Nurse J

Precipice

2011-09-12T20:12:00.000-07:00

For Shame

2011-05-10T21:56:00.000-07:00

i am a dood nurse. most nurses are females still, and have been for some time.

the recent influx of males into the profession of nursing may be a good thing. on the one hand, having more males in the profession is probably doing more to elevate nursing in status from being doctors handmaidens to, you know, an actual profession.

pro

case in point. our manager decided to try out a new thing. something about having the charge nurses introduce themselves to the patients every shift, or some such nonsense like that.

anyway, my manager is not the best communicator. he's this sooper non-confrontational guy, for one thing, and he's super old and kinda close to retiring. but, he has forgotten more about nursing than most of us will ever know, and he's sorta considered a saint around my hospital. for instance, he got grandfathered in and didn't have to get a BSN. like i said, he's an absolute saint.

so. with his new have-the-charge-nurses-introduce-themselves thing only sort of officially rolled out, chaos ensued. some charge nurses were like, so, are we supposed to do this every shift? and other nurses were super gung-ho about it, charging in and whatever.

now, i know that there are some hospital and floors that do this sort of thing already. the mom-baby floor were we delivered our kiddle-diddles did this, for example. it was perfect, the charge nurse came in, introduced herself in a non-threatening way, said she would be available, blah blah blah.

in an ICU, it is a little different. okay, it's really different. mom-baby, healthy people (mostly) having babies, flowers and sunshine and puppies and rainbows coming outta orifices and whatever.

ICU, hover between life and death.

so, when our sainted fearless leader didn't provide a script or guideline or anything for the charge nurses, many things were said. sometimes, what the charge nurses said caused the patients families to ask and wonder, 'why are you checking up on my nurse? is there something wrong? and then gung-ho charge nurse would have to back-track.

what needed to happen was a script needed to have been provided that took into consideration what patient families might think, and say things in a way that, oh whatever. it needed to have been done better.

one of charge nurses got asked by a patient for some dilaudid, and the charge nurse was all like, sure, i'll get right on that. the she sailed out of the room. well, turns out the dilaudid was discontinued, and the primary RN was left to pick of the pieces.

a lot of other stuff happened too, and most of it involved female charge nurse and female nursing staff. there were a lot of hurt feelings, and nobody said anything to Female Gung-Ho Charge Nurse. there was a lot of back talking and gossip though.

everytime somebody mentioned this, i always asked, okay, who is going to fix this? who is going to approach Female Gung-Ho Charge nurse? now, this may be stereotypical, but, this chatty bunch of women did nothing.

we have only two male charge nurses. and one of them did the gung-ho thing once, and he happened to do it a patient that was assigned to a male nurse that was friend of his.

scene 1: male charge nurse in the room, speaking with family and patient.

primary nurse walks in. 'whats going on?'

charge nurse, 'oh, you know, checking up on you. it's okay, the family says you're doing a good job.'

scene 2: right outside the room, right after scene 1, charge nurse and primary nurse.

primary nurse, 'what the HELL do you think you're doing in there, calling MY nursing into question with that family?'

(heating discussion follows, almost coming to physical blows, by some reports.)

and those two were friends!

afterwards, the to made up and it never happened again.

see, if i was being stereotypical, this would be the breakdown: female offends females, there is no confrontation, stuff gets dragged on, blah. dood offends dood, they immediately hash it out, problem solved, problem over.

okay, nuff of that. here's the con.

scene: an ICU, a LARGE female patient on a rotobed.

male ICU nurse (in a room full of other male nurses), 'okay, everybody grab something, and lets get this patient scooted up in bed. oh hey, be careful of her gunt.'

nurse j, ' whats a gunt?'

male ICU nurse, ' you know man, not quite a gut, not quite a ........'

nurse j, 'oh okay, i get it.'

awesome. 'gunt,' huh?

for shame. the darker side of male nursing.

Do you Speak Penis?

2011-05-10T21:41:00.000-07:00

i wrote a while ago about my co-worker friend who has a way, shall we say, with catheters, in The Penis Whisperer.

i had a chance to put in a catheter with a urologist. it was pretty funny. i told him about my coworker. the urologist said he wasn't so much a whisperer as much as a 'penis shouter.' it was pretty funny.

Compliance

2011-01-28T05:38:00.000-08:00

this happens all too often.......

Obit Backtrack

2011-01-27T05:08:00.000-08:00

when my wife and i first got married, 6-ish years ago, she did something that sorta bugged me. when we got the sunday newspaper, or any paper for that matter, she would read the comics.....and the obituaries. i thought that was kinda weird, and i asked her about it. she said that all nurses read the obituaries. i though okay, whatever. this was well before i had any plans or aspirations of becoming a nurse myself.

then we decided that i should go to nursing school as well. i got a job at my wife's same hospital working as a nurse's aide. and guess what? all the nurses there would read the obituaries.

i would shake my head in disgust. for some reason, that just seemed wrong to me. something about that sort of morbid curiosity that rubbed me the wrong way. i could not the justify the interest in the dead.

now i understand. i've been a nurse now for a little over a year, and guess what? now i too read the obituaries. i had my first patient appear in one, and our hospital got a brief mention in the thanks section of my (former) patient's tribute.

it's so weird, i never thought i'd be an obit reader, and now here i am.

Rapport, Rock, Hard Place, and the NFL playoffs.

2011-01-13T21:30:00.000-08:00

–noun

relation; connection, esp. harmonious or sympathetic relation: a teacher trying to establish close rapport with students.

from dictionary.reference.com.

i had a patient who was gonna die. in a sense, all of my patients are going to die, but with a terminal illness, sometimes you know someone is going to die sooner rather than later. the patient was in a bad way. young (40's) and terminal. they had a form of cancer that had spread throughout the body, and the only treatment was one that would be really, really bad for certain organs. said organs belonging to my patient were not working, and had not been working for some time.

i had an instructor in nursing skool tell me that all medicines were poison. i still think of them that way. i mean, look at all the commercials for meds on TV. the majority of the time, they have time to state the name of the drug, what it might help with, then the remainder of the time left, they pay those used car sales guys to go thru, like, 50 bazillion side effects.

'depressed? try abilify! side effects may include, increasedriskofsuicidedepressionanxietydecreasedlibidosexualfunctioningdeathorworse.

so my patient had this cancer, and these crappy organs, and had apparently been using home/herbal remedies to try and fix said organs. the ROCK; the patient had cancer. a treatable cancer, but the treatment wrecks havoc on certain organs which THE HARD PLACE were in failure, necessitating a transplant. the patient really needed an organ transplant, but with the cancer, there was no way.

you get the picture? terminal.

so, i'm work a buncha days in a row, then i have a buncha days off. so i had there patient for a long time at night, while during the days, there were different nurses that came and went. most of the day nurses would report to me that the patient was in a sooper funk, and either depressed or in denial or inappropriately processing, if at all, the fact that DEATH was in the room.

however, the patient was totally 'with it.' for me.

why?

well, for one thing, i didn't talk to the patient about dying. didn't mention it. instead, i talked about stuff like college and pro football, favorite books i read/was reading. i spoke about my family. i asked about my patient's family. and really got to know about my patient and the life that was BEFORE.

where dayshift got one-word answers or no answers at all, i got life stories. i didn't walk into the room with a sympathetic look on my face and encourage my patient to 'just let it all out,' or 'give a good cry.' i refused to look in the corner of the room where DEATH was sitting, reading his copy of People magazine.

lest you think i'm some sort of genius or something for my approach, let me tell you why i did what i did. i am not good with emotions. i'm not a fan of how my emotions make me feel. plus, the mechanism that enables most humans to cry broke on me a long time ago and i never took it back in to get it fixed. when i cry, it sounds like hell and looks worse. snot, redness, weird noises and the works. NOT. PRETTY.

so i do not allow my self to get emotional. not for my self or for my patients. i don't want to cry, and i don't want my patients to cry either. that is not to say that i don't feel for my patients, i feel very deeply for them, just not while i'm at work. i save that feeling crap for my days off the occasional bottle of Blue Moon.

so DEATH is in the room. sitting at the bedside, in his dark rotting robes, playing 'angry birds' on his ipad, like everybody else. he's probably pissed that i'm ignoring him, or maybe not. i figure he's seen everything at this point. point is, i ignore him. and for twelve hours that is my shift, my patient can ignore him too. because i am babbling about Malcolm Gladwell and Brett Fav-ruh, and the Miracle at Qwest field. and my wife'd boob-feeding and how max drives me crazy.

and it is just what my patient needed. (disclaimer; i do offer to hold my patients hands, if needed and appropriate. i do practice appropriate therapeutic touch. and i touch my patients without gloves. at least a couple times per shift.)

Frustration & Delight

2011-01-13T21:09:00.001-08:00

from Conversations with a 3.5 year old.

nurse j; 'please put your shoes on.'

max; 'put my shoes on?'

nurse j; 'yes. the brown shoes.'

max; 'these shoes?'

'no, the brown ones. the ones right in front of you.'

'these ones?'

'no, the other ones.'

'these ones?'

'no.'

'these ones?'

'no"

'these ones?' (as maximus continues to grab EVERY SINGLE PAIR OF SHOES HE OWNS, WITH THE EXCEPTION OF THE ONES I WANT HIM TO WEAR, WHICH ARE NEAREST TO HIM AND RIGHT IN FRONT OF HIM).

there is much internal cursing, nurse j head explodes.

*************************************************************************************

max; 'where we going?'

nurse j; 'to pick up mama from the dentist.'

max; 'to pick up mama?'

nurse j; 'yes.'

'from the dentist?'

'yes.'

we pick up the action in our story...............2 seconds later.

'we going to pick up mama?'

'yes.'

'from the dentist?'

'yes.'

2 seconds later.

'where's mama?'

cursing, head explodes.

************************************************************************************

just writing this down brings back that familiar, when-is-my-head-gonna explode feeling that i had when the conversations first took place. or when many similar conversations like these take place every day. the poor kid just wants to talk and be a part of the action, he just doesn't have the vocabulary to maintain a conversation longer that 15 seconds that doesn't center around Toy Story Free or Cars.

i wonder what an ART line would show my pressure was during those moments.

or this one, which probably happens just often enough to keep my head from ackshually exploding.

max; 'dadda...'

nurse j; 'yes, max.'

max; 'i love you.'

nurse j; 'thank you max, i love you too.'

'dadda, we best friends?'

'yes max, we're best friends.'

'i love you dadda. sing-you are my shunshine. gotta singy song to me, sing shunshine. okay, dadda?'

'okay max. you are my sunshine, my only sunshine............'

Exasperation

2011-01-05T12:28:00.000-08:00

i remember conversations my father and mother would have that would drive my dad NUTS. he would ask a question of my mother and she would answer him in such a way i could ackshully see my dad's head hurting.

i used to laugh. it was funny.

one time my mom was trying to call our neighbors, but she kept dialing our number, which kept ringing back busy. finally, (we were sitting at the table eating dinner) when she told us what number she was dialing, and we told her that was OUR number, she burst out with, "why don't you answer when i called ME?!?!?"

it was hilarious.

back then.

now, i am married.

yeah, you know what's coming.

The other day i'm in super clean mode. putting away christmas, making trips to the storage garage we share with our friends, doing laundry, cleaning, etcetera.

I'm about to do a garbage run, so i ask my wife (who's breastfeeeding Brutus at the time-hey, maybe that's it-any chance she'e leaking brain cells in her boob milk? do they grow back? easy people, i just want my usually-smarter-than-me, more common-sense-than-me wife back) if the garbages need to be emptied.

it was a simple query. "are the garbages in the bathrooms empty?"

two things to consider; 1) the garbage bags in the bathrooms, 2) are they empty. question mark.

i was looking for either a yes (meaning the wifey had already emptied them, a distinct possibility, since i was already looking at several plastic garbage bags full of stuff), or a no, meaning the garbages in the bathrooms were still full.

yes (go empty the garbages) or no (already done).

what i got was, 'yes, they need to be emptied.'

i had instant brain freeze and flashback to all those times i'd laughed at my old man slowly being driven to drink/insane by my moms crazy answers.

so, do women go to school to learn how to do this, is it passed on from generation to generation, is it genetic or what?

Worst Patient Olympics

2011-01-03T14:52:00.000-08:00

candidate #2

the end of the year means a lot of things to different people. to some, it means you eat a lot. to others, it's all about family.

to people who have met their health insurance deductible, it can mean only one thing-free surgery!!

the end of the year is surprisingly busy for certain kinds of docs, docs that do things that may be considered 'elective surgeries.' like getting that knee that's been bothering you some time looked at, or that pesky hernia you've had ever since you helped your uncle charlie switch out his big old tube TV for the new plasma, or even that funny growth you've had on the side of your neck removed.

so you've met your deductible. that means free surgery. THAT much you do know. you don't know much about medicine or anything like that, that's for the nerds you made fun of in high school (those nerds, coincidentally, are now your doctors and accountants and engineers-imagine that!). one thing those nerds with soft hands do worry about is what kinds of meds you use. now, you did have those stents placed in you heart in April (eat vegetables? more fiber? what do i look like, a rabbit? i'm a MAN, and i eat whatever the damn heck i feel like, and that means MEAT and POTATOES), and so you've been on blood thinners since then.

whatever. if being on that dang blood-thinner means i can't have my surgery now, while it's free, then i'll just stop taking it. or i'll tell him that i stopped a while ago. yeah, sounds like a plan.

so my patient blatantly lied to his surgeon about being on a potent blood thinner, or anti platelet aggregator. think plavix, only better and more badass. i did some research on the drug, and it turns out it is undetectable in plasma, which may explain why this guys presurgery labs turned out okay. also, it is a competitive inhibitor, which means that the only way to get rid of the stuff is to bleed it out. the website recommends stopping effient at least 7 days prior to any planned surgery. seven. not 2, or three, but seven. SEVEN.

did my patient lie about being on the drug? yes. did he discontinue the drug 7 days prior? no. did he start to bleed like crazy on the capillary level were he got his non-essential, non-life threatening, elective surgery days before Christmas? yes. did he end up almost dying and having to have emergency surgery, get intubated, right before the holidaze? yup, yup, yuppers and sure did.

the things people do. seriously.

Worst Patient Olympics

2011-01-03T13:48:00.000-08:00

candidate #1

as i walk into the room to assess my just-got-her-knee-fixed lady;

"hi, my husband is an attorney, and he loves to sue people like you. so.......have you done anything wrong i could sue you for?"

the look on her face said she wasn't kidding. not one little bit.

Speaking of Endo......

2010-12-30T15:04:00.000-08:00

this was posted outside the employees entrance to our outpatient endoscopy department (the people that are in charge of sticking cameras and scopes where the sun don't shine.) i thought it was funny.

ANYONE IN NEED OF AN

ORIFICE PROBING HERE

IN ENDOSCOPY:

PLEASE CHECK IN

THROUGH OUR FRONT

ENTRANCE.

WE ARE THE ONLY ONES

WHO GET TO USE THE

BACK DOOR.

THANK YOU!

Ready, Set,.......GI BLEED!

2010-12-30T13:46:00.000-08:00

in case you've been living under a rock for the last few years or so, vampires are back in popular demand.
and there sure seem to be no sexier creatures than a voluptuous blood-sucking babe vampiressess.

personally, i'm all about Team Alice, presented here, for your viewing pleasure.

(this is Ashley Greene, the actress who portrays Alice in the Twilight series)

..........and we're back.

which leads me to this question; do vampires poop like GI bleeders do?

ha ha, ha, ho, oh boy, that was a good one nurse j, you're SO funny!

mokay, well, at least i think i'm funny.

see, the hooman GI (gastrointestinal, or gut) system is not designed to consume blood, specially not your own.

so, the other night, i had a GI bleeder.

there are several things that suck about GI bleeds.

first, the poop smells turrrrrrrible. not that poop generally smells good to begin with under the best of circumstances, but trust me, this is worse. if the bleed is above the small intestine, like in your esophagus or stomach, you will have dark tar like poop. and probably coffee ground barf. if it is in your lower interstines, or your large intestine, the poop-blood with still be horrible, just more parts blood than bloody poop. in either case, it smells. bad.

possible worse than the smell is the preparation. if it is a lower GI scope (insert scope into anus, have a look around), the patient gets to drink a gallon (4000 mls) of a delightful concoction called GoLYTELY. it is called this probably because it is full of electrolytes to help replace what you're gonna lose, since the other wonderful thing that GoLYTELY does is clean. you. out.

literally. we have to make you drink this stuff till you are pooping straight water out your behind.

'when the poop runs clear, bring that scope near.'

if you are unlucky enough to have a patient that is bed bound, you are looking at a night filled with multiple linen changes, because your patient is going to POOP. HIS. SMELLY. GUTS. OUT.

you should also be prepared for the awesome poop-running-off-of-the-bed-scenario.

if you have a patient that can walk, or sorta walk, then you are in for the 5 second 5 yard dash Olympics.

luckily, my GI bleeder was a walker. sort of. he was not a sexy female vampiressess though. i asked. maybe, under that old man exterior.....but no. just a legit old man bleeder.

anyways, over the course of the night, i sprinted to his room every time the call light rang. i had it down to a science. we had ditched the SCD's after the first run, and moved the bed closer to the crapper.

call lights rings, and i'm off. run into the room, pulling gloves on as i round the corner. he's already taking off the blood pressure cuff, and then i sleep the monitor, tear the blankets off, disconnect the leads and sat monitor, make sure the IV line was clear, then shuffle shuffle shuffle.

then, while he fills the room and the hall with the smell of freshly baked bread (i wish), i would change his chux and or his sheets, depending on how badly he leaked, as well as wipe up the floor.

then i would vacate the room for a few minutes to breathe, uh, i mean give him some privacy.

when he would ring again, i'd help him back into bed, make him drink more stuff, and then wait to do it all over again.

on the bright side, the more often he pooped, the less bad the smell was. either that or i was getting used to the smell and was that much closer to being dead inside.

ten trips. 1st poop; bloody hell!! 10th poop; clear. mission accomplished!

i hope they were able to fix what ever it was of his that was bleeding inside.

Precautions

2010-12-30T13:18:00.001-08:00

i got a call one night from the son of one of my patients. the dood was calling to ask 'what bug is it that dad has?' and we proceeded to have an interesting conversation.......

nurse j, 'clostridium difficile.'

Mr Oblivious, 'is there something easier i can tell the doctor? my son, the one who was visiting his grandpa yesterday, well, he's got real bad diarrhea and vomiting now. we were wondering if maybe he picked up whatever it is that his grandpa has......we're thinking we might have to take him to his pediatrician.'

nurse j, 'well, we call it 'C-diff' for short........how old is the kid?'

Mr Oblivious, 'my son is four. he was, you know, acting like a four year old, crawling around the room and stuff. you know how four year olds can be.'

nurse j, *head suddenly hurting in exasperation* 'yeah, i sure do.'

