difficult days at work

I worked the last two days as a PCA at my job; it was really the last two days that I will work there because once a PCA has her RN license, she isn't allowed to work on the floor as a PCA anymore. I don't know why as other floors allow it, but my floor does not. I actually passed the boards in March, but because I enjoyed my job, needed the money, and didn't have time to look for or orient in a new job during school, I didn't tell any of the RNs, just the other PCAs.

While I had signed up to work the past two days, as a per diem employee, I don't know why they had me come in. Generally Sunday and Monday day are the quietest days, no surgeries and lots of discharges over the weekend; most of the surgery patients on Monday go initially to the ICU before coming to our unit. By Monday night, the floor starts filling up and by Friday it is a dance for rooms.The patient census wasn't high enough. I was working as a respiratory walker and there were only 5 or 6 stepdown-ICU patients; all the rest were regular floor patients and only a couple of them needed the thoracic walker or a companion to walk with (if we are worried about falls). So I spent a lot of time over the twenty hours trying to look busy.

Finally for the last hour I replaced another PCA who was sitting with a confused patient. This patient's case gave me the heebie-jeebies. She'd been at another elite hospital for more than a month, had gone home to die and had been home only a few short weeks before her family heard about the amazing surgeon here and decided that this surgeon would save the life of their beloved older family member. One family member even told me that he couldn't wait for the surgery. I knew at this point from Rounds that surgery was not an option. The cancer was too far advanced and the patient was too weak. A family meeting was called for more than 5 days later (time for all family members to arrive) where the news would be broken that surgery is not an option.

The patient, whose mental state was cloudy due to all the pain medication, has now been in the hospital for almost two months straight. Now, this is projection on my part, but if I were her, if my options were going to be palliative care or hospice, I'd want to know right away. I'd want to go home. I found it very difficult to sit there with her and not ask her if she wanted to go home or what she wanted. I get impatient with time lags. Hospitals are deadening places. I don't want to die in one unless it were the only way my symptoms could be controlled. Part of me does think that the way I want to die, if I have to die slowly, should be with a morphine and ativan drip. Morphine to control my pain and breathlessness. Ativan because, and I haven't seen this yet, but another nurse friend tells me, dying is anxiety producing and psychologically unpleasant. My ideal way to die would be with chronic renal failure when I am old enough to know that I don't want dialysis; then I will just drift off.