I’ve been the triage nurse for the past 2 weeks at the clinic. Though it has been very stressful at times (especially when I am multi-tasking the job of one RN {aka the triage nurse} while taking the workload of another nurse at the same time), it has been very rewarding too. I’ve had the opportunity to talk with a lot of different people- some make me want to scream, some make me want to cry- and others always bring a smile to my face. I’ve been criticized, yelled at, cursed at and challenged- but I have also been complemented, loved, blessed and thanked.
I never know how many patients I am able to take- sometimes I can take a lot (like my 11 yesterday!) and other times I can’t take any at all. The amount of patients I can take depend on how many doctors we have in clinic and how many of their appointments actually show up. With the uncertainty each day, it often takes a few hours before we can inform patients of whether or not they will have a medical or psychological evaluation that day.
At 5:30pm tonight, I opened my triage window for the evening clinic. I had one doctor with a full schedule and I had it narrowed down to one patient, Mr. J, that I wanted to get evaluated. I determined that Mr. J had a fever and required medical attention, but the head nurse would not let me process him due to the doctor’s schedule. I wanted Mr. J to be seen, so I had him wait in the lobby until I had a better idea of what could be done. I was growing disheartened as each scheduled patient showed up, but every time I made eye contact with Mr. J I smiled and mouthed- “hold tight- I’m working on it!”
At 7pm, Mr. J approached me asking what the chances were that he could be seen and discharged before 8pm. Mr. J has been homeless for 3 days and has been staying at a shelter near the clinic. I’m not too familiar with shelters elsewhere, but here in SD each shelter has a “curfew” to guarantee that a bed won’t go wasted any night. This shelter had an 8pm curfew- no exceptions. I offered Mr. J the option of returning to the clinic the next morning to get triaged again, but with the triage hierarchy, an appointment tomorrow was just as uncertain. Mr. J was sick- I could tell that- and was not surprised when he decided to wait around a little longer.
I don’t know if it was because I was triage-happy, I was feeling defiant or because I knew this man was not feeling well, but, despite the head nurse’s hesitance to process Mr. J, I went ahead and had Mr. J fill out the patient registration form. I walked back to the doctor’s charting office and asked the doctor for permission to give him another patient. Ah, the beauty of ask and you shall receive. I got the patient in by 7:45 and by 8:15 he was waiting for his medications with a diagnosis of bronchitis.
While he waited for his prescription to be filled, I tried to call Mr. J’s shelter to inform them that he was at a medical clinic and will be returning to the shelter soon. No luck. My three calls to the shelter rang a hundred times and went to a voice messaging system that had a full inbox- I couldn’t even leave a message. “I’m sorry, Mr. J,” I said, “but I can’t get in touch with anyone at the shelter.”
“Thanks for trying,” he said sincerely, then followed with, “I’m going to try and get into the shelter tonight, but in the likely case that I can’t get in tonight, where do I sleep?”
I didn’t have the heart to tell him I didn’t know, because that would have been a lie. He would sleep outside, where hundreds of thousands of others sleep each night. And even though we are in sunny SD, the nights get cold. I go to bed with a few layers under my sweatshirt and sweatpants, socks, two comforters and a fleece blanket- heat on- and I am still often cold. This man had nothing but the clothes on his back, and because I pushed to get him evaluated tonight, he had no bed to sleep in. No roof over his head. No blanket to keep him warm. Each week I see patients who are beaten up on the street or whose backpacks are stolen with all of their belongings inside. (Just last week I had a woman come to get her prescription re-filled because her backpack was stolen- then she broke down in tears because inside her backpack were also her mother’s ashes that she had carried around for two years…) Some people are ruthless. The people living on the streets have a world of their own- they know who belongs and who doesn’t. Mr. J does not belong. This was his third or fourth night without a home, and would be his first night sleeping outside. He offered to buy me a soda, and though I didn’t want the soda, I wanted him to have 1 less dollar that could make him a victim. I wanted to offer him my house, my bed and my blankets- but I knew I couldn’t. I said goodbye and wished him luck. He kept thanking me for helping him get medical attention and “everything else I did.”
I had to watch him leave the clinic tonight with his bag of medications, a horrible cough, and an immediate future so uncertain it was unsettling for me. Is Mr. J sleeping on the streets tonight or in a warm bed in the shelter? I know which I would prefer to believe, but my gut feeling tells me otherwise- and though I would like Mr. J to return one day to tell me how this night ended up, I couldn’t bear to find out that I was the reason this man was entirely homeless for a night and maybe longer. I’d like to think I did more good by having him medically evaluated and prescribed medication, but in the long run I don’t know. I’ll never know. But this feeling sucks- had I told him from the start that the doctor’s schedule was full and he would have to return tomorrow, he would be in a bed right now sleeping. Warm.