Mr Oblivious, 'so, it it real bad? this cliff diff thing?'

nurse j, 'well, we have natural bacteria, 'good bacteria,' if you will, in our gut already, including this c-diff, or clostridium difficile. when we put you on antibiotics, the antibiotics don't discriminate between the bad bacteria that is causing your dad's pneumonia and the good bacteria in your gut. so the 'good bacteria' gets killed off, and that give the c-diff an opportunity to take over. that is why your dad also has this slimy mucousy diarrhea. so then we usually have to start yet another antibiotic to combat the c-diff. is any of this making sense.'

Mr Oblivious, 'uh, yeah kinda. so it's bad? i mean, we go in there all the time, and hold his hand and stuff. and we wash our hands too, most of the time after we leave. but, you know, not really good, like 60 seconds and stuff, or use hot water. should we be using gloves or something?'

nurse j, *huge sigh* plus silent *facepalm* 'um yeah, that's why we have a notice on the door that has 'CONTACT PRECAUTIONS' on it, as well as that cart with gloves and disposable gowns in it for visitors and staff to wear........have you seen the cart and the sign?'

Mr Oblivious, 'ha, oh yeah, we pass right by that cart all the time. i guess we should be using it, huh?'

nurse j, 'yeah, that might be something to think about.'

ps, our floor has a no one under 11 years old policy, and this visit did NOT occur on my shift. musta happened on day shift or something. sheesh man.

Sacred Moments

2010-12-30T09:27:00.000-08:00

the holidaze are interesting times to work in healthcare. all the people with seniority are at home, and as far as scheduled things, doc's try to avoid doing elective stuff right beforehand so they don't have to round on peeps/get called during this special time.

so the patient population is those peeps that are REALLY sick, and you generally have skeleton/rookie/newer/less experienced people taking care of them.

i have been a nurse for a little over a year, and i work on a floor with a wealth of experience, so yeah, i worked a lot of holidaze.

on one of those holidaze, i had a patient die. i don't want to say that i 'lost' him, rather, i 'let him go.'

basically, the dood had been stringing lights (at 96!) had found a nest of bugs (some of which he may have been allergic to-) done the 'i-found-bugs-i'm-allergic-to' dance, while still on the ladder, and down goes frazier.

he was lucky he only broke a coupla ribs, his hip and humerus. unfortunately, at that advanced age, it usually only takes one little thing like that to push people over the edge, and in the end, it was the pneumonia that did him in. 96 years old, frequent, productive, ineffective cough. NOT clearing his own secretions. cause of death could have been listed as 'booger.'

he was DNR (do not resuscitate) NCR (no cardiac resuscitation, meaning no cardiac stuff, like cardioversion or cardiac drips), as well as DNI (do not intubate). thank the good Lord for that.

within the bounds of these limitations, because of course being code status DNR, DNI, and NCR does not mean 'do not treat,' we were doing everything else we could for him. antibiotics, frequent suctioning, BiPAP.

he mucus plugged the night before Thanksgiving eve. i noticed his O2 saturation line was going squirrelly on me, so i walked into his room to check it's position, thinking maybe it has slipped off of his finger. normally, this guys had rales and rhonchi (unnatural noises your lungs make when there is stuff in them that shouldn't be, like lotso' boogers) so loud that you could hear them without a stethoscope just walking into the room.

when i walked in, there was silence. the only sound was of the BiPAP, trying ineffectually to push air into this guys lungs. that meant that he had mucus plugged, or gotten boogers so backed up in his lungs that it had occluded his airway, hence the inability to 'move air,' hence the silence. he was still alert, and was in fact waving his arms around and still had good color.

i like working my particular weekend in part because matching my 6-in-a-row shifts is the worlds best RT, or respiratory therapist. if you need an ART line, a ABG, a stat intubation, this is your man. Bartholomew is the MAN. anyways, i called him, and between the nursing team and him, we pulled the guy back. at one point, the color on this dood was so bad, he could have been the fourth member of the blue man group. but we got him back, he was alert and oriented and back to where he was before.

almost.

during this ....... event, things had gotten so hairy i wasn't sure if he was gonna pull out, so i had asked our charge nurse to notify family. if the hospital is calling you at 4 in th AM, it is hardly ever a good thing.

a coupla of the kids had shown up by the time we'd pulled old dad thru, and so i explained to them what had happened and what we'd done and basically told them that it would probably happen again, and that there was no way to know when it would happen, and that one of those times, we would probably loose him.

before he mucus plugged that first time, he was the chipperiest 96 year old you ever met. man, he was WITH it. all into college basketball and the foosball and everything.

after the first mucus plug, he just slept a lot.

by midnight on Thanksgiving, when he mucus plugged for the fourth time in 20 hours, we were pulling up more than just sticky yellow boogers. we were getting blood back as well, and we couldn't get the offending plug free. the family came again, and once we pulled all ventilation support, he only lasted 10 minutes. just long enough to tell his family he loved them, and it was time for him to sleep.

i imagine that there have got to be no better words to hear from a dying parent. the love part is self-explanatory, but the key is the 'i'm ready to go.' i feel like it absolves the children of any feelings of responsibility for allowing death to take it's natural course. and i admire the bravery, courage and self restraint the kids displayed in honoring their dad's wishes. the difficult thing in those circumstances is that at any time, any of the kids could have changed course and asked or demanded intubation, cardioversion or reversal of any of the parameters i mentioned earlier. they did not, and the Death came as peacefully as it could have, under those circumstances.

in those final moments, i administered some comfort measure doses of ativan and morphine, and left them to be with their dad alone.

what do you do when your dad dies on a holiday? how many holidays does it take before it does't kill you when people talk about it?

anyways, i got to be in the room again while somebody passed thru to the other side.

sometimes i wish i still remembered how to cry.

Nurse K! The Triumphant Return!

2010-12-22T12:40:00.000-08:00

Go read my biggest inspiration! Tell her I sent you!! Nurse K!

Full Moon

2010-12-20T22:41:00.000-08:00

'bad things happen in hospitals when there is a full moon. '

i'd heard this before, and always pooh-poohed it as a stupid superstition. like the one that a nursing school instructor told me about. she said that when she had a patient that was going south, she would tie a knot in the patients bedsheet, and swore up and down that it kept patients alive.

baloney.

then, i had a full moon night.

1900 hours.

first of all, the ER was nuts. that seems to be the first prerequisite for a truly crayzee full moon night. eventually, they went on divert, at around 2 in the morning.

before that, we had been triaging people like crayzee. the neuro/shock/trauma/cardiovascular intensive care units were full, so that left us as the the last stand for new/crashing admits. yay.

2300 hours.

triaging means that you look at the patients on your floor and decide who is MOST stable. we move people to less acute floors that maybe would have been going there anyways the next day......and so forth. so, you make a hard decision, ship somebody out, and prepare to get a crashing patient. not fun.

of course, thru our charge nurse, we hear the scuttle-butt from the rest of the hospital that this patient is going to this floor or that floor. we watch the ER board like hawks, waiting to see where the chips would fall. we had, like three codes blues and a couple of rapid responses.

0000 hours.

one of those code blues needed one of our rooms, and while we were busy triaging, they had to bag the entire time, until our room became available.

good times all around.

0200 hours.

there was also a storm, and so, of course, the power goes out. just as we're stabilizing the crashing patient that we just admitted.

nice.

darkness for a few seconds, then auxiliary power comes on......and we're back. we have these green, glow-in-dark outlets that are the designated outlets for these situations. problem is, we don't really have enough outlets to go around for all the equipment AND the computers. so not only do most of the computers in the rooms not work, neither do most of the computers in the nurses station.

well, the power will come back on later, we'll chart stuff then.

0245 hours.

hey, nurse J, looks like we need to triage another patient. somebody in the ER needs it so........ lets move 29.

okay.

the patient in 29 is a recovering abdominal surgery, stable as anything, totally on the mend, on the way out for sure. mid fifties, newly retired, looking forward to an impeding grandson. pt spouse, on the way out early that night had jokingly admonished me to,"keep my sweetie alive, nurse j, i'm too young to be alone." smile and nod, "of course i will."

right?

0300 hours.

walk into the room right behind the respiratory therapist, who got the same news i did and is in there to get the CPAP ready for transfer.

i glance at the monitor. sinus rhythm, sats in the.....90? well, the waveform looks like crap, no wonder. i grab the sat monitor to see if it on the patients finger correctly and yeah, it's on there good. hmmmm...........

89.........88........87..........

0301 hours.

uh oh, where's my pulse? (feeling for a pulse, patients is still warm in the legs and feet)

can't find a pulse.

0301 hours 30 seconds.

i see the charge nurse walking past my room, hey, man we're not gonna be able to transfer this patient, we're gonna code'em in second.

charge nurse, great. we better call it overhead.

0301 hours 45 seconds.

help arrives.

i'm trying to find a pulse and getting ready to start CPR when another nurse walks in to help.

uh-oh, what's going on with the QRS? quick glance at the monitor from me reveals that i've lost the nice even sinus rhythm i had going, and my QRS's were now getting really really wide.

shit.

0302 hours.

start CPR. begin nightmare dream sequence.

0302 hours thru 0320 hours;

attempt to intubate. pt vomits on most people within a three foot radius. intubate. can't get labs up or a history because the computers in the room aren't working because the power is still out. draw stat labs (100% WNL-within normal limits-100%). continue CPR, with pauses to see if we can ever get a pulse. no joy. try to answer the questions of the cardiologist, the hospitalist, three residents, and a pulmonologist (who was the gal that ordered the pt be transfered in the first place.)

no, nothing is wrong with the labs, everything was normal. crit, electrolytes, lactate ..... everything. afebrile, alert and oriented, vital signs stable.

WITHIN NORMAL LIMITS.

0319 hours.

cardiologist, 'does anyone here object to ending this now? anything we missed?'

silence. except for the rhythmic beat of the CPR, and the whoosh from the person bagging my patient, no one objects.

0321 hours. call off the code. TOD (time of death) 0320 hours.

0322. start cleaning up the patient. is it an ME (medical examiner) case? nope.

okay. remove lines, tubes, drains, leads, patches. clean up vomit, poop and blood. change the sheets. throw stuff away.

deodorize the room, throw away the garbages.

hide the evidence of my failure and my broken promise.

0340 hours.

patient spouse arrives from motel down the street. it took a while to get to the hospital, what with the storm and the power outage and having to get dressed by the light of your cell phone, but the spouse is here now, sitting in a chair outside the room, speaking with the doctor.

i'm sorry, but there was nothing more that we could do. we did everything we could. i'm sorry for your loss.

0345 hours.

room is clean. spouse is at the bedside, holding hands with the deceased. i close the door and leave to go sit at the nurses station. the cameras still have power, i promise the doctor that i will keep an eye on the spouse, because she "doesn't need another patient tonight."

0400 hours, accompany spouse to the parking lot, in a light drizzle. find the car.

are you gonna be okay?

yeah. i think. i'm not sure. pause.......i'm not ready to be alone.

0630 hours.

mercifull the shift is over. as i pull into my driveway, i happen to look up and see that, nice, tonight was a full moon.

damn you, stupid moon. and my disbelief about nursing superstitions. that's what i get for dissing the karmic gods of nursing, they piss buckets of horribleness out on me.

shoulda tied a knot in that patient's bedsheet.

Confession

2010-10-20T21:29:00.000-07:00

This is Maximus. My dad is Nurse J, who, apparently, doesn't know how to use the shift key to capitalize letters and has atrocious spelling.

Anywho, I'm doing a guest post. I need a place to vent, and probably nobody reads my pops' blog, right? So I'll just blow off some steam into that vast emptiness known as cyberspace. Plus, my dad is currently making dumb faces at my new little brother Brutus. I just can't win. And I was doing so well......

Before I get too far ahead of the story, please allow me to introduce myself.

My name is Maximus. I've been addicted to pacifiers my whole life, all three and one half years.

If this was a real BA (Binkies Anonymous) meeting, this is the part where the crowd would say, "Hi Max."

This is my story.

So, like I said, I'm addicted to pacifiers. Or binkies, like we say on the street. I was good, too. sometimes I would 'lose' one or two of my binkies and get my old man to get me another one. I'd go to sleep and have the sweetest nighttime ever. Me old man would only find out about it in the morning, when he would come in to wake me and would find me with one in my mouth and one in each hand.

Sometimes I'd even rub the Mr Binky down the side of my face. My dad never understood why I did it, and to tell you the truth, I don't know why myself. I just had to do it. Call it a benign form of binky obsessive compulsiveness. Luckily my parents thought it was cute and endearing. Or not.

Maybe that is why they thought it was time for Mr Binky to take a hike. My mom had tried, years and years ago. Her timing was off, however. She tried to wean me right after we moved and I got sick. According to her, I was doing just fine, and would have quit the bink successfully if it hadn't been for that move and that darn cold.

Earlier this year she tried again. Some friend of hers told her about some program that had worked for her kid. It was a psychological ploy-type thing. First, you tell your kid they don't need the binky. Create friction between the two of you. Say things like, "Ew, gross, look at that thing. It's all cracked and grody-it's probably crawling with infection. It doesn't even look clean after I run it in the dishwasher anymore." Yeah, lady, duh. It doesn't belong in the dishwasher, it belongs in my face. And I like the way it looks, I've just got it worn in.

My mom's friends' kid bought the story. So one day, when they were cruising on the freeway, she rolled down her kids' window and asked him if he was ready and if he was to sling that bink out the window. According to my moms' friend, the kid did just that. On the freeway. You can't come back from that. Wow. If that story is true (and I have my reservations), that is one brave kid. Cold turkey. I could never do it, at least not voluntarily.

So my mom bought the whole thing. Tried it out on me. She knows I have a thing for garbage trucks (what can I say, I'm a sucker for heavy machinery) so one day she had me collect all my binks. Put them in a plastic bag.....

Wow this is worse than I thought. I told myself I was past the worst of the pain, but putting my words down on screen is harder than I imagined. That shrink better be right about the 'therapeutic value' this will have for me...........

So. I put them in a plastic bag and on garbage day, we walked down to the dumpster and threw them in. I don't know what came over me. Or why I actually did it. I mean, why? In my defense, I was only almost three years old. I'm a much older 3.5 year old now. Then we watched as Mr Monday Garbage truck dumped and drove away with my binks.

The shock of it didn't really set in until nap time later that day. It hit me like a ton of heavy stuff. What the frankenweiner had I done? What had I DONE?!?!

I did everything I could think of, and even learned new things. Stalling became my standby. Get a drink, go to potty, request another story, another song-and repeat. Basically, anything to make nap and night time as much of a mess for my parents as possible. I didn't have to say it, and they didn't ask, but we knew the score. One binky, and all the sleep time troubles would go away.

My dad cracked first. My mom was a rock. I'm not sure why she hated Mr Binky so bad, but she did. Some nonsense about messing up my teeth. Lame. Binky use only during nap and nightime isn't going to front anyones teeth. Sheesh.

Like I said, my dad cracked first. Went to the store, bought me some brand spanking new, top of the line 18 month Avent beauties. All while muttering something along the lines of, "They don't even make them for 3 year olds! Yes, thank you Tear-git, for judging me. My kid has a problem. I don't care, I just need to SLEEP!"

The nightmares are probably what got to him. I'll bet he hated to hear me startle awake screaming and crying in the night. If only I had something to help comfort me in my darkest sleepiest moments......

He bought me some more binkies and things were a little dicey between him and my mom for a while. But they got over it.

Until the 'Big Boy' Campaign in the summer of '10. They went all out. New bed, with side rails and room underneath for three totes worth of toy bins. Toy Story spread with matching pillowcase and sheets. And all the talk about big boy this and big boy that and big boys don't need binkies and binkies are for babies. None of your friends used binkies and blah, blah, blah. I didn't care, I wasn't ashamed of my love.

However, I couldn't resist under the weight of the cumulative attack. So I made it off of the binky. I was clean for almost four months.

Then Brutus made his appearance. I went to preschool like normal one day, come home and boom-Mom's skinny again and I have a BROTHER?!? Is that how this works? All that stuff about, "You're going to be a big brother soon," was real, man. Not just talk.

And so this is what it means. A sibling. Some one to look after on the playgrounds. Someone to blame for stuff besides the cat.

And once more, it means there are pacifiers in the house.

Oh, just to put it in my mouth and taste that sweet plastic goodness once more.........

I swear, it was only that one time, and I confessed right after......

I'm gonna need some help.

Fine Line, Three Things

2010-10-14T21:38:00.000-07:00

how comfortable are you with . . . . . . being an agent of death? with being the one to push that last bit of morphine and ativan to send someone onwards from this life?

i'm still working on that issue.

one of the nurses i work with was telling me about a time that he, as we say, 'pushed' the death dose, and it has stuck with him ever since. even years later it hard for him to administer the big 'comfort care' doses that are usually prescribed for end-of-life situations.

there are three things that we do at the 'ospital.

thing one that we do; everything we can. if your heart starts to go, we can hit you with drugs, drips, and electricity. and cardiologists, cardiology hospitalists, or heart surgeons/thoracic surgeons. we can give you meds to keep your heart steady, increase its contractility, keep your blood pressure low or high. if your kidneys fail, we gots nephrologists, we can give you meds for high potassium, clean your blood with dialysis machines, and replace your electrolytes. we try to prevent clots. if your throw a clot anyways, we can pull it out or try to dissolve it with TPA. if you have infection we have some pretty big-time antibiotics. if you are bleeding we can stick tubes with video cameras and grabbers down your throat or up your pooper pipe. we can make you swallow a 'pill-camera' that will take pictures of your whole GI system, transmit it to a receptor on your belt. wow. there are LOTS of things that we can do to prevent death, turn back illness.

and unless you tell us otherwise, we do all this and more. to and for everybody. that's the baseline.

thing two that we do, is almost the same as the above, except for DNR/DNI. those letters stand for 'do not resuscitate,' and 'do not intubate.' which means, like i said, we do all of the things above (and more, by no means was that an exhaustive list of all the things we can do), EXCEPT FOR breathing for you (DNI) and doing chest compressions (DNR) on you, should your heart/lungs just up and quit.

the last thing that we do is comfort care. it's pretty simple-we just do stuff to make you comfortable. this is reserved for people who have reached the end of the medical rope, so to speak. people who have no chance of recovery, or who are too frail/weak/broken/old to survive whatever procedures we have left that might 'prolong life.' for some people, that means withdrawing support. if you are already on a ventilator and can no longer breathe on your own, removing ventilator support will send you on your merry way very quickly. those decisions are not mine to make or to carry out. first of all, i work nights. decisions like that are for day-time awake doctors and social workers and family members. occasionally, support will be withdrawn and the patient will last a little while, like into night shift. my turf.

it happened to me one night. the room was full of family, and the patient had no chance for a recovery. the patient had ackshully been undergoing some kind of treatment and not tolerated it well. it was then discovered that instead of being checked, the disease process had advanced considerably past the point of expectation for a reasonable recovery. by the time the patient got to us, he was in pretty bad shape. losing pressures, heart arrythmias, things we recognized as Circling the Drain. the family recognized this and, in accordance with the patients' previously expressed wishes, it was decided to withdraw the care we were ready to provide.

one family member did have a special request. he sat at the patients bedside, held his hand and told him that he just had to hang on for a little bit longer, because the family needed to gather to say a proper good-bye. now, this was a patient that was so far gone, he had not responded to painful stimuli of any kind for a while. we weren't sure he was even still 'in there,' if you know what i mean. however, when his nephew made his request, a funny thing happened......

the patient's blood pressures stabilized. his heart quit doin' funny things. and his breathing settled down.

it was amazing.

he stayed that way, too, until the next night shift. when he did die, he was in the room surrounded by tons of loving, grieving family members.

here's where it gets tricky. before he died he started to breathe funny. not unexpected, but disturbing for sure to the family in the room. and struggling for air. and rattling in his throat.

comfort care means making the patient comfortable. in this case, we had large doses of morphine and ativan ordered. morphine is a narcotic, and ativan is a benzo. together, they have a synergistic effect, increasing the others power. morphine, by itself, depresses your drive to breath. combined with ativan........it is very effective. basically it stops you from breathing. you s-l-o-w-l-y breathe slower, and then, you don't breathe at all.

the patient had some family members in the room that were in the medical profession, and i felt doubly awkward walking in to the room with enough morphine and ativan to, essentially, stop this man's breathing. worse, the patients spouse asked me what i was giving the patient as i was giving it.

well, this is to make the patient more comfortable.........

sure enough, the patient slowly, quietly died a few minutes later. stopped breathing funny first, though.

now, cause of death was not listed as 'Nurse J.'

i didn't kill him, the cancer did.

at least that's what i keep telling myself.................

