Older Sick People...

... are not my favorite.  I didn't realize how much I enjoyed peds until I had to switch back to the older crowd.  This quarter we have two clinical classes, public health (post coming soon) and continuum of care.  Continuum of care makes you look at the bigger picture and not just what needs to be done right now.  It makes you think about discharge and the patient's living situation/amenities.  For example, you can't just discharge someone to go home who lives on the second floor, but can't walk up stairs.  This class is suppose to make us think of more individualized care.

This quarter I am commuting to Rush Oak Park Hospital, which is nice because, again I am getting a brand new hospital experience.  Oak Park is more of a community hospital and services the surrounding area.  Recently one nearby medical center shut down and another is converting to strictly a psych facility, so Rush Oak Park has become the main hospital in the area and is packed.

I am on a general med/surg unit where the population tends to be more geriatric.  We will see anything from transplant patients, to heart disease, to poor diabetes management etc.  These patients are usually more tricky because of all the co-morbidities they have.  It's not just I have heart disease, but I have heart disease, diabetes, hypertension and dementia.

My clinical instructor is pretty relaxed.  She doesn't believe in unnecessary homework and encourages us to get paperwork complete while at the hospital.  She is actually a graduate from the first cohort of the program Im in right now.  It's nice to have someone who knows exactly what you're going through.  Our first day we just oriented to the hospital, went over expectations and then she released us to any patient's room.  We had to go in completely blind and find out as much as we could about the patient just by what was in the room and what we asked them.  My patient was a 57 yo woman who was sent to the hospital for hyperglycemia.  Her blood sugar was in the 700s!  When I asked her about home management she really didn't know much.  Her daughter does all the cooking and says its a diabetic friendly diet, but I beg to differ if her glucose was that high.  Now, I don't think she was being non-compliant, as many jump to assume, but rather she just doesn't know how to manage her illness.  When I asked her about medications, she didn't know what she took.  It took a lot of probing just for me to figure out she takes insulin and "pressure pills."  Education is going to have to be a huge part of her care so she and her family can manage her care at home.
 

The next week my instructor gave me one of the heaviest patients on the floor.  He was a total care, meaning I needed to feed him, turn him, bath him, everything.  He came from a nearby nursing home with a fever, dehydration and mental status changes.  He also had dementia and while he would tell you "watch my knee" or "I don't want anymore" he couldn't answer any questions.  Not even can you tell me your name.  He also had severe hip and knee contractures, likely due to neglect from the nursing home.  The muscle naturally wants to be in a contracted state and if you don't exercise your muscles they will permanently become contracted.  Now he just lays in bed (like the position in the picture) unable to straighten his legs.  He had 14 different medications, which again is a little change coming from pediatrics, and they were for several different routes.  Some were PO but since he can't swallow them we'd crush them into apple sauce and cross our fingers that he ate it.  He also had a subcutaneous injection and a suppository.  Yes, this was my first suppository and it didn't bother me at all.  What did bother me was knowing what that suppository was going to do and the fact that I'd have to clean it all up because he's incontinent.  This is what we like to call the "ick factor."  You can be the most caring and compassionate person in the world, but if you can't handle the ick factor, you just aren't going to cut it as a nurse.  Thankfully I was able to use my delegation skills to pull someone in the room to help me, but it still was an hour long process.

Later my clinical instructor commented that she hadn't seen me all day, to which I replied, I have a heavy patient today and gave her a quick report.  While I feel I am enhancing my skills and critical thinking as a nurse, I realize there is still a long road ahead.  It is hard to believe I am almost done with school but feel I don't know anything.  This one patient was exhausting, I can't imagine have to take care of two to three other patients on top of that.  I suppose I should add time management on top of everything else that still needs fine-tuning.  