I never know how many patients I am able to take- sometimes I can take a lot (like my 11 yesterday!) and other times I can’t take any at all. The amount of patients I can take depend on how many doctors we have in clinic and how many of their appointments actually show up. With the uncertainty each day, it often takes a few hours before we can inform patients of whether or not they will have a medical or psychological evaluation that day.
At 5:30pm tonight, I opened my triage window for the evening clinic. I had one doctor with a full schedule and I had it narrowed down to one patient, Mr. J, that I wanted to get evaluated. I determined that Mr. J had a fever and required medical attention, but the head nurse would not let me process him due to the doctor’s schedule. I wanted Mr. J to be seen, so I had him wait in the lobby until I had a better idea of what could be done. I was growing disheartened as each scheduled patient showed up, but every time I made eye contact with Mr. J I smiled and mouthed- “hold tight- I’m working on it!”
At 7pm, Mr. J approached me asking what the chances were that he could be seen and discharged before 8pm. Mr. J has been homeless for 3 days and has been staying at a shelter near the clinic. I’m not too familiar with shelters elsewhere, but here in SD each shelter has a “curfew” to guarantee that a bed won’t go wasted any night. This shelter had an 8pm curfew- no exceptions. I offered Mr. J the option of returning to the clinic the next morning to get triaged again, but with the triage hierarchy, an appointment tomorrow was just as uncertain. Mr. J was sick- I could tell that- and was not surprised when he decided to wait around a little longer.
I don’t know if it was because I was triage-happy, I was feeling defiant or because I knew this man was not feeling well, but, despite the head nurse’s hesitance to process Mr. J, I went ahead and had Mr. J fill out the patient registration form. I walked back to the doctor’s charting office and asked the doctor for permission to give him another patient. Ah, the beauty of ask and you shall receive. I got the patient in by 7:45 and by 8:15 he was waiting for his medications with a diagnosis of bronchitis.
While he waited for his prescription to be filled, I tried to call Mr. J’s shelter to inform them that he was at a medical clinic and will be returning to the shelter soon. No luck. My three calls to the shelter rang a hundred times and went to a voice messaging system that had a full inbox- I couldn’t even leave a message. “I’m sorry, Mr. J,” I said, “but I can’t get in touch with anyone at the shelter.”
“Thanks for trying,” he said sincerely, then followed with, “I’m going to try and get into the shelter tonight, but in the likely case that I can’t get in tonight, where do I sleep?”
I didn’t have the heart to tell him I didn’t know, because that would have been a lie. He would sleep outside, where hundreds of thousands of others sleep each night. And even though we are in sunny SD, the nights get cold. I go to bed with a few layers under my sweatshirt and sweatpants, socks, two comforters and a fleece blanket- heat on- and I am still often cold. This man had nothing but the clothes on his back, and because I pushed to get him evaluated tonight, he had no bed to sleep in. No roof over his head. No blanket to keep him warm. Each week I see patients who are beaten up on the street or whose backpacks are stolen with all of their belongings inside. (Just last week I had a woman come to get her prescription re-filled because her backpack was stolen- then she broke down in tears because inside her backpack were also her mother’s ashes that she had carried around for two years…) Some people are ruthless. The people living on the streets have a world of their own- they know who belongs and who doesn’t. Mr. J does not belong. This was his third or fourth night without a home, and would be his first night sleeping outside. He offered to buy me a soda, and though I didn’t want the soda, I wanted him to have 1 less dollar that could make him a victim. I wanted to offer him my house, my bed and my blankets- but I knew I couldn’t. I said goodbye and wished him luck. He kept thanking me for helping him get medical attention and “everything else I did.”
I had to watch him leave the clinic tonight with his bag of medications, a horrible cough, and an immediate future so uncertain it was unsettling for me. Is Mr. J sleeping on the streets tonight or in a warm bed in the shelter? I know which I would prefer to believe, but my gut feeling tells me otherwise- and though I would like Mr. J to return one day to tell me how this night ended up, I couldn’t bear to find out that I was the reason this man was entirely homeless for a night and maybe longer. I’d like to think I did more good by having him medically evaluated and prescribed medication, but in the long run I don’t know. I’ll never know. But this feeling sucks- had I told him from the start that the doctor’s schedule was full and he would have to return tomorrow, he would be in a bed right now sleeping. Warm.
AF
ReplyDeleteYou did the right thing by getting him in to see the doctor. Broncitis turns to pneumonia (sp?) way too often.
You can only provide so much.