*************************************************************************************

our hospital has tons of crap on the walls about 'mission statements' and catchphrases to remind us to be better nurses.

it is all a bunch of crap.

i don't have any of the cute sayings mesmerized, nor could i repeat any of them to you. i'm a good nurse (or trying to be) because i want to be. i come to work everyday with the expectation that my patients deserve the best care possible, as if they were my family. if that was my uncle/brother/sister/wife/aunt what have you, how would i want them treated? keeps it real simple for me. it works too, because everybody has difficult family members. have a patient that's a lying sneaking thieving drug addict? hey, so's my dear old Uncle Bobby, i'll just pretend that's my patient and care for him like family. have a fat, outta shape patient that poorly manages their diabetes and is in the hospital every other month in DKA? hello Cousin Jodi! and so on and so forth.

plus, i am invested. this is a career, not merely a job. i care about my success, and the success and well being of my co-workers and my hospital in general. that is how i operate. i smile because i'm a smiley happy guy dammit, and if smiling is appropriate, i'll smile because i want to, not because i saw it on some silly poster of five things to do every shift in all my 'patient interactions.'

which brings me back to my original question. how do i feel about being the one to push those last deadly doses? if that really was my mother/brother/aunt, would i want this same care?

now, cause of death was not listed as 'Nurse J.

i didn't kill him, the cancer did.

at least that's what i keep telling myself.................................

Green Mile

2010-10-14T15:58:00.000-07:00

we have a 20 bed unit. the first 5 units you pass by on the way into the unit all have windows that get good sun, and there are no other rooms on the opposite side of them.

recently, due to some strange whim of the Hospital Gods, those rooms have all had some seriously sick/long term peeps in them this last little while. the rest of the rooms on our floor wrap around our nurses/ breakroom/ equipment island, and while they have the occasional sick sickee, it is nothing like how the first 5 rooms are loaded.

we usually have two patients each, so the general consensus is, for those of us assigned to any patient on the Green Mile (as i started to call it this weekend) we have a pairing with an easier patient.

except me.

i got two. it was ackshully okay. one of my patients had a sitter with them all the time, so that saved a lot of work. sitter + vitamin A (Ativan, or lorazepam, a benzodiazepine aniti-anxiety med) equals a not-too-bad night for me. that patient was still a lot of work.

as for my other 'patient,' well, we'll save that story for another day. let's just say......there was a lot of sadness there. lets also say that, there is NO WAY on frogs green earth that i am working any extras between now an the time i have to go back.

i'm still wrestling with my patients in my sleep and hearing beeps and boops in my waking.

Vaganus

2010-10-08T07:01:00.000-07:00

my second male child was born a coupla days ago, and i learned a new word.

we had a sooper cool L&D nurse. she was nice. my wife was induced because male child number 1 came about a week late (he was ackshully born on the day he was scheduled to be induced), and weighed in a 9-ish pounds.

i've never passed anything out of any of my orifices that weighed 9 pounds, but lemme tell you, even with an epidural, it did NOT look pretty.

i'm not gonna post any pictures, so you're going to have to uses your imagination. so, walk with me. from the bottom, you have, of course, the anus. above that, there is the vagina, or the birth canal. now, this is important; those are TWO separate orifices, and should always be kept apart. sometimes, when babies come, the vagina tears. it usually tears down, towards the anus. there are different levels of tearing. grade one is minimal, and 4 means the hole for your vagina and your anus have...........become one. literally. this is not a good thing.

anyways, my first male child made a mess coming into this world. it wasn't quite a grade 4, but close. lets put it this way, when i asked the doc how bad it was, he said 'well, its at least a 3.....' then he trailed off, poked the 'mess,' hummed, 'hmmmmmmm' to himself, and then threw in a few more stitches.

i quit asking how bad it was.

so my biggest concern going in to the second male child was; how can we minimize the tearing? the doc (a different doctor, by the by) said that with second children, the moms usually tear less, so that was reassuring.

we also mentioned my concerns to my nice L&D nurse, and she taught me the new word 'o' the week.

she's was all, 'yeah, that why when i had my kid, i did an elective c-section. no way did i want a vaganus.' (pronounced vag-anus)

ta-da! my new favorite word of the week. it may very well be common L&D lingo, but it was new to me, and funny. funnier too, since...........

baby is healthy (if a little cross-eyed-that'll go away, right? maybe? hopefully?) and so is the baby momma. and, no vaganus. yay!

a.b., if you're reading this, um, ....... please don't be scared. like they say, the juice is worth the squeeze. according to Spouse. and she would know, because she didn't want a vaganus the second time around either.

Adrenalin

2010-10-05T14:51:00.000-07:00

i've been in code situations before.

the announcement goes out on the PA system. if you're doing something, outta half of your ear you hear the news, it takes a moment to register, then boom, you act. or, if it's on your own floor, you realize that the somebody that is yelling is a co-worker and they ain't yelling cuz they need more ice chips. they need a crash cart and some muscle for compressions.

that's when the adrenalin kicks in. in a controlled fashion, or course. if you're meant for this kind of work, it helps you think clearly and concisely. you know what needs to be done, and how. it takes a certain amount of practice of course, and if you work long enough with a good enough team, you can walk into the middle of the beginning of a code and know where the needs are and what you can do to fill in. specially on night shift, when it's just the night shift nurses, and if you're lucky, a sleepy snarling doctor. day shift means pharmacists, social workers, physical therapists doing the compressions-dayshift; it's s whole different world.

some people aren't built for this, and some people take a little longer to get used to it than others. one of my clinical educator friends told me that when she first had a code, she ran around screaming, "What do i do, what do i DO?!?!?" now of course she is an awesome ICU nurse and can run a code in her sleep.

so there is a learning curve involved. some people of course, aren't meant for code situations and nothing will ever change that. that's why the code teams in most hospitals involve the ER staff or teams of charge nurses or ICU nurses.

so......anyways, the other day i got rear-ended.

i was on my way to work, and like always, i checked the traffic websites to see what the situation was. since the frizzleway looked like poop on a stick, i decided to take a back road. it runs parallel, has a coupla a stops, and is usually a pretty good alternate choice. the only problem is, of course, that it is a small road, only one lane going in each direction, and there ARE stoplights at random places.

so i'm going along, and there were more than a few other people who decided the back way was the best way as well. one of those tricksey little stop lights caught a bunch of us by surprise. since the road is thin, and there were so many of us, the stop was a little abrupt. even i had to slam my brakes a little. after i came to a complete stop, just short of the truck in front of me, looked up in my rearview to make sure the dood behind me was also gonna stop.

no joy.

a little snazzy four-door Lexus coupe smacked my backside. luckily for me the damage was minor. when i stopped, i ended up on some train tracks, so when Distracted Driver (as i looked up in time to see him hit me, i saw that he was on his cell phone) ran into me, he was low and i was high. my trunk was fine and we were't going that fast anyway, maybe 30-40 mph. only my bumper got hit.

end result, i was in a rental car for a week (it was nicer than my current ride, not because the insurance company paid for it, but because i upgraded), and my car got fixed just fine.

but the interesting thing to me was, right after the impact, the adrenalin kicked in and i got fuzzy. like, i couldn't think. the light changed and i was all, like, uh, what do i do? um........i guess i move offa the road? i pulled forward on to the side of the road and collected myself for a moment, then looked up to see if the dood that hit me pulled off, too.

so, like i've said, i've been in codes before. and i've never been the chicken-with-my-head cut off routine person. so why did i lose it when the crap hit my fan?

i guess it's different when its you.

Women's World

2010-10-04T13:08:00.000-07:00

many nurses are women. in fact, most nurses may be women. i think.

anyways, i am a nurse, but NOT a woman. sometimes i have trouble remembering what it takes to be a good co-worker to my women co-worker peeps.

like the other day, Female Co-worker starts to tell me about her problems with her kids. so as i'm listening, all i can think of is solutions to her problems.

what an idiot. it's the Duct Tape Philosophy thing that most men are afflicted with that pretty much makes it impossible to listen to someone's problems without offering suggestions/solutions. women know how to listen and be engaged in that, while guys can't keep a lid on their fixes.

this situation has happened before, and i'm sure it'll happen again. the weird this is, i was aware of it as it was happening, and yet was still powerless to stop myself. sheesh.

if i was a sooper-hero, i'd be Captain Oblivious Man, able to withstand all subtleties of normal human interaction. susceptible only to the most obvious barbs of direction.

What is this feeling? Why am I feeling it?

2010-09-30T10:44:00.001-07:00

if you've working in critical care long enough, you've seen people die.

what may be worse, you've seen people that should die, but have families attached that want 'everything done.' these people, for whatever reason, think that their aged/sick/unresponsive/brain dead/kidneys-dead/lungs-dead/whatever family member is going to make a complete recovery.

everybody (staff) talks about how the family needs to get a grip. we speak like that under our breaths with each other, and try to be as objective and non-judgmental as possible when actually speaking with the family, of course. we say things like, if i'm ever so far gone that {insert medical treatment here, such as 'maxed out on pressors,' 'wearing a rectal tube,' 'on continuous dialysis,' 'stuck on a vent,' etcetera}, just let me go, man.

sadly, it seems that the majority of people that end up on our units are like that. maybe the smart ones stay away, and know better then to end up in a hospital when the inevitable happens. maybe the majority of people that die are smart about it and make their wishes clear and the ones we see are the minority.

i doubt it.

at any rate, when we get a 'do all you can,' type, we accept it and go about our work.

end case is usually a stable patient on a vent (usually trached), with pressor support (levo, dopa), and sometimes something for the heart, like cardizem or amiodarone. the patient, so to speak, spends their day like this; oral care every two hours, getting suctioned with breathing treatments every so often. once or twice a day the patient gets 'bathed,' with little foam wipes. Shaved occasionally, lotioned occasionally, and turned at least every two hours. the turning is important to combat the pressure sores that usually, inevitably develop, if not from the constant pressure of laying in a bed all day, then from the breakdown of the skin in the peri area. even with special mattresses. there are daily shots, at least one a day for the lovenox, a anti-blood clot med, and maybe more shots for blood sugar control, not to metion the finger sticks to check said blood sugar. for sure there is a catheter to collect the urine, so there is risk of infection from that. at this stage, there is usually a central like, something stable like a PICC or a subclavian line, which presents another avenue for possible infection. then there is the constant battle with pain and the constipation it brings on, which leads patients either having raging belly issues due to constant constipation, or raging diarrhea. there's hardly ever any inbetween.

is this life? is this quality? is this how you envision yourself going out of this world?

who would choose this for themselves? who would choose this for a loved one?

many people do.

and we get a lot of people like this. i mean, like, a LOT.

here is the problem. there are two kinds of old people (because, mostly, we're talking about old people here), the prepared, and the unprepared. the prepared ones know enough not to go to the hospital. if they get sick, they make themselves comfortable, gather their families (if they have time), or they go quickly. or they get something acute.

man, what happened to G-ma?

well, we found her down. she musta had a stroke. but man, you know how she hated hospitals and doctors and stuff, we all knew better than to call an ambulance. she knew what she wanted, she knew it was time.

yeah, she wanted to go out on her terms. that was our G-ma; always a fighter, and a classy lady. she went out in style.

yeah man, she was cool. she died in her favorite rocker, with a newpaper in hand. i think she was picking her fantasy team, man.

really? who's she have.............

the other kind are not prepared. this population is fragile. any number of 'one little things,' could push them over the edge. like, for example.....

older people are usually dehydrated. they don't have either the bladder control to hold it for long periods of time, the memory to drink enough fluids to remain in a state compatible with healthy living, and they'd rather sit than be drinkin' and peein' all the time. so this group of elderly probably live in a constant state of renal insufficiency and dehydration. not to mention malnutrition. you're just not as hungry as you get older, and that's if you're not fat to begin with. then there is just the age thing. when things get older, they don't work as well, nor do they recover as well. a 96 year old pair of kidneys or lungs is not gonna function as well as a 40 year old set.

what i'm saying is, it does not take that much to push you over the edge. then begins a cascade of events that leads to a state we like to call, 'circling the drain.' one thing leads to another, and before you know it, you have more problems than you can fix.

this is a really long post, and i haven't said anything you haven't heard before or don't already know, but i promise i have a point. thanks for sticking with me.

anyways. rarely do we have somebody come in to the hospital at the beginning of the Bad Cascade of Events that Will Lead to Ultimate Demise, recognize the writing on the wall, and say, you know what? let's not do this. no dialysis, no intubation, no CPR, no drips. lets just make Dear Family Member comfy, get'em outta this place if we can, and get some where we can gather and experience a peaceful death surrounded by loved ones and memories and not machines, meds, tubes and medical types.

you know what happens when we do get somebody like that? i get a sense of revulsion. i call it revulsion, but maybe that is an inappropriate term. i'm not sure what to call my reaction, but internally, i recoil. maybe that is why is is so hard to let go. maybe i'm all talk, and letting go, even after what i've seen of dying, is something that would be hard for me to do.

i'm all, like, man, they're letting go easy. did they not really love Dear Patient? what's going on? why don't hey wanna fight till bitter end?

why, after all my griping about having patients and families that Don't Get It, do i feel this way? why?

maybe asking for comfort care is a Hard Thing. a Rational Thing. can i make that choice, if not for myself, then for others?

i guess someday we'll see.

Lube, a Cautionary Tale.

2010-09-16T00:01:00.000-07:00

i've mentioned on this blog before that i'm not a fan of the neuro patients. they smell funny, you have to do neuro checks ALL THE TIME, you can't sedate them usually.........basically neuro patients are my least favorite. also, their communication skills are lacking.

i had this patient, neuro dood (alkyhall + motor transportation = neuro patient at my hospital), who had some communication problems. i'm getting this in report from Nurse Dayshifter, also another male nurse. so, Dayshifter is spaining to me that the guy had some pain and couldn't really verbalize or localize the pain. what ever it was, it hurt worse than the hole in his head. so Dayshifter is valiantly trying to ascertain where the pain is coming from.

does you head hurt? does your chest hurt? do you need to poo? are you having a hard time breathing? and etcetera.

finally he worked his way to-is your catheter hurting you? and got an affirmative nod. so Dayshifter inspects the offending foley catheter.

warning; what he found will make any dood readers cringe. fair warning, don't say i didn't warn 'ya.........

the guy's penis tip had dried up and gotten sort of stuck to one spot on the catheter. and then, as if that wasn't bad enough, the guy's penis had gotten a little more blood in it (making it longer, for those of you born without aforementioned equipment. growth and shrinkage are a natural part of the day-), and so his.........tip had sort of inverted, being as it was, stuck to that particular stretch of foley tubing.

we will now allow a brief intermission for the male readers of this blog to recover from that last sentence. i'm shuddering a little myself just thinking about it.............

................and we're back. so Dayshifter procured a syringe of lube and 'freed' the penile tip from his unlubed situation.

wow.

Dayshifter is telling me this in report and we're both just cringing, just from his telling me the story.

yikes. i tell ya, for some reason, the female dayshift nurse i gave report to the following morning seemed......unimpressed. i guess it takes having one to know the true gravity of the situation.

the guy slept really well afterwards though. poor guy, he was probably exhausted.

Normal Person

2010-09-15T23:24:00.000-07:00

i am a mexican. i speak english (my second language) WITHOUT a spanish accent. i have olive skin that tans very well (i like to refer to it as SPF Mexican), and dark hair and brownish eyes. i do speak spanish (my first language), without an american accent, and russian is my third language (long story).

living in This State, i get asked a lot where i am from. that is the first clue that the indigenous population of this state is mostly white. so when i have a person look at me and see someone with slightly darker skin, and they ask 'where are you from?' i know they are not interesting in knowing which town i live it locally; i am darker-skinned, so i must not be from around here.......

so when somebody asks me where i'm from, i like to get straight to the point and either say i'm from el paso, texas, or i just say 'i'm a mexican.' (it's kind of embarrassing to make people that want to know what race/ethnicity i am go thru the hoops of-'where are you from' 'Local Town, nearby.' 'no, i mean, where are you from from.' 'i'm from Local Town. well i did used to live in Other Local Town, but i moved.' pause for exasperated silence, followed finally by, 'what race/ethnicity are you?' oh, is that what you really wanted to know, you racist stereotyping bigot? well, you should have asked that at the beginning, instead of thinking you could be sneaky and find out my race by asking me where i'm from.....) anyways, usually i just spit out mexican and get it over with.

so, conversation gets started with another patient.

patient: 'where are you from?'

nurse j: 'el paso, texas.'

patient: 'are you spanish?'

(another pet peeve. 'Spanish,' means, when referring to a person, that they are of Spanish descent, as in, they are from 'Spain.' because i speak spanish does not make me 'Spanish.' LOTS of countries in the world have Spanish as their primary language. it's really not that hard. it's like assuming everyone that speaks English is from England. i swear the next idiot that asks me if i'm 'spanish' because i speak spanish is gonna get an 'are you english? your english is wonderful. you don't even have an accent,' from me. sorry, had to get that off my chest. end rant)

anyways, back to the conversation-

nurse j: 'no, i'm a mexican. both my parents were born in mexico.'

patient: 'wow, you don't even look mexican.'

nurse j: 'really? what do i look like?'

patient: ' a normal person.'

*sigh*

in case you were wondering, the conversation did not get any better after this last little gem. patient went from telling me i looked like a normal person to telling me that with a little education, even mexicans can make something of themselves. thanks for that newsflash buddy. how's the weather?

************************************************************

thanks to the current hoopla over immigration, i also had another patient recently ask me, when i went into the room with another nurse (not my patient) to help turn him and stuff pillows, if i was 'illegal,' right off the bat. smooth operator that one. nothing got by him. damn fox news, riling up our elderly.

by the by, no picture for this post. for a good time, use google images to look for 'normal person.' it's a blast.

Clean-up on aisle........Honda?

