Tuesday, December 24, 2013

Don't Lie - A Public Service Announcement

I recently came across this YouTube video:


This is utterly stunning that someone would make a video like this. As a public service, I will tell you that it will not work. If you come into the ER with a non life threatening condition, then you may have to wait. Life is difficult sometimes, suck it up and put you big kid panties on.

As an example, I had this one patient come in complaining of chest pain. We are a certified chest pain center, so he was immediately taken back and the "million dollar" work up began. He asked about his other complaint, but it was a minor one (it was the real reason he wanted to go to the ER). He was told in no uncertain terms that it would not be addressed since the chest pain is a major concern and it would take precedence over anything else. Epic fail on his part. He confided in me later and told me his doctor told him to complain of chest pain so he wouldn't have to wait. I was flabbergasted. What doctor would tell a patient that? I got the name of the doctor and told the patient that I hope he realized that the chest pain complaint would now be in his medical record, that the confession would be part of his chart and that he would be financially responsible for the whole work up. He said he didn't know. I informed the ER doc who, upon hearing the new discovery, shrugged and said he will call this doctor about his poor advice and the patient will only be seen for his initial complaint - he could go to his doctor or an urgent care clinic for his minor symptom.

So take this patient's hard knock lesson - don't pretend to complain of something you don't have to get into the ER faster. You may get harmed if we give you medications for the complaint thinking it is legitimate, you will be financially responsible for what we do, your deceit will be charted in your records, and you probably will not have your original complaint addressed. The other more important reason, you took nurses and doctors away from someone else who was truly experiencing something serious.

Friday, December 20, 2013

The Christmas Card

I wait patiently this time of year for a certain person to send me a Christmas card.

Over ten years ago, when I was working as a firefighter/paramedic, I went on a CPR call. This was the most unusual CPR I've ever worked. The patient was found awake with defibrillator pads on his chest that were placed by a bystander who was a nurse. She saw my confusion and said that she had shocked him several times and performed CPR - he would "wake up" after each shock.
My partner and I quickly did a 12 lead ECG. It wasn't pretty.

We rushed him into the back of the ambulance while the patient told me what happened. He said he knew  when "it" was coming and then wouldn't remember anything, feel extreme pain and then wake up.
As we were throwing a quick IV into him, the patient quietly said, "Uh oh, here it goes again."
His face turned bright red and he coded. We shocked him and immediately afterwards he yelled, "AAAAAARGHH - don't DO THAT AGAIN!!!"

Our eyes were as big as saucers - I've never experienced that before. During the ambulance ride, he coded a few times more and each time, waking up yelling and then apologizing to me for being rude.

"AAARRGH, you did it again."
"Well, you did it again. Stop doing that!"
He laughed, but I could see the fear in his eyes.
"We're going to get through this. We're almost at the hospital. Just stay with me, okay?"
"Okay." And he held my hand.

Later, we were told by the cardiologist that he had what's called "the widowmaker", a 99% occlusion of the left anterior descending coronary artery, more than 90% of people with this type of occlusion die.
The patient and his family visited our fire station about 2 months later and thanked my partner and me for saving his life. It was a very nice gesture since most of the time, we never get to find out what happens to the patient after they leave our care in EMS.

Since that year, every Christmas, my patient and I exchange Christmas cards. I look forward to hear from him every year. I have never done this with a patient before our meeting or since. There was something special about this patient and we bonded during that unfortunate call.
I received my card the other day and my special patient is enjoying another year with his family and grandchildren. His card reminds me that what I do matters to people and sometimes I need that to recenter myself.
I needed that reminder this year and I thank God for him still being in my life.

Monday, December 2, 2013

Empty

I haven't been motivated to write lately, especially after a certain shift that left me, well ....empty.
We had three codes that day. The first 2 were run of the mill, "it was just your time" type of code blue. This probably sounds horrible to non medical people, but it's a fact. I question the family's knowledge and decision when they want grandpa 'saved' at all costs regardless of the quality of life he will endure after the code. It's sad.
The last code was a pediatric one due to an accident at the house. Due to the nature of the circumstances, there was never any hope that the child would be resuscitated, but we tried. We tried everything we could think of to save that kid. All efforts were futile. The other nurse and I prepared the body for the parents to come into the room while the doctor went to talk with them. I was okay until I heard the unearthly wailing of both parents. I don't think I can truly describe the sound. I lost my composure and escaped into the break room bathroom and cried for a few minutes. I've never cried at work before. Once I got myself together, I had tons of paperwork to do and was interrupted occasionally because I had to cover my ears due to the wailing. I couldn't even finish everything that needed to be done because other patients, the ones that had such minor reasons, medical problems that should have been seen in a doctor's office or a clinic, continued to come out to complain about the wait or that they wanted food. I tried to explain that there had been several critical patients that tied up the doctor's time and they would be seen soon. They didn't like that or didn't care, one actually had the audacity to tell me that they were critical too. I looked at the reason for his visit - a complaint that he has had for over a year. I had three dead people in nearby rooms and this guy was giving me a hard time. I lost my capacity to tolerate stupid people for the rest of the day and counted the hours to go home.
I keep thinking about that mother, hoping she doesn't blame herself for her child's death. I can't even imagine going through that experience. I went home that night and hugged my children for a very, very long time.
My daughter noticed and asked, "Did you have a stressful day at work today, Mommy?"
"Yes baby, I did."

Thursday, November 14, 2013

No Dilaudid for You!

A patient that is well known to us arrives by ambulance. We all know what he wants....the prized fix of dilaudid. He only comes in for that and amazingly seems to get it.

The doctor on shift today is one that everyone likes and respects. I think it soared to new levels after his assessment and subsequent handling of our frequent flyer.

The doctor told the patient he would do everything in his power to help him with his pain except he was not going to give him dilaudid. The patient told him, no thanks! He will sign the AMA as soon as the nurse could bring it because he said he can go down the road to another hospital that would give him the drug he wants.

Our patient who was incapacitated with so much pain, jumped off the stretcher and walked away without so much as a hitch in his step. 
Bravo Doctor! Bravo!

Thursday, October 24, 2013

They Don't Like It.

I've worked the past several days at both ER's I do PRN work. The hot topic of discussion was the ACA aka "Obamacare" which was brought up by the patients. I never bring up controversial topics with patients. 1) It's not professional 2) I don't have time to get involved with deep discussions unless it's with regard to the patient's health 3) I don't want the appearance of biased based care.

With that being said, the patients I spoke with hate the ACA. They're angry, they are afraid, especially the elderly. On one shift, I was the float nurse. It's a position where you are not assigned any rooms or patients and you float around and help people with doctor's orders or catch up on patient care. We affectionately call that position "the turd". Get it? ha. ER humor.

I was helping this one nurse with a new arrival. The couple was originally from a European country and came to the US years ago. They were awesome, friendly, and had a sense of humor. I wanted to shrink them and place them in my pocket for the day. As I performed my assessment and started the IV, they told me about their original country and why they came to the US. It was fascinating. The wife expressed her absolute fear and where this country is heading and the direction of the ACA. "You must stop this. You don't want this. We left a country with this type of healthcare and it is horrible. Many people, the old people, will die just because they are old. They don't consider if you're healthy and old - they see the age and won't spend any money to help you because of it." They also both expressed their fear of the dwindling privacy in this country and compared it to the rise of the Gestapo and Hitler since they were there during that time and remembered it. "You have to understand what this all means to this country. I don't think the Americans truly understand because they haven't experienced something like this before. We will all lose our freedoms."

I don't know if they thought I personally had a way to fix this, but their passionate hushed tones and pleading made me feel like I did.

The other patients did not have the same story as this couple, but were all against the law for various reasons: lack of privacy, more money to pay, fear of losing freedoms and not having control over their health. I even had a few conversations with different doctors I know all in various specialties. It was unanimous, doctor's didn't like it either.

I'm not saying that my little world represents the entire country, but I'm sure there are more areas like mine.