Creative Collaborations

My favorite part about being on Bear Necessities Auxiliary Board is working with the kids.  Our winter event is called creative collaborations where the kids and families come to our office to do a bunch of craft projects and have a nice lunch.  This year we were spoiled because Sable was very generous in donating the food for us. Kids are busy working while parents sit back and relax.  One mom was telling me at the end of the day that she felt bad because she spent the whole day talking to people and didn't even know what all her kids did.  I told her that's the point, we hang out with the kids and she gets her me time.  I think it's very therapeutic for the parents to talk to other parents that have gone through the same thing.  Most parents talk about activities their kids are involved in and when they lost their first tooth, I heard these parents talking about the number of chemo treatments and when their kid's hair started growing back

While this day is all about the kids and families having a nice Saturday afternoon, our other mission of the day is getting auction items for our events.  We make thousands of dollars off of their artwork.  It's pretty amazing actually.  The parents are cute because some are like, is this going to be an auction item because we'll make sure its a really good one.  The older kids also understand that their artwork will make money to help other kids that have cancer too.

The kids loved our crafts this year and they are all easy do it yourself projects that can be done at home.  But first we needed their hand prints.  Each VIP goodie bag is personalized with hand prints from one of our kids.  We needed 200 and while some kids wanted no part in it, there were a few that wanted to do them all.

 

One of my favorites.  He's such a typical 8yo
boy and was feeling very patriotic this day.
All his crafts were red, white and blue.

Bubble Painting:  mix paint with water and dish soap in a cup.  The kids blow bubbles like in a glass of milk and then pop the bubbles by placing a piece of paper on top.  The popped paint bubbles leave a cool design on the paper.

Marble painting:  take a piece of paper in a cake pan.  Dip marbles in paint and then roll them around.  Fun and simple!  Sorry I don't have pictures of the paint projects, but they looked really cool.

Quilt Squares:  taken from the concept of t-shirt quilts, each kids got a square of flannel material and fabric markers to draw whatever they want.  Some are so adorable and a picture doesn't really capture how great the blanket turned out (not to toot my own horn or anything).  I just loved the stories each square had.  I already had the back complete and couldn't wait to get home and finish the front with all the kids pictures.

cutting the squares is the hardest part 

Sewing is a cinch.  It's just all straight lines.

I wanted to direct one girl away from a rainbow because there were like 3 rainbow bears already.  And our conversation went a little like this... So I said lets have your bear do something, like build a snowman or swim on the beach.  Whats your favorite season?  Spring.  What types of things can we do in spring?  Maybe pick flowers.  It rains in spring.  Right so should we draw an umbrella in your bear's hand?  Well after it rains there is a rainbow.  You're so smart, I guess we can draw a rainbow...  The other square is by an 8 year old boy.  He originally wanted to write Cubs Suck, we settled for Cubs are bad!  There is discussion on whether this will "depreciate" the value of the quilt.

This 6 year old boy was obsessed with penguins so it was only fitting that he drew himself walking a penguin.  When I looked at the final product I asked Whats that pointing to the jockstrap looking detail?  To which he replied, that's my underwear.  I was like good call, you don't want to walk your penguin without underwear! The other square was by a 10 year old girl who loved to draw.  She did a square earlier with a really good sun and bee.  I told her I knew how to draw a cow and she wanted to learn so I showed her step by step how to make it.  After lunch she went back to the quilting station and drew a cow on another square.  I must say she did an awesome job and she was excited to go to school and show her art teacher her new talent of cow drawing.

This little 4 year old was so adorable.  he was just drawing away and when mom realized it was going to be sewn into a quilt she asked for another one.  We were like, No! we love what he's doing!  There was a lot of concentration going on (those are super heros, by the way).  The other square was the one that preceded the cow drawing.

The final product.

The star of the show was the crayon melting project.  You hot glue crayons to a canvas and then melt them with a hair dryer.  It takes some time to get the crayons going, but once they do the kids get excited.  Oh, and I think Crayola works best.  Some turned out really artsie!