2010-09-08T23:49:00.000-07:00

code white is a code that is probably most frequently called in my hospital.

the lady with the monotone voice comes on after the beep, 'Code white, ........South 642.' i don't know why she pauses, but she always does.

it means that in the south tower (where the babies are born), a baby is coming RIGHT NOW without a doctor in the room yet. our ICU is under the mom/baby/NICU/peds peeps, in the same tower. i've seen a coupla cars peel into the parking lot underneath our windows and have a scrub-clad doc sprint from the vehicle and make a mad dash for the stairs to get to a birth in time. always a good time.

well, the other night, we had a little twist.

-beeeeeeeeeeeeep-

"Code white, ............south parking lot,.............code white............south parking lot."

what the what the? that's right under my window. i ran over the window in my patients room, and looked over to the pregnant parking circle thing, and sure enough, there was a little two door Honda with the doors open and the lights on.

well, crap, i'm going down there! My patient was a turn and wiper, out on propofol. he wasn't going anywhere.

boom, off i go.

of course, by the time i got there, the good stuff was done. there was a doc in the car asking for scissors, ready to cut the cord, and a nurse had the baby in his arms, ready to ......go some where i guess. the doc comes outta the car, asks where the dad was (he was standing by my side, a little distraught) and said, 'okay, lets go.' by this point, there were probably a dozen nurses and therapist trickling out. security had a wheelchair by the car, so i kind helped the mom go from the back of the car to the wheelchair. and by helped, i mean i got placenta juice on my (ungloved) hand.

somebody else wheeled her to mom/baby. so, we have some security guards and some ER staff hanging out looking at the car.

first of all, why was the mom in the BACK of a two door coupe? 'oh CRAP, the babies coming, get in the back of the car?'

anyways, there was conversation about getting some of our housekeeping staff out to the car to clean up the car a little for them. there was a large chunk of purple ........ something on the seat. and hopefully move it to an ackshual parking spot so it wouldn't get towed.

man i feel sorry for that house keeper. can you imagine? pager goes off, what the...? clean up a car? i don't get paid enough for this crap.

or imagine being the lucky RN, carrying back a chux full of placenta to send to the patho to make sure it was all there.

some good excitement to break up the monotony of a turn-and-wipe kinda night.

hope the kid was okay.

Landcruiser Enthusiast

2010-09-04T04:01:00.000-07:00

these are for you, nurseXY. meet, 'dadda's truck.' '95, with a center differential lock. my daily driver and weekend warrior.

Parking

2010-09-01T12:23:00.000-07:00

first of all, we are at the gym. a place where you go to exercise. you, know, burn calories? get the blood flowing?

if you have to park your huge-a$$ truck sooooooooooooo close to my car that in order to get out of your own vehicle, you have to go out thru the passenger side, maybe you parked too close to me. maybe, just maybe, you could have parked 3 spaces over where there was more space for your ginormous truck.

after all, we are at the gym. walking that extra 15 feet isn't gonna kill you. idiot.

Snapshots

2010-08-31T21:13:00.000-07:00

if you were to take a mental picture of every day you worked in ICU, what would it look like? i don't know who this dood is, but you can see that it is a picture made from other pictures. cool right?

except......imagine if all the picture were of this dood sick and dying, septic, intubated, pooping, bleeding, combative, confused, etcetera. you get the picture. ICU nurses mostly see their patients when they are on deaths door.

i think it wears on your soul.

grinds you down, beats you to a hopeless faith-in-people less state. if you let it.

the original plan was to become an FBI agent. to that end, i was majoring in Russian at (Local Religious School). the fibbies require, like, a bachelors degree plus three years work experience. so i was gonna finish my degree in russki, then work as a copper somewhere and start applying for jobs in the military, NSA, CIA, FBI, etcetera.

then i met wifey. who decided, i mean we then decided that a life in the military or guv'mint service was not for us. she was already a nurse, so i too entered this glorious field.

so here i am. a trilingual male nurse, who secretly aspires to life carrying a gun and a badge and going after bad guys.

hmmm......

funny thing about plans, hey?

so, the thing i've learned is, don't get caught up in letting what you do define you as to who you are. i mean, the whole thing with being a police officer is that it is a super hard career that in many cases requires both spouses to be married to the profession. i've talked to many cops that feel like their profession contributed to the demise of their marriage.

i mean, if you are the first responder on the scene of a child dying cuz an unattended piece of playground equipment fell on a 3 year old and killed him, in his own backyard, steps away from his parents.......what effect can that have on you?

you do CPR anyways, for the sake of the parents. to at least make it look like there might be a chance. even if everything in your gut tells you-it's over man. when EMS gets to the scene, and looks at you like a crazy person, and say what the heck man? and you simply glance over at the already grief-stricken parents and continue CPR, the EMS guys will join in. then later, if you go home and your wife doesn't wanna hear about it cuz she's kind of a selfish bee-yatch.......what do you do?

the above, by the way, is a true story. how long do you think that marriage will last?

the truth is, i really didn't land very far being a cop. we all (nurses, cops, EMS, firefighters, docs, RTs) see some terrible crap.

at the very least, my wife is a nurse as well. so when i've had a perpendicularly hard shift, i can come home and vent to my wife, and viska versa.

and whatever i do, i need to remember to define myself according to how i want to be defined. no matter what the pictures i collect of work look like, who i am is what i choose to be. father, husband, son, neighbor, uncle, cousin, friend, future youth soccer coach, aspiring foodie, Landcruiser enthusiast, reader, funny happy-go-lucky guy, what ever.

my work will not define me.

i love my job, and i give it my best, twelve hours at a time, but when i go home.........work stays at work. it is more than a job, it is a career, but because of nature of the work, i need to protect my mental self from the rigors of the work.

Vegoose

2010-08-29T21:42:00.000-07:00

found a new blog worthy of reading. the dood is an RT. respiratory therapists-i love'em. the whole breathing thing, it's kind of a big deal.

anyways, i was reading his stuff and he's been getting close to burnout. like, scary close. like, he wanted to hurt some Joint Commission bee-yatch that wanted him to know that it was not okay to have more that 12 oxygen tanks in a patient care area, and did he know that there were 17? i might've wanted to punch her in the mouth, too. but, the point is, it is important to take a little bit of time away.

so my wife and i did just that. we went to Vegoose with some Dear Friends. it was awesome. except for the smoking. probably never get used to that.

3 days with no kids, to alarm clocks, gourmet food (dinner at The Fix, Japonais, and Bobby Flay's Mesa Grill), pool time, relaxation time, fancy flying flexible bendy people show (Mystere), one book (i know, just one? weak sauce that. but it was a good book. the accidental billionaires), was just PERFECT. loved it.

no burnout here! back to the grind......

A Fate Worse than Death or Tomato

2010-08-20T17:11:00.000-07:00

i would hear about young doods dying in motorcycle accident and think, man, that is the pits.

then i started working in ICU, and found the patients that ended up like veggies, or paralyzed.

so, okay, i had to revise my things-worse-than-dead scale. if you are a young dood, and don't die, but end up like a tomato, that would have to be the worst.

wrong again, boyo. looks like more revision is needed on aisle scale'o'bad things.

so. classic formula, alcohol + motorcycle use = no bueno. fine, we've been over that road before on this blog. but, a new twist. no paralysis, no vegetative state, but what we DO have is a return to a 3-4 year old level.

oh my.......

can you imagine? you're running along in life, minding your business, have four (FOUR!) great kids, beautiful wife, then BOOM! now you're a five year old. or, worseness, you're the spouse, and now your hubs is a five year old. yikes. i can not imagine. i feel so bad for this family.

so, scale 'o'bad things, revised;

married to a dead guy, you're a widow. okay, that's pretty bad.

married to a tomato, eventually you may pull the plug. i used to think this was the worst.

but,

married to a 5 year old? how can he be a dad? or a husband? how do you stay married to that? this had gotta be the worst.

i may never ride again.

Stank You Very Much

2010-08-20T15:08:00.000-07:00

so, there are different smells that the human body is capable of producing. ABB over at asystole had a post about this a while back, so i thought i'd throw in my two cents.

patients stink. they all have their own 'brand' of stink. lets try to catalog them, shall we?

neuro patients.

they stinky. probably my least favorite, hands down. i don't really know how Head Nurse does it, but i can't STAND neuro patients at all. neuro patients get this sort of musky dank smell, that's kinda hard to describe. but if you have ever stood in at the bedside of someone who's had their brain messed with, you'd know.

while we're on the subject of neuro patients, let me also add that i don't like them because you can't knock'em out. generally, you have to do all kinds of neuro checks every hour or four hours or 15 minutes to make sure they're not getting worse.......which means no propofol. my favorite patients-the kinds that are sleeping. and not stinky.

fearful patients.

you know how they say that dogs can smell fear? i think ICU nurses can too. i've had patients from stroke to PE to heart attack patients and i can just tell they're FREAKIN' out. part of my nursing care when i clue in on this is reassurance (as much as possible, i prefer the pessimistic approach, mostly), but the other thing i clue in on is fear smell. your body must just put out this universal scent of fear, or it may just be the smell of the catecholamine surge and the adrenalin leaking out your body that puts out this smell. really pervades the room. not too bad. nothing a little peppermint essential oil in a plastic 30 ml medicine cup can't fix. i just put it in the room, i don't make my patient swallow it or anything, in case you were wondering. soooooooooo glad our pharmacy stocks that.

GI bleed.

probably other peoples least favorite. but i actually don't mind it that much. don't get me wrong, it's bad, i'm not about to market it as aftershave or anything, but it's tolerable to me. smells kinda like horse poop, but worse, and without that fresh minty alfalfa aftertaste. the worst part about these patients is just that you're in there every hour changing smelly poop. that can get old real fast. and skinny easy-to-turn people never really have GI bleeds. course, now most of the patients come from the heavyweight division anyways.......

Smoky Wino.

when you have consumed sooooo much alcohol and nicotine in your life that being scrubbed with hibicleanse, dial anti-bacterial soap, mouthwash, betadine and johnson& johnson's baby shampoo doesn't help, it may be time to lay offa that bottle of booze and that pack o'cigs. my facility has a policy that if you are on a vent, you get bathed at night, otherwise, day shift does the bath. but really, bathing is a PRN thing. if you stinky, get bathed. especially if i have to be in the room all night, smelling your funk, i'm gonna wash you. for my sake as much as yours. the nice thing about these patients is that usually they have family members that smell just as good as the patients.........

The Neglected

i had this patient once, back in the day when i was an aide, that had had a syncopal episode whilst standing to pee. he wakes up in the morning, goes into the john first thing in the morning like he has for the last 40 years, and passes out. smacked the crap outta his face, ribs, shoulders, he was a mess. the whole side of his face was black and blue, plus that side of his body. guy was a mess otherwise too. i mean, he had this gnarly beard thing going, if he had an ackshual bird come outta that thing i wouldn't have been surprised. his toenails hadn't been cut in ages, and smelled ne-glec-ted. i thought that the guy MUST have been homeless or something, right? surprise surprise, the family comes in, and they're NORMAL. like, they smell great, have clean clothes,.....it was weird. if you live with your dad/spouse, what the freak are you doing letting him be so stinky?!?!? you dress nicely, shower daily, look normal, and allow your dad/spouse to look like Ted Kasinscki living in that cabin in montana??? it was so, so, so weird man. these people i feel bad for, cuz they came in stinky and they probably don't even know they smell.

Aunt Flo

i might catch some flack for this one, but please bear in mind that i am an alternate gendered nurse, as Cartoon Characters likes to call me. but i ackshully have a question; if i have a patient that is, um.....enjoying a visit from Aunt Flo, what can I do to help them out? do i walk in and offer to help 'clean' them up? send in a female coworker? what would be the least awkward/embarrassing for me and the patient? any advice would be greatly appreciated.

any i missed?

Dood.....

2010-08-15T01:12:00.000-07:00

....seriously. it's more than a little awkward when i walk into the breakroom to get my grub from the fridge and you're in there chatting it up with your bros or your lady friends, and i can tell you just farted.

from the expression on your face as i walk into the cloud and make a face. and from the smell that invaded my face when i walked into the cloud.

i know, i know, not many people ackshully use the breakroom, but still man, i gotts to get my grub from the fridge......

it's just rude. either

a) give a heads up-common courtesy, or

b) fart in the bathroom, the storeroom, or a patients room. like the rest of us.

sincerely,

your coworker.

12 hours

2010-08-14T06:51:00.000-07:00

i learned something about myself working as an aide on a med-surg floor, with 6-9 patients per night.

i can do anything for 12 hours.

i can wrestle crazyee's, wipe poop, hold back hair to keep it from going into the vomit, clean up poop, pee, vomit........ANYTHING. i can do it. for 12 hours at a time.

but man, i had a shift recently that made me wanna lose my mind. it wasn't even really hard or anything , it was just...........mentally taxing. both of my patients were the kind that drive ICU nurses to burn out.

standing in the red corner, weighing in at confused, obeys commands intermittently, and needs to be restrained, we have Mr. Poop-oozer. a gin-u-wine vented heavy that would ooze poop everytime he coughed or was suctioned or moved. every-single-time.

poop that was too thick for a rectal tube, and too soft to be formed, but juuuuuuuuuuuuuust right to ooooooze out all of my shift.

*sigh*

standing to my left, in the blue corner, we have Mr Used To Workhere. he's confused as well, not oriented, forgetful, and mentally, he is gone man, just gone. there is nothing up there.

warning, if you hadn't figured it out already, this is a vent post. for those you with weaker stomachs, now might be the time to look away........

if i had both of these doods for more than 1 day, i might have shot myself. or been rooting for a mucus plug or something.

anyways, i'm sure i'm forgetting half of the stuff that i was gonna post............and i' starting to type phunny. time for bed.

g'night!

Letters

2010-08-10T12:43:00.000-07:00

dear Patient family,

this letter is in reference to your request for a status update on the current condition of Patient Gonna B Deadsoon.

you family member does not have current good health, their health is deteriorating, and the outlook for the future is bleak.

despite days of bumex (a med to 'wake up' kidneys) including a bumex drip, Patient Deadsoon's kidneys have not woken up. currently, even though we are performing dialysis for 5-6 hours on a daily basis, the urine output on average has been less than 50 mls per day. also, the BUN and creatinine clearance (lab blood work numbers that indicate kidney function) continue to go in the wrong direction. this glaring lack of kidney function, at this age, is a good indicator that the end is (or should be) near.

and yes, to address the query you made about the possibilities for a kidney transplant.

*sigh*

where to begin?

Gonna B Deadsoon is currently 96 years old. Ninety-six. also, on admission, it was understood that the patient did nothing more all day before admission to the hospital than sleep a lot and sometimes nod his/her head. occasionally. it is not as though this turn of events was sudden.

not only is the advanced age of your family member a concern for transplant, but the list of co-morbidities Patient Deadsoon has is too long to list here. shall we try anyways? COPD (lung disease) CHF (heart disease) Chronic pain (necessitating pain meds which has led to this current state of massive constipation, bowel distention......which has led to this aggressive bowel motility regime.....which had led to numerous blowouts to the ankles and poop dripping off of the bottom of the bed thing.....) and the fragile skin from the steroids for the lung disease) portal hypertension (which, coupled with the bowel distension from the constipation, has led to a fairly impressive distended midsection).........need I go on? did i mention the seepy weeping anasarca?

your family member is currently intubated, and sedated. there is a tube in the throat, two in the nose, 4 in the chest, one in the urethra, and we may have to place one in the rectum. despite our best efforts, the fragile skin is starting to break down. a machine is breathing for the patient (lungs, old and bad). Another machine is filtering the blood (kidneys, old and dead). medicine is maintaining the blood pressure in a state compatible with life, and another drip is keeping that heart in a good rhythm (heart, old, bad and dying). notice a pattern here? the pattern is dead, dying or trying to die. it's like theme party, and all of the organs and organ systems are coming. no matter what we do.

yet another machine is dripping pain medicine into your family member all the time for the chronic pain, and then there. is. the. constipation. which we are fighting which has led to the explosive diarrhea. explosive diarrhea. uncontrollable, explosive diarrhea.

remember what you said about knowing that the patient DID NOT WANT TO BE 'KEPT ALIVE ON MACHINES'? i think we are currently totally, 'on the machines.'

so unfortunately, your family member is most totally probably really seriously not kidding even a little bit NOT a good candidate for a kidney transplant. or a liver transplant. or a lung transplant. even from other family members. tolerating a transplant procedure or the following immunosuppresant treatment that would have to follow to prevent rejection.......not likely either. really.

did i mention your family member was 96 years old? hasn't it been a good run?

oh what's that you say? what about what the doctor said?

yes, ahem. i can address that as well. Dr Cure Ebrryboddy tells every patient and every patient's family that they are getting better, and things are looking up. something about his religion and his idea about sanctity of 'life' (using the term 'life' as a very very very loose descriptive term here borrowed straight from him- you'll have to speak directly to the good doctor as what that means to him. ps, don't bring up the words 'quality of life' with him, or mention them together in the same sentence), that precludes him, despite his many years of practice in this field of staving off death, from ever akshully telling a patient that modern medicine has reached the end of it's rope. sometimes his stubbornness and dogged determination to hang on no matter what is refreshing..............and sometimes it's not.

so, to recap. outlook, no bueno. future, bleak. chance of full recovery, none. doctor, mistaken. transplant, of any kind, from any source, NO.

sincerely, nurse j.

disclaimer-

*yes, i may very well be a cruel heartless bastard,

*but these are the thoughts that may or may not run thru my pretty little head at 5 in the AM when i notice poop dripping off the end of the bed for the 5 time in a 12 hour shift, and the fourth time in the last 3 hours. yeah, the sennakot, colace, lactulose, reglan, gastrogafin, nistigmine, ethylene glycol are working now. promise. i almost could NOT shower enough when i got home.

Never Get Old, A How-to Guide, or, Conversations only nurses can have.

2010-08-07T12:36:00.000-07:00

co-worker, 'man, i hope i never get old."

nurse j, 'oh yeah. i hear ya.'

co-worker, '4 bottles of insulin. that's how i'll go out.'

nurse j, 'four bottles, huh? how'dja figure that out?'

co-worker, 'i had a patient that had only 3. and they still made it. so when i go out, i'll do 4.'

nurse j, 'three bottles would've been enough, the thing was somebody found your patient. the trick would be making sure you weren't found in time.'

co-worker, 'yeah, i guess you're right.'

nurse j, 'a little planning goes a long way.'

Gold Star

2010-08-05T07:37:00.001-07:00

seeing's how i've been 'tagged' twice now, this post is long overdue.

the nerve of some people............reading my stuff and liking it and such.......

why do i blog?

1) it has always been a dream of mine to be a writer, and this medium provides practice. i don't know if i'll ever have the 10,000 hours (Malcolm Gladwell, Outliers reference)......but it sure is fun to try.

2) catharsis. i love having a place to vent. i feel like i am a part of a community. an interweb community of people sorta like me, many with the same job, but a community nonetheless.

