Saturday, November 1, 2008

Juice please

“Is there anything I can do for you Mrs. Smith?” I say as I finish my morning assessment. “Can I have something to eat? I have not eaten in three days.” Mrs. Smith is calm and polite, but I hear a building distress in her voice. It is not unusual for a patient in the Surgical ICU (SICU) to be NPO (nothing by mouth) for a few days, particularly if a surgery has been performed on any part of the GI tract. Mrs. Smith’s procedure two days ago had been elsewhere though. I went through her orders. No diet. All patients are kept NPO for twelve hours or so before procedures. Anesthesia sometimes causes vomiting and keeping the stomach empty minimizes the risk of choking. Did they just forget to restart Mrs. Smith’s diet after the procedure? I cannot think of any other explanation, but I have just floated to the SICU a few times before this and there is a lot I still do not know. I turn to MK.

MK is one of the surgical residents. She is a rare one and well loved, especially by the nurses. One of the charge nurses, a young man, first introduced her to me saying shyly, “This is MK. We do not like her a lot or anything like that.” What is uncommon about MK is her mood. She does not use her position to elevate herself above others. She is not here to fix it all, just to do whatever she can to make it better. She is cool calm and collected and she brings her full attention and skills to her work when it is time. She does not ask for any breaks. As a floater, I particularly appreciated her openness. When the unit staff does not know you, it is often hard to get anything done. Even the techs will not listen to you, what to speak of the doctors.

MK listens and does not give the standard “We will address this on rounds,” reply. She goes directly to the fellow. “Is there any reason why Mrs. Smith needs to be NPO, or did we just forget to give her a diet?” “She can eat,” is the answer.

The SICU does not have much around for the patients to eat and it will take a while for something to come from the kitchen even with a request for a late tray. I scrounge some juice and give Mrs. Smith the choice between apple and orange. She chooses apple, happy that her fast will soon be ended. Some patients would be furious at this point, but Mrs. Smith does not seem to have any interest in going that way.

I get a cup, a lid, a straw and some ice and empty two of the small plastic containers of juice into it. When I return to the room, Mrs. Smith’s surgeon is there speaking with her. “Here is your apple juice Mrs. Smith.” The surgeon stops me in my tracks, “She does not like apple juice.” “She said that she wanted it.” “She does not like it. It is too acidic.” I look at Mrs. Smith. She waves me over. Her gesture says, “Its okay, just give me the juice!” “Don’t you remember telling me you do not like apple juice?” booms the surgeon. Mrs. Smith does not engage him. She probably did say it at one point, days ago maybe. He continues to block me. “She has been NPO for three days,” I protest. “I know,” he answers proudly, missing the point entirely, “I made her NPO.” (Me big doctor, You little nurse.)

Okay. So this little nurse knows that the big doctors never hang around for long. Mrs. Smith only had to wait another minute for her juice.