Back to the Grind

It's crazy to think that I am in my last didactic quarter of nursing school!  Come April all I'll have left is immersion and my capstone project.  People in my cohort have changed their tone and we've all talking about NCLEX reviews, portfolios, immersion placements, graduation, where we want to work and weekly countdowns.  It definitely doesn't get any easier.  We still only have one day of class, but we have two days of clinical and assignments for two additional online classes.  It's a heavy load and I'm trying to manage working 20-24 hours a week on top of it.  We also will be required to start collecting 132 "indirect hours"  which is volunteer work in a non-clinical setting that is nursing/health care related.  Monday through Friday is a drain and all I want to do when I get home from work on friday is lay on the couch and watch some mindless tv.  Days where I get to sleep in past 5:45 are far and few between, but I guess that is the life of a nurse.

• Mondays:  Public Health Clinical at Misericordia 3-9
• Tuesdays:  Work at Lurie's 7-3:30 or 7:30
• Wednesdays: Comprehensive Care Clinical at Rush Oak Park Hospital 6:45-3:30
• Thursday:  Class 9-4
• Friday: Work at Lurie's 7-3:30 or 7:30
• (every 3rd weekend I work so I get either Tuesday or Friday off) 

I'm half way through my second week of the quarter and still haven't gotten into "school mode" per say.   I've put all assignments, tests and other important dates/meetings in my planner and color coded them, but that's pretty much it as far as prep work for the quarter is concerned.  I know I can't get the ball rolling until I'm completely organized otherwise I'm a scatter brain and constantly wondering what I need to do when.  So I guess that's a start and now I just have to look at my assignments and what they actually are.  For my first assignment of the quarter I had to post this leadership discussion by Monday at 9 am.  I posted it at 12:30 am.  I promised myself that I'll get more on top of things come Saturday morning...

All about the kids

...kidneys that is.  When you think of end stage renal disease (ESRD) and kidney failure you usually don't associate it with adolescents, but through my clinical and work experiences I have come to know a few children with this unfortunate disease.  Here are some interesting characteristics about the adolescent kidney, as they are not just "mini kidneys."

• adolescent kidney function can decrease just from stress 
• infants cannot concentrate urine so specific gravity is irrelevant
• complete bladder control is not obtained until age 4-5 (Potty training too early will just frustrate you if the body isn't physically ready for this task.)
• Most children can regenerate and regain full function in Acute Renal Failure if caught early
• Heart disease and Renal issues usually go hand in hand because the systems develop during same gestational period.

hemodialysis catheter going straight to
the heart.  Not a good idea to pull on it.

Chronic renal failure in children is usually caused by structural abnormalities or specific renal diseases.  Only when 5-10% of function remains, will the medical team initiate aggressive treatments such dialysis or transplant.  The first patient I had with ESRD was an 18 year old non-verbal autistic boy.  He was put on the transplant list, but due to the dire need for a kidney, they started testing family members for a match.   His stepfather was the best match and was going to donate his kidney after the work up was complete.  Until then he was receiving hemodialysis every other day of the week.  Imagine asking a non-verbal autistic child who doesn't understand what's going on to sit in a bed with PICC lines filtering his blood for four hours.  My job was to make sure he stayed in bed and didn't pull on the lines or anything.  Each time he was mildly sedated with Ativan, but never really fell asleep.  Because of the Ativan dose, he was admitted each time rather than simply going to an out patient clinic like most kidney patients.  That meant admit and discharge papers had to be signed and completed every other day for this family.  It was an all day process.

I watched the boy on 3-4 occasions during his hemodialysis treatments and got to know the family pretty well.  Mom had 4 kids: the patient, an older daughter in college and 10 year old twins.  I got to know the boy a little better too, which helped when trying to distract him during his treatments.  He understood simple commands like "throw this away" and "wipe your mouth" and liked to pick things up.  We would literally spend an hour with me putting five straws on the table and he'd put them in a cup, then I'd take them out and we'd do it all over again.  He liked to go on walks down the hall and wander around his room when not hooked up to the dialysis machine.  One overnight shift I couldn't get him in bed and then I had a light bulb go off.  I tossed a couple of his straws in the bed and voila he went to the bed to pick them up.  Worked like a charm.