3) creative outlet. i love changing the identities of patients and co-workers and such, so as to make them untraceable. the challenge of HIPPA and PHI is fun to overcome.

my blog honor roll. see side bar >>>------------------------------> here.

just kidding.

in no particular order:

1. doc grumpy. prolific, funny, intelligent. great mix of exasperating (stupid) patient encounters, historical stuff, and learning moments. a lot of funny. other doc blogs that also rock; Ask an MD, Movin' Meat, Fizzy, Asystole (okay, she's like, mostly-almost-kinda a doc), OldMDGirl, ER Stories,

2. Head Nurse. like, the original inspiration. if you don't already know..........i don't know what to tell you.

3. Abilene Rob. ex-jarhead, cool/oddball sense of humor, this guy's gonna be a great nurse. sometimes, about the great ones, you can just tell. great writer.

4. nurseXY. same here. blunt, brutally honest about nursing skool and personal life, guy is also a GREAT writer. hey nurseXY, you should post a link to your older blog. just for me.

5. Maha. the first gal that made me fall in love with ER blogs. i've gone back and read her since her start, back when she was still in nursing skool, and it has been interesting to see her progression. other ER blogs that rock my world; Running Wildly, New Nurse in the Hood, Fundus Chop, Thoughs from the Night Shift,

6. Weird Nursing Tales. guy can't sing worth a lick (he and i would make a great duo), but a fellow nurse, and he's from my home town of El Paso? gotta love'im.

7. pharm doods. Your Pharmacist May Hate You, and The Angry Pharmacist. why are they so angry? read'em and find out.

8. the Canadians. Call Me Nurse, Running Wildly, Maha, Asystole. all Canadian, all cool. what's up with that?

9. everybody else on my blog roll. seriously, i'm not real great with the technology thing, and it's taken me FOREVER just to make this *$#@ post, what with the copying links and such.

and lastly, Nurse K, come baaaaaaaaaaaaaaaaaaaaaack!

mmm'okay, love you 'bye!

Tribute; Worms.

2010-08-04T14:44:00.000-07:00

remembered a joke my pops liked to tell from back in the day. though i'd share it here.

how do you cure (intestinal) worms?

recipe: you'll need 4 bananas, 3 cookies, and 1 hammer.

day one of treatment, shove 1 banana up your butt, followed by one cookie.

days 2, and 3-same.

day 4: shove last remaining banana up your butt and wait (if you've followed the directions exactly, you should be out of cookies at this point).

when the worm sticks his head out and says, 'hey man, where's the cookie?'-hit'em on the head with the hammer.

What the ................?

2010-08-03T07:55:00.000-07:00

i had my first LOL with fake boobage the other day. the LOL (little old lady), was in for something or other, i can't remember what, but anyways, i go to listen to her lungs and there they were.

usually, i start by listening first to one side of the chest, then the other side in the same spot, and work my way down. i usually listen to at least 3 points per lung. only..........when i went in for the listen on the second spot, the.......um........appendages in question, refused to move. (patented nurse j high squeaky voice) *awk-ward. *

usually, LOL anatomy dictates that the, um, tissue lies flat alongside the side of the chest, due to the combined factors of gravity and well, gravity, and not perkily pointing at the ceiling tiles. normally, the last point, um part on the lungs that i listen to are these precise places. generally, i have to use the back of my hand to discretely lift said breastest tissue and place the bell of my stethoscope there to listen.

it was hard to listen to the heart as well, cuz, well, the twin towers wouldn't move. it's kinda weird to think that someday that lady will be nothing more than bones and, ......um, two bags of silicone.

about the pictures........well, never let it be said that my due diligence in researching for my posts was lacking (using google for the term 'old lady boobs' can count as research, right?). the first was actually from an ad for a thing you can put in between your melons while sleeping to combat the dastardly effects of gravity. remember, sag never sleeps, even if you do.

and the other is what a boobs job looks like now. yeck.

as for the after i had to deal with on my shift, dear readers, i'll just let your imagination fill in the ......er.........blanks.

The Beat Goes On

2010-08-01T05:02:00.000-07:00

i had a pretty exciting night recently. i had a patient come back from surgery with a heart rate in the 130's. the patient also had orders to call the doc if the heart rate was greater than 125. okay.........guess i'm calling the doc.

he wanted a CVP set up and said that after that particular kind of surgery, patients tend to be really dry. (CVP stands for central venous pressure, and it is a measure of how much fluid you have. low CVP numbers mean you are dry and dehydrated-which can lead to increased heart rate. high CVP number means you have too much fluid-which can lead to other problems.) so i set up a CVP and the first numbers are, like, 1-2. low. sooooooper.

time for a bolus. a bolus is when you shoot a bunch of fluid into a person really fast. i started up giving a liter and 1/2 in an hour. it's kinda a lot.

didn't work.

fortunately the surgeon (who had probably been in surgery all day and still had to come back the next day) had consulted with the intensivist service to assist. so our pulmonologist was on board, who got a cardiologist on board.

so we cardioverted. i've written about this before, but a quick review. you push this drug really fast (adenosine) it stops the heart. the idea is that when the heart starts up again, it will be in a normal rhythm & rate.

its kind of like slapping somebody in the face who is freakin' out and telling them to SNAP OUT OF IT! only it's your heart, not your face. and it's not a glass of cold water, its 6 mls of a drug. again, for my non medical readers, the heart is that pumpy-beaty thing in the middle of your chest. it's kind of a big deal.

as it is for me, the guy essentially stopping your heart.

seriously, sometimes the things we do in nursing boggles my mind. i can't really tell you what boggling my mind feels like per se, but i think i've had my mind boggled. yup, pretty sure. boggle boggle boggle....okay, i'll stop.

so we pushed some adenosine.

heart rate; 153...............127.........................87.........................130................150...150....150...150...

mmm'okay. well, so much for that. granted, we could have pushed the drug a coupla more times, tried some higher doses, but the cardiologist was satisfied that the rhythm was sinus, and with the patient being asymptomatic, well, the rate was something we could live with. if it stayed sinus in the 150's. (sinus means that the heart is still beating the way it should, with the correct waves indicating the correct chambers of the heart are firing in correct sequence and blah blah).

at this point, with CVP numbers kinda where we wanted them (5-10), the heart was clipping along nicely in sinus at 150. if you're chuggin' along on a treadmill for a half hour, that's fine (depending on your age, fitness level, blah blah), if you are asleep in bed.......not so much. with her fluid level in the right spot however, the consensus was that we could live with it.

pulmonologist and cardiologist go back to where ever it is in our hospitals docs use to crash and curse the sounds of their pagers going off.

what with all the running around i did and having another patient besides, i hadn't had time to eat yet. i had brought something healthy with me, but the lateness of the hour, the crappiness of the shift so far, combined with the fact that nearly everybody else on staff that shift had gone and gotten something with fries, which i could smell as they ate them and walked past me from the cafeteria.........yeah, there was some fried food in my future. at this point it's about 0100. i go get some food, gobble it down so i can start charting,.......and my patients heart rate shoots up to 200.

son of a.........

i still had ketchup on my mustache and salt on my lips, dammit all.

time to wake up the docs, who were SOOPER thrilled to be called back for this, i'm sure.

mind you, the whole time, the patient remained asymptomatic. no signs or symptoms of distress whatsoever. no chest pain, no shortness of breath (SOB), nuthin'.

the docs convene. defecation hits the oscillation in other parts of the hospital. somebody codes on some other floor, which means i lost my intensivist. somebody else needed help in ER, so i lost the cardiologist. poor guy, he had to do a mini-research project in the middle of the night. he was reading notes and trying to determine the patients history because surprise surprise, the patient was an 'unreliable historian,' as we say in the biz. right before he leaves, he tells me, if patient continues, we'll have to shock.......

mmm'okay.

so round 'bouts 0430, the cardiologist calls to ask if said patient is still tachy (fast). yup. still fast. we've clocked the patient in the range of 190 to as high as 220. still asymptomatic.

okay, set up for electric cardioversion.

grab crash cart. grab etomidate (knock you OUT drug, short-acting). grab consent.

um, yes, could you sign here? yeah, this just means we're gonna electrocute you and try to stop your heart. uh-huh. and initial here. okay, thanks.

place paddles. one one right breast, one on left scapula (shoulder). connect to machine. respiratory therapist in room. charge nurse in room. sleepy family (spouse) in room. (um yeah, you're gonna have to have wake up, we're gonna zap your honey-nut-bunches of oats, that heart thingy problem is still going on).

joking with patient. joking with family. everyone in room smiling. doc gives order for etomidate. patient talking and laughing one minute, head rolled back the next. poke poke, hey are you awake? no response.

doctor; okay, hit the juice.

i'm clear, you're clear, we're all clear (making sure no one else is touching the bed).

zap!

flatline..............................................

then.........beep, beep, beep.

sinus in the 140's. we can live with that.

success!

phew, that was a long night.

Presenting.....

2010-07-29T01:27:00.000-07:00

Doctor Grumpy.

if you're not reading this guy, something's wrong with you. you should probably see a neurologist for that.

start here.

there is a fracture. i need to fix it.................

(for you non-medical types, 'a cyst o'lee" is 'asystole.' that flat line on the monitor that means the patient is dead because the heart is no longer beating.

Best of Me

2010-07-28T06:48:00.000-07:00

i am a funny happy-go-lucky guy. i try to generally be happy and positive. i know this about myself because others tell me this. and, it makes it hard to have an 'off' day. if i show up to work the least bit tired, flat or out of sorts, my co-workers will notice, and ask what is wrong. nurse j, you're usually so happy, but you've been on shift for 5 minutes and you haven't smiled yet...? whats wrong?

i guess that's good. it makes people like me, and i am glad for that. no one wants to hang around a sourpuss, right? right. and when i am down, my co-workers noticing right away lets me know i'm loved and usually perks me right up.

also, the funny bit. i like to make jokes. i could be on the receiving end of flying GI bleed poop, trust me, i'll FIND a way to make a funny.

for twelve hours at a time, at least three days a week, i'm on. i'm saving lives and i'm funny and fun to hang out with. on those days, my work peeps get The Best of Me.

what does that leave for my family? glad you asked.

not much. i come home hoping to sleep as much as i can, recharge so that i can probably go back and do it all over again. if i get woken, there is no charming repartee, just grumpy mcgrumperson.

my wife is a nurse, and we work opposite-i work nights, and she works days. whenever i make a particularly good joke at work, or engage in witty banter with my work peeps, i think of my wife and my boy.

my wife, practically being a single mom on those stretches where i work a bunch in a row.

my son, who, when he does see me, is so excited to see me he just bubbles over with words of joy and news of his past activities. you go work wast night? yes max, i did. oh, okay. das good dadda, das good. good job. thank you son. wook wook dadda, i got shoes on. i can do all-by-my-sewf. good job bubba. wook wook dadda, das one, two, free. and das weh-woah schoo bus. i wike candy. me to have candy?

rat race. you suck. i love my job, but seriously, if i won the lottery, i'd be outta here so fast........i'd leave skid marks. like that flying-poop GI bleed guy.

see what i mean?

Seatbelts Save Lives; For Max

2010-07-28T06:35:00.000-07:00

*this post is for Max.

my son. who is three right now, but may someday (hopefully) be a strong, young athletic teenager on the cusp of enjoying life.

dear future Max,

wear your seatbelt. always. even if you are hanging out with a couple of your buddies after soccer practice doing 'harmless' doughnuts in the parking lot in full view of the rest of the team.

what could go wrong?

you might lose control. you might tip over. you might get partially ejected. the jeep might land on your head. the team might come over and lift the jeep off of your body.

and nurses and doctors in an intensive care unit might do all that is medically possible for you. it might still not be enough.

but it would still break my heart.

please please please Max.

be safe. i love you. please don't break my heart.

love

your papa.

You know....

2010-07-28T06:31:00.001-07:00

...that you've left a mark on someone's life when they ask you to come visit them at their house later for a fishing trip. you know, after all this being sick business is done.

really? after only two nights? and i had you in restraints? and i had to keep upping your propofol? and keep you in bed and not out milking goats or shooting that damn moose at 2 in the morning?

no, i guess you might not remember that. but i'm glad you still like me anyways.

Southern Comfort; Um.........anything else?????

2010-07-22T05:12:00.000-07:00

illustration 1
illustration 2

my ICU is a pretty big deal. basically, there are two kinds of hospitals; ones that the helicopter takes off from, and ones where they land. mine is the kind where they land. pretty much anything serious happens in the south end of my state and it comes to us.

so we can get some sick people. i was working a shift the other night, and i started out the night with 2 patients. when that happens on ICU, it usually means that it is two less sick hoomins you have for patients. if you have a really really sick hoomin, you usually only have to take care of 1. well, one of my patient's wasn't really that sick, so we triaged him down to our step down intermediate care floor, just in general anticipation of getting somebody really sick. which means that if we did get somebody really sick, it would be my patient.

i got somebody really sick. (said the only-been-a-nurse-six-months ICU nurse)

the report did not start off well. in that south that i mentioned before, there exist a number of smaller hospitals. bless them, they do the best they can with what they have.........but there are great reasons why if they get a really sick hoomin, they ship them to us.

so i get word that i'm going to get an admit, some kind of respiratory distress. alright, bring it. the call for report comes thru, and i get on the horn.

Report Person: 'so this dood has been here for a coupla days, was satting just fine on 2 liters, then the sats dropped allofasudden, so we intubated and the patient is on the way to you.'

me: waiting.......'anything else?'

Report Person: 'what else do you want to know?'

me, in my head, 'what the f*** do you mean, what else do you want to know? you're the one calling report and THAT is all you tell me?!?!?!? -then, out loud, 'why did he come to the hospital? was he alert and oriented? what has he had for pain? what are you using for sedation?when? where? how? who? do they have IV access? is he running a temp?

sigh.

every question i asked bought me an, 'uh, i don't know, lemme find out.'

turns out that the patient was so sick that the nurse who was responsible for the patient was on the ambulance helping to bag the patient. the patient was so sick that they intubated, but either did not have ventilators or did not have a transport ventilator, so they had driven in the ambulance from PoDunkville the hour to my facility baggin' all the way. and the Report Person who was trying to give me report was an LPN whose only assignment had been to take vitals and, tragically, call me with 'report.'

and, to top it all off, the patient arrives with his sats in the 40's. FOURTY'S. that is out of a possible hundred. and the transport team claimed that the sats had actualy been in the nineties, and had only dropped in the last 5 or so minutes. riiiiiiiiiiiight.

the problem with that 'claim' as we observed it, was that they had been bagging him incorrectly as they came into our facility. had they been doing that the entire hour long trip?

i never did find out. if you will direct your attention to the picture above (illustration 1), you will notice someone appropriately 'bagging.' (of course, our victim, erm, patient was already intubated, so instead of a mask over the patients mouth, imagine the bag the right hand is holding connected to a tube that, hopefully, goes into the patient's lungs). a key component of this device is the tube at the end, the part at the very end of the bag-valve or bag-mask combination. it is connected to an O2 source, and in order for it to function at it's best, it should be completely open. it looks like a vacuum cleaner hose, only it is collapsible. it should be filled with 100% oxygen. if it is collapsed, it can't hold oxygen.

our 'transport' team did not have that hose fully extended.

so my patient made an hour long journey with inadequate ventilation.

which put him at risk for an anoxic (without oxygen) brain injury.

sigh.

so, anyway, we hooked our patient up to a real ventilator and ended up doing a bunch of cool interventions. central lines, pronating beds (illustration 2), feeding tube placements, etcetera. pretty cool stuff from a technical standpoint.

*the pronating bed is a medieval-looking device that you strap a patient into, and it turns them like a rotisserie chicken. it helps patients who have compromised lungs to breath. pretty cool Star-Trekian stuff.

moral of the story; don't get sick in the south of my state. and if you do, don't stop at the little hospitals, just keep on drivin' north.

also, i may be starting to maybe possibly kinda getting this whole nursing thing. i am, after all, at the six month mark.

Idiots. They walk among us.

2010-07-18T08:43:00.000-07:00

there't this crap surgeon that lives in my town, and occasionally i'll see him at Local Big Warehouse Store or tooling around town. usually he's wearing his scrubs, too. like he likes people to see him in uniform or something. guy's a crap surgeon.

i had one of his patients come to me post-op for a lap-chole or something, cuz it went bad somehow. pt had the surgery, then, next day, something busted loose, pt had some non-responsive episodes in med-surg, crit was in the tank, moved over to ICU. put in a central line, take him over to CT. the Dinkus is there mind you, and even hung out while the CT was done, in the room.

well, we wheel the pt back to ICU, and as soon as i walk in, the secretary tells me, hey, the radiologist is on the line for you.

mmm'okay. already? i get on the phone, and he's like, dood, there is a MASSIVE bleed. Dr Crapsurgeon walks in as i'm hearing this, so i interrupt the radiologist and hand the phone to him. so the radiologist explains his dx directly to Dr Crapsurgeon, and Dr Crapsurgeon just tells me to 'keep an eye on this one.'

um, when the RADIOLOGIST interrupts his dictation to CALL the NURSE right away to tell you there is problem, there is probably a problem. i liked how the radiologist covered his bases in his dictation, too. he wrote, 'discussed dx with Dr Dinkus McCrapsurgeon,' just to make sure that, you know, this pt's death wouldn't some back to him. and in big bold letters, clearly wrote 'MASSIVE BLEED' in his dictation. i guess he got the feeling Dinkus wasn't going to do what he should have done.

oh, you're going out of town soon? isn't that odd, that you're going out of town soon, and you don't want to take this patient back to surgery, when clearly, they need it. OTHER doctors think the pt needs to go back to surgery, for pete's sake. sheesh.

pt lived, but whaddya know, another surgeon had to take the pt back into surgery the next day, cuz, gosh darn, that bleeding hadn't stopped.

Doctor Dinkus McCrapsurgeon loves to tool around town in his doctor scrubs so people can see him.

what a tool.

Thumbs Up!

2010-07-12T21:25:00.000-07:00

so, at shift change the other day, we had a patient go tachy on us. like, he was sinus in the 220's. we're all sitting around, finishing report (1925-ish), and and a coupla of the day shifters plus our charge go in there to assess the pt. i'm not in there mind you, just out side the pt's room at the desk, watching the monitors. the nurse for the pt got the intensivist on the phone, and the followed ensued:

Night Shift Nurse: 'Yeah, so Pt Tachy here is in the 220's.....'

listens for a minute....

Night Shift Nurse: 'Yeah, so do you think we should give him a little adenosine?' Okay,..'then he nods in the direction of the room, where our charge nurse (Brave Leader) was waiting to chemically cardiovert the patient, and hangs up on the doc.

adenosine is a powerful short acting drug that makes your heart stop. the idea is that the drug is administered, the heart stops, .............and then starts back up again in a normal rhythm and at a normal rate. watching that happen on a monitor is scary amazing. it is the longest however many seconds of your life you will EVER have, waiting for the heart to start back up.

anyways, so i'm still at the desk watching the monitor, and i hear Brave Leader yell, 'Okay, i'm going to push it.....' and i'm watching the monitors and the heart rate goes 223.......... 150...........87............and then i hear the charge nurse say, 'hey, i didn't even give it.'

and the heart rate stayed sinus in the 80's. so then they make sure the patient is fine, and the day shifters start coming out of the room and putting the crash cart away and heading back to finish up report.

me, to my nurse that had been giving me report, 'what happened?'