Tuesday, October 22, 2013

Thanks to Barbie, I'm an Orthopedic Surgeon!!

My daughter was talking about school and how they were discussing professions. She said everyone told the class what one of their parents did for a living. So I asked her if she spoke about me or her father.

"I told them what you did Mommy and how you are an orthopedic surgeon."
"WHAT??!!"
"Aren't you an orthopedic surgeon?"
"What did your teacher say?"
"She said, 'Wow, I did not know that.'"
"Our neighbor is an orthopedic surgeon, I am not one. Where did you get this from?"
"I thought you were one."
I'm utterly confused at this point. "Uh...no. Where do I work?"
"The ER."
"What do I do there?"
"Umm, you're a doctor?"
"What? No, I'm a nurse, honey. I didn't go to medical school. You should know that."
"But don't you cut people open in the ER?"
"I try very hard not to." (lol)
"But you fixed Lisa's (a friend of my daughter) Barbie leg that time. Remember?"
"Yes, but fixing a doll's leg doesn't make me an orthopedic surgeon. I'm an ER nurse."

If I had known that popping Barbie's legs back into their sockets made me a surgeon, I would have been billing patients a long time ago.

Monday, September 30, 2013

Making Simple Things Difficult....

I've been frustrated with my daughter's school lately. Actually, it's been a growing frustration. I remember (decades ago) carrying multiple books home with me in elementary school to do my homework. These kids have copied work sheets - no books to bring home. I've requested to see her books in the past just so I knew what the heck they were learning. How are parents suppose to monitor and help their children with homework if we have no idea of what they are suppose to be learning?

I also thought math is math - you can't change the basics, however, apparently you can. She showed me her worksheet and it was basic multiplication:  135 x 23 for example. I told her, "You know how to do this, is this just a review?"
Nope. They have to solve the problem using the distributive property of multiplication. Now are they just trying to confuse the hell out of these kids or are they preparing them for algebra? Shouldn't they just practice the normal way of solving this problem to master the basics? She's in the 5th grade - I don't foresee algebra until high school.
So, using that example from above this is what you have to do for the problem:

135  -->     100+30+5
x23  -->      20+3
-----------------------
100 x 3 =     300
30  x 3 =      90
5 x 3 =         15
100 x 20 =   2000
20 x 30 =     600
20 x 5 =       100
_________+_______
                   3105

I asked my daughter if she remembered how to do this problem 'normally' and she did. I guess I'll have to contact the math teacher and find out what this is all about. I bet these teachers think I'm a pain in the ass because I usually ask for materials and writing notes because I want to know what's going on with their classes when I see something strange to me.

So she comes home this past Friday with a failing grade on a science test. I'm surprised because she loves science and is normally a very good student. She's learning basic chemistry and she was able to bring the book home. We reread every chapter this past weekend together, reviewed her old test and I had her take the make up exam on her own. She had one question that she didn't understand. I read it and couldn't answer it, I showed it to my husband and he couldn't either. He said, "This is a bullshit question." We both have multiple degrees, certifications, and he has a graduate degree - together we couldn't answer this question - how is a 5th grader suppose to do it?
So I wrote yet another note to the teacher requesting that she allow my daughter to bring home the book once a week so I can review it with her.

So now I have math & science to do with my daughter, keep an eye on my son's schoolwork, and prepare for my next degree starting in January. If we could add another few hours in the day, I might be able to do this all. Sigh.

Thursday, September 19, 2013

Where Vomit Hides....

My 7 year old son was setting up the ole 'I'm sick, so I don't know if I can go to school tomorrow' routine. He complained of a headache, I gave him some ibuprofen then he complained of nausea.
After describing what his day would look like in no uncertain terms (in bed, no Wii, no TV, no friends, no fun), he mysteriously got better after taking his shower.

"Mommy, I feel better. I think the medicine helped. The throw up went into my feet."

"What?! Your feet? You mean your nausea is gone?"

"No, the throw up. The medicine scared it to my feet."

"Umm, okay. Why did it go to your feet?"

"Because that's where throw up hides for me, in my feet. Everyone is different. Mine goes to a secret, dark hiding spot in the middle of my feet and when I have to throw up next time, it rushes out, up to my mouth and I throw it up. I'm fine now, it's locked up."

"I did not know about this."

"You're a nurse, mommy, didn't they teach that to you in school?"

"I guess not."

"Where does your throw up hide?"

"I don't really know."

"You should look at your feet, I bet it's in there."

LOL!

Thursday, September 12, 2013

Hope without 'this'

I had another young patient in the ER for drug related problems. As the doctor was bedside and I was assisting him in a procedure, the patient mentioned that she was starting nursing school. The doctor engaged in some more chit chat and then left the room. I decided we were going to have a little talk while I bandaged her wound.

"We're going to have a chat."
"I know, I know....I did a stupid thing. I swear this is the last time I will do something this stupid. I've only done this once before."
"Yeah, well....you say you're starting nursing school, if that is a goal of yours, you're not going to reach it by doing this. You can't be a nurse and do drugs. No one will trust you or hire you."
"I know."
"Look, I'm old enough to be your mother, so I'm going to give you a little motherly advice."
"You don't look old enough to be my mother."
"Well, I am."
"My mom is a drunken bitch, she's horrible."
"I'm sorry about that.....do you want to do the same thing to your child? Do you want your baby to have the same childhood that you did?"
"No."
"You're young, pretty, and you must be intelligent to get into that nursing program - you have a great opportunity to have a terrific life.....do you want to trade all of that and your children for this?" I held up a vial to make my point. She looked at me with tears in her eyes.
"This will take away everything you have in life and this will be the only thing you will have left. Is it worth it to you? Don't answer me, just please think about it. Get help if you need to. Don't go down this path. Don't do this to yourself and your family. Don't trade this for your baby. You can have such a wonderful life, you can be a great mom to your child, you can have a loving family life even though you didn't when you were young, you can have a satisfying career.........don't throw it all away, don't let this take it all from you because it will. Think about it, okay?"
She shook her head.

After I did her discharge teaching, I turned to her and told her she could get dressed and go home.
"Think about what we talked about, okay?"
"I will."
"I don't ever want to see you back in my ER for this again. I mean it."
"You won't."

As she was leaving she passed me in the hall, gave me a tight hug and whispered, "Thanks for being my mom."
And then she left.

I try to talk to every drug user that I have as a patient. I realize it's mostly wasted breath on my part, but if I can reach just one person, just one.....then it's worth it.
I have hope for this one.





Friday, September 6, 2013

Stop taking meth and feel better!

"Okay, I'm going to discharge you now and take out your saline lock."
"Wait, why am I all jittery?"
"Well, because you've been taking meth for 2 days."
"Wait, what are all of these things all over my arm?"
"I just took your blankets off of you. Those are goosebumps from being cold."
"Wait, why do I feel so bad?"
"Because you've been taking meth. Don't do that anymore."
"I want to speak to the doctor. I don't like you or your answers!"

"Doctor, why am I jittery?"
"You went on a meth binge. Don't take meth if you don't want to feel this way."
"What are these things all over my arms?"
Looks at her arm, "goosebumps."
"Wait, doctor, I feel bad, why do I feel so bad?"
"You took meth for 2 days. Stop taking meth and you'll feel better."

She didn't like the doctor's answers either.

Tuesday, September 3, 2013

But Why?

"I've been having seizures again."
"Have you been taking your seizure medication?"
"No."
"How long have you been off of them?"
"About 2 weeks. Oh, I've been drinking a lot lately and I stayed up all night last night playing video games."
"I don't understand why this started again."

Maybe because you haven't been taking your seizure medications, drank a lot of alcohol and didn't sleep?
Just a guess here.....


Saturday, August 24, 2013

What If.......

My son has been going through a long period of asking "what if..." It drives me crazy at times.