So many people ask if it's sad to see all these sick kids every day and to be honest, I feel the parents and families feel the effects of a child's illness more than the child themselves.  One of the days the mom asked if they could change one of the dialysis dates because she had an event to attend for her daughter who had been neglected during this whole process.  Doctors tried to be as flexible as possible, but there was no way they could skip.  Mom just needed to figure out how to be in two places at once.  Another time, everything was done and mom was just waiting for discharge papers.  Why they were taking so long was beyond me, but after two hours of waiting she just left.  I tried to stall her and see what the deal was, but bottom line she needed to pick the twins up from school.  To be honest I kinda agreed with her decision.  They are in the hospital every other day, there is no reason why there should be any delay in the discharge process.  To top it off, while I was trying to stall her in the hall and sign all the papers she could, I didn't realize the resident was sitting right there in the office.  Only after they left did she come out and ask where they went and why.

With kidney transplants, they usually
don't remove the failing kidney.
They just add the new one. 

Another patient I had was during clinical at U of C.  He was a 16 year old boy who appeared much younger than stated age.  Decreased renal functioning and the anti-rejection medications can drastically stunt growth and development.  He had a kidney transplant from a living donor, his third grade teacher, a few years back.  When I took care of him he had just had his second transplant, this time kidney and liver from a nonliving donor.  He was readmitted because his electrolyte levels weren't being controlled by PO meds.  A couple weeks later he was still there with suspected rejection from the recent transplant.  He took his illness in stride and had enough pills to take each day to fill up a fun size bag of M&M's.  There are 4,600 children on the donor transplant list in Illinois with 2/3 waiting for a kidney.  The average length to wait is 4-6 years.  Children get priority on non-living donors under a certain age.  Don't remember the number, it's either mid-twenties or early thirties.

My clinical instructor was a PA who works very closely with transplant patients.  When we had orientation at U of C, she mentioned a lot about international patients coming in for transplants.  I inquired about how international patients work into the national transplant donation list and was a bit stunned at what I found out.  The government of some countries that do not do transplants will pay for families to come to America for the procedure.  When the family comes over for the work up, they just hop onto the donor list wherever they fall.  The sicker you are the higher up on the list you go.  That means someone can fly over from any country and hop ahead of hundreds of kids who have been waiting on the list if sick enough.  Don't know if I necessarily agree with this system, but money talks in a capitalist society and if the country is going to flip the bill, why can't the kid get on the list.  It is also a huge commitment on the families part as well.  As long as the family is on the list they need to stay in the US.  Sometimes families are split for years waiting for an organ and there is no guarantee that they'll even get one before time runs out.

Moral of this post... register to be a organ donor if not already.  It's as simple as a clicking here and registering with your state.  It's not just donating an organ, it's donating a life.  

When Patients Attack!

 I worked the day after Christmas and since all I've been working lately are 12 hour shifts, I just assumed it was another 12.  When the charge was talking about losing me at 3:30 I was like huh.  Well I was only scheduled for an 8 which would have been a nice surprise, but since they were super busy and seemed short staffed I offered to stay for 12 if they wanted me and of course they didn't decline the offer.

Since I was doing them a "favor" by staying the charge told me I could stay on the floor or sit for one of the regulars.  My past experiences with sitting have been very low key where we watch movies, I read a book while they sleep, we play games.  It's like babysitting, just in a hospital room.  The nurse told me he needs a sitter to make sure he doesn't hurt himself if/when he goes into a tantrum, but he's been good all day so far, so I opted to sit.

