, who knew; not the two CNA's from my shift who prepared the remains for the mortuary after her passing. Each person had assumed that I knew.

So I was expecting the new admission to come in on one gurney, and the mortician to come in with another, and hoping like heck the two gurneys did not get mixed up.

Mushroom Nurse: kept in the dark and fed "nonsense".

Moral: always do your rounds first, no matter what.