'Honey, don't climb on the outside of the stair railing, the railing could break and you could get hurt.'
"Mommy, what if it broke?"
'Then you could fall backwards and get hurt.'
"What if I got hurt? What would I hurt?"
'Well, you would hurt your back and hit your head and have a head injury.'
"What if I had a head injury?"
'Then I would have to take you to the ER and I'm not going to work today.'
"What if..."
'JUST DON'T DO IT!'
"okay."
_________________________________________

One day he asked me about knee replacements. What?!!
He wanted to know all about them, what they used, how they do it, what the scar would look like.
I told him the basics of what I knew, but he wanted to know very specific things. I told him to ask the orthopedic surgeon that lives in our neighborhood because I didn't know.
'Wait, why do you want to know about knee replacements?'
He shrugs, "I was thinking about it."
'How do you know about knee replacements? Where did you hear about them?'
"I don't know."
My son is seven years old, why knee replacements?!!


Endless questions for all situations of what if...

The other day I decided to mess with him. He wanted me to take a sip of his sour lemonade which he loves and I dislike. I declined to take the sip. He insisted.
"Well, what if you were at the bottom of a well and you had no food or drink except this lemonade to drink. Would you take a sip then?"
'A well?!! What am I doing at the bottom of a well?'
"You fell into it."
'How did I do that?'
"You were walking and fell in."
'Where was I going?'
"To the store."
'What type of store?'
"A grocery store."
'If I was going to the grocery store, then I would drive the car. Where is this well?'
"Ummm...I don't know."
'Then how would you give me the lemonade?'
"So you're not going to take a sip?"
'No, peanut. You drink it.'

HA HA!!









Thursday, August 22, 2013

Blue Light Specials

Apparently, I did not receive the notice that my ER was running specials on testicular pain and meth overdoses caused by swallowing multiple baggies of the drug when the police are trying to pull you over.

So, if you have one of the two aforementioned (or both), please stop by my ER - we have a special in the works just for you!

As a Public Service Announcement:

When the police are trying to pull you over, for whatever reason, and you have bags of meth on your person - you have a choice! The fastest and easiest course of action would be to pull over and receive the consequences of your actions. The long term course would be to swallow all of the bags of meth. You then can be transported to the ER where you will experience the lovely experience of a full blown cardiac arrest. After you are saved, you will enjoy all the comforts of the ER personnel placing a tube in every orifice you possess and a trip to the ICU for an undetermined amount of time. If you survive that, ultimately, you will come full circle and the police will embrace you after your lengthy trip.
The choice is yours! Please choose wisely!
Thank you.
This has been a Public Service Announcement.

Wednesday, August 14, 2013

Triage Zen

I've been in triage lately and from previous blog posts (if you read them) I normally despise triage.
I have adopted a zen like attitude towards it now which, hopefully, will last a while.

"Do you have any medical problems?"
"I think I have fibromyalgia."
"You think? Has a doctor diagnosed you with that?"
"No, but I read about it on the internet. And a friend of mine has it, so I think I caught it from her."
"You can't "catch it", it's not infectious."
"Well, I think I did."
"Okay".......ooooohhhmmmmmm. Takes a cleansing breath and smile. :-)
________________________________________________
"You wrote down that you have ovarian pain? Have you had that before? Have you had ovarian cysts?"
"No."
"Then how do you know you have ovarian pain?"
"I looked at a picture on the internet."
"Where is your pain?"
She points to her pain.
"Your ovaries are not way up there."
"Well, mine are.....and that's what the picture showed."
Breathe in, breathe out.
________________________________________________
"Could you be pregnant?"
"Absolutely not."
"All right, what type of birth control do you use?"
"I don't use birth control."
"Do you have sex?"
"Uh, yeah."
"Have you had a tubal ligation or a hysterectomy?"
"No."
"When was your last menstrual period?"
"I don't know, it's been such a long time."
"Then you could be pregnant."
"But I don't want to be."
Ooooooohmmmm....aren't wishes nice things?
_______________________________________________
"Do you have any medical problems?"
"Nope."
"Great. Do you take any medications?"
"Yes."  The list was lengthy.
"Why do you take these medications if you have no medical problems?"
"Well, after I had surgery and the cancer, I had a stroke which caused a heart attack......"
"Do you understand that those are medical problems?"
"Well, they really aren't problems."
<No, of course not.>
__________________________________________________

I think I got through the day with a good attitude and did not want to run like a mad woman swinging a bat at various strangers after my shift.
I believe I'm making progress.....

Sunday, August 11, 2013

Golden Showers.....

Nurses in my ER have a 1:4 patient ratio, regardless of acuity. Of course, if someone has a critical patient, other nurses will help out with the less acute patients although this is not always a given. When I'm hit with 2-3 new patients all at the same time, I quickly assess just how sick they are. If all the new patients are pretty much equal in acuity, then I'll start the "to do" list: starting IVs, drawing blood, collecting urine samples, etc.

I let this one patient know that I would need a urine sample in the near future. She said she couldn't give me one at this time. As time passed and her lab results were coming in, the tech said he checked and still nothing. I went into her room and told her the only thing we were waiting on is her urine. I let her know that in the ER, when "things" don't come out, we will "go in" and "get them". This normally motivates people to try to urinate for me.

A little later, she had her sample. I had an ambulance coming into another room and wanted to finish up with this patient because it would be a while before I could return to her.

"I have my pee."

"Awesome! I'll send it to the lab and results shouldn't take too long."

"Okay, that's the last thing you needed from me?" She said as the tech came into the room to tell me the ambulance had arrived and he would send the sample to the lab. He smiled and stated, "Glad we have this - thanks!"

"You guys sure get excited about pee."

I joked and let out a little laugh, "I bet no one has ever been excited about your urine before."

"Well, yeah....my boyfriend. He likes it when I stand over him and pee on him."

All righty then!

Saturday, August 10, 2013

It's not about the sex, darling....

When my patient arrived via EMS, she was wearing a sort of jeweled turban, large dark sunglasses and a lovely satin pajama set. I thought she looked like one of those 1940's actresses. She was in her 90's and did not even look close to mid 60's in age.

"Daaarling, I really don't want to wear one of those ugly shirts you gave me. They're hideous. I needed to get my hair done this morning, so I just had to throw on my headdress."

"ummm, okay."

She was quite demanding and talkative.
"Do you know how long I'm going to be here? I need to be out by the weekend to go dancing and I do not want to disappoint my boys. I need some soda crackers, be a dear and get some for me."

"Your boys?"

"Yes. I just broke up with my male 'friend', he was in his 50's and couldn't keep up with me, poor soul. I had to let him go. The boys at the club are naturally happy about it."

"Naturally. Your boyfriend was in his 50's?"

"Yes, men my age are decrepit. They're too old. It's going to be awful when I reach 100."

"Oh."

"I want a young man. It's not about the sex honey, it's companionship. I want a man who will go out dancing, travel, be alive! Although the sex would be nice too."

"Well, of course."



Wednesday, August 7, 2013

Motorcycle Driving Freshman

Whenever I have pediatric patient, I love to joke with them (I call it "mess" with them). I normally ask if they go to college or drive a car - they normally laugh and say 'no silly, I'm only 6 years old!'. It's goofy, but I have fun with them.
The doctor asked if I had just a few minutes to sit with this kid in the hallway while he examined his family member. Sure. I started my little routine about asking the questions to pass the time.

"So, do you go to school?" The boy was 5 years old.
"Yes."
"Do you go to college?"
"Yes." He was serious. I was amused.
"Really? What year are you?"
"First."
"What's your major?"
"I don't know yet."
Hmmmm.....This kid is a good fibber.
"How do you get to classes? Do you drive?"
"Yes."
"What kind of car do you have?"
"A motorcycle."
He then talked about his motorcycle. He was very specific.

Maybe he was in college too.....

Sunday, August 4, 2013

No Dignity...