He was a 10 year old boy who was diagnosed with congenital insensitivity to pain with anhidrosis.  It's a rare neurological disorder where you never have felt pain and you don't sweat.  I don't know where the disconnect in the pain path is, I just know they can't feel it.  People diagnosed with this often have a lot of self-inflicted injuries because they are unaware.  There was even a Grey's episode about it, if you watch that.  Only a few hundred people in the world have been diagnosed with it.  In addition to that there were some psych issues and he was a little developmentally delayed.  I don't know the entire family history is, but I do know via some of the nurses that once mom told him she was going to be right back and flat out left the hospital.  She also hadn't been there to visit him since this last admission, mind you Christmas was the day before.  The kid had 5 inch scar on his neck, huge scars all over his legs and his feet were wrapped because of fresh wounds which lead to this admission.  Someone was telling me that they had to remove his baby teeth because he kept biting off his finger.  How do you teach a baby who can't feel pain that you can't do that?!

examples of wounds from kids with CIPA

When I walked into the room he was pretty hyper but a manageable temperament.  We played "dj" for the first half of the time I was there.  I made headphones out of cups and turn tables with an apple laptop out of paper.  He was fine.  When he kept creeping to the door and laying with half of his body out of the room is when we started to have problems.  After trying to negotiate with him I bent down and picked him up and he went on a rampage kicking and hitting me, but more malicious than just a tantrum.  He would pause and aim for where he wanted to kick and punch me.  I pretty much just tried to hold him down which wasn't too hard because he was such a little guy.  He hardly calmed down and I wanted to get him to his bed where there was a little more cushion so I picked up the flailing kid and sat him down in bed.

After he was done, I asked, "Are you done?  Do you want to eat now?" as if we just finished coloring a picture or something.  He calmed down but didn't like me "looking at him".  He would mumble don't look at me, dont f-ing look at me.  Then he started throwing his food at me, so I calmly removed everything from his tray and he was only able to eat one thing at a time.  He occasionally would continue to ramble something but the only word I recognized were b!tch and f#ck off.  Then he would flick me off, which I found ironic because all he had left were nubby half fingers.  While I was "not looking at him" I would notice his nubby fingers couldn't open his juice or mix his salad and would ask if he wanted help.  Sometimes he would object and struggle with it a few more minutes before I asked again and sometimes he would just submit to the fact that he can't do all his activities of daily living the first time I asked.

My main goal was to stay calm and show no emotion, but I was fuming inside.  The nurses that knew him well came in and told me to take a few minutes so he could calm down.  As I washed my hands I was holding back tears and I didn't know where they were coming from.  I knew it wasn't personal and it wasn't like he really hurt me.  Maybe it was that I felt sorry for the kid.  For a 10 year old he had so much anger built up inside him.  It was nothing I've ever seen before. The nurses had to medicate him to calm him down and ended up giving me the rest of my shift off (it was only 30 min).  The other people on the floor kept saying that this always happens at night and I didn't do anything to provoke it, but I just felt bad and it didn't help that I was exhausted from working for floor from 7-4 with little sleep.  At least I have my first "attack" under my belt.      

All things holiday in one post. Go!

It seems every year there is a ton of prep for the holidays and then it's all over in a flash.  However, between work and school I had minimal time to prep and had to squeeze it all in a few days.  On a random weekend night, when all three of us happened to be staying in, the Christmas decorations went up.  I must admit it is a very nice tree, but being limited by the color or my wrapping paper is getting harder each year.  This year I went with a brown owl paper and created a "rustic theme."  I used twine as ribbon, felt as name tags and had pine cone and cinnamon accents.  It was the cheapest wrapping I've ever done and a big hit among the recipients.

I allotted two days in my schedule to get all my shopping done and Christmas cards out.  I ended up staying up til 3 in the morning finishing my cards, but they were done and I knew I could sleep in the next day.  I love shopping for gifts for people and am probably the worst person to go shopping with because I will literally spend over an hour in a store just trying to pick something out for one person.  Now you all know the love and thought that goes into each gift!  I know many despise the "hassle" of shopping but it always makes me warm and fuzzy.  All the gifts were a big hit and makes the time and energy especially worth it.  I'm kinda a holiday sap.