Bearded Nurse, 'i diged him.' (pronounced 'didged').

me: ' you gave him digoxin?'

Bearded Nurse: 'no, i stuck my fingers up the butt-hole.'

you see, sometimes when you are in that kind of an abnormal rapid rhythm, you can brady (slow your heart rate) down by bearing down as if you were trying to convince a particularly stubborn piece of poop to vacate your bowels. in fact, sitting on the pot is a frequent place to have heart attacks, because of people struggling to poop, bear down so hard that they stop their own hearts, but that is another story.

so, how do you make someone bear down?

go the wrong way up the exit-only highway.

ah, gotta love it. you sure can learn something new everyday in critical care.

haiku

2010-06-30T01:07:00.000-07:00

ice cold Diet Coke
working nights cut me I bleed
ice cold Diet Coke

Tiger Jesse Woods James, or, Why Adultery Matters.

2010-06-28T22:16:00.000-07:00

the two people in the world that will love you the most are your mom and your spouse. the one because she carried you in her body, sacrificed herself for you, and birthed you. the other because it was a choice.

there is an implied contract when you join your life to someone else's, whether it is merely implied, for legal reasons only, or just between the two of you. the heart of this contract is love, which, among many things, is a decision. i decide to love you and you decide to love me, and we'll stick to it and each other through thick and thin and poorer and nursing school (poorest), and thick and sickness and health.

moms (okay, most moms) have no choice. you are born, they love you. mostly. hopefully.
spouses? that is as sacred because it represents a choice.

so when a person breaks that contract with one of the two people in this life who will love you the most, should it matter?

i say it does.

well, what i do in my private time is my own thing.

yeah, but.......if you can't keep your word to your spouse, why should i trust you? huh, Doctor Boinks-the-RT's?

i bring this up not to rag on anybody or be judgmental (i mostly manage to keep my phobias safely locked up in my little head), but because it is one of my biggest fears.

a relationship is a 50-50 thing when it comes to deciding to stay and be together. if one person decides that they're just not in it anymore, the other person in powerless to increase the amount that they put in to change that. the desire to stay together has to be equal. so....i don't like watching movies where there is adultery involved. that scares me more than anything. anything.

and, it sorta bums me out when i hear of people at work that well, you know, play around. if there is one place that can't keep a secret, it's a hospital.

there is this one former charge nurse, we'll call him Don Juan, who had a little something-something on the side, once upon a time. he'd disappear for HOURS at a time, (leaving his charge nurse phone with the secretary, imagine that) and come back with wrinkled clothes and hair all........jml. you know, just-made-love. although calling it that denigrates what i believe to be the true definition of love.

anyway, Don Juan would come back from his......trysts, and everybody knew what & who he was ......occupying himself with, and just sorta let it slide.

on the plus side, when he got back, he'd feel so guilty that he'd draw everybody's labs. funny how refreshed he'd be.........

discovery, death of a hobby

2010-06-15T00:21:00.000-07:00

i have made a tremendous discovery. the discovery is the world's BEST motorcycle helmet. it is......drum roll please.....a car. or a truck. or an SUV. or a tank. definitely though, don't just wear a helmet. or leathers. or a kevlar suit. because, odds are, no matter what you're wearing when car or concrete meets biker biker, bike and biker will lose.

working in critical care, i've almost already seen more motorcycle wreaks than i can count. not only is the record for four-wheeled transportation versus motorcycles really really good, concrete is UNDEFEATED. as in, it has never been hurt when a motorcycle rider has hit it, bit it, slid on it, or challenged it in any way.

which is kinda of a bummer for me, man. i used to ride, heavy emphasis on 'used to.'

when i was young and bullet-proof and un-heath-insured, i had a college room mate that had a big bike. some yamaha 600 something or other. i used to luuuuuuuuurve to cruise that thing around, helmetless.

then i got married, and lucky me, got a bike of my own. it was a cheap summer ride, unregistered, just enough to get me to college and work. my wife made one condition; and that was that if i rode, i was to wear a helmet. i did wreak that summer, and of course, the score was concrete 1, me zero. plus scuffed shorts, scuffed elbow, and a pristine helmet. hat didn't even hit the floor.

coincidentally, my wife and i had decided earlier that week to get me a real bike. as in, one that i could legally register blah blah blah. so i layed down one bike and still got another. yeah, i know, my wife is a peach. it is the bike pictured above.

anyway, i'm not a small person. 5'10", about 280......and swarthy. basically i looked like a bear on a bicycle riding that thing around. but it was fun, great on gas and got me from work and school and home just fine. okay, so i did get smashed on that bike, too. but it wasn't my fault! that stupid lady totally did a u-turn into me. and after a little body work, the bike was fine, too. (and i have a story to tell to accompany the resultant scar on the leather jacket i had on at the time. helmet-still unkissed by that wicked temptress of concussion and hemorrhage, Concretia).

now i have no bikes, i wipe the butts of people who had bikes but broke themselves on bikes, and my wife makes me wear a helmet when i ride my bicycle.

oh how the mighty have fallen.

hellish nights, Golytlely

2010-06-06T21:57:00.001-07:00

i had a horrible terrible no-good night the other night. i woke up from my nap and my hips and legs felt like they were not connected to the rest of my body right. and i had left hip/sciatic nerve pain. which made bending at the waist very tough. so i show up to work anyways, and i then get the fever chills and aches. and also, my intest-tines were angry with me. maybe because i ate, like, 3 very tasty oranges for lunch. too much? maybe.

sheesh man, it sucked.

luckily, my patients and i survived the night.

that was the first night of a four-fer. the next night, because i felt sooooo much better, i drank some GoLytely. it's the stuff we give patients as a bowel prep. basically, it makes you poop. everything in you. outside. in a hurry.

somebody was supposed to give it to their patient, but the patient hadn't finished their entire dose, so there was about half a gallon left over. so we played quarters. the other three nurses i was playing with weren't really serious about drinking any, so i just filled a cup and chugged her on down. pineapple flavor. really sweet. horrid aftertaste. no ill effects.

ha. good 'old iron belly. still got it.

JP Juice

2010-05-24T23:46:00.001-07:00

for this last 4-ish shifts i've had a pretty big patient. there was some abdominal surgery so the patient also had some JP drains. JP stands for Jackson-Pratt, and it is a bulb suction system that collects fluid from inside bodies after surgeries.

anyway, like i said, i've had this patient for a coupla shifts already, and everything had been peachy-keen. last night, i go in there to strip and empty the drain, and they're kinda trapped under my patient's pannus.

guess who decides to gently give the tube a tug to see if he can work the bulb free without having to lift the pannus? yeah, me.

so of course the tube that is connected to the inside of the patient comes off of the bulb part and whips JP juice all over the place, including in my left eye.

nice.

hey, there's no way someone's bladder cancer can mets to my eye right?

also, nerd alert; i will now be wearing goggles whenever i have to empty one of those suckers ever again. or i can be more careful and less lazy.

Public Service Announcement. Sort of.

2010-05-22T20:35:00.000-07:00

do not try brushing your teeth in the dark. turn the lights on.

while it is a very nice thought you have to not wake your wife by not turning on the light when brushing your teeth in the morning, hemrroid creme DOES NOT clean teeth as well as toothpaste.

additionally, having the thought occur to you that, 'hey, this toothpaste tastes funny,' is prooooobably a pretty good sign you should stop brushing and investigate the matter, preferably with the light on.

for future referrence, maybe you should keep the two tubes in seperate drawers anyways.

the more you know......

origins

2010-05-21T00:20:00.000-07:00

i must call attention to this post-Call Me Nurse. it is awesome, and like nurseXY, i too have been inspired to tell the story of my origins as well.

story to follow.

stay tuned.

Leaving Las Vegas

2010-05-18T21:49:00.000-07:00

so, i guess there's this movie that nic cage won an Oscar for where he decides to commit suicide by Jack Daniels, Jimmy Bean and Johnny Walker Red. or something like that. i'm not really sure, i've never ackshully seen it. but i did just look it up on wikipedia-never let it be said i failed to perform my due diligence in the writing of this blog. that's called research baby.

anyway, according to the wisdom that is wikipedia, the main character in the story decides to go to vegas and drink himself to death, blah blah blah, ends up *SPOILER ALERT* dying peacefully in the arms of a pretty prostitute. you know the death, that quiet kind where the character just closes his eyes and 'dies.'

well, my friends, i have been there and done that, and trust me, it was not that pretty. nor that easy.

i write the following as a testament to the awesomeness of my floor.

we got an admit to my floor from the ER. i was over on the neuro side when they wheeled the patient past me. the patient looked as yellow as those legal pads. yikes. my patient was pretty stable, so i wandered over there a little later to lend a hand and see if i could learn anything.

turns out the patient had a horrendously low hematocrit and hemoglobin, so the patient was getting transfused with a bunch of PRBC's (packed red blood cells) and FFP's (fresh frozen plasma). i was talking with the pulmonologist, Dr Dolina, when the nurse in charge of the new patient handed him a paper with the latest H & H. they were bad. bad enough for the doc to whistle and pop open his eyes.

so he ordered 4 more PRBC's and 4 more FFP's, and the fun began.

the patient's condition kept deteriorating. kept needing more and more help breathing, and the color kept getting worse. also, the patient's abdomen kept getting more and more distended. the doc was able to get a history from the patient before the patient became completely unresponsive, and discovered that the patient had a leeeeeeetle drinking problem. besides having a ruined liver from drink, there was also probably had a bleeding ulcer involved, hence the low hematocrit and hemoglobin.

i've mentioned that my patient was stable, and i was still keeping an eye on him. i'd check on him every hour, and i had another nurse covering me in case anything started beeping in his room or anything like that. the most that could happen with my patient was having the propofol run out. so i'd go check on my patient, do what i had to do, chart my stuff, then head back over to help out some more. there was always something to do.

as it became more and more apparent that this patient was seriously trying to die on us, more and more people were sticking around to help.

those of us with the most stable patient's helped the most. one time i got back and was asked to find the yellow isolation gowns and the surgical face masks with the eye protection. huh? okay. i got back to the room with the stuff, and asked why we needed it. the consensus was that in light of the belly distention, and the continued dropping of the hematocrit, and the patient's continuously increasing O2 needs, intubation was the next step, and it would probably involve a lot of bloody vomit. hence the need for the face masks with eye shields.

so i'm like, if we know the patient is gonna hurl, why don't we stick an NG tube down first? seemed like a good idea to me, but the decision was to try the intubation first and risk the vomit, because if the intubation went well, getting the NG or OG tube into the stomach would be much easier. fair enough.

intubation was a success, as in there was no vomit. by this point, i might mention, the patient had received about 12 or 15 units of blood and an equal amount of plasma. so when we placed the NG tube, it came as no surprise that we IMMEDIATELY got out 1000 mls of straight blood. without even having any suction.

bless our pulmonologist. as it became obvious that the patient was losing the blood and plasma we were pumping into his veins thru the hole in his stomach as fast as we were pumping it him, he was trying to find a way to fix it. surgery wouldn't take our patient, the patient was considered too unstable. same for endo. our only hope was interventional radiology.

we had a femoral ART line, and you could totally see how the blood and plasma helped the patient's pressures. we'd have 50's over 30's, then we'd infuse and we'd get pressures of 80's over 50's. then we'd gradually lose the pressures.

so as the night is going on, i'm still keeping an eye out on my patient and helping as much as i can with the crash admit. by this time, we've got a respiratory therapist in the room at all times, we've called over the charge nurse from another floor for back-up, and our charge nurse hasn't left the room for hours. plus, besides me, there were at least two other nurses in there pretty much at all times as well.

interventional radiology gave the word that they were willing to try and were ready to go, so the whole team, minus me, went down for the attempt to cauterize the bleeding. they had to use the big ventilator and not the transport one because the O2 needs were so great that the little one wouldn't have been able to keep up, which meant two therapists were needed. there were also two nurses hand pumping in blood and plasma all the way down the hall in a last ditch effort to keep the patient's volume up, plus three other nurse carrying charts and IV's and everything else.

the patient .......well, lets just say that the interventional radiology team was able to stop the bleeding. pressures were stable in the 120's over 70's. thats better than mine!

from what i understand however, when you get some thing like 40 units of blood and 40 units of plasma and have that much of a shock to your body, every organ system in your body takes a hit. you're looking at respiratory failure, complete kidney failure.....it's just not real pretty.

so, while the heroic efforts of our night were successful in staving off immediate death and the bleeding was stopped, the patient expired/was let go just before i came back that night for my back-to-back shift.

was it a lost cause?

the patient, it turns out, may have had a bad divorce and may have intentionally been trying to drink him/herself to death. in which case, he/she was successful. i still feel bad for the person, and at least i got to learn something.

specially that my floor and the staff are AWESOME.

man i love my job.

alien versus predator.......AVR?

2010-05-18T01:42:00.001-07:00

cardiovascular intensive care unit is, apparently different than your regular old medical-neuro-trauma-surgical intensive care unit.

who'da thunk?

i was in between a couple of night shifts and called to pick up an extra on days, and ended up in the CVICU. normally i work in the MSICU, but hey, how different could it be, right?

wrong.

it was WAY different.

for one thing, with the sick hearts, they still do paper charting. the first patient i had was super easy. she had IV access, but wasn't even running anything, nor did she require any O2 or really, much of anything else. she had undergone a heart cath that had gone bad (blown out the angioseal somehow, and caused a fairly large hematoma) and had lost pulses and sensation in her right leg/foot. so she had to get cathed again, only this time they went in the other leg to the heart and then back down to site of the original catheterization and fixed it.

easy peasy. i transferred her to the fifth floor and then i had no patients. fine. but, two of the other nurses (the more experienced ones, that could Do Things, like fresh hearts and balloon pumps) were getting two fresh hearts. so i took over for one of them. the nurse is giving me report on this dood and looking over her shoulder because she's getting this fresh heart real soon. plus, she's giving me all this information that i'm like, huh? LIMA? that's the capital of Peru, right? why are we talking about Peru? AVR.......i'm familiar with AVP, Aliens versus Predator, what the crap is AVR? then, it gets better. she hands me this flow chart thingy.......and i'm like, whats this? and, still looking over her shoulder like she's got Tourette's, she's like, oh yeah, we do paper charting.

wow. by this point, i'm laughing. in my head of course, because this is WAY different.

stoopid paper charting. later i spent 5 minutes looking at that damn paper trying to figure out how to chart the blood pressure, and then i still had to go and ask somebody.

turns out LIMA is CVICU slang for left internal mammary artery, which is what the docs harvest to re-vascularize the heart. during a CABG, or coronary artery bypass graft (pronounced just like the vegetable that gives me gas, cabbage. thats probably more information about me than you needed to know, but hey, now its out there, so what? cabbage gives me gas). anyway, there were a bunch of other letter combinations that she spat out for me, and when she saw the confused look on my face, she says, just write them down and tell the next nurse what i'm telling you, they'll understand. oh, and AVR? thats atrial valve repair. i think.......

nice. now if only i understood anything about my patient, that would be great.

so.....that was that. i paper 'charted' to the best of my ability, didn't kill anybody, and left.

coupla nights later, i get pulled to CVICU. staffing calls and says, so yeah, tonight you're gonna be over on CVICU. huh? okay, whatever. probably more easy patients right?

wrong again boyo.

i like to show up early for my shifts, like 10-15 minutes minimum, to scope things out, and the nurse that i'm replacing isn't done charting yet, so i'm just chilling next to her waiting for her to finish. the way our critical care units are set up, there is usually a computer station outside and in between two rooms. so if you are assigned to two patients in adjoining rooms, from your computer you can see right into both rooms. so, Dayshifter Nurse is charting, and i'm leaning into the one room. i notice on the monitor that she (the patient) has a lot going on. including some numbers in yellow i have never seen.

lemme see here....those red numbers are the blood pressure from an ART line. okay, got that. theres also the heart rhythm, pulse, oxygen, respirations per minute........and then there are the yellow numbers that i have never seen. hmmm.......?

being the curious sort that i am, i casually ask the nurse i'm taking over for, 'say, what are the yellow numbers?'

she stops charting. looks over to me, presumably to see if i was being serious. because then she says, 'are you serious?'

and i reply, 'um, yeah.'

'that's a Swan-Ganz.'

me, with as much nonchalance as i can muster, 'oh.'

her, with more and more concern, 'you.........you've had those before, right?'

'um, nope.' stoopid grin on face. hey, i didn't ask to be here. not this time anyway.

so she gives me report. i have two fresh hearts, both about 2-3 days out. more paper charting. yay.

thankfully, there were some other awesome nurses that had time and concern enough for me to walk me thru stuff. thankfully.

again, no patients were harmed in the making of this post.

the next night, i got pulled again. only the one lady didn't want me back. understandable. it happens, and maybe not because of anything wrong that i did, she just didn't want me back. fine.

so i got sent to the b-side. easier patients. hopefully. and by easier i mean more stable, less special-CVICU craziness.

my patient was this totally a/o pleasant little old dood that had also had a heart cath and stent placed to open up and occluded coronary artery. Abilene Rob has a great post about your heart and blood and such, view here; http://www.abilenerob.com/?p=330 .

so, i check on my guy throughout the night, sooper easy. didn't need any meds, didn't need O2, just a little bit of help peeing once in a while. guy ackshully slept most of the night. i got a great head start on my shift end stuff, and was ready to give report at 0530.

so i'm thinking, great, easy night. this patient could have had something Really Bad happen to them, but nothing did, so we're good. got my charting done, next shift paper work printed up, i'm great, ready to go.

then my replacement shows up, Mr Chipper.

heres the thing about day shift nurses. there are two types that replace us night shifters. type numero 1; sleepy. they just woke up, rolled out of bed, and barely remember getting to work. they're gonna need some combination of and or all three of the following-coffee/energy drink/breakfast before they really wake up. type numero 2; bright-eyed and bushy-tailed. this type is READY TO GO.

(you night shifters know what i'm talkin' about right? the weird thing is coming back that night and getting report from them-its like two different people.)

well, my guy was Mr Chipper. which type do you think he was? type 2? correct. i give him report on my 'easy' patient, and meanwhile, he's looking through the chart and just checking things out.

i'm confident. i mean, why shouldn't be? i did everything i was supposed to, right?

right?

Mr Chipper, 'did you give plavix or (some other med)?'

me, 'huh? why?'

Mr Chipper, 'well, because anytime a stent is placed, we have to give a anti-platelet aggregator right away.'

me (always the eager to learn beaver, and also, my stomach was s-l-o-w-l-y deciding to decend into my shoes thru my now puckered up sphincter) 'why?'