Like most people in the medical field, I've witness a lot of deaths. Deaths from medical reasons I seem to be okay with, I mean if you have a disease or condition, eventually it'll get the best of you. It's fun to do the detective work and try to turn it around.
Traumatic deaths cause me to get philosophical. One minute you're there, BAM, now you're dead. Other than the trauma causing it, I can't find the reasoning behind it other than "it was his time to go".

The Trauma Code was called out over the loudspeaker. The code was quite short. I wondered why this person wasn't just covered at the accident as a DOS (dead on scene). The patient was a broken, bloody mess. I was doing compression until time of death was called shortly after the patient arrived. I always look up at the same clock when death is called and note the time. I thought about how many times this clock was used for a death announcement when I looked at it and remembered some of the most recent deaths in this room.
I looked down at the mess of a patient. She was young. I bet, never in a million years, did she wake up this morning, shower, eat breakfast, go out with her friends and know that this was the day she was going to die.

That is why I hate trauma. It's so random.

"Is she missing part of her head?" There was a large towel saturated in blood around her head. "No, we put that there because of spraying blood".
I looked around at the numerous firefighter/paramedics, the flight crew and the ER nurses - all covered in blood and moving around to get paperwork started, equipment together. I noticed that I was bloody up to my elbows and realized I needed to scrub.
I looked back down at her, clothes cut off, spinal packaged, tubes coming out of everywhere and said my silent prayer for her like I do after every death I work.

There's no dignity in this death, or any death come to think of it. At least not the ones I witness. I hope that when I die it's either in my sleep or if it's a trauma, that they just throw a blanket on me at the accident scene. Otherwise, I think the whole CPR to the hospital is horrific. I probably won't care since I'll be dead, but for me envisioning going through it, it sucks. And another reason to hate trauma, I get too damned philosophical!


Thursday, August 1, 2013

Self Diagnosis

I had a patient come in for a migraine. She self diagnosed herself as having meningitis.

I looked at her vitals and asked some questions:

"Why do you think you have meningitis?"
"Well, my neck is sore and I work in the hospital."
"What do you do in the hospital?"
"I'm a nurse."
"Have you been around anyone with meningitis?"
"No."

Ummm, okay. Nothing I saw would raise the meningitis red flag. She proceeded to act like she was dying and suddenly was unable to do simple things like raise her arm to apply the blood pressure cuff.
Come on! Seriously?!!
I told her since she thought she has meningitis then she would have to wear a mask for the duration of her visit. I also told her that since she stated she was too weak to get into the wheelchair to go to radiology (she walked into the ER) and raise her arms for a BP cuff, that she would have to use a bedpan. I don't think she liked that very much.

I caught the doctor before going into the room and let him know why the patient was wearing a mask for a migraine. He smiled and said, "Oh yes, precautions must be taken since she knows she has meningitis."

Miraculously, she was cured of all symptoms by the end of her visit and she gained enough strength to walk out of the ER on her own. We truly are miracle workers!

Friday, July 26, 2013

Everyone has choices....

I had a rambunctious little patient who obviously didn't like to listen to his parents or behave or do anything he was told to do. In other words, he was a brat. The PA came out of the room, rolled her eyes and said, "Good luck with that one." Obviously, the parents didn't practice the art of discipline, in any form.

Later, I went in the room to give him some Zofran ODT. He wouldn't take it and threw a fit in his mother's arms. I didn't have time to deal with this. I gave him a choice - I told the little devil, "You can take this pill which tastes like candy or I can give you a shot in your leg with a very big needle. Which one do you want to do?"
The little monster pointed to the pill and immediately ate it without complaint or resistance.

There's always more than one way to skin a cat!

Tuesday, July 23, 2013

More of the New Job

Well, I worked this entire weekend plus Monday at the new PRN job except at a different facility. Unfortunately, I had to miss a family reunion on my husband's side during this time. It was quite lonely to return home after working 12 hours to open the door to silence. Normally, the kids run to me and give me big hugs and start to chatter away about what I missed that day. I realized just how much I miss those ankle biters!

I had an 8 hour orientation to the new place - to learn the flow or process of the ER. I think the most annoying aspect was the underlying attitude of the nurses. Many of them have around 1 year of experience and they treat the new people as though they have none, even if you let them know your experience. For example, I was helping the triage nurse take vitals for a pedi patient which required a rectal temp. I grabbed the thermometer and the first thing she asked me was, "You got the red one, right?" I laughed (surprised that she would ask me that) "I'm certainly not going to use blue". She got kind of miffed by my comment. <For those non medical people: Red = rectal thermometer, Blue = oral thermometer - a very basic fact that nursing students learn their 1st semester> Ah....I decided to just roll with it, they continued to say stupid little things like that, but what the heck - no use getting pissy about things I can't control. I guess I proved my worth when I discovered a serious cardiac condition in a patient and assisted the doctor. There was another nurse who knew what she was doing, so we both took control.

When I showed up on Monday, I was on my own, so to speak, with another nurse to run the entire facility. As we introduced ourselves, he asked if I could show him around. Ummm....WHAT?!! Apparently, he had an orientation sometime 2 months ago and haven't worked since. I was the experienced one. HAha. We both had enough ER nursing experience, so I was comforted that if anything bad came in, then we were covered. I shrugged and told him I'd show him what I was taught yesterday and the rest we could either figure it out or wing it. The doctor stopped by the nurse's station to say hello and we advised him that it was collectively our first day, so be prepared and let us know if we mess up any of the ER flow. I guess he wasn't too happy when we asked him if he had a swipe badge to open the med room since we were never given one. It would be difficult to treat patients if the nurses couldn't get into that very important room.

I must say, I haven't had this much fun at any job in a while. We got along and clicked right away. We had more problem solving phone calls and paperwork than patients, but we solved them all - perhaps not in the official process way of this ER, but it got done. No attitudes, lots of stories and laughs, a very mellow day. I hope I work with nurse again, it was certainly a pleasure 'winging it'.

Wednesday, July 3, 2013

Another PRN job...

I started a PRN job recently at a freestanding ER and clinic.
When I went on the job interview, the ER director told me that it would be a slower pace than what I'm probably accustomed to and less acute patients. "Actually, more like clinic patients. Sometimes we get a patient to transfer to the hospital ER, but not very often." The interview was more like a "you're hired already - this is what it's like, do YOU want to work here?"

During my first training day, we saw a bunch of patients and transferred 3 out. The nurses and doctor were amazed at how busy they were. I was surprised because compared to my usual ER shift, this was the slowest day in comparison.

Every ER is different, but I have always found that there is a good working relationship between the doctors and nurses. This place is odd. There was really no talking between the two. Everything is computer based - documentation, orders, etc. So, the doctor would walk out of the patient's room, not even say 'boo' to the nurse sitting right in front of him, go to his computer and type in the orders. The nurse would wait until something popped up on the screen and then would know what the orders would be. I don't know, I find it strange. No speaking, no heads up, nada.

I placed a patient in the room and he had a laceration that needed sutures. I then placed all of the items in the room so the PA could walk in, assess and suture. He walked in as I was finishing up.
"What are you doing?"
"I got all of your things together for a lac repair."
"Oh wow, thanks!" He appeared bewildered.

Very, very odd. The nurse training me said, "well, they like to get their own stuff. We don't get it for them"
All righty then.
One of the nurses said he was going to go on a Starbucks run. He collected our orders and I noticed that the doctor and PA weren't on the list. My God, they sit 10 feet away from us! I turned my head and asked them if they were ordering. They declined, but the nurses were surprised by my asking.

The nurses told me about how certain doctors like certain things. For instance, this one doctor does not want the paper lining for the exam table UNDER the band, he wants it OVER the band. I was in disbelief - who the hell cares about something like that?!! Seriously?? This isn't the OR!

As we were going through shift change, this one night shift doctor walked out of a patient's room after performing a lac repair and literally threw all of the items to be autoclaved  (they were wrapped in a towel) onto the counter next to me. It landed with a big crash. I looked down at the mess and then up at him with no expression, back down at the pile and then back to the other nurses. He looked at me and then walked on. OH HELL NO! I hope I don't have to work with this guy a lot because I'm not playing that game. How unprofessional and juvenile.