Caitlin working real hard in Nani's sweatshop

With that being said, I take every opportunity to spend time with family.  With our latest family addition, Libby (my now goddaughter), I figured I'd give Bobby and Beth an opportunity to do what they want and steal Abigail and Caitlin away for a bit.  Nani just so happened to make Christmas cookies so I figured I'd invite the gang over to help.  Mom wasn't busy, Chelsey didn't have to work till later and Bobby was not about to let me get extra brownie points so it turned into an impromptu lunch party.  I'm positive nani and papa thoroughly enjoyed the company even though they didn't know everyone was coming.

I worked the day before christmas eve and the day after christmas, which was a first for me.  I had always been in school or teaching and had all that time off, but that is not how the nursing schedules work and I guess it's a think Ill have to get use to.  In mid December we had our holiday party at Lurie's aka a nice meal set up in the conference room.  I waited in line for 45 minutes during my break to get my meal, but it was worth the wait.  For thanksgiving they had a traditional turkey and all the fixings which was a nice treat.  For Christmas they had a lovely spread and transformed the 11th floor into a festive dining experience.  Here is what it took to feed the staff at Lurie's Children's hospital...

• 18 hours of prep and 8 hours of cooking.
• 2,840 meals were served 
• 810 lbs of tenderloin cooked 
• 6,970 butternut squash raviolis made
• 13,115 shrimp grilled on the skewer

Christmas Eve I went to Aunt Brina's a little early to have a few pre-church cocktails.  I remember when we use to have to save two pews for all our family, but slowly that number has dwindled and only 7 of us went this year.  It was a quick service and the priest had a cute story about jesus missing from the nativity scene and the priest spotting a boy with the it in his wagon.  When the priest ran out and confronted the boy about his actions, the boy replied, I told jesus if he gave me a wagon for Christmas I would give him the first ride.  The lesson of the night was "give people the benefit of the doubt," which I don't think is a poor guideline.  We went back to the house where the rest of the gang was and engaged in our annual Christmas trivia which can sometimes get a little heated.  Fun Facts:  Michigan grows the greatest variety of Christmas trees.  Teddy Roosevelt is the only president who has banned Christmas trees in the White House.  The other 15 questions don't come to mind at this moment.  Aunt Neici and I gladly took third, but could have snubbed second if she remembered that Uncle Willie lost the $8,000 bet in It's a Wonderful Life, not Uncle Lester (who isn't even a character).  I'm already calling for a new partner next year.  Following dinner we played our White Elephant game where every gift had to be $5 and food related.  This has become the alternative to Santa visiting each year.  

Christmas morning was low key and casual.  Mom, dad, Chelsey and I had muffins and coffee while opening our presents.  It was nice to have everyone together.  Then it was off to make the rounds.  First stop Grandma's.  The hors d'oeuvres are always plentiful.  While saddened that grandma's world famous cheese ball was replaced by a hickory farms version, the great spread of vegetables more than made up for it (just pullin' your chain grandma ;o).  After another round of gift giving and eating, Chels and I headed to Nani's just in enough time to sit down for dinner.  This year they made 101 raviolis, of which I ate one because I was so stuffed from all the other meals and it was only 3 in the afternoon.  I must say I received the best gift by being asked to be little Libby's godmother.  I look forward to watching her grow into a strong, confident woman and know I will love her just as much as I do her bigger sisters.

Nani and Papa got the second best gift and Im sure the rest of the family would agree.  Since the bass lake cottage was auctioned off this year I thought it was only right to make a book of all the memories we shared there.  I spent over 20 hours collecting pictures, scanning pictures and organizing pictures to tell the story of Bass Lake over the last 40 years.  It was a big hit among all the family and even was granted a few tears.  I must have looked it over 100 times while making it and still smile every time.  The book is available for viewing at http://basslakebook.shutterfly.com  I must say, I'm really proud of this one.

My favorite picture of Papa

  

So what's a GSW?