Mr Chipper, 'well, the body views the stent as a foreign object and will form a clot around the stent the same as any other foreign body, so you could REALLY have a problem. he could clot off and have a much worse MI (myocardial infarction, or heart attack) than what he came in with. thats why, like, we wake them up as soon as possible and give them a loading dose, then they have to be on this therapy for a coupla months at least, until the inner lining of the stented vessel has time to grow over the stent.'

me (in my head) 'SHIT!!!' (then, out loud, in a normal voice. okay, i might have sqeaked. a little.) 'that makes sense.' then (again, in my head) 'SHIT!!!'

so he ends up going thru the chart, looking for orders that i missed (i didn't miss any) and documentation that maybe the med had been given by somebody else (nope).

sigh.

great. so, turns out, the cardiologist does the catheterization to see where the vessels are occluded, but then, when the stent needs to be placed, the cardiovascular surgeon comes in, places it and leaves. sometimes, he doesn't even write orders for the patient, since he's just on the procedure. or something like that.

so, the patient didn't die, and it wasn't my fault. still, i HATE HATE HATE HATE that feeling. walking away from the job knowing that there was more to be done, that SHOULD have happened. in this case, it was a med that was missed (a pretty important one) but the patient suffered no real damage.

augh.

the heart's that beaty thing in the middle of your chest, right? okay good, just checking.

broken heart brushing teeth

2010-05-16T14:33:00.000-07:00

ugh. i know, another post about death. sorry in advance.

i love the bee gees. they have a song called, 'how can you mend a broken heart.'

the lyrics go thusly;

how can you mend a broken heart?

how can you stop the rain from falling down?

and then later

how can you this broken man?

i think about this song often, especially because of the dead/dying people i deal with. how many people do you think the average person see die in a lifetime? you know, the average, non-critical care nurse person? before i started working in the medical field, i'd say the number of people i actually saw die was....................none.

since i have entered the nursing field, that number has increased. dramatically. and i'm including the number of people that i take care of that are probably already dead, only, for whatever reason, the 'miracle' of modern medical technology is keeping them 'alive.'

so what?

well, sometimes it really sucks. i've written about how hard the work is sometimes before, and how nurses need to grow thick skin, but the other day, i did have an incident that momentarily cracked my armor.

everybody knows that brushing your teeth is good right? little know fact, the tooth muscle is connected to the heart muscle. antibiotics are commonly prescribed for people undergoing dental procedures, because what happens is that the plaque and junk that is knocked from your teeth somehow ends up in your blood much easier. cut on you hand get infected from a papercut? no problem. infection or abscess on a tooth or in your mouth.....uh-oh, we got problems.

see, infection in your blood eventually ends up in your heart. infection in your heart......no bueno. this is a problem for IV drug users as well. they use dirty needles and get infection their blood just like crappy teeth brusher people. the infection in your blood tends to accumulate in your heart and form fungus. you can even see this fungus on echocardiograms (ultrasound examinations of the heart). it looks like flags of filth, just waving in the flow of blood, hanging onto your valves. again, not a good thing. because these flags of fungus, as i like to call them, can break off and cause all kinds of damage. they act just like blood clots, and do things like get clogged in the capillaries of your extremities, so you have parts or your fingertips and toes that end up with necrotic purple dead parts. also (and this is how you ended up on my critical care unit) these 'septic emboli' floated on up thru your blood system and ended up in your brain, causing you to have a series of major strokes.

so, when you are a pretty good mother of 3 young kids under the age of ten, you're about my age, have a loving family that supports you and has every reason to believe you're gonna be around for a while.......and then this happens to you, it sucks.

this particular patient i had not worked with until the last shift of my 6-fer. work 6 twelve hour shifts, then have 8 days off, not a bad grind ackshully, i kind of enjoyed it. anyways, i had this lady on my last day, so i sort of had an idea of what i was in for. she had come it after the birth of her last kid (another little known fact, besides people having dental procedures done, preggo women are another at-risk group for Bad Things to Happen Related to Teeth Issues) and was just sick. eventually, some of the bits of the heart fungus flags of filth broke off and caused the stroke and dead bits of fingers and toes. she went from walkie talkie new mom to unresponsive (human-like) vegetable in less than a month.

less. than. a. month.

needless to say, sadness.

well, in defense of my sanity, i try NOT to think too much about these things, specially whilst i am at work. but, thru the course of my night taking care of this lady, i started looking at some of the pictures her family had posted on the walls of her room.

mistake number one right there, lemme tell ya,

besides the famblee pics, she had this paper, no signature, just a heart and the phrase, 'mom please wakeup.'

damn.

it was from a kid just learning to write, obviously, maybe a 5-6 year-old level.

thus the wheels started turning. what would it be like, to lose my wife now? how would i could i cope? what about if she lost me? it could happen. i'm young, fairly healthy, but then so was my patient.

sometimes i complain about the number of of old people i have to take care of, and lets face it, it is mostly old people, breaking down with years and abuse and cumulative stuff that i take care of. so then i get a young person and man, it just messes with my world. gimme back the oldies, quick.

anyways, the care of this lady, and that damn picture/drawing that i found cracked the old armor for a bit. i'm getting better at holding in my feelings, not that it would have mattered with her, she hadn't opened her eyes in two weeks, and if her hearing was still intact, it probably wouldn't have been the first time she'd heard crying in her room.

excuse me while i go floss and brush.

Portal to Heaven and Hell

2010-04-17T23:59:00.000-07:00

so, there are several hard things about working in critical care. i've mentioned a few of them in passing, things like smelly patients, patients who do stupid things to themselves, crazy family members, etcetera. also, my job has its share of crappy co-workers, management issues and other stuff that probably most every other job in the world has. there are, however, some things that i find personally very hard to deal with.

i had a case, back in nursing skool, that involved a young teen. lets say this person already had a history indicative of poor health in general, so maybe some of what eventually happened wasn't totally unexpected. lets also say that we (and by 'we' allow me to generously include myself in the care of this patient, but lets be real-the amazing ER staff at that hospital were the ones doing the real work), did everything that we could to help this patient out.

this person was a someone that we did CPR on, on and off, for a few hours. this was a pediatric case, so we were of course trying our best to stabilize this patient enough for transport to Local Huge University Childrens Hospital. the specialized childrens flight team couldn't actually fly in due to weather, so they were on their way via ambulance.

during this time, there were two ER docs , two or three respiratory therapists, as many as five nurses, a cardiologist, and three or four mid-levels (nurse practitioners or physicians assistants) in the room at one time or another, trying to work on this patient. what i'm trying to say is that the crew was professional and thorough, and working well as a team to provide the best level of care that 21st century emergency medicine could offer.

two things i want to point out from this experience. one of those things is flight nurses are the best of the best, and that experience is what led me to want to become an icu nurse. remember how many people were in that room, working on that patient? check out what happened when the flight team nurses got there.

first of all, they're really short and bitty. helicopter flight nurses need to weigh less than 220 lbs when fully loaded with gear, and they usually have 20 to 30 pounds of gear. so these two nurses (two! just two!) walk into the room exuding, in my mind, complete calm and confidence. i really didn't feel that it was at all cocky, i just felt like the A team had arrived. they asked a few questions, and then......made a few suggestions. and......the doctors LISTENED! to a coupla NURSES! the nurses suggested things in a way that was very considerate of the doctors ego's of course, and when the doctor actually said, 'hmmmm, i've never thought of that ....' and then TRIED it, i was floored. i decided right then and then and there to be the best icu nurse i could ever be. i didn't and still don't aspire to be a flight nurse, cuz, let's face it, i haven't weighed less than 220 stark naked since i got married x number of years ago....but icu nurse extraordinaire i can aim for and might actually hit.

the other thing is one of those Hard Things this post is about.

at some point in the development of emergent medical care, somebody researched and determined that when doing life-saving procedures on people, its okay to let the family observe. instead of shunting patient family away from what is going on, family members are allowed to be as close as they can stand (figuratively speaking, as long as they're not actually in the way) to their loved one as possible.

so during this four hour tour, i was standing with the house supervisor, who was charged with the task of 'recording' the code. that meant that they were writing things down as they were happening. as she was writing, she ran out of paper, and so i offered her some of mine (as a student, i was forever taking notes). she, out of the goodness of her heart and maybe the crampiness of her writing hand, let me write out the rest of the code. she stayed on my left shoulder, coaching me on what to write and 'splaining things to me as they were happening.

at some point, i turned and realized that the person standing on my right shoulder was the patients father.

watching people rhythmically thump their childs chest, put tubes in, pump drugs in, take measurements of, feel for pulses, cut clothes off, discuss in cold abstract medical language.......

just standing there. tears pouring off of his face.

he looked like he had just gotten off of work. tired. older, maybe.....late fifties? wearing a thick brown wool suit. looked too old to have teen-aged child. he had another child, older, maybe my age, the one that had brought the patient in, standing just outside the trauma room, supporting the mom, in tears, on his shoulder. the mom, a woman whose face i couldn't see because she couldn't take her face out of her other kids shoulder. i could hear her sobs, she was that close, but she couldn't go into that room.

i am proud to say that, in that moment, i kept my composure. later, when things had settled down, i had a chance to ask some of the other nurses what they did so that stuff they saw did not affect them. the answer that i got was 'you get used to it.' another answer that i got was from my clinical instructor, who said that this kid didn't even merit any sympathy. his reasoning was that there were millions of other kids suffering way worse in other parts of the country, for reasons as stupid as not having enough to eat. hmmm.........

is that a bad thing? 'getting used' to the sight of hoomin suffering? comparing the suffering of different people to find someone worse off? and this is no ordinary run-of-the-mill hoomin suffering, this is parent-losing-child kind.....

the fact of the matter is that sometimes, most times, growing such an unusual thick skin is the only way to survive. somebody at work the other day mentioned that in the ICU, we are a portal to heaven or hell, and i laughed cuz it was a great line, and in many respects, it is totally true. sometimes, the souls are already on their way to one of those places, and what we are taking care of down below may just really be the physical portion. but we are left to deal with the family, making agonizing decisions. sometimes these are decisions based on selfish reasons, sometimes there is a lot of denial, sometimes they're the 'right' reasons but regardless, there are some very hard decisions to be made.

if we take every death personally, we can do more than burn out. we can really hurt ourselves. i like the fact that i don't take my work home with me. i punch out and i'm gone man, gone. the healthiest nurses i know, the ones that have been in nursing the longest are also the ones that have full and complete 'things' away from nursing. enjoying the outdoors, being involved in politics, building paper airplanes, making music. yeah, i only work three days out of seven. yeah, i can make my 'weekends' during the week, and go shopping on tuesdays, have casual lunches on wednesday and watch movies on thurday nights, all times when there are fewer people around. because listen, the kind of contact i have with people when i am on the job...........trust me when i tell you YOU wouldn't want to be around people on your time off either.

Judging People

2010-04-14T03:37:00.000-07:00

so....there are many hard things about getting report from the previous shift. you can have somebody that is a Long Pointless Talker, a Storyteller, a Shrifter (person who pawns off their work on you), or an everloving variety of Incompetants. The sneakiest kind, however, is the Prejudiced Preconception Report.

the kind where whatever judgements the previous nurse has made kinda sorta get passed along to you, so that when you walk into the room, there is no clean slate, but the somebody else's baggage in there with you.

report;

facts- heavyset lady, history of cancer that had metastasized (medi-speech for spread) from one area to another. for some reason, she had abruptly stopped taking a med on friday that should have been tapered off S-L-O-W-L-Y. it was a med for swelling due to this malignant spreading cancer currently in her brain. the abrupt stopping of this med had caused this patient to display some stroke-like symptoms, because, oh yeah, her brain swelled.

see, if you get a boo-boo on your knee or your arm, the tissues swell. when you have a boo-boo in your brain, the tissues swell, too, but unlike your arm or knee, the swelling has no where to go. the swelling pushing in on your brain, and........bad news for you.

impressions;

this lady (heavy, in medi-speech, this means 'obese') and her family are clueless. for cancer this bad and in this spot.......
(from the day nurse) 'i don't think this guy gets it, i overheard him on the phone talking to someone about-'well, they think she might have had a stroke'- man, she didn't have a stroke, she's gone man, gone.'
the impression that i got from him, Mr Daynurse, was that these people -didn't have a clue.

my expectations;

stoopid family, can't let go, come'on, this lady has lived her life.........

outcome;

family walks in. husband. blue collar. mechanic's shirt, still covered in the evidences of an honest days work. tall. thin. back straight, head slightly stooped. more evidence of a hard fought life, earned The Right Way. reminded me of my Old Man.

daughter. best be described as 'homely' but, a smart kid. involved in the drama-choir circle. attending Local Well-Respected Religious University. asks me, without fear or hesitation, about DNR packet. totally with it, facing facts, and preparing herself for what may come, for what Mr Daynurse feels has already happened.

friends. many, loving and speaking about Dear Patient in such glowing terms......

the husband, upon deciding to that it was time to go, takes his wife by the hand, speaks to her. (it is very difficult for me to write this, i am tearing up thinking about it now, because this Man reminds me so much of my father, he speaks in such a loving tone, i feel dirty hearing him address his wife, his friend, his partner, his Mate, even now....weeks later, the tears come easily) 'sweety pie, i love you so much, i have to go now, i have to work tomorrow.....

i leave i can't stand it i feel like i am intruding in someone's life, so personal, like i am standing in their bedroom.

turns out, it was never explained to them that the med that they had so abruptly stopped needed to be slowly tapered. the doctor had mentioned something about stopping it, but they had never been properly told how........so when the perscription ran out.....

good, solid blue-collar folks, a mechanic and a schoolteacher, trusting in the Medical Community some Doctor Fellow....and somewhere along the way, someone had failed them, patients who wrote everything down, tried hard to understand, asked great questions, were COMPLETELY compliant.....

even though the mistake was not mine, i felt as if i had let them down. made me want to track down this Doctor Fellow, show him his Betrayal of this family's trust. SCREAM!!

the patient was not alert and oriented. would not track to one side. would not obey commands. had one-sided weakness. would try and tear her clothes off. had to be restrained (medi-speech for 'tied-down')

at the beginning of my shift.

the neurologist came. evaluated the patient. increased the dose of the anti-inflammatory med.

guess what happened at 2 in the AM?

patient woke up. alert and oriented. could tell me her name, birthdate and the name of her child and husband. left our floor the next day.

miracle.

hey, nurse j, maybe next time, try not to be such an asshole and believe EVERYTHING you hear.

Drugs

2010-03-27T08:11:00.000-07:00

you remember that commercial about doing drugs? you know the one, the one with the frying pan, and this is you, and this is you on drugs one? yeah, that commercial sucks. i get to see what drugs REALLY do to your life, and that frying egg in a pan thing does NOT do the reality justice.

drug seekers are the worst people in the world.

please please please please PLEASE Max don't do drugs. ever. don't try them. i will beat you to within an inch of your life, so help me. and then piss test you til you move out.

one of the most common things i have heard about our patients that have abuse problems is that they stay at the age whence they began using. so if you have an uber manipulative 28 year old dude with a shabby work history, a wife who loves him, four kids, religious grandparents who think the WORLD of him, and the dood started using drugs when he was 14, then yeah, he has the mental capacity of a 14 year old. that is why the whole fam damily thinks that he's been 'clean' since October, when guess what, he's positive for benzo's, coke, heroin, meth and who know what else THIS WEEK.

hmmmm, that's so weird how you have vegetation growing in your heart, that's a problem only IV drug users have, but you've been clean since October right? how on earth did that vegetation get there? we have a mystery!

here's why i never tried drugs. the idea of losing control of myself and giving myself over to some chemical reaction that i couldn't control never appealed to me. all that bulls**t about 'i can stop whenever i want to, and who am i really hurting'-is just that-bulls**t. if you're an orphan, then please, by all means, waste your life and resources getting high. when you get to my hospital with no known next of kin that you've manipulated into thinking you are a great person to convince us to 'do everything,' we'll let you down easy.

that never happens. these needy, drug seeking people who have old people's diseases show up with tons of family. and when they come to the desk with tears in their eyes, 'johnny's in a lot of pain, is there anything you can do for him? i do hate to see him suffer.....' oh how i wish i could pop their little bubble of naivete and tell them, 'listen, your dear sweet little johnny was shooting up last week, and he's been high so much of his life the pain meds we have him on, that would knock out an elephant, can't really touch him. so yeah.'

of course, i can't bust their bubble and tell their kid where to shove it, because i'm a compassionate nurse and i care for any and all equally in my practice, without prejudice or judgement.

i save that for the blog.

The Penis Whisperer

2010-03-26T08:04:00.000-07:00

all hoomans are not created equally, and the variance in anatomy can be very great.

basically, if you are sick enough to be in the units, you get tubes stuck in pretty much every orifice the hooman body has. you can get intravenous lines, nasogastric lines, tubes in your throat (sometimes we'll cut a hole in your neck to get the tube in your throat), rectal tubes, and the famous retention catheter, or foley. who Mr. or Mrs. Foley was, i may never know, but thank goodness for him or her.

so, you get a tube in your urethra to collect your urine for you so you don't wet the bed or have to get up to pee.

problem numero uno; insertion.

there is some debate as to whether it is harder to insert one in men or women. you might be thinking, how hard can it be? plenty hard. women have anatomy that sags and hangs with age, so finding that little pee hole can be like hide'n'seek, and the older the patient, the harder the seek. men present their own challenges. not with finding the hole (that's usually on the end of penis), but with getting the foley past the prostate gland.

foley insertion should be a sterile process, and you usually end up designating one hand 'clean' and one hand 'dirty.' the first step is to clean the 'area.' for women that are particularly saggy, i like to do a preemptive find with a sterile q-tip. you find the pee hole using the q-tip, and leave it in, so that when you are ready, you just follow the line of the q-tip with your foley and viola! you are in. next, you prepare your stuff (and if you really want to know the particulars, you can go to nursing skool like i did), and use your dirty hand to either spread the lip or steady the shaft. then, you clean. then, you insert. if you are on the mark or the prostate gland is compliant, you should see a 'flash' of urine in your tube. victory is now yours.

the next step is inflating a small bladder on the end of the foley, the part that is inside the patients bladder. this (in theory) prevents the foley from being pulled out. ah, how i love theory.

anyway, finding the hole is the worst with women, and getting past the prostate is the worst with men.

unless you have The Penis Whisperer. good thing my floor has The Penis Whisperer. this nurse received this nickname with love and respect because there is no prostate on earth or saggy old lady anatomy that can thwart him. it is awesome to behold.

wonder what my super power will be?

Things you don't wanna hear...

2010-03-21T06:30:00.001-07:00

there are some things you don't want to hear when your friendly neighborhood Asian hospitalist is getting ready to put in a central line, right after he explains to you all the things that can go wrong with putting in a central line:

yeah, i always have bad luck.

i swear, i have a dark cloud around me all the time.

my whole life, things never work out for me.

oh, that that probably won't happen, but it could........

yeah, i got at ticket yesterday leaving work.

ooops, sorry.

ER nurses are so duuuuuuuuhhhh-mmm.