Like I said, strange place. I guess I'll see how it goes this weekend when I work again. This will be my first time on my own - I sure hope I remember how to place that paper liner! <sarcasm> ;-)


Wednesday, June 5, 2013

The Witching Hour

So, it was a slow day in the ER. It's nice to have a change of pace every once in a while. As the day went on, so did the reduction in staff. I don't understand this concept from management. On the floors, yes, no patients means literally nothing for the nurse to do except catch up on e-mails and education courses. I say let them do it and then decide. However, the ER is a different animal. At one moment you can have a few patients and the next, a bus crashes and now you have a mass casualty incident.
Now we have been severely cut back to bare bones staff. Only an hour left of the shift and if you have read my previous post, this does not mean good things for me. It's the witching hour. And that is what happened.....

I get an ambulance call, back pain x 2 weeks. Okay, I wonder why call an ambulance. I get the patient, he walks over to the stetcher without difficulty. I start to ask him questions when he interrupts me, "I'm going to the bathroom."  He pops up and walks down the hall. I'm speechless because I was in the middle of admitting him to the ER. I wait for him to come back and then ask him what happened today that made him call an ambulance to bring him to the hospital.
"Nothing"
"Have you seen a doctor for your back since it's been a couple of weeks?"
"No"
"Okay, so you just decided to call an ambulance?"
"Yes, my son said I wouldn't have to wait if I called an ambulance."
"You realize that's not how it works, right?"
"What?"
"There are not a lot of people in the ER right now, so if you had come on your own, you would have gone straight back. If we were extremely busy, then you would have gone to the lobby regardless if you had come by ambulance or not."
"Oh."
"Also, I want you to realize that if the insurance company does not deem your condition a medical emergency for the ambulance ride, they don't cover it."
"OH!"

I'm taking it one patient at a time, educating one patient at a time - like the story about the child throwing the starfish back into the ocean when someone told him that he couldn't save them all and he said, well, I can save this one. He tossed it into the water. I feel that way with the patients - one a time.

Oh, and true to tradition - 1800 - the witching hour - we got a call from the fire chief about a hazmat call - one patient and two firefighter were exposed. The hospital hazmat team was called in. Part of the ER was closed, sealed off from the rest of the hospital, hazmat suits, decon area set up, closed the ambulance bay, etc. It was a freakin' beautiful thing. I knew, KNEW this would happen when they cut our staff to bare bones. HAHA! It was classic. I guess they'll never learn......

Leibster Nominee

I just discovered that a fellow blogger, adot, http://darngoodandsureofit.blogspot.com/ , received an award called the Leibster Award. Congratulations! I recommend reading adot's blog because it contains a wealth of information that is presented in a reader friendly way. Well, also, because it's a darn interesting blog!

Since I had no clue as to what the Liebster Award is, I looked it up.

The Liebster Award is given to up and coming bloggers who have less than 200 followers. So, what is a Liebster?  The meaning: Liebster is German and means sweetest, kindest, nicest, dearest, beloved, lovely, kind, pleasant, valued, cute, endearing, and welcome. Isn't that sweet? Blogging is about building a community and it's a great way to connect with other bloggers and help spread the word about newer bloggers/blogs.

She nominated my blog and I am suppose to answer her questions posed to her nominees. So here it goes....

11 Questions They Have to Answer:
  1. Cat or Dog or Alpaca?   Umm...how about goldfish? It probably sounds animal unfriendly, but there's only so much poop one nurse can clean up. I'm selfish that way.
  2. Do you have any allergies?    NKDA  although I am terribly allergic to ragweed. I keep Allegra in business in the fall months. Perhaps I should buy stock options.
  3. Say you won $10 000 000 dollars, what would you do with it? (it was going to be 1 000 000, but $1 000 000 doesn’t go very far anymore)   Buy some stock in Allegra, take care of my family, give to a few charities and yes, quit my job. I would find something else to do perhaps a position where I can eat lunch and pee every once in a while. For splurging....I would travel with my hubby and kids. This is probably boring, but it's what comes to mind right now.
  4. Where is the furthest place you have traveled to?  Once summer I actually got to travel around the world: California to Japan to Singapore to Malaysia to Bahrain to Malaysia to Netherlands back to the US. It was wonderful!
  5. What is your favorite song?   It has always been Pachelbel's Canon. It broke my heart when I heard it used for a car commercial one time. Right now I really like Sail by AWOLNation.
  6. What do you spend the greatest percentage of your waking time doing: sitting, standing, or standing?  Standing, definitely standing.
  7. Would you live a year without technology?  Sure, why not? Wait, let me think about that....
  8. Do you have any piercings or tattoos or rebel-marks?  I haven't heard of rebel-marks???  I did celebrate a milestone with a tattoo. So....I got that going for me.
  9. What direction does your bedroom window face? (that wasn’t supposed to be so creepy)  North. That is a unique question!
  10. Are you aware of your own health?  I guess so....
  11. Do you have a favorite phrase or word?  For the longest time I exclaimed "Shoot a Monkey" instead of a cuss word because of my little kids. I once cussed like a sailor. They changed that for me. I guess it's now "PISS!" when something goes wrong. I didn't realize this until I heard my 9 y/o say this when she was working on a project and something went wrong. At least it wasn't shit!
Thank you, adot, for the nomination and questions!

Wednesday, May 15, 2013

Missing Mom

I worked the day before Mother's Day. I saw that a fellow nurse had gotten a new patient via ambulance and went into the room to help out. I looked at the patient and knew immediately that he would be admitted to the hospital. He was a really down-to-earth older gentleman and fun from the get go.
I grabbed some supplies to start an IV and draw labs.

The doctor (who has a personality larger than life and hyperactive to boot) comes into the room like a whirlwind, talks to the patient for a minute and declares that he's staying and will be admitted to the hospital.

The patient starts crying. I'm talking about a big sobbing bawl. The doctor leaves the room and the primary nurse collects her paperwork and leaves too. I'm left alone with this large, crying man.

"Hey, hey, hey....you have a chronic disease, this isn't the first time that you had to be hospitalized. You knew that you would stay here, right?
The patient agreed.
"So, what's going on with you?"

"Tomorrow is Mother's Day and I wanted to be there for my mother. I knew I was getting worse and tried to hold out until Monday."

I looked at the patient's age on his band and thought his mother had to be an impressive age to still be alive.

"She's dying and I wanted to be there on this day." More crying.

"Do you visit her on other days?"

"Yes, everyday I see her. But tomorrow is Mother's Day."

"Well, I'm a mother too. My first priority is to make sure that my son is healthy and feeling well. And if he wasn't, I would want him to take care of himself. I would consider every day that my son visits me as Mother's Day. Don't let this one day take away from all the time you spend with her. You know your mom understands and appreciates and loves all of your visits everyday, right?"

He stopped crying and considered what I had said. He thanked me for making him feel better.
My heart broke just listening to how badly he wanted to see his mother on that Sunday. I have no doubt that when he gets out of the hospital, his first stop will be to see his mom.



Friday, May 10, 2013

The Ultimate Shot

I had this older patient in one of my rooms with her husband. When I went in there to perform an assessment, the husband asked me if she was going to live.

"Umm, yes. I'm thinking she's got a chance."

Hubby: Well, she's getting up there in age and if she lives, she may get her "ultimate shot".

"Her what?"

Hubby: If she get's too old, then under Obamacare, they're going to decide she's too old and put her down.

Pt: Shut up honey! Hopefully, they won't do that today. <smiles>

I'm sure they were joking, but I asked.

Hubby: Well, the way that we're headed, I wouldn't doubt it. Obama already said old people don't need a lot of care - just give them a pill. I think it'll be a shot - the ultimate shot.

Later after I went through her discharge instructions, she asked, "so no ultimate shot for me today?"

