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!
Sunday, August 4, 2013
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!
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!
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'.
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> ;-)
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......
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:
- 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.
- 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.
- 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.
- 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!
- 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.
- What do you spend the greatest percentage of your waking time doing: sitting, standing, or standing? Standing, definitely standing.
- Would you live a year without technology? Sure, why not? Wait, let me think about that....
- 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.
- What direction does your bedroom window face? (that wasn’t supposed to be so creepy) North. That is a unique question!
- Are you aware of your own health? I guess so....
- 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!
Subscribe to:
Posts (Atom)