2010-03-20T01:55:00.000-07:00

so, ICU nurses think that ER nurses are dumb, and ER nurses hate ICU nurses.

i wish we could all just get along. most of the ICU nurses i work with just denigrate the ER staff to no end, and my friends in the ER just hate those 'damn, know-it-all ICU nurses.'

when i hear an ICU nurse getting report from the ER, the ICU nurse keep asking questions that they HAVE to KNOW the ER nurse didn't ask, because the ER nurse is not an ICU nurse.

having recently graduated from Nursing Skool (December), and still remembering my rotations in the ER, which i really liked, i have to shake my head. ER nurses are classified as adrenaline junkies, and maybe they are. but lets look at what their skill set is, shall we? if a hooman comes in with a REAL emergency, like Something is Falling Off, Bleeding, Squirting Blood, Rhythmically Squirting Blood, Turning Blue, Not Beating, or with more Extra Holes than hoomans are supposed to have, than you want an ER nurse. by the same token, i know MANY ICU nurses that don't like the emergent trauma situations. they say things like, i like my patients AFTER they've been cleaned up.

well then, what the heck? stop raggin' on the ER staff when they don't know the history. all they need to know is that the damn bleeding has stopped, thank you very much. and if you want a foley or an IV in a certain place, put it there yourself. i remember from my clinical rotations in various ER's that working in the ER was about the staff including a lot of docs. it couldn't be about the patients, because it's an ER, the patients aren't there very long. so the work is either Very Boring, or Very Exciting. sometimes, things are just Mundane. in the ICU, the patients can be there for weeks at a time, and the docs are few and far between.

the only real complaint about the ER staff that i think is justifiable is that they only Assess the Complaint. many times, i've seen an ER nurse pop her head into a patients room, make sure that nothing is Falling Off, Turning Blue, etcetera, and walk on. Why bother? the doctor will be in a minute anyway, and he is really the one that runs the show, and if he doesn't find something that is wrong, what is the ER nurse gonna find differently?

my Dearly Beloved, who is also in the bizness (also an ICU nurse), is on some committee that looks at things like charting on CHF protocols and door to cath lab times, and one thing that they found was that the ER staff had missed something.

warning; teaching moment ahead.

when someone comes into an ER complaining of chest pain, there are Some Things That MUST Happen. the patient has to undergo tests to determine if they are, indeed, Having A Heart Attack. if, thanks to these test, they are found to be Having A Heart Attack, then they needs to Get To a Cath Lab. cath labs are places where specialized teams go into a femoral artery to the heart and clear up whatever it is that is occluding blood flow to the heart. the timeline for all this to happen is 90 minutes, from Door to Cath Lab.

well, women have what is known as atypical symptoms of heart attack. so at the rural (read; small) hospital where my wife works, the ER had an older women come with a chief complaint of flu-like symptoms. so she got treated for the flu. until some time later, when she kinda sorta oh yeah, mentions-my chest kinda hurts. hmmm, turns out, flu-like symptoms are typical atypical MI (heart attack) symptoms for women. well, turns out she WAS having a heart attack, only now, her door to cath lab time was shot.

now, as an ICU nurse, i do a really thorough assessment of my patients, all the time. even multiple times during my shift. ER nurses? not so much.

would an ICU nurse doing an intake assessment on this lady have caught it? who knows. i just know that i like my friends in the ER, and when i get report from them, i expect that the bleeding will have stopped, or the holes have been patched and not much else. i'm the ICU nurse, i'll take it from here.

Salma Hayek & Living In the U.S.A.

2010-03-20T01:22:00.000-07:00

so i read that Salma Hayek was doing humanitarian work somewhere and breastfed some poor starving boy and that got me thinking. while i was appropriately jealous of that little boy (i mean, have you ever SEEN a picture of that women's ....'gifts?'), it also led me to ponder just how lucky i am to live in This Here Country.

last night i fed my kid a balanced meal, with all white meat chicken nuggets with no trans fats, fresh salad greens with yummy dressing, and mac'n'cheese made with hormone free milk. also gave him orange juice and a spread of vitamins that included omega oils, calcium, vitamin C, and a multi vitamin. then i bathed the little booger in clean water that was good enough to drink straight from the tap, after which i gave him another vitamin that had fluoride in it to make sure his little teeth grow strong. then i brushed his teeth. oh yeah, when i got him out of his bath, i wrapped him in a towel that i had warmed up in the dryer first so that he was 'nice'n'warm.' then i lay him down to sleep.....

and to think, in some countries, the only milk available comes from celebrity breasts.

you get the point. we (citizens of This Here Country) are so lucky to live here, and enjoy so many things that the majority of people in other countries can't even fathom.

still jealous of the that kid.

Nurses

2010-03-14T01:30:00.000-08:00

what kind of a person would be a nurse? well, it turns out, it takes all kinds. one thing i have noticed about working in such a female-dominated profession is the number of women who work because they are the only support for their families or the best support. it's actually what's making it very VERY hard right now for new nurses like me to even get jobs. i graduated from little dinky-but-soooper-expensive accelerated private program, and feel uber lucky to have a job, while i've heard that half of the graduating class of Local Well-Respected University doesn't even have jobs right now.

so, with the economy tanking, many women who had been working part time or per diem went back to work as their husbands lost their jobs. also, hospitals quit hiring as many agency nurses or travel nurses, so those nurses got regular jobs.

the thing about working with some of these nurses is that they don't really want to be working. there is a different level of ......dislike? discomfort? associated with them that is palpable. one of my co-workers has four little girls, but she's always working extras and worried about extras and how can i get extras. not only that, but she wears this look of disgust on her face that is just ugly to watch. it's like she's just hanging on, waiting for..........something. it's got to be hard, having these little girls and this family you want to be with but can't, because you have to kill yourself to try and work 3 or 4 or 5 12 hour shifts during the week.

i've found that my wife needs a break every once in a while. she needs something to look forward to, something to anticipate. we took a recent trip to costa rica, and i'm waiting for the glow of that trip to wear off and her gentle requests for another trip to begin. she needs some light at the end of the tunnel, some kind of joy to latch onto when things get rough during a shift.

when you have to give lactulose or kayexalate, and your patient has pooped the bed for the 6th time that day................yeah, let's just say it's absolutely necessary to have a happy place to run to.

the sad thing about these women is that they probably don't have anything to look forward to, no happy place to run to, no end of the road to hang on for. if you are a nurse and your husband is a student, there is light. but if your 40-50 year old husband doesn't have a job, or has lost his job......yikes.

and yeah, newsflash, lots of people don't like their jobs, i know. but it's a weird thing for me to be so excited about learning to be a great icu nurse and starting this career...........and be working in the same place as someone who is doing the same job but hates the job and wishes they could get out.

my wife is due to have our second kid soon, and after that she will no longer work full time. i hope that is some pretty good light at the end of the work day tunnel for her.

Seizures Pills for Sparky

2010-03-13T14:31:00.000-08:00

you know the cat lady cliche? well, i took care of the cat lady dood.

so, i get report that i'm getting this hypotensive respiratory distress dood, some guy who's already had 4 liters in the ER. on his way out the door to go see somebody else, the dr tells me, 'if his pressures are still low, let me know so we can throw in a line.'

first pressure-50/30.

great, bring on the pain.

thankfully we have kick butt pulmonologists that are super aggressive, and wanted to throw in a line to get some pressors on board. except of course that he was a hard stick (read: fat guy). first we try for a subclavian, only, with pressures so low, we can't hardly feel a pulse, which is how you landmark where you aim for the line.

warning; teaching moment ahead...

central lines are lines that go anywhere into a major vein and then thread right to the heart, which means that any med you put into the line goes right to the heart, so meds work faster. also, some meds that you give are vesicants (bad for tissues), and if you give them in a peripheral line, like one in the arm or hand, and the line breaks, you can end up destroying the tissue (extravasation). plus, the meds you give for maintaining pressures have a short half-life so.........central lines are better. also, when you draw labs, you just stop all the meds, draw your labs, and you save your patient another stick.

course, normal size people don't get sick, sickly fatty fat people get sick, mostly cuz they're fat, and they're hard to work with. sometimes you have to have five people in the room to put a foley in. fact, there was this one time, we had this nurse named Skinny Mexican who got the short straw and had to put in a catheter in a 5 person fat lady.

so, this is the scene. one nurse is holding a leg, another nurse has the other leg, and two nurses are using a drawsheet to hold back the fat, and Skinny is going in for the stick up the middle. and that my friends, is a 5 person fat lady. there was also a doctor NOT holding anything in the room for good measure.

well, the doc starts laughing (the lady, by the way, completely a/o) and so does one of the nurses holding the sheet. well......the sheet slips, and then the other nurse holding the sheet starts to laugh and lets go of the sheet. so now the whole room is laughing, with the exception of the patient......and Skinny, who is stuck up to the elbows in this lady's.....area, yelling 'HELP, i can't get OUT!!'

ah, fat people. gotta love'em. the way they smell cuz that can't wash all of their....surface area. anyway, that's a topic for another post.

back to cat lady dood. so, we're trying to put this line in, and the guy starts crying cuz he has a cat at home that has seizures and needs his meds. at two o'clock. who's gonna give Sparky his meds?

so his kid (who turns out, is a normal dood) comes in and asks questions about his dad, and yadda yadda yadda. kid goes home, promises he's just across the street, and call if we have any questions. and to feed the damn cat his pills. well, kid calls back and wants to ask his dad where the pills are.

in a cup on the kitchen counter.

i don't see a cup anywhere. well, i'll keep looking.

five minutes later, another phone call.....

are the meds with dad?

uh, i'll go look.

so, i'm looking through this grocery bag of meds, clonazepam, lortabs, allegra, seroquel-basically, dood has tons of meds, and then paydirt. a bottle of something made out for Sparky Hypotensive. I hand the bottle to Mr Hypotensive, and he puts the bottle 1 centimeter away from his face to read the label and says, 'yeah, these are Sparky's meds."

great, Mr Hypotensive can't see two inches in front of his nose and he's got 30 bottles of pills. polypharmacy waiting to happen. probably how he dehydrated himself and tanked his pressures in the first place.

damn cats. and their owners.

Groceries

2010-03-11T01:49:00.000-08:00

working in the medical/surgical/neurological/trauma ICU of this here fine hospital has been interesting. i never would have thought that i could compare working here to working at a grocery store, but tonight, on my side of the floor, we have vegetables. that is what we are taking care of. a turnip over on 27 that is engaged to a young woman. in my room, i have a pumkin that occasionaly moves it's arms. all around are different kinds, eggplants, carrots, potatoes.....

why would a young woman want to marry a turnip? granted, the turnip used to be a man, but he ran off the road helmetless on his motorcycle, and now is a turnip. man, denial looks like no fun.

in other news, people who don't bathe start to smell bad. and those foam wipes that you dip in warm water and then use on the patients, the kind that you 'don't' have to rinse off with water? you know the kind? yeah, they suck. they just make the BO smell worse. seriously. it's dial or nothing for getting the stink off of people.

also, neuro pts have a musky smell to them, so i've been told. i'm actually not that worried about assigning distinguishing characteristics to the different brands of stink that ICU pts have, right now, midshift, i just hate'em all.

well, time to go take care of my vegetable.

beep beep dreams

2010-03-06T14:45:00.000-08:00

maybe someday i'll be able to go to sleep without dreaming of the sound of beep beep in my ear. working in critical care, we have all sorts of alarms hooked up to people, and they go off all the time. i mean, ALL the time.

reasons for an alarm to go off; oxygen saturation too low, heart rate too slow, heart rate too high, premature ventricular contractions, premature atrial contractions, supraventricular tachycardia, asystole, leads off (white lead, red lead, black lead, brown lead, green lead), ventricular tachycardia, or........the patient scratches his chest, coughs, or a pretty girl walks in the room.

ha. so, funny story, i have this patient, a teenager-ished kid who faceplanted off of a skateboard (sidenote-my kids will NEVER own skateboards) and broke his face. well, 'bout 2100, his cousin and his girlfriend walk into the room to say hello to Kid Brokenface, and his heart rate skyrockets into the 150's . ha. awesome. the girl was pretty cute, but, man, talk about an akward time to be hooked up to a heart monitor. ha.

so, pretty much there are alarms going off all the time. after working for three nights in a row, i go home and hear the alarms going off in my subconscious. man, it drives me nuts.

when i used to work in a warehouse, it was forklifts, same in manufacturing. now beep beep, heart monitors.

8 milligrams

2010-03-06T00:15:00.000-08:00

8 milligrams. thats how much morphine it takes to kill somebody.

specially if you're an old Mr. Kantbreathe with lung disease that is ready to go, who has a family that is ready to let go, whom God is ready to receive.

course, it wasn't me that did it. i kinda wish it was, you see, 'cept i didn't know how. i had this dood all night, and just barely kept him alive, with smaller doses of morphine to 'fight air hunger.' morphine does that, you know. it just knocks down your drive to breathe-give enough and you just, you know, sorta stop breathing. so while the order read 2 to 8 mgs morphine q hour, i only gave 4 at a time. shoulda given the whole dose.

which is what the more experienced nurse who followed me did. i asked him about it when i came back that night. i gave report, splained to him the situation, and 1 hour later, Mr Kantbreathe was released from his earthly bounds and sent onward.

how did you do it?

i just gave the full dose.

really?

yeah, sure. most of my patients that have died on me are lung disease people. i explain that the scar tissue that is built up in the lungs just isn't allowing the lung to do what they are supposed to, which is why Dearly Beloved is working so hard to breathe. if their heart doesn't give from beating 100 times a minute for DAYS, think of how exhausted they are from breathing 30 to 40 times a minute.

(for those of you keeping track at home, thats a lot. like, a lot a lot. try it; sit down, get comfortable, and breathe 40 times a minute. through a coffee straw. see how long you last.....)

how do you start that conversation?

first thing i do is ask 'what did the doctor tell you?' and take it from there. then i show the family the orders, and explain that they were written to give the patient comfort, and that i am comfortable doing whatever the family wants to make the pt not suffer. 8 mgs is actually not very much, comfort measure orders are usually, like, 10-15 of morphine plus 2 of ativan, it really relaxes the muscles and helps ease up the process.

well, i know that there was nobody left that needed to say good-bye.

yeah, the family was ready, and the poor guy.......he was ready, too.

well, now i know for next time. if i'm brave enough, or courageous enough.

Gang Green

2010-03-04T06:51:00.000-08:00

you know what smells bad? gangrene. it really stinks. what does gangrene smell like, you wonder? wonder no more-night shift ninja nurse is here to answer your wonderings!

gangrene smells like a delicate balance of chicken poop, fecal material, rotting-in-the-sun skunk carcass, wet dog, and body odor. ugh.

the worst part is that my facial hairs seem to capture and retain the horrid smells that i encounter during the course of my work. yuck.

tell you what, if i ever become a super-duper non-compliant brittle diabetic who only treats his disease with herbal remedies (read: weed, pot, dope, mary jane, grass-you get the picture), kill me. just load me up with morphine and let me go quietly into the night.

yuck.

Worry

2010-03-01T19:39:00.000-08:00

i've always been of the philosophy that if there was something i couldn't change, then it wasn't worth worrying about. that has worked great for the majority of my life, until my wife got pregnant.

now, there exist Important Things that are Out Of My Control. and i hate that.

what if the pregnancy doesn't stick? sure we got pregnant the with our first kid easier than a dress falls off of a drunk girl on prom, but why did it take us so long and so much practice for the second kid this time around? what if the kid isn't healthy? not that i minded the extra practice.......but after a while you start to worry about Things. Important Things.

for some reason, maybe because i hadn't gone thru nursing skool for the first kid, i was less worried. now, however, as a graduate of nursing skool, i know more now about what can go wrong, and therefore-i worry more.

maybe ignorance really is bliss.

Death with Dignity

2010-02-27T23:05:00.000-08:00

there are worse things than death. like living after a stroke that takes away the complete function of one side of your body. seriously, what would that be like, to go from being active, healthy, going on cruises, going to football games, teaching piano lessons then-boom, next day. half of your body is gone. GONE. HALF.

wouldn't you want to stop breathing, too?

the next hardest thing would be being the spouse. i know that i married my best friend, how do you go from full speed to full stop on that progression? i hate seeing the spouses suffer, and can't imagine what it is that they go through. part of the reason that i started this web log, besides to hone my writing (not that it's really great or anything), is to give me a chance to reflect on what it is that i see on a daily basis in my work and give myself a chance to see things from the patient's side of the rabbit hole.

my shifts are so busy that i can't always stop and think about less emergent issues like loss of self or loss of partner when i'm (rightly) too concerned with loss of capture or shortness of breath. also, i'm a crier, and as much as crying with my patients might help them, it wouldn't help me. i hate it when my mascara runs.

okay, you're the spouse. your loved one went from fully functioning hooman being to not being able to track things to the left, not being able to feel when they had pooped, and being unable to breath on thier own. beloved also is in pain and discomfort, and obviously hating the breathing thingy. teaching kids doe-ray-me to having strangers clean you, poke you and prod you, shine lights in your eyes, ask you stoopid questions like, what's your name, sweetheart? when is your birthday? what is today? oh, close, yeah, it's january alright. great, oh you pooped again, great, let me get that for you.

how much time is enough time to wrap your head around this? how long before you can accept that when beloved says, 'i wanna die,' they mean it and in that moment, are ready to go?

1 day?

2 days?

never?

can you ever wrap your head around that? how do you prepare for that?

what can i, shiny new murse (male-nurse) do differently in my practice to be sensitive to the needs of my patients?

what do i do if the patient is telling me they want to die, but the husband or the kids keep asking me how long before beloved pulls through?

honey child, there's no pulling through this one.

Thin Walls

2010-02-27T11:23:00.000-08:00

(children playing)

(children crying)

(woman screaming, in a high-pitched voice):

'oh my gosh, what are you doing?!?!'

' you've got to be freakin' kidding me right now, i don't believe this right now!'

'you must be freakin' RETARDED!'

'WHAT were you thinking???'

'if you ever touch scissors again, i'm gonna chop your heads off!!'

(children crying)

(woman's voice)

'no, no, NO! get back.'

'mommy is SO mad right now, i can't even believe this right now.'

(children crying)

(woman's voice)

'who cut his hair? landon, did you cut his hair? brook, did you cut your own hair?'

(child's voice)

'yes mommy.'

(woman's voice)

'if you ever touch scissors again, mommy will be VERY mad, okay?'

(children crying)

Pressure

2009-11-14T01:53:00.001-08:00

you know that billy joel song, pressure? yeah, that's kinda what it's like.

i am a fairly new nurse, and was surprised that i could be hired to as important an area as critical care right off the bat. i'm still suprised, and wonder at my luck every time i clock in, right about the time i am finishing my, 'let's not kill any of my patients today, please dear God help me' prayer. and cleaning out the throw-up in my mouth. maybe someday i'll get used to this. maybe not.

i feel like every shift is a battle, and the enemy is death. death from CHF, PE's, diabetes (or, the 'sugah's' as i like to call it), old age, accidents, etcetera.

on my second day of orientation, i made the stupid mistake of asking my orienting nurse how often we had codes. right. twenty minutes later, guess who was doing compressions? right, i was. and did again on my next shift. and again on my next shift. first 4 days of working, 3 codes. NOT my patients, but still.

also, in related news, doing chest compressions on a 600 pound plus patient, without a backboard (cuz pt was too heavy to emergently move to place one under said pt), at sort of an angle because this patient's body was round.......less effective.

also, breaking ribs loose while doing chest compressions on old lady chest......weird.