"No. They were going to give it to you, but I pleaded your case and said you had at least a good year left and they were satisfied with that."

Hubby: After next year, they're going to put all of us oldies down. We're looking to move to South America and finish retirement down there.








Friday, May 3, 2013

Tick, Tick, Tick!

The hospitalist came out of my patient's room and asked me if I noticed anything unusual about the patient's family member. Umm, no. That person was there was the patient first arrived, but left and I guess returned while I was out of the room. He told me that he is covered in bugs. Huh, interesting.

"What kind of bug?"
"I don't know, I didn't want to get close to him."

I walked in there to check it out. The family member said something to me and as he did, he fixed the collar of his shirt. Several little insects crawled out from beneath it and crawled up his neck. Then I noticed he was trying to clean his jacket. There were little bug bodies all over the floor, some were slowing crawling away, others appeared dead.

I told the unit secretary to order a terminal clean in that room after my patient leaves.
Once the room was clear, another nurse and I went in there to investigate. The little suckers were crawling everywhere!

Ticks! The bugs were ticks. I believe this an ER first. Now, we've had lice, scabies, maggots, dead snakes and 1 live snake, but never ticks. How exciting. Housekeeping was not happy about it. It took 2 terminal cleans to get rid of them all. After the first one, I checked out the room and noticed a bunch clinging to the wall and one actually made in out into the hall. He was a spunky tick. I named him Gerald.

It's never boring in the ER!

<A great picture of Gerald>

Tuesday, April 30, 2013

Say Seizure Pads Again!!!

We have a bunch of new graduate nurses working now. Most of them are males and I think they add a fun, new dynamic to the place. One is incredibly funny in an annoying little brother way. I like him. He's smart, witty, and knows his stuff. I'm actually surprised that he's a new grad - he's just that good. Another one is personable, amusing, and seems to know a lot, I think the rest will come with time. He's got potential.
The other one is ....well, down right annoying. He thinks he knows everything already, talks more than any chatty Cathy I know, and is a STAN. In the fire service, a STAN is someone who always tries to 'one up' anything you happen to be talking about. STAN is an acronym for "Shit That Ain't Nothing". Every profession has a STAN, it's not exclusive to firefighting.

I'm not the only one who finds this incredibly annoying where I work. Sometimes, when I'm in the mood, I'll try to top his story and make stories up just to jack with him. Naturally, he's always got another story to one up my fictitious one. I find it extremely funny in a juvenile way.

Anyway, he was my replacement one shift and I was trying to give him his patient pass on reports. Prior to his arrival, I got an ambulance with about 15 minutes left before shift change. I didn't have any assistance, but was able to get the patient into the computer, perform an assessment, and notify the docs that the patient needed to get C-spine clearance. The patient was in the ER for a seizure and was backboarded. I thought backboard removal was priority in case the patient had another seizure and was injured due to being restrained.

I'm giving report to STAN and he asks if I put seizure pads on the stretcher. Umm, no not yet. After doing everything I just mentioned to him, I saw him and wanted to give report on that patient since I was waiting for a doc to clear the board from the patient. I literally just walked out of the room.

STAN: Oh, well we need to get seizure pads on the stretcher.

Me:  Yes, I know. Did you hear what I just told you? The patient just got here and I didn't have time yet to do that. I want him cleared from the backboard. The doc is aware of it.
I started to tell him about the patient and was interrupted.

STAN: Seizure pads. The patient needs seizure pads.

Me: Uh huh. The patient had a generalized tonic clonic seizure....

STAN: Yeah, he needs seizure pads.

At that point, I felt like screaming at him like Samuel L. Jackson did in PULP FICTION with the boy who kept saying "What?!"
Say "SEIZURE PADS again M***** F*****! I dare you! Say it again!!

For those of you have not seen this movie, it is very graphic in language and situations. ***WARNING*** the video is graphic, but expresses my thoughts at that time. Replace WHAT with Seizure Pads and you get my drift.



Monday, April 29, 2013

Schizophrenic or not?

I was admitting this patient into the ER. He was a paranoid schizophrenic who had been off of his medications for a while and was experiencing an agitated episode. He was extremely polite and answered my direct questions coherently. I was quite impressed. He continued telling me about his theories regarding life, the government, and a stream of thoughts about whatever he was thinking about.

The longer I sat there speaking with him and listening, the more he made sense. He made some remarks that I secretly fully agreed with him. He was very articulate and intelligent. Hmmm...it really made me wonder.
Has anyone else experienced something like this?

Saturday, April 27, 2013

More for Less

Okay, this is not an ER post, but it's been something that I've noticed lately.

In this economy, prices have increased for everything. I'm getting sick of it, quite frankly. I noticed that the items I buy at the grocery store have not only gone up, but I'm getting less of it. The packaging is the same, but the particular item is either smaller or there are less items per package.

I like to eat a couple of granola bars before going to work. God only knows if I'll get a lunch break during my 12 hour shift, so at least I had something to eat during the day. The actual granola bar is about 25% smaller, yet the price for the box went up around 40 cents and the wrapper is the same size. It really irks me.

I make sugar free juice for my kids and keep a container in the frig for them. It takes 2 packets to fill the container. The package that the mix is in has 6 packets - now there are only 5 in them. I discovered that this morning.

I guess I could be the crazy lady and write my rantings to the companies. Give them a good tongue lashing and let them know that we, the consumers, are on to their little scheme. However, I don't think it'll do anything. I guess I'll either research alternatives to my favorite things or just suck it up and take it like everyone else.


Sunday, April 21, 2013

6:00 PM

I realize that the ER is considered an orchestrated flow of chaos, however, being the Type A/OCD-ish person I am, I still have a few rituals that I need to perform when I'm there.

For instance, at the beginning of my shift I will always check out my rooms and stock them. I know the techs are suppose to do this, but you know, they have so many rooms to do and rarely get to all of them once the place get jumping. I absolutely hate when I need something in the room during an emergency and it's not there. It gets all over me. Even if I'm busy from the time I start the shift, I will still make lists and stock as I go.
At the end of my shift (I normally work 7a-7p or a variation of that), around 5:30, I'll get all paperwork in order, restock any stuff I've used, and try to get my patients all situated before I give report. That way, if I get a new ambulance, then there is just one person to work on. It doesn't always work out that way, but I do my best to give the night shift a fair start.

There has been another trend (aside from getting those 2 codes per shift) that I've been noticing the past few shifts. I find it weird. At 6:00pm, and I'm talking on-the-dot, I've been receiving critical patients.
One shift, a cardiac arrest who arrived at 6:00pm. The patient was saved and in the cath lab by 6:22. Well, any nurse knows the piles of paperwork to do with something like that and the subsequent tracking of controlled medications, equipment used, etc. It threw off my mojo. That's okay, I work in the ER - I expect it.
The next shift, around 5:40 a state trooper walks up to the desk. We figured he was there for a DWI blood draw.
"I'm here for the MVC (motor vehicle crash) patient."
"Umm....we don't have anyone here like that."
"You will. Everyone died in the crash except him."
The other nurse and I looked at each other then walked over to the docs to forewarn them. Upon hearing the information, one doc exclaimed, "Well, that patient is f***ed!"
Anyway, he arrived at.....you guessed it 6:00pm.

If this trend continues, then I guess I'll have to rearrange my OCD rituals. We'll see tomorrow....of course, I could get assigned to fast track and break the trend.

Tuesday, April 9, 2013

Callousness

It seems to be a trend - 2 Code Blues a shift. I'll hear the overhead announcement "Code Blue - ER room 2", "Code Blue - ER room 2". I blow my bangs off of my forehead, sigh, and think, "Jeez, I hope this doesn't take forever."