My pediatric clinical rotation was on a Saturday, but there were only four and I wanted to see what Comer Children's Hospital at University of Chicago was like so I sucked it up.  On the third week our clinical instructor picked our patients for the day and in pre-conference she had said to me, "He has a GSW so let me know if there are any problems today?"  At first I thought GSW was some kind of drain or that the kid was really debilitated and needed a lot of care, but then I looked in the chart and realized a GSW was none of that.  A GSW is actually a gun shot wound.

perforated gunshot wound of sm. bowel 

The 15 year old boy was shot three times, once in the hand, once in the foot and one through the abdomen.  The bullet perforated his bowel in two places and lodged itself in the right area.  He lost 2 liters of blood (the adult male only has 5-6L) and was in such critical condition that for the first surgery all they could do was stop the bleeding because his body wouldn't be able to handle the reconstruction surgery.  After a few days in intensive care, they went in and re-sectioned his bowel.  He lost a few cm of the small bowel, but that won't effect his daily life at all.  As far as care was concerned, he was a pretty easy patient.  He only had one IV antibiotic and I had to do dressing changes on his hand and foot.  It was the psycho-social stuff that was hard that day. 

A good read if you have the chance

His mom saw him get shot.  He was standing on the lawn when two other kids came by.  She said she didn't know what to do and was talking about how the ambulance takes forever to get to their neighborhood.  It reminded me of a nonfiction book I read a few years ago based on a gang on the southside of Chicago around U of C.  The book hypothesizes that the neighborhood takes civil matters in their own hands and are mad at the cops because the cops don't come around as readily, but the cops don't come around as much because the neighborhood doesn't cooperate with them. It's a vicious cycle.  The social workers note said it may have been "girl related" but the the family denies that.  First thing that came to my mind was something gang related and the fact that dad has been shot 10 times according to the son, I might not be that far off.  Not to stereotype or anything, but the average citizen doesn't get shot 10 times.  They had visitor restrictions on the room and only family was allowed up and there was  a lot of family.  The note also mentioned that the boy was suspended from school for fighting with a teacher and has yet to go back even thought the suspension was over.  

He was a stubborn boy.  He had a PCA pump with morphine but would refuse to hit the button.  When I asked him if he was in pain he would say no and rate it at a 0.  Even when I called him out and said his grimacing face is saying otherwise he told me he had no pain.  To which I replied, "Okay, well you know what you feel and you know what you can do about it.  It's up to you to do it."  I don't know if he was refusing because he wanted to talk about what a tough guy he was or to prove to his father he was a man, but to me it makes no sense to suffer that much when it can be fixed with the push of a button.  All I could do was continuously chart that the patient reports 0/10 pain with contradictory non-verbal cues.  I must say though, his dad was a great support.  He held his hand, helped him walk down the halls and encouraged his son to be cooperative me and the other staff. 

He was not much of a talker either.  When I would ask him something he rarely would respond the first time and almost never made eye contact.  Some people would come in his room and say/ask something and if he didn't respond, they just carried on.  I made sure when I asked him something he acknowledged it.  I had to have a little Jerry Maguire momoent and be like, I know you're frustrated with what has happened, but you need to help us help you get well because as wonderful as all of us at the hospital are, we can't read your mind buddy.  You could tell he was very frustrated with his state of health at that point and I was getting frustrated with his non-cooperative behavior.

He had two IV sites, but only one had been used for a while, so I double checked that it was okay to take the other one out, since it could be an infection risk.  The most painful part is removing the Tegaderm which he flinched every single time I tried to take it off.  Only dad laughed when I made a comment about his man-hairs getting pulled with the tape.  I kept asking do you want me to grab some adhesive remover and he would say nothing.  Then he was like yeah and when I came back he had the IV in his hand.  The kid graciously took the liberty to take out his own IV.  Thanks...

But as the day went on, he started to open up a little more.  The fact that I got more than a sentence out of him was liberating.  We talked about his pitbull and the movie The Polar Express.  I laughed because this tough, I feel no pain kid, lit up when he saw that The Polar Express was on the movie cue.  He told me it was his favorite movie and you need to watch it a few times to really get what they're talking about.  It was warming to know that there was still a little bit of a kid inside.