My husband and I were talking the other night and he was telling me about how some things he says to his friend (female friend) who he has known since high school shocks her. He said she literally gasps and her eyes widens and proclaims, "Oh my God, that's terrible!!"
He said he sits there, stunned for a moment, and has to explain or calm her down. She's a "normal" person meaning non medical and non emergency type of person. He had to explain to her that he sees a lot of horrible things that many people don't get to witness (except, maybe in movies) and has to DO something about it. He said that he is so accustomed to speaking to people that are in the business and they never even blink an eye during conversations like that.
Hubby: "I'm straight forward and direct when I speak and some people are shocked by it."
Me: "Yeah, you are." "I'm that way too."
Hubby: "Yes, but you're calloused."
Me: "What?! No, I'm not."
Hubby: "Honey, you're the most calloused person I know."

I thought about that for a minute. Could it be true? Hmmm.....
I protested some more and he gave me some examples of why he thought the way he did. Well, yes, yes I am. Interesting.

I had another student on shift and when I saw who it was, I told her, "Huh, this is ironic. What the hell am I going to teach you?"

My student is an LVN who is finishing up her RN. She worked in the ER years ago and was "let go" when our non profit hospital was bought by the mega corporation for profit system. She was getting her RN so she could be rehired and work in the ER again. She was my unofficial mentor when I was new to the ER. So she hung around with me for the day.
Later she mentioned, "Wow, it's interesting to see how calloused you all are. I haven't been here for a few years and I'm amazed by actually seeing it."
There was that word again.

Later in the day during a one of the two codes we've been getting, her and another newbie student nurse were in the room. Apparently, we shocked the newbie student.

Obviously, some information has been changed and there were no family members present. We weren't screwing around, we were working this patient, trying to bring him back, but we were also talking while working.

"When was the last Epi?"
"3 minutes ago."
"Give another Epi."
"Do we have a pulse?"
"Nope"
"Okay, continue CPR"

"Anyone eat lunch yet?" asked this one nurse.
"No" everyone exclaimed.
"Hey, *****, did (the charge nurse) say you can make a lunch run?" I asked.
"Umm, yeah", he answered while doing chest compressions.

"Doc, time for another Epi."
"Okay, push some Sodium Bicarb too."
"Ok."
"Okay, both given. Do you want to get in on the lunch run?"
"Yeah, where you going? ....stop CPR, do we have a pulse?"

"Huh, yes. A strong carotid pulse."
"Okay, let's see what we have on the monitor"
"Good. Let's hang some Levo."
"What dose? Hey, what about Chili's? Everyone feel like Chili's?"
"2 mics, Chili's is good."

We discussed starting a central line, what else the doctor wanted done with the patient and then he left to talk to the family.
I thought the code went smoothly and we had a good outcome. It was a good code for a student to see. The student nurse was shocked and upset according to my former mentor. The student thought we should have been somber and crying/sad. She said she smoothed things over with her explaining how working in the ER will change a person's outlook on suffering/sad situations and dealing with stress.
"Did she think we were calloused?"
"Yeah, but I told her that her day will come and she'll be that way too."
Sigh.






Saturday, April 6, 2013

And that sort of thing and stuff...

Well, this was a long week. After 3 full shifts (which we worked 4 codes), I had the pleasure of renewing my TNCC certification. For those non nursey readers - it is the Trauma Nursing Core Course. If you work in any ER, they require you to have it.
Unfortunately, the closest recertification course offered is a long way away. That class is only a one day deal. So...I had to take the whole 2 day course. I know, what's another day? However, I really would've preferred to be home with my family instead.

The hospital system that provided the course held the class in a church. It was a beautiful old church. Large stained glass windows, dark wood ceilings that arched high overhead. It was magnificent.
I believe they did an excellent job except for one thing: the breaks. Now anyone who has set up or taught classes has learned that the max you can truly keep a student's attention is around an hour. Every course/class I've attended has had some sort of little break at the hour mark. To get up and stretch your legs. To go to the restroom. To move.

We had a break after 2 1/2 hours of sitting. I kept shifting in my seat because my ass was numb. Seriously, it got really uncomfortable. Most of the class had the "shifts". The second day, it was cram time. They still had a half day of lectures, then our patient scenerio test and written test. We began at 0715 and finally got to get out of our seats at 1200.

I was good until around the 2 hour mark. Then my internal dialogue got the best of me.
The instructor was discussing ocular, maxillofacial and neck trauma. Gory pictures of hyphemas, ruptured globes, and dismembered faces didn't even hold my interest.
"oh God, please stop talking. please. please. please."
I started to do something that I hadn't done since high school. I began to doodle on my notes for heaven's sake. I drew pictures of eyes, wrote, "please stop talking" in various forms of letters.
It was then that I noticed it. I wish I hadn't, but I did.
The instructor had this annoying habit of continually repeating one phrase. Over and over again.

"And that sort of thing and stuff."

It literally drove me mad. When I noticed she was saying this mantra, I started counting it. I guess that's pretty OCD of me, but it was mesmerizing. She used that phrase 34 times in a 30 minute time frame.

34 times!!!! I have the hash marks to prove it.

By the end of her lesson, I was screaming inside of my head, "AAAARGH, shut up! Let us go. Please stop talking. Please don't say"

".....so that is why a blind nasal intubation is contraindicated AND THAT SORT OF THING AND STUFF."

I survived. She finished her lecture. I'm sure she used that phrase as her "umm" that so many of us use as a filler when speaking in front of a crowd. I made a mental note to always give a break, even a couple of minutes to students if and when I teach in the future. Numb asses are not good listeners!


Wednesday, April 3, 2013

Progress....

I have been working on my perspective change lately. It's been slow, however, I am making some progress. I believe I'm making some progress....or maybe I'm just fooling myself, but I'm going to stand by the idea that I'm really trying.

My charge nurse asked if I would take a nursing student for the shift. Ugh. Normally, I like having students. I like to teach. I love it when that 'aha' moment crosses his/her face. We'll perform some task and they do it without difficulties. I then ask the student WHY we do it and why we perform it that way. They learn some good lessons that way and things click for them. I find that exciting.
However, at this time I'm in the middle of burn out and trying to deal with it. Like you already know, I'm not there yet.

"Please? She's a final semester student, you can give her all the gross things you don't want to do."
"ugh. Okay."

She turned out to be an awesome person. Enthusiastic without sunshine blowing out of every orifice, eager, and not a lazy bone in her body. The ER got super crazy and she was right there, following me around like a little chick. She received a good education that day, many skills to perform and things to see. I actually had fun teaching her things. I told her that once things got crazy, our conversations would become schizophrenic because the pace would be extremely fast. She did a good job. She stood back when appropriate and jumped in at the right times. I was impressed.
She got to see her first Code Blue. We spoke briefly about it between a chest pain protocol and a stroke that came in. She was amazed by how fast everyone worked and that everyone knew where to be and what to do. She got to help me quickly prep a patient before that person was swept away to the cath lab.
I think she had a good time.
Another nurse asked me to access a Mediport for one of her patients. I asked the student if she's done one before. She said only in lab. I looked at the clock and it was time for her to leave.
"Oh, your shift is done. You probably have a meeting with your instructor."
"Yes, but I can be late. Do you mind me staying for this?"
"Sure, because you're going to do it."

Her eyes widened with nervous excitement. As we gathered the supplies, I questioned her: What patients would have this kind of port? At what angle would you introduce the needle into the port and why? What is different about a Huber needle? Where are these ports in a patient? Why is this a sterile procedure? How do you set up a sterile field? Etc. Then we reviewed the steps before going in.
She did great. I knew this patient, so as long as he was going to get his dilaudid, he didn't care who accessed his port.
Before she left, she asked me if I was a preceptor for their final semester clinicals. This is where they are assigned to a hospital unit and work under an RN. I'm a PRN nurse, so my schedule varies and is not set like a full time nurse. They don't assign us students for their semester clinicals. Too bad. I've had many day clinical students ask me to be their preceptor. Those students said that I explain things in a way that it all makes sense for them. They also said that many nurses are mean to students or ignore them. I don't understand that school of thought.
Anyway, she helped me in my progress to correct my burn out attitude.
Perhaps when I'm old and crusty, I'll consider becoming a nursing school instructor. Who knows.



Friday, March 22, 2013

It is beyond my control

The past few days have been quite challenging. They scheduled only one doctor who is notorious for being the slowest patient moving doc in the ER. The situation was also exacerbated by the fact that all rooms in the hospital were full. So, while we still had to find places for new ER patients, we had to hold the ones waiting to go up. Everyone was cranky: the patients because they all had to wait for a very, very long time - no matter what situation they were in; the doctor because he was asked to work a little faster; the NP because he couldn't move his patients faster without the final stamp of approval from the doctor (remember..slow?); the nurses because we were getting grief from all sides.

While trying to appease patients with whatever I could to make their wait easier, most still snapped and snarked. After a while, I felt like John Malkovich in the break up scene from Dangerous Liaisons with Michelle Pfeiffer.

"blah, blah, blah......it is beyond my control."
"I understand you want to get your room, but there are none available right now. I will let you know when you have a room assignment. In the meantime, I'll try to make your stay in the ER as comfortable as I can."

"How long is it going to be? I don't want to stay down here."

"Blah, blah, blah......it is beyond my control."
It is beyond my control.
It is beyond my control.


Friday, March 1, 2013

Shifts like this...

It is a shift like this (and they're occurring more frequently) that I seriously question if it's actually worth the time and money to pursue my education in nursing. I have a diverse educational and career background, perhaps I should research other avenues to direct my attention.
The job is not going to change, attitudes are not going to change, patient's unrealistic demands and lack of personal responsibility are not going to change....so I have to be the one to change or get out.

I had my full load of patients and helped another nurse who was getting slammed with new patients all at the same time. I helped her with 2 of them. As time passed, I noticed that she wasn't taking care of the two that I  admitted to the ER and was asking for help with her two other patients. One of the adopted patients was stable, the other borderline critical. I was irked that she would not go into that room. If I didn't take care of him, he was basically on his own. Now, my patients were all stable and one was borderline BS. I popped in to that room minimally because the others (mine and the other adopted ones) needed more care. Obviously, the borderline critical patient kept crossing the line into critical. Critical patients are time suckers when you still have to take care of a full load of patients and are expected to treat them all as though you have all the availability in the world.

Can anyone guess who lodged a complaint against me?

That patient received her pain medications promptly except for the last order which was to be given before discharge. She had to wait 30 minutes for it. I didn't know there was a pain medication order with her chart, when I peered over to the pending orders rack - I saw D/C paperwork. So, I did what all of us do in the ER, prioritized. She was about to go home - she can wait, she's not going to die. I had to turn my attention to the one who was trying very hard to circle the drain.

This discharge patient didn't like that she had to wait 30 minutes for her medication. I understand that, if I had a headache I wouldn't either. Although, she did receive some nice strong IV medication not too long ago. I apologized and explained that I was with a critical patient who needed my attention.

"I know how the ER works."
"Well, then you understand my situation."
"I'm not happy with my service."

I offered the opportunity to speak to my charge nurse.
"Do I need to?" was the reply with a smug look on her face.
"I'm trying to help address your complaint."

I informed my charge of the situation which she replied, "Well, why did she have to wait for the medication? I'm busy, maybe I'll talk to her."
"Okay, consider yourself notified of the problem."

Sooo...no back up from my charge nurse, my critical adopted patient starting to crash now, AWOL unorganized nurse (discovered she was leaving for smoke breaks because the stress was getting to her) - I was on my own. I documented everything to cover my ass.

I seriously doubt this is what I want to continue pursuing. Call me crazy.....

Tuesday, February 26, 2013

Triage Day

Triage. The definition of triage is to sort. The purpose of triage in an ED is sort a patient's severity of signs and symptoms and prioritize the need for treatment.

I was the triage nurse the other shift. Ugh. I felt like putting a sign over my head which states "Just answer my questions, please do not tell me your whole life story."

Here's a sample of the endless droning:

Chief Complaint: pregnancy symptoms
Me: What brought you to the ED today?
Patient: I have pregnancy symptoms.
Me: And they are?
Patient: Nausea and vomiting.
Me: How many weeks pregnant are you?
Patient: I don't know.
Me: When was your last menstrual cycle?
Patient: I don't know.
Me: Have you seen a doctor yet?
Patient: No
Me: Have you taken a home pregnancy test?
Patient: No
Me: Soooo....you want a pregnancy test then.
Patient: Yes. I want a blood pregnancy test.

Makes sense. Instead of peeing on a $5 stick from Walmart, use the resources of the ER and waste hundreds of dollars.

Chief Complaint: facial bleeding 
Me: How did you injure yourself?
Pt: I don't know. It just started bleeding.
Me: Let me look at your face. You have to stop picking at it. If you stop picking at your face, it will stop bleeding.
Pt: (states while picking at face) I was here a couple of days ago and they put stuff on it. Now it's not working.
Me: Did you pick it off?
Pt: Yes.
Me: You have to stop picking at it. Take your right hand and put this bandage on it and place your left hand in your lap so you don't pick at it. What medical problems do you have?
Pt: I don't know.
Me: Do you take any medications? What are they?
Pt: Yes....pills. I don't know.

Of course you don't. Eye roll.

Chief Complaint: Sick kid

Me: Does Johnny have any allergies?
Mom: Well....the one time about a year ago, he took some medication and he got sick off of it and now I don't know if he's allergic to it, but the doctor said it wasn't an allergy, but I'm unsure.....
Me: What was the medication?
Mom: I don't remember. But it was a pink pill. What is that?
Me: I don't know based on the pill description. So, what is he allergic to?
Mom: Well.....blah blah blah blah ( I stopped listening at this point)
Me: (interrupting her blahing) Did the doctor ever tell you to never give him a medication because he's allergic to it?
Mom: No
Me: Does he have any medical problems?
Mom: Well....a long time ago....

<smacks forehead> In reality, I just wanted to smack the mom.

Other patient:
Me: Do you take any illegal drugs?
Pt: Yes.
Me: (kind of surprised that someone actually answered a question of mine directly and told the truth) What drugs do you do?
Pt: Any I can get my hands on.
Me: Ok, what have you gotten your hands on recently?
Pt: Cocaine, meth, and some pot.

This was the only patient in triage I liked that day. I asked a question, the patient answered it honestly and briefly. Go figure.


Thursday, January 24, 2013

Broken Dreams...

The ER doc and I were suturing this patient while her husband stood in the room and watched. His facial expressions were priceless to watch during our conversation. The laceration repair was pretty lengthy and the patient was gorked out on pain medications.

Dr:  Thanks for coming in and helping. I started this thing half blind, but I don't think it's too bad of a job.

<Husband's eyebrows went high into his forehead>

Dr:  It seems like after I had lasik surgery, I can't see anything up close anymore.
Me:  Well, when I had it done, the surgeon told me that it wouldn't fix near vision. He told me it was just normal eye aging.
Dr:  "sighs".....My bad vision prevented me from my dream job of flying for the military. I love flying. So...I had to just become a private pilot. "sighs"....broken dreams, broken dreams.
Me: What branch?
Dr:  AirForce

I told him my story of trying to fly for the Navy and the alternate offer of Navigator. Then I told him about my private pilot adventure which didn't pan out. To this story he replied:

Dr: Wow, your story is sadder than mine. That sucks.......so many broken dreams in this room, so many broken dreams.

The patient's husband looked amazed with his mouth agape. I guess he didn't realize that even doctors and nurses could have had other plans for their future.

Tuesday, January 22, 2013

Neuro Assessment

I was performing a quick neuro assessment on a sweet LOL (little old lady):

Me: What day of the week is it?

LOL: Tuesday.

Me: Umm....I thought it was Monday.

LOL: No, it's Tuesday.

I check and it is indeed Tuesday.

Me: Who is the president?

LOL: Oh sweetie, I really don't want to talk politics right now......and you really should know the answers to these questions.